"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" 0042T|EAP|0350|CT CEREBRAL PERFUSION ANA|Veterans Affairs|VETERANS ADMINISTRATION|3,271.20||||||| 100|DRG||SEIZURES W MCC|Medicare|MEDICARE ACUTE|68,641.13|14119.595|14119.595|14119.595|||| 10030|EAP|0481|GUIDE CATHET FLUID DRAINA|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|12.52||||||| 10030|EAP|0481|GUIDE CATHET FLUID DRAINA|Medicare|MEDICARE ACUTE|12.52||||||| 101|DRG||SEIZURES W/O MCC|Medicare|MEDICARE ACUTE|33,769.50|16261.47|16261.47|16261.47|||| 154|DRG||OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W MCC|Medicare|MEDICARE ACUTE|7,222.75|2451.4|2451.4|2451.4|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|United Healthcare|UNITED HEALTHCARE|100,715.75|16544.76|19051.23|15854.85|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Humana Medicare Advantage|HUMANA MA|112,233.50|15854.85|19051.23|15854.85|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Medicare|MEDICARE ACUTE|128,565.05|19051.23|19051.23|15854.85|||| 180|DRG||RESPIRATORY NEOPLASMS W MCC|Medicare|MEDICARE ACUTE|173,367.25|19053.09|19053.09|19053.09|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|110,523.10|116.49|16261.47|116.49|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Blue Cross PPO Specialty|BCBSTX PPO|152,239.50|245.1|16261.47|116.49|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|United Healthcare|UNITED HEALTHCARE OTHER|104,201.83|144.43|16261.47|116.49|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Medicare|MEDICARE ACUTE|91,384.55|16261.47|16261.47|116.49|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Blue Cross HMO Specialty|BCBSTX HMO|78,192.50|119.57|16261.47|116.49|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Blue Cross PPO Specialty|BCBSTX PPO|25,163.50|38.7|19326.625|38.7|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Managed Medicare|HEALTHSPRING MA|106,514.30|14282.3|19326.625|38.7|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Medicare|MEDICARE ACUTE|132,257.05|19326.625|19326.625|38.7|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1,234.03|9742.63|19326.625|38.7|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Medicare|MEDICARE ACUTE|131,802.95|21843.43|23331.88|184.35|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|145,980.50|23331.88|23331.88|184.35|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Blue Cross PPO Specialty|BCBSTX PPO|157,795.40|184.35|23331.88|184.35|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|Medicare|MEDICARE ACUTE|1,234.74|19440.03|19440.03|19440.03|||| 197|DRG||INTERSTITIAL LUNG DISEASE W CC|Medicare|MEDICARE ACUTE|52,037.55|19053.09|19053.09|19053.09|||| 280|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC|Medicare|MEDICARE ACUTE|101,486.40|18810.205|20878.22|18810.205|||| 280|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC|Managed Medicare|HEALTHSPRING MA|134,206.25|20878.22|20878.22|18810.205|||| 281|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC|Humana Medicare Advantage|HUMANA MA|106,354.25|17302.69|17302.69|15634.19|||| 281|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC|Medicare|MEDICARE ACUTE|77,946.25|15634.19|17302.69|15634.19|||| 289|DRG||ACUTE & SUBACUTE ENDOCARDITIS W CC|Medicare|MEDICARE ACUTE|153,182.50|18870.12|18870.12|18870.12|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Medicare|MEDICARE ACUTE|108,514.18|18191.84|18191.84|18191.84|||| 29125|EAP|0430|APP;SHT ARM SPLINT(F-ARM/|Blue Cross PPO Specialty|BCBSTX PPO|408.75||||||| 29125|EAP|0430|APP;SHT ARM SPLINT(F-ARM/|United Medicare Advantage|UHC MEDICARE GOLD MA|408.75||||||| 292|DRG||HEART FAILURE & SHOCK W CC|Medicare|MEDICARE ACUTE|129,969.25|23331.88|23331.88|23331.88|||| 299|DRG||PERIPHERAL VASCULAR DISORDERS W MCC|Medicare|MEDICARE ACUTE|123,065.53|20230.87|20230.87|20230.87|||| 306|DRG||CARDIAC CONGENITAL & VALVULAR DISORDERS W MCC|Medicare|MEDICARE ACUTE|118,535.60|16551.21|16551.21|16551.21|||| 308|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC|Medicare|MEDICARE ACUTE|109,591.05|18893.685|18893.685|18893.685|||| 309|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC|Medicare|MEDICARE ACUTE|88,064.40|21969.29|21969.29|21969.29|||| 312|DRG||SYNCOPE & COLLAPSE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|526.29|87.76|87.76|87.76|||| 314|DRG||OTHER CIRCULATORY SYSTEM DIAGNOSES W MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|167,555.80|177.65|177.65|177.65|||| 315|DRG||OTHER CIRCULATORY SYSTEM DIAGNOSES W CC|Medicare|MEDICARE ACUTE|99,434.75|19742.66|19742.66|19742.66|||| 32000|EAP|0361|THOROCENTESIS/CHEST|Medicare|MEDICARE ACUTE|14.74||||||| 32000|EAP|0361|THOROCENTESIS/CHEST|United Medicare Advantage|UHC MEDICARE GOLD MA|14.74||||||| 32421|EAP|0361|THORACENTESIS/CHEST LT|Medicare|MEDICARE ACUTE|14.74||||||| 335|DRG||PERITONEAL ADHESIOLYSIS W MCC|Medicare|MEDICARE ACUTE|197,552.15|20529.29|20529.29|20529.29|||| 36002|EAP|0361|US INJECTION PSEUDOANEURY|PHCS|HUMANA INSURANCE|10.70||||||| 36002|EAP|0361|US INJECTION PSEUDOANEURY|Medicare|MEDICARE ACUTE|10.70||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Blue Cross PPO Specialty|BCBSTX OTHER|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Managed Medicare|HEALTHSPRING MA|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Veterans Affairs|VETERANS ADMINISTRATION|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Workers Compensation|TEXAS MUTUAL INSURANCE|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Medicare|MEDICARE ACUTE|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Blue Cross PPO Specialty|BCBSTX PPO|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Aetna|AETNA OTHER|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|United Healthcare|UNITED HEALTHCARE OTHER|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|PHCS|HUMANA INSURANCE|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|United Medicare Advantage|UHC AARP MCR HMO MA|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|United Healthcare|TML GROUP BENEFITS|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Tricare|TRICARE EAST REGION|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|United Healthcare|UNITED HEALTHCARE|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Managed Medicare|BCBS MEDICARE PPO MA|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Humana Medicare Advantage|HUMANA MA|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Cigna|CIGNA|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|NON CONTRACTED|COMMERCIAL OTHER 1|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Blue Cross HMO Specialty|BCBSTX HMO|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Workers Compensation|WORKERS COMPENSATION OTHER|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Access Direct Platinum|HEALTHFIRST TPA UMR|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Aenta Medicare Advantage|AETNA MEDICARE MA|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Medicaid|MEDICAID|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Cigna|CIGNA OTHER|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Aetna|AETNA PPO|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.82||||||| 36415|EAP|0300|PHLEBOTOMY FEE|Access Direct Platinum|HEALTHFIRST TPA|0.82||||||| 36556|EAP|0361|INS NON TUN CVAC OVR 5YO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|26.75||||||| 36556|EAP|0361|INS NON TUN CVAC OVR 5YO|Medicare|MEDICARE ACUTE|26.75||||||| 36573|EAP|0761|PICC LINE >5YRS W/IMAGING|Managed Medicare|BCBS MEDICARE PPO MA|29.49||||||| 36573|EAP|0761|PICC LINE >5YRS W/IMAGING|Blue Cross PPO Specialty|BCBSTX PPO|29.49||||||| 36573|EAP|0761|PICC LINE >5YRS W/IMAGING|Managed Medicaid|MEDICAID UNITED HEALTHCARE|29.49||||||| 36573|EAP|0761|PICC LINE >5YRS W/IMAGING|Humana Medicare Advantage|HUMANA MA|29.49||||||| 36573|EAP|0761|PICC LINE >5YRS W/IMAGING|Workers Compensation|TEXAS MUTUAL INSURANCE|29.49||||||| 36573|EAP|0761|PICC LINE >5YRS W/IMAGING|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|29.49||||||| 36573|EAP|0761|PICC LINE >5YRS W/IMAGING|United Healthcare|UNITED HEALTHCARE|29.49||||||| 36573|EAP|0761|PICC LINE >5YRS W/IMAGING|United Medicare Advantage|UHC AARP MCR HMO MA|29.49||||||| 36573|EAP|0761|PICC LINE >5YRS W/IMAGING|Workers Compensation|WORKERS COMPENSATION OTHER|29.49||||||| 36573|EAP|0761|PICC LINE >5YRS W/IMAGING|Medicare|MEDICARE ACUTE|29.49||||||| 36573|EAP|0761|PICC LINE >5YRS W/IMAGING|Blue Cross HMO Specialty|BCBSTX HMO|29.49||||||| 36573|EAP|0761|PICC LINE >5YRS W/IMAGING|Blue Cross PPO Specialty|BCBSTX OTHER|29.49||||||| 36589|EAP|0361|REM TUN CVC WO PORT/PUMP|Medicare|MEDICARE ACUTE|26.75||||||| 36589|EAP|0361|REM TUN CVC WO PORT/PUMP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|26.75||||||| 36901|EAP|0323|INTRO CATH DIALYSIS CIRCU|Medicare|MEDICARE ACUTE|28.44||||||| 36901|EAP|0323|INTRO CATH DIALYSIS CIRCU|Blue Cross PPO Specialty|BCBSTX PPO|28.44||||||| 36905|EAP|0323|THRMBC/NFS DIALYSIS CIRCU|United Medicare Advantage|UHC MEDICARE GOLD MA|376.91||||||| 371|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC|Blue Cross PPO Specialty|BCBSTX PPO|103,493.40|141.9|141.9|141.9|||| 377|DRG||G.I. HEMORRHAGE W MCC|Medicare|MEDICARE ACUTE|50,910.60|12537.04|12537.04|12537.04|||| 380|DRG||COMPLICATED PEPTIC ULCER W MCC|Medicare|MEDICARE ACUTE|53,742.10|17520.38|17520.38|17520.38|||| 38221|EAP|0361|CT-BONE MARROW BIOPSY|Medicare|MEDICARE ACUTE|67.18||||||| 388|DRG||G.I. OBSTRUCTION W MCC|Medicare|MEDICARE ACUTE|106,144.15|15066.065|15066.065|15066.065|||| 389|DRG||G.I. OBSTRUCTION W CC|Medicare|MEDICARE ACUTE|53,066.75|19436.99|19436.99|19436.99|||| 391|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC|Medicare|MEDICARE ACUTE|134,625.80|21408.65|21408.65|21408.65|||| 393|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC|Medicare|MEDICARE ACUTE|95,818.30|17756.05|17756.05|17756.05|||| 441|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W MCC|Medicare|MEDICARE ACUTE|14,294.18|2853.015|2853.015|2853.015|||| 443|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W/O CC/MCC|Medicare|MEDICARE ACUTE|79,737.75|16139.44|16139.44|16139.44|||| 463|DRG||WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W MCC|Medicare|MEDICARE ACUTE|357,079.25|38011.62|38011.62|38011.62|||| 477|DRG||BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC|Medicare|MEDICARE ACUTE|124,600.92|18584.7|18584.7|18584.7|||| 493|DRG||LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR W CC|Humana Medicare Advantage|HUMANA MA|301,077.25|34201.31|34201.31|34201.31|||| 516|DRG||OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W CC|Medicare|MEDICARE ACUTE|182,934.89|21015.17|21015.17|21015.17|||| 51701|EAP|0450|INSERT BLADDER CATH STRAI|Veterans Affairs|VETERANS ADMINISTRATION|438.15||||||| 54|DRG||NERVOUS SYSTEM NEOPLASMS W MCC|United Healthcare|UNITED HEALTHCARE|148,598.75|236.34|236.34|129|||| 54|DRG||NERVOUS SYSTEM NEOPLASMS W MCC|Blue Cross PPO Specialty|BCBSTX PPO|82,952.28|129|236.34|129|||| 54|DRG||NERVOUS SYSTEM NEOPLASMS W MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|106,844.75|142.61|236.34|129|||| 542|DRG||PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W MCC|Blue Cross PPO Specialty|BCBSTX PPO|19,903.50|25.8|25.8|25.8|||| 546|DRG||CONNECTIVE TISSUE DISORDERS W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|88,645.25|104.5|104.5|104.5|||| 549|DRG||SEPTIC ARTHRITIS W CC|Medicare|MEDICARE ACUTE|107,134.75|12428.25|12428.25|12428.25|||| 55|DRG||NERVOUS SYSTEM NEOPLASMS W/O MCC|Medicare|MEDICARE ACUTE|153,049.15|28472.43|28472.43|28472.43|||| 551|DRG||MEDICAL BACK PROBLEMS W MCC|Humana Medicare Advantage|HUMANA MA|211,381.28|22424.45|22424.45|16224.345|||| 551|DRG||MEDICAL BACK PROBLEMS W MCC|Medicare|MEDICARE ACUTE|89,508.15|16224.345|22424.45|16224.345|||| 552|DRG||MEDICAL BACK PROBLEMS W/O MCC|Medicare|MEDICARE ACUTE|89,166.45|18101.12|18101.12|18101.12|||| 554|DRG||BONE DISEASES & ARTHROPATHIES W/O MCC|Medicare|MEDICARE ACUTE|102,741.21|134.23|134.23|134.23|||| 557|DRG||TENDONITIS, MYOSITIS & BURSITIS W MCC|Medicare|MEDICARE ACUTE|132,306.75|23694.67|23694.67|23694.67|||| 558|DRG||TENDONITIS, MYOSITIS & BURSITIS W/O MCC|Medicare|MEDICARE ACUTE|125,952.90|20614.77|20614.77|20614.77|||| 559|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|69,392.40|87.76|143280.4|87.76|||| 559|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC|Cigna|CIGNA|53,576.50|100.8|143280.4|87.76|||| 559|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC|Blue Cross HMO Specialty|BCBSTX HMO|245,780.95|209|143280.4|87.76|||| 559|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC|Medicare|MEDICARE ACUTE|120,392.05|21548.28|143280.4|87.76|||| 559|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC|Blue Cross PPO Specialty|BCBSTX PPO|238,969.33|28907.5|143280.4|87.76|||| 559|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|154,627.60|21015.17|143280.4|87.76|||| 559|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|137,166.85|31145.88|143280.4|87.76|||| 559|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC|Humana Medicare Advantage|HUMANA MA|222,573.75|21777.54|143280.4|87.76|||| 559|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC|Medicaid|MEDICAID|179,100.50|143280.4|143280.4|87.76|||| 56|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|138,058.25|186.49|85696.5|74.13|||| 56|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|238,007.40|33519.91|85696.5|74.13|||| 56|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|209,840.63|27019.715|85696.5|74.13|||| 56|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC|Blue Cross HMO Specialty|BCBSTX HMO|184,085.55|239.14|85696.5|74.13|||| 56|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC|Medicaid|MEDICAID|143.12|11449.6|85696.5|74.13|||| 56|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC|Cigna|CIGNA|1,586.18|277.2|85696.5|74.13|||| 56|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC|Medicare|MEDICARE ACUTE|133,145.28|24844.8|85696.5|74.13|||| 56|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC|Blue Cross PPO Specialty|BCBSTX PPO|2,008.07|228.27|85696.5|74.13|||| 56|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|556.47|74.13|85696.5|74.13|||| 56|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC|NON CONTRACTED|COMMERCIAL OTHER 1|85,696.50|85696.5|85696.5|74.13|||| 56|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC|PHCS|HUMANA INSURANCE|276,169.50|28909.94|85696.5|74.13|||| 56|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC|United Healthcare|UNITED HEALTHCARE|167,537.11|183.82|85696.5|74.13|||| 56|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC|Managed Medicare|HEALTHSPRING MA|1,024.25|18364.955|85696.5|74.13|||| 56|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC|Humana Medicare Advantage|HUMANA MA|130,795.70|25540.92|85696.5|74.13|||| 560|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC|Workers Compensation|WORKERS COMPENSATION OTHER|104,520.43|10111.59|35036.17|88.9|||| 560|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC|United Healthcare|UNITED HEALTHCARE|90,624.38|17084.02|35036.17|88.9|||| 560|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC|Workers Compensation|TEXAS MUTUAL INSURANCE|140,601.13|35036.17|35036.17|88.9|||| 560|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|1,152.44|34573.2|35036.17|88.9|||| 560|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|1,972.98|285.93|35036.17|88.9|||| 560|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|108,008.13|13712.5|35036.17|88.9|||| 560|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC|Blue Cross PPO Specialty|BCBSTX PPO|86,641.75|154.8|35036.17|88.9|||| 560|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC|Medicare|MEDICARE ACUTE|110,002.05|19302.02|35036.17|88.9|||| 560|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC|Humana Medicare Advantage|HUMANA MA|93,717.75|19802.21|35036.17|88.9|||| 560|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC|Blue Cross HMO Specialty|BCBSTX HMO|118,533.60|156.75|35036.17|88.9|||| 560|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1,038.03|88.9|35036.17|88.9|||| 560|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|24,704.50|9041.98|35036.17|88.9|||| 560|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC|Aenta Medicare Advantage|AETNA MEDICARE MA|87,513.05|16445.3|35036.17|88.9|||| 560|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC|Cigna|CIGNA|53,562.75|100.8|35036.17|88.9|||| 560|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|62,502.35|88.9|35036.17|88.9|||| 561|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|91,928.80|9927.5|17752.17|152|||| 561|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC|Medicare|MEDICARE ACUTE|92,162.25|17752.17|17752.17|152|||| 561|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC|Workers Compensation|WORKERS COMPENSATION OTHER|52,514.50|7704.78|17752.17|152|||| 561|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC|Aetna|AETNA PPO|71,641.25|152|17752.17|152|||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|113,390.50|212.85|33519.91|38.7|||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|Tricare|TRICARE EAST REGION|39,400.50||||||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|United Medicare Advantage|UHC AARP MCR HMO MA|219,629.25|367.64|33519.91|38.7|||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|Cigna|CIGNA|187,479.25|327.6|33519.91|38.7|||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|Access Direct Platinum|HEALTHFIRST TPA|102,173.05|10208.33|33519.91|38.7|||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|United Healthcare|TML GROUP BENEFITS|196.81|39.39|33519.91|38.7|||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|90,531.83|13654.655|33519.91|38.7|||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|77,954.75|130.44|33519.91|38.7|||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|202,301.75|32945.96|33519.91|38.7|||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|81,960.75|26026.46|33519.91|38.7|||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|United Healthcare|UNITED HEALTHCARE|71,580.50|131.3|33519.91|38.7|||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|Medicare|MEDICARE ACUTE|117,160.75|20614.77|33519.91|38.7|||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|Humana Medicare Advantage|HUMANA MA|126,424.63|22414.03|33519.91|38.7|||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|209,683.40|10208.33|33519.91|38.7|||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|Aetna|AETNA OTHER|163,020.35|338.96|33519.91|38.7|||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|93,413.88|131.64|33519.91|38.7|||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|Blue Cross PPO Specialty|BCBSTX OTHER|16,617.40|38.7|33519.91|38.7|||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|Blue Cross HMO Specialty|BCBSTX HMO|73,448.98|11413.5|33519.91|38.7|||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|Managed Medicare|HEALTHSPRING MA|109,968.50|33519.91|33519.91|38.7|||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|Managed Medicare|BCBS MEDICARE PPO MA|124,753.35|18607.53|33519.91|38.7|||| 58|DRG||MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W MCC|Medicare|MEDICARE ACUTE|140,062.25|23396.28|23396.28|23396.28|||| 60|DRG||MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W/O CC/MCC|Medicare|MEDICARE ACUTE|110,904.65|21546.27|21546.27|21546.27|||| 602|DRG||CELLULITIS W MCC|Medicare|MEDICARE ACUTE|123,221.30|23237.41|23237.41|23237.41|||| 603|DRG||CELLULITIS W/O MCC|Medicare|MEDICARE ACUTE|98,053.75|13415.48|13415.48|13415.48|||| 62270|EAP|0361|LUMBAR PUNCTURE|Medicare|MEDICARE ACUTE|17.02||||||| 62270|EAP|0361|LUMBAR PUNCTURE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|17.02||||||| 62287|EAP|0361|ASPIRATION DISC|United Medicare Advantage|UHC MEDICARE GOLD MA|155.77||||||| 638|DRG||DIABETES W CC|Blue Cross PPO Specialty|BCBSTX PPO|88,182.70|129|16591.72|129|||| 638|DRG||DIABETES W CC|Medicare|MEDICARE ACUTE|86,321.25|16591.72|16591.72|129|||| 640|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W MCC|Medicare|MEDICARE ACUTE|1,073.79|16591.72|16591.72|16591.72|||| 644|DRG||ENDOCRINE DISORDERS W CC|Medicare|MEDICARE ACUTE|46,185.05|13586.61|13586.61|13586.61|||| 69|DRG||TRANSIENT ISCHEMIA W/O THROMBOLYTIC|Medicare|MEDICARE ACUTE|87,231.60|13769.515|13769.515|83.6|||| 69|DRG||TRANSIENT ISCHEMIA W/O THROMBOLYTIC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|68,756.60|83.6|13769.515|83.6|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|Medicare|MEDICARE ACUTE|43,911.65|12186.38|12186.38|12186.38|||| 70|DRG||NONSPECIFIC CEREBROVASCULAR DISORDERS W MCC|Medicare|MEDICARE ACUTE|99,884.80|17114.77|17114.77|13429.9|||| 70|DRG||NONSPECIFIC CEREBROVASCULAR DISORDERS W MCC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|106,247.25|13429.9|17114.77|13429.9|||| 70371|EAP|0320|ESOPHA VIDEO W/ SPEECH PA|Blue Cross PPO Specialty|BCBSTX PPO|11.20||||||| 70371|EAP|0320|ESOPHA VIDEO W/ SPEECH PA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|11.20||||||| 70371|EAP|0320|ESOPHA VIDEO W/ SPEECH PA|Medicare|MEDICARE ACUTE|11.20||||||| 70371|EAP|0320|ESOPHA VIDEO W/ SPEECH PA|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|11.20||||||| 70371|EAP|0320|ESOPHA VIDEO W/ SPEECH PA|Humana Medicare Advantage|HUMANA MA|11.20||||||| 70371|EAP|0320|ESOPHA VIDEO W/ SPEECH PA|Blue Cross HMO Specialty|BCBSTX HMO|11.20||||||| 70371|EAP|0320|ESOPHA VIDEO W/ SPEECH PA|United Medicare Advantage|UHC AARP MCR HMO MA|11.20||||||| 70450|EAP|0350|CT HEAD E1M1115|Humana Medicare Advantage|HUMANA MA|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|Managed Medicare|BCBS MEDICARE PPO MA|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|Blue Cross PPO Specialty|BCBSTX PPO|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|Aetna|AETNA OTHER|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|Access Direct Platinum|HEALTHFIRST TPA|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|Blue Cross HMO Specialty|BCBSTX HMO|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|United Medicare Advantage|UHC AARP MCR HMO MA|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|Aenta Medicare Advantage|AETNA MEDICARE MA|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|Managed Medicare|HEALTHSPRING MA|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|United Healthcare|UNITED HEALTHCARE|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|United Healthcare|UNITED HEALTHCARE OTHER|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|Medicare|MEDICARE ACUTE|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|Veterans Affairs|VETERANS ADMINISTRATION|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|United Medicare Advantage|UHC MEDICARE GOLD MA|45.60||||||| 70470|EAP|0350|CT HEAD W/WO CONT 100CC|Humana Medicare Advantage|HUMANA MA|67.55||||||| 70470|EAP|0350|CT HEAD W/WO CONT 100CC|Medicare|MEDICARE ACUTE|67.55||||||| 70470|EAP|0350|CT HEAD W/WO CONT 100CC|Aetna|AETNA PPO|67.55||||||| 70487|EAP|0350|CT MAX-FACE W/CONT 100CC|Workers Compensation|WORKERS COMPENSATION OTHER|59.57||||||| 70491|EAP|0350|CT NECK-SOFT TIS W/CONT 1|Medicare|MEDICARE ACUTE|59.57||||||| 70496|EAP|0350|CT ANGIO HEAD|Veterans Affairs|VETERANS ADMINISTRATION|8,183.32||||||| 70496|EAP|0350|CT ANGIO HEAD|Medicare|MEDICARE ACUTE|75.53||||||| 70498|EAP|0350|CT ANGIO NECK|Veterans Affairs|VETERANS ADMINISTRATION|8,183.32||||||| 70551|EAP|0610|MRI HEAD WO/ CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|47.15||||||| 70551|EAP|0610|MRI HEAD WO/ CONTRAST|Humana Medicare Advantage|HUMANA MA|47.15||||||| 70551|EAP|0610|MRI HEAD WO/ CONTRAST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|47.15||||||| 70551|EAP|0610|MRI HEAD WO/ CONTRAST|United Medicare Advantage|UHC AARP MCR HMO MA|47.15||||||| 70551|EAP|0610|MRI HEAD WO/ CONTRAST|Cigna|CIGNA|47.15||||||| 70551|EAP|0610|MRI HEAD WO/ CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|47.15||||||| 70551|EAP|0610|MRI HEAD WO/ CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|47.15||||||| 70551|EAP|0610|MRI HEAD WO/ CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 1|47.15||||||| 70551|EAP|0610|MRI HEAD WO/ CONTRAST|Blue Cross PPO Specialty|BCBSTX OTHER|47.15||||||| 70551|EAP|0610|MRI HEAD WO/ CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|47.15||||||| 70551|EAP|0610|MRI HEAD WO/ CONTRAST|Medicare|MEDICARE ACUTE|47.15||||||| 70551|EAP|0610|MRI HEAD WO/ CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|47.15||||||| 70553|EAP|0610|MRI HEAD W/WO CONT|Medicare|MEDICARE ACUTE|63.79||||||| 70553|EAP|0610|MRI HEAD W/WO CONT|Managed Medicare|HEALTHSPRING MA|63.79||||||| 70553|EAP|0610|MRI HEAD W/WO CONT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|63.79||||||| 70553|EAP|0610|MRI HEAD W/WO CONT|Blue Cross PPO Specialty|BCBSTX PPO|63.79||||||| 71|DRG||NONSPECIFIC CEREBROVASCULAR DISORDERS W CC|Medicare|MEDICARE ACUTE|1,041.68|19126.97|19126.97|19126.97|||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Veterans Affairs|VETERANS ADMINISTRATION|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Medicare|MEDICARE ACUTE|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|United Healthcare|UNITED HEALTHCARE OTHER|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|PHCS|HUMANA INSURANCE|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Medicaid|MEDICAID|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|United Medicare Advantage|UHC AARP MCR HMO MA|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Cigna|CIGNA|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Aenta Medicare Advantage|AETNA MEDICARE MA|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Blue Cross PPO Specialty|BCBSTX PPO|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|United Medicare Advantage|UHC MEDICARE GOLD MA|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Access Direct Platinum|HEALTHFIRST TPA|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Humana Medicare Advantage|HUMANA MA|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Blue Cross PPO Specialty|BCBSTX OTHER|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Aetna|AETNA PPO|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Managed Medicare|HEALTHSPRING MA|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Blue Cross HMO Specialty|BCBSTX HMO|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Access Direct Platinum|HEALTHFIRST TPA UMR|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.48||||||| 71046|EAP|0320|XR-EXAM CHEST 2 VIEWS|Cigna|CIGNA|6.44||||||| 71046|EAP|0320|XR-EXAM CHEST 2 VIEWS|Humana Medicare Advantage|HUMANA MA|6.44||||||| 71046|EAP|0320|XR-EXAM CHEST 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|6.44||||||| 71046|EAP|0320|XR-EXAM CHEST 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|6.44||||||| 71046|EAP|0320|XR-EXAM CHEST 2 VIEWS|Managed Medicare|HEALTHSPRING MA|6.44||||||| 71046|EAP|0320|XR-EXAM CHEST 2 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|6.44||||||| 71046|EAP|0320|XR-EXAM CHEST 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|6.44||||||| 71046|EAP|0320|XR-EXAM CHEST 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|6.44||||||| 71046|EAP|0320|XR-EXAM CHEST 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|6.44||||||| 71046|EAP|0320|XR-EXAM CHEST 2 VIEWS|Workers Compensation|TEXAS MUTUAL INSURANCE|6.44||||||| 71046|EAP|0320|XR-EXAM CHEST 2 VIEWS|Medicare|MEDICARE ACUTE|6.44||||||| 71046|EAP|0320|XR-EXAM CHEST 2 VIEWS|United Medicare Advantage|UHC AARP MCR HMO MA|6.44||||||| 71046|EAP|0320|XR-EXAM CHEST 2 VIEWS|United Healthcare|UNITED HEALTHCARE|6.44||||||| 71046|EAP|0320|XR-EXAM CHEST 2 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|6.44||||||| 71046|EAP|0320|XR-EXAM CHEST 2 VIEWS|PHCS|HUMANA INSURANCE|6.44||||||| 71046|EAP|0320|XR-EXAM CHEST 2 VIEWS|Blue Cross PPO Specialty|BCBSTX OTHER|6.44||||||| 71048|EAP|0320|XR-EXAM CHEST 4+ VIEWS|Humana Medicare Advantage|HUMANA MA|7.82||||||| 71101|EAP|0320|RIBS UNIL 3VW|Blue Cross PPO Specialty|BCBSTX OTHER|9.12||||||| 71101|EAP|0320|RIBS UNIL 3VW|Medicare|MEDICARE ACUTE|9.12||||||| 71250|EAP|0350|CT CHEST E1M1021|Blue Cross PPO Specialty|BCBSTX PPO|42.70||||||| 71250|EAP|0350|CT CHEST E1M1021|Managed Medicare|HEALTHSPRING MA|42.70||||||| 71250|EAP|0350|CT CHEST E1M1021|United Medicare Advantage|UHC AARP MCR HMO MA|42.70||||||| 71250|EAP|0350|CT CHEST E1M1021|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|42.70||||||| 71250|EAP|0350|CT CHEST E1M1021|United Medicare Advantage|UHC MEDICARE GOLD MA|42.70||||||| 71250|EAP|0350|CT CHEST E1M1021|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|42.70||||||| 71250|EAP|0350|CT CHEST E1M1021|Medicare|MEDICARE ACUTE|42.70||||||| 71250|EAP|0350|CT CHEST E1M1021|Humana Medicare Advantage|HUMANA MA|42.70||||||| 71260|EAP|0350|CT CHEST W/CONT 100CC E1|Medicare|MEDICARE ACUTE|55.78||||||| 71260|EAP|0350|CT CHEST W/CONT 100CC E1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|55.78||||||| 71260|EAP|0350|CT CHEST W/CONT 100CC E1|Blue Cross PPO Specialty|BCBSTX PPO|55.78||||||| 71260|EAP|0350|CT CHEST W/CONT 100CC E1|United Medicare Advantage|UHC MEDICARE GOLD MA|55.78||||||| 71275|EAP|0352|CT PE CHEST ANGIOGRAPHY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|70.74||||||| 71275|EAP|0352|CT PE CHEST ANGIOGRAPHY|Blue Cross PPO Specialty|BCBSTX PPO|70.74||||||| 71275|EAP|0352|CT PE CHEST ANGIOGRAPHY|United Medicare Advantage|UHC MEDICARE GOLD MA|70.74||||||| 71275|EAP|0352|CT PE CHEST ANGIOGRAPHY|Humana Medicare Advantage|HUMANA MA|70.74||||||| 71275|EAP|0352|CT PE CHEST ANGIOGRAPHY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|70.74||||||| 71275|EAP|0352|CT PE CHEST ANGIOGRAPHY|Medicare|MEDICARE ACUTE|70.74||||||| 71275|EAP|0352|CT PE CHEST ANGIOGRAPHY|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|70.74||||||| 71275|EAP|0352|CT PE CHEST ANGIOGRAPHY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|70.74||||||| 71275|EAP|0352|CT PE CHEST ANGIOGRAPHY|Managed Medicare|HEALTHSPRING MA|70.74||||||| 71275|EAP|0352|CT PE CHEST ANGIOGRAPHY|PHCS|HUMANA INSURANCE|70.74||||||| 71275|EAP|0352|CT PE CHEST ANGIOGRAPHY|Blue Cross PPO Specialty|BCBSTX OTHER|70.74||||||| 72|DRG||NONSPECIFIC CEREBROVASCULAR DISORDERS W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|919.71|15895.58|15895.58|12484.76|||| 72|DRG||NONSPECIFIC CEREBROVASCULAR DISORDERS W/O CC/MCC|Medicare|MEDICARE ACUTE|38,759.25|12484.76|15895.58|12484.76|||| 72040|EAP|0320|SPINE CER 3VW|Medicare|MEDICARE ACUTE|536.50||||||| 72040|EAP|0320|SPINE CER AP/LAT 2VW|Medicare|MEDICARE ACUTE|536.50||||||| 72080|EAP|0320|SPINE THOR 2VW PORT|Medicare|MEDICARE ACUTE|8.24||||||| 72100|EAP|0320|SPINE LUM 2VW PORT|Blue Cross PPO Specialty|BCBSTX PPO|8.24||||||| 72100|EAP|0320|SPINE LUM 2VW PORT|United Medicare Advantage|UHC MEDICARE GOLD MA|8.24||||||| 72100|EAP|0320|SPINE LUM 2VW PORT|Humana Medicare Advantage|HUMANA MA|8.24||||||| 72100|EAP|0320|SPINE LUM 2VW PORT|Medicare|MEDICARE ACUTE|8.24||||||| 72125|EAP|0350|CT SPINE CERVICAL|United Healthcare|UNITED HEALTHCARE|45.60||||||| 72125|EAP|0350|CT SPINE CERVICAL|Medicare|MEDICARE ACUTE|45.60||||||| 72125|EAP|0350|CT SPINE CERVICAL|United Medicare Advantage|UHC AARP MCR HMO MA|45.60||||||| 72125|EAP|0350|CT SPINE CERVICAL|Humana Medicare Advantage|HUMANA MA|45.60||||||| 72125|EAP|0350|CT SPINE CERVICAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|45.60||||||| 72128|EAP|0350|CT SPINE THORACIC|United Healthcare|UNITED HEALTHCARE|42.70||||||| 72128|EAP|0350|CT SPINE THORACIC|Medicare|MEDICARE ACUTE|42.70||||||| 72131|EAP|0350|CT SPINE LUMBAR|United Healthcare|UNITED HEALTHCARE|42.70||||||| 72131|EAP|0350|CT SPINE LUMBAR|Medicare|MEDICARE ACUTE|42.70||||||| 72141|EAP|0610|MRI C SPINE WO/ CONTRAST|Cigna|CIGNA|47.15||||||| 72141|EAP|0610|MRI C SPINE WO/ CONTRAST|Blue Cross PPO Specialty|BCBSTX OTHER|47.15||||||| 72141|EAP|0610|MRI C SPINE WO/ CONTRAST|Medicare|MEDICARE ACUTE|47.15||||||| 72141|EAP|0610|MRI C SPINE WO/ CONTRAST|Humana Medicare Advantage|HUMANA MA|47.15||||||| 72146|EAP|0610|MRI T SPINE WO/ CONTRAST|United Healthcare|UNITED HEALTHCARE|57.91||||||| 72146|EAP|0610|MRI T SPINE WO/ CONTRAST|Medicare|MEDICARE ACUTE|57.91||||||| 72148|EAP|0610|MRI L SPINE WO/ CONTRAST|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|57.91||||||| 72148|EAP|0610|MRI L SPINE WO/ CONTRAST|Medicare|MEDICARE ACUTE|57.91||||||| 72148|EAP|0610|MRI L SPINE WO/ CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|57.91||||||| 72156|EAP|0610|MRI C-SPINE W/WO CONT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|63.79||||||| 72157|EAP|0610|MRI T-SPINE W/WO CONT|Blue Cross HMO Specialty|BCBSTX HMO|78.34||||||| 72157|EAP|0610|MRI T-SPINE W/WO CONT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|78.34||||||| 72157|EAP|0610|MRI T-SPINE W/WO CONT|United Medicare Advantage|UHC AARP MCR HMO MA|78.34||||||| 72158|EAP|0610|MRI L-SPINE W/WO CONT|Workers Compensation|WORKERS COMPENSATION OTHER|78.34||||||| 72158|EAP|0610|MRI L-SPINE W/WO CONT|Medicare|MEDICARE ACUTE|78.34||||||| 72158|EAP|0610|MRI L-SPINE W/WO CONT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|78.34||||||| 72170|EAP|0320|PELVIS 1VW PORT|Medicare|MEDICARE ACUTE|8.24||||||| 72192|EAP|0350|CT PELVIS E1M1236|United Healthcare|UNITED HEALTHCARE|42.70||||||| 72197|EAP|0610|MRI PELVIS W WO CONT|Medicare|MEDICARE ACUTE|78.34||||||| 723|DRG||MALIGNANCY, MALE REPRODUCTIVE SYSTEM W CC|Medicare|MEDICARE ACUTE|181,792.85|16669.27|16669.27|16669.27|||| 73|DRG||CRANIAL & PERIPHERAL NERVE DISORDERS W MCC|Medicare|MEDICARE ACUTE|56,820.88|10175.065|10175.065|10175.065|||| 73000|EAP|0320|CLAVICLE 2VW|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|8.24||||||| 73020|EAP|0320|SHOULDER 1VW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.22||||||| 73020|EAP|0320|SHOULDER 1VW|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|7.22||||||| 73030|EAP|0320|SHOULDER 3VW,AP AXILLARY,|United Medicare Advantage|UHC MEDICARE GOLD MA|8.24||||||| 73030|EAP|0320|XR SHOULDER 2 VIEW|PHCS|HUMANA INSURANCE|8.24||||||| 73030|EAP|0320|XR SHOULDER 2 VIEW|United Medicare Advantage|UHC MEDICARE GOLD MA|8.24||||||| 73030|EAP|0320|XR SHOULDER 2 VIEW|Humana Medicare Advantage|HUMANA MA|8.24||||||| 73030|EAP|0320|XR SHOULDER 2 VIEW|Medicare|MEDICARE ACUTE|8.24||||||| 73030|EAP|0320|XR SHOULDER 2 VIEW|Blue Cross PPO Specialty|BCBSTX PPO|8.24||||||| 73060|EAP|0320|HUMERUS 2VW|United Medicare Advantage|UHC MEDICARE GOLD MA|8.24||||||| 73060|EAP|0320|HUMERUS 2VW|Medicare|MEDICARE ACUTE|8.24||||||| 73070|EAP|0320|ELBOW 2VW|Medicare|MEDICARE ACUTE|8.24||||||| 73090|EAP|0320|FOREARM 2VW|Blue Cross PPO Specialty|BCBSTX PPO|8.24||||||| 73090|EAP|0320|FOREARM 2VW|Medicare|MEDICARE ACUTE|8.24||||||| 73100|EAP|0320|WRIST POST REDUCTION|Medicare|MEDICARE ACUTE|6.31||||||| 73110|EAP|0320|WRIST 3VW|Medicare|MEDICARE ACUTE|9.12||||||| 73110|EAP|0320|WRIST 3VW|United Medicare Advantage|UHC MEDICARE GOLD MA|9.12||||||| 73110|EAP|0320|WRIST 3VW|Blue Cross PPO Specialty|BCBSTX PPO|9.12||||||| 73130|EAP|0320|HAND 3VW|United Medicare Advantage|UHC MEDICARE GOLD MA|9.12||||||| 73130|EAP|0320|HAND 3VW|Humana Medicare Advantage|HUMANA MA|9.12||||||| 73130|EAP|0320|HAND 3VW|Medicare|MEDICARE ACUTE|9.12||||||| 73130|EAP|0320|HAND 3VW|Blue Cross PPO Specialty|BCBSTX PPO|9.12||||||| 73140|EAP|0320|FINGER 2VW|United Medicare Advantage|UHC MEDICARE GOLD MA|8.24||||||| 73140|EAP|0320|FINGER 2VW|Medicare|MEDICARE ACUTE|8.24||||||| 73200|EAP|0350|CT ELBOW W/O CONT|Medicare|MEDICARE ACUTE|2,753.50||||||| 73502|EAP|0320|X-RAY EXAM HIP UNI 2-3 VI|Aenta Medicare Advantage|AETNA MEDICARE MA|0.97||||||| 73502|EAP|0320|X-RAY EXAM HIP UNI 2-3 VI|Blue Cross PPO Specialty|BCBSTX PPO|0.97||||||| 73502|EAP|0320|X-RAY EXAM HIP UNI 2-3 VI|United Medicare Advantage|UHC AARP MCR HMO MA|0.97||||||| 73502|EAP|0320|X-RAY EXAM HIP UNI 2-3 VI|Medicare|MEDICARE ACUTE|0.97||||||| 73510|EAP|0320|HIP AP & LAT 2VW|Medicare|MEDICARE ACUTE|536.50||||||| 73510|EAP|0320|HIP AP & LAT 2VW|Blue Cross PPO Specialty|BCBSTX OTHER|536.50||||||| 73523|EAP|0320|X-RAY EXAM HIPS BI 5/> VI|Medicare|MEDICARE ACUTE|3.07||||||| 73551|EAP|0320|X-RAY EXAM OF FEMUR 1 LT|Medicare|MEDICARE ACUTE|0.97||||||| 73552|EAP|0320|X-RAY EXAM OF FEMUR 2/> L|United Medicare Advantage|UHC AARP MCR HMO MA|0.97||||||| 73552|EAP|0320|X-RAY EXAM OF FEMUR 2/> R|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|0.97||||||| 73552|EAP|0320|X-RAY EXAM OF FEMUR 2/> L|Blue Cross PPO Specialty|BCBSTX PPO|0.97||||||| 73552|EAP|0320|X-RAY EXAM OF FEMUR 2/> R|Medicare|MEDICARE ACUTE|0.97||||||| 73552|EAP|0320|X-RAY EXAM OF FEMUR 2/> L|Medicare|MEDICARE ACUTE|0.97||||||| 73560|EAP|0320|XR KNEE 1 VIEW|Medicare|MEDICARE ACUTE|470.25||||||| 73560|EAP|0320|KNEE 2VW|United Medicare Advantage|UHC AARP MCR HMO MA|7.22||||||| 73560|EAP|0320|KNEE 2VW|Medicare|MEDICARE ACUTE|7.22||||||| 73560|EAP|0320|KNEE 2VW|Aenta Medicare Advantage|AETNA MEDICARE MA|7.22||||||| 73560|EAP|0320|KNEE 2VW|Humana Medicare Advantage|HUMANA MA|7.22||||||| 73560|EAP|0320|KNEE 2VW|Blue Cross PPO Specialty|BCBSTX PPO|7.22||||||| 73560|EAP|0320|KNEE 2VW|Blue Cross HMO Specialty|BCBSTX HMO|7.22||||||| 73590|EAP|0320|TIB-FIB 2VW|Medicare|MEDICARE ACUTE|8.24||||||| 73590|EAP|0320|TIB-FIB 2VW|United Medicare Advantage|UHC MEDICARE GOLD MA|8.24||||||| 73590|EAP|0320|TIB-FIB 2VW|United Medicare Advantage|UHC AARP MCR HMO MA|8.24||||||| 73590|EAP|0320|TIB-FIB 2VW|Blue Cross PPO Specialty|BCBSTX PPO|8.24||||||| 73600|EAP|0320|ANKLE 2VW|United Medicare Advantage|UHC MEDICARE GOLD MA|8.24||||||| 73600|EAP|0320|ANKLE 2VW|Medicare|MEDICARE ACUTE|8.24||||||| 73600|EAP|0320|ANKLE 2VW|United Medicare Advantage|UHC AARP MCR HMO MA|8.24||||||| 73600|EAP|0320|ANKLE 2VW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|8.24||||||| 73610|EAP|0320|ANKLE 3VW|Medicare|MEDICARE ACUTE|9.12||||||| 73620|EAP|0320|FOOT 2VW PORT|Medicare|MEDICARE ACUTE|8.24||||||| 73630|EAP|0320|FOOT 3VW|Aetna|AETNA OTHER|9.12||||||| 73630|EAP|0320|FOOT 3VW|Humana Medicare Advantage|HUMANA MA|9.12||||||| 73630|EAP|0320|FOOT 3VW|Medicare|MEDICARE ACUTE|9.12||||||| 73700|EAP|0350|CT EXT-LEG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|42.70||||||| 73700|EAP|0350|CT FOOT W/O CONT|Aetna|AETNA OTHER|2,753.50||||||| 73700|EAP|0350|CT EXT-LEG|Medicare|MEDICARE ACUTE|42.70||||||| 73700|EAP|0350|CT FOOT W/O CONT|Medicare|MEDICARE ACUTE|2,753.50||||||| 73701|EAP|0350|CT EXT-LEG W/CONT 150CC|Medicare|MEDICARE ACUTE|55.78||||||| 73718|EAP|0610|MRI LOWER EXTREMITY W/O D|Medicare|MEDICARE ACUTE|3,461.50||||||| 73721|EAP|0610|MRI JNT OF LWR EXTRE W/O|Medicare|MEDICARE ACUTE|57.91||||||| 73721|EAP|0610|MRI JNT OF LWR EXTRE W/O|Blue Cross PPO Specialty|BCBSTX PPO|57.91||||||| 74|DRG||CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC|Medicare|MEDICARE ACUTE|87,655.13|17486.26|17486.26|198.55|||| 74|DRG||CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|226,008.60|198.55|17486.26|198.55|||| 74000|EAP|0320|KUB KIDNEY-U B|Humana Medicare Advantage|HUMANA MA|6.42||||||| 74000|EAP|0320|KUB KIDNEY-U B|Medicare|MEDICARE ACUTE|6.42||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|Blue Cross PPO Specialty|BCBSTX PPO|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|Managed Medicare|HEALTHSPRING MA|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|Aetna|AETNA PPO|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|Blue Cross HMO Specialty|BCBSTX HMO|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|Humana Medicare Advantage|HUMANA MA|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|Managed Medicare|BCBS MEDICARE PPO MA|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|Tricare|TRICARE EAST REGION|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|United Medicare Advantage|UHC MEDICARE GOLD MA|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|Medicare|MEDICARE ACUTE|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|United Healthcare|UNITED HEALTHCARE OTHER|7.45||||||| 74019|EAP|0320|XR-EXAM ABDOMEN 2 VIEWS|Managed Medicare|BCBS MEDICARE PPO MA|7.32||||||| 74019|EAP|0320|XR-EXAM ABDOMEN 2 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|7.32||||||| 74019|EAP|0320|XR-EXAM ABDOMEN 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|7.32||||||| 74019|EAP|0320|XR-EXAM ABDOMEN 2 VIEWS|Medicare|MEDICARE ACUTE|7.32||||||| 74022|EAP|0320|ABDOMEN SERIES 3VW|United Medicare Advantage|UHC AARP MCR HMO MA|5.29||||||| 74022|EAP|0320|ABDOMEN SERIES 3VW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.29||||||| 74022|EAP|0320|ABDOMEN SERIES 3VW|Managed Medicare|HEALTHSPRING MA|5.29||||||| 74022|EAP|0320|ABDOMEN SERIES 3VW|Humana Medicare Advantage|HUMANA MA|5.29||||||| 74022|EAP|0320|ABDOMEN SERIES 3VW|Blue Cross HMO Specialty|BCBSTX HMO|5.29||||||| 74022|EAP|0320|ABDOMEN SERIES 3VW|United Healthcare|UNITED HEALTHCARE OTHER|5.29||||||| 74022|EAP|0320|ABDOMEN SERIES 3VW|Medicare|MEDICARE ACUTE|5.29||||||| 74022|EAP|0320|ABDOMEN SERIES 3VW|Blue Cross PPO Specialty|BCBSTX PPO|5.29||||||| 74022|EAP|0320|ABDOMEN SERIES 3VW|United Medicare Advantage|UHC MEDICARE GOLD MA|5.29||||||| 74150|EAP|0350|CT KIDNEY W/O CONTRAST|Medicare|MEDICARE ACUTE|713.50||||||| 74176|EAP|0350|CT ABD/PELV WO CONT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|85.40||||||| 74176|EAP|0350|CT ABD/PELV WO CONT|Blue Cross HMO Specialty|BCBSTX HMO|85.40||||||| 74176|EAP|0350|CT ABD/PELV WO CONT|Blue Cross PPO Specialty|BCBSTX PPO|85.40||||||| 74176|EAP|0350|CT ABD/PELV WO CONT|Medicare|MEDICARE ACUTE|85.40||||||| 74176|EAP|0350|CT ABD/PELV WO CONT|PHCS|HUMANA INSURANCE|85.40||||||| 74176|EAP|0350|CT ABD/PELV WO CONT|Workers Compensation|WORKERS COMPENSATION OTHER|85.40||||||| 74176|EAP|0350|CT ABD/PELV WO CONT|Humana Medicare Advantage|HUMANA MA|85.40||||||| 74176|EAP|0350|CT ABD/PELV WO CONT|United Healthcare|UNITED HEALTHCARE OTHER|85.40||||||| 74177|EAP|0350|CT ABD/PELV W CONT|Humana Medicare Advantage|HUMANA MA|111.57||||||| 74177|EAP|0350|CT ABD/PELV W CONT|Tricare|TRICARE EAST REGION|111.57||||||| 74177|EAP|0350|CT ABD/PELV W CONT|NON CONTRACTED|COMMERCIAL OTHER 1|111.57||||||| 74177|EAP|0350|CT ABD/PELV W CONT|Aetna|AETNA PPO|111.57||||||| 74177|EAP|0350|CT ABD/PELV W CONT|United Medicare Advantage|UHC MEDICARE GOLD MA|111.57||||||| 74177|EAP|0350|CT ABD/PELV W CONT|Medicare|MEDICARE ACUTE|111.57||||||| 74177|EAP|0350|CT ABD/PELV W CONT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|111.57||||||| 74177|EAP|0350|CT ABD/PELV W CONT|Blue Cross PPO Specialty|BCBSTX OTHER|111.57||||||| 74181|EAP|0610|MRI ABDOMEN IP18700|Humana Medicare Advantage|HUMANA MA|57.91||||||| 74181|EAP|0610|MRI ABDOMEN IP18700|Medicare|MEDICARE ACUTE|57.91||||||| 74220|EAP|0320|ESOPHAG B/SWAL|Humana Medicare Advantage|HUMANA MA|8.46||||||| 74220|EAP|0320|ESOPHAG B/SWAL|Medicare|MEDICARE ACUTE|8.46||||||| 74241|EAP|0320|UPPER GI|Medicare|MEDICARE ACUTE|10.63||||||| 74250|EAP|0320|SMALL BOWEL SER|Medicare|MEDICARE ACUTE|9.31||||||| 74330|EAP|0320|ENDOSCOP COMBIN|Humana Medicare Advantage|HUMANA MA|22.51||||||| 75635|EAP|0352|CT ANGIO AORTO-ILLOFEMORA|Medicare|MEDICARE ACUTE|31.47||||||| 75710|EAP|0320|OR ARTERIOGRAM|Blue Cross PPO Specialty|BCBSTX PPO|99.08||||||| 75710|EAP|0320|OR ARTERIOGRAM|Medicare|MEDICARE ACUTE|99.08||||||| 75894|EAP|0320|EMBOLIZATION|Medicare|MEDICARE ACUTE|172.35||||||| 76000|EAP|0320|OR FLUORO 0 - 30 MIN|Medicare|MEDICARE ACUTE|12.51||||||| 76003|EAP|0320|NEEDLE BX W/FLUORO|United Medicare Advantage|UHC AARP MCR HMO MA|10.25||||||| 76005|EAP|0320|GUIDANCE & LOC FOR SPINE|United Medicare Advantage|UHC MEDICARE GOLD MA|8.20||||||| 76365|EAP|0350|CYST ASPIRATION|Medicare|MEDICARE ACUTE|29.06||||||| 76376|EAP|0402|3D RENDERING|Medicare|MEDICARE ACUTE|1,962.20||||||| 76376|EAP|0402|3D RENDERING|United Healthcare|UNITED HEALTHCARE|18.53||||||| 76536|EAP|0400|ECHO SOFT TISSUE NECK|Medicare|MEDICARE ACUTE|9.05||||||| 76604|EAP|0400|CHEST U/S PORT|Medicare|MEDICARE ACUTE|10.92||||||| 76700|EAP|0400|ABDOMINAL ECHO COMPL Q702|Blue Cross PPO Specialty|BCBSTX OTHER|12.21||||||| 76700|EAP|0400|ABDOMINAL ECHO COMPL Q702|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|12.21||||||| 76700|EAP|0400|ABDOMINAL ECHO COMPL Q702|Humana Medicare Advantage|HUMANA MA|12.21||||||| 76700|EAP|0400|ABDOMINAL ECHO COMPL Q702|Medicare|MEDICARE ACUTE|12.21||||||| 76705|EAP|0402|US ABDOMEN LIMITED|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|8.08||||||| 76705|EAP|0400|LIVER U/S Q730500|Medicare|MEDICARE ACUTE|745.50||||||| 76705|EAP|0402|US ABDOMEN LIMITED|United Healthcare|UNITED HEALTHCARE|8.08||||||| 76705|EAP|0402|US ABDOMEN LIMITED|Medicare|MEDICARE ACUTE|8.08||||||| 76705|EAP|0402|US ABDOMEN LIMITED|Humana Medicare Advantage|HUMANA MA|8.08||||||| 76770|EAP|0400|RENAL ECHO|Blue Cross HMO Specialty|BCBSTX HMO|8.77||||||| 76770|EAP|0400|RENAL ECHO|Managed Medicare|BCBS MEDICARE PPO MA|8.77||||||| 76770|EAP|0400|RENAL ECHO|Medicare|MEDICARE ACUTE|8.77||||||| 76770|EAP|0400|RENAL ECHO|United Medicare Advantage|UHC MEDICARE GOLD MA|8.77||||||| 76770|EAP|0400|RENAL ECHO|United Healthcare|UNITED HEALTHCARE OTHER|8.77||||||| 76770|EAP|0400|RENAL ECHO|Workers Compensation|TEXAS MUTUAL INSURANCE|8.77||||||| 76770|EAP|0400|RENAL ECHO|Humana Medicare Advantage|HUMANA MA|8.77||||||| 76770|EAP|0400|RENAL ECHO|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|8.77||||||| 76770|EAP|0400|RENAL ECHO|United Medicare Advantage|UHC AARP MCR HMO MA|8.77||||||| 76870|EAP|0400|SCROTUM U/S Q761500|Medicare|MEDICARE ACUTE|9.16||||||| 76881|EAP|0402|US EXTREMITY NON VASCULAR|Medicare|MEDICARE ACUTE|9.16||||||| 76937|EAP|0320|US GUIDANCE CVAD|Medicare|MEDICARE ACUTE|15.07||||||| 76937|EAP|0320|US GUIDANCE CVAD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|15.07||||||| 77001|EAP|0320|FLUORO GUIDANCE CVAD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.99||||||| 77001|EAP|0320|OR FLUORO GUIDANCE CVAD|Medicare|MEDICARE ACUTE|9.99||||||| 77001|EAP|0320|FLUORO GUIDANCE CVAD|Medicare|MEDICARE ACUTE|9.99||||||| 77001|EAP|0320|FLUORO GUIDANCE CVAD|Humana Medicare Advantage|HUMANA MA|9.99||||||| 77001|EAP|0320|OR FLUORO GUIDANCE CVAD|Blue Cross PPO Specialty|BCBSTX PPO|9.99||||||| 78264|EAP|0340|GASTRIC EMPTYING|Medicare|MEDICARE ACUTE|25.80||||||| 78264|EAP|0340|GASTRIC EMPTYING|United Healthcare|UNITED HEALTHCARE OTHER|25.80||||||| 78306|EAP|0340|BONE SCAN WB|Medicare|MEDICARE ACUTE|23.85||||||| 78306|EAP|0340|BONE SCAN WB|Managed Medicare|HEALTHSPRING MA|23.85||||||| 78465|EAP|0340|MYOCARDIAL PERF S&R ECT|Medicare|MEDICARE ACUTE|65.68||||||| 78580|EAP|0340|LUNG PERFUSION|Blue Cross PPO Specialty|BCBSTX PPO|23.42||||||| 78580|EAP|0340|LUNG PERFUSION|Medicare|MEDICARE ACUTE|23.42||||||| 78582|EAP|0340|NM PULMONARY VENTILATION|United Medicare Advantage|UHC MEDICARE GOLD MA|36.23||||||| 78582|EAP|0340|NM PULMONARY VENTILATION|Medicare|MEDICARE ACUTE|36.23||||||| 78582|EAP|0340|NM PULMONARY VENTILATION|Blue Cross HMO Specialty|BCBSTX HMO|36.23||||||| 78582|EAP|0340|NM PULMONARY VENTILATION|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|36.23||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Access Direct Platinum|HEALTHFIRST TPA UMR|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Access Direct Platinum|HEALTHFIRST TPA|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Cigna|CIGNA|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Blue Cross PPO Specialty|BCBSTX OTHER|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Managed Medicare|BCBS MEDICARE PPO MA|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Humana Medicare Advantage|HUMANA MA|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Cigna|CIGNA OTHER|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Blue Cross HMO Specialty|BCBSTX HMO|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Aetna|AETNA PPO|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Aenta Medicare Advantage|AETNA MEDICARE MA|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Managed Medicare|HEALTHSPRING MA|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Blue Cross PPO Specialty|BCBSTX PPO|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Medicaid|MEDICAID|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Aetna|AETNA OTHER|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Tricare|TRICARE EAST REGION|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|United Healthcare|UNITED HEALTHCARE OTHER|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Medicare|MEDICARE ACUTE|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|United Medicare Advantage|UHC AARP MCR HMO MA|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|PHCS|HUMANA INSURANCE|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Workers Compensation|WORKERS COMPENSATION OTHER|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Workers Compensation|TEXAS MUTUAL INSURANCE|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|United Healthcare|UNITED HEALTHCARE|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|United Medicare Advantage|UHC MEDICARE GOLD MA|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|NON CONTRACTED|COMMERCIAL OTHER 1|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Veterans Affairs|VETERANS ADMINISTRATION|2.09||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|United Healthcare|TML GROUP BENEFITS|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|NON CONTRACTED|COMMERCIAL OTHER 1|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Veterans Affairs|VETERANS ADMINISTRATION|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Medicare|MEDICARE ACUTE|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|United Healthcare|UNITED HEALTHCARE OTHER|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Workers Compensation|WORKERS COMPENSATION OTHER|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|United Healthcare|UNITED HEALTHCARE|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|United Medicare Advantage|UHC AARP MCR HMO MA|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Managed Medicare|HEALTHSPRING MA|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|United Medicare Advantage|UHC MEDICARE GOLD MA|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Access Direct Platinum|HEALTHFIRST TPA|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Workers Compensation|TEXAS MUTUAL INSURANCE|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Managed Medicare|BCBS MEDICARE PPO MA|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|PHCS|HUMANA INSURANCE|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Tricare|TRICARE EAST REGION|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Cigna|CIGNA OTHER|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Aetna|AETNA OTHER|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Blue Cross HMO Specialty|BCBSTX HMO|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Access Direct Platinum|HEALTHFIRST TPA UMR|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Blue Cross PPO Specialty|BCBSTX OTHER|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Medicaid|MEDICAID|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Aetna|AETNA PPO|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Humana Medicare Advantage|HUMANA MA|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Blue Cross PPO Specialty|BCBSTX PPO|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Cigna|CIGNA|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Aenta Medicare Advantage|AETNA MEDICARE MA|3.07||||||| 80061|EAP|0300|CARDIAC RISK PROFILE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.98||||||| 80061|EAP|0300|CARDIAC RISK PROFILE|Humana Medicare Advantage|HUMANA MA|1.98||||||| 80061|EAP|0300|CARDIAC RISK PROFILE|United Medicare Advantage|UHC AARP MCR HMO MA|1.98||||||| 80061|EAP|0300|CARDIAC RISK PROFILE|United Medicare Advantage|UHC MEDICARE GOLD MA|1.98||||||| 80061|EAP|0300|CARDIAC RISK PROFILE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.98||||||| 80061|EAP|0300|CARDIAC RISK PROFILE|Medicare|MEDICARE ACUTE|1.98||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|Medicare|MEDICARE ACUTE|3.07||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|Workers Compensation|TEXAS MUTUAL INSURANCE|3.07||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|United Medicare Advantage|UHC MEDICARE GOLD MA|3.07||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|3.07||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|United Healthcare|UNITED HEALTHCARE OTHER|3.07||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|Blue Cross PPO Specialty|BCBSTX PPO|3.07||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|Aetna|AETNA PPO|3.07||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.07||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|3.07||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|Managed Medicare|BCBS MEDICARE PPO MA|3.07||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|Managed Medicare|HEALTHSPRING MA|3.07||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|Aenta Medicare Advantage|AETNA MEDICARE MA|3.07||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|3.07||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|Blue Cross HMO Specialty|BCBSTX HMO|3.07||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|Humana Medicare Advantage|HUMANA MA|3.07||||||| 80074|EAP|0300|HEPATITIS PROFILE I|Managed Medicare|HEALTHSPRING MA|18.53||||||| 80074|EAP|0300|HEPATITIS PROFILE I|Blue Cross PPO Specialty|BCBSTX OTHER|18.53||||||| 80074|EAP|0300|HEPATITIS PROFILE I|Humana Medicare Advantage|HUMANA MA|18.53||||||| 80074|EAP|0300|HEPATITIS PROFILE I|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|18.53||||||| 80074|EAP|0300|HEPATITIS PROFILE I|Medicare|MEDICARE ACUTE|18.53||||||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Medicare|MEDICARE ACUTE|2.89||||||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|United Medicare Advantage|UHC MEDICARE GOLD MA|2.89||||||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Aenta Medicare Advantage|AETNA MEDICARE MA|2.89||||||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.89||||||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Humana Medicare Advantage|HUMANA MA|2.89||||||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|United Medicare Advantage|UHC AARP MCR HMO MA|2.89||||||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|2.89||||||| 80150|EAP|0300|AMIKACIN IA11981|Medicare|MEDICARE ACUTE|4.71||||||| 80156|EAP|0300|CARBAMAZEPINE QUANT GK307|Medicare|MEDICARE ACUTE|4.55||||||| 80156|EAP|0300|CARBAMAZEPINE QUANT GK307|United Medicare Advantage|UHC MEDICARE GOLD MA|4.55||||||| 80162|EAP|0300|DIGOXIN (LANOXIN)|Blue Cross PPO Specialty|BCBSTX PPO|4.15||||||| 80162|EAP|0300|DIGOXIN (LANOXIN)|Medicare|MEDICARE ACUTE|4.15||||||| 80162|EAP|0300|DIGOXIN (LANOXIN)|PHCS|HUMANA INSURANCE|4.15||||||| 80164|EAP|0300|VALPROIC ACID QUANT GL217|Medicare|MEDICARE ACUTE|4.24||||||| 80164|EAP|0300|VALPROIC ACID QUANT GL217|Humana Medicare Advantage|HUMANA MA|4.24||||||| 80170|EAP|0300|GENTAMICIN QUANT RIA IN10|United Healthcare|UNITED HEALTHCARE|5.13||||||| 80170|EAP|0300|RANDOM GENTAMICIN BLOOD L|Medicare|MEDICARE ACUTE|5.13||||||| 80178|EAP|0300|LITHIUM GF62300|Blue Cross PPO Specialty|BCBSTX PPO|2.07||||||| 80178|EAP|0300|LITHIUM GF62300|Medicare|MEDICARE ACUTE|2.07||||||| 80184|EAP|0300|PHENOBARBITAL LEVEL GH108|Medicare|MEDICARE ACUTE|3.58||||||| 80185|EAP|0300|DILANTIN GD01350|Blue Cross PPO Specialty|BCBSTX PPO|4.15||||||| 80185|EAP|0300|DILANTIN GD01350|Blue Cross HMO Specialty|BCBSTX HMO|4.15||||||| 80185|EAP|0300|DILANTIN GD01350|Aenta Medicare Advantage|AETNA MEDICARE MA|4.15||||||| 80185|EAP|0300|DILANTIN GD01350|United Medicare Advantage|UHC MEDICARE GOLD MA|4.15||||||| 80185|EAP|0300|DILANTIN GD01350|Managed Medicare|HEALTHSPRING MA|4.15||||||| 80185|EAP|0300|DILANTIN GD01350|Humana Medicare Advantage|HUMANA MA|4.15||||||| 80185|EAP|0300|DILANTIN GD01350|Medicare|MEDICARE ACUTE|4.15||||||| 80197|EAP|0300|TACROLIMUS (FK506)|United Medicare Advantage|UHC MEDICARE GOLD MA|546.75||||||| 80197|EAP|0300|TACROLIMUS (FK506)|Blue Cross PPO Specialty|BCBSTX PPO|546.75||||||| 80197|EAP|0300|TACROLIMUS (FK506)|Medicare|MEDICARE ACUTE|546.75||||||| 80200|EAP|0300|TOBRAMYCIN GK47800|Medicare|MEDICARE ACUTE|5.04||||||| 80202|EAP|0300|VANCOMYCIN LEVEL RL21775|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.24||||||| 80202|EAP|0300|VANCOMYCIN LEVEL RL21775|Blue Cross HMO Specialty|BCBSTX HMO|4.24||||||| 80202|EAP|0300|VANCOMYCIN LEVEL RL21775|Humana Medicare Advantage|HUMANA MA|4.24||||||| 80202|EAP|0300|VANCOMYCIN LEVEL RL21775|United Medicare Advantage|UHC AARP MCR HMO MA|4.24||||||| 80202|EAP|0300|VANCOMYCIN LEVEL RL21775|Medicare|MEDICARE ACUTE|4.24||||||| 80202|EAP|0300|VANCOMYCIN LEVEL RL21775|Workers Compensation|WORKERS COMPENSATION OTHER|4.24||||||| 80202|EAP|0300|VANCOMYCIN LEVEL RL21775|Blue Cross PPO Specialty|BCBSTX PPO|4.24||||||| 80202|EAP|0300|VANCOMYCIN LEVEL RL21775|United Medicare Advantage|UHC MEDICARE GOLD MA|4.24||||||| 80202|EAP|0300|VANCOMYCIN LEVEL RL21775|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.24||||||| 80202|EAP|0300|VANCOMYCIN LEVEL RL21775|Aenta Medicare Advantage|AETNA MEDICARE MA|4.24||||||| 80202|EAP|0300|VANCOMYCIN LEVEL RL21775|United Healthcare|UNITED HEALTHCARE|4.24||||||| 80202|EAP|0300|VANCOMYCIN LEVEL RL21775|Workers Compensation|TEXAS MUTUAL INSURANCE|4.24||||||| 80299|EAP|0300|KEPPRA LEVATIRACETAM|Medicare|MEDICARE ACUTE|545.75||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Managed Medicare|HEALTHSPRING MA|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Access Direct Platinum|HEALTHFIRST TPA UMR|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Blue Cross PPO Specialty|BCBSTX PPO|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Medicaid|MEDICAID|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Blue Cross PPO Specialty|BCBSTX OTHER|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Humana Medicare Advantage|HUMANA MA|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Cigna|CIGNA|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Veterans Affairs|VETERANS ADMINISTRATION|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Tricare|TRICARE EAST REGION|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Workers Compensation|TEXAS MUTUAL INSURANCE|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Medicare|MEDICARE ACUTE|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|United Medicare Advantage|UHC AARP MCR HMO MA|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|United Healthcare|UNITED HEALTHCARE OTHER|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Aetna|AETNA PPO|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|NON CONTRACTED|COMMERCIAL OTHER 1|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|United Medicare Advantage|UHC MEDICARE GOLD MA|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.01||||||| 81003|EAP|0300|URINALYSIS ROUTINE|United Healthcare|UNITED HEALTHCARE|0.88||||||| 81003|EAP|0300|URINALYSIS ROUTINE|Workers Compensation|TEXAS MUTUAL INSURANCE|0.88||||||| 81003|EAP|0300|PH URINE GH08500|Medicare|MEDICARE ACUTE|1.41||||||| 81003|EAP|0300|URINALYSIS ROUTINE|NON CONTRACTED|COMMERCIAL OTHER 1|0.88||||||| 81003|EAP|0300|URINALYSIS ROUTINE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.88||||||| 81003|EAP|0300|URINALYSIS ROUTINE|Tricare|TRICARE EAST REGION|0.88||||||| 81003|EAP|0300|URINALYSIS ROUTINE|United Medicare Advantage|UHC AARP MCR HMO MA|0.88||||||| 81003|EAP|0300|URINALYSIS ROUTINE|United Healthcare|UNITED HEALTHCARE OTHER|0.88||||||| 81003|EAP|0300|URINALYSIS ROUTINE|Medicare|MEDICARE ACUTE|0.88||||||| 81003|EAP|0300|URINALYSIS ROUTINE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|0.88||||||| 81003|EAP|0300|URINALYSIS ROUTINE|Humana Medicare Advantage|HUMANA MA|0.88||||||| 81003|EAP|0300|URINALYSIS ROUTINE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.88||||||| 81003|EAP|0300|URINALYSIS ROUTINE|Cigna|CIGNA|0.88||||||| 81003|EAP|0300|URINALYSIS ROUTINE|Veterans Affairs|VETERANS ADMINISTRATION|0.88||||||| 81003|EAP|0300|URINALYSIS ROUTINE|Blue Cross PPO Specialty|BCBSTX PPO|0.88||||||| 81003|EAP|0300|URINALYSIS ROUTINE|Access Direct Platinum|HEALTHFIRST TPA|0.88||||||| 81003|EAP|0300|URINALYSIS ROUTINE|Managed Medicare|HEALTHSPRING MA|0.88||||||| 81003|EAP|0300|URINALYSIS ROUTINE|Aenta Medicare Advantage|AETNA MEDICARE MA|0.88||||||| 81003|EAP|0300|URINALYSIS ROUTINE|Managed Medicare|BCBS MEDICARE PPO MA|0.88||||||| 81003|EAP|0300|URINALYSIS ROUTINE|Aetna|AETNA PPO|0.88||||||| 81003|EAP|0300|URINALYSIS ROUTINE|Access Direct Platinum|HEALTHFIRST TPA UMR|0.88||||||| 81003|EAP|0300|URINALYSIS ROUTINE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|0.88||||||| 81003|EAP|0300|URINALYSIS ROUTINE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.88||||||| 81003|EAP|0300|PH URINE GH08500|Blue Cross PPO Specialty|BCBSTX PPO|1.41||||||| 81003|EAP|0300|URINALYSIS ROUTINE|Medicaid|MEDICAID|0.88||||||| 81003|EAP|0300|URINALYSIS ROUTINE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.88||||||| 81003|EAP|0300|URINALYSIS ROUTINE|Blue Cross PPO Specialty|BCBSTX OTHER|0.88||||||| 81003|EAP|0300|URINALYSIS ROUTINE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.88||||||| 81003|EAP|0300|URINALYSIS ROUTINE|Blue Cross HMO Specialty|BCBSTX HMO|0.88||||||| 81015|EAP|0300|EOSINOPHIL COUNT URINE|Humana Medicare Advantage|HUMANA MA|1.20||||||| 81015|EAP|0300|EOSINOPHIL COUNT URINE|United Medicare Advantage|UHC MEDICARE GOLD MA|1.20||||||| 81015|EAP|0300|EOSINOPHIL COUNT URINE|Medicare|MEDICARE ACUTE|1.20||||||| 81015|EAP|0300|EOSINOPHIL COUNT URINE|United Medicare Advantage|UHC AARP MCR HMO MA|1.20||||||| 81015|EAP|0300|EOSINOPHIL COUNT URINE|Workers Compensation|TEXAS MUTUAL INSURANCE|1.20||||||| 81015|EAP|0300|EOSINOPHIL COUNT URINE|United Healthcare|UNITED HEALTHCARE OTHER|1.20||||||| 81025|EAP|0300|UCG PREGNANCY TEST|United Healthcare|UNITED HEALTHCARE OTHER|2.49||||||| 81240|EAP|0300|PROTHROMBIN G20210A MUTAT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|411.75||||||| 81240|EAP|0300|PROTHROMBIN G20210A MUTAT|Blue Cross PPO Specialty|BCBSTX PPO|411.75||||||| 81241|EAP|0300|FACTOR V LEIDEN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|15.91||||||| 81241|EAP|0300|FACTOR V LEIDEN|Blue Cross PPO Specialty|BCBSTX PPO|15.91||||||| 81256|EAP|0300|HEMOCHROMATOSIS(HFE) PCR|Medicare|MEDICARE ACUTE|8.36||||||| 814|DRG||RETICULOENDOTHELIAL & IMMUNITY DISORDERS W MCC|Medicare|MEDICARE ACUTE|75,882.75|15310.11|15310.11|15310.11|||| 82010|EAP|0300|ACETONE ASSAY|Medicare|MEDICARE ACUTE|2.38||||||| 82024|EAP|0300|ADRENOCORTICOTROPIC HORMO|Medicare|MEDICARE ACUTE|13.82||||||| 82024|EAP|0300|ADRENOCORTICOTROPIC HORMO|United Medicare Advantage|UHC MEDICARE GOLD MA|13.82||||||| 82040|EAP|0300|ALBUMIN (SERUM)|Blue Cross HMO Specialty|BCBSTX HMO|1.00||||||| 82040|EAP|0300|ALBUMIN (SERUM)|United Medicare Advantage|UHC MEDICARE GOLD MA|1.00||||||| 82040|EAP|0300|ALBUMIN (SERUM)|Aenta Medicare Advantage|AETNA MEDICARE MA|1.00||||||| 82040|EAP|0300|ALBUMIN (SERUM)|Humana Medicare Advantage|HUMANA MA|1.00||||||| 82040|EAP|0300|ALBUMIN (SERUM)|Medicare|MEDICARE ACUTE|1.00||||||| 82042|EAP|0300|ALBUMIN 24HR QUANT URINE|Blue Cross PPO Specialty|BCBSTX PPO|1.04||||||| 82105|EAP|0300|ALPHA FETOPROTEIN GA849|Medicare|MEDICARE ACUTE|3.72||||||| 82140|EAP|0300|AMMONIA GA92990|Humana Medicare Advantage|HUMANA MA|2.94||||||| 82140|EAP|0300|AMMONIA GA92990|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.94||||||| 82140|EAP|0300|AMMONIA GA92990|Blue Cross HMO Specialty|BCBSTX HMO|2.94||||||| 82140|EAP|0300|AMMONIA GA92990|Blue Cross PPO Specialty|BCBSTX PPO|2.94||||||| 82140|EAP|0300|AMMONIA GA92990|Medicare|MEDICARE ACUTE|2.94||||||| 82140|EAP|0300|AMMONIA GA92990|United Medicare Advantage|UHC AARP MCR HMO MA|2.94||||||| 82140|EAP|0300|AMMONIA GA92990|United Medicare Advantage|UHC MEDICARE GOLD MA|2.94||||||| 82140|EAP|0300|AMMONIA GA92990|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.94||||||| 82140|EAP|0300|AMMONIA GA92990|United Healthcare|UNITED HEALTHCARE OTHER|2.94||||||| 82150|EAP|0300|AMYLASE|PHCS|HUMANA INSURANCE|1.31||||||| 82150|EAP|0300|AMYLASE|United Healthcare|UNITED HEALTHCARE OTHER|1.31||||||| 82150|EAP|0300|AMYLASE|United Medicare Advantage|UHC MEDICARE GOLD MA|1.31||||||| 82150|EAP|0300|AMYLASE|Medicare|MEDICARE ACUTE|1.31||||||| 82150|EAP|0300|AMYLASE|Blue Cross PPO Specialty|BCBSTX OTHER|1.31||||||| 82150|EAP|0300|AMYLASE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.31||||||| 82150|EAP|0300|AMYLASE|Managed Medicare|BCBS MEDICARE PPO MA|1.31||||||| 82150|EAP|0300|AMYLASE|Blue Cross PPO Specialty|BCBSTX PPO|1.31||||||| 82150|EAP|0300|AMYLASE|Managed Medicare|HEALTHSPRING MA|1.31||||||| 82150|EAP|0300|AMYLASE|Humana Medicare Advantage|HUMANA MA|1.31||||||| 82247|EAP|0300|BILIRUBIN TOTAL|Blue Cross PPO Specialty|BCBSTX PPO|1.01||||||| 82247|EAP|0300|BILIRUBIN TOTAL|Medicare|MEDICARE ACUTE|1.01||||||| 82247|EAP|0300|BILIRUBIN TOTAL|Humana Medicare Advantage|HUMANA MA|1.01||||||| 82247|EAP|0300|BILIRUBIN TOTAL|United Healthcare|UNITED HEALTHCARE|1.01||||||| 82247|EAP|0300|BILIRUBIN TOTAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.01||||||| 82248|EAP|0300|BILIRUBIN DIRECT SERUM|United Healthcare|UNITED HEALTHCARE|1.01||||||| 82248|EAP|0300|BILIRUBIN DIRECT SERUM|Medicare|MEDICARE ACUTE|1.01||||||| 82248|EAP|0300|BILIRUBIN DIRECT SERUM|Humana Medicare Advantage|HUMANA MA|1.01||||||| 82248|EAP|0300|BILIRUBIN DIRECT SERUM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.01||||||| 82248|EAP|0300|BILIRUBIN DIRECT SERUM|Blue Cross PPO Specialty|BCBSTX PPO|1.01||||||| 82248|EAP|0300|BILIRUBIN DIRECT|Blue Cross PPO Specialty|BCBSTX PPO|1.01||||||| 82270|EAP|0300|OCCULT BLOOD FECES QUAL|Blue Cross HMO Specialty|BCBSTX HMO|0.66||||||| 82270|EAP|0300|OCCULT BLOOD FECES QUAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.66||||||| 82270|EAP|0300|OCCULT BLOOD FECES QUAL|Blue Cross PPO Specialty|BCBSTX PPO|0.66||||||| 82270|EAP|0300|OCCULT BLOOD FECES QUAL|Managed Medicare|HEALTHSPRING MA|0.66||||||| 82270|EAP|0300|OCCULT BLOOD FECES QUAL|Cigna|CIGNA OTHER|0.66||||||| 82270|EAP|0300|OCCULT BLOOD FECES QUAL|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|0.66||||||| 82270|EAP|0300|OCCULT BLOOD FECES QUAL|Aenta Medicare Advantage|AETNA MEDICARE MA|0.66||||||| 82270|EAP|0300|OCCULT BLOOD FECES QUAL|United Medicare Advantage|UHC MEDICARE GOLD MA|0.66||||||| 82270|EAP|0300|OCCULT BLOOD FECES QUAL|Medicare|MEDICARE ACUTE|0.66||||||| 82270|EAP|0300|OCCULT BLOOD FECES QUAL|NON CONTRACTED|COMMERCIAL OTHER 1|0.66||||||| 82270|EAP|0300|OCCULT BLOOD FECES QUAL|United Medicare Advantage|UHC AARP MCR HMO MA|0.66||||||| 82270|EAP|0300|OCCULT BLOOD FECES QUAL|PHCS|HUMANA INSURANCE|0.66||||||| 82270|EAP|0300|OCCULT BLOOD FECES QUAL|Humana Medicare Advantage|HUMANA MA|0.66||||||| 82270|EAP|0300|OCCULT BLOOD FECES QUAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.66||||||| 82306|EAP|0300|VITAMIN D 25 HYDROXY RL39|Tricare|TRICARE EAST REGION|1,082.50||||||| 82306|EAP|0300|VITAMIN D 25 HYDROXY RL39|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|1,082.50||||||| 82306|EAP|0300|VITAMIN D 25 HYDROXY RL39|Medicare|MEDICARE ACUTE|1,082.50||||||| 82306|EAP|0300|VITAMIN D 25 HYDROXY RL39|Humana Medicare Advantage|HUMANA MA|1,082.50||||||| 82306|EAP|0300|VITAMIN D 25 HYDROXY RL39|United Medicare Advantage|UHC AARP MCR HMO MA|1,082.50||||||| 82306|EAP|0300|VITAMIN D 25 HYDROXY RL39|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|1,082.50||||||| 82306|EAP|0300|VITAMIN D 25 HYDROXY RL39|Blue Cross HMO Specialty|BCBSTX HMO|1,082.50||||||| 82306|EAP|0300|VITAMIN D 25 HYDROXY RL39|Managed Medicare|HEALTHSPRING MA|1,082.50||||||| 82306|EAP|0300|VITAMIN D 25 HYDROXY RL39|United Medicare Advantage|UHC MEDICARE GOLD MA|1,082.50||||||| 82306|EAP|0300|VITAMIN D 25 HYDROXY RL39|Aenta Medicare Advantage|AETNA MEDICARE MA|1,082.50||||||| 82306|EAP|0300|VITAMIN D 25 HYDROXY RL39|Access Direct Platinum|HEALTHFIRST TPA|1,082.50||||||| 82306|EAP|0300|VITAMIN D 25 HYDROXY RL39|Aetna|AETNA OTHER|1,082.50||||||| 82306|EAP|0300|VITAMIN D 25 HYDROXY RL39|Cigna|CIGNA OTHER|1,082.50||||||| 82306|EAP|0300|VITAMIN D 25 HYDROXY RL39|Blue Cross PPO Specialty|BCBSTX PPO|1,082.50||||||| 82306|EAP|0300|VITAMIN D 25 HYDROXY RL39|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1,082.50||||||| 82306|EAP|0300|VITAMIN D 25 HYDROXY RL39|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,082.50||||||| 82330|EAP|0300|CALCIUM IONIZED(FREE)|Medicare|MEDICARE ACUTE|2.76||||||| 82390|EAP|0300|CERULOPLASMIN GC28200|Medicare|MEDICARE ACUTE|2.17||||||| 82397|EAP|0300|PTH-RELATED PROTEIN|Blue Cross HMO Specialty|BCBSTX HMO|5.63||||||| 82435|EAP|0300|CHLORIDE|Blue Cross PPO Specialty|BCBSTX PPO|0.93||||||| 82435|EAP|0300|CHLORIDE|Medicare|MEDICARE ACUTE|0.93||||||| 82436|EAP|0300|CHLORIDE GC31000|Medicare|MEDICARE ACUTE|0.93||||||| 82436|EAP|0300|CHLORIDE GC31000|United Medicare Advantage|UHC MEDICARE GOLD MA|0.93||||||| 82436|EAP|0300|CHLORIDE GC31000|United Medicare Advantage|UHC AARP MCR HMO MA|0.93||||||| 82465|EAP|0300|CHOLESTEROL TOTAL|Medicare|MEDICARE ACUTE|0.88||||||| 82533|EAP|0300|PLASMA CORTISOL GC638|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.62||||||| 82533|EAP|0300|PLASMA CORTISOL GC638|Blue Cross PPO Specialty|BCBSTX OTHER|3.62||||||| 82533|EAP|0300|PLASMA CORTISOL GC638|Medicare|MEDICARE ACUTE|3.62||||||| 82533|EAP|0300|PLASMA CORTISOL GC638|Blue Cross PPO Specialty|BCBSTX PPO|3.62||||||| 82533|EAP|0300|PLASMA CORTISOL GC638|United Medicare Advantage|UHC MEDICARE GOLD MA|3.62||||||| 82550|EAP|0300|CREATINE KINASE|United Healthcare|UNITED HEALTHCARE OTHER|1.31||||||| 82550|EAP|0300|CREATINE KINASE|Medicare|MEDICARE ACUTE|1.31||||||| 82550|EAP|0300|CREATINE KINASE|Managed Medicare|HEALTHSPRING MA|1.31||||||| 82550|EAP|0300|CREATINE KINASE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.31||||||| 82550|EAP|0300|CREATINE KINASE|Humana Medicare Advantage|HUMANA MA|1.31||||||| 82550|EAP|0300|CREATINE KINASE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.31||||||| 82565|EAP|0300|CREATININE BLOOD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.03||||||| 82565|EAP|0300|CREATININE BLOOD|Blue Cross PPO Specialty|BCBSTX PPO|1.03||||||| 82565|EAP|0300|CREATININE BLOOD|Workers Compensation|WORKERS COMPENSATION OTHER|1.03||||||| 82565|EAP|0300|CREATININE BLOOD|United Medicare Advantage|UHC AARP MCR HMO MA|1.03||||||| 82565|EAP|0300|CREATININE BLOOD|Veterans Affairs|VETERANS ADMINISTRATION|1.03||||||| 82565|EAP|0300|CREATININE BLOOD|Medicare|MEDICARE ACUTE|1.03||||||| 82570|EAP|0300|CREATININE OTHER SOURCE|Workers Compensation|TEXAS MUTUAL INSURANCE|0.45||||||| 82570|EAP|0300|CREATININE OTHER SOURCE|United Medicare Advantage|UHC AARP MCR HMO MA|0.45||||||| 82570|EAP|0300|CREATININE OTHER SOURCE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.45||||||| 82570|EAP|0300|CREATININE OTHER SOURCE|Medicare|MEDICARE ACUTE|0.45||||||| 82570|EAP|0300|CREATININE OTHER SOURCE|Humana Medicare Advantage|HUMANA MA|0.45||||||| 82575|EAP|0300|CREATININE CLEARANCE GC69|Medicare|MEDICARE ACUTE|1.90||||||| 82607|EAP|0300|CYANOCOBALAMIN VITAMIN B-|Humana Medicare Advantage|HUMANA MA|3.34||||||| 82607|EAP|0300|CYANOCOBALAMIN VITAMIN B-|Cigna|CIGNA OTHER|3.34||||||| 82607|EAP|0300|CYANOCOBALAMIN VITAMIN B-|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.34||||||| 82607|EAP|0300|CYANOCOBALAMIN VITAMIN B-|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|3.34||||||| 82607|EAP|0300|CYANOCOBALAMIN VITAMIN B-|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|3.34||||||| 82607|EAP|0300|CYANOCOBALAMIN VITAMIN B-|Managed Medicare|HEALTHSPRING MA|3.34||||||| 82607|EAP|0300|CYANOCOBALAMIN VITAMIN B-|Blue Cross HMO Specialty|BCBSTX HMO|3.34||||||| 82607|EAP|0300|CYANOCOBALAMIN VITAMIN B-|Access Direct Platinum|HEALTHFIRST TPA|3.34||||||| 82607|EAP|0300|CYANOCOBALAMIN VITAMIN B-|Aetna|AETNA PPO|3.34||||||| 82607|EAP|0300|CYANOCOBALAMIN VITAMIN B-|Aenta Medicare Advantage|AETNA MEDICARE MA|3.34||||||| 82607|EAP|0300|CYANOCOBALAMIN VITAMIN B-|Blue Cross PPO Specialty|BCBSTX PPO|3.34||||||| 82607|EAP|0300|CYANOCOBALAMIN VITAMIN B-|United Medicare Advantage|UHC AARP MCR HMO MA|3.34||||||| 82607|EAP|0300|CYANOCOBALAMIN VITAMIN B-|NON CONTRACTED|COMMERCIAL OTHER 1|3.34||||||| 82607|EAP|0300|CYANOCOBALAMIN VITAMIN B-|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|3.34||||||| 82607|EAP|0300|CYANOCOBALAMIN VITAMIN B-|United Medicare Advantage|UHC MEDICARE GOLD MA|3.34||||||| 82607|EAP|0300|CYANOCOBALAMIN VITAMIN B-|Medicare|MEDICARE ACUTE|3.34||||||| 82607|EAP|0300|CYANOCOBALAMIN VITAMIN B-|United Healthcare|UNITED HEALTHCARE OTHER|3.34||||||| 82607|EAP|0300|CYANOCOBALAMIN VITAMIN B-|United Healthcare|UNITED HEALTHCARE|3.34||||||| 82607|EAP|0300|CYANOCOBALAMIN VITAMIN B-|PHCS|HUMANA INSURANCE|3.34||||||| 82607|EAP|0300|CYANOCOBALAMIN VITAMIN B-|Tricare|TRICARE EAST REGION|3.34||||||| 82668|EAP|0300|ERYTHROPOIETIN ASSAY RD34|Medicare|MEDICARE ACUTE|749.25||||||| 82728|EAP|0300|FERRITIN ASSAY SERUM GD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.02||||||| 82728|EAP|0300|FERRITIN ASSAY SERUM GD|Humana Medicare Advantage|HUMANA MA|3.02||||||| 82728|EAP|0300|FERRITIN ASSAY SERUM GD|Blue Cross PPO Specialty|BCBSTX PPO|3.02||||||| 82728|EAP|0300|FERRITIN ASSAY SERUM GD|Managed Medicare|HEALTHSPRING MA|3.02||||||| 82728|EAP|0300|FERRITIN ASSAY SERUM GD|Medicare|MEDICARE ACUTE|3.02||||||| 82728|EAP|0300|FERRITIN ASSAY SERUM GD|Tricare|TRICARE EAST REGION|3.02||||||| 82728|EAP|0300|FERRITIN ASSAY SERUM GD|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|3.02||||||| 82728|EAP|0300|FERRITIN ASSAY SERUM GD|NON CONTRACTED|COMMERCIAL OTHER 1|3.02||||||| 82728|EAP|0300|FERRITIN ASSAY SERUM GD|Blue Cross HMO Specialty|BCBSTX HMO|3.02||||||| 82728|EAP|0300|FERRITIN ASSAY SERUM GD|United Medicare Advantage|UHC MEDICARE GOLD MA|3.02||||||| 82728|EAP|0300|FERRITIN ASSAY SERUM GD|PHCS|HUMANA INSURANCE|3.02||||||| 82728|EAP|0300|FERRITIN ASSAY SERUM GD|United Medicare Advantage|UHC AARP MCR HMO MA|3.02||||||| 82746|EAP|0300|FOLIC ACID GD71950|United Medicare Advantage|UHC AARP MCR HMO MA|3.26||||||| 82746|EAP|0300|FOLIC ACID GD71950|United Medicare Advantage|UHC MEDICARE GOLD MA|3.26||||||| 82746|EAP|0300|FOLIC ACID GD71950|Medicare|MEDICARE ACUTE|3.26||||||| 82746|EAP|0300|FOLIC ACID GD71950|Blue Cross PPO Specialty|BCBSTX PPO|3.26||||||| 82746|EAP|0300|FOLIC ACID GD71950|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.26||||||| 82784|EAP|0300|IMMUNOGLOBULIN A IGA|Medicare|MEDICARE ACUTE|1.88||||||| 82784|EAP|0300|IMMUNOGLOBULIN A IGA|United Medicare Advantage|UHC MEDICARE GOLD MA|1.88||||||| 82784|EAP|0300|IMMUNOGLOBUL G QUANT GF11|Medicare|MEDICARE ACUTE|1.88||||||| 82784|EAP|0300|IMMUNOGLOBUL M QUANT GF11|United Medicare Advantage|UHC MEDICARE GOLD MA|1.88||||||| 82784|EAP|0300|IMMUNOGLOBUL M QUANT GF11|Medicare|MEDICARE ACUTE|1.88||||||| 82784|EAP|0300|IMMUNOGLOBUL G QUANT GF11|United Medicare Advantage|UHC MEDICARE GOLD MA|1.88||||||| 82947|EAP|0300|GLUCOSE BLOOD GJ99600|Medicare|MEDICARE ACUTE|0.79||||||| 82947|EAP|0300|GLUCOSE BLOOD GJ99600|Blue Cross PPO Specialty|BCBSTX PPO|0.79||||||| 82947|EAP|0300|GLUCOSE CSF GK02200|Blue Cross PPO Specialty|BCBSTX PPO|0.79||||||| 82947|EAP|0300|GLUCOSE CSF GK02200|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.79||||||| 82947|EAP|0300|GLUCOSE CSF GK02200|Medicare|MEDICARE ACUTE|0.79||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|United Medicare Advantage|UHC MEDICARE GOLD MA|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Workers Compensation|TEXAS MUTUAL INSURANCE|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|NON CONTRACTED|COMMERCIAL OTHER 1|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|United Healthcare|UNITED HEALTHCARE|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Veterans Affairs|VETERANS ADMINISTRATION|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Medicare|MEDICARE ACUTE|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Workers Compensation|WORKERS COMPENSATION OTHER|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Aenta Medicare Advantage|AETNA MEDICARE MA|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Medicaid|MEDICAID|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Humana Medicare Advantage|HUMANA MA|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Aetna|AETNA OTHER|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|United Medicare Advantage|UHC AARP MCR HMO MA|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|United Healthcare|UNITED HEALTHCARE OTHER|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Cigna|CIGNA OTHER|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Managed Medicare|HEALTHSPRING MA|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Cigna|CIGNA|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Access Direct Platinum|HEALTHFIRST TPA|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Blue Cross PPO Specialty|BCBSTX PPO|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Blue Cross HMO Specialty|BCBSTX HMO|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Managed Medicare|BCBS MEDICARE PPO MA|0.57||||||| 82960|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.57||||||| 82977|EAP|0300|GAMMA GT GE05375|Medicare|MEDICARE ACUTE|0.55||||||| 83010|EAP|0300|HAPTOGLOBIN QUAN GE58100|Humana Medicare Advantage|HUMANA MA|2.54||||||| 83010|EAP|0300|HAPTOGLOBIN QUAN GE58100|Blue Cross PPO Specialty|BCBSTX PPO|2.54||||||| 83010|EAP|0300|HAPTOGLOBIN QUAN GE58100|Medicare|MEDICARE ACUTE|2.54||||||| 83010|EAP|0300|HAPTOGLOBIN QUAN GE58100|Aenta Medicare Advantage|AETNA MEDICARE MA|2.54||||||| 83036|EAP|0300|GLYCOSYLATED HEMOGLOBIN T|Blue Cross PPO Specialty|BCBSTX PPO|386.50||||||| 83036|EAP|0300|GLYCOSYLATED HEMOGLOBIN T|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|386.50||||||| 83036|EAP|0300|GLYCOSYLATED HEMOGLOBIN T|Aetna|AETNA PPO|386.50||||||| 83036|EAP|0300|GLYCOSYLATED HEMOGLOBIN T|Blue Cross HMO Specialty|BCBSTX HMO|386.50||||||| 83036|EAP|0300|GLYCOSYLATED HEMOGLOBIN T|United Medicare Advantage|UHC AARP MCR HMO MA|386.50||||||| 83036|EAP|0300|GLYCOSYLATED HEMOGLOBIN T|Medicare|MEDICARE ACUTE|386.50||||||| 83036|EAP|0300|GLYCOSYLATED HEMOGLOBIN T|NON CONTRACTED|COMMERCIAL OTHER 1|386.50||||||| 83516|EAP|0300|GLOMERULAR|Medicare|MEDICARE ACUTE|5.16||||||| 83516|EAP|0300|ACETYLCHOLINE RECEPTOR(AC|Medicare|MEDICARE ACUTE|538.75||||||| 83516|EAP|0300|ACETYLCHOLINE MODULATING|Medicare|MEDICARE ACUTE|538.75||||||| 83519|EAP|0300|ACHR RA54250|Medicare|MEDICARE ACUTE|14.57||||||| 83519|EAP|0300|RIA NONANTIBODY|Medicare|MEDICARE ACUTE|518.75||||||| 83519|EAP|0300|VOLTAGE-GATED CALCIUM CHA|Medicare|MEDICARE ACUTE|174.07||||||| 83520|EAP|0300|INTERLUKIN 6|Humana Medicare Advantage|HUMANA MA|5.63||||||| 83520|EAP|0300|INTERLUKIN 6|Medicare|MEDICARE ACUTE|5.63||||||| 83520|EAP|0300|INTERLUKIN 6|United Medicare Advantage|UHC MEDICARE GOLD MA|5.63||||||| 83525|EAP|0300|INSULIN RF15525|United Medicare Advantage|UHC MEDICARE GOLD MA|455.25||||||| 83540|EAP|0300|SERUM IRON GF21800|Blue Cross PPO Specialty|BCBSTX PPO|1.31||||||| 83540|EAP|0300|SERUM IRON GF21800|United Medicare Advantage|UHC AARP MCR HMO MA|1.31||||||| 83540|EAP|0300|SERUM IRON GF21800|Aetna|AETNA PPO|1.31||||||| 83540|EAP|0300|SERUM IRON GF21800|Managed Medicare|HEALTHSPRING MA|1.31||||||| 83540|EAP|0300|SERUM IRON GF21800|Humana Medicare Advantage|HUMANA MA|1.31||||||| 83540|EAP|0300|SERUM IRON GF21800|United Medicare Advantage|UHC MEDICARE GOLD MA|1.31||||||| 83540|EAP|0300|SERUM IRON GF21800|Workers Compensation|TEXAS MUTUAL INSURANCE|1.31||||||| 83540|EAP|0300|SERUM IRON GF21800|Tricare|TRICARE EAST REGION|1.31||||||| 83540|EAP|0300|SERUM IRON GF21800|Medicare|MEDICARE ACUTE|1.31||||||| 83550|EAP|0300|IRON BINDING CAPACITY GF2|Medicare|MEDICARE ACUTE|1.77||||||| 83550|EAP|0300|IRON BINDING CAPACITY GF2|United Medicare Advantage|UHC AARP MCR HMO MA|1.77||||||| 83550|EAP|0300|IRON BINDING CAPACITY GF2|Tricare|TRICARE EAST REGION|1.77||||||| 83550|EAP|0300|IRON BINDING CAPACITY GF2|Workers Compensation|TEXAS MUTUAL INSURANCE|1.77||||||| 83550|EAP|0300|IRON BINDING CAPACITY GF2|Blue Cross PPO Specialty|BCBSTX PPO|1.77||||||| 83550|EAP|0300|IRON BINDING CAPACITY GF2|United Medicare Advantage|UHC MEDICARE GOLD MA|1.77||||||| 83550|EAP|0300|IRON BINDING CAPACITY GF2|Managed Medicare|HEALTHSPRING MA|1.77||||||| 83550|EAP|0300|IRON BINDING CAPACITY GF2|Humana Medicare Advantage|HUMANA MA|1.77||||||| 83550|EAP|0300|IRON BINDING CAPACITY GF2|Aetna|AETNA PPO|1.77||||||| 83605|EAP|0300|LACTIC ACID GF46500|Humana Medicare Advantage|HUMANA MA|2.15||||||| 83605|EAP|0300|LACTIC ACID GF46500|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.15||||||| 83605|EAP|0300|LACTIC ACID GF46500|Blue Cross HMO Specialty|BCBSTX HMO|2.15||||||| 83605|EAP|0300|LACTIC ACID GF46500|Blue Cross PPO Specialty|BCBSTX PPO|2.15||||||| 83605|EAP|0300|LACTIC ACID GF46500|Workers Compensation|TEXAS MUTUAL INSURANCE|2.15||||||| 83605|EAP|0300|LACTIC ACID GF46500|United Medicare Advantage|UHC MEDICARE GOLD MA|2.15||||||| 83605|EAP|0300|LACTIC ACID GF46500|Medicare|MEDICARE ACUTE|2.15||||||| 83605|EAP|0300|LACTIC ACID GF46500|United Medicare Advantage|UHC AARP MCR HMO MA|2.15||||||| 83605|EAP|0300|LACTIC ACID GF46500|Medicaid|MEDICAID|2.15||||||| 83615|EAP|0300|LACTATE DEHYDROGENASE LDH|Medicare|MEDICARE ACUTE|1.22||||||| 83615|EAP|0300|LACTATE DEHYDROGENASE LDH|United Medicare Advantage|UHC MEDICARE GOLD MA|1.22||||||| 83615|EAP|0300|LACTATE DEHYDROGENASE LDH|Blue Cross PPO Specialty|BCBSTX PPO|1.22||||||| 83615|EAP|0300|LACTATE DEHYDROGENASE LDH|Humana Medicare Advantage|HUMANA MA|1.22||||||| 83615|EAP|0300|LACTATE DEHYDROGENASE LDH|Managed Medicare|HEALTHSPRING MA|1.22||||||| 83690|EAP|0300|LIPASE GF57700|Aetna|AETNA PPO|1.39||||||| 83690|EAP|0300|LIPASE GF57700|Humana Medicare Advantage|HUMANA MA|1.39||||||| 83690|EAP|0300|LIPASE GF57700|Medicare|MEDICARE ACUTE|1.39||||||| 83690|EAP|0300|LIPASE GF57700|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.39||||||| 83735|EAP|0300|MAGNESIUM GF84300|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|United Medicare Advantage|UHC MEDICARE GOLD MA|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Workers Compensation|WORKERS COMPENSATION OTHER|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|NON CONTRACTED|COMMERCIAL OTHER 1|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|United Healthcare|UNITED HEALTHCARE|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Medicare|MEDICARE ACUTE|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Tricare|TRICARE EAST REGION|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|United Medicare Advantage|UHC AARP MCR HMO MA|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|PHCS|HUMANA INSURANCE|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Workers Compensation|TEXAS MUTUAL INSURANCE|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|United Healthcare|UNITED HEALTHCARE OTHER|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Veterans Affairs|VETERANS ADMINISTRATION|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Cigna|CIGNA|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Humana Medicare Advantage|HUMANA MA|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Medicaid|MEDICAID|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Cigna|CIGNA OTHER|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Blue Cross HMO Specialty|BCBSTX HMO|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Aetna|AETNA PPO|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Access Direct Platinum|HEALTHFIRST TPA UMR|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Managed Medicare|BCBS MEDICARE PPO MA|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Access Direct Platinum|HEALTHFIRST TPA|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Managed Medicare|HEALTHSPRING MA|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Aetna|AETNA OTHER|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Aenta Medicare Advantage|AETNA MEDICARE MA|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Blue Cross PPO Specialty|BCBSTX OTHER|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Blue Cross PPO Specialty|BCBSTX PPO|1.35||||||| 83880|EAP|0300|B-TYPE NATRIURETIC PEPTID|Blue Cross HMO Specialty|BCBSTX HMO|5.16||||||| 83880|EAP|0300|B-TYPE NATRIURETIC PEPTID|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|5.16||||||| 83880|EAP|0300|B-TYPE NATRIURETIC PEPTID|Cigna|CIGNA|5.16||||||| 83880|EAP|0300|B-TYPE NATRIURETIC PEPTID|Humana Medicare Advantage|HUMANA MA|5.16||||||| 83880|EAP|0300|B-TYPE NATRIURETIC PEPTID|Managed Medicare|HEALTHSPRING MA|5.16||||||| 83880|EAP|0300|B-TYPE NATRIURETIC PEPTID|Blue Cross PPO Specialty|BCBSTX PPO|5.16||||||| 83880|EAP|0300|B-TYPE NATRIURETIC PEPTID|United Medicare Advantage|UHC MEDICARE GOLD MA|5.16||||||| 83880|EAP|0300|B-TYPE NATRIURETIC PEPTID|United Medicare Advantage|UHC AARP MCR HMO MA|5.16||||||| 83880|EAP|0300|B-TYPE NATRIURETIC PEPTID|Medicare|MEDICARE ACUTE|5.16||||||| 83880|EAP|0300|B-TYPE NATRIURETIC PEPTID|PHCS|HUMANA INSURANCE|5.16||||||| 83880|EAP|0300|B-TYPE NATRIURETIC PEPTID|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|5.16||||||| 83880|EAP|0300|B-TYPE NATRIURETIC PEPTID|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.16||||||| 83880|EAP|0300|B-TYPE NATRIURETIC PEPTID|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.16||||||| 83880|EAP|0300|B-TYPE NATRIURETIC PEPTID|United Healthcare|UNITED HEALTHCARE|5.16||||||| 83883|EAP|0300|KAPPA/LAMBDA LIGHT CHAINS|Medicare|MEDICARE ACUTE|541.50||||||| 83883|EAP|0300|KAPPA/LAMBDA LIGHT CHAINS|United Medicare Advantage|UHC MEDICARE GOLD MA|541.50||||||| 83930|EAP|0300|ASSAY OF BLOOD OSMOLALITY|Medicare|MEDICARE ACUTE|1.09||||||| 83930|EAP|0300|ASSAY OF BLOOD OSMOLALITY|United Medicare Advantage|UHC MEDICARE GOLD MA|1.09||||||| 83935|EAP|0300|OSMOLALITY URINE GG54000|United Medicare Advantage|UHC MEDICARE GOLD MA|0.99||||||| 83935|EAP|0300|OSMOLALITY URINE GG54000|Humana Medicare Advantage|HUMANA MA|0.99||||||| 83935|EAP|0300|OSMOLALITY URINE GG54000|Medicare|MEDICARE ACUTE|0.99||||||| 841|DRG||LYMPHOMA & NON-ACUTE LEUKEMIA W CC|Medicare|MEDICARE ACUTE|76,626.75|11976.55|11976.55|86.03|||| 841|DRG||LYMPHOMA & NON-ACUTE LEUKEMIA W CC|Blue Cross PPO Specialty|BCBSTX PPO|85,803.25|86.03|11976.55|86.03|||| 84100|EAP|0300|PHOSPHORUS|Blue Cross PPO Specialty|BCBSTX PPO|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Tricare|TRICARE EAST REGION|0.96||||||| 84100|EAP|0300|PHOSPHORUS|NON CONTRACTED|COMMERCIAL OTHER 1|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Workers Compensation|TEXAS MUTUAL INSURANCE|0.96||||||| 84100|EAP|0300|PHOSPHORUS|PHCS|HUMANA INSURANCE|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Veterans Affairs|VETERANS ADMINISTRATION|0.96||||||| 84100|EAP|0300|PHOSPHORUS|United Medicare Advantage|UHC AARP MCR HMO MA|0.96||||||| 84100|EAP|0300|PHOSPHORUS|United Healthcare|UNITED HEALTHCARE OTHER|0.96||||||| 84100|EAP|0300|PHOSPHORUS|United Healthcare|UNITED HEALTHCARE|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Medicare|MEDICARE ACUTE|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Access Direct Platinum|HEALTHFIRST TPA|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Aenta Medicare Advantage|AETNA MEDICARE MA|0.96||||||| 84100|EAP|0300|PHOSPHORUS|United Medicare Advantage|UHC MEDICARE GOLD MA|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Humana Medicare Advantage|HUMANA MA|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Cigna|CIGNA|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Managed Medicare|BCBS MEDICARE PPO MA|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Blue Cross HMO Specialty|BCBSTX HMO|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Aetna|AETNA PPO|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Aetna|AETNA OTHER|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Managed Medicare|HEALTHSPRING MA|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Cigna|CIGNA OTHER|0.96||||||| 84132|EAP|0300|POTASSIUM|Managed Medicare|HEALTHSPRING MA|0.93||||||| 84132|EAP|0300|POTASSIUM|Cigna|CIGNA|0.93||||||| 84132|EAP|0300|POTASSIUM|Blue Cross PPO Specialty|BCBSTX OTHER|0.93||||||| 84132|EAP|0300|POTASSIUM|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.93||||||| 84132|EAP|0300|POTASSIUM|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.93||||||| 84132|EAP|0300|POTASSIUM|Blue Cross HMO Specialty|BCBSTX HMO|0.93||||||| 84132|EAP|0300|POTASSIUM|Aenta Medicare Advantage|AETNA MEDICARE MA|0.93||||||| 84132|EAP|0300|POTASSIUM|Blue Cross PPO Specialty|BCBSTX PPO|0.93||||||| 84132|EAP|0300|POTASSIUM|Access Direct Platinum|HEALTHFIRST TPA|0.93||||||| 84132|EAP|0300|POTASSIUM|Humana Medicare Advantage|HUMANA MA|0.93||||||| 84132|EAP|0300|POTASSIUM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.93||||||| 84132|EAP|0300|POTASSIUM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.93||||||| 84132|EAP|0300|POTASSIUM|Medicaid|MEDICAID|0.93||||||| 84132|EAP|0300|POTASSIUM|Tricare|TRICARE EAST REGION|0.93||||||| 84132|EAP|0300|POTASSIUM|Medicare|MEDICARE ACUTE|0.93||||||| 84132|EAP|0300|POTASSIUM|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|0.93||||||| 84132|EAP|0300|POTASSIUM|Aetna|AETNA PPO|0.93||||||| 84132|EAP|0300|POTASSIUM|United Medicare Advantage|UHC AARP MCR HMO MA|0.93||||||| 84132|EAP|0300|POTASSIUM|Workers Compensation|WORKERS COMPENSATION OTHER|0.93||||||| 84132|EAP|0300|POTASSIUM|United Medicare Advantage|UHC MEDICARE GOLD MA|0.93||||||| 84132|EAP|0300|POTASSIUM|United Healthcare|UNITED HEALTHCARE OTHER|0.93||||||| 84132|EAP|0300|POTASSIUM|Workers Compensation|TEXAS MUTUAL INSURANCE|0.93||||||| 84132|EAP|0300|POTASSIUM|Veterans Affairs|VETERANS ADMINISTRATION|0.93||||||| 84132|EAP|0300|POTASSIUM|United Healthcare|UNITED HEALTHCARE|0.93||||||| 84132|EAP|0300|POTASSIUM|NON CONTRACTED|COMMERCIAL OTHER 1|0.93||||||| 84134|EAP|0300|PREALBUMIN|United Medicare Advantage|UHC AARP MCR HMO MA|1.70||||||| 84134|EAP|0300|PREALBUMIN|United Medicare Advantage|UHC MEDICARE GOLD MA|1.70||||||| 84134|EAP|0300|PREALBUMIN|Tricare|TRICARE EAST REGION|1.70||||||| 84134|EAP|0300|PREALBUMIN|Medicare|MEDICARE ACUTE|1.70||||||| 84134|EAP|0300|PREALBUMIN|Blue Cross PPO Specialty|BCBSTX PPO|1.70||||||| 84134|EAP|0300|PREALBUMIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.70||||||| 84134|EAP|0300|PREALBUMIN|Cigna|CIGNA OTHER|1.70||||||| 84134|EAP|0300|PREALBUMIN|Humana Medicare Advantage|HUMANA MA|1.70||||||| 84134|EAP|0300|PREALBUMIN|Managed Medicare|HEALTHSPRING MA|1.70||||||| 84134|EAP|0300|PREALBUMIN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.70||||||| 84134|EAP|0300|PREALBUMIN|Access Direct Platinum|HEALTHFIRST TPA|1.70||||||| 84134|EAP|0300|PREALBUMIN|Aenta Medicare Advantage|AETNA MEDICARE MA|1.70||||||| 84145|EAP|0300|PROCALCITONIN (PCT)|Humana Medicare Advantage|HUMANA MA|958.25||||||| 84153|EAP|0300|PROSTATIC SPECIFIC ANTIGE|Medicare|MEDICARE ACUTE|4.08||||||| 84153|EAP|0300|PROSTATIC SPECIFIC ANTIGE|United Medicare Advantage|UHC AARP MCR HMO MA|4.08||||||| 84153|EAP|0300|PROSTATIC SPECIFIC ANTIGE|Humana Medicare Advantage|HUMANA MA|4.08||||||| 84154|EAP|0300|PROSTATE SPECIFIC ANTIGEN|Humana Medicare Advantage|HUMANA MA|732.75||||||| 84154|EAP|0300|PROSTATE SPECIFIC ANTIGEN|Medicare|MEDICARE ACUTE|732.75||||||| 84155|EAP|0300|TOTAL PROTEIN|Tricare|TRICARE EAST REGION|0.74||||||| 84155|EAP|0300|TOTAL PROTEIN|United Medicare Advantage|UHC MEDICARE GOLD MA|0.74||||||| 84155|EAP|0300|TOTAL PROTEIN|Medicare|MEDICARE ACUTE|0.74||||||| 84155|EAP|0300|TOTAL PROTEIN|Blue Cross PPO Specialty|BCBSTX PPO|0.74||||||| 84155|EAP|0300|TOTAL PROTEIN|Humana Medicare Advantage|HUMANA MA|0.74||||||| 84155|EAP|0300|TOTAL PROTEIN|Aenta Medicare Advantage|AETNA MEDICARE MA|0.74||||||| 84156|EAP|0300|ASSAY OF PROTEIN URINE|Humana Medicare Advantage|HUMANA MA|0.48||||||| 84156|EAP|0300|ASSAY OF PROTEIN URINE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.48||||||| 84156|EAP|0300|ASSAY OF PROTEIN URINE|United Medicare Advantage|UHC AARP MCR HMO MA|0.48||||||| 84156|EAP|0300|ASSAY OF PROTEIN URINE|Medicare|MEDICARE ACUTE|0.48||||||| 84157|EAP|0300|PROTEIN CSF|Medicare|MEDICARE ACUTE|0.74||||||| 84157|EAP|0300|PROTEIN CSF|United Medicare Advantage|UHC MEDICARE GOLD MA|0.74||||||| 84157|EAP|0300|PROTEIN CSF|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.74||||||| 84157|EAP|0300|PROTEIN CSF|Blue Cross PPO Specialty|BCBSTX PPO|0.74||||||| 84165|EAP|0300|PROT ELECTROPHORESIS|Aenta Medicare Advantage|AETNA MEDICARE MA|4.28||||||| 84165|EAP|0300|PROT ELECTROPHORESIS|Humana Medicare Advantage|HUMANA MA|4.28||||||| 84165|EAP|0300|PROT ELECTROPHORESIS|Medicare|MEDICARE ACUTE|4.28||||||| 84165|EAP|0300|PROT ELECTROPHORESIS|United Medicare Advantage|UHC MEDICARE GOLD MA|4.28||||||| 84165|EAP|0300|PROT ELECTROPHORESIS|Tricare|TRICARE EAST REGION|4.28||||||| 84295|EAP|0300|SODIUM (NA) GJ66200|Medicare|MEDICARE ACUTE|0.97||||||| 84295|EAP|0300|SODIUM (NA) GJ66200|United Medicare Advantage|UHC MEDICARE GOLD MA|0.97||||||| 84295|EAP|0300|SODIUM (NA) GJ66200|Workers Compensation|TEXAS MUTUAL INSURANCE|0.97||||||| 84295|EAP|0300|SODIUM (NA) GJ66200|United Medicare Advantage|UHC AARP MCR HMO MA|0.97||||||| 84295|EAP|0300|SODIUM|Medicare|MEDICARE ACUTE|0.97||||||| 84295|EAP|0300|SODIUM|Blue Cross PPO Specialty|BCBSTX PPO|0.97||||||| 84295|EAP|0300|SODIUM (NA) GJ66200|Humana Medicare Advantage|HUMANA MA|0.97||||||| 84403|EAP|0300|TESTOSTERONE GK31600|Medicare|MEDICARE ACUTE|5.73||||||| 84436|EAP|0300|THYROXINE TOTAL T4 ID3964|Medicare|MEDICARE ACUTE|1.52||||||| 84439|EAP|0300|THYROXINE FREE T4|Blue Cross HMO Specialty|BCBSTX HMO|359.25||||||| 84439|EAP|0300|THYROXINE FREE T4|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|359.25||||||| 84439|EAP|0300|THYROXINE FREE T4|United Medicare Advantage|UHC MEDICARE GOLD MA|359.25||||||| 84439|EAP|0300|THYROXINE FREE T4|Blue Cross PPO Specialty|BCBSTX PPO|359.25||||||| 84439|EAP|0300|THYROXINE FREE T4|Humana Medicare Advantage|HUMANA MA|359.25||||||| 84439|EAP|0300|THYROXINE FREE T4|Medicare|MEDICARE ACUTE|359.25||||||| 84443|EAP|0300|THYROID STIMULATING HORMO|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|3.73||||||| 84443|EAP|0300|THYROID STIMULATING HORMO|PHCS|HUMANA INSURANCE|3.73||||||| 84443|EAP|0300|THYROID STIMULATING HORMO|Medicare|MEDICARE ACUTE|3.73||||||| 84443|EAP|0300|THYROID STIMULATING HORMO|United Healthcare|UNITED HEALTHCARE|3.73||||||| 84443|EAP|0300|THYROID STIMULATING HORMO|United Medicare Advantage|UHC MEDICARE GOLD MA|3.73||||||| 84443|EAP|0300|THYROID STIMULATING HORMO|United Medicare Advantage|UHC AARP MCR HMO MA|3.73||||||| 84443|EAP|0300|THYROID STIMULATING HORMO|United Healthcare|UNITED HEALTHCARE OTHER|3.73||||||| 84443|EAP|0300|THYROID STIMULATING HORMO|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|3.73||||||| 84443|EAP|0300|THYROID STIMULATING HORMO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.73||||||| 84443|EAP|0300|THYROID STIMULATING HORMO|Managed Medicare|HEALTHSPRING MA|3.73||||||| 84443|EAP|0300|THYROID STIMULATING HORMO|Blue Cross PPO Specialty|BCBSTX PPO|3.73||||||| 84443|EAP|0300|THYROID STIMULATING HORMO|Blue Cross HMO Specialty|BCBSTX HMO|3.73||||||| 84443|EAP|0300|THYROID STIMULATING HORMO|Aenta Medicare Advantage|AETNA MEDICARE MA|3.73||||||| 84443|EAP|0300|THYROID STIMULATING HORMO|NON CONTRACTED|COMMERCIAL OTHER 1|3.73||||||| 84443|EAP|0300|THYROID STIMULATING HORMO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|3.73||||||| 84443|EAP|0300|THYROID STIMULATING HORMO|Humana Medicare Advantage|HUMANA MA|3.73||||||| 84443|EAP|0300|THYROID STIMULATING HORMO|Cigna|CIGNA|3.73||||||| 84443|EAP|0300|THYROID STIMULATING HORMO|Access Direct Platinum|HEALTHFIRST TPA|3.73||||||| 84443|EAP|0300|THYROID STIMULATING HORMO|Cigna|CIGNA OTHER|3.73||||||| 84443|EAP|0300|THYROID STIMULATING HORMO|Blue Cross PPO Specialty|BCBSTX OTHER|3.73||||||| 84443|EAP|0300|THYROID STIMULATING HORMO|Aetna|AETNA OTHER|3.73||||||| 84443|EAP|0300|THYROID STIMULATING HORMO|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|3.73||||||| 84443|EAP|0300|THYROID STIMULATING HORMO|Medicaid|MEDICAID|3.73||||||| 84445|EAP|0300|AB THYROID STIMULATING|Medicare|MEDICARE ACUTE|14.31||||||| 84466|EAP|0300|TRANSFERRIN|Medicare|MEDICARE ACUTE|1.86||||||| 84478|EAP|0300|TRIGLYCERIDES|Medicare|MEDICARE ACUTE|1.16||||||| 84479|EAP|0300|THYROID HORMONE T3/T4 UPT|Blue Cross PPO Specialty|BCBSTX PPO|257.75||||||| 84479|EAP|0300|THYROID HORMONE T3/T4 UPT|Medicare|MEDICARE ACUTE|257.75||||||| 84480|EAP|0300|TRIIODOTHYRONINE T3 TOTAL|Medicare|MEDICARE ACUTE|3.15||||||| 84480|EAP|0300|TRIIODOTHYRONINE T3 TOTAL|Humana Medicare Advantage|HUMANA MA|3.15||||||| 84481|EAP|0300|TRIIODOTHYRONINE T3 FREE|Blue Cross PPO Specialty|BCBSTX PPO|675.25||||||| 84481|EAP|0300|TRIIODOTHYRONINE T3 FREE|Humana Medicare Advantage|HUMANA MA|675.25||||||| 84481|EAP|0300|TRIIODOTHYRONINE T3 FREE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|675.25||||||| 84481|EAP|0300|TRIIODOTHYRONINE T3 FREE|Medicare|MEDICARE ACUTE|675.25||||||| 84484|EAP|0300|TROPONIN QUANT|United Healthcare|UNITED HEALTHCARE|1.99||||||| 84484|EAP|0300|TROPONIN QUANT|Medicare|MEDICARE ACUTE|1.99||||||| 84484|EAP|0300|TROPONIN QUANT|United Medicare Advantage|UHC MEDICARE GOLD MA|1.99||||||| 84484|EAP|0300|TROPONIN QUANT|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|1.99||||||| 84484|EAP|0300|TROPONIN QUANT|PHCS|HUMANA INSURANCE|1.99||||||| 84484|EAP|0300|TROPONIN QUANT|United Healthcare|UNITED HEALTHCARE OTHER|1.99||||||| 84484|EAP|0300|TROPONIN QUANT|United Medicare Advantage|UHC AARP MCR HMO MA|1.99||||||| 84484|EAP|0300|TROPONIN QUANT|Access Direct Platinum|HEALTHFIRST TPA|1.99||||||| 84484|EAP|0300|TROPONIN QUANT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.99||||||| 84484|EAP|0300|TROPONIN QUANT|Blue Cross PPO Specialty|BCBSTX PPO|1.99||||||| 84484|EAP|0300|TROPONIN QUANT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.99||||||| 84484|EAP|0300|TROPONIN QUANT|Aenta Medicare Advantage|AETNA MEDICARE MA|1.99||||||| 84484|EAP|0300|TROPONIN QUANT|Blue Cross HMO Specialty|BCBSTX HMO|1.99||||||| 84484|EAP|0300|TROPONIN QUANT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.99||||||| 84484|EAP|0300|TROPONIN QUANT|Humana Medicare Advantage|HUMANA MA|1.99||||||| 84484|EAP|0300|TROPONIN QUANT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.99||||||| 84484|EAP|0300|TROPONIN QUANT|Managed Medicare|HEALTHSPRING MA|1.99||||||| 84484|EAP|0300|TROPONIN QUANT|Blue Cross PPO Specialty|BCBSTX OTHER|1.99||||||| 84520|EAP|0300|BUN|Blue Cross PPO Specialty|BCBSTX PPO|0.38||||||| 84520|EAP|0300|BUN|United Medicare Advantage|UHC AARP MCR HMO MA|0.38||||||| 84520|EAP|0300|BUN|Workers Compensation|WORKERS COMPENSATION OTHER|0.38||||||| 84520|EAP|0300|BUN|Medicare|MEDICARE ACUTE|0.38||||||| 84540|EAP|0300|UREA NITROGEN URINE|Medicare|MEDICARE ACUTE|0.96||||||| 84550|EAP|0300|URIC ACID|Blue Cross PPO Specialty|BCBSTX PPO|0.91||||||| 84550|EAP|0300|URIC ACID|Cigna|CIGNA OTHER|0.91||||||| 84550|EAP|0300|URIC ACID|Medicare|MEDICARE ACUTE|0.91||||||| 84550|EAP|0300|URIC ACID|United Medicare Advantage|UHC MEDICARE GOLD MA|0.91||||||| 84550|EAP|0300|URIC ACID|United Medicare Advantage|UHC AARP MCR HMO MA|0.91||||||| 84560|EAP|0300|URIC ACID URINE QUANT|Medicare|MEDICARE ACUTE|189.25||||||| 84560|EAP|0300|URIC ACID URINE QUANT|Humana Medicare Advantage|HUMANA MA|189.25||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Humana Medicare Advantage|HUMANA MA|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Blue Cross PPO Specialty|BCBSTX PPO|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Aetna|AETNA OTHER|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Aenta Medicare Advantage|AETNA MEDICARE MA|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.57||||||| 85007|EAP|0300|PERIPHERL BLOOD SMEAR GH0|Blue Cross PPO Specialty|BCBSTX PPO|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Blue Cross HMO Specialty|BCBSTX HMO|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Access Direct Platinum|HEALTHFIRST TPA UMR|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Cigna|CIGNA|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Managed Medicare|HEALTHSPRING MA|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|United Healthcare|UNITED HEALTHCARE OTHER|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Medicare|MEDICARE ACUTE|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Veterans Affairs|VETERANS ADMINISTRATION|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|United Medicare Advantage|UHC AARP MCR HMO MA|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Workers Compensation|TEXAS MUTUAL INSURANCE|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|United Healthcare|UNITED HEALTHCARE|1.57||||||| 85007|EAP|0300|PERIPHERL BLOOD SMEAR GH0|Medicare|MEDICARE ACUTE|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Tricare|TRICARE EAST REGION|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|United Medicare Advantage|UHC MEDICARE GOLD MA|1.57||||||| 85014|EAP|0300|HEMATOCRIT GE68500|Medicare|MEDICARE ACUTE|116.10||||||| 85014|EAP|0300|HEMATOCRIT GE68500|Tricare|TRICARE EAST REGION|1.08||||||| 85014|EAP|0300|HEMATOCRIT GE68500|Blue Cross PPO Specialty|BCBSTX PPO|1.08||||||| 85014|EAP|0300|HEMATOCRIT|Humana Medicare Advantage|HUMANA MA|1.08||||||| 85018|EAP|0300|HEMOGLOBIN|Humana Medicare Advantage|HUMANA MA|1.08||||||| 85018|EAP|0300|HEMOGLOBIN GE70400|Medicare|MEDICARE ACUTE|1.08||||||| 85018|EAP|0300|HEMOGLOBIN GE70400|Tricare|TRICARE EAST REGION|1.08||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|NON CONTRACTED|COMMERCIAL OTHER 1|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Workers Compensation|WORKERS COMPENSATION OTHER|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Veterans Affairs|VETERANS ADMINISTRATION|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|United Healthcare|UNITED HEALTHCARE OTHER|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Workers Compensation|TEXAS MUTUAL INSURANCE|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|United Medicare Advantage|UHC AARP MCR HMO MA|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|PHCS|HUMANA INSURANCE|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|United Healthcare|UNITED HEALTHCARE|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Medicare|MEDICARE ACUTE|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|United Healthcare|TML GROUP BENEFITS|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|United Medicare Advantage|UHC MEDICARE GOLD MA|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Blue Cross HMO Specialty|BCBSTX HMO|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Managed Medicare|HEALTHSPRING MA|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Humana Medicare Advantage|HUMANA MA|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Tricare|TRICARE EAST REGION|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Access Direct Platinum|HEALTHFIRST TPA UMR|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Managed Medicare|BCBS MEDICARE PPO MA|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Cigna|CIGNA|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Cigna|CIGNA OTHER|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Aenta Medicare Advantage|AETNA MEDICARE MA|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Aetna|AETNA OTHER|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Blue Cross PPO Specialty|BCBSTX PPO|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Access Direct Platinum|HEALTHFIRST TPA|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Blue Cross PPO Specialty|BCBSTX OTHER|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Aetna|AETNA PPO|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Medicaid|MEDICAID|1.61||||||| 85027|EAP|0300|COMPLETE BLOOD COUNT WO D|Blue Cross HMO Specialty|BCBSTX HMO|2.96||||||| 85027|EAP|0300|COMPLETE BLOOD COUNT WO D|Aenta Medicare Advantage|AETNA MEDICARE MA|2.96||||||| 85027|EAP|0300|COMPLETE BLOOD COUNT WO D|Humana Medicare Advantage|HUMANA MA|2.96||||||| 85027|EAP|0300|COMPLETE BLOOD COUNT WO D|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.96||||||| 85027|EAP|0300|COMPLETE BLOOD COUNT WO D|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.96||||||| 85027|EAP|0300|COMPLETE BLOOD COUNT WO D|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.96||||||| 85027|EAP|0300|COMPLETE BLOOD COUNT WO D|Medicare|MEDICARE ACUTE|2.96||||||| 85027|EAP|0300|COMPLETE BLOOD COUNT WO D|United Medicare Advantage|UHC MEDICARE GOLD MA|2.96||||||| 85045|EAP|0300|AUTOMATED RETICULOCYTE CO|United Medicare Advantage|UHC MEDICARE GOLD MA|1.96||||||| 85045|EAP|0300|AUTOMATED RETICULOCYTE CO|United Medicare Advantage|UHC AARP MCR HMO MA|1.96||||||| 85045|EAP|0300|AUTOMATED RETICULOCYTE CO|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|1.96||||||| 85045|EAP|0300|AUTOMATED RETICULOCYTE CO|PHCS|HUMANA INSURANCE|1.96||||||| 85045|EAP|0300|AUTOMATED RETICULOCYTE CO|Tricare|TRICARE EAST REGION|1.96||||||| 85045|EAP|0300|AUTOMATED RETICULOCYTE CO|NON CONTRACTED|COMMERCIAL OTHER 1|1.96||||||| 85045|EAP|0300|AUTOMATED RETICULOCYTE CO|Medicare|MEDICARE ACUTE|1.96||||||| 85045|EAP|0300|AUTOMATED RETICULOCYTE CO|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|1.96||||||| 85045|EAP|0300|AUTOMATED RETICULOCYTE CO|Access Direct Platinum|HEALTHFIRST TPA|1.96||||||| 85045|EAP|0300|AUTOMATED RETICULOCYTE CO|Blue Cross HMO Specialty|BCBSTX HMO|1.96||||||| 85045|EAP|0300|AUTOMATED RETICULOCYTE CO|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.96||||||| 85045|EAP|0300|AUTOMATED RETICULOCYTE CO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.96||||||| 85045|EAP|0300|AUTOMATED RETICULOCYTE CO|Aenta Medicare Advantage|AETNA MEDICARE MA|1.96||||||| 85045|EAP|0300|AUTOMATED RETICULOCYTE CO|Humana Medicare Advantage|HUMANA MA|1.96||||||| 85045|EAP|0300|AUTOMATED RETICULOCYTE CO|Blue Cross PPO Specialty|BCBSTX PPO|1.96||||||| 85045|EAP|0300|AUTOMATED RETICULOCYTE CO|Managed Medicare|HEALTHSPRING MA|1.96||||||| 85045|EAP|0300|AUTOMATED RETICULOCYTE CO|Cigna|CIGNA OTHER|1.96||||||| 85049|EAP|0300|PLATELET COUNT GH29300|Humana Medicare Advantage|HUMANA MA|0.96||||||| 85049|EAP|0300|PLATELET COUNT GH29300|Medicare|MEDICARE ACUTE|0.96||||||| 85097|EAP|0300|BONE MARROW STUDY GB74500|Medicare|MEDICARE ACUTE|10.82||||||| 85240|EAP|0300|FACTOR VIII GD54200|United Medicare Advantage|UHC AARP MCR HMO MA|3.47||||||| 85300|EAP|0300|ANTITHROMBIN III ACTIVITY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.42||||||| 85301|EAP|0300|ANTI-THROMBIN III ANTIGEN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|430.75||||||| 85347|EAP|0300|ACTIVATED CLOTTING TIME|Medicare|MEDICARE ACUTE|2.36||||||| 85362|EAP|0300|FIBRIN DEGRAD PROD GD6700|Medicare|MEDICARE ACUTE|3.15||||||| 85379|EAP|0300|D-DIMERS QUANTITATIVE|Humana Medicare Advantage|HUMANA MA|3.26||||||| 85379|EAP|0300|D-DIMERS QUANTITATIVE|United Medicare Advantage|UHC MEDICARE GOLD MA|3.26||||||| 85379|EAP|0300|D-DIMERS QUANTITATIVE|Medicare|MEDICARE ACUTE|3.26||||||| 85384|EAP|0300|FIBRINOGEN ACTIVITY|Medicare|MEDICARE ACUTE|3.88||||||| 85384|EAP|0300|FIBRINOGEN ACTIVITY|Humana Medicare Advantage|HUMANA MA|3.88||||||| 85520|EAP|0300|HEPARIN ASSAY|Humana Medicare Advantage|HUMANA MA|5.98||||||| 85520|EAP|0300|HEPARIN ASSAY|Medicare|MEDICARE ACUTE|5.98||||||| 85576|EAP|0300|PLATELET FUNCTION ASSAY P|Medicare|MEDICARE ACUTE|9.82||||||| 85576|EAP|0300|PLATELET FUNCTION ASSAY P|Workers Compensation|WORKERS COMPENSATION OTHER|9.82||||||| 85576|EAP|0300|PLATELET FUNCTION TEST|Workers Compensation|WORKERS COMPENSATION OTHER|9.82||||||| 85576|EAP|0300|PLATELET FUNCTION ASSAY A|Workers Compensation|WORKERS COMPENSATION OTHER|9.82||||||| 85576|EAP|0300|PLATELET FUNCTION ASSAY P|Blue Cross PPO Specialty|BCBSTX PPO|9.82||||||| 85576|EAP|0300|PLATELET FUNCTION ASSAY P|Humana Medicare Advantage|HUMANA MA|9.82||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|1.07||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.07||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|Aetna|AETNA PPO|1.07||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|Aenta Medicare Advantage|AETNA MEDICARE MA|1.07||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|Blue Cross HMO Specialty|BCBSTX HMO|1.07||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.07||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|Humana Medicare Advantage|HUMANA MA|1.07||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|Blue Cross PPO Specialty|BCBSTX PPO|1.07||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|Managed Medicare|BCBS MEDICARE PPO MA|1.07||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|Workers Compensation|TEXAS MUTUAL INSURANCE|1.07||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|Medicare|MEDICARE ACUTE|1.07||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|United Medicare Advantage|UHC AARP MCR HMO MA|1.07||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|United Healthcare|UNITED HEALTHCARE OTHER|1.07||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|1.07||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|PHCS|HUMANA INSURANCE|1.07||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|Workers Compensation|WORKERS COMPENSATION OTHER|1.07||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|Veterans Affairs|VETERANS ADMINISTRATION|123.05||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|United Medicare Advantage|UHC MEDICARE GOLD MA|1.07||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|United Healthcare|UNITED HEALTHCARE|1.07||||||| 85613|EAP|0300|LUPUS ANTICOAGULANT|Blue Cross PPO Specialty|BCBSTX PPO|3.20||||||| 85652|EAP|0300|SEDIMENTATION RATE|United Medicare Advantage|UHC AARP MCR HMO MA|1.62||||||| 85652|EAP|0300|SEDIMENTATION RATE|United Medicare Advantage|UHC MEDICARE GOLD MA|1.62||||||| 85652|EAP|0300|SEDIMENTATION RATE|Workers Compensation|TEXAS MUTUAL INSURANCE|1.62||||||| 85652|EAP|0300|SEDIMENTATION RATE|Humana Medicare Advantage|HUMANA MA|1.62||||||| 85652|EAP|0300|SEDIMENTATION RATE|Access Direct Platinum|HEALTHFIRST TPA|1.62||||||| 85652|EAP|0300|SEDIMENTATION RATE|Medicare|MEDICARE ACUTE|1.62||||||| 85652|EAP|0300|SEDIMENTATION RATE|Aenta Medicare Advantage|AETNA MEDICARE MA|1.62||||||| 85652|EAP|0300|SEDIMENTATION RATE|Blue Cross HMO Specialty|BCBSTX HMO|1.62||||||| 85652|EAP|0300|SEDIMENTATION RATE|Workers Compensation|WORKERS COMPENSATION OTHER|1.62||||||| 85652|EAP|0300|SEDIMENTATION RATE|Blue Cross PPO Specialty|BCBSTX PPO|1.62||||||| 85652|EAP|0300|SEDIMENTATION RATE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.62||||||| 85652|EAP|0300|SEDIMENTATION RATE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.62||||||| 85652|EAP|0300|SEDIMENTATION RATE|United Healthcare|UNITED HEALTHCARE|1.62||||||| 85730|EAP|0300|PARTIAL THROMBOPLASTIN TI|Blue Cross HMO Specialty|BCBSTX HMO|1.49||||||| 85730|EAP|0300|PARTIAL THROMBOPLASTIN TI|Blue Cross PPO Specialty|BCBSTX PPO|1.49||||||| 85730|EAP|0300|PARTIAL THROMBOPLASTIN TI|Humana Medicare Advantage|HUMANA MA|1.49||||||| 85730|EAP|0300|PARTIAL THROMBOPLASTIN TI|Aenta Medicare Advantage|AETNA MEDICARE MA|1.49||||||| 85730|EAP|0300|PARTIAL THROMBOPLASTIN TI|Aetna|AETNA PPO|1.49||||||| 85730|EAP|0300|PARTIAL THROMBOPLASTIN TI|Veterans Affairs|VETERANS ADMINISTRATION|171.35||||||| 85730|EAP|0300|PARTIAL THROMBOPLASTIN TI|United Medicare Advantage|UHC AARP MCR HMO MA|1.49||||||| 85730|EAP|0300|PARTIAL THROMBOPLASTIN TI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.49||||||| 85730|EAP|0300|PARTIAL THROMBOPLASTIN TI|United Medicare Advantage|UHC MEDICARE GOLD MA|1.49||||||| 85730|EAP|0300|PARTIAL THROMBOPLASTIN TI|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|1.49||||||| 85730|EAP|0300|PARTIAL THROMBOPLASTIN TI|United Healthcare|UNITED HEALTHCARE|1.49||||||| 85730|EAP|0300|PARTIAL THROMBOPLASTIN TI|Medicare|MEDICARE ACUTE|1.49||||||| 85730|EAP|0300|PARTIAL THROMBOPLASTIN TI|United Healthcare|UNITED HEALTHCARE OTHER|1.49||||||| 85730|EAP|0300|PARTIAL THROMBOPLASTIN TI|Workers Compensation|WORKERS COMPENSATION OTHER|1.49||||||| 86022|EAP|0300|HEP INDUCED PLATELET AB|Medicare|MEDICARE ACUTE|3.90||||||| 86038|EAP|0300|ANTINUCLEAR ANTIBODY GB10|Humana Medicare Advantage|HUMANA MA|2.38||||||| 86038|EAP|0300|ANTINUCLEAR ANTIBODY GB10|Blue Cross PPO Specialty|BCBSTX PPO|2.38||||||| 86038|EAP|0300|ANTINUCLEAR ANTIBODY GB10|Medicare|MEDICARE ACUTE|2.38||||||| 86140|EAP|0300|C-REACTIVE PROTEIN GC6650|United Healthcare|UNITED HEALTHCARE|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN GC6650|United Medicare Advantage|UHC MEDICARE GOLD MA|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN GC6650|Tricare|TRICARE EAST REGION|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN GC6650|NON CONTRACTED|COMMERCIAL OTHER 1|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN GC6650|Medicare|MEDICARE ACUTE|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN GC6650|United Medicare Advantage|UHC AARP MCR HMO MA|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN GC6650|Workers Compensation|WORKERS COMPENSATION OTHER|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN GC6650|Workers Compensation|TEXAS MUTUAL INSURANCE|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN GC6650|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN GC6650|Aenta Medicare Advantage|AETNA MEDICARE MA|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN GC6650|Blue Cross PPO Specialty|BCBSTX PPO|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN GC6650|Blue Cross HMO Specialty|BCBSTX HMO|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN GC6650|Access Direct Platinum|HEALTHFIRST TPA|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN GC6650|Humana Medicare Advantage|HUMANA MA|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN GC6650|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.02||||||| 86141|EAP|0300|C-REACTIVE PROTEIN HSCRP|Medicare|MEDICARE ACUTE|5.06||||||| 86147|EAP|0300|PHOSPHOLIPID AB IGA|Blue Cross PPO Specialty|BCBSTX PPO|3.13||||||| 86147|EAP|0300|PHOSPHOLIPID AB IGM|Blue Cross PPO Specialty|BCBSTX PPO|3.13||||||| 86147|EAP|0300|PHOSPHOLIPID AB IGG|Blue Cross PPO Specialty|BCBSTX PPO|3.13||||||| 86147|EAP|0300|PHOSPHOLIPID AB IGM|Medicare|MEDICARE ACUTE|3.13||||||| 86147|EAP|0300|PHOSPHOLIPID AB IGG|Medicare|MEDICARE ACUTE|3.13||||||| 86255|EAP|0300|ANTIMITOCHONRL ANTIBDY RB|Medicare|MEDICARE ACUTE|480.50||||||| 86255|EAP|0300|AB ANTI-SMOOTH MUSCLE|Medicare|MEDICARE ACUTE|714.75||||||| 86255|EAP|0300|ANIT-NEUTROPHL CYTOPLASMI|Medicare|MEDICARE ACUTE|480.50||||||| 86403|EAP|0300|CRYPTOCOCCAL ANTIGEN|Medicare|MEDICARE ACUTE|2.00||||||| 86430|EAP|0300|RA GE50200|Humana Medicare Advantage|HUMANA MA|1.11||||||| 86592|EAP|0300|RPR SERUM|Medicare|MEDICARE ACUTE|0.84||||||| 86592|EAP|0300|RPR SERUM|Blue Cross HMO Specialty|BCBSTX HMO|0.84||||||| 86592|EAP|0300|RPR SERUM|Managed Medicare|HEALTHSPRING MA|0.84||||||| 86592|EAP|0300|RPR SERUM|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.84||||||| 86592|EAP|0300|RPR SERUM|Humana Medicare Advantage|HUMANA MA|0.84||||||| 86611|EAP|0300|AB BARTONELLA QUINTANA IG|Medicare|MEDICARE ACUTE|3.26||||||| 86611|EAP|0300|AB BARTONELLA HENSELAE IG|Medicare|MEDICARE ACUTE|3.26||||||| 86618|EAP|0300|AB LYME CSF|Medicare|MEDICARE ACUTE|678.75||||||| 86701|EAP|0300|HIV-ANTIBODY GE91037|Medicare|MEDICARE ACUTE|7.13||||||| 86704|EAP|0300|AB HEPATITIS B CORE|Medicare|MEDICARE ACUTE|2.61||||||| 86705|EAP|0300|AB HEPATITIS B CORE IGM|Medicare|MEDICARE ACUTE|468.75||||||| 86706|EAP|0300|AB HEPATITIS B SURFACE|United Medicare Advantage|UHC MEDICARE GOLD MA|4.28||||||| 86706|EAP|0300|AB HEPATITIS B SURFACE|Medicare|MEDICARE ACUTE|4.28||||||| 86713|EAP|0300|LEGIONELLA DIRECT DNA RF5|Medicare|MEDICARE ACUTE|478.25||||||| 86803|EAP|0300|AB HEPATITIS C|Medicare|MEDICARE ACUTE|3.09||||||| 86880|EAP|0300|ANTIHUMAN GLOB TEST C3|Medicare|MEDICARE ACUTE|2.29||||||| 86880|EAP|0300|ANTIHUMAN GLOB TEST POLYS|Medicare|MEDICARE ACUTE|2.29||||||| 86880|EAP|0300|ANTIHUMAN GLOB TEST IGG|Medicare|MEDICARE ACUTE|2.29||||||| 86886|EAP|0300|COOMBS INDIRECT GC57100|Cigna|CIGNA OTHER|2.44||||||| 86886|EAP|0300|COOMBS INDIRECT GC57100|Cigna|CIGNA|2.44||||||| 86886|EAP|0300|COOMBS INDIRECT GC57100|Aenta Medicare Advantage|AETNA MEDICARE MA|2.44||||||| 86886|EAP|0300|COOMBS INDIRECT GC57100|Humana Medicare Advantage|HUMANA MA|2.44||||||| 86886|EAP|0300|COOMBS INDIRECT GC57100|Blue Cross PPO Specialty|BCBSTX PPO|2.44||||||| 86886|EAP|0300|COOMBS INDIRECT GC57100|Managed Medicare|HEALTHSPRING MA|2.44||||||| 86886|EAP|0300|COOMBS INDIRECT GC57100|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.44||||||| 86886|EAP|0300|COOMBS INDIRECT GC57100|PHCS|HUMANA INSURANCE|2.44||||||| 86886|EAP|0300|COOMBS INDIRECT GC57100|United Medicare Advantage|UHC MEDICARE GOLD MA|2.44||||||| 86886|EAP|0300|COOMBS INDIRECT GC57100|NON CONTRACTED|COMMERCIAL OTHER 1|2.44||||||| 86886|EAP|0300|COOMBS INDIRECT GC57100|Medicare|MEDICARE ACUTE|2.44||||||| 86886|EAP|0300|COOMBS INDIRECT GC57100|Workers Compensation|TEXAS MUTUAL INSURANCE|2.44||||||| 86886|EAP|0300|COOMBS INDIRECT GC57100|United Medicare Advantage|UHC AARP MCR HMO MA|2.44||||||| 86900|EAP|0300|ABO GROUP ONLY|PHCS|HUMANA INSURANCE|1.27||||||| 86900|EAP|0300|ABO GROUP ONLY|United Medicare Advantage|UHC MEDICARE GOLD MA|1.27||||||| 86900|EAP|0300|ABO GROUP ONLY|Workers Compensation|TEXAS MUTUAL INSURANCE|1.27||||||| 86900|EAP|0300|ABO GROUP ONLY|NON CONTRACTED|COMMERCIAL OTHER 1|1.27||||||| 86900|EAP|0300|ABO GROUP ONLY|United Medicare Advantage|UHC AARP MCR HMO MA|1.27||||||| 86900|EAP|0300|ABO GROUP ONLY|Medicare|MEDICARE ACUTE|1.27||||||| 86900|EAP|0300|ABO GROUP ONLY|Humana Medicare Advantage|HUMANA MA|1.27||||||| 86900|EAP|0300|ABO GROUP ONLY|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.27||||||| 86900|EAP|0300|ABO GROUP ONLY|Cigna|CIGNA|1.27||||||| 86900|EAP|0300|ABO GROUP ONLY|Aenta Medicare Advantage|AETNA MEDICARE MA|1.27||||||| 86900|EAP|0300|ABO GROUP ONLY|Blue Cross PPO Specialty|BCBSTX PPO|1.27||||||| 86900|EAP|0300|ABO GROUP ONLY|Cigna|CIGNA OTHER|1.27||||||| 86900|EAP|0300|ABO GROUP ONLY|Managed Medicare|HEALTHSPRING MA|1.27||||||| 86901|EAP|0390|RH TYPE ONLY|Blue Cross PPO Specialty|BCBSTX PPO|1.27||||||| 86901|EAP|0390|RH TYPE ONLY|Cigna|CIGNA|1.27||||||| 86901|EAP|0390|RH TYPE ONLY|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.27||||||| 86901|EAP|0390|RH TYPE ONLY|Humana Medicare Advantage|HUMANA MA|1.27||||||| 86901|EAP|0390|RH TYPE ONLY|Managed Medicare|HEALTHSPRING MA|1.27||||||| 86901|EAP|0390|RH TYPE ONLY|Cigna|CIGNA OTHER|1.27||||||| 86901|EAP|0390|RH TYPE ONLY|Aenta Medicare Advantage|AETNA MEDICARE MA|1.27||||||| 86901|EAP|0390|RH TYPE ONLY|NON CONTRACTED|COMMERCIAL OTHER 1|1.27||||||| 86901|EAP|0390|RH TYPE ONLY|United Medicare Advantage|UHC MEDICARE GOLD MA|1.27||||||| 86901|EAP|0390|RH TYPE ONLY|Workers Compensation|TEXAS MUTUAL INSURANCE|1.27||||||| 86901|EAP|0390|RH TYPE ONLY|PHCS|HUMANA INSURANCE|1.27||||||| 86901|EAP|0390|RH TYPE ONLY|United Medicare Advantage|UHC AARP MCR HMO MA|1.27||||||| 86901|EAP|0390|RH TYPE ONLY|Medicare|MEDICARE ACUTE|1.27||||||| 86903|EAP|0300|ANTIGEN SCREEN EA UNIT|Medicare|MEDICARE ACUTE|4.03||||||| 86922|EAP|0300|CROSS MATCH|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.23||||||| 86922|EAP|0300|CROSS MATCH|Blue Cross PPO Specialty|BCBSTX PPO|4.23||||||| 86922|EAP|0300|CROSS MATCH|United Medicare Advantage|UHC AARP MCR HMO MA|4.23||||||| 86922|EAP|0300|CROSS MATCH|Workers Compensation|TEXAS MUTUAL INSURANCE|4.23||||||| 86922|EAP|0300|CROSS MATCH|Medicare|MEDICARE ACUTE|4.23||||||| 86922|EAP|0300|COMPATABILITY TEST EA UNI|Medicare|MEDICARE ACUTE|7.36||||||| 86923|EAP|0300|COMPATABILITY TEST EA UNI|PHCS|HUMANA INSURANCE|4.23||||||| 86923|EAP|0300|COMPATABILITY TEST EA UNI|Medicare|MEDICARE ACUTE|4.23||||||| 86923|EAP|0300|COMPATABILITY TEST EA UNI|United Medicare Advantage|UHC AARP MCR HMO MA|4.23||||||| 86923|EAP|0300|COMPATABILITY TEST EA UNI|Cigna|CIGNA OTHER|4.23||||||| 86923|EAP|0300|COMPATABILITY TEST EA UNI|Humana Medicare Advantage|HUMANA MA|4.23||||||| 86923|EAP|0300|COMPATABILITY TEST EA UNI|Managed Medicare|HEALTHSPRING MA|4.23||||||| 86923|EAP|0300|COMPATABILITY TEST EA UNI|Blue Cross PPO Specialty|BCBSTX PPO|4.23||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Cigna|CIGNA|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Humana Medicare Advantage|HUMANA MA|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Blue Cross HMO Specialty|BCBSTX HMO|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Access Direct Platinum|HEALTHFIRST TPA UMR|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Blue Cross PPO Specialty|BCBSTX PPO|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Blue Cross PPO Specialty|BCBSTX OTHER|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Aenta Medicare Advantage|AETNA MEDICARE MA|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Medicaid|MEDICAID|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Medicare|MEDICARE ACUTE|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|United Medicare Advantage|UHC MEDICARE GOLD MA|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|United Medicare Advantage|UHC AARP MCR HMO MA|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Workers Compensation|TEXAS MUTUAL INSURANCE|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Workers Compensation|WORKERS COMPENSATION OTHER|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Tricare|TRICARE EAST REGION|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|United Healthcare|UNITED HEALTHCARE|4.88||||||| 87045|EAP|0300|STOOL CULTURE (87045)|Medicare|MEDICARE ACUTE|4.46||||||| 87045|EAP|0300|STOOL CULTURE (87045)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.46||||||| 87045|EAP|0300|STOOL CULTURE (87045)|Humana Medicare Advantage|HUMANA MA|4.46||||||| 87070|EAP|0300|RESPIRATORY CULTURE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.07||||||| 87070|EAP|0300|BODY FLUID CULTURE|Blue Cross PPO Specialty|BCBSTX PPO|3.15||||||| 87070|EAP|0300|CULTURE (87070) GC78200|Blue Cross HMO Specialty|BCBSTX HMO|4.07||||||| 87070|EAP|0300|RESPIRATORY CULTURE|Blue Cross HMO Specialty|BCBSTX HMO|4.07||||||| 87070|EAP|0300|RESPIRATORY CULTURE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.07||||||| 87070|EAP|0300|CULTURE (87070) GC78200|Humana Medicare Advantage|HUMANA MA|4.07||||||| 87070|EAP|0300|RESPIRATORY CULTURE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.07||||||| 87070|EAP|0300|CULTURE (87070) GC78200|Blue Cross PPO Specialty|BCBSTX PPO|4.07||||||| 87070|EAP|0300|BODY FLUID CULTURE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.15||||||| 87070|EAP|0300|BODY FLUID CULTURE|United Medicare Advantage|UHC MEDICARE GOLD MA|3.15||||||| 87070|EAP|0300|CULTURE THROAT|Medicare|MEDICARE ACUTE|4.07||||||| 87070|EAP|0300|RESPIRATORY CULTURE|PHCS|HUMANA INSURANCE|4.07||||||| 87070|EAP|0300|CULTURE BRONCHIAL BRUSH|PHCS|HUMANA INSURANCE|4.07||||||| 87070|EAP|0300|CULTURE (87070) GC78200|United Medicare Advantage|UHC MEDICARE GOLD MA|4.07||||||| 87070|EAP|0300|CULTURE (87070) GC78200|United Medicare Advantage|UHC AARP MCR HMO MA|437.53||||||| 87070|EAP|0300|RESPIRATORY CULTURE|Medicare|MEDICARE ACUTE|4.07||||||| 87070|EAP|0300|CULTURE (87070) GC78200|Medicare|MEDICARE ACUTE|4.07||||||| 87070|EAP|0300|BODY FLUID CULTURE|Medicare|MEDICARE ACUTE|3.15||||||| 87070|EAP|0300|CULTURE (87070) GC78200|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|4.07||||||| 87075|EAP|0300|ANAEROBIC CULTURE GA99200|Medicare|MEDICARE ACUTE|4.47||||||| 87075|EAP|0300|ANAEROBIC CULTURE GA99200|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|4.47||||||| 87075|EAP|0300|ANAEROBIC CULTURE GA99200|United Medicare Advantage|UHC AARP MCR HMO MA|480.53||||||| 87075|EAP|0300|ANAEROBIC CULTURE GA99200|United Medicare Advantage|UHC MEDICARE GOLD MA|4.47||||||| 87075|EAP|0300|ANAEROBIC CULTURE GA99200|Humana Medicare Advantage|HUMANA MA|4.47||||||| 87075|EAP|0300|ANAEROBIC CULTURE GA99200|Blue Cross HMO Specialty|BCBSTX HMO|480.53||||||| 87075|EAP|0300|ANAEROBIC CULTURE GA99200|Blue Cross PPO Specialty|BCBSTX PPO|4.47||||||| 87076|EAP|0300|ANAEROBE|Blue Cross HMO Specialty|BCBSTX HMO|440.45||||||| 87076|EAP|0300|ANAEROBE|Blue Cross PPO Specialty|BCBSTX PPO|3.83||||||| 87076|EAP|0300|ANAEROBE|Medicare|MEDICARE ACUTE|3.83||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|United Healthcare|UNITED HEALTHCARE OTHER|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|NON CONTRACTED|COMMERCIAL OTHER 1|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Workers Compensation|TEXAS MUTUAL INSURANCE|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|United Medicare Advantage|UHC MEDICARE GOLD MA|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|United Medicare Advantage|UHC AARP MCR HMO MA|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Tricare|TRICARE EAST REGION|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Medicare|MEDICARE ACUTE|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Managed Medicare|HEALTHSPRING MA|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Veterans Affairs|VETERANS ADMINISTRATION|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Access Direct Platinum|HEALTHFIRST TPA UMR|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Cigna|CIGNA|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Blue Cross PPO Specialty|BCBSTX OTHER|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Managed Medicare|BCBS MEDICARE PPO MA|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Blue Cross HMO Specialty|BCBSTX HMO|140.83||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Humana Medicare Advantage|HUMANA MA|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Medicaid|MEDICAID|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Aetna|AETNA PPO|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Blue Cross PPO Specialty|BCBSTX PPO|1.31||||||| 87081|EAP|0300|CULTURE, MRSA|Humana Medicare Advantage|HUMANA MA|1.64||||||| 87081|EAP|0300|CULTURE, MRSA|Medicare|MEDICARE ACUTE|1.64||||||| 87081|EAP|0300|CULTURE, MRSA|United Medicare Advantage|UHC MEDICARE GOLD MA|1.64||||||| 87081|EAP|0300|CULTURE VRE|Medicare|MEDICARE ACUTE|3.14||||||| 87081|EAP|0300|CULTURE, MRSA|United Healthcare|UNITED HEALTHCARE OTHER|1.64||||||| 87088|EAP|0300|URINE CULTURE (87086)|United Healthcare|UNITED HEALTHCARE OTHER|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|NON CONTRACTED|COMMERCIAL OTHER 1|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Tricare|TRICARE EAST REGION|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Medicare|MEDICARE ACUTE|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Veterans Affairs|VETERANS ADMINISTRATION|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|United Medicare Advantage|UHC AARP MCR HMO MA|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Access Direct Platinum|HEALTHFIRST TPA UMR|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|United Medicare Advantage|UHC MEDICARE GOLD MA|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Managed Medicare|HEALTHSPRING MA|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Blue Cross PPO Specialty|BCBSTX OTHER|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Cigna|CIGNA|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Managed Medicare|BCBS MEDICARE PPO MA|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Aetna|AETNA PPO|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Blue Cross HMO Specialty|BCBSTX HMO|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Workers Compensation|TEXAS MUTUAL INSURANCE|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Humana Medicare Advantage|HUMANA MA|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Medicaid|MEDICAID|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Blue Cross PPO Specialty|BCBSTX PPO|1.92||||||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Blue Cross HMO Specialty|BCBSTX HMO|277,305.45|250.8|16329.67|250.8|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Medicare|MEDICARE ACUTE|975.12|16329.67|16329.67|250.8|||| 87102|EAP|0300|FUNGUS CULTURE GD87000|Medicare|MEDICARE ACUTE|3.98||||||| 87102|EAP|0300|FUNGUS CULTURE GD87000|PHCS|HUMANA INSURANCE|3.98||||||| 87102|EAP|0300|FUNGUS CULTURE GD87000|Blue Cross HMO Specialty|BCBSTX HMO|457.70||||||| 87116|EAP|0306|CULTURE TUBERCLE, ACID FA|Blue Cross PPO Specialty|BCBSTX PPO|3.78||||||| 87116|EAP|0306|CULTURE TUBERCLE, ACID FA|PHCS|HUMANA INSURANCE|3.78||||||| 87116|EAP|0306|CULTURE TUBERCLE, ACID FA|Medicare|MEDICARE ACUTE|3.78||||||| 87186|EAP|0300|SENSITIVITY|Veterans Affairs|VETERANS ADMINISTRATION|1.78||||||| 87186|EAP|0300|SENSITIVITY|Workers Compensation|TEXAS MUTUAL INSURANCE|1.78||||||| 87186|EAP|0300|SENSITIVITY|United Healthcare|UNITED HEALTHCARE OTHER|1.78||||||| 87186|EAP|0300|SENSITIVITY|United Medicare Advantage|UHC MEDICARE GOLD MA|1.78||||||| 87186|EAP|0300|SENSITIVITY|Medicare|MEDICARE ACUTE|1.78||||||| 87186|EAP|0300|SENSITIVITY|United Medicare Advantage|UHC AARP MCR HMO MA|1.78||||||| 87186|EAP|0300|SENSITIVITY|Access Direct Platinum|HEALTHFIRST TPA UMR|1.78||||||| 87186|EAP|0300|SENSITIVITY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.78||||||| 87186|EAP|0300|SENSITIVITY|Tricare|TRICARE EAST REGION|1.78||||||| 87186|EAP|0300|SENSITIVITY|Managed Medicare|HEALTHSPRING MA|1.78||||||| 87186|EAP|0300|SENSITIVITY|Cigna|CIGNA|1.78||||||| 87186|EAP|0300|SENSITIVITY|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.78||||||| 87186|EAP|0300|SENSITIVITY|Blue Cross PPO Specialty|BCBSTX OTHER|1.78||||||| 87186|EAP|0300|SENSITIVITY|Blue Cross HMO Specialty|BCBSTX HMO|191.35||||||| 87186|EAP|0300|SENSITIVITY|Humana Medicare Advantage|HUMANA MA|1.78||||||| 87186|EAP|0300|SENSITIVITY|NON CONTRACTED|COMMERCIAL OTHER 1|1.78||||||| 87186|EAP|0300|SENSITIVITY|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.78||||||| 87186|EAP|0300|SENSITIVITY|Medicaid|MEDICAID|1.78||||||| 87186|EAP|0300|SENSITIVITY|Managed Medicare|BCBS MEDICARE PPO MA|1.78||||||| 87186|EAP|0300|SENSITIVITY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.78||||||| 87186|EAP|0300|SENSITIVITY|Blue Cross PPO Specialty|BCBSTX PPO|1.78||||||| 87186|EAP|0300|SENSITIVITY|Aetna|AETNA PPO|1.78||||||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Medicare|MEDICARE ACUTE|1,172.47|22138.06|22138.06|36.87|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|261.65|36.87|22138.06|36.87|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|54,271.50|10107.5|22138.06|36.87|||| 87205|EAP|0300|GRAM STAIN SMEAR GE44000|PHCS|HUMANA INSURANCE|2.01||||||| 87206|EAP|0306|SMEAR ACID FAST|Blue Cross PPO Specialty|BCBSTX PPO|1.33||||||| 87206|EAP|0306|SMEAR ACID FAST|PHCS|HUMANA INSURANCE|1.33||||||| 87206|EAP|0306|SMEAR ACID FAST|Medicare|MEDICARE ACUTE|1.33||||||| 87252|EAP|0300|HERPES CULTURE SCREEN RE|Blue Cross HMO Specialty|BCBSTX HMO|3.15||||||| 87341|EAP|0300|HEPATITIS B SURFAC AG|Medicare|MEDICARE ACUTE|5.37||||||| 87341|EAP|0300|HEPATITIS B SURFAC AG|United Medicare Advantage|UHC MEDICARE GOLD MA|5.37||||||| 87341|EAP|0300|HEPATITIS B SURFAC AG|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|5.37||||||| 87341|EAP|0300|HEPATITIS B SURFAC AG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|5.37||||||| 87449|EAP|0300|LEGIONELLA ANTIGEN URINE|Medicare|MEDICARE ACUTE|478.25||||||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Blue Cross HMO Specialty|BCBSTX HMO|4.69||||||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Blue Cross PPO Specialty|BCBSTX PPO|4.69||||||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|United Medicare Advantage|UHC MEDICARE GOLD MA|4.69||||||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Medicare|MEDICARE ACUTE|4.69||||||| 87522|EAP|0300|HCV RNA BY PCR QN|Medicare|MEDICARE ACUTE|1,130.75||||||| 87529|EAP|0300|HSV BY PCR|Blue Cross HMO Specialty|BCBSTX HMO|1,367.75||||||| 87651|EAP|0300|STREP A DNA AMP PROBE|Medicare|MEDICARE ACUTE|2.08||||||| 87799|EAP|0300|EBV BY PCR CSF|Medicare|MEDICARE ACUTE|1,392.50||||||| 87899|EAP|0300|INF AGENT AG DIRECT OPTIC|Medicare|MEDICARE ACUTE|478.25||||||| 88104|EAP|0311|CYTOPATH - FLUIDS WASHING|PHCS|HUMANA INSURANCE|1.39||||||| 88112|EAP|0311|CYTOPATH-SEL CELL ENHANCE|PHCS|HUMANA INSURANCE|1.83||||||| 88112|EAP|0311|CYTOPATH-SEL CELL ENHANCE|Medicare|MEDICARE ACUTE|2.40||||||| 88184|EAP|0310|FLOW CYTOMETRY/TC 1 MARKE|Medicare|MEDICARE ACUTE|228.70||||||| 88185|EAP|0310|FLOW CYTOMETRY / TC ADD-O|Medicare|MEDICARE ACUTE|17.28||||||| 88305|EAP|0312|LEVEL IV GROSS & MICRO|United Medicare Advantage|UHC MEDICARE GOLD MA|281.25||||||| 88305|EAP|0312|LEVEL IV GROSS & MICRO|Medicare|MEDICARE ACUTE|281.25||||||| 88305|EAP|0312|LEVEL IV GROSS & MICRO|PHCS|HUMANA INSURANCE|281.25||||||| 88307|EAP|0312|LEVEL V GROSS & MICRO|Medicare|MEDICARE ACUTE|4.17||||||| 88342|EAP|0312|IMMUNOSTAIN|Medicare|MEDICARE ACUTE|321.75||||||| 89050|EAP|0300|CELL COUNT W/O DIFF,BODY|Medicare|MEDICARE ACUTE|2.43||||||| 89051|EAP|0300|CELL COUNT, CSF GC24300|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.43||||||| 89051|EAP|0300|CELL COUNT, CSF GC24300|Blue Cross PPO Specialty|BCBSTX PPO|2.43||||||| 89051|EAP|0300|CELL COUNT, CSF GC24300|Medicare|MEDICARE ACUTE|2.43||||||| 89051|EAP|0300|CELL COUNT, CSF GC24300|United Medicare Advantage|UHC MEDICARE GOLD MA|2.43||||||| 89051|EAP|0300|CELL COUNT, CSF GC24300|PHCS|HUMANA INSURANCE|2.43||||||| 89051|EAP|0300|CELL COUNT, CSF GC24300|United Medicare Advantage|UHC AARP MCR HMO MA|2.43||||||| 89055|EAP|0300|LEUKOCYTE ASSESSMENT FECA|United Medicare Advantage|UHC MEDICARE GOLD MA|0.99||||||| 89055|EAP|0300|LEUKOCYTE ASSESSMENT FECA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.99||||||| 89055|EAP|0300|LEUKOCYTE ASSESSMENT FECA|Humana Medicare Advantage|HUMANA MA|0.99||||||| 89060|EAP|0300|BODY FLUID CRYSTALS|Medicare|MEDICARE ACUTE|3.67||||||| 90686|ERX|0250|INFLUENZA VACCINE|Medicare|MEDICARE ACUTE|100.35||||||| 90686|ERX|0250|INFLUENZA VACCINE|Blue Cross PPO Specialty|BCBSTX PPO|100.35||||||| 90686|ERX|0250|INFLUENZA VACCINE|Humana Medicare Advantage|HUMANA MA|100.35||||||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|United Medicare Advantage|UHC MEDICARE GOLD MA|413.75||||||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Medicare|MEDICARE ACUTE|413.75||||||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|PHCS|HUMANA INSURANCE|413.75||||||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Blue Cross PPO Specialty|BCBSTX PPO|413.75||||||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|413.75||||||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Managed Medicare|HEALTHSPRING MA|413.75||||||| 90761|EAP|0450|IV INF HYDRATION EA ADL H|Medicare|MEDICARE ACUTE|3.89||||||| 91|DRG||OTHER DISORDERS OF NERVOUS SYSTEM W MCC|Blue Cross PPO Specialty|BCBSTX PPO|94,518.10|167.7|177236.44|167.7|||| 91|DRG||OTHER DISORDERS OF NERVOUS SYSTEM W MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|221,545.55|177236.44|177236.44|167.7|||| 91|DRG||OTHER DISORDERS OF NERVOUS SYSTEM W MCC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|127,200.85|27282.81|177236.44|167.7|||| 91|DRG||OTHER DISORDERS OF NERVOUS SYSTEM W MCC|Medicare|MEDICARE ACUTE|118,860.13|18745.365|177236.44|167.7|||| 91|DRG||OTHER DISORDERS OF NERVOUS SYSTEM W MCC|United Healthcare|UNITED HEALTHCARE OTHER|139,980.90|23832.545|177236.44|167.7|||| 91|DRG||OTHER DISORDERS OF NERVOUS SYSTEM W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|138,811.80|24362.52|177236.44|167.7|||| 92|DRG||OTHER DISORDERS OF NERVOUS SYSTEM W CC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|154,776.25|28499.71|28499.71|12.9|||| 92|DRG||OTHER DISORDERS OF NERVOUS SYSTEM W CC|Blue Cross PPO Specialty|BCBSTX PPO|10,771.25|12.9|28499.71|12.9|||| 92|DRG||OTHER DISORDERS OF NERVOUS SYSTEM W CC|Medicare|MEDICARE ACUTE|73,222.38|18730.195|28499.71|12.9|||| 92507|EAP|0440|SPEECH/LANGUAGE/VOICE IND|Tricare|TRICARE EAST REGION|3.91||||||| 92507|EAP|0440|SPEECH/LANGUAGE/VOICE IND|Medicare|MEDICARE ACUTE|3.91||||3.91||| 92507|EAP|0440|SPEECH/LANGUAGE/VOICE IND|United Medicare Advantage|UHC MEDICARE GOLD MA|3.91||||3.91||| 92507|EAP|0440|SPEECH/LANGUAGE/VOICE IND|United Healthcare|UNITED HEALTHCARE OTHER|||||3.91||| 92507|EAP|0440|SPEECH/LANGUAGE/VOICE IND|United Medicare Advantage|UHC AARP MCR HMO MA|3.91||||||| 92507|EAP|0440|SPEECH/LANGUAGE/VOICE IND|Veterans Affairs|VETERANS ADMINISTRATION|3.91||||||| 92507|EAP|0440|SPEECH/LANGUAGE/VOICE IND|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|||||3.91||| 92507|EAP|0440|SPEECH/LANGUAGE/VOICE IND|NON CONTRACTED|COMMERCIAL OTHER 1|3.91||||3.91||| 92507|EAP|0440|SPEECH/LANGUAGE/VOICE IND|Texas Workforce Commission|VOC REHAB SERV (TWC)|||||3.91||| 92507|EAP|0440|SPEECH/LANGUAGE/VOICE IND|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|3.91||||||| 92507|EAP|0440|SPEECH/LANGUAGE/VOICE IND|Blue Cross PPO Specialty|BCBSTX PPO|3.91||||3.91||| 92507|EAP|0440|SPEECH/LANGUAGE/VOICE IND|Managed Medicare|HEALTHSPRING MA|3.91||||3.91||| 92507|EAP|0440|SPEECH/LANGUAGE/VOICE IND|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|3.91||||||| 92507|EAP|0440|SPEECH/LANGUAGE/VOICE IND|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|3.91||||3.91||| 92507|EAP|0440|SPEECH/LANGUAGE/VOICE IND|Cigna|CIGNA OTHER|||||3.91||| 92507|EAP|0440|SPEECH/LANGUAGE/VOICE IND|Cigna|CIGNA|3.91||||||| 92507|EAP|0440|SPEECH/LANGUAGE/VOICE IND|Managed Medicare|BCBS MEDICARE PPO MA|3.91||||||| 92507|EAP|0440|SPEECH/LANGUAGE/VOICE IND|Managed Medicaid|MEDICAID SUPERIOR|||||3.91||| 92507|EAP|0440|SPEECH/LANGUAGE/VOICE IND|Aetna|AETNA OTHER|3.91||||3.91||| 92507|EAP|0440|SPEECH/LANGUAGE/VOICE IND|Humana Medicare Advantage|HUMANA MA|3.91||||3.91||| 92507|EAP|0440|SPEECH/LANGUAGE/VOICE IND|Blue Cross HMO Specialty|BCBSTX HMO|3.91||||3.91||| 92507|EAP|0440|SPEECH/LANGUAGE/VOICE IND|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.91||||3.91||| 92507|EAP|0440|SPEECH/LANGUAGE/VOICE IND|Aenta Medicare Advantage|AETNA MEDICARE MA|3.91||||||| 92507|EAP|0440|SPEECH/LANGUAGE/VOICE IND|Aetna|AETNA PPO|3.91||||3.91||| 92508|EAP|0440|SPEECH & LANG GROUP|Blue Cross PPO Specialty|BCBSTX PPO|141.25||||||| 92508|EAP|0440|SPEECH & LANG GROUP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|141.25||||||| 92508|EAP|0440|SPEECH & LANG GROUP|Blue Cross HMO Specialty|BCBSTX HMO|141.25||||||| 92508|EAP|0440|SPEECH & LANG GROUP|Humana Medicare Advantage|HUMANA MA|141.25||||||| 92508|EAP|0440|SPEECH & LANG GROUP|United Medicare Advantage|UHC MEDICARE GOLD MA|141.25||||||| 92508|EAP|0440|SPEECH & LANG GROUP|Medicare|MEDICARE ACUTE|141.25||||||| 92508|EAP|0440|SPEECH & LANG GROUP|Veterans Affairs|VETERANS ADMINISTRATION|141.25||||||| 92522|EAP|0440|EVAL SPEECH SOUND PRODUCT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||421.75||| 92522|EAP|0440|EVAL SPEECH SOUND PRODUCT|Medicare|MEDICARE ACUTE|||||421.75||| 92522|EAP|0440|EVAL SPEECH SOUND PRODUCT|United Healthcare|UNITED HEALTHCARE OTHER|||||421.75||| 92522|EAP|0440|EVAL SPEECH SOUND PRODUCT|Humana Medicare Advantage|HUMANA MA|||||421.75||| 92522|EAP|0440|EVAL SPEECH SOUND PRODUCT|Cigna|CIGNA OTHER|||||421.75||| 92522|EAP|0440|EVAL SPEECH SOUND PRODUCT|Blue Cross PPO Specialty|BCBSTX PPO|||||421.75||| 92522|EAP|0440|EVAL SPEECH SOUND PRODUCT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||421.75||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|9.92||||||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Managed Medicare|BCBS MEDICARE PPO MA|9.92||||9.92||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Medicaid|MEDICAID|9.92||||||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|9.92||||||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Cigna|CIGNA|9.92||||||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.92||||9.92||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Blue Cross PPO Specialty|BCBSTX PPO|9.92||||9.92||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|9.92||||9.92||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Managed Medicare|HEALTHSPRING MA|9.92||||9.92||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Blue Cross HMO Specialty|BCBSTX HMO|9.92||||9.92||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Access Direct Platinum|HEALTHFIRST TPA|9.92||||||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|9.92||||||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Aetna|AETNA PPO|9.92||||9.92||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Cigna|CIGNA OTHER|9.92||||||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Humana Medicare Advantage|HUMANA MA|9.92||||9.92||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|9.92||||||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|9.92||||||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Blue Cross PPO Specialty|BCBSTX OTHER|9.92||||||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Access Direct Platinum|HEALTHFIRST TPA UMR|9.92||||||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Medicaid|LAW ENFORCEMENT OTHER|||||9.92||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Aetna|AETNA OTHER|9.92||||9.92||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Aenta Medicare Advantage|AETNA MEDICARE MA|9.92||||||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Veterans Affairs|VETERANS ADMINISTRATION|9.92||||||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|NON CONTRACTED|COMMERCIAL OTHER 1|9.92||||9.92||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|United Medicare Advantage|UHC AARP MCR HMO MA|9.92||||||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|PHCS|HUMANA INSURANCE|9.92||||||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|United Healthcare|UNITED HEALTHCARE|9.92||||||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|United Healthcare|TML GROUP BENEFITS|9.92||||||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|United Medicare Advantage|UHC MEDICARE GOLD MA|9.92||||9.92||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Texas Workforce Commission|VOC REHAB SERV (TWC)|||||9.92||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Medicare|MEDICARE ACUTE|9.92||||9.92||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|Tricare|TRICARE EAST REGION|9.92||||||| 92523|EAP|0440|SPEECH EVAL LANGUAGE COMP|United Healthcare|UNITED HEALTHCARE OTHER|9.92||||9.92||| 92524|EAP|0440|SPEECH EVAL OF VOICE|United Medicare Advantage|UHC MEDICARE GOLD MA|5.29||||5.29||| 92524|EAP|0440|SPEECH EVAL OF VOICE|Medicare|MEDICARE ACUTE|5.29||||5.29||| 92524|EAP|0440|SPEECH EVAL OF VOICE|United Healthcare|UNITED HEALTHCARE OTHER|5.29||||5.29||| 92524|EAP|0440|SPEECH EVAL OF VOICE|Veterans Affairs|VETERANS ADMINISTRATION|||||5.29||| 92524|EAP|0440|SPEECH EVAL OF VOICE|Aetna|AETNA PPO|||||5.29||| 92524|EAP|0440|SPEECH EVAL OF VOICE|Blue Cross PPO Specialty|BCBSTX PPO|||||5.29||| 92524|EAP|0440|SPEECH EVAL OF VOICE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||5.29||| 92524|EAP|0440|SPEECH EVAL OF VOICE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||5.29||| 92524|EAP|0440|SPEECH EVAL OF VOICE|Blue Cross HMO Specialty|BCBSTX HMO|||||5.29||| 92524|EAP|0440|SPEECH EVAL OF VOICE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||5.29||| 92524|EAP|0440|SPEECH EVAL OF VOICE|Humana Medicare Advantage|HUMANA MA|||||5.29||| 92524|EAP|0440|SPEECH EVAL OF VOICE|Blue Cross PPO Specialty|BCBSTX OTHER|||||5.29||| 92524|EAP|0440|SPEECH EVAL OF VOICE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||5.29||| 92526|EAP|0440|TREATMENT OF SWALLOWING D|Blue Cross PPO Specialty|BCBSTX OTHER|||||399.25||| 92526|EAP|0440|SWALLOWING AND/OR ORAL FU|Aenta Medicare Advantage|AETNA MEDICARE MA|3.05||||||| 92526|EAP|0440|TREATMENT OF SWALLOWING D|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|399.25||||399.25||| 92526|EAP|0440|TREATMENT OF SWALLOWING D|Managed Medicare|BCBS MEDICARE PPO MA|399.25||||||| 92526|EAP|0440|TREATMENT OF SWALLOWING D|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|3.05||||399.25||| 92526|EAP|0440|TREATMENT OF SWALLOWING D|Aenta Medicare Advantage|AETNA MEDICARE MA|399.25||||||| 92526|EAP|0440|TREATMENT OF SWALLOWING D|Managed Medicare|HEALTHSPRING MA|399.25||||||| 92526|EAP|0440|TREATMENT OF SWALLOWING D|Aetna|AETNA OTHER|399.25||||399.25||| 92526|EAP|0440|TREATMENT OF SWALLOWING D|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|3.05||||399.25||| 92526|EAP|0440|TREATMENT OF SWALLOWING D|Humana Medicare Advantage|HUMANA MA|3.05||||399.25||| 92526|EAP|0440|SWALLOWING AND/OR ORAL FU|Blue Cross HMO Specialty|BCBSTX HMO|3.05||||||| 92526|EAP|0440|SWALLOWING AND/OR ORAL FU|Managed Medicare|BCBS MEDICARE PPO MA|3.05||||||| 92526|EAP|0440|TREATMENT OF SWALLOWING D|Humana Medicare Advantage|HUMANA MA|399.25||||399.25||| 92526|EAP|0440|TREATMENT OF SWALLOWING D|Blue Cross HMO Specialty|BCBSTX HMO|399.25||||||| 92526|EAP|0440|TREATMENT OF SWALLOWING D|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.05||||399.25||| 92526|EAP|0440|TREATMENT OF SWALLOWING D|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||399.25||| 92526|EAP|0440|TREATMENT OF SWALLOWING D|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|399.25||||399.25||| 92526|EAP|0440|TREATMENT OF SWALLOWING D|Access Direct Platinum|HEALTHFIRST TPA|399.25||||||| 92526|EAP|0440|SWALLOWING AND/OR ORAL FU|Blue Cross PPO Specialty|BCBSTX PPO|3.05||||||| 92526|EAP|0440|TREATMENT OF SWALLOWING D|Blue Cross PPO Specialty|BCBSTX PPO|399.25||||||| 92526|EAP|0440|SWALLOWING AND/OR ORAL FU|Managed Medicare|HEALTHSPRING MA|3.05||||||| 92526|EAP|0440|SWALLOWING AND/OR ORAL FU|United Medicare Advantage|UHC AARP MCR HMO MA|3.05||||||| 92526|EAP|0440|TREATMENT OF SWALLOWING D|Tricare|TRICARE EAST REGION|3.05||||399.25||| 92526|EAP|0440|TREATMENT OF SWALLOWING D|Tricare|TRICARE EAST REGION|399.25||||399.25||| 92526|EAP|0440|TREATMENT OF SWALLOWING D|Medicare|MEDICARE ACUTE|3.05||||399.25||| 92526|EAP|0440|TREATMENT OF SWALLOWING D|United Medicare Advantage|UHC MEDICARE GOLD MA|399.25||||399.25||| 92526|EAP|0440|TREATMENT OF SWALLOWING D|United Medicare Advantage|UHC AARP MCR HMO MA|399.25||||||| 92526|EAP|0440|TREATMENT OF SWALLOWING D|United Healthcare|UNITED HEALTHCARE OTHER|3.05||||399.25||| 92526|EAP|0440|TREATMENT OF SWALLOWING D|United Medicare Advantage|UHC MEDICARE GOLD MA|3.05||||399.25||| 92526|EAP|0440|TREATMENT OF SWALLOWING D|Medicare|MEDICARE ACUTE|399.25||||399.25||| 92610|EAP|0440|EVALUATE SWALLOWING FUNCT|Veterans Affairs|VETERANS ADMINISTRATION|7.35||||6.13||| 92610|EAP|0440|EVALUATE SWALLOWING FUNCT|United Medicare Advantage|UHC MEDICARE GOLD MA|6.13||||6.13||| 92610|EAP|0440|EVAL ORAL/PHARYNGEAL SWAL|NON CONTRACTED|COMMERCIAL OTHER 1|7.35||||||| 92610|EAP|0440|EVAL ORAL/PHARYNGEAL SWAL|United Healthcare|UNITED HEALTHCARE|7.35||||||| 92610|EAP|0440|EVAL ORAL/PHARYNGEAL SWAL|PHCS|HUMANA INSURANCE|7.35||||||| 92610|EAP|0440|EVALUATE SWALLOWING FUNCT|Medicare|MEDICARE ACUTE|7.35||||6.13||| 92610|EAP|0440|EVALUATE SWALLOWING FUNCT|Tricare|TRICARE EAST REGION|||||6.13||| 92610|EAP|0440|EVALUATE SWALLOWING FUNCT|United Healthcare|UNITED HEALTHCARE OTHER|7.35||||6.13||| 92610|EAP|0440|EVALUATE SWALLOWING FUNCT|Blue Cross PPO Specialty|BCBSTX PPO|7.35||||6.13||| 92610|EAP|0440|EVALUATE SWALLOWING FUNCT|Humana Medicare Advantage|HUMANA MA|6.13||||6.13||| 92610|EAP|0440|EVAL ORAL/PHARYNGEAL SWAL|Blue Cross PPO Specialty|BCBSTX OTHER|7.35||||||| 92610|EAP|0440|EVAL ORAL/PHARYNGEAL SWAL|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|7.35||||||| 92610|EAP|0440|EVAL ORAL/PHARYNGEAL SWAL|Cigna|CIGNA OTHER|7.35||||||| 92610|EAP|0440|EVALUATE SWALLOWING FUNCT|Humana Medicare Advantage|HUMANA MA|7.35||||6.13||| 92610|EAP|0440|EVAL ORAL/PHARYNGEAL SWAL|Aenta Medicare Advantage|AETNA MEDICARE MA|7.35||||||| 92610|EAP|0440|EVAL ORAL/PHARYNGEAL SWAL|United Medicare Advantage|UHC AARP MCR HMO MA|7.35||||||| 92610|EAP|0440|EVALUATE SWALLOWING FUNCT|United Medicare Advantage|UHC MEDICARE GOLD MA|7.35||||6.13||| 92610|EAP|0440|EVALUATE SWALLOWING FUNCT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.35||||6.13||| 92610|EAP|0440|EVALUATE SWALLOWING FUNCT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|6.13||||6.13||| 92610|EAP|0440|EVALUATE SWALLOWING FUNCT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|7.35||||6.13||| 92610|EAP|0440|EVALUATE SWALLOWING FUNCT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|7.35||||6.13||| 92610|EAP|0440|EVALUATE SWALLOWING FUNCT|Medicare|MEDICARE ACUTE|6.13||||6.13||| 92610|EAP|0440|EVALUATE SWALLOWING FUNCT|Blue Cross PPO Specialty|BCBSTX PPO|6.13||||6.13||| 92610|EAP|0440|EVAL ORAL/PHARYNGEAL SWAL|Access Direct Platinum|HEALTHFIRST TPA|7.35||||||| 92610|EAP|0440|EVALUATE SWALLOWING FUNCT|Managed Medicare|HEALTHSPRING MA|6.13||||||| 92610|EAP|0440|EVAL ORAL/PHARYNGEAL SWAL|Managed Medicare|HEALTHSPRING MA|7.35||||||| 92610|EAP|0440|EVALUATE SWALLOWING FUNCT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||6.13||| 92610|EAP|0440|EVAL ORAL/PHARYNGEAL SWAL|Cigna|CIGNA|7.35||||||| 92610|EAP|0440|EVALUATE SWALLOWING FUNCT|Blue Cross HMO Specialty|BCBSTX HMO|7.35||||6.13||| 92610|EAP|0440|EVAL ORAL/PHARYNGEAL SWAL|Managed Medicare|BCBS MEDICARE PPO MA|7.35||||||| 92610|EAP|0440|EVALUATE SWALLOWING FUNCT|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|7.35||||6.13||| 92610|EAP|0440|EVALUATE SWALLOWING FUNCT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|7.35||||6.13||| 92610|EAP|0440|EVALUATE SWALLOWING FUNCT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|6.13||||6.13||| 92610|EAP|0440|EVAL ORAL/PHARYNGEAL SWAL|Medicaid|MEDICAID|7.35||||||| 92611|EAP|0440|MOTION FLUOROSCOPIC EVAL|Blue Cross PPO Specialty|BCBSTX PPO|7.35||||||| 92611|EAP|0440|MOTION FLUOROSCOPIC EVAL|Blue Cross HMO Specialty|BCBSTX HMO|7.35||||||| 92611|EAP|0440|MOTION FLUOROSCOPIC EVAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|7.35||||||| 92611|EAP|0440|MOTION FLUOROSCOPIC EVAL|Humana Medicare Advantage|HUMANA MA|7.35||||||| 92611|EAP|0440|MOTION FLUOROSCOPIC EVAL|Medicare|MEDICARE ACUTE|7.35||||||| 92611|EAP|0440|MOTION FLUOROSCOPIC EVAL|United Medicare Advantage|UHC AARP MCR HMO MA|7.35||||||| 92950|EAP|0410|CPR|Medicare|MEDICARE ACUTE|4.73||||||| 92950|EAP|0410|CPR|Medicaid|MEDICAID|4.73||||||| 93005|EAP|0730|STAT 12 LEAD|Blue Cross PPO Specialty|BCBSTX OTHER|10.35||||||| 93005|EAP|0730|ROUTINE 12 LEAD|Blue Cross PPO Specialty|BCBSTX OTHER|7.19||||||| 93005|EAP|0730|STAT 12 LEAD|Aenta Medicare Advantage|AETNA MEDICARE MA|10.35||||||| 93005|EAP|0730|ROUTINE 12 LEAD|Blue Cross HMO Specialty|BCBSTX HMO|7.19||||||| 93005|EAP|0730|STAT 12 LEAD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|10.35||||||| 93005|EAP|0730|ROUTINE 12 LEAD|Aenta Medicare Advantage|AETNA MEDICARE MA|7.19||||||| 93005|EAP|0730|EKG 12 LEAD|Humana Medicare Advantage|HUMANA MA|5.58||||||| 93005|EAP|0730|STAT 12 LEAD|Blue Cross HMO Specialty|BCBSTX HMO|10.35||||||| 93005|EAP|0730|ROUTINE 12 LEAD|Humana Medicare Advantage|HUMANA MA|7.19||||||| 93005|EAP|0730|ROUTINE 12 LEAD|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|7.19||||||| 93005|EAP|0730|STAT 12 LEAD|Humana Medicare Advantage|HUMANA MA|10.35||||||| 93005|EAP|0730|STAT 12 LEAD|Blue Cross PPO Specialty|BCBSTX PPO|10.35||||||| 93005|EAP|0730|ROUTINE 12 LEAD|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|7.19||||||| 93005|EAP|0730|ROUTINE 12 LEAD|Managed Medicare|HEALTHSPRING MA|7.19||||||| 93005|EAP|0730|ROUTINE 12 LEAD|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|7.19||||||| 93005|EAP|0730|EKG 12 LEAD|Blue Cross PPO Specialty|BCBSTX PPO|5.58||||||| 93005|EAP|0730|EKG 12 LEAD|Aetna|AETNA PPO|5.58||||||| 93005|EAP|0730|ROUTINE 12 LEAD|Aetna|AETNA OTHER|7.19||||||| 93005|EAP|0730|STAT 12 LEAD|United Healthcare|UNITED HEALTHCARE|10.35||||||| 93005|EAP|0730|STAT 12 LEAD|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|10.35||||||| 93005|EAP|0730|ROUTINE 12 LEAD|Blue Cross PPO Specialty|BCBSTX PPO|7.19||||||| 93005|EAP|0730|STAT 12 LEAD|United Medicare Advantage|UHC MEDICARE GOLD MA|10.35||||||| 93005|EAP|0730|ROUTINE 12 LEAD|Medicare|MEDICARE ACUTE|7.19||||||| 93005|EAP|0730|STAT 12 LEAD|Workers Compensation|TEXAS MUTUAL INSURANCE|10.35||||||| 93005|EAP|0730|STAT 12 LEAD|PHCS|HUMANA INSURANCE|10.35||||||| 93005|EAP|0730|ROUTINE 12 LEAD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.19||||||| 93005|EAP|0730|ROUTINE 12 LEAD|PHCS|HUMANA INSURANCE|7.19||||||| 93005|EAP|0730|ROUTINE 12 LEAD|Tricare|TRICARE EAST REGION|7.19||||||| 93005|EAP|0730|ROUTINE 12 LEAD|United Medicare Advantage|UHC MEDICARE GOLD MA|7.19||||||| 93005|EAP|0730|ROUTINE 12 LEAD|Veterans Affairs|VETERANS ADMINISTRATION|7.19||||||| 93005|EAP|0730|STAT 12 LEAD|United Medicare Advantage|UHC AARP MCR HMO MA|10.35||||||| 93005|EAP|0730|ROUTINE 12 LEAD|United Medicare Advantage|UHC AARP MCR HMO MA|7.19||||||| 93005|EAP|0730|ROUTINE 12 LEAD|United Healthcare|UNITED HEALTHCARE|7.19||||||| 93005|EAP|0730|ROUTINE 12 LEAD|United Healthcare|UNITED HEALTHCARE OTHER|7.19||||||| 93005|EAP|0730|STAT 12 LEAD|Medicare|MEDICARE ACUTE|10.35||||||| 93005|EAP|0730|EKG 12 LEAD|Medicare|MEDICARE ACUTE|5.58||||||| 93005|EAP|0730|EKG 12 LEAD|Veterans Affairs|VETERANS ADMINISTRATION|5.58||||||| 93005|EAP|0730|ROUTINE 12 LEAD|Workers Compensation|WORKERS COMPENSATION OTHER|7.19||||||| 93005|EAP|0730|EKG 12 LEAD|United Healthcare|UNITED HEALTHCARE|5.58||||||| 93005|EAP|0730|ROUTINE 12 LEAD|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|7.19||||||| 93015|EAP|0482|CARDIOLITE|Medicare|MEDICARE ACUTE|35.48||||||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Blue Cross PPO Specialty|BCBSTX PPO|50.53||||||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|50.53||||||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Aenta Medicare Advantage|AETNA MEDICARE MA|50.53||||||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Blue Cross HMO Specialty|BCBSTX HMO|50.53||||||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|PHCS|HUMANA INSURANCE|50.53||||||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|50.53||||||| 93306|EAP|0483|ECHOCARDIO 2D M DOPLR MAP|Aetna|AETNA PPO|27.68||||||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|50.53||||||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Humana Medicare Advantage|HUMANA MA|50.53||||||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Medicare|MEDICARE ACUTE|50.53||||||| 93308|EAP|0483|ECHO LTD OR FOLLOW UP|Medicare|MEDICARE ACUTE|11.64||||||| 93312|EAP|0483|TRANSESOPHAGEAL ECHO|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|48.38||||||| 93312|EAP|0483|TRANSESOPHAGEAL ECHO|Blue Cross HMO Specialty|BCBSTX HMO|48.38||||||| 93312|EAP|0483|TRANSESOPHAGEAL ECHO|United Healthcare|UNITED HEALTHCARE|48.38||||||| 93312|EAP|0483|TRANSESOPHAGEAL ECHO|United Medicare Advantage|UHC MEDICARE GOLD MA|48.38||||||| 93312|EAP|0483|TRANSESOPHAGEAL ECHO|Workers Compensation|TEXAS MUTUAL INSURANCE|48.38||||||| 93312|EAP|0483|TRANSESOPHAGEAL ECHO|Medicare|MEDICARE ACUTE|48.38||||||| 93325|EAP|0480|ECHO COLOR FLOW MAPPING|Workers Compensation|TEXAS MUTUAL INSURANCE|16.60||||||| 93325|EAP|0480|ECHO COLOR FLOW MAPPING|United Medicare Advantage|UHC MEDICARE GOLD MA|16.60||||||| 93325|EAP|0480|ECHO COLOR FLOW MAPPING|United Healthcare|UNITED HEALTHCARE|16.60||||||| 93325|EAP|0480|ECHO COLOR FLOW MAPPING|Medicare|MEDICARE ACUTE|16.60||||||| 93325|EAP|0480|ECHO COLOR FLOW MAPPING|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|16.60||||||| 93325|EAP|0480|ECHO COLOR FLOW MAPPING|Blue Cross HMO Specialty|BCBSTX HMO|16.60||||||| 93797|EAP|0943|CV REHAB W/O CONT EKG MON|Humana Medicare Advantage|HUMANA MA|||||6.41||| 93797|EAP|0943|CV REHAB W/O CONT EKG MON|Blue Cross PPO Specialty|BCBSTX PPO|||||6.41||| 93797|EAP|0943|CV REHAB W/O CONT EKG MON|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||6.41||| 93797|EAP|0943|CV REHAB W/O CONT EKG MON|Access Direct Platinum|HEALTHFIRST TPA|||||6.41||| 93797|EAP|0943|CV REHAB W/O CONT EKG MON|Veterans Affairs|VETERANS ADMINISTRATION|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|NON CONTRACTED|COMMERCIAL OTHER 1|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|United Healthcare|UNITED HEALTHCARE OTHER|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|Veterans Affairs|VETERANS ADMINISTRATION|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|United Medicare Advantage|UHC MEDICARE GOLD MA|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|Tricare|TRICARE EAST REGION|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|Medicare|MEDICARE ACUTE|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|Aetna|AETNA OTHER|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|Blue Cross PPO Specialty|BCBSTX PPO|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|Managed Medicare|BCBS MEDICARE PPO MA|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|Cigna|CIGNA OTHER|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|Blue Cross PPO Specialty|BCBSTX OTHER|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|Managed Medicaid|MEDICAID SUPERIOR|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|United Medicare Advantage|UHC AARP MCR HMO MA|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|Cigna|CIGNA|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|Blue Cross HMO Specialty|BCBSTX HMO|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|Humana Medicare Advantage|HUMANA MA|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|Managed Medicare|HEALTHSPRING MA|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|United Healthcare|UNITED HEALTHCARE|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|Aenta Medicare Advantage|AETNA MEDICARE MA|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|Aetna|AETNA PPO|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|Medicaid|MEDICAID|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|Access Direct Platinum|HEALTHFIRST TPA|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|Access Direct Platinum|HEALTHFIRST TPA UMR|||||6.41||| 93798|EAP|0943|CV REHAB W/ CONT EKG MONI|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||6.41||| 93880|EAP|0921|CAROTID DUPLEX BILATERAL|Humana Medicare Advantage|HUMANA MA|34.06||||||| 93880|EAP|0921|CAROTID DUPLEX BILATERAL|Managed Medicare|HEALTHSPRING MA|34.06||||||| 93880|EAP|0921|CAROTID DUPLEX BILATERAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|34.06||||||| 93880|EAP|0921|CAROTID DUPLEX BILATERAL|United Medicare Advantage|UHC AARP MCR HMO MA|34.06||||||| 93880|EAP|0921|CAROTID DUPLEX BILATERAL|United Medicare Advantage|UHC MEDICARE GOLD MA|34.06||||||| 93880|EAP|0921|CAROTID DUPLEX BILATERAL|Medicare|MEDICARE ACUTE|34.06||||||| 93886|EAP|0740|TRANSCRANIAL DOPPLER|United Medicare Advantage|UHC AARP MCR HMO MA|37.39||||||| 93886|EAP|0740|TRANSCRANIAL DOPPLER|Medicare|MEDICARE ACUTE|37.39||||||| 93886|EAP|0740|TRANSCRANIAL DOPPLER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|37.39||||||| 93886|EAP|0740|TRANSCRANIAL DOPPLER|Humana Medicare Advantage|HUMANA MA|37.39||||||| 93886|EAP|0740|TRANSCRANIAL DOPPLER|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|37.39||||||| 93892|EAP|0740|TCD EMBOLI DETECT W/O INJ|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|27.12||||||| 93892|EAP|0740|TCD EMBOLI DETECT W/O INJ|Humana Medicare Advantage|HUMANA MA|27.12||||||| 93892|EAP|0740|TCD EMBOLI DETECT W/O INJ|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|27.12||||||| 93892|EAP|0740|TCD EMBOLI DETECT W/O INJ|Medicare|MEDICARE ACUTE|27.12||||||| 93892|EAP|0740|TCD EMBOLI DETECT W/O INJ|United Medicare Advantage|UHC AARP MCR HMO MA|27.12||||||| 93893|EAP|0740|TCD EMBOLI DETECT W/INJ|Medicare|MEDICARE ACUTE|18.85||||||| 93893|EAP|0740|TCD EMBOLI DETECT W/INJ|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|18.85||||||| 93893|EAP|0740|TCD EMBOLI DETECT W/INJ|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|18.85||||||| 939|DRG||O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W MCC|Medicare|MEDICARE ACUTE|2,678.98|31452.875|31452.875|31452.875|||| 93922|EAP|0921|ANKLE BRACHIAL INDICES|United Medicare Advantage|UHC AARP MCR HMO MA|6.40||||||| 93922|EAP|0921|ANKLE BRACHIAL INDICES|United Medicare Advantage|UHC MEDICARE GOLD MA|6.40||||||| 93922|EAP|0921|ANKLE BRACHIAL INDICES|Medicare|MEDICARE ACUTE|6.40||||||| 93922|EAP|0921|ANKLE BRACHIAL INDICES|Blue Cross HMO Specialty|BCBSTX HMO|6.40||||||| 93922|EAP|0921|ANKLE BRACHIAL INDICES|Humana Medicare Advantage|HUMANA MA|6.40||||||| 93922|EAP|0921|ANKLE BRACHIAL INDICES|Managed Medicare|HEALTHSPRING MA|6.40||||||| 93922|EAP|0921|ANKLE BRACHIAL INDICES|Blue Cross PPO Specialty|BCBSTX PPO|6.40||||||| 93925|EAP|0921|ARTERIAL DUPLEX LOWER EXT|Medicare|MEDICARE ACUTE|35.89||||||| 93926|EAP|0921|ARTERIAL DUPLEX LOWER EXT|Workers Compensation|TEXAS MUTUAL INSURANCE|19.89||||||| 93926|EAP|0921|ARTERIAL GRAFTS LOWER EXT|Medicare|MEDICARE ACUTE|19.89||||||| 93926|EAP|0921|ARTERIAL DUPLEX LOWER EXT|Medicare|MEDICARE ACUTE|19.89||||||| 93926|EAP|0921|ARTERIAL DUPLEX LOWER EXT|United Medicare Advantage|UHC MEDICARE GOLD MA|19.89||||||| 93926|EAP|0921|PSEUDO ANEURYSM RULE OUT|PHCS|HUMANA INSURANCE|19.89||||||| 93926|EAP|0921|PSEUDO ANEURYSM RULE OUT|Medicare|MEDICARE ACUTE|19.89||||||| 93970|EAP|0921|VENOUS DUPLEX LOWER EXT B|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|48.89||||||| 93970|EAP|0921|VENOUS DUPLEX LOWER EXT B|Blue Cross PPO Specialty|BCBSTX PPO|48.89||||||| 93970|EAP|0921|VENOUS DUPLEX LOWER EXT B|Managed Medicare|HEALTHSPRING MA|48.89||||||| 93970|EAP|0921|VENOUS DUPLEX LOWER EXT B|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|48.89||||||| 93970|EAP|0921|VENOUS DUPLEX LOWER EXT B|Cigna|CIGNA|48.89||||||| 93970|EAP|0921|VENOUS DUPLEX LOWER EXT B|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|48.89||||||| 93970|EAP|0921|VENOUS DUPLEX UPPER EXT B|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|48.89||||||| 93970|EAP|0921|VENOUS DUPLEX LOWER EXT B|Blue Cross HMO Specialty|BCBSTX HMO|48.89||||||| 93970|EAP|0921|VENOUS DUPLEX LOWER EXT B|Aenta Medicare Advantage|AETNA MEDICARE MA|48.89||||||| 93970|EAP|0921|VENOUS DUPLEX LOWER EXT B|Humana Medicare Advantage|HUMANA MA|48.89||||||| 93970|EAP|0921|VENOUS DUPLEX LOWER EXT B|Aetna|AETNA PPO|48.89||||||| 93970|EAP|0921|VENOUS DUPLEX LOWER EXT B|Aetna|AETNA OTHER|48.89||||||| 93970|EAP|0921|VENOUS DUPLEX LOWER EXT B|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|48.89||||||| 93970|EAP|0921|VENOUS DUPLEX LOWER EXT B|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|48.89||||||| 93970|EAP|0921|VENOUS DUPLEX LOWER EXT B|Tricare|TRICARE EAST REGION|48.89||||||| 93970|EAP|0921|VENOUS DUPLEX LOWER EXT B|United Medicare Advantage|UHC AARP MCR HMO MA|48.89||||||| 93970|EAP|0921|VENOUS DUPLEX LOWER EXT B|Veterans Affairs|VETERANS ADMINISTRATION|48.89||||||| 93970|EAP|0921|VENOUS DUPLEX LOWER EXT B|United Healthcare|UNITED HEALTHCARE|48.89||||||| 93970|EAP|0921|VENOUS DUPLEX UPPER EXT B|Medicare|MEDICARE ACUTE|48.89||||||| 93970|EAP|0921|VENOUS DUPLEX LOWER EXT B|United Medicare Advantage|UHC MEDICARE GOLD MA|48.89||||||| 93970|EAP|0921|VENOUS DUPLEX LOWER EXT B|Medicare|MEDICARE ACUTE|48.89||||||| 93970|EAP|0921|VENOUS DUPLEX LOWER EXT B|United Healthcare|UNITED HEALTHCARE OTHER|48.89||||||| 93971|EAP|0921|VENOUS DUPLEX LOWER EXT U|Medicare|MEDICARE ACUTE|29.48||||||| 93971|EAP|0921|VENOUS DUPLEX UPPER EXT U|United Medicare Advantage|UHC MEDICARE GOLD MA|29.48||||||| 93971|EAP|0921|VENOUS DUPLEX UPPER EXT U|United Medicare Advantage|UHC AARP MCR HMO MA|29.48||||||| 93971|EAP|0921|VENOUS DUPLEX LOWER EXT U|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|29.48||||||| 93971|EAP|0921|VENOUS DUPLEX UPPER EXT U|Medicare|MEDICARE ACUTE|29.48||||||| 93971|EAP|0921|VENOUS DUPLEX LOWER EXT U|United Medicare Advantage|UHC MEDICARE GOLD MA|29.48||||||| 93971|EAP|0921|VENOUS DUPLEX UPPER EXT U|United Healthcare|UNITED HEALTHCARE|29.48||||||| 93971|EAP|0921|VENOUS DUPLEX LOWER EXT U|United Healthcare|UNITED HEALTHCARE|29.48||||||| 93971|EAP|0921|VENOUS DUPLEX LOWER EXT U|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|29.48||||||| 93971|EAP|0921|VENOUS DUPLEX UPPER EXT U|Blue Cross PPO Specialty|BCBSTX PPO|29.48||||||| 93971|EAP|0921|VENOUS DUPLEX LOWER EXT U|Blue Cross PPO Specialty|BCBSTX PPO|29.48||||||| 93971|EAP|0921|VENOUS DUPLEX LOWER EXT U|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|29.48||||||| 93971|EAP|0921|VENOUS DUPLEX LOWER EXT U|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|29.48||||||| 93971|EAP|0921|VENOUS DUPLEX LOWER EXT U|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|29.48||||||| 93971|EAP|0921|VENOUS DUPLEX LOWER EXT U|Access Direct Platinum|HEALTHFIRST TPA UMR|29.48||||||| 93971|EAP|0921|VENOUS DUPLEX LOWER EXT U|Humana Medicare Advantage|HUMANA MA|29.48||||||| 93971|EAP|0921|VENOUS DUPLEX LOWER EXT U|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|29.48||||||| 93971|EAP|0921|VENOUS DUPLEX UPPER EXT U|Managed Medicare|HEALTHSPRING MA|29.48||||||| 93971|EAP|0921|VENOUS DUPLEX LOWER EXT U|Managed Medicare|HEALTHSPRING MA|29.48||||||| 93978|EAP|0920|ARTERIAL DOP & VENUS DOP|Medicare|MEDICARE ACUTE|13.63||||||| 94|DRG||BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W MCC|Medicare|MEDICARE ACUTE|217,485.25|39951.09|39951.09|32.61|||| 94|DRG||BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W MCC|Humana Medicare Advantage|HUMANA MA|120,404.80|15863.08|39951.09|32.61|||| 94|DRG||BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W MCC|Blue Cross HMO Specialty|BCBSTX HMO|35,445.50|32.61|39951.09|32.61|||| 94060|EAP|0460|SPIROMETRY PRE/POST BD|Blue Cross PPO Specialty|BCBSTX OTHER|14.11||||||| 94250|EAP|0460|DLCO|Blue Cross PPO Specialty|BCBSTX OTHER|7.55||||||| 94260|EAP|0460|BODY PLETH/THORAC GAS VOL|Blue Cross PPO Specialty|BCBSTX OTHER|5.19||||||| 94640|EAP|0410|INCENTIVE SPIROMETRY THER|PHCS|HUMANA INSURANCE|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|United Medicare Advantage|UHC AARP MCR HMO MA|3.98||||||| 94640|EAP|0410|INCENTIVE SPIROMETRY THER|United Medicare Advantage|UHC AARP MCR HMO MA|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|United Medicare Advantage|UHC MEDICARE GOLD MA|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|United Healthcare|UNITED HEALTHCARE|3.98||||||| 94640|EAP|0410|INCENTIVE SPIROMETRY THER|Medicare|MEDICARE ACUTE|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Medicare|MEDICARE ACUTE|3.98||||||| 94640|EAP|0410|INCENTIVE SPIROMETRY THER|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Humana Medicare Advantage|HUMANA MA|3.98||||||| 94640|EAP|0410|INCENTIVE SPIROMETRY THER|Humana Medicare Advantage|HUMANA MA|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|United Healthcare|UNITED HEALTHCARE OTHER|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|PHCS|HUMANA INSURANCE|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Blue Cross PPO Specialty|BCBSTX PPO|3.98||||||| 94640|EAP|0410|INCENTIVE SPIROMETRY THER|Cigna|CIGNA|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Medicaid|MEDICAID|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.98||||||| 94640|EAP|0410|INCENTIVE SPIROMETRY THER|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|3.98||||||| 94640|EAP|0410|INCENTIVE SPIROMETRY THER|Blue Cross HMO Specialty|BCBSTX HMO|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Blue Cross HMO Specialty|BCBSTX HMO|3.98||||||| 94640|EAP|0410|INCENTIVE SPIROMETRY THER|Blue Cross PPO Specialty|BCBSTX PPO|3.98||||||| 94640|EAP|0410|INCENTIVE SPIROMETRY THER|United Medicare Advantage|UHC MEDICARE GOLD MA|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Managed Medicare|HEALTHSPRING MA|3.98||||||| 94640|EAP|0410|INCENTIVE SPIROMETRY THER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.98||||||| 94640|EAP|0410|INCENTIVE SPIROMETRY THER|Managed Medicare|HEALTHSPRING MA|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Aetna|AETNA PPO|3.98||||||| 94640|EAP|0410|INCENTIVE SPIROMETRY THER|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|3.98||||||| 94640|EAP|0410|INCENTIVE SPIROMETRY THER|Medicaid|MEDICAID|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|3.98||||||| 94667|EAP|0410|CHEST PHYSIOTHERAPY|Medicare|MEDICARE ACUTE|3.46||||||| 947|DRG||SIGNS & SYMPTOMS W MCC|Tricare|TRICARE EAST REGION|346,941.20||||||| 947|DRG||SIGNS & SYMPTOMS W MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|116,190.20|120.67|106467.86|120.67|||| 947|DRG||SIGNS & SYMPTOMS W MCC|Humana Medicare Advantage|HUMANA MA|516.41|14116.35|106467.86|120.67|||| 947|DRG||SIGNS & SYMPTOMS W MCC|Medicare|MEDICARE ACUTE|121,862.18|20968.97|106467.86|120.67|||| 947|DRG||SIGNS & SYMPTOMS W MCC|Blue Cross PPO Specialty|BCBSTX PPO|71,671.50|120.67|106467.86|120.67|||| 947|DRG||SIGNS & SYMPTOMS W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|176,753.15|23265.85|106467.86|120.67|||| 947|DRG||SIGNS & SYMPTOMS W MCC|PHCS|HUMANA INSURANCE|154,301.25|106467.86|106467.86|120.67|||| 94799|EAP|0410|BIPAP CIRCUIT|United Medicare Advantage|UHC AARP MCR HMO MA|118.75||||||| 94799|EAP|0410|HUMIDIFIER NEB RESEVOIR|United Medicare Advantage|UHC AARP MCR HMO MA|125.25||||||| 94799|EAP|0410|BIPAP CIRCUIT|United Medicare Advantage|UHC MEDICARE GOLD MA|118.75||||||| 94799|EAP|0410|MAN RESUSCITATOR S|Medicare|MEDICARE ACUTE|6.13||||||| 94799|EAP|0410|INCENTIVE SPIROMETER|Medicare|MEDICARE ACUTE|240.25||||||| 94799|EAP|0410|HUMIDIFIER NEB RESEVOIR|Medicare|MEDICARE ACUTE|125.25||||||| 94799|EAP|0410|HUMIDIFIER NEB RESEVOIR|Managed Medicare|HEALTHSPRING MA|125.25||||||| 94799|EAP|0410|VENT AEROCHAMBER|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|160.75||||||| 94799|EAP|0410|HUMIDIFIER NEB RESEVOIR|Blue Cross PPO Specialty|BCBSTX PPO|125.25||||||| 94799|EAP|0410|BIPAP CIRCUIT|Medicare|MEDICARE ACUTE|118.75||||||| 94799|EAP|0410|HUMIDIFIER NEB RESEVOIR|Humana Medicare Advantage|HUMANA MA|125.25||||||| 94799|EAP|0410|HUMIDIFIER NEB RESEVOIR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|125.25||||||| 94799|EAP|0410|BIPAP CIRCUIT|Blue Cross PPO Specialty|BCBSTX PPO|118.75||||||| 94799|EAP|0410|HUMIDIFIER NEB RESEVOIR|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|125.25||||||| 94799|EAP|0410|VENT AEROCHAMBER|Medicare|MEDICARE ACUTE|160.75||||||| 94799|EAP|0410|BIOPSY FORCEPS (DISP)|Medicare|MEDICARE ACUTE|3.35||||||| 94799|EAP|0410|INCENTIVE SPIROMETER|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|240.25||||||| 94799|EAP|0410|BIPAP CIRCUIT|Access Direct Platinum|HEALTHFIRST TPA|118.75||||||| 94799|EAP|0410|INCENTIVE SPIROMETER|Humana Medicare Advantage|HUMANA MA|240.25||||||| 94799|EAP|0410|BIPAP CIRCUIT|Aetna|AETNA PPO|118.75||||||| 94799|EAP|0410|INCENTIVE SPIROMETER|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|240.25||||||| 94799|EAP|0410|BIPAP CIRCUIT|Humana Medicare Advantage|HUMANA MA|118.75||||||| 94799|EAP|0410|INCENTIVE SPIROMETER|Managed Medicare|HEALTHSPRING MA|240.25||||||| 94799|EAP|0410|INCENTIVE SPIROMETER|Blue Cross PPO Specialty|BCBSTX PPO|240.25||||||| 94799|EAP|0410|HUMIDIFIER NEB RESEVOIR|Aetna|AETNA PPO|125.25||||||| 94799|EAP|0410|INCENTIVE SPIROMETER|Medicaid|MEDICAID|240.25||||||| 94799|EAP|0410|MAN RESUSCITATOR S|Medicaid|MEDICAID|6.13||||||| 94799|EAP|0270|BRONCHIAL CYTO BRUSH|PHCS|HUMANA INSURANCE|328.75||||||| 94799|EAP|0410|FIBEROPTIC BRONCH PROC CO|PHCS|HUMANA INSURANCE|32.99||||||| 94799|EAP|0410|INCENTIVE SPIROMETER|United Medicare Advantage|UHC MEDICARE GOLD MA|240.25||||||| 94799|EAP|0410|INCENTIVE SPIROMETER|United Medicare Advantage|UHC AARP MCR HMO MA|240.25||||||| 94799|EAP|0410|HUMIDIFIER NEB RESEVOIR|United Medicare Advantage|UHC MEDICARE GOLD MA|125.25||||||| 948|DRG||SIGNS & SYMPTOMS W/O MCC|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|161,361.50|7202.18|126691.25|6587.75|||| 948|DRG||SIGNS & SYMPTOMS W/O MCC|Medicare|MEDICARE ACUTE|98,892.63|16275.11|126691.25|6587.75|||| 948|DRG||SIGNS & SYMPTOMS W/O MCC|Managed Medicare|BCBS MEDICARE PPO MA|48,365.25|6587.75|126691.25|6587.75|||| 948|DRG||SIGNS & SYMPTOMS W/O MCC|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|126,691.25|126691.25|126691.25|6587.75|||| 949|DRG||AFTERCARE W CC/MCC|NON CONTRACTED|COMMERCIAL OTHER 1|131,268.65|90575.37|98494.68|50.4|||| 949|DRG||AFTERCARE W CC/MCC|Veterans Affairs|VETERANS ADMINISTRATION|155,583.40|23414.87|98494.68|50.4|||| 949|DRG||AFTERCARE W CC/MCC|United Healthcare|UNITED HEALTHCARE|86,661.75|144.43|98494.68|50.4|||| 949|DRG||AFTERCARE W CC/MCC|United Healthcare|UNITED HEALTHCARE OTHER|53,387.25|105.04|98494.68|50.4|||| 949|DRG||AFTERCARE W CC/MCC|United Healthcare|UNITED HEALTHCARE|220,592.75|328.25|98494.68|50.4|||| 949|DRG||AFTERCARE W CC/MCC|Managed Medicare|HEALTHSPRING MA|137,770.20|21773.935|98494.68|50.4|||| 949|DRG||AFTERCARE W CC/MCC|Cigna|CIGNA OTHER|35,388.50|50.4|98494.68|50.4|||| 949|DRG||AFTERCARE W CC/MCC|Blue Cross PPO Specialty|BCBSTX OTHER|180,222.72|232.2|98494.68|50.4|||| 949|DRG||AFTERCARE W CC/MCC|Blue Cross HMO Specialty|BCBSTX HMO|122,046.65|163.05|98494.68|50.4|||| 949|DRG||AFTERCARE W CC/MCC|Access Direct Platinum|HEALTHFIRST TPA|105,033.05|9358.49|98494.68|50.4|||| 949|DRG||AFTERCARE W CC/MCC|Humana Medicare Advantage|HUMANA MA|117,260.75|20332.665|98494.68|50.4|||| 949|DRG||AFTERCARE W CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|193,852.60|172.06|98494.68|50.4|||| 949|DRG||AFTERCARE W CC/MCC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|93,931.30|24945.68|98494.68|50.4|||| 949|DRG||AFTERCARE W CC/MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|123,118.35|98494.68|98494.68|50.4|||| 949|DRG||AFTERCARE W CC/MCC|Access Direct Platinum|HEALTHFIRST TPA UMR|140,394.25|9757.96|98494.68|50.4|||| 949|DRG||AFTERCARE W CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|186,526.25|197.46|98494.68|50.4|||| 949|DRG||AFTERCARE W CC/MCC|Medicare|MEDICARE ACUTE|1,085.22|18722.78|98494.68|50.4|||| 949|DRG||AFTERCARE W CC/MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|1,030.47|18412.42|98494.68|50.4|||| 950|DRG||AFTERCARE W/O CC/MCC|Medicare|MEDICARE ACUTE|118,180.21|14346.32|22309.27|14346.32|||| 950|DRG||AFTERCARE W/O CC/MCC|Managed Medicare|HEALTHSPRING MA|96,314.55|22309.27|22309.27|14346.32|||| 9500034|ERX|0250|ACETAM-COD 120-12MG/5ML E|Blue Cross HMO Specialty|BCBSTX HMO|11.75||||||| 9500117|ERX|0250|METOCLOPRAMIDE 5MG/5ML, 1|United Medicare Advantage|UHC MEDICARE GOLD MA|9.25||||||| 9500117|ERX|0250|METOCLOPRAMIDE 5MG/5ML, 1|Humana Medicare Advantage|HUMANA MA|9.25||||||| 9500117|ERX|0250|METOCLOPRAMIDE 5MG/5ML, 1|Medicare|MEDICARE ACUTE|9.25||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|11.50||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Humana Medicare Advantage|HUMANA MA|11.50||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Blue Cross PPO Specialty|BCBSTX PPO|11.50||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Access Direct Platinum|HEALTHFIRST TPA|11.50||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Blue Cross HMO Specialty|BCBSTX HMO|11.50||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|11.50||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|11.50||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|11.50||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|11.50||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Medicare|MEDICARE ACUTE|11.50||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Managed Medicare|HEALTHSPRING MA|11.50||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Aenta Medicare Advantage|AETNA MEDICARE MA|11.50||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|PHCS|HUMANA INSURANCE|11.50||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|United Medicare Advantage|UHC AARP MCR HMO MA|11.50||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|United Healthcare|UNITED HEALTHCARE OTHER|11.50||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|United Medicare Advantage|UHC MEDICARE GOLD MA|11.50||||||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|Medicare|MEDICARE ACUTE|0.09||||||| 9500174|ERX|0250|GLYCERIN SUPP|Medicare|MEDICARE ACUTE|2.50||||||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Veterans Affairs|VETERANS ADMINISTRATION|28.25||||||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|United Medicare Advantage|UHC MEDICARE GOLD MA|28.25||||||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Blue Cross PPO Specialty|BCBSTX PPO|28.25||||||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|28.25||||||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Medicare|MEDICARE ACUTE|28.25||||||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Medicaid|MEDICAID|28.25||||||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Humana Medicare Advantage|HUMANA MA|28.25||||||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|28.25||||||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|28.25||||||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Blue Cross PPO Specialty|BCBSTX OTHER|28.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Blue Cross HMO Specialty|BCBSTX HMO|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Humana Medicare Advantage|HUMANA MA|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Aetna|AETNA PPO|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Blue Cross PPO Specialty|BCBSTX PPO|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Managed Medicare|BCBS MEDICARE PPO MA|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Managed Medicare|HEALTHSPRING MA|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Medicare|MEDICARE ACUTE|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Blue Cross PPO Specialty|BCBSTX OTHER|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Medicaid|MEDICAID|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Access Direct Platinum|HEALTHFIRST TPA|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Aenta Medicare Advantage|AETNA MEDICARE MA|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Tricare|TRICARE EAST REGION|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Workers Compensation|WORKERS COMPENSATION OTHER|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|United Healthcare|UNITED HEALTHCARE|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|NON CONTRACTED|COMMERCIAL OTHER 1|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|United Healthcare|UNITED HEALTHCARE OTHER|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|United Medicare Advantage|UHC AARP MCR HMO MA|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|United Medicare Advantage|UHC MEDICARE GOLD MA|5.25||||||| 9500406|ERX|0250|TRIAMCINOLONE ACET 0.1% ,|United Healthcare|UNITED HEALTHCARE|44.25||||||| 9500406|ERX|0250|TRIAMCINOLONE ACET 0.1% ,|United Medicare Advantage|UHC AARP MCR HMO MA|44.25||||||| 9500406|ERX|0250|TRIAMCINOLONE ACET 0.1% ,|United Medicare Advantage|UHC MEDICARE GOLD MA|44.25||||||| 9500406|ERX|0250|TRIAMCINOLONE ACET 0.1% ,|Medicare|MEDICARE ACUTE|44.25||||||| 9500406|ERX|0250|TRIAMCINOLONE ACET 0.1% ,|Blue Cross PPO Specialty|BCBSTX PPO|44.25||||||| 9500406|ERX|0250|TRIAMCINOLONE ACET 0.1% ,|Humana Medicare Advantage|HUMANA MA|44.25||||||| 9500422|ERX|0250|NYSTATIN OINT, 15 GM|Medicare|MEDICARE ACUTE|0.37||||||| 9500422|ERX|0250|NYSTATIN OINT, 15 GM|United Medicare Advantage|UHC AARP MCR HMO MA|0.37||||||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|United Medicare Advantage|UHC AARP MCR HMO MA|35.50||||||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|United Healthcare|UNITED HEALTHCARE|35.50||||||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|United Medicare Advantage|UHC MEDICARE GOLD MA|35.50||||||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|Medicare|MEDICARE ACUTE|35.50||||||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|Managed Medicare|HEALTHSPRING MA|35.50||||||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Medicare|MEDICARE ACUTE|46.25||||||| 9500489|ERX|0250|HYDROCORTISONE 1% CREAM,|Medicare|MEDICARE ACUTE|44.25||||||| 9500489|ERX|0250|HYDROCORTISONE 1% CREAM,|Humana Medicare Advantage|HUMANA MA|44.25||||||| 9500539|ERX|0250|NEOMYC-BACITR-POLYMYX ,3.|Medicare|MEDICARE ACUTE|1.03||||||| 9500562|ERX|0250|BETAMETHASONE VAL 0.1% 1|United Medicare Advantage|UHC AARP MCR HMO MA|71.25||||||| 9500562|ERX|0250|BETAMETHASONE VAL 0.1% 1|Medicare|MEDICARE ACUTE|71.25||||||| 9500562|ERX|0250|BETAMETHASONE VAL 0.1% 1|Blue Cross HMO Specialty|BCBSTX HMO|71.25||||||| 9500596|ERX|0250|PETROLATUM, WHITE, 30 GM|Medicare|MEDICARE ACUTE|16.50||||||| 9500620|ERX|0250|ERYTHROMYCIN EYE OINT, 3.|Medicare|MEDICARE ACUTE|112.50||||||| 9500638|ERX|0250|GENTAMICIN 0.1% CREAM, 15|Blue Cross PPO Specialty|BCBSTX PPO|0.46||||||| 9500638|ERX|0250|GENTAMICIN 0.1% CREAM, 15|Medicare|MEDICARE ACUTE|0.46||||||| 9500653|ERX|0250|NYSTATIN-TRIAMCINOLONE 1|United Medicare Advantage|UHC MEDICARE GOLD MA|54.50||||||| 9500653|ERX|0250|NYSTATIN-TRIAMCINOLONE 1|Blue Cross PPO Specialty|BCBSTX PPO|54.50||||||| 9500653|ERX|0250|NYSTATIN-TRIAMCINOLONE 1|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|54.50||||||| 9500653|ERX|0250|NYSTATIN-TRIAMCINOLONE 1|Humana Medicare Advantage|HUMANA MA|54.50||||||| 9500661|ERX|0250|NYSTATIN-TRIAMCINOLONE ,1|Medicare|MEDICARE ACUTE|54.50||||||| 9500661|ERX|0250|NYSTATIN-TRIAMCINOLONE ,1|United Medicare Advantage|UHC AARP MCR HMO MA|54.50||||||| 9500679|ERX|0250|MICONAZOLE 2% CREAM, 30 G|Medicare|MEDICARE ACUTE|39.50||||||| 9500679|ERX|0250|MICONAZOLE 2% CREAM, 30 G|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|39.50||||||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|United Medicare Advantage|UHC MEDICARE GOLD MA|0.47||||||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|0.47||||||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|Medicare|MEDICARE ACUTE|0.47||||||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.47||||||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|Blue Cross HMO Specialty|BCBSTX HMO|0.47||||||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.47||||||| 9500737|ERX|0250|POLYCARBOPHIL 625MG TABLE|Medicare|MEDICARE ACUTE|2.75||||||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Managed Medicare|HEALTHSPRING MA|0.10||||||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Blue Cross PPO Specialty|BCBSTX PPO|0.10||||||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Medicare|MEDICARE ACUTE|0.10||||||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|43.50||||||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|United Medicare Advantage|UHC AARP MCR HMO MA|43.50||||||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Cigna|CIGNA|43.50||||||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|43.50||||||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Humana Medicare Advantage|HUMANA MA|43.50||||||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|43.50||||||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|43.50||||||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Medicare|MEDICARE ACUTE|43.50||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Humana Medicare Advantage|HUMANA MA|15.50||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|15.50||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|15.50||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Medicare|MEDICARE ACUTE|15.50||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|15.50||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|15.50||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|15.50||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Managed Medicare|HEALTHSPRING MA|15.50||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|15.50||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|15.50||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|15.50||||||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|PHCS|HUMANA INSURANCE|25.50||||||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Tricare|TRICARE EAST REGION|25.50||||||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Humana Medicare Advantage|HUMANA MA|25.50||||||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Medicare|MEDICARE ACUTE|25.50||||||| 9500927|ERX|0250|MINOCYCLINE 50MG CAPSULE|Medicare|MEDICARE ACUTE|51.75||||||| 9500927|ERX|0250|MINOCYCLINE 50MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|51.75||||||| 9500927|ERX|0250|MINOCYCLINE 50MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|51.75||||||| 9500927|ERX|0250|MINOCYCLINE 50MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|51.75||||||| 9500927|ERX|0250|MINOCYCLINE 50MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|51.75||||||| 9500943|ERX|0250|OXAZEPAM 15MG CAPSULE|Managed Medicare|HEALTHSPRING MA|15.50||||||| 9500943|ERX|0250|OXAZEPAM 15MG CAPSULE|Medicare|MEDICARE ACUTE|15.50||||||| 9500943|ERX|0250|OXAZEPAM 15MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|15.50||||||| 9500943|ERX|0250|OXAZEPAM 15MG CAPSULE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|15.50||||||| 9500968|ERX|0250|TAMOXIFEN 10MG TABLET|Medicare|MEDICARE ACUTE|24.25||||||| 9501016|ERX|0250|BUPROPION SR 150MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|38.25||||||| 9501016|ERX|0250|BUPROPION SR 150MG TABLET|Humana Medicare Advantage|HUMANA MA|38.25||||||| 9501016|ERX|0250|BUPROPION SR 150MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|38.25||||||| 9501024|ERX|0250|BUPROPION 75MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|25.50||||||| 9501032|ERX|0250|BUPROPION 100MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|31.25||||||| 9501032|ERX|0250|BUPROPION 100MG TABLET|Humana Medicare Advantage|HUMANA MA|31.25||||||| 9501032|ERX|0250|BUPROPION 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|31.25||||||| 9501032|ERX|0250|BUPROPION 100MG TABLET|Medicare|MEDICARE ACUTE|31.25||||||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Medicare|MEDICARE ACUTE|7.25||||||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|7.25||||||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Humana Medicare Advantage|HUMANA MA|7.25||||||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|7.25||||||| 9501073|ERX|0250|DIGOXIN 250MCG TABLET|PHCS|HUMANA INSURANCE|7.25||||||| 9501073|ERX|0250|DIGOXIN 250MCG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|7.25||||||| 9501073|ERX|0250|DIGOXIN 250MCG TABLET|Medicare|MEDICARE ACUTE|7.25||||||| 9501115|ERX|0250|CLOBETASOL 0.05% CREAM, 1|Medicare|MEDICARE ACUTE|527.75||||||| 9501115|ERX|0250|CLOBETASOL 0.05% CREAM, 1|Humana Medicare Advantage|HUMANA MA|527.75||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Tricare|TRICARE EAST REGION|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Humana Medicare Advantage|HUMANA MA|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Aetna|AETNA OTHER|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Aetna|AETNA PPO|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Managed Medicare|HEALTHSPRING MA|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Blue Cross PPO Specialty|BCBSTX OTHER|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Medicare|MEDICARE ACUTE|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|8.80||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|536.75||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Blue Cross HMO Specialty|BCBSTX HMO|536.75||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Humana Medicare Advantage|HUMANA MA|536.75||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Aetna|AETNA OTHER|536.75||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Managed Medicare|HEALTHSPRING MA|536.75||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|536.75||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Blue Cross PPO Specialty|BCBSTX PPO|536.75||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|536.75||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Medicare|MEDICARE ACUTE|536.75||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Medicaid|MEDICAID|536.75||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|United Healthcare|UNITED HEALTHCARE OTHER|536.75||||||| 9501255|ERX|0250|LAMOTRIGINE 25MG TABLET|United Healthcare|UNITED HEALTHCARE|49.75||||||| 9501255|ERX|0250|LAMOTRIGINE 25MG TABLET|Medicare|MEDICARE ACUTE|49.75||||||| 9501255|ERX|0250|LAMOTRIGINE 25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|49.75||||||| 9501255|ERX|0250|LAMOTRIGINE 25MG TABLET|Humana Medicare Advantage|HUMANA MA|49.75||||||| 9501263|ERX|0250|DEMECLOCYCLINE 150MG TABL|Medicare|MEDICARE ACUTE|1.21||||||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|PHCS|HUMANA INSURANCE|8.80||||||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|NON CONTRACTED|COMMERCIAL OTHER 1|8.80||||||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Humana Medicare Advantage|HUMANA MA|8.80||||||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|8.80||||||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Managed Medicare|BCBS MEDICARE PPO MA|8.80||||||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|8.80||||||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|8.80||||||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Medicare|MEDICARE ACUTE|8.80||||||| 9501305|ERX|0250|LAMOTRIGINE 100MG TABLET|Humana Medicare Advantage|HUMANA MA|54.25||||||| 9501305|ERX|0250|LAMOTRIGINE 100MG TABLET|Medicare|MEDICARE ACUTE|54.25||||||| 9501305|ERX|0250|LAMOTRIGINE 100MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|54.25||||||| 9501305|ERX|0250|LAMOTRIGINE 100MG TABLET|United Healthcare|UNITED HEALTHCARE|54.25||||||| 9501305|ERX|0250|LAMOTRIGINE 100MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|54.25||||||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|282.25||||||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Medicare|MEDICARE ACUTE|282.25||||||| 9501412|ERX|0250|DUTASTERIDE 0.5MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|0.37||||||| 9501412|ERX|0250|DUTASTERIDE 0.5MG CAPSULE|Medicare|MEDICARE ACUTE|0.37||||||| 9501412|ERX|0250|DUTASTERIDE 0.5MG CAPSULE|Managed Medicare|BCBS MEDICARE PPO MA|0.37||||||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|54.50||||||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|54.50||||||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|54.50||||||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|54.50||||||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Cigna|CIGNA|54.50||||||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Medicare|MEDICARE ACUTE|54.50||||||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|54.50||||||| 9501479|ERX|0250|SUMATRIPTAN 25MG TABLET|Medicare|MEDICARE ACUTE|2.82||||||| 9501479|ERX|0250|SUMATRIPTAN 25MG TABLET|Humana Medicare Advantage|HUMANA MA|2.82||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|72.25||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|72.25||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|72.25||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|72.25||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Managed Medicare|HEALTHSPRING MA|72.25||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|72.25||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|72.25||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Humana Medicare Advantage|HUMANA MA|72.25||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Medicare|MEDICARE ACUTE|72.25||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|72.25||||||| 9501560|ERX|0250|ACYCLOVIR 200MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|0.30||||||| 9501560|ERX|0250|ACYCLOVIR 200MG CAPSULE|Medicare|MEDICARE ACUTE|0.30||||||| 9501586|ERX|0250|POTASSIUM CITRATE 10 MEQ|Blue Cross PPO Specialty|BCBSTX PPO|9.25||||||| 9501594|ERX|0250|OLANZAPINE 2.5MG TABLET|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|86.75||||||| 9501594|ERX|0250|OLANZAPINE 2.5MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|86.75||||||| 9501594|ERX|0250|OLANZAPINE 2.5MG TABLET|Managed Medicare|HEALTHSPRING MA|86.75||||||| 9501594|ERX|0250|OLANZAPINE 2.5MG TABLET|Medicare|MEDICARE ACUTE|86.75||||||| 9501594|ERX|0250|OLANZAPINE 2.5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|86.75||||||| 9501602|ERX|0250|FINASTERIDE 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|35.50||||||| 9501602|ERX|0250|FINASTERIDE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|35.50||||||| 9501602|ERX|0250|FINASTERIDE 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|35.50||||||| 9501602|ERX|0250|FINASTERIDE 5MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|35.50||||||| 9501602|ERX|0250|FINASTERIDE 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|35.50||||||| 9501602|ERX|0250|FINASTERIDE 5MG TABLET|Medicare|MEDICARE ACUTE|35.50||||||| 9501610|ERX|0250|CALCIUM CITRATE W/VIT D T|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9501610|ERX|0250|CALCIUM CITRATE W/VIT D T|Medicare|MEDICARE ACUTE|2.50||||||| 9501610|ERX|0250|CALCIUM CITRATE W/VIT D T|United Medicare Advantage|UHC AARP MCR HMO MA|2.50||||||| 9501610|ERX|0250|CALCIUM CITRATE W/VIT D T|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9501610|ERX|0250|CALCIUM CITRATE W/VIT D T|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.50||||||| 9501651|ERX|0250|CYANOCOBALAMIN 500MCG TAB|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9501651|ERX|0250|CYANOCOBALAMIN 500MCG TAB|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|2.50||||||| 9501651|ERX|0250|CYANOCOBALAMIN 500MCG TAB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9501651|ERX|0250|CYANOCOBALAMIN 500MCG TAB|Medicare|MEDICARE ACUTE|2.50||||||| 9501651|ERX|0250|CYANOCOBALAMIN 500MCG TAB|United Medicare Advantage|UHC AARP MCR HMO MA|2.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|2.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|United Healthcare|UNITED HEALTHCARE|2.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Medicare|MEDICARE ACUTE|2.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|2.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|2.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|2.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Managed Medicare|HEALTHSPRING MA|2.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|2.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|2.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Medicaid|MEDICAID|2.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|NON CONTRACTED|COMMERCIAL OTHER 1|2.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|United Medicare Advantage|UHC AARP MCR HMO MA|2.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|United Healthcare|UNITED HEALTHCARE|2.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Workers Compensation|TEXAS MUTUAL INSURANCE|2.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Medicare|MEDICARE ACUTE|2.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9501701|ERX|0250|VITAMIN E 400 UNIT CAPSUL|Medicare|MEDICARE ACUTE|2.50||||||| 9501701|ERX|0250|VITAMIN E 400 UNIT CAPSUL|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9501727|ERX|0250|PYRIDOXINE 50MG TABLET|Medicare|MEDICARE ACUTE|2.50||||||| 9501727|ERX|0250|PYRIDOXINE 50MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|2.50||||||| 9501750|ERX|0250|PREDNISONE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9501750|ERX|0250|PREDNISONE 5MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|2.50||||||| 9501750|ERX|0250|PREDNISONE 5MG TABLET|Medicare|MEDICARE ACUTE|2.50||||||| 9501750|ERX|0250|PREDNISONE 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Medicare|MEDICARE ACUTE|2.50||||||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|2.50||||||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|2.50||||||| 9501776|ERX|0250|ISOSORBIDE DINITRATE 10MG|Humana Medicare Advantage|HUMANA MA|4.25||||||| 9501776|ERX|0250|ISOSORBIDE DINITRATE 10MG|Managed Medicare|BCBS MEDICARE PPO MA|4.25||||||| 9501776|ERX|0250|ISOSORBIDE DINITRATE 10MG|Blue Cross PPO Specialty|BCBSTX PPO|4.25||||||| 9501776|ERX|0250|ISOSORBIDE DINITRATE 10MG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.25||||||| 9501776|ERX|0250|ISOSORBIDE DINITRATE 10MG|Medicare|MEDICARE ACUTE|4.25||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|6.75||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Medicare|MEDICARE ACUTE|6.75||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|6.75||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|6.75||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Humana Medicare Advantage|HUMANA MA|6.75||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|6.75||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|6.75||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|6.75||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|6.75||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Managed Medicare|HEALTHSPRING MA|6.75||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|41.75||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|41.75||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|41.75||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Humana Medicare Advantage|HUMANA MA|41.75||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|41.75||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Managed Medicare|HEALTHSPRING MA|41.75||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Medicare|MEDICARE ACUTE|41.75||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|United Healthcare|UNITED HEALTHCARE|41.75||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|41.75||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|41.75||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|United Medicare Advantage|UHC AARP MCR HMO MA|2.75||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Medicare|MEDICARE ACUTE|2.75||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|United Healthcare|UNITED HEALTHCARE|2.75||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|United Medicare Advantage|UHC MEDICARE GOLD MA|2.75||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Access Direct Platinum|HEALTHFIRST TPA|2.75||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.75||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.75||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Blue Cross HMO Specialty|BCBSTX HMO|2.75||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Blue Cross PPO Specialty|BCBSTX PPO|2.75||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.75||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Humana Medicare Advantage|HUMANA MA|2.75||||||| 9501875|ERX|0250|HYDRALAZINE 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.75||||||| 9501875|ERX|0250|HYDRALAZINE 10MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|4.75||||||| 9501875|ERX|0250|HYDRALAZINE 10MG TABLET|Medicare|MEDICARE ACUTE|4.75||||||| 9501883|ERX|0250|CYANOCOBALAMIN 1000MCG TA|Medicare|MEDICARE ACUTE|2.50||||||| 9501883|ERX|0250|CYANOCOBALAMIN 1000MCG TA|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|2.50||||||| 9501883|ERX|0250|CYANOCOBALAMIN 1000MCG TA|Tricare|TRICARE EAST REGION|2.50||||||| 9501883|ERX|0250|CYANOCOBALAMIN 1000MCG TA|United Medicare Advantage|UHC AARP MCR HMO MA|2.50||||||| 9501883|ERX|0250|CYANOCOBALAMIN 1000MCG TA|United Healthcare|UNITED HEALTHCARE|2.50||||||| 9501883|ERX|0250|CYANOCOBALAMIN 1000MCG TA|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9501883|ERX|0250|CYANOCOBALAMIN 1000MCG TA|Aenta Medicare Advantage|AETNA MEDICARE MA|2.50||||||| 9501883|ERX|0250|CYANOCOBALAMIN 1000MCG TA|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9501883|ERX|0250|CYANOCOBALAMIN 1000MCG TA|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.50||||||| 9501883|ERX|0250|CYANOCOBALAMIN 1000MCG TA|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9501883|ERX|0250|CYANOCOBALAMIN 1000MCG TA|Managed Medicare|HEALTHSPRING MA|2.50||||||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|9.25||||||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Managed Medicare|BCBS MEDICARE PPO MA|9.25||||||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Access Direct Platinum|HEALTHFIRST TPA UMR|9.25||||||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Humana Medicare Advantage|HUMANA MA|9.25||||||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|9.25||||||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|9.25||||||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|9.25||||||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|United Healthcare|UNITED HEALTHCARE|9.25||||||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Workers Compensation|WORKERS COMPENSATION OTHER|9.25||||||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Medicare|MEDICARE ACUTE|9.25||||||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|United Medicare Advantage|UHC AARP MCR HMO MA|9.25||||||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|9.25||||||| 9501917|ERX|0250|CYPROHEPTADINE 4MG TABLET|United Healthcare|UNITED HEALTHCARE|7.75||||||| 9501917|ERX|0250|CYPROHEPTADINE 4MG TABLET|Medicare|MEDICARE ACUTE|7.75||||||| 9501925|ERX|0250|CARBAMAZEPINE 200MG TABLE|Medicare|MEDICARE ACUTE|0.08||||||| 9501925|ERX|0250|CARBAMAZEPINE 200MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.08||||||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|Humana Medicare Advantage|HUMANA MA|0.08||||||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.08||||||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|Medicare|MEDICARE ACUTE|0.08||||||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|0.08||||||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.08||||||| 9501958|ERX|0250|PREDNISONE 10MG TABLET|Medicare|MEDICARE ACUTE|2.50||||||| 9501958|ERX|0250|PREDNISONE 10MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|2.50||||||| 9501958|ERX|0250|PREDNISONE 10MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|2.50||||||| 9501958|ERX|0250|PREDNISONE 10MG TABLET|Managed Medicare|HEALTHSPRING MA|2.50||||||| 9501958|ERX|0250|PREDNISONE 10MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|2.50||||||| 9501958|ERX|0250|PREDNISONE 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Managed Medicare|HEALTHSPRING MA|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Aetna|AETNA PPO|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Cigna|CIGNA|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Blue Cross PPO Specialty|BCBSTX OTHER|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|United Healthcare|TML GROUP BENEFITS|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Medicare|MEDICARE ACUTE|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|PHCS|HUMANA INSURANCE|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|2.50||||||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|United Healthcare|UNITED HEALTHCARE|26.25||||||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|Medicare|MEDICARE ACUTE|26.25||||||| 9502063|ERX|0250|BISMUTH SUBSAL 262MG/15ML|Humana Medicare Advantage|HUMANA MA|5.75||||||| 9502063|ERX|0250|BISMUTH SUBSAL 262MG/15ML|Managed Medicare|HEALTHSPRING MA|5.75||||||| 9502063|ERX|0250|BISMUTH SUBSAL 262MG/15ML|Medicare|MEDICARE ACUTE|5.75||||||| 9502089|ERX|0250|PROPRANOLOL 10MG TABLET|PHCS|HUMANA INSURANCE|0.05||||||| 9502089|ERX|0250|PROPRANOLOL 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.05||||||| 9502089|ERX|0250|PROPRANOLOL 10MG TABLET|Medicare|MEDICARE ACUTE|0.05||||||| 9502089|ERX|0250|PROPRANOLOL 10MG TABLET|Humana Medicare Advantage|HUMANA MA|0.05||||||| 9502089|ERX|0250|PROPRANOLOL 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.05||||||| 9502121|ERX|0250|METOCLOPRAMIDE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|7.75||||||| 9502121|ERX|0250|METOCLOPRAMIDE 5MG TABLET|Aetna|AETNA PPO|7.75||||||| 9502121|ERX|0250|METOCLOPRAMIDE 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|7.75||||||| 9502121|ERX|0250|METOCLOPRAMIDE 5MG TABLET|Medicare|MEDICARE ACUTE|7.75||||||| 9502121|ERX|0250|METOCLOPRAMIDE 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|7.75||||||| 9502121|ERX|0250|METOCLOPRAMIDE 5MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|7.75||||||| 9502139|ERX|0250|NITROFURANTOIN MACRO 50MG|Medicare|MEDICARE ACUTE|15.50||||||| 9502139|ERX|0250|NITROFURANTOIN MACRO 50MG|United Medicare Advantage|UHC AARP MCR HMO MA|15.50||||||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|Blue Cross HMO Specialty|BCBSTX HMO|2.50||||||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|Managed Medicare|HEALTHSPRING MA|2.50||||||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.50||||||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|United Medicare Advantage|UHC AARP MCR HMO MA|2.50||||||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|United Healthcare|UNITED HEALTHCARE|2.50||||||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|Medicare|MEDICARE ACUTE|2.50||||||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9502170|ERX|0250|FOLIC ACID 0.4MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Aenta Medicare Advantage|AETNA MEDICARE MA|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Blue Cross HMO Specialty|BCBSTX HMO|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Cigna|CIGNA|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Aetna|AETNA PPO|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Medicaid|MEDICAID|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Managed Medicare|BCBS MEDICARE PPO MA|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Access Direct Platinum|HEALTHFIRST TPA|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Managed Medicare|HEALTHSPRING MA|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Blue Cross PPO Specialty|BCBSTX OTHER|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|United Medicare Advantage|UHC AARP MCR HMO MA|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Veterans Affairs|VETERANS ADMINISTRATION|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|United Healthcare|UNITED HEALTHCARE|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Workers Compensation|TEXAS MUTUAL INSURANCE|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Medicare|MEDICARE ACUTE|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9502196|ERX|0250|CLOTRIMAZOLE 7 DAY VAG 4|Medicare|MEDICARE ACUTE|92.50||||||| 9502196|ERX|0250|CLOTRIMAZOLE 7 DAY VAG 4|United Medicare Advantage|UHC MEDICARE GOLD MA|92.50||||||| 9502196|ERX|0250|CLOTRIMAZOLE 7 DAY VAG 4|Humana Medicare Advantage|HUMANA MA|92.50||||||| 9502196|ERX|0250|CLOTRIMAZOLE 7 DAY VAG 4|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|92.50||||||| 9502196|ERX|0250|CLOTRIMAZOLE 7 DAY VAG 4|Blue Cross PPO Specialty|BCBSTX OTHER|92.50||||||| 9502196|ERX|0250|CLOTRIMAZOLE 7 DAY VAG 4|Managed Medicaid|MEDICAID UNITED HEALTHCARE|92.50||||||| 9502196|ERX|0250|CLOTRIMAZOLE 7 DAY VAG 4|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|92.50||||||| 9502196|ERX|0250|CLOTRIMAZOLE 7 DAY VAG 4|Blue Cross PPO Specialty|BCBSTX PPO|92.50||||||| 9502212|ERX|0250|CARBAMIDE PEROXIDE DROP,|Medicare|MEDICARE ACUTE|36.75||||||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|0.10||||||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|0.10||||||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Medicare|MEDICARE ACUTE|0.10||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Medicare|MEDICARE ACUTE|2.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|2.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|2.50||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Managed Medicare|HEALTHSPRING MA|4.25||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Blue Cross PPO Specialty|BCBSTX PPO|4.25||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Humana Medicare Advantage|HUMANA MA|4.25||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|4.25||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.25||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Blue Cross HMO Specialty|BCBSTX HMO|4.25||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Workers Compensation|WORKERS COMPENSATION OTHER|4.25||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|PHCS|HUMANA INSURANCE|4.25||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|United Healthcare|UNITED HEALTHCARE|4.25||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Medicare|MEDICARE ACUTE|4.25||||||| 9502352|ERX|0250|NABUMETONE 500MG TABLET|Medicare|MEDICARE ACUTE|17.50||||||| 9502352|ERX|0250|NABUMETONE 500MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|17.50||||||| 9502402|ERX|0250|CHOLESTYRAMINE-ASPART 4G|Medicare|MEDICARE ACUTE|34.50||||||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|38.25||||||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Aetna|AETNA PPO|38.25||||||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Blue Cross PPO Specialty|BCBSTX PPO|38.25||||||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Medicare|MEDICARE ACUTE|38.25||||||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|United Medicare Advantage|UHC AARP MCR HMO MA|38.25||||||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|United Medicare Advantage|UHC MEDICARE GOLD MA|38.25||||||| 9502444|ERX|0250|LIDOCAINE 2%MDV 20ML|Medicare|MEDICARE ACUTE|0.43||||||| 9502493|ERX|0250|LIDOCAINE 2%MDV 50ML|Medicare|MEDICARE ACUTE|||||76.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|37.75||||||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Humana Medicare Advantage|HUMANA MA|37.75||||||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Blue Cross HMO Specialty|BCBSTX HMO|37.75||||||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Aetna|AETNA PPO|37.75||||||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Blue Cross PPO Specialty|BCBSTX PPO|37.75||||||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|PHCS|HUMANA INSURANCE|37.75||||||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Medicare|MEDICARE ACUTE|37.75||||||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|United Healthcare|UNITED HEALTHCARE|37.75||||||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|37.75||||||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|United Medicare Advantage|UHC AARP MCR HMO MA|37.75||||||| 9502519|ERX|0250|LIDOCAINE 4%PF 40MG/ML, 5|Medicare|MEDICARE ACUTE|93.25||||||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Blue Cross PPO Specialty|BCBSTX PPO|231.75||||||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Medicare|MEDICARE ACUTE|94.50||||||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Blue Cross PPO Specialty|BCBSTX PPO|94.50||||||| 9502576|ERX|0250|BUDESONIDE 3MG CAPSULE|Medicare|MEDICARE ACUTE|51.50||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|15.50||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Humana Medicare Advantage|HUMANA MA|15.50||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|15.50||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Blue Cross PPO Specialty|BCBSTX PPO|15.50||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Managed Medicare|BCBS MEDICARE PPO MA|15.50||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Blue Cross HMO Specialty|BCBSTX HMO|15.50||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|15.50||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|United Medicare Advantage|UHC AARP MCR HMO MA|15.50||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Medicare|MEDICARE ACUTE|15.50||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|United Healthcare|UNITED HEALTHCARE OTHER|15.50||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|United Medicare Advantage|UHC MEDICARE GOLD MA|15.50||||||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|United Healthcare|UNITED HEALTHCARE|15.50||||||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Veterans Affairs|VETERANS ADMINISTRATION|15.50||||||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Medicare|MEDICARE ACUTE|15.50||||||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|United Medicare Advantage|UHC MEDICARE GOLD MA|15.50||||||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|United Medicare Advantage|UHC AARP MCR HMO MA|15.50||||||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Blue Cross PPO Specialty|BCBSTX PPO|15.50||||||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Humana Medicare Advantage|HUMANA MA|15.50||||||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Aetna|AETNA PPO|15.50||||||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Access Direct Platinum|HEALTHFIRST TPA|15.50||||||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|15.50||||||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|15.50||||||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Managed Medicare|HEALTHSPRING MA|15.50||||||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|Humana Medicare Advantage|HUMANA MA|1.05||||||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|United Healthcare|UNITED HEALTHCARE|1.05||||||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|Medicare|MEDICARE ACUTE|1.05||||||| 9502733|ERX|0250|BUDESONIDE NEB 0.25MG/2ML|Medicare|MEDICARE ACUTE|71.25||||||| 9502733|ERX|0250|BUDESONIDE NEB 0.25MG/2ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|71.25||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Humana Medicare Advantage|HUMANA MA|72.50||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Aetna|AETNA PPO|72.50||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|72.50||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|72.50||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Managed Medicare|HEALTHSPRING MA|72.50||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|72.50||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Blue Cross HMO Specialty|BCBSTX HMO|72.50||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|PHCS|HUMANA INSURANCE|72.50||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|United Healthcare|UNITED HEALTHCARE OTHER|72.50||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Medicare|MEDICARE ACUTE|72.50||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|United Medicare Advantage|UHC AARP MCR HMO MA|72.50||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|72.50||||||| 9502758|ERX|0250|ESOMEPRAZOLE 40MG PACKET|Medicare|MEDICARE ACUTE|43.25||||||| 9502758|ERX|0250|ESOMEPRAZOLE 40MG PACKET|United Medicare Advantage|UHC AARP MCR HMO MA|43.25||||||| 9502758|ERX|0250|ESOMEPRAZOLE 40MG PACKET|Aenta Medicare Advantage|AETNA MEDICARE MA|43.25||||||| 9502758|ERX|0250|ESOMEPRAZOLE 40MG PACKET|Humana Medicare Advantage|HUMANA MA|43.25||||||| 9502758|ERX|0250|ESOMEPRAZOLE 40MG PACKET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|43.25||||||| 9502758|ERX|0250|ESOMEPRAZOLE 40MG PACKET|Blue Cross PPO Specialty|BCBSTX PPO|43.25||||||| 9502758|ERX|0250|ESOMEPRAZOLE 40MG PACKET|Blue Cross HMO Specialty|BCBSTX HMO|43.25||||||| 9502758|ERX|0250|ESOMEPRAZOLE 40MG PACKET|Medicaid|MEDICAID|43.25||||||| 9502808|ERX|0250|DEXTROSE GEL 15 G|Medicare|MEDICARE ACUTE|27.25||||||| 9502824|ERX|0250|PYRIDOSTIGMINE 60MG TABLE|Medicare|MEDICARE ACUTE|15.50||||||| 9502840|ERX|0250|PYRIDOSTIGINE TIMESPAN 18|Medicare|MEDICARE ACUTE|23.50||||||| 9502865|ERX|0250|FLUCYTOSINE 250MG CAPSULE|Medicare|MEDICARE ACUTE|65.75||||||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|Cigna|CIGNA|0.25||||||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|Humana Medicare Advantage|HUMANA MA|0.25||||||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|Managed Medicare|HEALTHSPRING MA|0.25||||||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|0.25||||||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.25||||||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.25||||||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.25||||||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.25||||||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.25||||||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.25||||||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|United Healthcare|UNITED HEALTHCARE|0.25||||||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|PHCS|HUMANA INSURANCE|0.25||||||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.25||||||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|0.25||||||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|Medicare|MEDICARE ACUTE|0.25||||||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.25||||||| 9503004|ERX|0250|FIBER (GUAR GUM) PACKET|Medicare|MEDICARE ACUTE|6.75||||||| 9503046|ERX|0250|SODIUM CHLORIDE 1 G TABLE|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9503046|ERX|0250|SODIUM CHLORIDE 1 G TABLE|Managed Medicare|HEALTHSPRING MA|2.50||||||| 9503046|ERX|0250|SODIUM CHLORIDE 1 G TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9503046|ERX|0250|SODIUM CHLORIDE 1 G TABLE|Medicare|MEDICARE ACUTE|2.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Tricare|TRICARE EAST REGION|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Medicare|MEDICARE ACUTE|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Workers Compensation|WORKERS COMPENSATION OTHER|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|United Medicare Advantage|UHC AARP MCR HMO MA|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Cigna|CIGNA|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|United Healthcare|UNITED HEALTHCARE OTHER|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|PHCS|HUMANA INSURANCE|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Aetna|AETNA PPO|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Access Direct Platinum|HEALTHFIRST TPA|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Medicaid|MEDICAID|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Blue Cross PPO Specialty|BCBSTX OTHER|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Cigna|CIGNA|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Managed Medicare|BCBS MEDICARE PPO MA|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Blue Cross HMO Specialty|BCBSTX HMO|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Humana Medicare Advantage|HUMANA MA|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Aetna|AETNA PPO|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Blue Cross PPO Specialty|BCBSTX OTHER|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Blue Cross PPO Specialty|BCBSTX PPO|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Managed Medicare|HEALTHSPRING MA|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Access Direct Platinum|HEALTHFIRST TPA|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Access Direct Platinum|HEALTHFIRST TPA UMR|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Medicaid|MEDICAID|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|United Healthcare|UNITED HEALTHCARE OTHER|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Tricare|TRICARE EAST REGION|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|United Medicare Advantage|UHC AARP MCR HMO MA|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|PHCS|HUMANA INSURANCE|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|United Healthcare|UNITED HEALTHCARE|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Workers Compensation|WORKERS COMPENSATION OTHER|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Veterans Affairs|VETERANS ADMINISTRATION|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Medicare|MEDICARE ACUTE|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Workers Compensation|TEXAS MUTUAL INSURANCE|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|NON CONTRACTED|COMMERCIAL OTHER 1|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|United Medicare Advantage|UHC MEDICARE GOLD MA|5.50||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|NON CONTRACTED|COMMERCIAL OTHER 1|2.50||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Workers Compensation|TEXAS MUTUAL INSURANCE|2.50||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|United Medicare Advantage|UHC AARP MCR HMO MA|2.50||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Medicare|MEDICARE ACUTE|2.50||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Aenta Medicare Advantage|AETNA MEDICARE MA|2.50||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.50||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.50||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Blue Cross HMO Specialty|BCBSTX HMO|2.50||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.50||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Medicaid|MEDICAID|2.50||||||| 9503152|ERX|0250|MULTIVITAMINS TABLET|Cigna|CIGNA|2.50||||||| 9503152|ERX|0250|MULTIVITAMINS TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9503152|ERX|0250|MULTIVITAMINS TABLET|United Healthcare|UNITED HEALTHCARE|2.50||||||| 9503152|ERX|0250|MULTIVITAMINS TABLET|Tricare|TRICARE EAST REGION|2.50||||||| 9503152|ERX|0250|MULTIVITAMINS TABLET|Medicare|MEDICARE ACUTE|2.50||||||| 9503152|ERX|0250|MULTIVITAMINS TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9503202|ERX|0250|NA CHL 0.65% NASAL SPRAY,|Medicare|MEDICARE ACUTE|39.50||||||| 9503202|ERX|0250|NA CHL 0.65% NASAL SPRAY,|United Healthcare|UNITED HEALTHCARE|39.50||||||| 9503210|ERX|0250|MAGNESIUM GLUCONATE 500MG|Blue Cross PPO Specialty|BCBSTX PPO|4.25||||||| 9503210|ERX|0250|MAGNESIUM GLUCONATE 500MG|Managed Medicare|HEALTHSPRING MA|4.25||||||| 9503210|ERX|0250|MAGNESIUM GLUCONATE 500MG|United Medicare Advantage|UHC AARP MCR HMO MA|4.25||||||| 9503210|ERX|0250|MAGNESIUM GLUCONATE 500MG|Workers Compensation|TEXAS MUTUAL INSURANCE|4.25||||||| 9503210|ERX|0250|MAGNESIUM GLUCONATE 500MG|Medicare|MEDICARE ACUTE|4.25||||||| 9503434|ERX|0250|ANASTROZOLE 1MG TABLET|Medicare|MEDICARE ACUTE|113.50||||||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|Cigna|CIGNA|0.46||||||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|Managed Medicare|HEALTHSPRING MA|0.46||||||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|Medicare|MEDICARE ACUTE|0.46||||||| 9503475|ERX|0250|DORZOLAMIDE 2% EYE DROP,|Medicare|MEDICARE ACUTE|514.50||||||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Humana Medicare Advantage|HUMANA MA|26.75||||||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Managed Medicare|HEALTHSPRING MA|26.75||||||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|26.75||||||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|26.75||||||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|26.75||||||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Workers Compensation|TEXAS MUTUAL INSURANCE|26.75||||||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Medicare|MEDICARE ACUTE|26.75||||||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|United Healthcare|UNITED HEALTHCARE|26.75||||||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|26.75||||||| 9503558|ERX|0250|BICALUTAMIDE 50MG TABLET|Medicare|MEDICARE ACUTE|187.25||||||| 9503558|ERX|0250|BICALUTAMIDE 50MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|187.25||||||| 9503574|ERX|0250|ROSUVASTATIN 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.39||||||| 9503574|ERX|0250|ROSUVASTATIN 10MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.39||||||| 9503574|ERX|0250|ROSUVASTATIN 10MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|0.39||||||| 9503574|ERX|0250|ROSUVASTATIN 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.39||||||| 9503574|ERX|0250|ROSUVASTATIN 10MG TABLET|Medicare|MEDICARE ACUTE|0.39||||||| 9503574|ERX|0250|ROSUVASTATIN 10MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|0.39||||||| 9503574|ERX|0250|ROSUVASTATIN 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.39||||||| 9503582|ERX|0250|ROSUVASTATIN 20MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.39||||||| 9503582|ERX|0250|ROSUVASTATIN 20MG TABLET|Medicare|MEDICARE ACUTE|0.39||||||| 9503582|ERX|0250|ROSUVASTATIN 20MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.39||||||| 9503582|ERX|0250|ROSUVASTATIN 20MG TABLET|Humana Medicare Advantage|HUMANA MA|0.39||||||| 9503582|ERX|0250|ROSUVASTATIN 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.39||||||| 9503582|ERX|0250|ROSUVASTATIN 20MG TABLET|Managed Medicare|HEALTHSPRING MA|0.39||||||| 9503582|ERX|0250|ROSUVASTATIN 20MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.39||||||| 9503582|ERX|0250|ROSUVASTATIN 20MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.39||||||| 9503590|ERX|0250|ROSUVASTATIN 5MG TABLET|Medicare|MEDICARE ACUTE|0.39||||||| 9503608|ERX|0258|WATER FOR IRRIGATION 3000|Medicare|MEDICARE ACUTE|105.75||||||| 9503640|ERX|0258|CEFAZOLIN 1 GM/50ML D5W|Medicare|MEDICARE ACUTE|110.50||||||| 9503657|ERX|0258|VANCOMYCIN 1000MG/200ML D|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|377.50||||||| 9503657|ERX|0258|VANCOMYCIN 1000MG/200ML D|Aenta Medicare Advantage|AETNA MEDICARE MA|377.50||||||| 9503657|ERX|0258|VANCOMYCIN 1000MG/200ML D|Blue Cross HMO Specialty|BCBSTX HMO|377.50||||||| 9503657|ERX|0258|VANCOMYCIN 1000MG/200ML D|Managed Medicaid|MEDICAID UNITED HEALTHCARE|377.50||||||| 9503657|ERX|0258|VANCOMYCIN 1000MG/200ML D|Humana Medicare Advantage|HUMANA MA|377.50||||||| 9503657|ERX|0258|VANCOMYCIN 1000MG/200ML D|Blue Cross PPO Specialty|BCBSTX PPO|377.50||||||| 9503657|ERX|0258|VANCOMYCIN 1000MG/200ML D|United Medicare Advantage|UHC AARP MCR HMO MA|377.50||||||| 9503657|ERX|0258|VANCOMYCIN 1000MG/200ML D|United Medicare Advantage|UHC MEDICARE GOLD MA|377.50||||||| 9503657|ERX|0258|VANCOMYCIN 1000MG/200ML D|Medicare|MEDICARE ACUTE|377.50||||||| 9503657|ERX|0258|VANCOMYCIN 1000MG/200ML D|Workers Compensation|WORKERS COMPENSATION OTHER|377.50||||||| 9503657|ERX|0258|VANCOMYCIN 1000MG/200ML D|Workers Compensation|TEXAS MUTUAL INSURANCE|377.50||||||| 9503657|ERX|0258|VANCOMYCIN 1000MG/200ML D|United Healthcare|UNITED HEALTHCARE|377.50||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|PHCS|HUMANA INSURANCE|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|United Healthcare|UNITED HEALTHCARE OTHER|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Tricare|TRICARE EAST REGION|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|United Healthcare|UNITED HEALTHCARE|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|NON CONTRACTED|COMMERCIAL OTHER 1|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Medicare|MEDICARE ACUTE|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|United Medicare Advantage|UHC MEDICARE GOLD MA|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|United Medicare Advantage|UHC AARP MCR HMO MA|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Cigna|CIGNA|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Managed Medicare|HEALTHSPRING MA|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Cigna|CIGNA OTHER|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Humana Medicare Advantage|HUMANA MA|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Blue Cross PPO Specialty|BCBSTX PPO|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Aetna|AETNA OTHER|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Managed Medicare|BCBS MEDICARE PPO MA|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Blue Cross HMO Specialty|BCBSTX HMO|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Access Direct Platinum|HEALTHFIRST TPA|5.25||||||| 9503780|ERX|0250|TIMOLOL/DORZOLAM DROP,10M|Medicare|MEDICARE ACUTE|1,010.25||||||| 9503780|ERX|0250|TIMOLOL/DORZOLAM DROP,10M|United Medicare Advantage|UHC AARP MCR HMO MA|1,010.25||||||| 9503848|ERX|0250|GUANFACINE 1MG TABLET|Medicare|MEDICARE ACUTE|13.50||||||| 9503863|ERX|0250|LEVOTHYROXINE 25MCG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|5.25||||||| 9503863|ERX|0250|LEVOTHYROXINE 25MCG TABLE|Managed Medicare|BCBS MEDICARE PPO MA|5.25||||||| 9503863|ERX|0250|LEVOTHYROXINE 25MCG TABLE|Humana Medicare Advantage|HUMANA MA|5.25||||||| 9503863|ERX|0250|LEVOTHYROXINE 25MCG TABLE|Managed Medicare|HEALTHSPRING MA|5.25||||||| 9503863|ERX|0250|LEVOTHYROXINE 25MCG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|5.25||||||| 9503863|ERX|0250|LEVOTHYROXINE 25MCG TABLE|Medicare|MEDICARE ACUTE|5.25||||||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Medicare|MEDICARE ACUTE|5.25||||||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|5.25||||||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Humana Medicare Advantage|HUMANA MA|5.25||||||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Aetna|AETNA PPO|5.25||||||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Managed Medicare|HEALTHSPRING MA|5.25||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Cigna|CIGNA|5.50||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|5.50||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Humana Medicare Advantage|HUMANA MA|5.50||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Medicare|MEDICARE ACUTE|5.50||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|United Healthcare|UNITED HEALTHCARE OTHER|5.50||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|5.50||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|United Medicare Advantage|UHC AARP MCR HMO MA|5.50||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Medicare|MEDICARE ACUTE|5.50||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Veterans Affairs|VETERANS ADMINISTRATION|5.50||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|United Medicare Advantage|UHC MEDICARE GOLD MA|5.50||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|United Healthcare|UNITED HEALTHCARE OTHER|5.50||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Humana Medicare Advantage|HUMANA MA|5.50||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Blue Cross HMO Specialty|BCBSTX HMO|5.50||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Blue Cross PPO Specialty|BCBSTX PPO|5.50||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.50||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|5.50||||||| 9503905|ERX|0250|LEVOTHYROXINE 112MCG TABL|Humana Medicare Advantage|HUMANA MA|6.75||||||| 9503905|ERX|0250|LEVOTHYROXINE 112MCG TABL|Blue Cross PPO Specialty|BCBSTX PPO|6.75||||||| 9503905|ERX|0250|LEVOTHYROXINE 112MCG TABL|Medicare|MEDICARE ACUTE|6.75||||||| 9503905|ERX|0250|LEVOTHYROXINE 112MCG TABL|United Healthcare|UNITED HEALTHCARE|6.75||||||| 9503905|ERX|0250|LEVOTHYROXINE 112MCG TABL|United Medicare Advantage|UHC MEDICARE GOLD MA|6.75||||||| 9503905|ERX|0250|LEVOTHYROXINE 112MCG TABL|United Medicare Advantage|UHC AARP MCR HMO MA|6.75||||||| 9503913|ERX|0250|LEVOTHYROXINE 125MCG TABL|Medicare|MEDICARE ACUTE|6.75||||||| 9503913|ERX|0250|LEVOTHYROXINE 125MCG TABL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|6.75||||||| 9503913|ERX|0250|LEVOTHYROXINE 125MCG TABL|Humana Medicare Advantage|HUMANA MA|6.75||||||| 9503954|ERX|0250|NITROGLYCERIN 0.1MG PATCH|Medicare|MEDICARE ACUTE|20.50||||||| 9503962|ERX|0250|NITROGLYCERIN 0.2MG PATCH|Humana Medicare Advantage|HUMANA MA|20.75||||||| 9503970|ERX|0250|NITROGLYCERIN 0.4MG PATCH|Medicare|MEDICARE ACUTE|0.24||||||| 9504051|ERX|0250|MORPHINE ER 15MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.14||||||| 9504051|ERX|0250|MORPHINE ER 15MG TABLET|Medicare|MEDICARE ACUTE|0.14||||||| 9504051|ERX|0250|MORPHINE ER 15MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.14||||||| 9504101|ERX|0250|TEMAZEPAM 7.5MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|76.25||||||| 9504101|ERX|0250|TEMAZEPAM 7.5MG CAPSULE|Medicare|MEDICARE ACUTE|76.25||||||| 9504101|ERX|0250|TEMAZEPAM 7.5MG CAPSULE|NON CONTRACTED|COMMERCIAL OTHER 1|76.25||||||| 9504101|ERX|0250|TEMAZEPAM 7.5MG CAPSULE|Humana Medicare Advantage|HUMANA MA|76.25||||||| 9504101|ERX|0250|TEMAZEPAM 7.5MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|76.25||||||| 9504101|ERX|0250|TEMAZEPAM 7.5MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|76.25||||||| 9504101|ERX|0250|TEMAZEPAM 7.5MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|76.25||||||| 9504176|ERX|0250|VERAPAMIL 5MG/2ML|Medicare|MEDICARE ACUTE|17.25||||||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|0.55||||||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|Managed Medicare|HEALTHSPRING MA|0.55||||||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|United Medicare Advantage|UHC AARP MCR HMO MA|0.55||||||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|Medicare|MEDICARE ACUTE|0.55||||||| 9504234|ERX|0636|MORPHINE 10MG/1ML|United Medicare Advantage|UHC AARP MCR HMO MA|17.50||||||| 9504234|ERX|0636|MORPHINE 10MG/1ML|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|17.50||||||| 9504234|ERX|0636|MORPHINE 10MG/1ML|Medicare|MEDICARE ACUTE|17.50||||||| 9504234|ERX|0636|MORPHINE 10MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|17.50||||||| 9504234|ERX|0636|MORPHINE 10MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|17.50||||||| 9504234|ERX|0636|MORPHINE 10MG/1ML|Access Direct Platinum|HEALTHFIRST TPA|17.50||||||| 9504234|ERX|0636|MORPHINE 10MG/1ML|Humana Medicare Advantage|HUMANA MA|17.50||||||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Humana Medicare Advantage|HUMANA MA|17.50||||||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|17.50||||||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|17.50||||||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Medicare|MEDICARE ACUTE|17.50||||||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|United Medicare Advantage|UHC AARP MCR HMO MA|17.50||||||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Medicare|MEDICARE ACUTE|0.36||||||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Blue Cross HMO Specialty|BCBSTX HMO|0.36||||||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.36||||||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Blue Cross HMO Specialty|BCBSTX HMO|34.75||||||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Medicare|MEDICARE ACUTE|34.75||||||| 9504416|ERX|0250|BUPIVACAINE 0.75%PF 10ML|Medicare|MEDICARE ACUTE|39.25||||||| 9504473|ERX|0250|BUPIVACAINE 0.5% MDV 50ML|Medicare|MEDICARE ACUTE|0.46||||||| 9504531|ERX|0250|BUPIVACAINE-EPI 0.25%MDV|Blue Cross PPO Specialty|BCBSTX PPO|0.70||||||| 9504598|ERX|0250|AMIKACIN 250MG/ML|Medicare|MEDICARE ACUTE|129.50||||||| 9504606|ERX|0250|NA CHLORIDE 0.9%(B'STAT)|Medicare|MEDICARE ACUTE|0.13||||||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.66||||||| 9504705|ERX|0250|LIDOCAINE-EPI 1% MDV 30ML|Medicare|MEDICARE ACUTE|62.50||||||| 9504705|ERX|0250|LIDOCAINE-EPI 1% MDV 30ML|Humana Medicare Advantage|HUMANA MA|62.50||||||| 9504796|ERX|0250|RALOXIFENE 60MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|36.75||||||| 9504796|ERX|0250|RALOXIFENE 60MG TABLET|Medicare|MEDICARE ACUTE|36.75||||||| 9504804|ERX|0250|FONDAPARINUX 2.5MG/0.5ML|Blue Cross HMO Specialty|BCBSTX HMO|4.47||||||| 9504804|ERX|0250|FONDAPARINUX 2.5MG/0.5ML|Medicare|MEDICARE ACUTE|4.47||||||| 9504929|ERX|0250|WATER FOR INJ.,STERILE 20|United Medicare Advantage|UHC MEDICARE GOLD MA|0.13||||||| 9504929|ERX|0250|WATER FOR INJ.,STERILE 20|United Healthcare|UNITED HEALTHCARE|0.13||||||| 9504929|ERX|0250|WATER FOR INJ.,STERILE 20|Medicare|MEDICARE ACUTE|0.13||||||| 9504929|ERX|0250|WATER FOR INJ.,STERILE 20|Tricare|TRICARE EAST REGION|0.13||||||| 9504929|ERX|0250|WATER FOR INJ.,STERILE 20|United Medicare Advantage|UHC AARP MCR HMO MA|0.13||||||| 9504929|ERX|0250|WATER FOR INJ.,STERILE 20|Aenta Medicare Advantage|AETNA MEDICARE MA|0.13||||||| 9504929|ERX|0250|WATER FOR INJ.,STERILE 20|Humana Medicare Advantage|HUMANA MA|0.13||||||| 9504929|ERX|0250|WATER FOR INJ.,STERILE 20|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||||| 9504929|ERX|0250|WATER FOR INJ.,STERILE 20|Managed Medicare|HEALTHSPRING MA|0.13||||||| 9504945|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|Medicare|MEDICARE ACUTE|0.13||||||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Aenta Medicare Advantage|AETNA MEDICARE MA|61.50||||||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Blue Cross PPO Specialty|BCBSTX PPO|61.50||||||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Medicare|MEDICARE ACUTE|61.50||||||| 9504994|ERX|0250|LIDOCAINE ABBOJECT 100MG/|Medicare|MEDICARE ACUTE|46.50||||||| 9504994|ERX|0250|LIDOCAINE ABBOJECT 100MG/|Humana Medicare Advantage|HUMANA MA|46.50||||||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|Medicare|MEDICARE ACUTE|0.48||||||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Medicare|MEDICARE ACUTE|150.25||||||| 9505025|ERX|0250|CA CHLORIDE 1000MG/10ML|Medicare|MEDICARE ACUTE|49.25||||||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Medicare|MEDICARE ACUTE|0.13||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.13||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Access Direct Platinum|HEALTHFIRST TPA|0.13||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Cigna|CIGNA OTHER|0.13||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Humana Medicare Advantage|HUMANA MA|0.13||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Blue Cross HMO Specialty|BCBSTX HMO|0.13||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.13||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.13||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|United Medicare Advantage|UHC AARP MCR HMO MA|0.13||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|PHCS|HUMANA INSURANCE|0.13||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|0.13||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|United Healthcare|UNITED HEALTHCARE|0.13||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Medicare|MEDICARE ACUTE|0.13||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|114.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|United Medicare Advantage|UHC AARP MCR HMO MA|114.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|United Healthcare|UNITED HEALTHCARE|114.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Workers Compensation|WORKERS COMPENSATION OTHER|114.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Medicare|MEDICARE ACUTE|114.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|114.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Humana Medicare Advantage|HUMANA MA|114.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|114.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Blue Cross HMO Specialty|BCBSTX HMO|114.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|114.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|114.25||||||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Medicare|MEDICARE ACUTE|36.75||||||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Humana Medicare Advantage|HUMANA MA|42.75||||||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Medicare|MEDICARE ACUTE|42.75||||||| 9505223|ERX|0250|K CHLORIDE 2 MEQ/ML,20ML|Medicare|MEDICARE ACUTE|0.13||||||| 9505223|ERX|0250|K CHLORIDE 2 MEQ/ML,20ML|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Cigna|CIGNA|25.50||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Humana Medicare Advantage|HUMANA MA|25.50||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|25.50||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|25.50||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|25.50||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Managed Medicare|HEALTHSPRING MA|25.50||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|25.50||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|25.50||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|25.50||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Medicare|MEDICARE ACUTE|25.50||||||| 9505264|ERX|0258|MAGNESIUM SULF 2 GM/50ML|United Medicare Advantage|UHC MEDICARE GOLD MA|1.19||||||| 9505264|ERX|0258|MAGNESIUM SULF 2 GM/50ML|Medicare|MEDICARE ACUTE|1.19||||||| 9505264|ERX|0258|MAGNESIUM SULF 2 GM/50ML|Humana Medicare Advantage|HUMANA MA|1.19||||||| 9505264|ERX|0258|MAGNESIUM SULF 2 GM/50ML|Blue Cross PPO Specialty|BCBSTX PPO|1.19||||||| 9505272|ERX|0258|K CHLORIDE 20 MEQ/100ML|Medicare|MEDICARE ACUTE|207.75||||||| 9505330|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|218.50||||||| 9505330|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Managed Medicare|HEALTHSPRING MA|218.50||||||| 9505330|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Blue Cross HMO Specialty|BCBSTX HMO|218.50||||||| 9505330|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Humana Medicare Advantage|HUMANA MA|218.50||||||| 9505330|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Blue Cross PPO Specialty|BCBSTX PPO|218.50||||||| 9505330|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Blue Cross PPO Specialty|BCBSTX OTHER|218.50||||||| 9505330|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|United Medicare Advantage|UHC MEDICARE GOLD MA|218.50||||||| 9505330|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Medicare|MEDICARE ACUTE|218.50||||||| 9505330|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|United Medicare Advantage|UHC AARP MCR HMO MA|218.50||||||| 9505330|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Workers Compensation|TEXAS MUTUAL INSURANCE|218.50||||||| 9505330|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|United Healthcare|UNITED HEALTHCARE|218.50||||||| 9505355|ERX|0258|WATER FOR INJECTION 100ML|Medicare|MEDICARE ACUTE|19.25||||||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|25.50||||||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Humana Medicare Advantage|HUMANA MA|25.50||||||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|25.50||||||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Managed Medicare|HEALTHSPRING MA|25.50||||||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|25.50||||||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|25.50||||||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|25.50||||||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Medicaid|MEDICAID|25.50||||||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|25.50||||||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|25.50||||||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Medicare|MEDICARE ACUTE|25.50||||||| 9505397|ERX|0258|NA CHLORIDE 0.9%,1000ML I|Medicare|MEDICARE ACUTE|145.50||||||| 9505397|ERX|0258|NA CHLORIDE 0.9%,1000ML I|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|145.50||||||| 9505397|ERX|0258|NA CHLORIDE 0.9%,1000ML I|Blue Cross PPO Specialty|BCBSTX PPO|145.50||||||| 9505405|ERX|0258|WATER FOR IRRIGATION 1000|Medicare|MEDICARE ACUTE|190.25||||||| 9505439|ERX|0250|K PHOSPHATE 3 MMOL/ML,15M|Medicare|MEDICARE ACUTE|0.13||||||| 9505447|ERX|0250|NA PHOSPHATE 3 MMOL/ML,15|Humana Medicare Advantage|HUMANA MA|0.13||||||| 9505447|ERX|0250|NA PHOSPHATE 3 MMOL/ML,15|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||||| 9505447|ERX|0250|NA PHOSPHATE 3 MMOL/ML,15|United Medicare Advantage|UHC MEDICARE GOLD MA|0.13||||||| 9505447|ERX|0250|NA PHOSPHATE 3 MMOL/ML,15|Medicare|MEDICARE ACUTE|0.13||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Medicare|MEDICARE ACUTE|107.50||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|107.50||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Humana Medicare Advantage|HUMANA MA|107.50||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Blue Cross HMO Specialty|BCBSTX HMO|107.50||||||| 9505603|ERX|0250|GENTAMICIN 80MG/100ML NS|United Healthcare|UNITED HEALTHCARE|107.50||||||| 9505629|ERX|0258|DEX 5%-1/2NS KCL 20 MEQ 1|Medicare|MEDICARE ACUTE|127.25||||||| 9505686|ERX|0258|DEXTROSE 5%-WATER 250ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.67||||||| 9505686|ERX|0258|DEXTROSE 5%-WATER 250ML|Aenta Medicare Advantage|AETNA MEDICARE MA|1.67||||||| 9505686|ERX|0258|DEXTROSE 5%-WATER 250ML|Blue Cross PPO Specialty|BCBSTX PPO|1.67||||||| 9505686|ERX|0258|DEXTROSE 5%-WATER 250ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.67||||||| 9505686|ERX|0258|DEXTROSE 5%-WATER 250ML|Blue Cross HMO Specialty|BCBSTX HMO|1.67||||||| 9505686|ERX|0258|DEXTROSE 5%-WATER 250ML|Humana Medicare Advantage|HUMANA MA|1.67||||||| 9505686|ERX|0258|DEXTROSE 5%-WATER 250ML|United Healthcare|UNITED HEALTHCARE|1.67||||||| 9505686|ERX|0258|DEXTROSE 5%-WATER 250ML|Medicare|MEDICARE ACUTE|1.67||||||| 9505686|ERX|0258|DEXTROSE 5%-WATER 250ML|Workers Compensation|WORKERS COMPENSATION OTHER|1.67||||||| 9505686|ERX|0258|DEXTROSE 5%-WATER 250ML|United Medicare Advantage|UHC MEDICARE GOLD MA|1.67||||||| 9505702|ERX|0258|DEXTROSE 5%-WATER 1000ML|United Medicare Advantage|UHC AARP MCR HMO MA|1.61||||||| 9505702|ERX|0258|DEXTROSE 5%-WATER 1000ML|United Medicare Advantage|UHC MEDICARE GOLD MA|1.61||||||| 9505702|ERX|0258|DEXTROSE 5%-WATER 1000ML|Medicare|MEDICARE ACUTE|1.61||||||| 9505702|ERX|0258|DEXTROSE 5%-WATER 1000ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.61||||||| 9505702|ERX|0258|DEXTROSE 5%-WATER 1000ML|Humana Medicare Advantage|HUMANA MA|1.61||||||| 9505710|ERX|0258|DEXTROSE 5%-WATER 150ML 1|Blue Cross PPO Specialty|BCBSTX PPO|1.11||||||| 9505710|ERX|0258|DEXTROSE 5%-WATER 150ML 1|Aenta Medicare Advantage|AETNA MEDICARE MA|1.11||||||| 9505710|ERX|0258|DEXTROSE 5%-WATER 150ML 1|Humana Medicare Advantage|HUMANA MA|1.11||||||| 9505710|ERX|0258|DEXTROSE 5%-WATER 150ML 1|Managed Medicare|BCBS MEDICARE PPO MA|1.11||||||| 9505710|ERX|0258|DEXTROSE 5%-WATER 150ML 1|Medicare|MEDICARE ACUTE|1.11||||||| 9505710|ERX|0258|DEXTROSE 5%-WATER 150ML 1|United Medicare Advantage|UHC MEDICARE GOLD MA|1.11||||||| 9505736|ERX|0258|DEXTROSE 5%-WATER 100ML|Medicare|MEDICARE ACUTE|122.25||||||| 9505736|ERX|0258|DEXTROSE 5%-WATER 100ML|United Medicare Advantage|UHC MEDICARE GOLD MA|122.25||||||| 9505736|ERX|0258|DEXTROSE 5%-WATER 100ML|United Healthcare|UNITED HEALTHCARE OTHER|122.25||||||| 9505736|ERX|0258|DEXTROSE 5%-WATER 100ML|Blue Cross PPO Specialty|BCBSTX PPO|122.25||||||| 9505736|ERX|0258|DEXTROSE 5%-WATER 100ML|Humana Medicare Advantage|HUMANA MA|122.25||||||| 9505769|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|Medicare|MEDICARE ACUTE|179.75||||||| 9505793|ERX|0258|DEXTROSE 10%-WATER 1000ML|Medicare|MEDICARE ACUTE|206.50||||||| 9505819|ERX|0250|ROPINIROLE 0.25MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|28.50||||||| 9505819|ERX|0250|ROPINIROLE 0.25MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|28.50||||||| 9505819|ERX|0250|ROPINIROLE 0.25MG TABLET|Medicare|MEDICARE ACUTE|28.50||||||| 9505827|ERX|0258|DEXTROSE 5%-NS 1000ML|Medicare|MEDICARE ACUTE|1.96||||||| 9505827|ERX|0258|DEXTROSE 5%-NS 1000ML|Humana Medicare Advantage|HUMANA MA|1.96||||||| 9505827|ERX|0258|DEXTROSE 5%-NS 1000ML|Blue Cross PPO Specialty|BCBSTX PPO|1.96||||||| 9505843|ERX|0258|LACTATED RINGERS 1000ML|Aetna|AETNA PPO|180.25||||||| 9505843|ERX|0258|LACTATED RINGERS 1000ML|Medicare|MEDICARE ACUTE|180.25||||||| 9505868|ERX|0258|NA CHLORIDE 0.9%,3000ML I|United Medicare Advantage|UHC AARP MCR HMO MA|166.75||||||| 9505868|ERX|0258|NA CHLORIDE 0.9%,3000ML I|Blue Cross PPO Specialty|BCBSTX PPO|166.75||||||| 9505868|ERX|0258|NA CHLORIDE 0.9%,3000ML I|Humana Medicare Advantage|HUMANA MA|166.75||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Medicaid|MEDICAID|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Blue Cross HMO Specialty|BCBSTX HMO|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Humana Medicare Advantage|HUMANA MA|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Aenta Medicare Advantage|AETNA MEDICARE MA|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Access Direct Platinum|HEALTHFIRST TPA UMR|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Blue Cross PPO Specialty|BCBSTX PPO|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Managed Medicare|BCBS MEDICARE PPO MA|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|United Medicare Advantage|UHC MEDICARE GOLD MA|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Medicare|MEDICARE ACUTE|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Workers Compensation|WORKERS COMPENSATION OTHER|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Workers Compensation|TEXAS MUTUAL INSURANCE|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Veterans Affairs|VETERANS ADMINISTRATION|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Tricare|TRICARE EAST REGION|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|United Medicare Advantage|UHC AARP MCR HMO MA|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|United Healthcare|UNITED HEALTHCARE OTHER|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|United Healthcare|UNITED HEALTHCARE|142.25||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|United Medicare Advantage|UHC AARP MCR HMO MA|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|PHCS|HUMANA INSURANCE|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Medicare|MEDICARE ACUTE|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Workers Compensation|TEXAS MUTUAL INSURANCE|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|United Medicare Advantage|UHC MEDICARE GOLD MA|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Access Direct Platinum|HEALTHFIRST TPA|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Cigna|CIGNA OTHER|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Aenta Medicare Advantage|AETNA MEDICARE MA|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Blue Cross HMO Specialty|BCBSTX HMO|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Humana Medicare Advantage|HUMANA MA|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Blue Cross PPO Specialty|BCBSTX PPO|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Managed Medicare|BCBS MEDICARE PPO MA|154.75||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Aenta Medicare Advantage|AETNA MEDICARE MA|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Blue Cross HMO Specialty|BCBSTX HMO|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Humana Medicare Advantage|HUMANA MA|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Managed Medicare|HEALTHSPRING MA|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Blue Cross PPO Specialty|BCBSTX PPO|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Medicaid|MEDICAID|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Managed Medicare|BCBS MEDICARE PPO MA|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Blue Cross PPO Specialty|BCBSTX OTHER|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|United Medicare Advantage|UHC AARP MCR HMO MA|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|United Medicare Advantage|UHC MEDICARE GOLD MA|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|PHCS|HUMANA INSURANCE|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Medicare|MEDICARE ACUTE|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|United Healthcare|UNITED HEALTHCARE OTHER|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Workers Compensation|TEXAS MUTUAL INSURANCE|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|United Healthcare|UNITED HEALTHCARE|1.78||||||| 9505918|ERX|0258|SODIUM CHLORIDE 0.9% 150M|Medicare|MEDICARE ACUTE|117.50||||||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|28.50||||||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|28.50||||||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|28.50||||||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|Medicare|MEDICARE ACUTE|28.50||||||| 9505942|ERX|0258|SODIUM CHLORIDE 0.9% 100M|United Medicare Advantage|UHC MEDICARE GOLD MA|121.50||||||| 9505942|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Medicare|MEDICARE ACUTE|121.50||||||| 9505942|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|121.50||||||| 9505942|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|121.50||||||| 9505942|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Aenta Medicare Advantage|AETNA MEDICARE MA|121.50||||||| 9505942|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Humana Medicare Advantage|HUMANA MA|121.50||||||| 9505942|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|121.50||||||| 9505942|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Blue Cross PPO Specialty|BCBSTX PPO|121.50||||||| 9505959|ERX|0258|SODIUM CHLORIDE 0.45% 100|Medicare|MEDICARE ACUTE|2.18||||||| 9505975|ERX|0258|DEX 5%-1/2NS KCL 10 MEQ 1|Medicare|MEDICARE ACUTE|168.75||||||| 9506064|ERX|0250|ESTRADIOL 1MG TABLET|Humana Medicare Advantage|HUMANA MA|22.25||||||| 9506064|ERX|0250|ESTRADIOL 1MG TABLET|Medicare|MEDICARE ACUTE|22.25||||||| 9506072|ERX|0250|PHENAZOPYRIDINE 100MG TAB|United Medicare Advantage|UHC AARP MCR HMO MA|15.50||||||| 9506072|ERX|0250|PHENAZOPYRIDINE 100MG TAB|Medicare|MEDICARE ACUTE|15.50||||||| 9506072|ERX|0250|PHENAZOPYRIDINE 100MG TAB|Access Direct Platinum|HEALTHFIRST TPA|15.50||||||| 9506072|ERX|0250|PHENAZOPYRIDINE 100MG TAB|Humana Medicare Advantage|HUMANA MA|15.50||||||| 9506114|ERX|0250|NA HYPOCHLOR 0.25% SOLN,4|Medicare|MEDICARE ACUTE|90.25||||||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|0.46||||||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.46||||||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Humana Medicare Advantage|HUMANA MA|0.46||||||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.46||||||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|United Medicare Advantage|UHC AARP MCR HMO MA|0.46||||||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Medicare|MEDICARE ACUTE|0.46||||||| 9506189|ERX|0250|THYROID 30MG TABLET|Medicare|MEDICARE ACUTE|5.25||||||| 9506189|ERX|0250|THYROID 30MG TABLET|Cigna|CIGNA|5.25||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Access Direct Platinum|HEALTHFIRST TPA|16.75||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Humana Medicare Advantage|HUMANA MA|16.75||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|16.75||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Managed Medicare|HEALTHSPRING MA|16.75||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|16.75||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|PHCS|HUMANA INSURANCE|16.75||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|United Healthcare|UNITED HEALTHCARE|16.75||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|United Healthcare|UNITED HEALTHCARE OTHER|16.75||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Medicare|MEDICARE ACUTE|16.75||||||| 9506254|ERX|0250|LEVOTHYROXINE 88MCG TABLE|Medicare|MEDICARE ACUTE|5.25||||||| 9506254|ERX|0250|LEVOTHYROXINE 88MCG TABLE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|5.25||||||| 9506254|ERX|0250|LEVOTHYROXINE 88MCG TABLE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|5.25||||||| 9506254|ERX|0250|LEVOTHYROXINE 88MCG TABLE|Humana Medicare Advantage|HUMANA MA|5.25||||||| 9506254|ERX|0250|LEVOTHYROXINE 88MCG TABLE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|5.25||||||| 9506254|ERX|0250|LEVOTHYROXINE 88MCG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.25||||||| 9506270|ERX|0250|VENLAFAXINE XL 37.5MG CAP|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|40.75||||||| 9506270|ERX|0250|VENLAFAXINE XL 37.5MG CAP|Medicare|MEDICARE ACUTE|40.75||||||| 9506296|ERX|0250|NEBIVOLOL 5MG TABLET|Medicare|MEDICARE ACUTE|17.25||||||| 9506296|ERX|0250|NEBIVOLOL 5MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|17.25||||||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|33.50||||||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|33.50||||||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|33.50||||||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Humana Medicare Advantage|HUMANA MA|33.50||||||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|33.50||||||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|33.50||||||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|33.50||||||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Workers Compensation|TEXAS MUTUAL INSURANCE|33.50||||||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|United Healthcare|UNITED HEALTHCARE|33.50||||||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Medicare|MEDICARE ACUTE|33.50||||||| 9506346|ERX|0250|MEMANTINE HCL 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|29.75||||||| 9506346|ERX|0250|MEMANTINE HCL 5MG TABLET|Medicare|MEDICARE ACUTE|29.75||||||| 9506353|ERX|0250|MEMANTINE 10MG TABLET|Humana Medicare Advantage|HUMANA MA|29.75||||||| 9506353|ERX|0250|MEMANTINE 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|29.75||||||| 9506353|ERX|0250|MEMANTINE 10MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|29.75||||||| 9506353|ERX|0250|MEMANTINE 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|29.75||||||| 9506353|ERX|0250|MEMANTINE 10MG TABLET|Medicare|MEDICARE ACUTE|29.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|PHCS|HUMANA INSURANCE|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|United Healthcare|UNITED HEALTHCARE|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Medicare|MEDICARE ACUTE|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Tricare|TRICARE EAST REGION|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Medicaid|MEDICAID|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Cigna|CIGNA|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Aetna|AETNA PPO|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Managed Medicare|HEALTHSPRING MA|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Humana Medicare Advantage|HUMANA MA|46.75||||||| 9506411|ERX|0250|TACROLIMUS 0.5MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|25.50||||||| 9506411|ERX|0250|TACROLIMUS 0.5MG CAPSULE|Medicare|MEDICARE ACUTE|25.50||||||| 9506429|ERX|0636|TACROLIMUS 1MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|49.25||||||| 9506429|ERX|0636|TACROLIMUS 1MG CAPSULE|Medicare|MEDICARE ACUTE|49.25||||||| 9506429|ERX|0636|TACROLIMUS 1MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|49.25||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Humana Medicare Advantage|HUMANA MA|169.50||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|169.50||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Medicare|MEDICARE ACUTE|169.50||||||| 9506494|ERX|0636|MICAFUNGIN 50MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|960.25||||||| 9506551|ERX|0250|SIROLIMUS 1MG TABLET|Medicare|MEDICARE ACUTE|93.75||||||| 9506577|ERX|0250|NYSTATIN 100000 UNIT, 1ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|174.25||||||| 9506577|ERX|0250|NYSTATIN 100000 UNIT, 1ML|Humana Medicare Advantage|HUMANA MA|174.25||||||| 9506577|ERX|0250|NYSTATIN 100000 UNIT, 1ML|Blue Cross PPO Specialty|BCBSTX PPO|174.25||||||| 9506577|ERX|0250|NYSTATIN 100000 UNIT, 1ML|Managed Medicare|BCBS MEDICARE PPO MA|174.25||||||| 9506577|ERX|0250|NYSTATIN 100000 UNIT, 1ML|Managed Medicare|HEALTHSPRING MA|174.25||||||| 9506577|ERX|0250|NYSTATIN 100000 UNIT, 1ML|Blue Cross HMO Specialty|BCBSTX HMO|174.25||||||| 9506577|ERX|0250|NYSTATIN 100000 UNIT, 1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|174.25||||||| 9506577|ERX|0250|NYSTATIN 100000 UNIT, 1ML|Medicare|MEDICARE ACUTE|174.25||||||| 9506577|ERX|0250|NYSTATIN 100000 UNIT, 1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|174.25||||||| 9506577|ERX|0250|NYSTATIN 100000 UNIT, 1ML|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|174.25||||||| 9506577|ERX|0250|NYSTATIN 100000 UNIT, 1ML|Veterans Affairs|VETERANS ADMINISTRATION|174.25||||||| 9506577|ERX|0250|NYSTATIN 100000 UNIT, 1ML|United Healthcare|UNITED HEALTHCARE OTHER|174.25||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.31||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Medicare|MEDICARE ACUTE|0.31||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.31||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Humana Medicare Advantage|HUMANA MA|0.31||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Managed Medicare|BCBS MEDICARE PPO MA|0.31||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Managed Medicare|HEALTHSPRING MA|0.31||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.31||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.31||||||| 9506650|ERX|0250|PHENYTOIN 100MG/4ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.25||||||| 9506650|ERX|0250|PHENYTOIN 100MG/4ML|Blue Cross HMO Specialty|BCBSTX HMO|0.25||||||| 9506668|ERX|0250|K PHOS,MONOBASIC 500MG TA|Medicare|MEDICARE ACUTE|2.75||||||| 9506676|ERX|0250|POTASS-SOD PHOS 155-852-1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.05||||||| 9506676|ERX|0250|POTASS-SOD PHOS 155-852-1|United Medicare Advantage|UHC MEDICARE GOLD MA|0.05||||||| 9506676|ERX|0250|POTASS-SOD PHOS 155-852-1|Medicare|MEDICARE ACUTE|0.05||||||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|United Medicare Advantage|UHC MEDICARE GOLD MA|16.75||||||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Medicare|MEDICARE ACUTE|16.75||||||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Managed Medicare|HEALTHSPRING MA|16.75||||||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Humana Medicare Advantage|HUMANA MA|16.75||||||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Blue Cross PPO Specialty|BCBSTX PPO|16.75||||||| 9506726|ERX|0250|METHYLNALTREXONE 12MG/0.6|Humana Medicare Advantage|HUMANA MA|3.71||||||| 9506726|ERX|0250|METHYLNALTREXONE 12MG/0.6|United Medicare Advantage|UHC MEDICARE GOLD MA|3.71||||||| 9506726|ERX|0250|METHYLNALTREXONE 12MG/0.6|Medicare|MEDICARE ACUTE|3.71||||||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|United Medicare Advantage|UHC AARP MCR HMO MA|15.50||||||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|United Medicare Advantage|UHC MEDICARE GOLD MA|15.50||||||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|Medicare|MEDICARE ACUTE|15.50||||||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|15.50||||||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|15.50||||||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|Humana Medicare Advantage|HUMANA MA|15.50||||||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|Managed Medicare|HEALTHSPRING MA|15.50||||||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|Blue Cross PPO Specialty|BCBSTX PPO|15.50||||||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|Access Direct Platinum|HEALTHFIRST TPA|15.50||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|0.48||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|0.48||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Cigna|CIGNA OTHER|0.48||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Humana Medicare Advantage|HUMANA MA|0.48||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.48||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.48||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.48||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Medicare|MEDICARE ACUTE|0.48||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.48||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|United Healthcare|UNITED HEALTHCARE|0.48||||||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|United Medicare Advantage|UHC AARP MCR HMO MA|13.50||||||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|United Medicare Advantage|UHC MEDICARE GOLD MA|13.50||||||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|United Healthcare|UNITED HEALTHCARE|13.50||||||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Medicare|MEDICARE ACUTE|13.50||||||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|13.50||||||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Humana Medicare Advantage|HUMANA MA|13.50||||||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Blue Cross PPO Specialty|BCBSTX PPO|13.50||||||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|13.50||||||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Access Direct Platinum|HEALTHFIRST TPA|13.50||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Managed Medicare|HEALTHSPRING MA|0.74||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Humana Medicare Advantage|HUMANA MA|0.74||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.74||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.74||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|United Medicare Advantage|UHC AARP MCR HMO MA|0.74||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Medicare|MEDICARE ACUTE|0.74||||||| 9507039|ERX|0250|PRIMIDONE 50MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|8.75||||||| 9507039|ERX|0250|PRIMIDONE 50MG TABLET|Medicare|MEDICARE ACUTE|8.75||||||| 9507070|ERX|0250|SELENIUM 1% SHAMPOO, 207M|Blue Cross PPO Specialty|BCBSTX PPO|0.54||||||| 9507070|ERX|0250|SELENIUM 1% SHAMPOO, 207M|Medicare|MEDICARE ACUTE|0.54||||||| 9507120|ERX|0250|NIACIN 100MG TABLET|Medicare|MEDICARE ACUTE|2.50||||||| 9507146|ERX|0250|DIPHENHYDRAMINE CREAM, 30|Medicare|MEDICARE ACUTE|40.75||||||| 9507203|ERX|0250|LIDOCAINE 2% URO-JET 20ML|Humana Medicare Advantage|HUMANA MA|114.25||||||| 9507203|ERX|0250|LIDOCAINE 2% URO-JET 20ML|Blue Cross PPO Specialty|BCBSTX PPO|114.25||||||| 9507203|ERX|0250|LIDOCAINE 2% URO-JET 20ML|Medicare|MEDICARE ACUTE|114.25||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|17.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|17.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Medicare|MEDICARE ACUTE|17.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|17.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|17.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|United Healthcare|UNITED HEALTHCARE|17.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|17.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Humana Medicare Advantage|HUMANA MA|17.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|17.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|17.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|17.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Blue Cross PPO Specialty|BCBSTX OTHER|17.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|17.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|17.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|17.50||||||| 9507328|ERX|0250|PHENYLEPH-SHK LV-MO-PET,W|Humana Medicare Advantage|HUMANA MA|0.68||||||| 9507328|ERX|0250|PHENYLEPH-SHK LV-MO-PET,W|Access Direct Platinum|HEALTHFIRST TPA|0.68||||||| 9507328|ERX|0250|PHENYLEPH-SHK LV-MO-PET,W|Blue Cross PPO Specialty|BCBSTX PPO|0.68||||||| 9507328|ERX|0250|PHENYLEPH-SHK LV-MO-PET,W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.68||||||| 9507328|ERX|0250|PHENYLEPH-SHK LV-MO-PET,W|United Medicare Advantage|UHC MEDICARE GOLD MA|0.68||||||| 9507328|ERX|0250|PHENYLEPH-SHK LV-MO-PET,W|Medicare|MEDICARE ACUTE|0.68||||||| 9507328|ERX|0250|PHENYLEPH-SHK LV-MO-PET,W|United Healthcare|UNITED HEALTHCARE|0.68||||||| 9507385|ERX|0250|HYDROCORTISONE 10MG TABLE|Medicare|MEDICARE ACUTE|9.25||||||| 9507385|ERX|0250|HYDROCORTISONE 10MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.25||||||| 9507468|ERX|0250|PROMETHAZINE 12.5MG SUPP|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|39.75||||||| 9507468|ERX|0250|PROMETHAZINE 12.5MG SUPP|United Medicare Advantage|UHC AARP MCR HMO MA|39.75||||||| 9507468|ERX|0250|PROMETHAZINE 12.5MG SUPP|Medicare|MEDICARE ACUTE|39.75||||||| 9507559|ERX|0250|PROBENECID 500MG TABLET|Humana Medicare Advantage|HUMANA MA|15.25||||||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.07||||||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Medicare|MEDICARE ACUTE|0.07||||||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|United Healthcare|UNITED HEALTHCARE|0.07||||||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.07||||||| 9507609|ERX|0250|MINOXIDIL 2.5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|9.25||||||| 9507609|ERX|0250|MINOXIDIL 2.5MG TABLET|Medicare|MEDICARE ACUTE|9.25||||||| 9507633|ERX|0250|ASPIRIN-DIPYRIDAMOLE 25-2|Medicare|MEDICARE ACUTE|28.50||||||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH, 4|United Medicare Advantage|UHC MEDICARE GOLD MA|1,450.75||||||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH, 4|Medicare|MEDICARE ACUTE|1,450.75||||||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|Managed Medicare|HEALTHSPRING MA|0.42||||||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|0.42||||||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.42||||||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|Medicare|MEDICARE ACUTE|0.42||||||| 9507674|ERX|0250|CLONIDINE 0.1MG PATCH|Medicare|MEDICARE ACUTE|226.25||||||| 9507674|ERX|0250|CLONIDINE 0.1MG PATCH|Humana Medicare Advantage|HUMANA MA|226.25||||||| 9507674|ERX|0250|CLONIDINE 0.1MG PATCH|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|226.25||||||| 9507682|ERX|0250|CLONIDINE 0.2MG PATCH|Humana Medicare Advantage|HUMANA MA|419.50||||||| 9507682|ERX|0250|CLONIDINE 0.2MG PATCH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|419.50||||||| 9507682|ERX|0250|CLONIDINE 0.2MG PATCH|Medicare|MEDICARE ACUTE|419.50||||||| 9507690|ERX|0250|CLONIDINE 0.3MG PATCH|Medicare|MEDICARE ACUTE|6.35||||||| 9507690|ERX|0250|CLONIDINE 0.3MG PATCH|Humana Medicare Advantage|HUMANA MA|6.35||||||| 9507690|ERX|0250|CLONIDINE 0.3MG PATCH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|6.35||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Cigna|CIGNA|32.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Humana Medicare Advantage|HUMANA MA|32.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|32.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Managed Medicare|BCBS MEDICARE PPO MA|32.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|32.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|32.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|32.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Managed Medicare|HEALTHSPRING MA|32.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|32.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|32.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|United Medicare Advantage|UHC AARP MCR HMO MA|32.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Medicare|MEDICARE ACUTE|32.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|32.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Workers Compensation|TEXAS MUTUAL INSURANCE|32.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|United Healthcare|UNITED HEALTHCARE|32.50||||||| 9507724|ERX|0250|METHYLPREDNISOLONE 4MG TA|United Medicare Advantage|UHC AARP MCR HMO MA|18.25||||||| 9507724|ERX|0250|METHYLPREDNISOLONE 4MG TA|United Medicare Advantage|UHC MEDICARE GOLD MA|18.25||||||| 9507724|ERX|0250|METHYLPREDNISOLONE 4MG TA|Medicare|MEDICARE ACUTE|18.25||||||| 9507799|ERX|0250|PRAMIPEXOLE 0.25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|25.50||||||| 9507799|ERX|0250|PRAMIPEXOLE 0.25MG TABLET|Humana Medicare Advantage|HUMANA MA|25.50||||||| 9507799|ERX|0250|PRAMIPEXOLE 0.25MG TABLET|Medicare|MEDICARE ACUTE|25.50||||||| 9507807|ERX|0250|PRAMIPEXOLE 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.29||||||| 9507807|ERX|0250|PRAMIPEXOLE 1MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.29||||||| 9507807|ERX|0250|PRAMIPEXOLE 1MG TABLET|Medicare|MEDICARE ACUTE|0.29||||||| 9507807|ERX|0250|PRAMIPEXOLE 1MG TABLET|Humana Medicare Advantage|HUMANA MA|0.29||||||| 9507815|ERX|0250|POVIDONE-IODINE 10% OINT,|United Medicare Advantage|UHC MEDICARE GOLD MA|71.50||||||| 9507922|ERX|0250|COLCHICINE 0.6MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|5.50||||||| 9507922|ERX|0250|COLCHICINE 0.6MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|5.50||||||| 9507922|ERX|0250|COLCHICINE 0.6MG TABLET|Humana Medicare Advantage|HUMANA MA|5.50||||||| 9507922|ERX|0250|COLCHICINE 0.6MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|5.50||||||| 9507922|ERX|0250|COLCHICINE 0.6MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|5.50||||||| 9507922|ERX|0250|COLCHICINE 0.6MG TABLET|Medicare|MEDICARE ACUTE|5.50||||||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|United Medicare Advantage|UHC AARP MCR HMO MA|14.25||||||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Medicare|MEDICARE ACUTE|14.25||||||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|United Healthcare|UNITED HEALTHCARE OTHER|14.25||||||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Aenta Medicare Advantage|AETNA MEDICARE MA|14.25||||||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Blue Cross PPO Specialty|BCBSTX PPO|14.25||||||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Managed Medicare|HEALTHSPRING MA|14.25||||||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|14.25||||||| 9508011|ERX|0250|MEDROXYPROGESTERONE 2.5MG|Medicare|MEDICARE ACUTE|14.25||||||| 9508037|ERX|0250|SULFASALAZINE 500MG TABLE|Humana Medicare Advantage|HUMANA MA|5.25||||||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|United Medicare Advantage|UHC AARP MCR HMO MA|0.13||||||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|PHCS|HUMANA INSURANCE|0.13||||||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Medicare|MEDICARE ACUTE|0.13||||||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Cigna|CIGNA OTHER|0.13||||||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||||| 9508136|ERX|0250|HEPARIN 1000 UNIT/1ML|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||||| 9508136|ERX|0250|HEPARIN 1000 UNIT/1ML|Medicare|MEDICARE ACUTE|0.13||||||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Medicare|MEDICARE ACUTE|0.13||||||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.13||||||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Medicare|MEDICARE ACUTE|38.50||||||| 9508185|ERX|0250|CHLORPROMAZINE 25MG/1ML|Humana Medicare Advantage|HUMANA MA|0.99||||||| 9508185|ERX|0250|CHLORPROMAZINE 25MG/1ML|Medicare|MEDICARE ACUTE|0.99||||||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|20.50||||||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Medicare|MEDICARE ACUTE|20.50||||||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|United Medicare Advantage|UHC AARP MCR HMO MA|20.50||||||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Humana Medicare Advantage|HUMANA MA|20.50||||||| 9508219|ERX|0250|GENTAMICIN 40MG/ML, 20ML|Medicare|MEDICARE ACUTE|1.29||||||| 9508227|ERX|0250|HEPARIN 1000 UNIT/ML, 10M|Humana Medicare Advantage|HUMANA MA|15.50||||||| 9508227|ERX|0250|HEPARIN 1000 UNIT/ML, 10M|Managed Medicare|HEALTHSPRING MA|15.50||||||| 9508227|ERX|0250|HEPARIN 1000 UNIT/ML, 10M|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|15.50||||||| 9508227|ERX|0250|HEPARIN 1000 UNIT/ML, 10M|United Medicare Advantage|UHC MEDICARE GOLD MA|15.50||||||| 9508227|ERX|0250|HEPARIN 1000 UNIT/ML, 10M|Medicare|MEDICARE ACUTE|15.50||||15.50||| 9508243|ERX|0250|ALPRAZOLAM 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|25.50||||||| 9508243|ERX|0250|ALPRAZOLAM 1MG TABLET|Medicare|MEDICARE ACUTE|25.50||||||| 9508243|ERX|0250|ALPRAZOLAM 1MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|25.50||||||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|Managed Medicare|HEALTHSPRING MA|2.50||||||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.50||||||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|Blue Cross HMO Specialty|BCBSTX HMO|2.50||||||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|Medicare|MEDICARE ACUTE|2.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|PHCS|HUMANA INSURANCE|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Medicare|MEDICARE ACUTE|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Workers Compensation|WORKERS COMPENSATION OTHER|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|United Healthcare|UNITED HEALTHCARE OTHER|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|United Medicare Advantage|UHC AARP MCR HMO MA|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Aetna|AETNA PPO|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Medicaid|MEDICAID|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|United Medicare Advantage|UHC MEDICARE GOLD MA|9.25||||||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|United Medicare Advantage|UHC AARP MCR HMO MA|9.25||||||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Medicare|MEDICARE ACUTE|9.25||||||| 9508417|ERX|0250|HYDROCORTISONE 25MG SUPP|Medicare|MEDICARE ACUTE|14.50||||||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Medicare|MEDICARE ACUTE|26.25||||||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|26.25||||||| 9508433|ERX|0250|FLUOXETINE 10MG CAPSULE|Humana Medicare Advantage|HUMANA MA|58.25||||||| 9508433|ERX|0250|FLUOXETINE 10MG CAPSULE|Managed Medicare|HEALTHSPRING MA|58.25||||||| 9508433|ERX|0250|FLUOXETINE 10MG CAPSULE|Medicare|MEDICARE ACUTE|58.25||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|59.25||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|United Healthcare|UNITED HEALTHCARE OTHER|59.25||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Medicare|MEDICARE ACUTE|59.25||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Cigna|CIGNA|59.25||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|59.25||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|59.25||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Managed Medicare|HEALTHSPRING MA|59.25||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Humana Medicare Advantage|HUMANA MA|59.25||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|59.25||||||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|62.75||||||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Blue Cross PPO Specialty|BCBSTX PPO|62.75||||||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|United Medicare Advantage|UHC MEDICARE GOLD MA|62.75||||||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Medicare|MEDICARE ACUTE|62.75||||||| 9508581|ERX|0250|IMIPRAMINE 25MG TABLET|Medicare|MEDICARE ACUTE|13.50||||||| 9508607|ERX|0250|DICLOFENAC SODIUM 25MG TA|Medicare|MEDICARE ACUTE|15.25||||||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Cigna|CIGNA|38.50||||||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Humana Medicare Advantage|HUMANA MA|38.50||||||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|38.50||||||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|38.50||||||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Medicare|MEDICARE ACUTE|38.50||||||| 9508714|ERX|0250|MENTHOL-LAN-CAL-ZN OX ,11|United Medicare Advantage|UHC MEDICARE GOLD MA|42.75||||||| 9508714|ERX|0250|MENTHOL-LAN-CAL-ZN OX ,11|Medicare|MEDICARE ACUTE|42.75||||||| 9508714|ERX|0250|MENTHOL-LAN-CAL-ZN OX ,11|United Healthcare|UNITED HEALTHCARE OTHER|42.75||||||| 9508714|ERX|0250|MENTHOL-LAN-CAL-ZN OX ,11|United Medicare Advantage|UHC AARP MCR HMO MA|42.75||||||| 9508714|ERX|0250|MENTHOL-LAN-CAL-ZN OX ,11|Humana Medicare Advantage|HUMANA MA|42.75||||||| 9508714|ERX|0250|MENTHOL-LAN-CAL-ZN OX ,11|Managed Medicare|HEALTHSPRING MA|42.75||||||| 9508714|ERX|0250|MENTHOL-LAN-CAL-ZN OX ,11|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|42.75||||||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|Blue Cross HMO Specialty|BCBSTX HMO|156.50||||||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|Blue Cross PPO Specialty|BCBSTX PPO|156.50||||||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|156.50||||||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|Medicare|MEDICARE ACUTE|156.50||||||| 9508755|ERX|0250|VITAMIN E 1000 UNIT CAPSU|Medicare|MEDICARE ACUTE|2.75||||||| 9508789|ERX|0250|VITAMIN A 10000 UNIT CAPS|Medicare|MEDICARE ACUTE|2.50||||||| 9508797|ERX|0250|CALAMINE LOTION, 120ML|Aenta Medicare Advantage|AETNA MEDICARE MA|20.25||||||| 9508797|ERX|0250|CALAMINE LOTION, 120ML|Medicare|MEDICARE ACUTE|20.25||||||| 9508805|ERX|0250|COLESTIPOL 5 G PACKET|Medicare|MEDICARE ACUTE|26.75||||||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Humana Medicare Advantage|HUMANA MA|7.75||||||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|7.75||||||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|7.75||||||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|7.75||||||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Medicare|MEDICARE ACUTE|7.75||||||| 9508839|ERX|0250|CYANOCOBALAMIN 250MCG TAB|Medicare|MEDICARE ACUTE|2.50||||||| 9508839|ERX|0250|CYANOCOBALAMIN 250MCG TAB|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9508870|ERX|0250|PENTOXIFYLLINE 400MG TABL|United Medicare Advantage|UHC MEDICARE GOLD MA|0.10||||||| 9508870|ERX|0250|PENTOXIFYLLINE 400MG TABL|Medicare|MEDICARE ACUTE|0.10||||||| 9508912|ERX|0250|SENNOSIDES 8.8MG/5ML, 60M|Medicare|MEDICARE ACUTE|46.75||||||| 9508912|ERX|0250|SENNOSIDES 8.8MG/5ML, 60M|United Medicare Advantage|UHC AARP MCR HMO MA|46.75||||||| 9508938|ERX|0258|PERIT.DIALYSIS 1.5% DEX 2|Blue Cross PPO Specialty|BCBSTX PPO|345.75||||||| 9508938|ERX|0258|PERIT.DIALYSIS 1.5% DEX 2|Medicare|MEDICARE ACUTE|345.75||||||| 9508946|ERX|0258|PERIT.DIALYSIS 1.5% DEX 2|Medicare|MEDICARE ACUTE|394.75||||||| 9508953|ERX|0258|PERIT.DIALYSIS 1.5% DEX 3|Medicare|MEDICARE ACUTE|454.75||||||| 9508961|ERX|0258|PERIT.DIALYSIS 2.5% DEX 2|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|385.75||||||| 9508961|ERX|0258|PERIT.DIALYSIS 2.5% DEX 2|Blue Cross PPO Specialty|BCBSTX PPO|385.75||||||| 9508961|ERX|0258|PERIT.DIALYSIS 2.5% DEX 2|Medicare|MEDICARE ACUTE|385.75||||||| 9508979|ERX|0258|PERIT.DIALYSIS 2.5% DEX 2|Medicare|MEDICARE ACUTE|394.75||||||| 9508979|ERX|0258|PERIT.DIALYSIS 2.5% DEX 2|Blue Cross PPO Specialty|BCBSTX PPO|394.75||||||| 9508987|ERX|0258|PERIT.DIALYSIS 2.5% DEX 3|Medicare|MEDICARE ACUTE|454.75||||||| 9509001|ERX|0258|PERIT. DIALYSIS 4.25% 200|Blue Cross PPO Specialty|BCBSTX PPO|389.25||||||| 9509001|ERX|0258|PERIT. DIALYSIS 4.25% 200|Medicare|MEDICARE ACUTE|389.25||||||| 9509019|ERX|0258|PERIT. DIALYSIS 4.25% 250|Medicare|MEDICARE ACUTE|400.50||||||| 9509084|ERX|0250|METHYLPRED DEPO 40MG/ML,1|Blue Cross HMO Specialty|BCBSTX HMO|535.25||||||| 9509084|ERX|0250|METHYLPRED DEPO 40MG/ML,1|Medicare|MEDICARE ACUTE|535.25||||||| 9509209|ERX|0250|LUBRICANT EYE DROP, 15ML|United Medicare Advantage|UHC MEDICARE GOLD MA|97.25||||||| 9509209|ERX|0250|LUBRICANT EYE DROP, 15ML|United Medicare Advantage|UHC AARP MCR HMO MA|97.25||||||| 9509209|ERX|0250|LUBRICANT EYE DROP, 15ML|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|97.25||||||| 9509209|ERX|0250|LUBRICANT EYE DROP, 15ML|Medicare|MEDICARE ACUTE|97.25||||||| 9509209|ERX|0250|LUBRICANT EYE DROP, 15ML|Humana Medicare Advantage|HUMANA MA|97.25||||||| 9509209|ERX|0250|LUBRICANT EYE DROP, 15ML|Medicaid|MEDICAID|97.25||||||| 9509209|ERX|0250|LUBRICANT EYE DROP, 15ML|Blue Cross PPO Specialty|BCBSTX PPO|97.25||||||| 9509225|ERX|0250|BISMUTH SUBSALIC 262MG TA|Medicare|MEDICARE ACUTE|2.50||||||| 9509274|ERX|0250|PROPOFOL 200MG/20ML|Humana Medicare Advantage|HUMANA MA|123.25||||||| 9509274|ERX|0250|PROPOFOL 200MG/20ML|Aetna|AETNA PPO|123.25||||||| 9509274|ERX|0250|PROPOFOL 200MG/20ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|123.25||||||| 9509274|ERX|0250|PROPOFOL 200MG/20ML|Blue Cross PPO Specialty|BCBSTX PPO|123.25||||||| 9509274|ERX|0250|PROPOFOL 200MG/20ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|123.25||||||| 9509274|ERX|0250|PROPOFOL 200MG/20ML|United Medicare Advantage|UHC MEDICARE GOLD MA|123.25||||||| 9509274|ERX|0250|PROPOFOL 200MG/20ML|PHCS|HUMANA INSURANCE|123.25||||||| 9509274|ERX|0250|PROPOFOL 200MG/20ML|Medicare|MEDICARE ACUTE|123.25||||||| 9509274|ERX|0250|PROPOFOL 200MG/20ML|United Healthcare|UNITED HEALTHCARE|123.25||||||| 9509274|ERX|0250|PROPOFOL 200MG/20ML|United Medicare Advantage|UHC AARP MCR HMO MA|123.25||||||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.13||||||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|0.13||||||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Medicare|MEDICARE ACUTE|0.13||||0.13||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Humana Medicare Advantage|HUMANA MA|0.13||||||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Medicare|MEDICARE ACUTE|17.50||||||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Medicare|MEDICARE ACUTE|17.50||||||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|25.50||||||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|25.50||||||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|25.50||||||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|25.50||||||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|25.50||||||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|Medicare|MEDICARE ACUTE|25.50||||||| 9509571|ERX|0250|BENZOCAINE DENTAL GEL|Workers Compensation|WORKERS COMPENSATION OTHER|44.25||||||| 9509571|ERX|0250|BENZOCAINE DENTAL GEL|Medicare|MEDICARE ACUTE|44.25||||||| 9509571|ERX|0250|BENZOCAINE DENTAL GEL|Humana Medicare Advantage|HUMANA MA|44.25||||||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Humana Medicare Advantage|HUMANA MA|17.50||||||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Aetna|AETNA PPO|17.50||||||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|17.50||||||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|17.50||||||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|17.50||||||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|United Medicare Advantage|UHC AARP MCR HMO MA|17.50||||||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|17.50||||||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Medicare|MEDICARE ACUTE|17.50||||17.50||| 9509712|ERX|0250|UREA 10% CREAM, 142 GM|United Medicare Advantage|UHC MEDICARE GOLD MA|106.25||||||| 9509712|ERX|0250|UREA 10% CREAM, 142 GM|United Medicare Advantage|UHC AARP MCR HMO MA|106.25||||||| 9509712|ERX|0250|UREA 10% CREAM, 142 GM|Medicare|MEDICARE ACUTE|106.25||||||| 9509712|ERX|0250|UREA 10% CREAM, 142 GM|Aenta Medicare Advantage|AETNA MEDICARE MA|106.25||||||| 9509712|ERX|0250|UREA 10% CREAM, 142 GM|Cigna|CIGNA OTHER|106.25||||||| 9509712|ERX|0250|UREA 10% CREAM, 142 GM|Humana Medicare Advantage|HUMANA MA|106.25||||||| 9509712|ERX|0250|UREA 10% CREAM, 142 GM|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|106.25||||||| 9509712|ERX|0250|UREA 10% CREAM, 142 GM|Access Direct Platinum|HEALTHFIRST TPA|106.25||||||| 9509712|ERX|0250|UREA 10% CREAM, 142 GM|Managed Medicare|HEALTHSPRING MA|106.25||||||| 9509712|ERX|0250|UREA 10% CREAM, 142 GM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|106.25||||||| 9509712|ERX|0250|UREA 10% CREAM, 142 GM|Blue Cross PPO Specialty|BCBSTX PPO|106.25||||||| 9509712|ERX|0250|UREA 10% CREAM, 142 GM|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|106.25||||||| 9509712|ERX|0250|UREA 10% CREAM, 142 GM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|106.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Aenta Medicare Advantage|AETNA MEDICARE MA|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Humana Medicare Advantage|HUMANA MA|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Aetna|AETNA PPO|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Managed Medicare|HEALTHSPRING MA|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Blue Cross HMO Specialty|BCBSTX HMO|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Managed Medicaid|MEDICAID UNITED HEALTHCARE|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Access Direct Platinum|HEALTHFIRST TPA|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Blue Cross PPO Specialty|BCBSTX PPO|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|United Medicare Advantage|UHC MEDICARE GOLD MA|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|PHCS|HUMANA INSURANCE|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|United Healthcare|UNITED HEALTHCARE OTHER|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Medicare|MEDICARE ACUTE|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|United Medicare Advantage|UHC AARP MCR HMO MA|84.25||||||| 9509779|ERX|0250|PREDNISOLONE 1% EYE DROP,|Medicare|MEDICARE ACUTE|291.25||||||| 9509779|ERX|0250|PREDNISOLONE 1% EYE DROP,|Blue Cross PPO Specialty|BCBSTX PPO|291.25||||||| 9509811|ERX|0250|OFLOXACIN 0.3% EYE DROP,|Medicare|MEDICARE ACUTE|561.50||||||| 9509878|ERX|0250|TESTOSTERONE CYPION 200MG|United Medicare Advantage|UHC MEDICARE GOLD MA|291.50||||||| 9509878|ERX|0250|TESTOSTERONE CYPION 200MG|Medicare|MEDICARE ACUTE|291.50||||||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.50||||||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|2.50||||||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Medicare|MEDICARE ACUTE|2.50||||2.50||| 9509993|ERX|0250|COLESTIPOL 1 G TABLET|United Healthcare|UNITED HEALTHCARE|12.75||||||| 9509993|ERX|0250|COLESTIPOL 1 G TABLET|Medicare|MEDICARE ACUTE|12.75||||||| 9509993|ERX|0250|COLESTIPOL 1 G TABLET|Humana Medicare Advantage|HUMANA MA|12.75||||||| 9510041|ERX|0250|SIMETHICONE 40MG/0.6ML, 3|Medicare|MEDICARE ACUTE|110.75||||||| 9510066|ERX|0250|COENZYME Q10 30MG CAPSULE|Medicare|MEDICARE ACUTE|0.09||||||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|Humana Medicare Advantage|HUMANA MA|0.42||||||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UMR|0.42||||||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.42||||||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.42||||||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.42||||||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|Medicare|MEDICARE ACUTE|0.42||||||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|0.42||||||| 9510165|ERX|0250|CLOTRIMAZOLE 10MG TROCHE|Medicare|MEDICARE ACUTE|25.50||||||| 9510181|ERX|0250|METHYLPREDNISOLONE 1000MG|Blue Cross PPO Specialty|BCBSTX PPO|261.50||||||| 9510298|ERX|0250|TIMOLOL 0.5% EYE DROP, 5M|Medicare|MEDICARE ACUTE|174.75||||||| 9510298|ERX|0250|TIMOLOL 0.5% EYE DROP, 5M|Blue Cross PPO Specialty|BCBSTX PPO|174.75||||||| 9510512|ERX|0250|NAPROXEN SODIUM 220MG TAB|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9510512|ERX|0250|NAPROXEN SODIUM 220MG TAB|Medicare|MEDICARE ACUTE|2.50||||||| 9510520|ERX|0250|THROMBIN (RECOMB) 5,000 U|PHCS|HUMANA INSURANCE|637.75||||||| 9510546|ERX|0250|FLECAINIDE 100MG TABLET|Aetna|AETNA OTHER|43.75||||||| 9510546|ERX|0250|FLECAINIDE 100MG TABLET|Medicare|MEDICARE ACUTE|43.75||||||| 9510579|ERX|0250|VITAMIN B COMP W-C TABLE|Medicare|MEDICARE ACUTE|2.50||||||| 9510579|ERX|0250|VITAMIN B COMP W-C TABLE|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9510587|ERX|0250|PSYLLIUM SEED (SUGAR FREE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|5.25||||||| 9510587|ERX|0250|PSYLLIUM SEED (SUGAR FREE|Humana Medicare Advantage|HUMANA MA|5.25||||||| 9510587|ERX|0250|PSYLLIUM SEED (SUGAR FREE|Blue Cross PPO Specialty|BCBSTX PPO|5.25||||||| 9510587|ERX|0250|PSYLLIUM SEED (SUGAR FREE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.25||||||| 9510587|ERX|0250|PSYLLIUM SEED (SUGAR FREE|United Medicare Advantage|UHC MEDICARE GOLD MA|5.25||||||| 9510587|ERX|0250|PSYLLIUM SEED (SUGAR FREE|Medicare|MEDICARE ACUTE|5.25||||||| 9510611|ERX|0250|SELEGILINE 5MG CAPSULE|Medicare|MEDICARE ACUTE|27.50||||||| 9510728|ERX|0250|TUBERCULIN,PPD 5 UNIT/ 0.|PHCS|HUMANA INSURANCE|44.25||||||| 9510728|ERX|0250|TUBERCULIN,PPD 5 UNIT/ 0.|Medicare|MEDICARE ACUTE|44.25||||||| 9510777|ERX|0250|CALCITRIOL 0.25MCG CAPSUL|Managed Medicare|HEALTHSPRING MA|18.25||||||| 9510777|ERX|0250|CALCITRIOL 0.25MCG CAPSUL|Blue Cross PPO Specialty|BCBSTX PPO|18.25||||||| 9510777|ERX|0250|CALCITRIOL 0.25MCG CAPSUL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|18.25||||||| 9510777|ERX|0250|CALCITRIOL 0.25MCG CAPSUL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|18.25||||||| 9510777|ERX|0250|CALCITRIOL 0.25MCG CAPSUL|United Medicare Advantage|UHC MEDICARE GOLD MA|18.25||||||| 9510777|ERX|0250|CALCITRIOL 0.25MCG CAPSUL|Medicare|MEDICARE ACUTE|18.25||||||| 9510835|ERX|0250|CALCIUM ACETATE 667MG CAP|Medicare|MEDICARE ACUTE|0.10||||||| 9510835|ERX|0250|CALCIUM ACETATE 667MG CAP|Humana Medicare Advantage|HUMANA MA|0.10||||||| 9510835|ERX|0250|CALCIUM ACETATE 667MG CAP|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.10||||||| 9510835|ERX|0250|CALCIUM ACETATE 667MG CAP|Blue Cross PPO Specialty|BCBSTX PPO|0.10||||||| 9510835|ERX|0250|CALCIUM ACETATE 667MG CAP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.10||||||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Aetna|AETNA PPO|13.50||||||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Blue Cross HMO Specialty|BCBSTX HMO|13.50||||||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Blue Cross PPO Specialty|BCBSTX PPO|13.50||||||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|13.50||||||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|13.50||||||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|13.50||||||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|13.50||||||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|United Medicare Advantage|UHC MEDICARE GOLD MA|13.50||||||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|United Medicare Advantage|UHC AARP MCR HMO MA|13.50||||||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|PHCS|HUMANA INSURANCE|13.50||||||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Medicare|MEDICARE ACUTE|13.50||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|United Medicare Advantage|UHC MEDICARE GOLD MA|7.50||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|PHCS|HUMANA INSURANCE|7.50||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|United Healthcare|UNITED HEALTHCARE|7.50||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|United Medicare Advantage|UHC AARP MCR HMO MA|7.50||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Medicare|MEDICARE ACUTE|7.50||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Managed Medicare|HEALTHSPRING MA|7.50||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Humana Medicare Advantage|HUMANA MA|7.50||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Blue Cross HMO Specialty|BCBSTX HMO|7.50||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Managed Medicaid|MEDICAID UNITED HEALTHCARE|7.50||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Blue Cross PPO Specialty|BCBSTX PPO|7.50||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Blue Cross PPO Specialty|BCBSTX OTHER|7.50||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|7.50||||||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Blue Cross PPO Specialty|BCBSTX PPO|90.25||||||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|United Medicare Advantage|UHC MEDICARE GOLD MA|90.25||||||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Medicare|MEDICARE ACUTE|90.25||||||| 9511049|ERX|0250|DAPSONE 100MG TABLET|Medicare|MEDICARE ACUTE|4.75||||||| 9511080|ERX|0250|HYDROXYZINE HCL 10MG TABL|Medicare|MEDICARE ACUTE|9.25||||||| 9511098|ERX|0250|ERGOCALCIFEROL 50000 UNIT|Managed Medicare|HEALTHSPRING MA|21.75||||||| 9511098|ERX|0250|ERGOCALCIFEROL 50000 UNIT|Humana Medicare Advantage|HUMANA MA|21.75||||||| 9511098|ERX|0250|ERGOCALCIFEROL 50000 UNIT|Blue Cross PPO Specialty|BCBSTX PPO|21.75||||||| 9511098|ERX|0250|ERGOCALCIFEROL 50000 UNIT|United Medicare Advantage|UHC MEDICARE GOLD MA|21.75||||||| 9511098|ERX|0250|ERGOCALCIFEROL 50000 UNIT|Medicare|MEDICARE ACUTE|21.75||||||| 9511213|ERX|0250|DORNASE ALFA 2.5MG 2.5ML|Medicare|MEDICARE ACUTE|582.75||||||| 9511262|ERX|0250|SOTALOL 80MG TABLET|Humana Medicare Advantage|HUMANA MA|0.36||||||| 9511262|ERX|0250|SOTALOL 80MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.36||||||| 9511262|ERX|0250|SOTALOL 80MG TABLET|Medicare|MEDICARE ACUTE|0.36||||||| 9511270|ERX|0250|METHYLPREDNISOL DEPO 40MG|Medicare|MEDICARE ACUTE|105.75||||||| 9511288|ERX|0250|ESTRADIOL 0.05MG PATCH|United Medicare Advantage|UHC MEDICARE GOLD MA|122.25||||||| 9511361|ERX|0250|FENTANYL 25MCG PATCH|Tricare|TRICARE EAST REGION|200.25||||||| 9511361|ERX|0250|FENTANYL 25MCG PATCH|Medicare|MEDICARE ACUTE|200.25||||||| 9511379|ERX|0250|FENTANYL 50MCG PATCH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|365.75||||||| 9511379|ERX|0250|FENTANYL 50MCG PATCH|Blue Cross PPO Specialty|BCBSTX PPO|365.75||||||| 9511379|ERX|0250|FENTANYL 50MCG PATCH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|365.75||||||| 9511379|ERX|0250|FENTANYL 50MCG PATCH|Tricare|TRICARE EAST REGION|365.75||||||| 9511379|ERX|0250|FENTANYL 50MCG PATCH|Medicare|MEDICARE ACUTE|365.75||||||| 9511445|ERX|0250|RISPERIDONE 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|51.75||||||| 9511445|ERX|0250|RISPERIDONE 1MG TABLET|Medicare|MEDICARE ACUTE|51.75||||||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Humana Medicare Advantage|HUMANA MA|181.25||||||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|United Medicare Advantage|UHC MEDICARE GOLD MA|181.25||||||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Medicare|MEDICARE ACUTE|181.25||||||| 9511460|ERX|0250|RISPERIDONE 0.25MG TABLET|Medicare|MEDICARE ACUTE|44.50||||||| 9511460|ERX|0250|RISPERIDONE 0.25MG TABLET|Humana Medicare Advantage|HUMANA MA|44.50||||||| 9511460|ERX|0250|RISPERIDONE 0.25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|44.50||||||| 9511460|ERX|0250|RISPERIDONE 0.25MG TABLET|Managed Medicare|HEALTHSPRING MA|44.50||||||| 9511551|ERX|0250|CLINDAMYCIN 300MG/50ML D5|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|132.50||||||| 9511585|ERX|0250|GALANTAMINE ER 8MG CAPSUL|United Medicare Advantage|UHC MEDICARE GOLD MA|0.70||||||| 9511650|ERX|0250|LEVETIRACETAM 500MG/5ML|Medicare|MEDICARE ACUTE|385.25||||||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|United Medicare Advantage|UHC AARP MCR HMO MA|2.06||||||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Managed Medicare|BCBS MEDICARE PPO MA|38.25||||||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Humana Medicare Advantage|HUMANA MA|38.25||||||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|38.25||||||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Managed Medicare|HEALTHSPRING MA|38.25||||||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|38.25||||||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|38.25||||||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|United Medicare Advantage|UHC AARP MCR HMO MA|38.25||||||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Veterans Affairs|VETERANS ADMINISTRATION|38.25||||||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Medicare|MEDICARE ACUTE|38.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|United Medicare Advantage|UHC AARP MCR HMO MA|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|PHCS|HUMANA INSURANCE|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|United Healthcare|UNITED HEALTHCARE|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|United Healthcare|UNITED HEALTHCARE OTHER|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Medicare|MEDICARE ACUTE|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Humana Medicare Advantage|HUMANA MA|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Managed Medicare|HEALTHSPRING MA|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Cigna|CIGNA OTHER|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Aetna|AETNA PPO|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Aetna|AETNA OTHER|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Medicaid|MEDICAID|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Cigna|CIGNA|9.25||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Aetna|AETNA OTHER|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Access Direct Platinum|HEALTHFIRST TPA|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Blue Cross PPO Specialty|BCBSTX OTHER|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Managed Medicare|HEALTHSPRING MA|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Managed Medicare|BCBS MEDICARE PPO MA|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|United Medicare Advantage|UHC AARP MCR HMO MA|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Veterans Affairs|VETERANS ADMINISTRATION|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Tricare|TRICARE EAST REGION|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|United Healthcare|UNITED HEALTHCARE|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|United Healthcare|UNITED HEALTHCARE OTHER|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Workers Compensation|WORKERS COMPENSATION OTHER|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Medicare|MEDICARE ACUTE|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|NON CONTRACTED|COMMERCIAL OTHER 1|2.50||||||| 9511833|ERX|0250|SALIVA SUBSTITUTE, 60ML|United Medicare Advantage|UHC MEDICARE GOLD MA|54.50||||||| 9511833|ERX|0250|SALIVA SUBSTITUTE, 60ML|Workers Compensation|TEXAS MUTUAL INSURANCE|54.50||||||| 9511833|ERX|0250|SALIVA SUBSTITUTE, 60ML|Medicare|MEDICARE ACUTE|54.50||||||| 9511833|ERX|0250|SALIVA SUBSTITUTE, 60ML|Humana Medicare Advantage|HUMANA MA|54.50||||||| 9511833|ERX|0250|SALIVA SUBSTITUTE, 60ML|Managed Medicare|BCBS MEDICARE PPO MA|54.50||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|0.45||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Humana Medicare Advantage|HUMANA MA|0.45||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.45||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Aetna|AETNA PPO|0.45||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UMR|0.45||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.45||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|0.45||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.45||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.45||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.45||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Managed Medicare|HEALTHSPRING MA|0.45||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|0.45||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.45||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.45||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Tricare|TRICARE EAST REGION|0.45||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|0.45||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Medicare|MEDICARE ACUTE|0.45||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|United Medicare Advantage|UHC AARP MCR HMO MA|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|PHCS|HUMANA INSURANCE|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Workers Compensation|WORKERS COMPENSATION OTHER|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|NON CONTRACTED|COMMERCIAL OTHER 1|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Medicare|MEDICARE ACUTE|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Aenta Medicare Advantage|AETNA MEDICARE MA|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Cigna|CIGNA|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Cigna|CIGNA OTHER|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Blue Cross HMO Specialty|BCBSTX HMO|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Access Direct Platinum|HEALTHFIRST TPA UMR|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Medicaid|MEDICAID|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Blue Cross PPO Specialty|BCBSTX OTHER|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Managed Medicare|BCBS MEDICARE PPO MA|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Access Direct Platinum|HEALTHFIRST TPA|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Managed Medicare|HEALTHSPRING MA|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.50||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|0.03||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|0.03||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Humana Medicare Advantage|HUMANA MA|0.03||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.03||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|0.03||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Managed Medicare|HEALTHSPRING MA|0.03||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.03||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.03||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|United Healthcare|UNITED HEALTHCARE|0.03||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.03||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Medicare|MEDICARE ACUTE|0.03||||||| 9511940|ERX|0250|CARISOPRODOL 350MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|9.25||||||| 9511940|ERX|0250|CARISOPRODOL 350MG TABLET|Medicare|MEDICARE ACUTE|9.25||||||| 9511940|ERX|0250|CARISOPRODOL 350MG TABLET|Cigna|CIGNA|9.25||||||| 9511940|ERX|0250|CARISOPRODOL 350MG TABLET|Humana Medicare Advantage|HUMANA MA|9.25||||||| 9511940|ERX|0250|CARISOPRODOL 350MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|9.25||||||| 9511940|ERX|0250|CARISOPRODOL 350MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|9.25||||||| 9511940|ERX|0250|CARISOPRODOL 350MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|9.25||||||| 9511940|ERX|0250|CARISOPRODOL 350MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.25||||||| 9511957|ERX|0250|CHLORTHALIDONE 25MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.25||||||| 9511957|ERX|0250|CHLORTHALIDONE 25MG TABLE|Medicare|MEDICARE ACUTE|4.25||||||| 9511999|ERX|0250|DIPHENOX-ATROP 2.5-0.025M|Medicare|MEDICARE ACUTE|8.50||||||| 9511999|ERX|0250|DIPHENOX-ATROP 2.5-0.025M|Blue Cross PPO Specialty|BCBSTX PPO|8.50||||||| 9512005|ERX|0250|DIPYRIDAMOLE 25MG TABLET|Medicare|MEDICARE ACUTE|0.07||||||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.50||||||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Veterans Affairs|VETERANS ADMINISTRATION|2.50||||||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Medicare|MEDICARE ACUTE|2.50||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|2.75||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|2.75||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|2.75||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Tricare|TRICARE EAST REGION|2.75||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|2.75||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|2.75||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Medicare|MEDICARE ACUTE|2.75||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|2.75||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Humana Medicare Advantage|HUMANA MA|2.75||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|2.75||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.75||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Managed Medicare|HEALTHSPRING MA|2.75||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|2.75||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.75||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Cigna|CIGNA|0.03||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.03||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Managed Medicare|HEALTHSPRING MA|0.03||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Humana Medicare Advantage|HUMANA MA|0.03||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.03||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.03||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.03||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|0.03||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.03||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Medicaid|MEDICAID|0.03||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.03||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.03||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|0.03||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|United Healthcare|UNITED HEALTHCARE|0.03||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Medicare|MEDICARE ACUTE|0.03||||||| 9512070|ERX|0250|MIRTAZAPINE 15MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.28||||||| 9512070|ERX|0250|MIRTAZAPINE 15MG TABLET|Medicare|MEDICARE ACUTE|0.28||||||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|5.25||||||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|5.25||||||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|5.25||||||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Medicare|MEDICARE ACUTE|5.25||||||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Medicare|MEDICARE ACUTE|7.75||||||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|United Medicare Advantage|UHC AARP MCR HMO MA|7.75||||||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|7.75||||||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|United Healthcare|UNITED HEALTHCARE OTHER|7.75||||||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|7.75||||||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Humana Medicare Advantage|HUMANA MA|7.75||||||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|7.75||||||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|7.75||||||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|7.75||||||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.75||||||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|7.75||||||| 9512120|ERX|0250|ACETAM-CODEINE 300-60MG T|Cigna|CIGNA|9.25||||||| 9512120|ERX|0250|ACETAM-CODEINE 300-60MG T|Blue Cross PPO Specialty|BCBSTX PPO|9.25||||||| 9512120|ERX|0250|ACETAM-CODEINE 300-60MG T|Medicare|MEDICARE ACUTE|9.25||||||| 9512120|ERX|0250|ACETAM-CODEINE 300-60MG T|United Medicare Advantage|UHC MEDICARE GOLD MA|9.25||||||| 9512120|ERX|0250|ACETAM-CODEINE 300-60MG T|United Healthcare|UNITED HEALTHCARE|9.25||||||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|Medicare|MEDICARE ACUTE|0.07||||||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.07||||||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.07||||||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|Humana Medicare Advantage|HUMANA MA|0.07||||||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|Humana Medicare Advantage|HUMANA MA|6.25||||||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|Medicare|MEDICARE ACUTE|6.25||||||| 9512161|ERX|0250|METRONIDAZOLE 500MG TABLE|Medicare|MEDICARE ACUTE|0.13||||||| 9512161|ERX|0250|METRONIDAZOLE 500MG TABLE|United Medicare Advantage|UHC AARP MCR HMO MA|0.13||||||| 9512161|ERX|0250|METRONIDAZOLE 500MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|0.13||||||| 9512161|ERX|0250|METRONIDAZOLE 500MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||||| 9512161|ERX|0250|METRONIDAZOLE 500MG TABLE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.13||||||| 9512161|ERX|0250|METRONIDAZOLE 500MG TABLE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.13||||||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Humana Medicare Advantage|HUMANA MA|0.19||||||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Blue Cross PPO Specialty|BCBSTX PPO|0.19||||||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.19||||||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.19||||||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Medicare|MEDICARE ACUTE|0.19||||||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|United Medicare Advantage|UHC MEDICARE GOLD MA|0.19||||||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|United Healthcare|UNITED HEALTHCARE OTHER|0.19||||||| 9512195|ERX|0250|AMITRIPTYLINE 10MG TABLET|Medicare|MEDICARE ACUTE|4.25||||||| 9512211|ERX|0250|AMITRIPTYLINE 50MG TABLET|Humana Medicare Advantage|HUMANA MA|9.25||||||| 9512211|ERX|0250|AMITRIPTYLINE 50MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.25||||||| 9512211|ERX|0250|AMITRIPTYLINE 50MG TABLET|Medicare|MEDICARE ACUTE|9.25||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Medicare|MEDICARE ACUTE|6.25||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|United Medicare Advantage|UHC MEDICARE GOLD MA|6.25||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|United Medicare Advantage|UHC AARP MCR HMO MA|6.25||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|PHCS|HUMANA INSURANCE|6.25||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Tricare|TRICARE EAST REGION|6.25||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|United Healthcare|TML GROUP BENEFITS|6.25||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|United Healthcare|UNITED HEALTHCARE OTHER|6.25||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|United Healthcare|UNITED HEALTHCARE|6.25||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Aenta Medicare Advantage|AETNA MEDICARE MA|6.25||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|6.25||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Blue Cross HMO Specialty|BCBSTX HMO|6.25||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Humana Medicare Advantage|HUMANA MA|6.25||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Aetna|AETNA PPO|6.25||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Blue Cross PPO Specialty|BCBSTX OTHER|6.25||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Blue Cross PPO Specialty|BCBSTX PPO|6.25||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Managed Medicare|HEALTHSPRING MA|6.25||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Managed Medicare|BCBS MEDICARE PPO MA|6.25||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|6.25||||||| 9512260|ERX|0250|INDOMETHACIN 25MG CAPSULE|Medicare|MEDICARE ACUTE|7.25||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.05||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Humana Medicare Advantage|HUMANA MA|0.05||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.05||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.05||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Medicare|MEDICARE ACUTE|0.05||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.05||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.05||||||| 9512344|ERX|0250|ALLOPURINOL 300MG TABLET|Medicare|MEDICARE ACUTE|9.25||||||| 9512344|ERX|0250|ALLOPURINOL 300MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|9.25||||||| 9512344|ERX|0250|ALLOPURINOL 300MG TABLET|Humana Medicare Advantage|HUMANA MA|9.25||||||| 9512344|ERX|0250|ALLOPURINOL 300MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|9.25||||||| 9512344|ERX|0250|ALLOPURINOL 300MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.25||||||| 9512344|ERX|0250|ALLOPURINOL 300MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|9.25||||||| 9512344|ERX|0250|ALLOPURINOL 300MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|9.25||||||| 9512351|ERX|0250|BENZTROPINE 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|5.50||||||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.25||||||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|5.25||||||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|5.25||||||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|5.25||||||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Medicare|MEDICARE ACUTE|5.25||||||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|United Medicare Advantage|UHC AARP MCR HMO MA|5.25||||||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|NON CONTRACTED|COMMERCIAL OTHER 1|5.25||||||| 9512419|ERX|0250|DIAZEPAM 2MG TABLET|Medicare|MEDICARE ACUTE|5.25||||||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|5.75||||||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.75||||||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Medicare|MEDICARE ACUTE|5.75||||||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Medicare|MEDICARE ACUTE|5.25||||||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|5.25||||||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|5.25||||||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|5.25||||||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|5.25||||||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Humana Medicare Advantage|HUMANA MA|5.25||||||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Managed Medicare|HEALTHSPRING MA|5.25||||||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|5.25||||||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|5.25||||||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.25||||||| 9512450|ERX|0250|CLONIDINE 0.2MG TABLET|Humana Medicare Advantage|HUMANA MA|5.75||||||| 9512450|ERX|0250|CLONIDINE 0.2MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|5.75||||||| 9512450|ERX|0250|CLONIDINE 0.2MG TABLET|Managed Medicare|HEALTHSPRING MA|5.75||||||| 9512450|ERX|0250|CLONIDINE 0.2MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|5.75||||||| 9512450|ERX|0250|CLONIDINE 0.2MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.75||||||| 9512450|ERX|0250|CLONIDINE 0.2MG TABLET|Medicare|MEDICARE ACUTE|5.75||||||| 9512450|ERX|0250|CLONIDINE 0.2MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|5.75||||||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.14||||||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Medicare|MEDICARE ACUTE|0.14||||||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|United Healthcare|UNITED HEALTHCARE|0.14||||||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Humana Medicare Advantage|HUMANA MA|0.14||||||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.14||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|11.50||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Humana Medicare Advantage|HUMANA MA|11.50||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|11.50||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Managed Medicare|HEALTHSPRING MA|11.50||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|11.50||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|11.50||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|11.50||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Medicare|MEDICARE ACUTE|11.50||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|11.50||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|United Healthcare|UNITED HEALTHCARE|11.50||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|11.50||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|United Medicare Advantage|UHC AARP MCR HMO MA|11.50||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Medicare|MEDICARE ACUTE|11.50||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|11.50||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Humana Medicare Advantage|HUMANA MA|11.50||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|11.50||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Managed Medicare|HEALTHSPRING MA|11.50||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|11.50||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|11.50||||||| 9512567|ERX|0250|CILOSTAZOL 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|23.50||||||| 9512567|ERX|0250|CILOSTAZOL 100MG TABLET|Managed Medicare|HEALTHSPRING MA|23.50||||||| 9512567|ERX|0250|CILOSTAZOL 100MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|23.50||||||| 9512567|ERX|0250|CILOSTAZOL 100MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|23.50||||||| 9512567|ERX|0250|CILOSTAZOL 100MG TABLET|Medicare|MEDICARE ACUTE|23.50||||||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.10||||||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|Medicare|MEDICARE ACUTE|0.10||||||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|Humana Medicare Advantage|HUMANA MA|0.10||||||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.10||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|7.75||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Humana Medicare Advantage|HUMANA MA|7.75||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|7.75||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|7.75||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|7.75||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|7.75||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Managed Medicare|HEALTHSPRING MA|7.75||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.75||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|7.75||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|7.75||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Medicare|MEDICARE ACUTE|7.75||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|7.75||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|7.75||||||| 9512617|ERX|0250|LINEZOLID 600MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|842.50||||||| 9512617|ERX|0250|LINEZOLID 600MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|842.50||||||| 9512617|ERX|0250|LINEZOLID 600MG TABLET|Medicare|MEDICARE ACUTE|842.50||||||| 9512617|ERX|0250|LINEZOLID 600MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|842.50||||||| 9512617|ERX|0250|LINEZOLID 600MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|842.50||||||| 9512617|ERX|0250|LINEZOLID 600MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|842.50||||||| 9512617|ERX|0250|LINEZOLID 600MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|842.50||||||| 9512617|ERX|0250|LINEZOLID 600MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|842.50||||||| 9512617|ERX|0250|LINEZOLID 600MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|842.50||||||| 9512633|ERX|0250|MEGESTROL 40MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|15.50||||||| 9512633|ERX|0250|MEGESTROL 40MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|15.50||||||| 9512633|ERX|0250|MEGESTROL 40MG TABLET|Workers Compensation|TEXAS MUTUAL INSURANCE|15.50||||||| 9512633|ERX|0250|MEGESTROL 40MG TABLET|Medicare|MEDICARE ACUTE|15.50||||||| 9512658|ERX|0250|DOXEPIN 25MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|7.75||||||| 9512690|ERX|0250|AMANTADINE 100MG CAPSULE|Managed Medicare|HEALTHSPRING MA|9.25||||||| 9512690|ERX|0250|AMANTADINE 100MG CAPSULE|Medicare|MEDICARE ACUTE|9.25||||||| 9512773|ERX|0250|CHLORPROMAZINE 25MG TABLE|Medicare|MEDICARE ACUTE|5.25||||||| 9512773|ERX|0250|CHLORPROMAZINE 25MG TABLE|Humana Medicare Advantage|HUMANA MA|5.25||||||| 9512799|ERX|0250|PROCHLORPERAZINE 5MG TABL|Blue Cross PPO Specialty|BCBSTX PPO|9.25||||||| 9512799|ERX|0250|PROCHLORPERAZINE 5MG TABL|Medicare|MEDICARE ACUTE|9.25||||||| 9513003|ERX|0250|AMOXICILLIN 250MG CAPSULE|Medicare|MEDICARE ACUTE|5.25||||||| 9513011|ERX|0250|AMOXICILLIN 500MG CAPSULE|Humana Medicare Advantage|HUMANA MA|8.50||||||| 9513011|ERX|0250|AMOXICILLIN 500MG CAPSULE|Medicare|MEDICARE ACUTE|8.50||||||| 9513011|ERX|0250|AMOXICILLIN 500MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|8.50||||||| 9513029|ERX|0250|CEPHALEXIN 500MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.22||||||| 9513029|ERX|0250|CEPHALEXIN 500MG CAPSULE|United Medicare Advantage|UHC AARP MCR HMO MA|0.22||||||| 9513029|ERX|0250|CEPHALEXIN 500MG CAPSULE|Medicare|MEDICARE ACUTE|0.22||||||| 9513029|ERX|0250|CEPHALEXIN 500MG CAPSULE|Workers Compensation|WORKERS COMPENSATION OTHER|0.22||||||| 9513029|ERX|0250|CEPHALEXIN 500MG CAPSULE|United Healthcare|UNITED HEALTHCARE|0.22||||||| 9513029|ERX|0250|CEPHALEXIN 500MG CAPSULE|Access Direct Platinum|HEALTHFIRST TPA UMR|0.22||||||| 9513029|ERX|0250|CEPHALEXIN 500MG CAPSULE|Humana Medicare Advantage|HUMANA MA|0.22||||||| 9513029|ERX|0250|CEPHALEXIN 500MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|0.22||||||| 9513029|ERX|0250|CEPHALEXIN 500MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|0.22||||||| 9513029|ERX|0250|CEPHALEXIN 500MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.22||||||| 9513052|ERX|0250|PRAZOSIN 1MG CAPSULE|Humana Medicare Advantage|HUMANA MA|5.50||||||| 9513052|ERX|0250|PRAZOSIN 1MG CAPSULE|Medicare|MEDICARE ACUTE|5.50||||||| 9513052|ERX|0250|PRAZOSIN 1MG CAPSULE|United Healthcare|UNITED HEALTHCARE OTHER|5.50||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|United Medicare Advantage|UHC MEDICARE GOLD MA|0.15||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|United Medicare Advantage|UHC AARP MCR HMO MA|0.15||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|0.15||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Workers Compensation|TEXAS MUTUAL INSURANCE|0.15||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|United Healthcare|UNITED HEALTHCARE|0.15||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Medicare|MEDICARE ACUTE|0.15||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.15||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|0.15||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Humana Medicare Advantage|HUMANA MA|0.15||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Cigna|CIGNA|0.15||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Blue Cross HMO Specialty|BCBSTX HMO|0.15||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Aetna|AETNA PPO|0.15||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Managed Medicare|BCBS MEDICARE PPO MA|0.15||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.15||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Blue Cross PPO Specialty|BCBSTX PPO|0.15||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.15||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.15||||||| 9513151|ERX|0250|ATENOLOL 50MG TABLET|Humana Medicare Advantage|HUMANA MA|13.50||||||| 9513151|ERX|0250|ATENOLOL 50MG TABLET|Medicare|MEDICARE ACUTE|13.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|11.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|United Medicare Advantage|UHC AARP MCR HMO MA|11.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|NON CONTRACTED|COMMERCIAL OTHER 1|11.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|United Healthcare|UNITED HEALTHCARE|11.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|United Healthcare|UNITED HEALTHCARE OTHER|11.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Medicare|MEDICARE ACUTE|11.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Humana Medicare Advantage|HUMANA MA|11.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Managed Medicare|BCBS MEDICARE PPO MA|11.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|11.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|11.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|11.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|11.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|11.50||||||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Medicaid|MEDICAID|2.50||||||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Medicare|MEDICARE ACUTE|2.50||||||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|United Healthcare|UNITED HEALTHCARE|2.50||||||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|2.50||||||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Medicare|MEDICARE ACUTE|0.08||||||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|0.08||||||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|0.08||||||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.08||||||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Humana Medicare Advantage|HUMANA MA|0.08||||||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.08||||||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.08||||||| 9513235|ERX|0250|CARBIDOPA-LEVODOPA 10-100|Medicare|MEDICARE ACUTE|11.75||||||| 9513243|ERX|0250|CARBIDOPA-LEVODOPA 25-100|United Medicare Advantage|UHC MEDICARE GOLD MA|12.50||||||| 9513243|ERX|0250|CARBIDOPA-LEVODOPA 25-100|Medicare|MEDICARE ACUTE|12.50||||||| 9513243|ERX|0250|CARBIDOPA-LEVODOPA 25-100|United Medicare Advantage|UHC AARP MCR HMO MA|12.50||||||| 9513243|ERX|0250|CARBIDOPA-LEVODOPA 25-100|Blue Cross PPO Specialty|BCBSTX PPO|12.50||||||| 9513243|ERX|0250|CARBIDOPA-LEVODOPA 25-100|Humana Medicare Advantage|HUMANA MA|12.50||||||| 9513250|ERX|0250|ATENOLOL 25MG TABLET|Medicare|MEDICARE ACUTE|12.50||||||| 9513250|ERX|0250|ATENOLOL 25MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|12.50||||||| 9513268|ERX|0250|CARBIDOPA-LEVODOPA 25-250|United Medicare Advantage|UHC MEDICARE GOLD MA|0.15||||||| 9513268|ERX|0250|CARBIDOPA-LEVODOPA 25-250|Humana Medicare Advantage|HUMANA MA|0.15||||||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|12.25||||||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Humana Medicare Advantage|HUMANA MA|12.25||||||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|12.25||||||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|12.25||||||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Cigna|CIGNA|12.25||||||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|12.25||||||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|12.25||||||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Medicare|MEDICARE ACUTE|12.25||||||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|United Healthcare|UNITED HEALTHCARE|12.25||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Aetna|AETNA PPO|9.25||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Aetna|AETNA OTHER|9.25||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|9.25||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Humana Medicare Advantage|HUMANA MA|9.25||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.25||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|United Healthcare|UNITED HEALTHCARE OTHER|9.25||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Blue Cross HMO Specialty|BCBSTX HMO|9.25||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Blue Cross PPO Specialty|BCBSTX PPO|9.25||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Veterans Affairs|VETERANS ADMINISTRATION|9.25||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|United Medicare Advantage|UHC MEDICARE GOLD MA|9.25||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Medicare|MEDICARE ACUTE|9.25||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|United Healthcare|UNITED HEALTHCARE|9.25||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Aenta Medicare Advantage|AETNA MEDICARE MA|9.25||||||| 9513326|ERX|0250|NORTRIPTYLINE 10MG CAPSUL|Medicare|MEDICARE ACUTE|0.08||||||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.07||||||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|Medicare|MEDICARE ACUTE|0.07||||||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.07||||||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.07||||||| 9513433|ERX|0250|SUCRALFATE 1 G TABLET|Medicare|MEDICARE ACUTE|12.25||||||| 9513441|ERX|0250|GLYBURIDE 2.5MG TABLET|Medicare|MEDICARE ACUTE|5.50||||||| 9513458|ERX|0250|GLYBURIDE 5MG TABLET|Medicare|MEDICARE ACUTE|0.09||||||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|7.50||||||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|7.50||||||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|Medicare|MEDICARE ACUTE|7.50||||||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|Humana Medicare Advantage|HUMANA MA|7.50||||||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|7.50||||||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.50||||||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|United Healthcare|UNITED HEALTHCARE|7.50||||||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|7.50||||||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|7.50||||||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|7.50||||||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|7.50||||||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|7.50||||||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|7.50||||||| 9513482|ERX|0250|VERAPAMIL SR 120MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|14.50||||||| 9513490|ERX|0250|VERAPAMIL SR 180MG TABLET|Medicare|MEDICARE ACUTE|15.50||||||| 9513508|ERX|0250|CARBIDOPA-LEVO SR 50-200M|Medicare|MEDICARE ACUTE|25.50||||||| 9513508|ERX|0250|CARBIDOPA-LEVO SR 50-200M|Blue Cross PPO Specialty|BCBSTX PPO|25.50||||||| 9513508|ERX|0250|CARBIDOPA-LEVO SR 50-200M|Humana Medicare Advantage|HUMANA MA|25.50||||||| 9513516|ERX|0250|DILTIAZEM SR 60MG CAPSULE|Medicare|MEDICARE ACUTE|12.25||||||| 9513516|ERX|0250|DILTIAZEM SR 60MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|12.25||||||| 9513516|ERX|0250|DILTIAZEM SR 60MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|12.25||||||| 9513557|ERX|0250|LABETALOL 100MG TABLET|Medicare|MEDICARE ACUTE|8.50||||||| 9513557|ERX|0250|LABETALOL 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|8.50||||||| 9513557|ERX|0250|LABETALOL 100MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|8.50||||||| 9513573|ERX|0250|TRIAMTERENE/HCTZ 37.5-25M|Medicare|MEDICARE ACUTE|0.08||||||| 9513573|ERX|0250|TRIAMTERENE/HCTZ 37.5-25M|Humana Medicare Advantage|HUMANA MA|0.08||||||| 9513599|ERX|0250|ENALAPRIL 5MG TABLET|Medicare|MEDICARE ACUTE|15.50||||||| 9513599|ERX|0250|ENALAPRIL 5MG TABLET|Cigna|CIGNA|15.50||||||| 9513599|ERX|0250|ENALAPRIL 5MG TABLET|Humana Medicare Advantage|HUMANA MA|15.50||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Medicare|MEDICARE ACUTE|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|PHCS|HUMANA INSURANCE|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Cigna|CIGNA OTHER|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Tricare|TRICARE EAST REGION|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|United Healthcare|UNITED HEALTHCARE|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UMR|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Humana Medicare Advantage|HUMANA MA|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|United Healthcare|TML GROUP BENEFITS|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Aetna|AETNA OTHER|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Cigna|CIGNA|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Blue Cross PPO Specialty|BCBSTX OTHER|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Medicaid|MEDICAID|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Aetna|AETNA PPO|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Managed Medicare|HEALTHSPRING MA|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|22.25||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.50||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Managed Medicare|BCBS MEDICARE PPO MA|2.50||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|United Medicare Advantage|UHC AARP MCR HMO MA|2.50||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Blue Cross HMO Specialty|BCBSTX HMO|2.50||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Cigna|CIGNA|2.50||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|United Healthcare|UNITED HEALTHCARE OTHER|2.50||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Medicare|MEDICARE ACUTE|2.50||||2.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|PHCS|HUMANA INSURANCE|2.50||||||| 9513656|ERX|0250|CARBIDOPA-LEVO SR 25-100M|Humana Medicare Advantage|HUMANA MA|14.25||||||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|0.14||||||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Medicare|MEDICARE ACUTE|0.14||||||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.14||||||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.14||||||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.14||||||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Cigna|CIGNA OTHER|0.14||||||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Humana Medicare Advantage|HUMANA MA|0.14||||||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|0.14||||||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.14||||||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.14||||||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|United Healthcare|UNITED HEALTHCARE|15.50||||||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Medicare|MEDICARE ACUTE|15.50||||||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|15.50||||||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|15.50||||||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|15.50||||||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|15.50||||||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|15.50||||||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Managed Medicare|HEALTHSPRING MA|15.50||||||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Humana Medicare Advantage|HUMANA MA|15.50||||||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Cigna|CIGNA|15.50||||||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Medicaid|MEDICAID|15.50||||||| 9513730|ERX|0250|SOLIFENACIN 5MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UMR|0.45||||||| 9513748|ERX|0250|CHLORHEXIDINE 0.12% ORAL|Medicare|MEDICARE ACUTE|169.50||||||| 9513748|ERX|0250|CHLORHEXIDINE 0.12% ORAL|Blue Cross HMO Specialty|BCBSTX HMO|169.50||||||| 9513748|ERX|0250|CHLORHEXIDINE 0.12% ORAL|Humana Medicare Advantage|HUMANA MA|169.50||||||| 9513748|ERX|0250|CHLORHEXIDINE 0.12% ORAL|Blue Cross PPO Specialty|BCBSTX PPO|169.50||||||| 9513789|ERX|0250|BISOPROLOL 5MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|31.25||||||| 9513938|ERX|0250|AZTREONAM 1000MG VIAL|Humana Medicare Advantage|HUMANA MA|3.74||||||| 9513938|ERX|0250|AZTREONAM 1000MG VIAL|Medicare|MEDICARE ACUTE|3.74||||||| 9513953|ERX|0250|CEFEPIME 1 G VIAL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|2.32||||||| 9513953|ERX|0250|CEFEPIME 1 G VIAL|Veterans Affairs|VETERANS ADMINISTRATION|2.32||||||| 9513953|ERX|0250|CEFEPIME 1 G VIAL|Humana Medicare Advantage|HUMANA MA|2.32||||||| 9513953|ERX|0250|CEFEPIME 1 G VIAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.32||||||| 9514001|ERX|0250|NYSTATIN CREAM, 15 GM|Humana Medicare Advantage|HUMANA MA|33.50||||||| 9514001|ERX|0250|NYSTATIN CREAM, 15 GM|Cigna|CIGNA|33.50||||||| 9514001|ERX|0250|NYSTATIN CREAM, 15 GM|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|33.50||||||| 9514001|ERX|0250|NYSTATIN CREAM, 15 GM|Medicare|MEDICARE ACUTE|33.50||||||| 9514019|ERX|0250|CLOTRIMAZOLE 1% CREAM, 15|United Healthcare|UNITED HEALTHCARE OTHER|69.75||||||| 9514019|ERX|0250|CLOTRIMAZOLE 1% CREAM, 15|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|69.75||||||| 9514019|ERX|0250|CLOTRIMAZOLE 1% CREAM, 15|Medicare|MEDICARE ACUTE|69.75||||||| 9514019|ERX|0250|CLOTRIMAZOLE 1% CREAM, 15|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|69.75||||||| 9514019|ERX|0250|CLOTRIMAZOLE 1% CREAM, 15|United Medicare Advantage|UHC MEDICARE GOLD MA|69.75||||||| 9514043|ERX|0250|ACETAZOLAMIDE 250MG TABLE|Aetna|AETNA PPO|7.75||||||| 9514043|ERX|0250|ACETAZOLAMIDE 250MG TABLE|Managed Medicare|HEALTHSPRING MA|7.75||||||| 9514043|ERX|0250|ACETAZOLAMIDE 250MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.75||||||| 9514043|ERX|0250|ACETAZOLAMIDE 250MG TABLE|Medicare|MEDICARE ACUTE|7.75||||||| 9514043|ERX|0250|ACETAZOLAMIDE 250MG TABLE|Humana Medicare Advantage|HUMANA MA|7.75||||||| 9514043|ERX|0250|ACETAZOLAMIDE 250MG TABLE|United Healthcare|UNITED HEALTHCARE OTHER|7.75||||||| 9514043|ERX|0250|ACETAZOLAMIDE 250MG TABLE|United Medicare Advantage|UHC AARP MCR HMO MA|7.75||||||| 9514043|ERX|0250|ACETAZOLAMIDE 250MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|7.75||||||| 9514050|ERX|0250|RENAL VITAMIN TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|8.50||||||| 9514050|ERX|0250|RENAL VITAMIN TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|8.50||||||| 9514050|ERX|0250|RENAL VITAMIN TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|8.50||||||| 9514050|ERX|0250|RENAL VITAMIN TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|8.50||||||| 9514050|ERX|0250|RENAL VITAMIN TABLET|Blue Cross HMO Specialty|BCBSTX HMO|8.50||||||| 9514050|ERX|0250|RENAL VITAMIN TABLET|Medicare|MEDICARE ACUTE|8.50||||||| 9514050|ERX|0250|RENAL VITAMIN TABLET|Access Direct Platinum|HEALTHFIRST TPA|8.50||||||| 9514050|ERX|0250|RENAL VITAMIN TABLET|Humana Medicare Advantage|HUMANA MA|8.50||||||| 9514050|ERX|0250|RENAL VITAMIN TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|8.50||||||| 9514050|ERX|0250|RENAL VITAMIN TABLET|Cigna|CIGNA OTHER|8.50||||||| 9514050|ERX|0250|RENAL VITAMIN TABLET|Blue Cross PPO Specialty|BCBSTX PPO|8.50||||||| 9514050|ERX|0250|RENAL VITAMIN TABLET|Managed Medicare|HEALTHSPRING MA|8.50||||||| 9514050|ERX|0250|RENAL VITAMIN TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|8.50||||||| 9514050|ERX|0250|RENAL VITAMIN TABLET|United Healthcare|UNITED HEALTHCARE OTHER|8.50||||||| 9514076|ERX|0250|PRENATAL VIT-FE FUMARATE-|Blue Cross PPO Specialty|BCBSTX PPO|5.75||||||| 9514076|ERX|0250|PRENATAL VIT-FE FUMARATE-|Humana Medicare Advantage|HUMANA MA|5.75||||||| 9514076|ERX|0250|PRENATAL VIT-FE FUMARATE-|Medicare|MEDICARE ACUTE|5.75||||||| 9514076|ERX|0250|PRENATAL VIT-FE FUMARATE-|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.75||||||| 9514076|ERX|0250|PRENATAL VIT-FE FUMARATE-|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|5.75||||||| 9514076|ERX|0250|PRENATAL VIT-FE FUMARATE-|United Medicare Advantage|UHC MEDICARE GOLD MA|5.75||||||| 9514084|ERX|0250|PEG 3350, 4L|Humana Medicare Advantage|HUMANA MA|198.75||||||| 9514084|ERX|0250|PEG 3350, 4L|Medicare|MEDICARE ACUTE|198.75||||||| 9514100|ERX|0250|LATANOPROST EYE DROP, 2.5|Medicare|MEDICARE ACUTE|772.75||||||| 9514100|ERX|0250|LATANOPROST EYE DROP, 2.5|Blue Cross PPO Specialty|BCBSTX PPO|772.75||||||| 9514100|ERX|0250|LATANOPROST EYE DROP, 2.5|Humana Medicare Advantage|HUMANA MA|772.75||||||| 9514100|ERX|0250|LATANOPROST EYE DROP, 2.5|United Medicare Advantage|UHC MEDICARE GOLD MA|772.75||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Managed Medicare|BCBS MEDICARE PPO MA|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|PHCS|HUMANA INSURANCE|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|NON CONTRACTED|COMMERCIAL OTHER 1|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Tricare|TRICARE EAST REGION|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|United Healthcare|UNITED HEALTHCARE OTHER|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Medicare|MEDICARE ACUTE|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|United Healthcare|UNITED HEALTHCARE|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|United Medicare Advantage|UHC MEDICARE GOLD MA|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Aenta Medicare Advantage|AETNA MEDICARE MA|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|United Medicare Advantage|UHC AARP MCR HMO MA|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Cigna|CIGNA|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Access Direct Platinum|HEALTHFIRST TPA|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Workers Compensation|WORKERS COMPENSATION OTHER|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Veterans Affairs|VETERANS ADMINISTRATION|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Humana Medicare Advantage|HUMANA MA|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Blue Cross PPO Specialty|BCBSTX PPO|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Managed Medicaid|MEDICAID UNITED HEALTHCARE|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Managed Medicare|HEALTHSPRING MA|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Aetna|AETNA PPO|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Blue Cross HMO Specialty|BCBSTX HMO|25.50||||||| 9514175|ERX|0250|LOXAPINE 25MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|32.50||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Aenta Medicare Advantage|AETNA MEDICARE MA|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Managed Medicare|HEALTHSPRING MA|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Humana Medicare Advantage|HUMANA MA|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Cigna|CIGNA|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Aetna|AETNA PPO|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Blue Cross PPO Specialty|BCBSTX PPO|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|United Medicare Advantage|UHC AARP MCR HMO MA|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|United Medicare Advantage|UHC MEDICARE GOLD MA|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Blue Cross HMO Specialty|BCBSTX HMO|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Workers Compensation|TEXAS MUTUAL INSURANCE|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Workers Compensation|WORKERS COMPENSATION OTHER|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Medicare|MEDICARE ACUTE|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Tricare|TRICARE EAST REGION|21.25||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|United Medicare Advantage|UHC AARP MCR HMO MA|15.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|NON CONTRACTED|COMMERCIAL OTHER 1|15.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|15.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Cigna|CIGNA OTHER|15.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Medicare|MEDICARE ACUTE|15.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Workers Compensation|WORKERS COMPENSATION OTHER|15.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Aenta Medicare Advantage|AETNA MEDICARE MA|15.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|15.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|United Healthcare|UNITED HEALTHCARE|15.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Access Direct Platinum|HEALTHFIRST TPA|15.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|United Medicare Advantage|UHC MEDICARE GOLD MA|15.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|15.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Humana Medicare Advantage|HUMANA MA|15.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Cigna|CIGNA|15.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|15.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Blue Cross PPO Specialty|BCBSTX PPO|15.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|15.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|15.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Blue Cross HMO Specialty|BCBSTX HMO|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|United Healthcare|UNITED HEALTHCARE OTHER|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|United Healthcare|UNITED HEALTHCARE|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Aetna|AETNA OTHER|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Access Direct Platinum|HEALTHFIRST TPA|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Aenta Medicare Advantage|AETNA MEDICARE MA|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Managed Medicaid|MEDICAID UNITED HEALTHCARE|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Blue Cross HMO Specialty|BCBSTX HMO|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Humana Medicare Advantage|HUMANA MA|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Blue Cross PPO Specialty|BCBSTX PPO|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Blue Cross PPO Specialty|BCBSTX OTHER|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Medicaid|MEDICAID|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|United Medicare Advantage|UHC MEDICARE GOLD MA|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Cigna|CIGNA|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Aetna|AETNA PPO|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|United Medicare Advantage|UHC AARP MCR HMO MA|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Workers Compensation|WORKERS COMPENSATION OTHER|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Managed Medicare|HEALTHSPRING MA|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|NON CONTRACTED|COMMERCIAL OTHER 1|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Medicare|MEDICARE ACUTE|15.50||||||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Humana Medicare Advantage|HUMANA MA|0.21||||||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Access Direct Platinum|HEALTHFIRST TPA|0.21||||||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|United Healthcare|UNITED HEALTHCARE|0.21||||||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Medicare|MEDICARE ACUTE|0.21||||||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|United Medicare Advantage|UHC MEDICARE GOLD MA|0.21||||||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Managed Medicare|BCBS MEDICARE PPO MA|0.21||||||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.21||||||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Blue Cross PPO Specialty|BCBSTX PPO|0.21||||||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|0.21||||||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.21||||||| 9514290|ERX|0250|HYDROCODONE-CHLORPHEN, 5M|Medicare|MEDICARE ACUTE|30.75||||||| 9514340|ERX|0250|METOLAZONE 2.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.23||||||| 9514340|ERX|0250|METOLAZONE 2.5MG TABLET|Medicare|MEDICARE ACUTE|0.23||||||| 9514340|ERX|0250|METOLAZONE 2.5MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.23||||||| 9514340|ERX|0250|METOLAZONE 2.5MG TABLET|Humana Medicare Advantage|HUMANA MA|0.23||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Medicare|MEDICARE ACUTE|2.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|United Healthcare|UNITED HEALTHCARE|2.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|2.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|2.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Tricare|TRICARE EAST REGION|2.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Cigna|CIGNA OTHER|2.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Cigna|CIGNA|2.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|2.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|2.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|2.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|2.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Managed Medicare|HEALTHSPRING MA|2.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Aetna|AETNA PPO|2.50||||||| 9514381|ERX|0250|MINOXIDIL 10MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|16.50||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|31.50||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Medicaid|MEDICAID|31.50||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|31.50||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|31.50||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|31.50||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|31.50||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|31.50||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Managed Medicare|HEALTHSPRING MA|31.50||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|31.50||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|31.50||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|31.50||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Medicare|MEDICARE ACUTE|31.50||||||| 9514498|ERX|0250|LANTHANUM CARBONATE 500MG|Medicare|MEDICARE ACUTE|55.75||||||| 9514589|ERX|0250|FISH OIL (OM3FA) 1000MG C|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.50||||||| 9514589|ERX|0250|FISH OIL (OM3FA) 1000MG C|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.50||||||| 9514589|ERX|0250|FISH OIL (OM3FA) 1000MG C|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9514589|ERX|0250|FISH OIL (OM3FA) 1000MG C|Medicare|MEDICARE ACUTE|2.50||||||| 9514589|ERX|0250|FISH OIL (OM3FA) 1000MG C|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Medicare|MEDICARE ACUTE|0.31||||||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Humana Medicare Advantage|HUMANA MA|0.31||||||| 9514837|ERX|0250|DOXYCYCLINE 100MG VIAL|Medicare|MEDICARE ACUTE|1.67||||||| 9514944|ERX|0250|POLYMYXIN B 500000 UNIT V|Blue Cross PPO Specialty|BCBSTX PPO|170.75||||||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|21.75||||||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|21.75||||||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Medicare|MEDICARE ACUTE|21.75||||||| 9515123|ERX|0250|ACYCLOVIR 500MG VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|118.50||||||| 9515123|ERX|0250|ACYCLOVIR 500MG VIAL|Medicare|MEDICARE ACUTE|118.50||||||| 9515123|ERX|0250|ACYCLOVIR 500MG VIAL|Managed Medicare|BCBS MEDICARE PPO MA|118.50||||||| 9515255|ERX|0250|CINACALCET 30MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|123.75||||||| 9515255|ERX|0250|CINACALCET 30MG TABLET|Medicare|MEDICARE ACUTE|123.75||||||| 9515255|ERX|0250|CINACALCET 30MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|123.75||||||| 9515388|ERX|0250|PILOCARPINE 5MG TABLET|Medicare|MEDICARE ACUTE|24.50||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|United Medicare Advantage|UHC MEDICARE GOLD MA|0.16||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Managed Medicare|HEALTHSPRING MA|0.16||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.16||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.16||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Blue Cross PPO Specialty|BCBSTX PPO|0.16||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Workers Compensation|WORKERS COMPENSATION OTHER|0.16||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Medicare|MEDICARE ACUTE|0.16||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|PHCS|HUMANA INSURANCE|0.16||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|United Medicare Advantage|UHC AARP MCR HMO MA|0.16||||||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Medicare|MEDICARE ACUTE|13.75||||||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|United Medicare Advantage|UHC MEDICARE GOLD MA|45.25||||||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|PHCS|HUMANA INSURANCE|45.25||||||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|Medicare|MEDICARE ACUTE|45.25||||||| 9515628|ERX|0250|SEVELAMER 800MG TABLET|Humana Medicare Advantage|HUMANA MA|0.18||||||| 9515628|ERX|0250|SEVELAMER 800MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.18||||||| 9515628|ERX|0250|SEVELAMER 800MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.18||||||| 9515628|ERX|0250|SEVELAMER 800MG TABLET|Medicare|MEDICARE ACUTE|0.18||||||| 9515628|ERX|0250|SEVELAMER 800MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.18||||||| 9515628|ERX|0250|SEVELAMER 800MG TABLET|Managed Medicare|HEALTHSPRING MA|0.18||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|NON CONTRACTED|COMMERCIAL OTHER 1|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Medicare|MEDICARE ACUTE|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Workers Compensation|WORKERS COMPENSATION OTHER|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|PHCS|HUMANA INSURANCE|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|United Medicare Advantage|UHC MEDICARE GOLD MA|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|United Healthcare|UNITED HEALTHCARE OTHER|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Tricare|TRICARE EAST REGION|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Aenta Medicare Advantage|AETNA MEDICARE MA|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Medicaid|MEDICAID|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|United Healthcare|UNITED HEALTHCARE|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Access Direct Platinum|HEALTHFIRST TPA|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|United Medicare Advantage|UHC AARP MCR HMO MA|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Cigna|CIGNA|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Humana Medicare Advantage|HUMANA MA|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Managed Medicare|BCBS MEDICARE PPO MA|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Blue Cross PPO Specialty|BCBSTX PPO|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Blue Cross HMO Specialty|BCBSTX HMO|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Managed Medicare|HEALTHSPRING MA|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|12.25||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Blue Cross PPO Specialty|BCBSTX OTHER|12.25||||||| 9515693|ERX|0250|OXYCODONE SR 10MG TABLET|Medicare|MEDICARE ACUTE|23.25||||||| 9515693|ERX|0250|OXYCODONE SR 10MG TABLET|United Healthcare|UNITED HEALTHCARE|23.25||||||| 9515735|ERX|0250|MAGNESIUM LACTATE 84MG TA|Medicare|MEDICARE ACUTE|4.75||||||| 9515768|ERX|0250|ARIPIPRAZOLE 5MG TABLET|Aetna|AETNA OTHER|144.25||||||| 9515768|ERX|0250|ARIPIPRAZOLE 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|144.25||||||| 9515768|ERX|0250|ARIPIPRAZOLE 5MG TABLET|Medicare|MEDICARE ACUTE|144.25||||||| 9515917|ERX|0250|GLYCOPYRROLATE 1MG TABLET|Medicare|MEDICARE ACUTE|28.75||||||| 9516048|ERX|0250|ZOLPIDEM 5MG TABLET|Cigna|CIGNA|0.46||||||| 9516048|ERX|0250|ZOLPIDEM 5MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|0.46||||||| 9516048|ERX|0250|ZOLPIDEM 5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.46||||||| 9516048|ERX|0250|ZOLPIDEM 5MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.46||||||| 9516048|ERX|0250|ZOLPIDEM 5MG TABLET|Humana Medicare Advantage|HUMANA MA|0.46||||||| 9516048|ERX|0250|ZOLPIDEM 5MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|0.46||||||| 9516048|ERX|0250|ZOLPIDEM 5MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|0.46||||||| 9516048|ERX|0250|ZOLPIDEM 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.46||||||| 9516048|ERX|0250|ZOLPIDEM 5MG TABLET|Blue Cross PPO Specialty|BCBSTX OTHER|0.46||||||| 9516048|ERX|0250|ZOLPIDEM 5MG TABLET|United Healthcare|UNITED HEALTHCARE|0.46||||||| 9516048|ERX|0250|ZOLPIDEM 5MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.46||||||| 9516048|ERX|0250|ZOLPIDEM 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.46||||||| 9516048|ERX|0250|ZOLPIDEM 5MG TABLET|Medicare|MEDICARE ACUTE|0.46||||||| 9516048|ERX|0250|ZOLPIDEM 5MG TABLET|Workers Compensation|TEXAS MUTUAL INSURANCE|0.46||||||| 9516048|ERX|0250|ZOLPIDEM 5MG TABLET|United Healthcare|TML GROUP BENEFITS|0.46||||||| 9516048|ERX|0250|ZOLPIDEM 5MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|0.46||||||| 9516048|ERX|0250|ZOLPIDEM 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.46||||||| 9516055|ERX|0250|NIACIN SR 500MG TABLET|Medicare|MEDICARE ACUTE|24.50||||||| 9516055|ERX|0250|NIACIN SR 500MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|24.50||||||| 9516063|ERX|0250|METHIMAZOLE 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|12.25||||||| 9516063|ERX|0250|METHIMAZOLE 5MG TABLET|Medicare|MEDICARE ACUTE|12.25||||||| 9516063|ERX|0250|METHIMAZOLE 5MG TABLET|Managed Medicare|HEALTHSPRING MA|12.25||||||| 9516089|ERX|0250|LIOTHYRONINE 5MCG TABLET|Medicare|MEDICARE ACUTE|0.12||||||| 9516097|ERX|0250|LIOTHYRONINE 25MCG TABLET|Medicare|MEDICARE ACUTE|0.15||||||| 9516097|ERX|0250|LIOTHYRONINE 25MCG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.15||||||| 9516139|ERX|0250|METAXALONE 800MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|33.75||||||| 9516139|ERX|0250|METAXALONE 800MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|33.75||||||| 9516139|ERX|0250|METAXALONE 800MG TABLET|Medicaid|MEDICAID|33.75||||||| 9516139|ERX|0250|METAXALONE 800MG TABLET|Medicare|MEDICARE ACUTE|33.75||||||| 9516139|ERX|0250|METAXALONE 800MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|33.75||||||| 9516139|ERX|0250|METAXALONE 800MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|33.75||||||| 9516139|ERX|0250|METAXALONE 800MG TABLET|Humana Medicare Advantage|HUMANA MA|33.75||||||| 9516204|ERX|0250|NADOLOL 40MG TABLET|Medicare|MEDICARE ACUTE|0.31||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Managed Medicare|BCBS MEDICARE PPO MA|25.75||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|25.75||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Humana Medicare Advantage|HUMANA MA|25.75||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Medicare|MEDICARE ACUTE|25.75||||||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Medicare|MEDICARE ACUTE|12.50||||||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Humana Medicare Advantage|HUMANA MA|0.28||||||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|0.28||||||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Medicare|MEDICARE ACUTE|0.28||||||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.28||||||| 9516352|ERX|0250|BRIMONIDINE 0.2% EYE DROP|Medicare|MEDICARE ACUTE|232.75||||||| 9516386|ERX|0250|TIMOLOL GEL 0.5% EYE DROP|Medicare|MEDICARE ACUTE|306.50||||||| 9516410|ERX|0250|CIPROFLOXACIN 0.3% DROP,5|United Healthcare|UNITED HEALTHCARE OTHER|85.25||||||| 9516410|ERX|0250|CIPROFLOXACIN 0.3% DROP,5|Humana Medicare Advantage|HUMANA MA|85.25||||||| 9516568|ERX|0250|RAMIPRIL 1.25MG CAPSULE|Medicare|MEDICARE ACUTE|0.21||||||| 9516568|ERX|0250|RAMIPRIL 1.25MG CAPSULE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|0.21||||||| 9516584|ERX|0250|RAMIPRIL 5MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|24.50||||||| 9516584|ERX|0250|RAMIPRIL 5MG CAPSULE|Medicare|MEDICARE ACUTE|24.50||||||| 9516584|ERX|0250|RAMIPRIL 5MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|24.50||||||| 9516634|ERX|0250|FLUDROCORTISONE 0.1MG TAB|Medicare|MEDICARE ACUTE|0.15||||||| 9516634|ERX|0250|FLUDROCORTISONE 0.1MG TAB|United Medicare Advantage|UHC AARP MCR HMO MA|0.15||||||| 9516634|ERX|0250|FLUDROCORTISONE 0.1MG TAB|Humana Medicare Advantage|HUMANA MA|0.15||||||| 9516634|ERX|0250|FLUDROCORTISONE 0.1MG TAB|Aenta Medicare Advantage|AETNA MEDICARE MA|0.15||||||| 9516766|ERX|0250|DILTIAZEM XL 300MG CAPSUL|Managed Medicare|HEALTHSPRING MA|26.25||||||| 9516766|ERX|0250|DILTIAZEM XL 300MG CAPSUL|Medicare|MEDICARE ACUTE|26.25||||||| 9516790|ERX|0250|DONEPEZIL 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|65.50||||||| 9516790|ERX|0250|DONEPEZIL 5MG TABLET|Medicare|MEDICARE ACUTE|65.50||||||| 9516790|ERX|0250|DONEPEZIL 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|65.50||||||| 9516790|ERX|0250|DONEPEZIL 5MG TABLET|Humana Medicare Advantage|HUMANA MA|65.50||||||| 9516873|ERX|0250|CYCLOSPORINE 0.05% UD OPT|Medicare|MEDICARE ACUTE|33.75||||||| 9517020|ERX|0250|AMOX-CLAV 400-57MG/5ML,50|Medicare|MEDICARE ACUTE|346.75||||||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|United Healthcare|UNITED HEALTHCARE OTHER|135.25||||||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Medicare|MEDICARE ACUTE|135.25||||||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Medicare|MEDICARE ACUTE|59.25||||||| 9517152|ERX|0250|PROTAMINE 50MG/5ML|Medicare|MEDICARE ACUTE|75.75||||||| 9517236|ERX|0250|TOBRAMYCIN 40MG/ML, 2ML|Blue Cross PPO Specialty|BCBSTX PPO|0.50||||||| 9517236|ERX|0250|TOBRAMYCIN 40MG/ML, 2ML|Medicare|MEDICARE ACUTE|0.50||||||| 9517236|ERX|0250|TOBRAMYCIN 40MG/ML, 2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.50||||||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Medicare|MEDICARE ACUTE|124.25||||||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.63||||||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|1.63||||||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|Medicare|MEDICARE ACUTE|1.63||||||| 9517418|ERX|0250|ESZOPICLONE 1MG TABLET|Medicare|MEDICARE ACUTE|52.25||||||| 9517418|ERX|0250|ESZOPICLONE 1MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|52.25||||||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Medicare|MEDICARE ACUTE|93.75||||||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|Medicare|MEDICARE ACUTE|93.75||||||| 9517483|ERX|0250|MODAFINIL 100MG TABLET|Blue Cross PPO Specialty|BCBSTX OTHER|76.75||||||| 9517483|ERX|0250|MODAFINIL 100MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|76.75||||||| 9517483|ERX|0250|MODAFINIL 100MG TABLET|Medicare|MEDICARE ACUTE|76.75||||||| 9517574|ERX|0250|OXYCODONE-ACETAM 5-325MG|Blue Cross PPO Specialty|BCBSTX PPO|17.50||||||| 9517574|ERX|0250|OXYCODONE-ACETAM 5-325MG|United Medicare Advantage|UHC MEDICARE GOLD MA|17.50||||||| 9517574|ERX|0250|OXYCODONE-ACETAM 5-325MG|Medicare|MEDICARE ACUTE|17.50||||||| 9517574|ERX|0250|OXYCODONE-ACETAM 5-325MG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|17.50||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Blue Cross HMO Specialty|BCBSTX HMO|79.50||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|79.50||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Managed Medicare|HEALTHSPRING MA|79.50||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Cigna|CIGNA|79.50||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|79.50||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Blue Cross PPO Specialty|BCBSTX PPO|79.50||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Humana Medicare Advantage|HUMANA MA|79.50||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|79.50||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|NON CONTRACTED|COMMERCIAL OTHER 1|79.50||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|79.50||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|United Healthcare|UNITED HEALTHCARE OTHER|79.50||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Workers Compensation|WORKERS COMPENSATION OTHER|79.50||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Medicare|MEDICARE ACUTE|79.50||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|United Healthcare|UNITED HEALTHCARE|79.50||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|United Medicare Advantage|UHC AARP MCR HMO MA|79.50||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|United Medicare Advantage|UHC MEDICARE GOLD MA|79.50||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|PHCS|HUMANA INSURANCE|79.50||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.51||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|0.51||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.51||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Cigna|CIGNA|0.51||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|0.51||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.51||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.51||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Managed Medicare|HEALTHSPRING MA|0.51||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.51||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Humana Medicare Advantage|HUMANA MA|0.51||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|0.51||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.51||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Medicare|MEDICARE ACUTE|0.51||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|0.51||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.51||||||| 9517640|ERX|0250|PHENOBARBITAL 32.4MG TABL|Medicare|MEDICARE ACUTE|2.50||||||| 9517640|ERX|0250|PHENOBARBITAL 32.4MG TABL|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9517657|ERX|0250|TORSEMIDE 20MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|15.75||||||| 9517657|ERX|0250|TORSEMIDE 20MG TABLET|Medicare|MEDICARE ACUTE|15.75||||||| 9517657|ERX|0250|TORSEMIDE 20MG TABLET|Humana Medicare Advantage|HUMANA MA|15.75||||||| 9517657|ERX|0250|TORSEMIDE 20MG TABLET|United Healthcare|UNITED HEALTHCARE|15.75||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Humana Medicare Advantage|HUMANA MA|7.25||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|7.25||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|7.25||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.25||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Aetna|AETNA PPO|7.25||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|7.25||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Managed Medicare|HEALTHSPRING MA|7.25||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|7.25||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|7.25||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Medicaid|MEDICAID|7.25||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|7.25||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|7.25||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Medicare|MEDICARE ACUTE|7.25||||||| 9517673|ERX|0250|GUAIFEN-DEXTROMETH 600-30|United Medicare Advantage|UHC MEDICARE GOLD MA|0.08||||||| 9517673|ERX|0250|GUAIFEN-DEXTROMETH 600-30|Medicare|MEDICARE ACUTE|0.08||||||| 9517699|ERX|0250|POTASSIUM CHLORIDE 8 MEQ|Medicare|MEDICARE ACUTE|0.11||||||| 9517756|ERX|0250|DILTIAZEM XL 120MG CAPSUL|Veterans Affairs|VETERANS ADMINISTRATION|24.50||||||| 9517756|ERX|0250|DILTIAZEM XL 120MG CAPSUL|Aenta Medicare Advantage|AETNA MEDICARE MA|24.50||||||| 9517756|ERX|0250|DILTIAZEM XL 120MG CAPSUL|United Medicare Advantage|UHC MEDICARE GOLD MA|24.50||||||| 9517756|ERX|0250|DILTIAZEM XL 120MG CAPSUL|Managed Medicare|HEALTHSPRING MA|24.50||||||| 9517756|ERX|0250|DILTIAZEM XL 120MG CAPSUL|Blue Cross PPO Specialty|BCBSTX PPO|24.50||||||| 9517756|ERX|0250|DILTIAZEM XL 120MG CAPSUL|Medicare|MEDICARE ACUTE|24.50||||||| 9517756|ERX|0250|DILTIAZEM XL 120MG CAPSUL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|24.50||||||| 9517756|ERX|0250|DILTIAZEM XL 120MG CAPSUL|United Healthcare|UNITED HEALTHCARE OTHER|24.50||||||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|29.50||||||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|United Healthcare|UNITED HEALTHCARE|29.50||||||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|Medicare|MEDICARE ACUTE|29.50||||||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|29.50||||||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|29.50||||||| 9517772|ERX|0250|DILTIAZEM XL 240MG CAPSUL|Medicare|MEDICARE ACUTE|0.42||||||| 9517798|ERX|0250|PIOGLITAZONE 15MG TABLET|Managed Medicare|HEALTHSPRING MA|46.75||||||| 9517798|ERX|0250|PIOGLITAZONE 15MG TABLET|Medicare|MEDICARE ACUTE|46.75||||||| 9517798|ERX|0250|PIOGLITAZONE 15MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|46.75||||||| 9517798|ERX|0250|PIOGLITAZONE 15MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|46.75||||||| 9517806|ERX|0250|LUBIPROSTONE 24MCG CAPSUL|Medicare|MEDICARE ACUTE|35.50||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Cigna|CIGNA|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Access Direct Platinum|HEALTHFIRST TPA UMR|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Humana Medicare Advantage|HUMANA MA|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Managed Medicare|BCBS MEDICARE PPO MA|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Managed Medicare|HEALTHSPRING MA|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Blue Cross PPO Specialty|BCBSTX OTHER|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Aetna|AETNA PPO|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Access Direct Platinum|HEALTHFIRST TPA|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Veterans Affairs|VETERANS ADMINISTRATION|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Tricare|TRICARE EAST REGION|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Workers Compensation|TEXAS MUTUAL INSURANCE|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|United Healthcare|UNITED HEALTHCARE OTHER|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|United Healthcare|UNITED HEALTHCARE|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Medicare|MEDICARE ACUTE|0.03||||||| 9517871|ERX|0250|AZATHIOPRINE 50MG TABLET|Medicare|MEDICARE ACUTE|34.50||||||| 9517889|ERX|0250|COLESEVELAM 625MG TABLET|Medicare|MEDICARE ACUTE|0.15||||||| 9517905|ERX|0250|HYDROCORTISONE 2.5% RECT|Medicare|MEDICARE ACUTE|163.50||||||| 9517905|ERX|0250|HYDROCORTISONE 2.5% RECT|Blue Cross PPO Specialty|BCBSTX PPO|163.50||||||| 9517947|ERX|0250|PROPAFENONE 150MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|39.50||||||| 9518028|ERX|0250|CAPSAICIN 0.025% CREAM, 6|Medicare|MEDICARE ACUTE|122.75||||||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.09||||||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|United Healthcare|UNITED HEALTHCARE|0.09||||||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|Medicare|MEDICARE ACUTE|0.09||||||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.09||||||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.09||||||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|0.09||||||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.09||||||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.09||||||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|0.09||||||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|0.09||||||| 9518093|ERX|0250|PRIMIDONE 250MG TABLET|Medicare|MEDICARE ACUTE|30.25||||||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|Humana Medicare Advantage|HUMANA MA|34.50||||||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|34.50||||||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|Medicare|MEDICARE ACUTE|34.50||||||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|34.50||||||| 9518184|ERX|0250|RANOLAZINE 500MG TABLET|Humana Medicare Advantage|HUMANA MA|36.75||||||| 9518184|ERX|0250|RANOLAZINE 500MG TABLET|Medicare|MEDICARE ACUTE|36.75||||||| 9518309|ERX|0250|HYDROXYCHLOROQUINE 200MG|Humana Medicare Advantage|HUMANA MA|25.50||||||| 9518309|ERX|0250|HYDROXYCHLOROQUINE 200MG|Blue Cross PPO Specialty|BCBSTX PPO|25.50||||||| 9518309|ERX|0250|HYDROXYCHLOROQUINE 200MG|United Medicare Advantage|UHC MEDICARE GOLD MA|25.50||||||| 9518309|ERX|0250|HYDROXYCHLOROQUINE 200MG|Tricare|TRICARE EAST REGION|25.50||||||| 9518309|ERX|0250|HYDROXYCHLOROQUINE 200MG|Medicare|MEDICARE ACUTE|25.50||||||| 9518309|ERX|0250|HYDROXYCHLOROQUINE 200MG|United Medicare Advantage|UHC AARP MCR HMO MA|25.50||||||| 9518390|ERX|0250|MAGNESIUM CHLORIDE TABLET|Medicare|MEDICARE ACUTE|0.03||||||| 9518390|ERX|0250|MAGNESIUM CHLORIDE TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|0.03||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Cigna|CIGNA|0.05||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.05||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Blue Cross PPO Specialty|BCBSTX OTHER|0.05||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Humana Medicare Advantage|HUMANA MA|0.05||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|0.05||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UMR|0.05||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Aetna|AETNA PPO|0.05||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|0.05||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.05||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Managed Medicare|HEALTHSPRING MA|0.05||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|0.05||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Medicaid|MEDICAID|0.05||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.05||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.05||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.05||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|PHCS|HUMANA INSURANCE|0.05||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.05||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|0.05||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Medicare|MEDICARE ACUTE|0.05||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|United Healthcare|UNITED HEALTHCARE|0.05||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.05||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|0.05||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.05||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|0.05||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|0.05||||||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|PHCS|HUMANA INSURANCE|8.25||||||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|8.25||||||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|United Medicare Advantage|UHC AARP MCR HMO MA|8.25||||||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|Aenta Medicare Advantage|AETNA MEDICARE MA|8.25||||||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|United Medicare Advantage|UHC MEDICARE GOLD MA|8.25||||||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|Medicare|MEDICARE ACUTE|8.25||||||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|Cigna|CIGNA|8.25||||||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|Humana Medicare Advantage|HUMANA MA|8.25||||||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|8.25||||||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|Managed Medicaid|MEDICAID UNITED HEALTHCARE|8.25||||||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|Blue Cross PPO Specialty|BCBSTX PPO|8.25||||||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|Managed Medicare|HEALTHSPRING MA|8.25||||||| 9518440|ERX|0250|MEGESTROL 400MG/10ML|Blue Cross PPO Specialty|BCBSTX PPO|12.75||||||| 9518440|ERX|0250|MEGESTROL 400MG/10ML|Blue Cross HMO Specialty|BCBSTX HMO|12.75||||||| 9518440|ERX|0250|MEGESTROL 400MG/10ML|Humana Medicare Advantage|HUMANA MA|12.75||||||| 9518440|ERX|0250|MEGESTROL 400MG/10ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|12.75||||||| 9518440|ERX|0250|MEGESTROL 400MG/10ML|Managed Medicare|HEALTHSPRING MA|12.75||||||| 9518440|ERX|0250|MEGESTROL 400MG/10ML|Medicare|MEDICARE ACUTE|12.75||||||| 9518440|ERX|0250|MEGESTROL 400MG/10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|12.75||||||| 9518457|ERX|0250|METHYL SALIC/MENTHOL ,120|Aenta Medicare Advantage|AETNA MEDICARE MA|0.52||||||| 9518457|ERX|0250|METHYL SALIC/MENTHOL ,120|Medicare|MEDICARE ACUTE|0.52||||||| 9518457|ERX|0250|METHYL SALIC/MENTHOL ,120|Humana Medicare Advantage|HUMANA MA|0.52||||||| 9518499|ERX|0250|PENTAZOCINE-NALOXONE TABL|Medicare|MEDICARE ACUTE|0.24||||||| 9518499|ERX|0250|PENTAZOCINE-NALOXONE TABL|United Medicare Advantage|UHC AARP MCR HMO MA|0.24||||||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|Blue Cross HMO Specialty|BCBSTX HMO|14.50||||||| 9518523|ERX|0250|RASAGILINE 0.5MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|94.50||||||| 9518523|ERX|0250|RASAGILINE 0.5MG TABLET|Medicare|MEDICARE ACUTE|94.50||||||| 9518580|ERX|0250|ETHAMBUTOL 400MG TABLET|Medicare|MEDICARE ACUTE|0.22||||||| 9518598|ERX|0250|LITHIUM 300MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.25||||||| 9518655|ERX|0250|COD LIVER OIL-ZN OXIDE ,3|Medicare|MEDICARE ACUTE|28.50||||||| 9518655|ERX|0250|COD LIVER OIL-ZN OXIDE ,3|United Healthcare|UNITED HEALTHCARE OTHER|28.50||||||| 9518655|ERX|0250|COD LIVER OIL-ZN OXIDE ,3|Blue Cross HMO Specialty|BCBSTX HMO|28.50||||||| 9518655|ERX|0250|COD LIVER OIL-ZN OXIDE ,3|Humana Medicare Advantage|HUMANA MA|28.50||||||| 9518689|ERX|0250|MENTHOL-CAMP-PHEN LIPBALM|Aenta Medicare Advantage|AETNA MEDICARE MA|0.10||||||| 9518689|ERX|0250|MENTHOL-CAMP-PHEN LIPBALM|Blue Cross HMO Specialty|BCBSTX HMO|0.10||||||| 9518689|ERX|0250|MENTHOL-CAMP-PHEN LIPBALM|Access Direct Platinum|HEALTHFIRST TPA|0.10||||||| 9518689|ERX|0250|MENTHOL-CAMP-PHEN LIPBALM|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.10||||||| 9518689|ERX|0250|MENTHOL-CAMP-PHEN LIPBALM|United Medicare Advantage|UHC AARP MCR HMO MA|0.10||||||| 9518689|ERX|0250|MENTHOL-CAMP-PHEN LIPBALM|Medicare|MEDICARE ACUTE|0.10||||||| 9518689|ERX|0250|MENTHOL-CAMP-PHEN LIPBALM|United Medicare Advantage|UHC MEDICARE GOLD MA|0.10||||||| 9518689|ERX|0250|MENTHOL-CAMP-PHEN LIPBALM|Humana Medicare Advantage|HUMANA MA|0.10||||||| 9518697|ERX|0250|FLUOCINONIDE 0.05% CREAM,|Humana Medicare Advantage|HUMANA MA|499.75||||||| 9518770|ERX|0258|SODIUM CHLORIDE 0.9%,100M|Medicare|MEDICARE ACUTE|43.25||||||| 9518770|ERX|0258|SODIUM CHLORIDE 0.9%,100M|Access Direct Platinum|HEALTHFIRST TPA|43.25||||||| 9518796|ERX|0250|LEVOTHYROZINE 100MCG VIAL|Medicare|MEDICARE ACUTE|563.50||||||| 9518895|ERX|0250|ZOLPIDEM CR 6.25MG TABLET|Humana Medicare Advantage|HUMANA MA|48.25||||||| 9518895|ERX|0250|ZOLPIDEM CR 6.25MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|48.25||||||| 9518903|ERX|0250|K-NA PHOS 280-160-250MG P|Aenta Medicare Advantage|AETNA MEDICARE MA|4.75||||||| 9518903|ERX|0250|K-NA PHOS 280-160-250MG P|United Healthcare|UNITED HEALTHCARE|4.75||||||| 9518903|ERX|0250|K-NA PHOS 280-160-250MG P|Medicare|MEDICARE ACUTE|4.75||||||| 9518903|ERX|0250|K-NA PHOS 280-160-250MG P|Managed Medicare|HEALTHSPRING MA|4.75||||||| 9518903|ERX|0250|K-NA PHOS 280-160-250MG P|Blue Cross PPO Specialty|BCBSTX PPO|4.75||||||| 9518903|ERX|0250|K-NA PHOS 280-160-250MG P|Humana Medicare Advantage|HUMANA MA|4.75||||||| 9518903|ERX|0250|K-NA PHOS 280-160-250MG P|United Medicare Advantage|UHC AARP MCR HMO MA|4.75||||||| 9518903|ERX|0250|K-NA PHOS 280-160-250MG P|United Medicare Advantage|UHC MEDICARE GOLD MA|4.75||||||| 9518903|ERX|0250|K-NA PHOS 280-160-250MG P|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.75||||||| 9518952|ERX|0250|COENZYME Q10 100MG CAPSUL|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9518952|ERX|0250|COENZYME Q10 100MG CAPSUL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9518952|ERX|0250|COENZYME Q10 100MG CAPSUL|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9518952|ERX|0250|COENZYME Q10 100MG CAPSUL|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9518952|ERX|0250|COENZYME Q10 100MG CAPSUL|Medicare|MEDICARE ACUTE|4.50||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|NON CONTRACTED|COMMERCIAL OTHER 1|11.25||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|Medicare|MEDICARE ACUTE|11.25||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|11.25||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|11.25||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|11.25||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|Aetna|AETNA PPO|11.25||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|11.25||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|11.25||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|11.25||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|Humana Medicare Advantage|HUMANA MA|11.25||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|United Healthcare|UNITED HEALTHCARE|11.25||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|Cigna|CIGNA|11.25||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|United Medicare Advantage|UHC AARP MCR HMO MA|11.25||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|11.25||||||| 9519018|ERX|0250|FERROUS GLUCONATE 325MG T|Cigna|CIGNA OTHER|2.50||||||| 9519018|ERX|0250|FERROUS GLUCONATE 325MG T|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9519018|ERX|0250|FERROUS GLUCONATE 325MG T|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9519018|ERX|0250|FERROUS GLUCONATE 325MG T|Medicare|MEDICARE ACUTE|2.50||||||| 9519018|ERX|0250|FERROUS GLUCONATE 325MG T|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9519026|ERX|0250|CLOPIDOGREL 300MG TABLET|Medicare|MEDICARE ACUTE|213.25||||||| 9519075|ERX|0250|LACTOBACILLUS GRANULES 1|Blue Cross HMO Specialty|BCBSTX HMO|12.25||||||| 9519075|ERX|0250|LACTOBACILLUS GRANULES 1|Humana Medicare Advantage|HUMANA MA|12.25||||||| 9519075|ERX|0250|LACTOBACILLUS GRANULES 1|Blue Cross PPO Specialty|BCBSTX PPO|12.25||||||| 9519075|ERX|0250|LACTOBACILLUS GRANULES 1|Medicare|MEDICARE ACUTE|12.25||||||| 9519075|ERX|0250|LACTOBACILLUS GRANULES 1|Workers Compensation|TEXAS MUTUAL INSURANCE|12.25||||||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|United Medicare Advantage|UHC AARP MCR HMO MA|0.06||||||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|Blue Cross HMO Specialty|BCBSTX HMO|0.06||||||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|United Medicare Advantage|UHC MEDICARE GOLD MA|0.06||||||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|Medicare|MEDICARE ACUTE|0.06||||||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.27||||||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|Blue Cross HMO Specialty|BCBSTX HMO|0.27||||||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|Humana Medicare Advantage|HUMANA MA|0.27||||||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|Blue Cross PPO Specialty|BCBSTX PPO|0.27||||||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|Tricare|TRICARE EAST REGION|0.27||||||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|Medicare|MEDICARE ACUTE|0.27||||||| 9519158|ERX|0250|FENTANYL 12MCG PATCH|Medicare|MEDICARE ACUTE|139.50||||||| 9519281|ERX|0250|AMPICILLIN 2 GM NS MB+ 10|Medicare|MEDICARE ACUTE|2.08||||||| 9519331|ERX|0250|MEROPENEM 1 GM/100ML MB+|Medicare|MEDICARE ACUTE|682.50||||||| 9519349|ERX|0250|MEROPENEM 500MG/100ML MB+|Blue Cross HMO Specialty|BCBSTX HMO|3.79||||||| 9519349|ERX|0250|MEROPENEM 500MG/100ML MB+|Humana Medicare Advantage|HUMANA MA|3.79||||||| 9519349|ERX|0250|MEROPENEM 500MG/100ML MB+|Blue Cross PPO Specialty|BCBSTX PPO|3.79||||||| 9519349|ERX|0250|MEROPENEM 500MG/100ML MB+|United Medicare Advantage|UHC MEDICARE GOLD MA|3.79||||||| 9519349|ERX|0250|MEROPENEM 500MG/100ML MB+|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.79||||||| 9519349|ERX|0250|MEROPENEM 500MG/100ML MB+|United Medicare Advantage|UHC AARP MCR HMO MA|3.79||||||| 9519349|ERX|0250|MEROPENEM 500MG/100ML MB+|Tricare|TRICARE EAST REGION|3.79||||||| 9519349|ERX|0250|MEROPENEM 500MG/100ML MB+|Medicare|MEDICARE ACUTE|3.79||||||| 9519349|ERX|0250|MEROPENEM 500MG/100ML MB+|Managed Medicare|BCBS MEDICARE PPO MA|3.79||||||| 9519364|ERX|0250|NAFCILLIN 2 GM/100ML MB+|United Medicare Advantage|UHC AARP MCR HMO MA|2.17||||||| 9519364|ERX|0250|NAFCILLIN 2 GM/100ML MB+|United Healthcare|UNITED HEALTHCARE|2.17||||||| 9519364|ERX|0250|NAFCILLIN 2 GM/100ML MB+|Medicare|MEDICARE ACUTE|2.17||||||| 9519372|ERX|0250|AMPICILL-SULBAC 1.5G/100|Medicare|MEDICARE ACUTE|1.14||||||| 9519380|ERX|0250|AMPICILLIN-SULBAC 3G/100M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.92||||||| 9519380|ERX|0250|AMPICILLIN-SULBAC 3G/100M|Medicare|MEDICARE ACUTE|1.92||||||| 9519398|ERX|0250|VANCOMYCIN 500MG/100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|0.56||||||| 9519398|ERX|0250|VANCOMYCIN 500MG/100ML NS|Medicare|MEDICARE ACUTE|0.56||||||| 9519455|ERX|0250|DRONEDARONE 400MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.31||||||| 9519455|ERX|0250|DRONEDARONE 400MG TABLET|Humana Medicare Advantage|HUMANA MA|0.31||||||| 9519455|ERX|0250|DRONEDARONE 400MG TABLET|Medicare|MEDICARE ACUTE|0.31||||||| 9519471|ERX|0250|HYDROCHLOROTHIAZIDE 12.5M|United Medicare Advantage|UHC MEDICARE GOLD MA|0.06||||||| 9519471|ERX|0250|HYDROCHLOROTHIAZIDE 12.5M|Humana Medicare Advantage|HUMANA MA|0.06||||||| 9519471|ERX|0250|HYDROCHLOROTHIAZIDE 12.5M|Blue Cross PPO Specialty|BCBSTX PPO|0.06||||||| 9519471|ERX|0250|HYDROCHLOROTHIAZIDE 12.5M|United Medicare Advantage|UHC AARP MCR HMO MA|0.06||||||| 9519505|ERX|0250|FLUCONAZOLE 100MG IN NS 5|Blue Cross HMO Specialty|BCBSTX HMO|113.50||||||| 9519588|ERX|0250|CEFUROXIME 750MG/100ML NS|Medicare|MEDICARE ACUTE|0.85||||||| 9519687|ERX|0250|VANCO ORAL SOLN 250MG/5ML|Medicare|MEDICARE ACUTE|152.50||||||| 9519869|ERX|0250|PRASUGREL 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|46.50||||||| 9519869|ERX|0250|PRASUGREL 10MG TABLET|Medicare|MEDICARE ACUTE|46.50||||||| 9519927|ERX|0250|RIFAMPIN 150MG CAPSULE|Medicare|MEDICARE ACUTE|15.50||||||| 9519927|ERX|0250|RIFAMPIN 150MG CAPSULE|United Healthcare|UNITED HEALTHCARE|15.50||||||| 9519950|ERX|0250|CELECOXIB 100MG CAPSULE|Humana Medicare Advantage|HUMANA MA|25.50||||||| 9519950|ERX|0250|CELECOXIB 100MG CAPSULE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|25.50||||||| 9519950|ERX|0250|CELECOXIB 100MG CAPSULE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|25.50||||||| 9519950|ERX|0250|CELECOXIB 100MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|25.50||||||| 9519950|ERX|0250|CELECOXIB 100MG CAPSULE|Cigna|CIGNA|25.50||||||| 9519950|ERX|0250|CELECOXIB 100MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|25.50||||||| 9519950|ERX|0250|CELECOXIB 100MG CAPSULE|Medicare|MEDICARE ACUTE|25.50||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|12.75||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Medicare|MEDICARE ACUTE|12.75||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Aenta Medicare Advantage|AETNA MEDICARE MA|12.75||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|12.75||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Blue Cross PPO Specialty|BCBSTX PPO|12.75||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Blue Cross HMO Specialty|BCBSTX HMO|12.75||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Humana Medicare Advantage|HUMANA MA|12.75||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|12.75||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Access Direct Platinum|HEALTHFIRST TPA|12.75||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|12.75||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Managed Medicare|HEALTHSPRING MA|12.75||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|United Medicare Advantage|UHC MEDICARE GOLD MA|12.75||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|12.75||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|12.75||||||| 9520107|ERX|0250|DICLOFENAC 1% GEL, 100 GM|Cigna|CIGNA OTHER|682.25||||||| 9520107|ERX|0250|DICLOFENAC 1% GEL, 100 GM|Blue Cross PPO Specialty|BCBSTX PPO|682.25||||||| 9520107|ERX|0250|DICLOFENAC 1% GEL, 100 GM|United Medicare Advantage|UHC MEDICARE GOLD MA|682.25||||||| 9520107|ERX|0250|DICLOFENAC 1% GEL, 100 GM|United Medicare Advantage|UHC AARP MCR HMO MA|682.25||||||| 9520107|ERX|0250|DICLOFENAC 1% GEL, 100 GM|Medicare|MEDICARE ACUTE|682.25||||||| 9520123|ERX|0250|NA HYPOCHL 0.125% SOLN,47|Medicare|MEDICARE ACUTE|65.25||||||| 9520123|ERX|0250|NA HYPOCHL 0.125% SOLN,47|Blue Cross PPO Specialty|BCBSTX PPO|65.25||||||| 9520123|ERX|0250|NA HYPOCHL 0.125% SOLN,47|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|65.25||||||| 9520214|ERX|0250|METRONIDAZOLE 0.75% GEL,4|Medicare|MEDICARE ACUTE|357.50||||||| 9520248|ERX|0250|BRIMONIDINE 0.1% EYE DROP|Managed Medicare|HEALTHSPRING MA|529.50||||||| 9520255|ERX|0250|VERAPAMIL SR 240MG TABLET|Medicare|MEDICARE ACUTE|30.25||||||| 9520255|ERX|0250|VERAPAMIL SR 240MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|30.25||||||| 9520289|ERX|0250|LIPASE-PROT-AMYL 6-19-30K|Humana Medicare Advantage|HUMANA MA|11.75||||||| 9520289|ERX|0250|LIPASE-PROT-AMYL 6-19-30K|Medicare|MEDICARE ACUTE|11.75||||||| 9520420|ERX|0250|DARUNAVIR 600MG TABLET|Medicare|MEDICARE ACUTE|1.24||||||| 9520529|ERX|0250|FENOFIBRATE 54MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|12.75||||||| 9520529|ERX|0250|FENOFIBRATE 54MG TABLET|Medicare|MEDICARE ACUTE|12.75||||||| 9520537|ERX|0250|FENOFIBRATE 134MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|12.75||||||| 9520537|ERX|0250|FENOFIBRATE 134MG TABLET|Medicare|MEDICARE ACUTE|12.75||||||| 9520537|ERX|0250|FENOFIBRATE 134MG TABLET|Cigna|CIGNA|12.75||||||| 9520537|ERX|0250|FENOFIBRATE 134MG TABLET|Humana Medicare Advantage|HUMANA MA|12.75||||||| 9520537|ERX|0250|FENOFIBRATE 134MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|12.75||||||| 9520636|ERX|0250|FEBUXOSTAT 40MG TABLET|Medicare|MEDICARE ACUTE|0.45||||||| 9520719|ERX|0250|LACOSAMIDE 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|49.25||||||| 9520719|ERX|0250|LACOSAMIDE 100MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|49.25||||||| 9520719|ERX|0250|LACOSAMIDE 100MG TABLET|Medicare|MEDICARE ACUTE|49.25||||||| 9520800|ERX|0250|SALINE-MINERAL OIL-GLYC,3|Medicare|MEDICARE ACUTE|67.50||||||| 9520818|ERX|0250|DEXAME-NYST-DIPHE-SUCRAL,|Blue Cross HMO Specialty|BCBSTX HMO|123.75||||||| 9520818|ERX|0250|DEXAME-NYST-DIPHE-SUCRAL,|Medicare|MEDICARE ACUTE|123.75||||||| 9520834|ERX|0250|DABIGATRAN 75MG CAPSULE|Medicare|MEDICARE ACUTE|0.37||||||| 9520875|ERX|0636|ACETAMINOPHEN INJ 100ML B|Medicare|MEDICARE ACUTE|98.25||||||| 9520909|ERX|0250|RIFAXIMIN 550MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|152.25||||||| 9520909|ERX|0250|RIFAXIMIN 550MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|152.25||||||| 9520909|ERX|0250|RIFAXIMIN 550MG TABLET|Medicare|MEDICARE ACUTE|152.25||||||| 9521097|ERX|0258|SODIUM CHLORIDE IRRIG SOL|Medicare|MEDICARE ACUTE|136.75||||||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Blue Cross HMO Specialty|BCBSTX HMO|6.69||||||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Humana Medicare Advantage|HUMANA MA|6.69||||||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Blue Cross PPO Specialty|BCBSTX PPO|6.69||||||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|United Medicare Advantage|UHC AARP MCR HMO MA|6.69||||||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Medicare|MEDICARE ACUTE|6.69||||||| 9521253|ERX|0250|PAROXETINE 20MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|39.25||||||| 9521253|ERX|0250|PAROXETINE 20MG TABLET|Medicare|MEDICARE ACUTE|39.25||||||| 9521253|ERX|0250|PAROXETINE 20MG TABLET|Humana Medicare Advantage|HUMANA MA|39.25||||||| 9521253|ERX|0250|PAROXETINE 20MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|39.25||||||| 9521253|ERX|0250|PAROXETINE 20MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|39.25||||||| 9521311|ERX|0250|AMOX-CLAV 500-125MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|61.25||||||| 9521311|ERX|0250|AMOX-CLAV 500-125MG TABLE|Medicare|MEDICARE ACUTE|61.25||||||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|83.75||||||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Managed Medicare|HEALTHSPRING MA|83.75||||||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|83.75||||||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|83.75||||||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|NON CONTRACTED|COMMERCIAL OTHER 1|83.75||||||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|83.75||||||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|United Medicare Advantage|UHC AARP MCR HMO MA|83.75||||||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Workers Compensation|WORKERS COMPENSATION OTHER|83.75||||||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Medicare|MEDICARE ACUTE|83.75||||||| 9521345|ERX|0250|AMOX-CLAV 250-62.5MG/5ML,|Humana Medicare Advantage|HUMANA MA|644.25||||||| 9521378|ERX|0250|GUAIFENESIN 100MG/5ML, 11|United Medicare Advantage|UHC AARP MCR HMO MA|0.54||||||| 9521378|ERX|0250|GUAIFENESIN 100MG/5ML, 11|PHCS|HUMANA INSURANCE|0.54||||||| 9521378|ERX|0250|GUAIFENESIN 100MG/5ML, 11|Medicare|MEDICARE ACUTE|0.54||||||| 9521378|ERX|0250|GUAIFENESIN 100MG/5ML, 11|Blue Cross HMO Specialty|BCBSTX HMO|0.54||||||| 9521378|ERX|0250|GUAIFENESIN 100MG/5ML, 11|Humana Medicare Advantage|HUMANA MA|0.54||||||| 9521378|ERX|0250|GUAIFENESIN 100MG/5ML, 11|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.54||||||| 9521451|ERX|0250|AZELASTINE NASAL SPRAY, 3|Medicare|MEDICARE ACUTE|935.25||||||| 9521667|ERX|0250|TOPIRAMATE 25MG TABLET|Blue Cross PPO Specialty|BCBSTX OTHER|24.50||||||| 9521667|ERX|0250|TOPIRAMATE 25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|24.50||||||| 9521667|ERX|0250|TOPIRAMATE 25MG TABLET|Medicare|MEDICARE ACUTE|24.50||||||| 9521667|ERX|0250|TOPIRAMATE 25MG TABLET|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|24.50||||||| 9521675|ERX|0250|TOPIRAMATE 100MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|65.25||||||| 9521675|ERX|0250|TOPIRAMATE 100MG TABLET|Medicare|MEDICARE ACUTE|65.25||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|18.25||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|18.25||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|18.25||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Humana Medicare Advantage|HUMANA MA|18.25||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|18.25||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|18.25||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UMR|18.25||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|18.25||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|18.25||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Managed Medicare|HEALTHSPRING MA|18.25||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|18.25||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|18.25||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|18.25||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|18.25||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|18.25||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Medicare|MEDICARE ACUTE|18.25||||||| 9521733|ERX|0250|LEVOFLOXACIN 250MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|116.25||||||| 9521733|ERX|0250|LEVOFLOXACIN 250MG TABLET|Medicare|MEDICARE ACUTE|116.25||||||| 9521733|ERX|0250|LEVOFLOXACIN 250MG TABLET|Humana Medicare Advantage|HUMANA MA|116.25||||||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|1.33||||||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.33||||||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|1.33||||||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Medicare|MEDICARE ACUTE|1.33||||||| 9521766|ERX|0250|PROPRANOLOL XL 60MG CAPSU|Medicare|MEDICARE ACUTE|0.38||||||| 9521782|ERX|0250|ESTROGENS,CONJ 0.625MG TA|Medicare|MEDICARE ACUTE|18.25||||||| 9521808|ERX|0250|ESTROGENS,CONJ VAG CRM,42|Medicare|MEDICARE ACUTE|1,035.75||||||| 9521915|ERX|0250|PENICILLIN G POTASSIUM 5|Medicare|MEDICARE ACUTE|65.50||||||| 9521964|ERX|0250|GLIPIZIDE XL 2.5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.09||||||| 9521964|ERX|0250|GLIPIZIDE XL 2.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.09||||||| 9521964|ERX|0250|GLIPIZIDE XL 2.5MG TABLET|Medicare|MEDICARE ACUTE|0.09||||||| 9521980|ERX|0250|DOXAZOSIN 2MG TABLET|Medicare|MEDICARE ACUTE|0.20||||||| 9521980|ERX|0250|DOXAZOSIN 2MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|0.20||||||| 9521980|ERX|0250|DOXAZOSIN 2MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.20||||||| 9521980|ERX|0250|DOXAZOSIN 2MG TABLET|Humana Medicare Advantage|HUMANA MA|0.20||||||| 9521980|ERX|0250|DOXAZOSIN 2MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.20||||||| 9521980|ERX|0250|DOXAZOSIN 2MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|0.20||||||| 9521980|ERX|0250|DOXAZOSIN 2MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.20||||||| 9521980|ERX|0250|DOXAZOSIN 2MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.20||||||| 9522012|ERX|0250|VORICONAZOLE 200MG TABLET|Medicare|MEDICARE ACUTE|4.25||||||| 9522038|ERX|0250|FLUCONAZOLE 200MG/100ML N|Blue Cross HMO Specialty|BCBSTX HMO|163.75||||||| 9522038|ERX|0250|FLUCONAZOLE 200MG/100ML N|United Medicare Advantage|UHC AARP MCR HMO MA|163.75||||||| 9522038|ERX|0250|FLUCONAZOLE 200MG/100ML N|Medicare|MEDICARE ACUTE|163.75||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|117.50||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|117.50||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|117.50||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|117.50||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Medicare|MEDICARE ACUTE|117.50||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|117.50||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|117.50||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Humana Medicare Advantage|HUMANA MA|117.50||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|117.50||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|117.50||||||| 9522061|ERX|0250|FLUCONAZOLE 200MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|192.25||||||| 9522061|ERX|0250|FLUCONAZOLE 200MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|192.25||||||| 9522061|ERX|0250|FLUCONAZOLE 200MG TABLET|Humana Medicare Advantage|HUMANA MA|192.25||||||| 9522061|ERX|0250|FLUCONAZOLE 200MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|192.25||||||| 9522061|ERX|0250|FLUCONAZOLE 200MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|192.25||||||| 9522061|ERX|0250|FLUCONAZOLE 200MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|192.25||||||| 9522061|ERX|0250|FLUCONAZOLE 200MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|192.25||||||| 9522061|ERX|0250|FLUCONAZOLE 200MG TABLET|Medicare|MEDICARE ACUTE|192.25||||||| 9522079|ERX|0250|FLUCONAZOLE 400MG/200ML N|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|261.25||||||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|Medicare|MEDICARE ACUTE|1.45||||||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|Managed Medicare|HEALTHSPRING MA|1.45||||||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|1.45||||||| 9522111|ERX|0250|ZIPRASIDONE 20MG CAPSULE|Medicare|MEDICARE ACUTE|0.65||||||| 9522111|ERX|0250|ZIPRASIDONE 20MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|0.65||||||| 9522111|ERX|0250|ZIPRASIDONE 20MG CAPSULE|Humana Medicare Advantage|HUMANA MA|0.65||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|United Healthcare|UNITED HEALTHCARE|36.75||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Medicare|MEDICARE ACUTE|36.75||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|36.75||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|36.75||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|36.75||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|36.75||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Humana Medicare Advantage|HUMANA MA|36.75||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|36.75||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Aetna|AETNA PPO|36.75||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|36.75||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|36.75||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|36.75||||||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|70.50||||||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|Humana Medicare Advantage|HUMANA MA|70.50||||||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|Aetna|AETNA PPO|70.50||||||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|70.50||||||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|70.50||||||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|70.50||||||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|70.50||||||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|Tricare|TRICARE EAST REGION|70.50||||||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|Medicare|MEDICARE ACUTE|70.50||||||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|Workers Compensation|TEXAS MUTUAL INSURANCE|70.50||||||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|196.25||||||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Medicare|MEDICARE ACUTE|196.25||||||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Humana Medicare Advantage|HUMANA MA|196.25||||||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.04||||||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Managed Medicare|HEALTHSPRING MA|0.04||||||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Cigna|CIGNA OTHER|0.04||||||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Humana Medicare Advantage|HUMANA MA|0.04||||||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.04||||||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.04||||||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.04||||||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.04||||||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Medicare|MEDICARE ACUTE|0.04||||||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|United Healthcare|UNITED HEALTHCARE OTHER|85.75||||||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|Medicare|MEDICARE ACUTE|85.75||||||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|Humana Medicare Advantage|HUMANA MA|85.75||||||| 9522434|ERX|0250|HYDROXYUREA 500MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.18||||||| 9522558|ERX|0250|CALCIUM CARB 1250MG (500M|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.03||||||| 9522558|ERX|0250|CALCIUM CARB 1250MG (500M|Humana Medicare Advantage|HUMANA MA|0.03||||||| 9522558|ERX|0250|CALCIUM CARB 1250MG (500M|United Medicare Advantage|UHC AARP MCR HMO MA|0.03||||||| 9522558|ERX|0250|CALCIUM CARB 1250MG (500M|Aenta Medicare Advantage|AETNA MEDICARE MA|0.03||||||| 9522558|ERX|0250|CALCIUM CARB 1250MG (500M|Medicare|MEDICARE ACUTE|0.03||||||| 9522574|ERX|0250|CODEINE 30MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|8.75||||||| 9522574|ERX|0250|CODEINE 30MG TABLET|Medicare|MEDICARE ACUTE|8.75||||||| 9522590|ERX|0250|DEXAMETHASONE 1MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|0.06||||||| 9522590|ERX|0250|DEXAMETHASONE 1MG TABLET|Medicare|MEDICARE ACUTE|0.06||||||| 9522590|ERX|0250|DEXAMETHASONE 1MG TABLET|United Healthcare|UNITED HEALTHCARE|0.06||||||| 9522590|ERX|0250|DEXAMETHASONE 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.06||||||| 9522590|ERX|0250|DEXAMETHASONE 1MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.06||||||| 9522590|ERX|0250|DEXAMETHASONE 1MG TABLET|Humana Medicare Advantage|HUMANA MA|0.06||||||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|0.09||||||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Medicare|MEDICARE ACUTE|0.09||||||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.09||||||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Humana Medicare Advantage|HUMANA MA|0.09||||||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.09||||||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.09||||||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|0.09||||||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.09||||||| 9522624|ERX|0250|DEXAMETHASONE 0.75MG TABL|Humana Medicare Advantage|HUMANA MA|0.06||||||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Blue Cross HMO Specialty|BCBSTX HMO|15.50||||||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Medicare|MEDICARE ACUTE|15.50||||||| 9522665|ERX|0250|LITHIUM 300MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|12.50||||||| 9522673|ERX|0250|METHOTREXATE 2.5MG TABLET|Medicare|MEDICARE ACUTE|0.35||||||| 9522707|ERX|0250|METHADONE 10MG TABLET|Humana Medicare Advantage|HUMANA MA|7.50||||||| 9522707|ERX|0250|METHADONE 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|7.50||||||| 9522715|ERX|0250|MORPHINE IR 15MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.50||||||| 9522723|ERX|0250|PREDNISONE 1MG TABLET|Medicare|MEDICARE ACUTE|4.75||||||| 9522731|ERX|0250|WARFARIN 1MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|14.50||||||| 9522731|ERX|0250|WARFARIN 1MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|14.50||||||| 9522731|ERX|0250|WARFARIN 1MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|14.50||||||| 9522731|ERX|0250|WARFARIN 1MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|14.50||||||| 9522731|ERX|0250|WARFARIN 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|14.50||||||| 9522731|ERX|0250|WARFARIN 1MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|14.50||||||| 9522731|ERX|0250|WARFARIN 1MG TABLET|Medicare|MEDICARE ACUTE|14.50||||||| 9522749|ERX|0250|WARFARIN 2MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.15||||||| 9522749|ERX|0250|WARFARIN 2MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.15||||||| 9522749|ERX|0250|WARFARIN 2MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|0.15||||||| 9522749|ERX|0250|WARFARIN 2MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.15||||||| 9522749|ERX|0250|WARFARIN 2MG TABLET|Medicare|MEDICARE ACUTE|0.15||||||| 9522749|ERX|0250|WARFARIN 2MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|0.15||||||| 9522749|ERX|0250|WARFARIN 2MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.15||||||| 9522756|ERX|0250|WARFARIN 5MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|0.15||||||| 9522756|ERX|0250|WARFARIN 5MG TABLET|Medicare|MEDICARE ACUTE|0.15||||||| 9522756|ERX|0250|WARFARIN 5MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.15||||||| 9522756|ERX|0250|WARFARIN 5MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.15||||||| 9522780|ERX|0250|WARFARIN 2.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.15||||||| 9522780|ERX|0250|WARFARIN 2.5MG TABLET|Medicare|MEDICARE ACUTE|0.15||||||| 9522780|ERX|0250|WARFARIN 2.5MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|0.15||||||| 9522780|ERX|0250|WARFARIN 2.5MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.15||||||| 9522814|ERX|0250|CARBIDOPA 25MG TABLET|Medicare|MEDICARE ACUTE|11.75||||||| 9522814|ERX|0250|CARBIDOPA 25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|11.75||||||| 9522863|ERX|0250|MICONAZOLE VAG CREAM, 45|Blue Cross PPO Specialty|BCBSTX OTHER|95.75||||||| 9522863|ERX|0250|MICONAZOLE VAG CREAM, 45|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|95.75||||||| 9522863|ERX|0250|MICONAZOLE VAG CREAM, 45|Medicare|MEDICARE ACUTE|95.75||||||| 9522863|ERX|0250|MICONAZOLE VAG CREAM, 45|Humana Medicare Advantage|HUMANA MA|95.75||||||| 9522913|ERX|0250|COLLAGENASE OINT, 30 GM|Medicare|MEDICARE ACUTE|7.33||||||| 9522962|ERX|0250|BRINZOLAMIDE 1% EYE DROP,|Humana Medicare Advantage|HUMANA MA|649.25||||||| 9522962|ERX|0250|BRINZOLAMIDE 1% EYE DROP,|Medicare|MEDICARE ACUTE|649.25||||||| 9523184|ERX|0250|CIPROFLOX-DEXAMETH DROP,|Humana Medicare Advantage|HUMANA MA|6.78||||||| 9523184|ERX|0250|CIPROFLOX-DEXAMETH DROP,|Blue Cross PPO Specialty|BCBSTX PPO|6.78||||||| 9523226|ERX|0250|TERBINAFINE 1% CREAM, 12|Blue Cross PPO Specialty|BCBSTX PPO|88.50||||||| 9523234|ERX|0250|SCOPOLAMINE 1.5MG PATCH|Medicare|MEDICARE ACUTE|0.94||||||| 9523234|ERX|0250|SCOPOLAMINE 1.5MG PATCH|Managed Medicare|BCBS MEDICARE PPO MA|0.94||||||| 9523242|ERX|0250|NICOTINE 7MG PATCH|Blue Cross PPO Specialty|BCBSTX PPO|26.25||||||| 9523242|ERX|0250|NICOTINE 7MG PATCH|United Medicare Advantage|UHC AARP MCR HMO MA|26.25||||||| 9523242|ERX|0250|NICOTINE 7MG PATCH|Managed Medicare|HEALTHSPRING MA|26.25||||||| 9523242|ERX|0250|NICOTINE 7MG PATCH|Medicare|MEDICARE ACUTE|26.25||||||| 9523259|ERX|0250|NICOTINE 14MG PATCH|United Medicare Advantage|UHC MEDICARE GOLD MA|26.25||||||| 9523259|ERX|0250|NICOTINE 14MG PATCH|Humana Medicare Advantage|HUMANA MA|26.25||||||| 9523259|ERX|0250|NICOTINE 14MG PATCH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|26.25||||||| 9523259|ERX|0250|NICOTINE 14MG PATCH|Medicare|MEDICARE ACUTE|26.25||||||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|26.25||||||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Blue Cross PPO Specialty|BCBSTX PPO|26.25||||||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Blue Cross PPO Specialty|BCBSTX OTHER|26.25||||||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Humana Medicare Advantage|HUMANA MA|26.25||||||| 9523267|ERX|0250|NICOTINE 21MG PATCH|United Medicare Advantage|UHC AARP MCR HMO MA|26.25||||||| 9523267|ERX|0250|NICOTINE 21MG PATCH|United Healthcare|UNITED HEALTHCARE OTHER|26.25||||||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Medicare|MEDICARE ACUTE|26.25||||||| 9523341|ERX|0250|VARENICLINE 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|24.50||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Medicare|MEDICARE ACUTE|27.50||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|27.50||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Humana Medicare Advantage|HUMANA MA|27.50||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Aetna|AETNA PPO|27.50||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Aetna|AETNA OTHER|27.50||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|27.50||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Managed Medicare|HEALTHSPRING MA|27.50||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|27.50||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|27.50||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|27.50||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|United Healthcare|UNITED HEALTHCARE|27.50||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|27.50||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|27.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|24.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|24.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|24.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|24.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|United Healthcare|UNITED HEALTHCARE|24.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|24.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|24.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Medicaid|MEDICAID|24.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|24.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|24.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Managed Medicare|HEALTHSPRING MA|24.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|24.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|24.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|24.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|24.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|24.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Medicare|MEDICARE ACUTE|24.50||||||| 9523424|ERX|0250|CETIRIZINE-PSEUDOEPHED TA|Medicare|MEDICARE ACUTE|16.75||||||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Humana Medicare Advantage|HUMANA MA|1.05||||||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Managed Medicare|HEALTHSPRING MA|1.05||||||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.05||||||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.05||||||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|1.05||||||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Medicare|MEDICARE ACUTE|1.05||||||| 9523473|ERX|0250|AZITHROMYCIN 500MG VIAL|Medicare|MEDICARE ACUTE|353.50||||||| 9523499|ERX|0250|SILDENAFIL 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|141.75||||||| 9523499|ERX|0250|SILDENAFIL 20MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|141.75||||||| 9523515|ERX|0250|PHENYTOIN CHEWABLE 50MG T|Medicare|MEDICARE ACUTE|0.09||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|31.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|31.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|31.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Humana Medicare Advantage|HUMANA MA|31.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|31.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|31.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|31.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|31.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Managed Medicare|HEALTHSPRING MA|31.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Blue Cross PPO Specialty|BCBSTX OTHER|31.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|31.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Medicaid|MEDICAID|31.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|31.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|31.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|United Healthcare|UNITED HEALTHCARE|31.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Medicare|MEDICARE ACUTE|31.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|31.50||||||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|46.75||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|0.45||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.45||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Tricare|TRICARE EAST REGION|0.45||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.45||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|0.45||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|United Healthcare|TML GROUP BENEFITS|0.45||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|United Healthcare|UNITED HEALTHCARE|0.45||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Medicare|MEDICARE ACUTE|0.45||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.45||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|0.45||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|0.45||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Cigna|CIGNA OTHER|0.45||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Cigna|CIGNA|0.45||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.45||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Humana Medicare Advantage|HUMANA MA|0.45||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|0.45||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.45||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|0.45||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Managed Medicare|HEALTHSPRING MA|0.45||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.45||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.45||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|0.45||||||| 9523598|ERX|0250|PHENYTOIN 100MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|7.50||||||| 9523598|ERX|0250|PHENYTOIN 100MG CAPSULE|Humana Medicare Advantage|HUMANA MA|7.50||||||| 9523598|ERX|0250|PHENYTOIN 100MG CAPSULE|Managed Medicare|HEALTHSPRING MA|7.50||||||| 9523598|ERX|0250|PHENYTOIN 100MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|7.50||||||| 9523598|ERX|0250|PHENYTOIN 100MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|7.50||||||| 9523598|ERX|0250|PHENYTOIN 100MG CAPSULE|Medicare|MEDICARE ACUTE|7.50||||||| 9523606|ERX|0250|VALGANCICLOVIR 450MG TABL|Medicare|MEDICARE ACUTE|4.23||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|0.13||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.13||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Access Direct Platinum|HEALTHFIRST TPA|0.13||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.13||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Medicaid|MEDICAID|0.13||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.13||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|United Medicare Advantage|UHC AARP MCR HMO MA|0.13||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|0.13||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Tricare|TRICARE EAST REGION|0.13||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Managed Medicare|HEALTHSPRING MA|0.13||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Humana Medicare Advantage|HUMANA MA|0.13||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|United Healthcare|UNITED HEALTHCARE|0.13||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|0.13||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Medicare|MEDICARE ACUTE|0.13||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.13||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|0.13||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|24.50||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|United Medicare Advantage|UHC AARP MCR HMO MA|24.50||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|24.50||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|24.50||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|24.50||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|24.50||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Managed Medicare|BCBS MEDICARE PPO MA|24.50||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|24.50||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Access Direct Platinum|HEALTHFIRST TPA|24.50||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Humana Medicare Advantage|HUMANA MA|24.50||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|24.50||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Managed Medicare|HEALTHSPRING MA|24.50||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Medicare|MEDICARE ACUTE|24.50||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|United Healthcare|UNITED HEALTHCARE|24.50||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|United Healthcare|UNITED HEALTHCARE OTHER|24.50||||||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|24.50||||||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|Cigna|CIGNA|24.50||||||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|United Medicare Advantage|UHC AARP MCR HMO MA|24.50||||||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|24.50||||||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|Medicare|MEDICARE ACUTE|24.50||||||| 9523648|ERX|0250|PREGABALIN 25MG CAPSULE|Tricare|TRICARE EAST REGION|24.50||||||| 9523648|ERX|0250|PREGABALIN 25MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|24.50||||||| 9523648|ERX|0250|PREGABALIN 25MG CAPSULE|Workers Compensation|WORKERS COMPENSATION OTHER|24.50||||||| 9523648|ERX|0250|PREGABALIN 25MG CAPSULE|Medicare|MEDICARE ACUTE|24.50||||||| 9523648|ERX|0250|PREGABALIN 25MG CAPSULE|Cigna|CIGNA|24.50||||||| 9523648|ERX|0250|PREGABALIN 25MG CAPSULE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|24.50||||||| 9523648|ERX|0250|PREGABALIN 25MG CAPSULE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|24.50||||||| 9523648|ERX|0250|PREGABALIN 25MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|24.50||||||| 9523648|ERX|0250|PREGABALIN 25MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|24.50||||||| 9523671|ERX|0250|PREGABALIN 100MG CAPSULE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|24.50||||||| 9523671|ERX|0250|PREGABALIN 100MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|24.50||||||| 9523671|ERX|0250|PREGABALIN 100MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|24.50||||||| 9523671|ERX|0250|PREGABALIN 100MG CAPSULE|United Healthcare|UNITED HEALTHCARE|24.50||||||| 9523671|ERX|0250|PREGABALIN 100MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|24.50||||||| 9523671|ERX|0250|PREGABALIN 100MG CAPSULE|Medicare|MEDICARE ACUTE|24.50||||||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Humana Medicare Advantage|HUMANA MA|20.25||||||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|20.25||||||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Medicare|MEDICARE ACUTE|20.25||||||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|20.25||||||| 9523697|ERX|0250|GABAPENTIN 250MG/5ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|89.75||||||| 9523697|ERX|0250|GABAPENTIN 250MG/5ML|Medicare|MEDICARE ACUTE|89.75||||||| 9523697|ERX|0250|GABAPENTIN 250MG/5ML|Humana Medicare Advantage|HUMANA MA|89.75||||||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Medicare|MEDICARE ACUTE|0.18||||||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.18||||||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.18||||||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|0.18||||||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|United Healthcare|UNITED HEALTHCARE|0.18||||||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|0.18||||||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.18||||||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Humana Medicare Advantage|HUMANA MA|0.18||||||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.18||||||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Managed Medicare|HEALTHSPRING MA|0.18||||||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.18||||||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.18||||||| 9523762|ERX|0250|VALPROATE 500MG 5ML|Medicare|MEDICARE ACUTE|184.50||||||| 9523804|ERX|0250|HYDROMORPHONE 2MG TABLET|Medicare|MEDICARE ACUTE|12.50||||||| 9523861|ERX|0250|CLARITHROMYCIN 500MG TABL|Medicare|MEDICARE ACUTE|0.58||||||| 9523895|ERX|0250|DULOXETINE 20MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|37.50||||||| 9523895|ERX|0250|DULOXETINE 20MG CAPSULE|Medicare|MEDICARE ACUTE|37.50||||||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|Medicare|MEDICARE ACUTE|0.59||||||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|Humana Medicare Advantage|HUMANA MA|0.59||||||| 9523986|ERX|0250|TERAZOSIN 1MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|24.50||||||| 9523986|ERX|0250|TERAZOSIN 1MG CAPSULE|Medicare|MEDICARE ACUTE|24.50||||||| 9523986|ERX|0250|TERAZOSIN 1MG CAPSULE|Humana Medicare Advantage|HUMANA MA|24.50||||||| 9524000|ERX|0250|TERAZOSIN 5MG CAPSULE|Medicare|MEDICARE ACUTE|24.50||||||| 9524000|ERX|0250|TERAZOSIN 5MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|24.50||||||| 9524018|ERX|0250|DIVALPROEX ER 250MG TABLE|Medicare|MEDICARE ACUTE|21.25||||||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|Humana Medicare Advantage|HUMANA MA|24.50||||||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|Medicare|MEDICARE ACUTE|24.50||||||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|24.50||||||| 9524232|ERX|0250|DESMOPRESSIN 0.1MG TABLET|Medicare|MEDICARE ACUTE|39.25||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|3.37||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Aenta Medicare Advantage|AETNA MEDICARE MA|3.37||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Cigna|CIGNA|3.37||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Humana Medicare Advantage|HUMANA MA|3.37||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Aetna|AETNA PPO|3.37||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|3.37||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.37||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|3.37||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Managed Medicare|HEALTHSPRING MA|3.37||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Blue Cross PPO Specialty|BCBSTX OTHER|3.37||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Medicare|MEDICARE ACUTE|3.37||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|NON CONTRACTED|COMMERCIAL OTHER 1|3.37||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Blue Cross HMO Specialty|BCBSTX HMO|3.37||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.37||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|United Medicare Advantage|UHC MEDICARE GOLD MA|3.37||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|United Medicare Advantage|UHC AARP MCR HMO MA|3.37||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|3.37||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Tricare|TRICARE EAST REGION|3.37||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Workers Compensation|TEXAS MUTUAL INSURANCE|3.37||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|United Healthcare|UNITED HEALTHCARE OTHER|3.37||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|United Healthcare|UNITED HEALTHCARE|3.37||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Blue Cross PPO Specialty|BCBSTX PPO|3.37||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Managed Medicare|BCBS MEDICARE PPO MA|3.37||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|United Healthcare|TML GROUP BENEFITS|3.37||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Veterans Affairs|VETERANS ADMINISTRATION|3.37||||||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Medicare|MEDICARE ACUTE|493.75||||||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|United Medicare Advantage|UHC AARP MCR HMO MA|493.75||||||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|493.75||||||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Humana Medicare Advantage|HUMANA MA|493.75||||||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Blue Cross PPO Specialty|BCBSTX PPO|493.75||||||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|493.75||||||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Humana Medicare Advantage|HUMANA MA|606.75||||||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|606.75||||||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Blue Cross PPO Specialty|BCBSTX PPO|606.75||||||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Medicare|MEDICARE ACUTE|606.75||||||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|United Medicare Advantage|UHC MEDICARE GOLD MA|606.75||||||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Medicare|MEDICARE ACUTE|758.75||||||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|758.75||||||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|758.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|252.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|252.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Aenta Medicare Advantage|AETNA MEDICARE MA|252.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Cigna|CIGNA|252.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Humana Medicare Advantage|HUMANA MA|252.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|252.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|252.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Blue Cross HMO Specialty|BCBSTX HMO|252.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|252.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Access Direct Platinum|HEALTHFIRST TPA UMR|252.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|252.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Blue Cross PPO Specialty|BCBSTX PPO|252.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Medicare|MEDICARE ACUTE|252.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|United Medicare Advantage|UHC AARP MCR HMO MA|252.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|252.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Workers Compensation|WORKERS COMPENSATION OTHER|252.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|United Healthcare|UNITED HEALTHCARE|252.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|NON CONTRACTED|COMMERCIAL OTHER 1|252.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|United Medicare Advantage|UHC MEDICARE GOLD MA|252.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|252.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Medicaid|MEDICAID|252.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Blue Cross PPO Specialty|BCBSTX OTHER|252.75||||||| 9524323|ERX|0250|ENOXAPARIN 120MG/0.8ML|Medicare|MEDICARE ACUTE|809.50||||||| 9524323|ERX|0250|ENOXAPARIN 120MG/0.8ML|Blue Cross PPO Specialty|BCBSTX PPO|809.50||||||| 9524323|ERX|0250|ENOXAPARIN 120MG/0.8ML|United Medicare Advantage|UHC AARP MCR HMO MA|809.50||||||| 9524471|ERX|0250|TERBINAFINE 250MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|157.50||||||| 9524539|ERX|0250|LETROZOLE 2.5MG TABLET|Medicare|MEDICARE ACUTE|116.75||||||| 9524539|ERX|0250|LETROZOLE 2.5MG TABLET|Humana Medicare Advantage|HUMANA MA|116.75||||||| 9524554|ERX|0250|CALCITONIN 200 UNITS, 3.7|Medicare|MEDICARE ACUTE|1,300.75||||||| 9524596|ERX|0250|OXCARBAZEPINE 300MG TABLE|Medicare|MEDICARE ACUTE|32.25||||||| 9524596|ERX|0250|OXCARBAZEPINE 300MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|32.25||||||| 9524679|ERX|0250|VALSARTAN 80MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|24.50||||||| 9524679|ERX|0250|VALSARTAN 80MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|24.50||||||| 9524679|ERX|0250|VALSARTAN 80MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|24.50||||||| 9524679|ERX|0250|VALSARTAN 80MG TABLET|Medicare|MEDICARE ACUTE|24.50||||||| 9524679|ERX|0250|VALSARTAN 80MG TABLET|Humana Medicare Advantage|HUMANA MA|24.50||||||| 9524679|ERX|0250|VALSARTAN 80MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|24.50||||||| 9524679|ERX|0250|VALSARTAN 80MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|24.50||||||| 9524729|ERX|0636|MYCOPHENOLATE SODIUM 180M|Medicare|MEDICARE ACUTE|32.25||||||| 9524737|ERX|0636|MYCOPHENOLATE SODIUM 360M|Medicare|MEDICARE ACUTE|64.50||||||| 9524810|ERX|0636|MYCOPHENOLATE MOFETIL 250|Medicare|MEDICARE ACUTE|40.50||||||| 9524810|ERX|0636|MYCOPHENOLATE MOFETIL 250|United Medicare Advantage|UHC MEDICARE GOLD MA|40.50||||||| 9524869|ERX|0250|METHYLPHENIDATE 5MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|11.75||||||| 9524943|ERX|0250|MYCOPHENOLATE 200MG/ML,17|Blue Cross PPO Specialty|BCBSTX PPO|65.27||||||| 9524950|ERX|0250|CARBAMAZEPINE 100MG TABLE|Medicare|MEDICARE ACUTE|8.25||||||| 9525031|ERX|0250|BACITRACIN-POLYMYX B SULF|Cigna|CIGNA|0.48||||||| 9525106|ERX|0250|CLOTRIMAZ-BETAMETHASONE|Medicare|MEDICARE ACUTE|386.25||||||| 9525106|ERX|0250|CLOTRIMAZ-BETAMETHASONE|United Medicare Advantage|UHC MEDICARE GOLD MA|386.25||||||| 9525106|ERX|0250|CLOTRIMAZ-BETAMETHASONE|Access Direct Platinum|HEALTHFIRST TPA|386.25||||||| 9525189|ERX|0250|NIFEDIPINE SA 30MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.20||||||| 9525189|ERX|0250|NIFEDIPINE SA 30MG TABLET|Humana Medicare Advantage|HUMANA MA|0.20||||||| 9525189|ERX|0250|NIFEDIPINE SA 30MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.20||||||| 9525189|ERX|0250|NIFEDIPINE SA 30MG TABLET|Medicare|MEDICARE ACUTE|0.20||||||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Medicare|MEDICARE ACUTE|323.25||||||| 9525296|ERX|0250|CIPROFLOXACIN 250MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|54.25||||||| 9525296|ERX|0250|CIPROFLOXACIN 250MG TABLE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|54.25||||||| 9525296|ERX|0250|CIPROFLOXACIN 250MG TABLE|Medicare|MEDICARE ACUTE|54.25||||||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|United Healthcare|UNITED HEALTHCARE|0.15||||||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Medicare|MEDICARE ACUTE|0.15||||||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.15||||||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.15||||||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.15||||||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|0.15||||||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Aetna|AETNA OTHER|0.15||||||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.15||||||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.15||||||| 9525429|ERX|0250|BUSPIRONE 10MG TABLET|Medicare|MEDICARE ACUTE|24.50||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.15||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|0.15||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Humana Medicare Advantage|HUMANA MA|0.15||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.15||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|0.15||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|0.15||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Workers Compensation|TEXAS MUTUAL INSURANCE|0.15||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|0.15||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|0.15||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|United Healthcare|UNITED HEALTHCARE|0.15||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Medicare|MEDICARE ACUTE|0.15||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.15||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.15||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|0.15||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.15||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Managed Medicare|HEALTHSPRING MA|0.15||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Aetna|AETNA OTHER|0.15||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.15||||||| 9525486|ERX|0250|METFORMIN XL 500MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.15||||||| 9525486|ERX|0250|METFORMIN XL 500MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.15||||||| 9525486|ERX|0250|METFORMIN XL 500MG TABLET|Medicare|MEDICARE ACUTE|0.15||||||| 9525494|ERX|0250|METFORMIN 850MG TABLET|Medicare|MEDICARE ACUTE|0.23||||||| 9525494|ERX|0250|METFORMIN 850MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.23||||||| 9525577|ERX|0250|CALCIUM CARB 500 W/VIT D|Medicare|MEDICARE ACUTE|2.50||||||| 9525585|ERX|0250|LEFLUNOMIDE 20MG TABLET|Medicare|MEDICARE ACUTE|212.25||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.56||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Blue Cross HMO Specialty|BCBSTX HMO|0.56||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.56||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Managed Medicare|HEALTHSPRING MA|0.56||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Humana Medicare Advantage|HUMANA MA|0.56||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Blue Cross PPO Specialty|BCBSTX PPO|0.56||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.56||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|0.56||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.56||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Medicaid|MEDICAID|0.56||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Medicare|MEDICARE ACUTE|0.56||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.56||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|United Medicare Advantage|UHC AARP MCR HMO MA|0.56||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Veterans Affairs|VETERANS ADMINISTRATION|0.56||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Workers Compensation|TEXAS MUTUAL INSURANCE|0.56||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|United Healthcare|UNITED HEALTHCARE|0.56||||||| 9525635|ERX|0250|HC ACETAT-PRAMOXINE FOAM,|Blue Cross PPO Specialty|BCBSTX PPO|648.75||||||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Medicare|MEDICARE ACUTE|163.75||||||| 9525775|ERX|0250|NORTRIPTYLINE 25MG CAPSUL|United Medicare Advantage|UHC AARP MCR HMO MA|11.75||||||| 9525783|ERX|0250|KETOCONAZOLE 2% CREAM, 15|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|162.75||||||| 9525783|ERX|0250|KETOCONAZOLE 2% CREAM, 15|Managed Medicare|HEALTHSPRING MA|162.75||||||| 9525783|ERX|0250|KETOCONAZOLE 2% CREAM, 15|Managed Medicare|BCBS MEDICARE PPO MA|162.75||||||| 9525783|ERX|0250|KETOCONAZOLE 2% CREAM, 15|Blue Cross PPO Specialty|BCBSTX PPO|162.75||||||| 9525783|ERX|0250|KETOCONAZOLE 2% CREAM, 15|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|162.75||||||| 9525783|ERX|0250|KETOCONAZOLE 2% CREAM, 15|Medicare|MEDICARE ACUTE|162.75||||||| 9525973|ERX|0250|VENLAFAXINE 37.5MG TABLET|Medicare|MEDICARE ACUTE|24.50||||||| 9525973|ERX|0250|VENLAFAXINE 37.5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|24.50||||||| 9525973|ERX|0250|VENLAFAXINE 37.5MG TABLET|Aetna|AETNA OTHER|24.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|7.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Aenta Medicare Advantage|AETNA MEDICARE MA|7.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Humana Medicare Advantage|HUMANA MA|7.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|7.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Managed Medicare|HEALTHSPRING MA|7.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Blue Cross PPO Specialty|BCBSTX PPO|7.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Blue Cross PPO Specialty|BCBSTX OTHER|7.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|7.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|7.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Access Direct Platinum|HEALTHFIRST TPA|7.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Medicare|MEDICARE ACUTE|7.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Tricare|TRICARE EAST REGION|7.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|United Healthcare|UNITED HEALTHCARE OTHER|7.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|United Healthcare|UNITED HEALTHCARE|7.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|PHCS|HUMANA INSURANCE|7.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|United Medicare Advantage|UHC AARP MCR HMO MA|7.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|United Medicare Advantage|UHC MEDICARE GOLD MA|7.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|NON CONTRACTED|COMMERCIAL OTHER 1|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|United Medicare Advantage|UHC AARP MCR HMO MA|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Veterans Affairs|VETERANS ADMINISTRATION|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Workers Compensation|WORKERS COMPENSATION OTHER|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|United Healthcare|UNITED HEALTHCARE OTHER|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|United Healthcare|UNITED HEALTHCARE|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Aenta Medicare Advantage|AETNA MEDICARE MA|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Cigna|CIGNA OTHER|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Blue Cross HMO Specialty|BCBSTX HMO|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|PHCS|HUMANA INSURANCE|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Medicare|MEDICARE ACUTE|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Managed Medicare|BCBS MEDICARE PPO MA|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Managed Medicare|HEALTHSPRING MA|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Medicaid|MEDICAID|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.50||||||| 9526179|ERX|0250|DIPHENHYDRAMINE ELIX 25MG|Blue Cross PPO Specialty|BCBSTX PPO|0.07||||||| 9526179|ERX|0250|DIPHENHYDRAMINE ELIX 25MG|Medicare|MEDICARE ACUTE|0.07||||||| 9526336|ERX|0250|CEFAZOLIN 1 GM/100 ML MB+|Medicare|MEDICARE ACUTE|0.22||||||| 9526336|ERX|0250|CEFAZOLIN 1 GM/100 ML MB+|United Medicare Advantage|UHC AARP MCR HMO MA|0.22||||||| 9526336|ERX|0250|CEFAZOLIN 1 GM/100 ML MB+|Blue Cross HMO Specialty|BCBSTX HMO|0.22||||||| 9526336|ERX|0250|CEFAZOLIN 1 GM/100 ML MB+|Blue Cross PPO Specialty|BCBSTX PPO|0.22||||||| 9526401|ERX|0250|SILVER NITRATE APPLICATOR|Medicare|MEDICARE ACUTE|0.28||||||| 9526468|ERX|0250|EPHEDRINE 50 MG/10 ML SYR|Humana Medicare Advantage|HUMANA MA|44.75||||||| 9526468|ERX|0250|EPHEDRINE 50 MG/10 ML SYR|Blue Cross PPO Specialty|BCBSTX PPO|44.75||||||| 9526468|ERX|0250|EPHEDRINE 50 MG/10 ML SYR|Medicare|MEDICARE ACUTE|44.75||||||| 9526468|ERX|0250|EPHEDRINE 50 MG/10 ML SYR|United Medicare Advantage|UHC MEDICARE GOLD MA|44.75||||||| 9526484|ERX|0250|PHENYLEPH 1,000 MCG/10ML|Medicare|MEDICARE ACUTE|37.50||||||| 9526484|ERX|0250|PHENYLEPH 1,000 MCG/10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|37.50||||||| 9526484|ERX|0250|PHENYLEPH 1,000 MCG/10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|37.50||||||| 9526484|ERX|0250|PHENYLEPH 1,000 MCG/10ML|Humana Medicare Advantage|HUMANA MA|37.50||||||| 9526484|ERX|0250|PHENYLEPH 1,000 MCG/10ML|Blue Cross PPO Specialty|BCBSTX PPO|37.50||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.31||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Aenta Medicare Advantage|AETNA MEDICARE MA|0.31||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Blue Cross HMO Specialty|BCBSTX HMO|0.31||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Humana Medicare Advantage|HUMANA MA|0.31||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Managed Medicare|BCBS MEDICARE PPO MA|0.31||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.31||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Managed Medicare|HEALTHSPRING MA|0.31||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Blue Cross PPO Specialty|BCBSTX PPO|0.31||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Medicare|MEDICARE ACUTE|0.31||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|United Medicare Advantage|UHC MEDICARE GOLD MA|0.31||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|PHCS|HUMANA INSURANCE|0.31||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|United Healthcare|UNITED HEALTHCARE|0.31||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|United Healthcare|UNITED HEALTHCARE OTHER|0.31||||||| 9526575|ERX|0250|COMBIGAN 5 ML OPTH DROP|Medicare|MEDICARE ACUTE|5.69||||||| 9526641|ERX|0250|DESFLURANE ANESTHETIC GAS|Medicare|MEDICARE ACUTE|324.75||||||| 9526666|ERX|0250|SEVOFLURANE ANESTHETIC GA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.07||||||| 9526666|ERX|0250|SEVOFLURANE ANESTHETIC GA|Humana Medicare Advantage|HUMANA MA|4.07||||||| 9526666|ERX|0250|SEVOFLURANE ANESTHETIC GA|Blue Cross PPO Specialty|BCBSTX PPO|4.07||||||| 9526666|ERX|0250|SEVOFLURANE ANESTHETIC GA|Medicare|MEDICARE ACUTE|4.07||||||| 9526666|ERX|0250|SEVOFLURANE ANESTHETIC GA|United Medicare Advantage|UHC AARP MCR HMO MA|423.25||||||| 9526666|ERX|0250|SEVOFLURANE ANESTHETIC GA|United Medicare Advantage|UHC MEDICARE GOLD MA|4.07||||||| 9526666|ERX|0250|SEVOFLURANE ANESTHETIC GA|PHCS|HUMANA INSURANCE|4.07||||||| 9526716|ERX|0250|0.45% SODIUM CHLORIDE KCL|Workers Compensation|TEXAS MUTUAL INSURANCE|2.10||||||| 9526724|ERX|0250|KETROLAC 0.5% 3ML|Medicare|MEDICARE ACUTE|319.50||||||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Aenta Medicare Advantage|AETNA MEDICARE MA|13.75||||||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Humana Medicare Advantage|HUMANA MA|13.75||||||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|13.75||||||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Blue Cross HMO Specialty|BCBSTX HMO|13.75||||||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Blue Cross PPO Specialty|BCBSTX PPO|13.75||||||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Medicare|MEDICARE ACUTE|13.75||||||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|United Medicare Advantage|UHC AARP MCR HMO MA|13.75||||||| 9526773|ERX|0250|RIVAROXABAN 10 MG TABLET|Medicare|MEDICARE ACUTE|61.50||||||| 9526773|ERX|0250|RIVAROXABAN 10 MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|61.50||||||| 9526773|ERX|0250|RIVAROXABAN 10 MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|61.50||||||| 9526773|ERX|0250|RIVAROXABAN 10 MG TABLET|PHCS|HUMANA INSURANCE|61.50||||||| 9526773|ERX|0250|RIVAROXABAN 10 MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|61.50||||||| 9526773|ERX|0250|RIVAROXABAN 10 MG TABLET|Managed Medicare|HEALTHSPRING MA|61.50||||||| 9526773|ERX|0250|RIVAROXABAN 10 MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|61.50||||||| 9526773|ERX|0250|RIVAROXABAN 10 MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|61.50||||||| 9526773|ERX|0250|RIVAROXABAN 10 MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|61.50||||||| 9526781|ERX|0250|HEPARIN 100UNIT/ML 5 ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|11.75||||||| 9526781|ERX|0250|HEPARIN 100UNIT/ML 5 ML|Medicare|MEDICARE ACUTE|11.75||||||| 9526831|ERX|0250|TICAGRELOR 90 MG TABLET|Medicare|MEDICARE ACUTE|40.25||||||| 9526831|ERX|0250|TICAGRELOR 90 MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|40.25||||||| 9526831|ERX|0250|TICAGRELOR 90 MG TABLET|Managed Medicare|HEALTHSPRING MA|40.25||||||| 9526872|ERX|0250|SEVELAMER 0.8 G POWDER PK|Medicare|MEDICARE ACUTE|0.58||||||| 9526872|ERX|0250|SEVELAMER 0.8 G POWDER PK|Blue Cross PPO Specialty|BCBSTX PPO|0.58||||||| 9526872|ERX|0250|SEVELAMER 0.8 G POWDER PK|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.58||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Medicare|MEDICARE ACUTE|0.19||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|United Medicare Advantage|UHC MEDICARE GOLD MA|0.19||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|United Medicare Advantage|UHC AARP MCR HMO MA|0.19||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|United Healthcare|UNITED HEALTHCARE OTHER|0.19||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|United Healthcare|UNITED HEALTHCARE|0.19||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.19||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Humana Medicare Advantage|HUMANA MA|0.19||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|PHCS|HUMANA INSURANCE|0.19||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Aetna|AETNA PPO|0.19||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Managed Medicare|HEALTHSPRING MA|0.19||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Blue Cross PPO Specialty|BCBSTX PPO|0.19||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.19||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Medicaid|MEDICAID|0.19||||||| 9527094|ERX|0250|DEXTROMETHORPHAN-QUINIDIN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.60||||||| 9527094|ERX|0250|DEXTROMETHORPHAN-QUINIDIN|Medicare|MEDICARE ACUTE|0.60||||||| 9527417|ERX|0250|ROFLUMILAST 500MG TABLET|Medicare|MEDICARE ACUTE|48.50||||||| 9527417|ERX|0250|ROFLUMILAST 500MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|48.50||||||| 9527565|ERX|0250|MAGNESIUM SULFATE 1G/100M|United Medicare Advantage|UHC AARP MCR HMO MA|103.25||||||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|41.75||||||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|41.75||||||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|41.75||||||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Humana Medicare Advantage|HUMANA MA|41.75||||||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|41.75||||||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|41.75||||||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|41.75||||||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|41.75||||||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Medicare|MEDICARE ACUTE|41.75||||||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|41.75||||||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|41.75||||||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|PHCS|HUMANA INSURANCE|41.75||||||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|Medicare|MEDICARE ACUTE|247.75||||||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|Blue Cross HMO Specialty|BCBSTX HMO|247.75||||||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|247.75||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.41||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Humana Medicare Advantage|HUMANA MA|1.41||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.41||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Managed Medicare|BCBS MEDICARE PPO MA|1.41||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|1.41||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Access Direct Platinum|HEALTHFIRST TPA UMR|1.41||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Medicare|MEDICARE ACUTE|1.41||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|United Medicare Advantage|UHC AARP MCR HMO MA|1.41||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|United Healthcare|UNITED HEALTHCARE|1.41||||||| 9527730|ERX|0250|CEFTAZIDIME 1G/100ML NS|Medicare|MEDICARE ACUTE|103.75||||||| 9527789|ERX|0250|CEFTRIAXONE 500MG VIAL|Humana Medicare Advantage|HUMANA MA|278.50||||||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|Medicare|MEDICARE ACUTE|1.29||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.41||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Blue Cross HMO Specialty|BCBSTX HMO|1.41||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Humana Medicare Advantage|HUMANA MA|1.41||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.41||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|1.41||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Blue Cross PPO Specialty|BCBSTX OTHER|1.41||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Access Direct Platinum|HEALTHFIRST TPA|1.41||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Medicare|MEDICARE ACUTE|1.41||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|United Medicare Advantage|UHC AARP MCR HMO MA|1.41||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|1.41||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Workers Compensation|TEXAS MUTUAL INSURANCE|1.41||||||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Medicare|MEDICARE ACUTE|1.76||||||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Humana Medicare Advantage|HUMANA MA|1.76||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|103.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|103.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Aenta Medicare Advantage|AETNA MEDICARE MA|103.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Blue Cross HMO Specialty|BCBSTX HMO|103.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Humana Medicare Advantage|HUMANA MA|103.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Aetna|AETNA OTHER|103.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|103.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Managed Medicare|HEALTHSPRING MA|103.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Managed Medicare|BCBS MEDICARE PPO MA|103.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|103.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Cigna|CIGNA|103.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Blue Cross PPO Specialty|BCBSTX PPO|103.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Medicaid|MEDICAID|103.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|103.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|103.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|103.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Access Direct Platinum|HEALTHFIRST TPA|103.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Medicare|MEDICARE ACUTE|103.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|United Medicare Advantage|UHC MEDICARE GOLD MA|103.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|United Medicare Advantage|UHC AARP MCR HMO MA|103.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Veterans Affairs|VETERANS ADMINISTRATION|103.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Workers Compensation|WORKERS COMPENSATION OTHER|103.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Workers Compensation|TEXAS MUTUAL INSURANCE|103.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|United Healthcare|UNITED HEALTHCARE OTHER|103.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|United Healthcare|UNITED HEALTHCARE|103.50||||||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Medicare|MEDICARE ACUTE|59.50||||||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Blue Cross PPO Specialty|BCBSTX PPO|59.50||||||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|59.50||||||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|Humana Medicare Advantage|HUMANA MA|59.50||||||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|59.50||||||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|Blue Cross PPO Specialty|BCBSTX PPO|59.50||||||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|United Medicare Advantage|UHC MEDICARE GOLD MA|59.50||||||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|Medicare|MEDICARE ACUTE|59.50||||||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|United Medicare Advantage|UHC AARP MCR HMO MA|59.50||||||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|Medicare|MEDICARE ACUTE|0.55||||||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|United Medicare Advantage|UHC AARP MCR HMO MA|0.55||||||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|United Medicare Advantage|UHC MEDICARE GOLD MA|0.55||||||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.55||||||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|Humana Medicare Advantage|HUMANA MA|0.55||||||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|Blue Cross PPO Specialty|BCBSTX PPO|0.55||||||| 9528258|ERX|0250|CEPACOL LOZENGE|Blue Cross HMO Specialty|BCBSTX HMO|0.11||||||| 9528258|ERX|0250|CEPACOL LOZENGE|Blue Cross PPO Specialty|BCBSTX PPO|0.11||||||| 9528258|ERX|0250|CEPACOL LOZENGE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.11||||||| 9528258|ERX|0250|CEPACOL LOZENGE|United Healthcare|UNITED HEALTHCARE OTHER|0.11||||||| 9528258|ERX|0250|CEPACOL LOZENGE|Medicare|MEDICARE ACUTE|0.11||||||| 9528258|ERX|0250|CEPACOL LOZENGE|United Medicare Advantage|UHC AARP MCR HMO MA|0.11||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Medicare|MEDICARE ACUTE|261.50||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|261.50||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|United Medicare Advantage|UHC AARP MCR HMO MA|261.50||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Workers Compensation|WORKERS COMPENSATION OTHER|261.50||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|261.50||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Aenta Medicare Advantage|AETNA MEDICARE MA|261.50||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Blue Cross HMO Specialty|BCBSTX HMO|261.50||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Humana Medicare Advantage|HUMANA MA|261.50||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|261.50||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|261.50||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Medicaid|MEDICAID|261.50||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Humana Medicare Advantage|HUMANA MA|103.25||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Medicare|MEDICARE ACUTE|103.25||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|United Healthcare|UNITED HEALTHCARE OTHER|103.25||||||| 9528654|ERX|0250|ROXANOL 20MG/1ML ORAL SYR|Medicare|MEDICARE ACUTE|0.11||||||| 9528654|ERX|0250|ROXANOL 20MG/1ML ORAL SYR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.11||||||| 9528704|ERX|0250|SODIUM CHLORIDE 0.9% IRRI|Medicare|MEDICARE ACUTE|103.25||||||| 9528704|ERX|0250|SODIUM CHLORIDE 0.9% IRRI|PHCS|HUMANA INSURANCE|103.25||||||| 9528852|ERX|0250|BUPIVACAINE LIPOSOME 1.3%|Blue Cross PPO Specialty|BCBSTX PPO|1,786.50||||||| 9528852|ERX|0250|BUPIVACAINE LIPOSOME 1.3%|Medicare|MEDICARE ACUTE|1,786.50||||||| 9528860|ERX|0636|MORPHINE 4MG/ML VIAL|Medicare|MEDICARE ACUTE|15.50||||||| 9528860|ERX|0636|MORPHINE 4MG/ML VIAL|Workers Compensation|WORKERS COMPENSATION OTHER|0.16||||||| 9528969|ERX|0250|GUAIFENESIN 100MG 5ML UD|Blue Cross PPO Specialty|BCBSTX PPO|0.10||||||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Medicare|MEDICARE ACUTE|509.75||||||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|509.75||||||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Humana Medicare Advantage|HUMANA MA|509.75||||||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Blue Cross PPO Specialty|BCBSTX PPO|509.75||||||| 9529157|ERX|0250|LINACLOTIDE 145MCG CAPSUL|Managed Medicare|BCBS MEDICARE PPO MA|0.78||||||| 9529157|ERX|0250|LINACLOTIDE 145MCG CAPSUL|Medicare|MEDICARE ACUTE|0.78||||||| 9529157|ERX|0250|LINACLOTIDE 145MCG CAPSUL|United Medicare Advantage|UHC MEDICARE GOLD MA|0.78||||||| 9529199|ERX|0250|TICAGRELOR 60MG TABLET|Medicare|MEDICARE ACUTE|0.36||||||| 9529256|ERX|0250|NALOXEGOL 25 MG TABLET|Medicare|MEDICARE ACUTE|66.82||||||| 9529355|ERX|0250|OSELTAMIVIR 30 MG CAPSULE|Medicare|MEDICARE ACUTE|82.24||||||| 9529389|ERX|0250|MULTIVITAMIN LIQUID, 15 M|Aenta Medicare Advantage|AETNA MEDICARE MA|8.80||||||| 9529389|ERX|0250|MULTIVITAMIN LIQUID, 15 M|Humana Medicare Advantage|HUMANA MA|8.80||||||| 9529389|ERX|0250|MULTIVITAMIN LIQUID, 15 M|Medicare|MEDICARE ACUTE|8.80||||||| 9529397|ERX|0250|SACUBITRIL-VALSARTAN 24-2|Medicare|MEDICARE ACUTE|46.92||||||| 9529405|ERX|0250|SACUBITRIL-VALSARTAN 49-5|Humana Medicare Advantage|HUMANA MA|46.92||||||| 9529405|ERX|0250|SACUBITRIL-VALSARTAN 49-5|Medicare|MEDICARE ACUTE|46.92||||||| 9529405|ERX|0250|SACUBITRIL-VALSARTAN 49-5|United Medicare Advantage|UHC MEDICARE GOLD MA|46.92||||||| 9529421|ERX|0250|MIRABEGRON 25 MG TABLET|Medicare|MEDICARE ACUTE|75.05||||||| 9529421|ERX|0250|MIRABEGRON 25 MG TABLET|Humana Medicare Advantage|HUMANA MA|75.05||||||| 9529587|ERX|0250|MULTIVITAMIN LIQUID 30 ML|Medicare|MEDICARE ACUTE|8.80||||||| 9529751|ERX|0250|DOLUTEGRAVIR 25 MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|165.75||||||| 95816|EAP|0740|EEG AWAKE Q506675|Medicare|MEDICARE ACUTE|17.21||||||| 95816|EAP|0740|EEG AWAKE Q506675|United Medicare Advantage|UHC MEDICARE GOLD MA|17.21||||||| 95816|EAP|0740|EEG AWAKE Q506675|Blue Cross PPO Specialty|BCBSTX PPO|17.21||||||| 95816|EAP|0740|EEG AWAKE Q506675|Aenta Medicare Advantage|AETNA MEDICARE MA|17.21||||||| 95816|EAP|0740|EEG AWAKE Q506675|Blue Cross HMO Specialty|BCBSTX HMO|17.21||||||| 95819|EAP|0740|EEG AWAKE AND ASLEEP|Blue Cross PPO Specialty|BCBSTX PPO|13.78||||||| 95819|EAP|0740|EEG AWAKE AND ASLEEP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|13.78||||||| 95819|EAP|0740|EEG AWAKE AND ASLEEP|Aenta Medicare Advantage|AETNA MEDICARE MA|13.78||||||| 95819|EAP|0740|EEG AWAKE AND ASLEEP|Humana Medicare Advantage|HUMANA MA|13.78||||||| 95819|EAP|0740|EEG AWAKE AND ASLEEP|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|13.78||||||| 95819|EAP|0740|EEG AWAKE AND ASLEEP|Medicare|MEDICARE ACUTE|13.78||||||| 95819|EAP|0740|EEG AWAKE AND ASLEEP|United Medicare Advantage|UHC MEDICARE GOLD MA|13.78||||||| 95819|EAP|0740|EEG AWAKE AND ASLEEP|United Medicare Advantage|UHC AARP MCR HMO MA|13.78||||||| 95819|EAP|0740|EEG AWAKE AND ASLEEP|Veterans Affairs|VETERANS ADMINISTRATION|13.78||||||| 95819|EAP|0740|EEG AWAKE AND ASLEEP|United Healthcare|UNITED HEALTHCARE OTHER|13.78||||||| 95822|EAP|0740|EEG ASLEEP|Medicare|MEDICARE ACUTE|21.03||||||| 9582883|ERX|0250|PAPAVERINE 60MG/ 2ML VIAL|Medicare|MEDICARE ACUTE|26.50||||||| 9583071|ERX|0250|GUAIFENESIN-DM 100-10MG/5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.10||||||| 9583071|ERX|0250|GUAIFENESIN-DM 100-10MG/5|Humana Medicare Advantage|HUMANA MA|0.10||||||| 9583071|ERX|0250|GUAIFENESIN-DM 100-10MG/5|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.10||||||| 9583071|ERX|0250|GUAIFENESIN-DM 100-10MG/5|Blue Cross PPO Specialty|BCBSTX PPO|0.10||||||| 9583071|ERX|0250|GUAIFENESIN-DM 100-10MG/5|Medicare|MEDICARE ACUTE|0.10||||||| 9583071|ERX|0250|GUAIFENESIN-DM 100-10MG/5|United Medicare Advantage|UHC MEDICARE GOLD MA|0.10||||||| 9583097|ERX|0636|CEFAZOLIN 2GM 50ML D5W|Medicare|MEDICARE ACUTE|95.75||||||| 9583097|ERX|0636|CEFAZOLIN 2GM 50ML D5W|United Medicare Advantage|UHC MEDICARE GOLD MA|95.75||||||| 9583097|ERX|0636|CEFAZOLIN 2GM 50ML D5W|United Medicare Advantage|UHC AARP MCR HMO MA|95.75||||||| 9583097|ERX|0636|CEFAZOLIN 2GM 50ML D5W|Workers Compensation|TEXAS MUTUAL INSURANCE|95.75||||||| 9583097|ERX|0636|CEFAZOLIN 2GM 50ML D5W|Blue Cross PPO Specialty|BCBSTX PPO|95.75||||||| 9583097|ERX|0636|CEFAZOLIN 2GM 50ML D5W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|95.75||||||| 95831|EAP|0420|MUSCLE TEST MANUAL, EXT/T|Managed Medicaid|MEDICAID AMERIGROUP|||||2.34||| 95831|EAP|0420|MUSCLE TEST MANUAL, EXT/T|Blue Cross PPO Specialty|BCBSTX PPO|||||2.34||| 95831|EAP|0420|MUSCLE TEST MANUAL, EXT/T|Medicare|MEDICARE ACUTE|||||2.34||| 9583105|ERX|0250|REFRESH PLUS 0.5% UD EYE|Medicare|MEDICARE ACUTE|0.10||||||| 9583691|ERX|0250|HEPARIN 2000 UNITS/1000ML|Medicare|MEDICARE ACUTE|||||1.63||| 9583725|ERX|0250|LOPERAMIDE 1MG/ 7.5ML 4OZ|Blue Cross HMO Specialty|BCBSTX HMO|22.50||||||| 9583725|ERX|0250|LOPERAMIDE 1MG/ 7.5ML 4OZ|Humana Medicare Advantage|HUMANA MA|22.50||||||| 9583725|ERX|0250|LOPERAMIDE 1MG/ 7.5ML 4OZ|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|22.50||||||| 9583725|ERX|0250|LOPERAMIDE 1MG/ 7.5ML 4OZ|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|22.50||||||| 9583725|ERX|0250|LOPERAMIDE 1MG/ 7.5ML 4OZ|Medicare|MEDICARE ACUTE|22.50||||||| 9583766|ERX|0250|LEVALBUTEROL 1.25MG/.05ML|Medicare|MEDICARE ACUTE|48.50||||||| 9583766|ERX|0250|LEVALBUTEROL 1.25MG/.05ML|United Medicare Advantage|UHC MEDICARE GOLD MA|48.50||||||| 9584129|ERX|0250|VALPROATE SOD LIQ 250MG/5|Humana Medicare Advantage|HUMANA MA|0.10||||||| 9584129|ERX|0250|VALPROATE SOD LIQ 250MG/5|Medicare|MEDICARE ACUTE|0.10||||||| 9584442|ERX|0250|CEFOXITIN 2G D5W 50ML DUP|Aetna|AETNA PPO|130.50||||||| 9584459|ERX|0250|CEFTRIAXONE 1G D5W 50ML D|Medicare|MEDICARE ACUTE|95.75||||||| 9584467|ERX|0250|CEFTRIAXONE 2G D5W 50ML D|Blue Cross HMO Specialty|BCBSTX HMO|130.50||||||| 9584467|ERX|0250|CEFTRIAXONE 2G D5W 50ML D|Humana Medicare Advantage|HUMANA MA|130.50||||||| 9584467|ERX|0250|CEFTRIAXONE 2G D5W 50ML D|Medicare|MEDICARE ACUTE|130.50||||||| 9584483|ERX|0250|CEFEPIME 2G D5W 50ML DUPL|Medicare|MEDICARE ACUTE|135.75||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.10||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Humana Medicare Advantage|HUMANA MA|0.10||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Managed Medicare|HEALTHSPRING MA|0.10||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.10||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Access Direct Platinum|HEALTHFIRST TPA|0.10||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Medicare|MEDICARE ACUTE|0.10||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|United Healthcare|UNITED HEALTHCARE OTHER|0.10||||||| 9584772|ERX|0250|FERROUS SULFATE 300MG/5ML|Medicare|MEDICARE ACUTE|0.10||||||| 9584772|ERX|0250|FERROUS SULFATE 300MG/5ML|Workers Compensation|WORKERS COMPENSATION OTHER|0.10||||||| 9584772|ERX|0250|FERROUS SULFATE 300MG/5ML|Blue Cross HMO Specialty|BCBSTX HMO|0.10||||||| 9584772|ERX|0250|FERROUS SULFATE 300MG/5ML|Humana Medicare Advantage|HUMANA MA|0.10||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.27||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Cigna|CIGNA OTHER|0.27||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|0.27||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.27||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Humana Medicare Advantage|HUMANA MA|0.27||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Managed Medicare|HEALTHSPRING MA|0.27||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.27||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|0.27||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.27||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.27||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.27||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Medicare|MEDICARE ACUTE|0.27||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|PHCS|HUMANA INSURANCE|0.27||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Tricare|TRICARE EAST REGION|0.27||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|United Healthcare|UNITED HEALTHCARE|0.27||||||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.27||||||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.27||||||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|Medicare|MEDICARE ACUTE|0.27||||||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|United Healthcare|UNITED HEALTHCARE|0.27||||||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|Humana Medicare Advantage|HUMANA MA|0.27||||||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|0.27||||||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|Managed Medicare|HEALTHSPRING MA|0.27||||||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.27||||||| 9585274|ERX|0250|VANCOMYCIN 750 MG VIAL|Medicare|MEDICARE ACUTE|39.50||||||| 9585886|ERX|0250|OCUVITE TABLET|Medicare|MEDICARE ACUTE|0.10||||||| 9586348|ERX|0250|LIDO-MAALOX-BENADRYL 30ML|Managed Medicare|BCBS MEDICARE PPO MA|12.50||||||| 9586348|ERX|0250|LIDO-MAALOX-BENADRYL 30ML|Medicare|MEDICARE ACUTE|12.50||||||| 9586348|ERX|0250|LIDO-MAALOX-BENADRYL 30ML|Workers Compensation|WORKERS COMPENSATION OTHER|12.50||||||| 9587130|ERX|0250|SELENIUM 200 MCG TABLET|Medicare|MEDICARE ACUTE|8.80||||||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Medicare|MEDICARE ACUTE|17.60||||||| 9589185|ERX|0250|HYDROC-ACET 2.5-108MG/5ML|Medicare|MEDICARE ACUTE|0.32||||||| 9589193|ERX|0250|HYDROC-ACET 2.5-108MG/5ML|Humana Medicare Advantage|HUMANA MA|25.50||||||| 9589292|ERX|0250|NALOXONE 4MG NASAL SPRAY|Medicare|MEDICARE ACUTE|3.75||||||| 9589417|ERX|0250|ROTIGOTINE 4MG PATCH|Humana Medicare Advantage|HUMANA MA|1.24||||||| 9589417|ERX|0250|ROTIGOTINE 4MG PATCH|Medicare|MEDICARE ACUTE|1.24||||||| 9589623|ERX|0250|REHAB JOINT KIT|Medicare|MEDICARE ACUTE|312.50||||||| 9590084|ERX|0250|LURASIDONE 20 MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|151.25||||||| 9590084|ERX|0250|LURASIDONE 20 MG TABLET|Medicare|MEDICARE ACUTE|151.25||||||| 9590126|ERX|0250|NITROGLYCERIN 1 MG/10 D5W|Medicare|MEDICARE ACUTE|0.15||||||| 9590126|ERX|0250|NITROGLYCERIN 1 MG/10 D5W|Blue Cross PPO Specialty|BCBSTX PPO|0.15||||||| 9590142|ERX|0250|BENZOCAINE ORAL SPRAY 0.5|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|73.25||||||| 9590142|ERX|0250|BENZOCAINE ORAL SPRAY 0.5|United Medicare Advantage|UHC MEDICARE GOLD MA|73.25||||||| 9590142|ERX|0250|BENZOCAINE ORAL SPRAY 0.5|Medicare|MEDICARE ACUTE|73.25||||||| 9590241|ERX|0250|RIBAVIRIN 200MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|62.25||||||| 9590241|ERX|0250|RIBAVIRIN 200MG CAPSULE|Medicare|MEDICARE ACUTE|62.25||||||| 9590241|ERX|0250|RIBAVIRIN 200MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|62.25||||||| 9590449|ERX|0250|EMPAGLIFLOZIN(JARDIANCE)2|Humana Medicare Advantage|HUMANA MA|0.86||||||| 9590449|ERX|0250|EMPAGLIFLOZIN(JARDIANCE)2|Blue Cross PPO Specialty|BCBSTX PPO|0.86||||||| 9590449|ERX|0250|EMPAGLIFLOZIN(JARDIANCE)2|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.86||||||| 9590449|ERX|0250|EMPAGLIFLOZIN(JARDIANCE)2|Medicare|MEDICARE ACUTE|0.86||||||| 9590456|ERX|0250|LINAGLIPTIN(TRADJENTA) 5M|United Medicare Advantage|UHC MEDICARE GOLD MA|0.83||||||| 9590456|ERX|0250|LINAGLIPTIN(TRADJENTA) 5M|Medicare|MEDICARE ACUTE|0.83||||||| 9590456|ERX|0250|LINAGLIPTIN(TRADJENTA) 5M|Veterans Affairs|VETERANS ADMINISTRATION|0.83||||||| 9590456|ERX|0250|LINAGLIPTIN(TRADJENTA) 5M|Workers Compensation|TEXAS MUTUAL INSURANCE|0.83||||||| 9590456|ERX|0250|LINAGLIPTIN(TRADJENTA) 5M|United Healthcare|UNITED HEALTHCARE|0.83||||||| 9590456|ERX|0250|LINAGLIPTIN(TRADJENTA) 5M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.83||||||| 9590456|ERX|0250|LINAGLIPTIN(TRADJENTA) 5M|Aenta Medicare Advantage|AETNA MEDICARE MA|0.83||||||| 9590456|ERX|0250|LINAGLIPTIN(TRADJENTA) 5M|Blue Cross HMO Specialty|BCBSTX HMO|0.83||||||| 9590456|ERX|0250|LINAGLIPTIN(TRADJENTA) 5M|Humana Medicare Advantage|HUMANA MA|0.83||||||| 9590456|ERX|0250|LINAGLIPTIN(TRADJENTA) 5M|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.83||||||| 9590456|ERX|0250|LINAGLIPTIN(TRADJENTA) 5M|Managed Medicare|HEALTHSPRING MA|0.83||||||| 9590456|ERX|0250|LINAGLIPTIN(TRADJENTA) 5M|Blue Cross PPO Specialty|BCBSTX PPO|0.83||||||| 9590456|ERX|0250|LINAGLIPTIN(TRADJENTA) 5M|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.83||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Cigna|CIGNA OTHER|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Cigna|CIGNA|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Blue Cross HMO Specialty|BCBSTX HMO|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Humana Medicare Advantage|HUMANA MA|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Aetna|AETNA PPO|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Managed Medicare|HEALTHSPRING MA|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Blue Cross PPO Specialty|BCBSTX PPO|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Access Direct Platinum|HEALTHFIRST TPA|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|United Medicare Advantage|UHC MEDICARE GOLD MA|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|United Medicare Advantage|UHC AARP MCR HMO MA|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Medicare|MEDICARE ACUTE|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|United Healthcare|UNITED HEALTHCARE OTHER|202.75||||||| 9590571|ERX|0250|PHYTONADIONE 1MG TABLET|Medicare|MEDICARE ACUTE|0.02||||||| 9590571|ERX|0250|PHYTONADIONE 1MG TABLET|Workers Compensation|TEXAS MUTUAL INSURANCE|0.02||||||| 9590571|ERX|0250|PHYTONADIONE 1MG TABLET|United Healthcare|UNITED HEALTHCARE|0.02||||||| 9590605|ERX|0636|NEOSTIGMINE 3MG/3ML SYRIN|Medicare|MEDICARE ACUTE|1.77||||||| 9590639|ERX|0250|PHENYLEPH-SHARK LIVER-CCB|United Medicare Advantage|UHC MEDICARE GOLD MA|9.25||||||| 9590639|ERX|0250|PHENYLEPH-SHARK LIVER-CCB|Medicare|MEDICARE ACUTE|9.25||||||| 9590639|ERX|0250|PHENYLEPH-SHARK LIVER-CCB|United Healthcare|UNITED HEALTHCARE|9.25||||||| 95992|EAP|0420|CANALITH REPOSITIONING PR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||204.50||| 95992|EAP|0420|CANALITH REPOSITIONING PR|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||204.50||| 95992|EAP|0420|CANALITH REPOSITIONING PR|NON CONTRACTED|COMMERCIAL OTHER 1|||||204.50||| 95992|EAP|0420|CANALITH REPOSITIONING PR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||204.50||| 95992|EAP|0420|CANALITH REPOSITIONING PR|Medicare|MEDICARE ACUTE|||||204.50||| 96105|EAP|0440|APHASIA ASSESSMENT PER HR|NON CONTRACTED|COMMERCIAL OTHER 1|5.36||||||| 96105|EAP|0440|APHASIA ASSESSMENT PER HR|Medicare|MEDICARE ACUTE|5.36||||||| 96105|EAP|0440|APHASIA ASSESSMENT PER HR|Cigna|CIGNA|5.36||||||| 96105|EAP|0440|APHASIA ASSESSMENT PER HR|Blue Cross HMO Specialty|BCBSTX HMO|5.36||||||| 96105|EAP|0440|APHASIA ASSESSMENT PER HR|Humana Medicare Advantage|HUMANA MA|5.36||||||| 96125|EAP|0440|COGNITIVE EVAL|Blue Cross PPO Specialty|BCBSTX PPO|363.50||||5.29||| 96125|EAP|0440|COGNITIVE EVAL|Blue Cross PPO Specialty|BCBSTX OTHER|363.50||||5.29||| 96125|EAP|0440|COGNITIVE EVAL|Humana Medicare Advantage|HUMANA MA|363.50||||5.29||| 96125|EAP|0440|COGNITIVE EVAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|363.50||||5.29||| 96125|EAP|0440|COGNITIVE EVAL|Access Direct Platinum|HEALTHFIRST TPA UMR|||||5.29||| 96125|EAP|0440|COGNITIVE EVAL|Tricare|TRICARE EAST REGION|||||5.29||| 96125|EAP|0440|COGNITIVE EVAL|United Healthcare|TML GROUP BENEFITS|||||5.29||| 96125|EAP|0440|COGNITIVE EVAL|Medicare|MEDICARE ACUTE|363.50||||5.29||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Medicare|MEDICARE ACUTE|11.25||||||| 96374|EAP|0450|IV PUSH SNGL OR INIT DRUG|Aetna|AETNA PPO|3.46||||||| 96374|EAP|0450|IV PUSH SNGL OR INIT DRUG|Medicare|MEDICARE ACUTE|3.46||||||| 96374|EAP|0450|IV PUSH SNGL OR INIT DRUG|Veterans Affairs|VETERANS ADMINISTRATION|3.46||||||| 96374|EAP|0450|IV PUSH SNGL OR INIT DRUG|Workers Compensation|WORKERS COMPENSATION OTHER|3.46||||||| 97|DRG||NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W MCC|Blue Cross PPO Specialty|BCBSTX PPO|67,442.30|116.1|116.1|116.1|||| 97001|EAP|0420|PHYSICAL THERAPY EVALUATI|Blue Cross PPO Specialty|BCBSTX PPO|||||448.50||| 97012|EAP|0420|MECHANICAL TRACTION|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.56||| 97012|EAP|0420|MECHANICAL TRACTION|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.56||| 97012|EAP|0420|MECHANICAL TRACTION|Veterans Affairs|VETERANS ADMINISTRATION|||||1.56||| 97012|EAP|0420|MECHANICAL TRACTION|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.56||| 97012|EAP|0420|MECHANICAL TRACTION|United Healthcare|UNITED HEALTHCARE|||||1.56||| 97012|EAP|0420|MECHANICAL TRACTION|United Healthcare|UNITED HEALTHCARE OTHER|||||1.56||| 97012|EAP|0420|MECHANICAL TRACTION|Tricare|TRICARE EAST REGION|||||1.56||| 97012|EAP|0420|MECHANICAL TRACTION|Medicare|MEDICARE ACUTE|||||1.56||| 97012|EAP|0420|MECHANICAL TRACTION|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.56||| 97012|EAP|0420|MECHANICAL TRACTION|Cigna|CIGNA OTHER|||||1.56||| 97012|EAP|0420|MECHANICAL TRACTION|Cigna|CIGNA|||||1.56||| 97012|EAP|0420|MECHANICAL TRACTION|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.56||| 97012|EAP|0420|MECHANICAL TRACTION|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.56||| 97012|EAP|0420|MECHANICAL TRACTION|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.56||| 97012|EAP|0420|MECHANICAL TRACTION|Humana Medicare Advantage|HUMANA MA|||||1.56||| 97012|EAP|0420|MECHANICAL TRACTION|Managed Medicaid|MEDICAID SUPERIOR|||||1.56||| 97012|EAP|0420|MECHANICAL TRACTION|Aetna|AETNA OTHER|||||1.56||| 97012|EAP|0420|MECHANICAL TRACTION|Aetna|AETNA PPO|||||1.56||| 97012|EAP|0420|MECHANICAL TRACTION|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.56||| 97012|EAP|0420|MECHANICAL TRACTION|Blue Cross PPO Specialty|BCBSTX PPO|||||1.56||| 97012|EAP|0420|MECHANICAL TRACTION|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.56||| 97018|EAP|0430|PARAFFIN BATH|Blue Cross PPO Specialty|BCBSTX PPO|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|Cigna|CIGNA|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|Humana Medicare Advantage|HUMANA MA|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|Aetna|AETNA PPO|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|Aetna|AETNA OTHER|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|Workers Compensation|CLAIMS ADMINISTRATIVE WKCP|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|Managed Medicaid|MEDICAID SUPERIOR|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|United Medicare Advantage|UHC AARP MCR HMO MA|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|Workers Compensation|TEXAS MUTUAL INSURANCE|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|Veterans Affairs|VETERANS ADMINISTRATION|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|Tricare|TRICARE EAST REGION|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|Workers Compensation|ZURICH COMPANY|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|Workers Compensation|STATE OFFICE OF RISK MANAGEMNT|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|Workers Compensation|BROOKSHIRES WORKERS COMP|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|United Healthcare|UNITED HEALTHCARE|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|United Healthcare|UNITED HEALTHCARE OTHER|||||1.36||| 97018|EAP|0430|PARAFFIN BATH|Medicare|MEDICARE ACUTE|||||1.36||| 97022|EAP|0430|FLUIDOTHERAPY|United Medicare Advantage|UHC AARP MCR HMO MA|||||1.56||| 97022|EAP|0430|FLUIDOTHERAPY|Workers Compensation|LIBERTY MUTUAL INSURANCE WKCP|||||1.56||| 97022|EAP|0430|FLUIDOTHERAPY|Veterans Affairs|VETERANS ADMINISTRATION|||||1.56||| 97022|EAP|0430|FLUIDOTHERAPY|Tricare|TRICARE EAST REGION|||||1.56||| 97022|EAP|0430|FLUIDOTHERAPY|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.56||| 97022|EAP|0430|FLUIDOTHERAPY|Workers Compensation|UT EMPLOYEE INJURY|||||1.56||| 97022|EAP|0430|FLUIDOTHERAPY|Workers Compensation|TEXAS MUTUAL INSURANCE|||||1.56||| 97022|EAP|0430|FLUIDOTHERAPY|Workers Compensation|STATE OFFICE OF RISK MANAGEMNT|||||1.56||| 97022|EAP|0430|FLUIDOTHERAPY|Workers Compensation|BROOKSHIRES WORKERS COMP|||||1.56||| 97022|EAP|0430|FLUIDOTHERAPY|United Healthcare|UNITED HEALTHCARE OTHER|||||1.56||| 97022|EAP|0430|FLUIDOTHERAPY|United Healthcare|GEHA|||||1.56||| 97022|EAP|0430|FLUIDOTHERAPY|United Healthcare|UNITED HEALTHCARE|||||1.56||| 97022|EAP|0430|FLUIDOTHERAPY|Medicare|MEDICARE ACUTE|||||1.56||| 97022|EAP|0430|FLUIDOTHERAPY|Blue Cross PPO Specialty|BCBSTX PPO|||||1.56||| 97022|EAP|0430|FLUIDOTHERAPY|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.56||| 97022|EAP|0430|FLUIDOTHERAPY|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.56||| 97022|EAP|0430|FLUIDOTHERAPY|Brinson Benefits|THE HEALTH PLAN SMITH CO|||||1.56||| 97022|EAP|0430|FLUIDOTHERAPY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.56||| 97022|EAP|0430|FLUIDOTHERAPY|Blue Cross HMO Specialty|BCBSTX HMO|||||1.56||| 97022|EAP|0430|FLUIDOTHERAPY|Humana Medicare Advantage|HUMANA MA|||||1.56||| 97022|EAP|0430|FLUIDOTHERAPY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.56||| 97022|EAP|0430|FLUIDOTHERAPY|Aetna|AETNA PPO|||||1.56||| 97022|EAP|0430|FLUIDOTHERAPY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.56||| 97022|EAP|0430|FLUIDOTHERAPY|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.56||| 97022|EAP|0430|FLUIDOTHERAPY|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.56||| 97022|EAP|0430|FLUIDOTHERAPY|Managed Medicare|HEALTHSPRING MA|||||1.56||| 97032|EAP|0430|ELECTRICAL STIMULATION, A|Blue Cross PPO Specialty|BCBSTX PPO|||||175.50||| 97032|EAP|0430|ELECTRICAL STIMULATION, A|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||175.50||| 97032|EAP|0430|ELECTRICAL STIMULATION, A|Cigna|CIGNA OTHER|||||175.50||| 97032|EAP|0420|ELECTRICAL STIMULATION, A|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||175.50||| 97032|EAP|0420|ELECTRICAL STIMULATION, A|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||175.50||| 97032|EAP|0420|ELECTRICAL STIMULATION, A|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||175.50||| 97032|EAP|0420|ELECTRICAL STIMULATION, A|Humana Medicare Advantage|HUMANA MA|||||175.50||| 97032|EAP|0430|ELECTRICAL STIMULATION, A|Humana Medicare Advantage|HUMANA MA|||||175.50||| 97032|EAP|0430|ELECTRICAL STIMULATION, A|Managed Medicaid|MEDICAID SUPERIOR|||||175.50||| 97032|EAP|0430|ELECTRICAL STIMULATION, A|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||175.50||| 97032|EAP|0420|ELECTRICAL STIMULATION, A|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||175.50||| 97032|EAP|0420|ELECTRICAL STIMULATION, A|Blue Cross PPO Specialty|BCBSTX PPO|||||175.50||| 97032|EAP|0420|ELECTRICAL STIMULATION, A|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||175.50||| 97032|EAP|0420|ELECTRICAL STIMULATION, A|United Medicare Advantage|UHC MEDICARE GOLD MA|||||175.50||| 97032|EAP|0420|ELECTRICAL STIMULATION, A|United Medicare Advantage|UHC AARP MCR HMO MA|||||175.50||| 97032|EAP|0430|ELECTRICAL STIMULATION, A|United Medicare Advantage|UHC MEDICARE GOLD MA|||||175.50||| 97032|EAP|0430|ELECTRICAL STIMULATION, A|Veterans Affairs|VETERANS ADMINISTRATION|||||175.50||| 97032|EAP|0420|ELECTRICAL STIMULATION, A|Veterans Affairs|VETERANS ADMINISTRATION|||||175.50||| 97032|EAP|0420|ELECTRICAL STIMULATION, A|United Healthcare|UNITED HEALTHCARE OTHER|||||175.50||| 97032|EAP|0420|ELECTRICAL STIMULATION, A|Medicare|MEDICARE ACUTE|||||175.50||| 97032|EAP|0430|ELECTRICAL STIMULATION, A|Medicare|MEDICARE ACUTE|||||175.50||| 97033|EAP|0420|IONTOPHORESIS|Tricare|TRICARE EAST REGION|||||175.50||| 97033|EAP|0420|IONTOPHORESIS|United Healthcare|TML GROUP BENEFITS|||||175.50||| 97033|EAP|0420|IONTOPHORESIS|Medicare|MEDICARE ACUTE|||||175.50||| 97033|EAP|0420|IONTOPHORESIS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||175.50||| 97033|EAP|0420|IONTOPHORESIS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||175.50||| 97033|EAP|0420|IONTOPHORESIS|Humana Medicare Advantage|HUMANA MA|||||175.50||| 97033|EAP|0420|IONTOPHORESIS|Aetna|AETNA PPO|||||175.50||| 97033|EAP|0420|IONTOPHORESIS|Blue Cross PPO Specialty|BCBSTX PPO|||||175.50||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Blue Cross PPO Specialty|BCBSTX PPO|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.36||| 97035|EAP|0420|ULTRASOUND/PHONOPHORESIS|ChampVA|CHAMPVA CENTER|||||1.36||| 97035|EAP|0420|ULTRASOUND/PHONOPHORESIS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Cigna|CIGNA OTHER|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Cigna|CIGNA|||||1.36||| 97035|EAP|0420|ULTRASOUND/PHONOPHORESIS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.36||| 97035|EAP|0420|ULTRASOUND/PHONOPHORESIS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.36||| 97035|EAP|0420|ULTRASOUND/PHONOPHORESIS|Humana Medicare Advantage|HUMANA MA|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Humana Medicare Advantage|HUMANA MA|||||1.36||| 97035|EAP|0420|ULTRASOUND/PHONOPHORESIS|Managed Medicaid|MEDICAID SUPERIOR|||||1.36||| 97035|EAP|0420|ULTRASOUND/PHONOPHORESIS|Aetna|AETNA PPO|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Managed Medicaid|MEDICAID SUPERIOR|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Managed Medicare|HEALTHSPRING MA|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Aetna|AETNA OTHER|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Aetna|AETNA PPO|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Aetna|BOON CHAPMAN|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Access Direct Platinum|HEALTHFIRST TPA UMR|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Managed Medicaid|MEDICAID AMERIGROUP|||||1.36||| 97035|EAP|0420|ULTRASOUND/PHONOPHORESIS|Blue Cross PPO Specialty|BCBSTX PPO|||||1.36||| 97035|EAP|0420|ULTRASOUND/PHONOPHORESIS|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.36||| 97035|EAP|0420|ULTRASOUND/PHONOPHORESIS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.36||| 97035|EAP|0420|ULTRASOUND/PHONOPHORESIS|United Medicare Advantage|UHC AARP MCR HMO MA|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|United Medicare Advantage|UHC AARP MCR HMO MA|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Blue Cross HMO Specialty|BCBSTX HMO|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|||||1.36||| 97035|EAP|0420|ULTRASOUND/PHONOPHORESIS|Veterans Affairs|VETERANS ADMINISTRATION|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Veterans Affairs|VETERANS ADMINISTRATION|||||1.36||| 97035|EAP|0420|ULTRASOUND/PHONOPHORESIS|Tricare|TRICARE EAST REGION|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Tricare|TRICARE EAST REGION|||||1.36||| 97035|EAP|0420|ULTRASOUND/PHONOPHORESIS|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Workers Compensation|ZURICH COMPANY|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Brinson Benefits|THE HEALTH PLAN SMITH CO|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Workers Compensation|UT EMPLOYEE INJURY|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Workers Compensation|TEXAS MUTUAL INSURANCE|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Workers Compensation|STATE OFFICE OF RISK MANAGEMNT|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Workers Compensation|LIBERTY MUTUAL INSURANCE WKCP|||||1.36||| 97035|EAP|0420|ULTRASOUND/PHONOPHORESIS|United Healthcare|UNITED HEALTHCARE|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|United Healthcare|TML GROUP BENEFITS|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|United Healthcare|UNITED HEALTHCARE OTHER|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|United Healthcare|UNITED HEALTHCARE|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|United Healthcare|GEHA|||||1.36||| 97035|EAP|0420|ULTRASOUND/PHONOPHORESIS|Medicare|MEDICARE ACUTE|||||1.36||| 97035|EAP|0430|ULTRASOUND/PHONOPHORESIS|Medicare|MEDICARE ACUTE|||||1.36||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Workers Compensation|WORKERS COMPENSATION OTHER|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Workers Compensation|UT EMPLOYEE INJURY|||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Workers Compensation|TRAVELERS INSURANCE COMPANY|||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Workers Compensation|LIBERTY MUTUAL INSURANCE WKCP|||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Workers Compensation|CLAIMS ADMINISTRATIVE WKCP|||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Workers Compensation|BROOKSHIRES WORKERS COMP|||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|United Healthcare|UNITED HEALTHCARE|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|United Healthcare|GEHA|||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|United Healthcare|UNITED HEALTHCARE ERS|||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|United Healthcare|UNITED HEALTHCARE OTHER|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|United Healthcare|ZZZZZ UNITED HEALTHCARE|||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|United Healthcare|TML GROUP BENEFITS|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Workers Compensation|CLAIMS ADMINISTRATIVE WKCP|||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|United Healthcare|AARP|||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|United Healthcare|UNITED HEALTHCARE OTHER|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|United Healthcare|GEHA|||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Medicare|MEDICARE ACUTE|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Medicare|MEDICARE ACUTE|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Blue Cross PPO Specialty|BCBSTX PPO|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Medicaid|MEDICAID|194.75||||||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|194.75||||||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Brinson Benefits|THE HEALTH PLAN SMITH CO|||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Brinson Benefits|THE HEALTH PLAN SMITH CO|||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|ChampVA|CHAMPVA CENTER|||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Cigna|CIGNA OTHER|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Cigna|CIGNA|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Medicaid|MEDICAID|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Cigna|CIGNA OTHER|||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Medicaid|SMITH COUNTY INDIGENT HEALTH|||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Aenta Medicare Advantage|AETNA MEDICARE MA|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Blue Cross HMO Specialty|BCBSTX HMO|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Blue Cross HMO Specialty|BCBSTX HMO|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Aenta Medicare Advantage|AETNA MEDICARE MA|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Humana Medicare Advantage|HUMANA MA|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Access Direct Platinum|HEALTHFIRST TPA|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Humana Medicare Advantage|HUMANA MA|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Cigna|CIGNA|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Access Direct Platinum|HEALTHFIRST TPA UMR|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Managed Medicaid|MEDICAID UNITED HEALTHCARE|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Managed Medicaid|MEDICAID SUPERIOR|||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Managed Medicaid|MEDICAID AMERIGROUP|||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Aetna|AETNA PPO|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Blue Cross PPO Specialty|BCBSTX OTHER|||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Aetna|AETNA OTHER|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Aetna|BOON CHAPMAN|||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Managed Medicaid|MEDICAID UNITED HEALTHCARE|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Managed Medicaid|MEDICAID SUPERIOR|||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Managed Medicaid|MEDICAID AMERIGROUP|||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Aetna|BOON CHAPMAN|||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Aetna|AETNA PPO|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|United Healthcare|UNITED HEALTHCARE|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|United Healthcare|TML GROUP BENEFITS|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Aetna|AETNA OTHER|||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Managed Medicare|BCBS MEDICARE PPO MA|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Aetna Value Network|AETNA VALUE NETWORK|||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Access Direct Platinum|HEALTHFIRST TPA UMR|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Access Direct Platinum|HEALTHFIRST TPA|194.75||||||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|United Healthcare|AARP|||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Workers Compensation|STATE OFFICE OF RISK MANAGEMNT|||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Managed Medicare|HEALTHSPRING MA|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Managed Medicare|BCBS MEDICARE PPO MA|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Workers Compensation|ZURICH COMPANY|||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Managed Medicare|HEALTHSPRING MA|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Medicaid|MEDICAID HMO|||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Medicaid|LAW ENFORCEMENT OTHER|||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Medicaid|LAW ENFORCEMENT OTHER|||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Medicaid|MEDICAID HMO|||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Blue Cross PPO Specialty|BCBSTX PPO|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Blue Cross PPO Specialty|BCBSTX OTHER|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|NON CONTRACTED|COMMERCIAL OTHER 2|||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|NON CONTRACTED|COMMERCIAL OTHER 1|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Workers Compensation|TEXAS MUTUAL INSURANCE|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|PHCS|HUMANA INSURANCE|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|United Medicare Advantage|UHC MEDICARE GOLD MA|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|United Medicare Advantage|UHC AARP WELLMED HMO MA|||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|United Medicare Advantage|UHC AARP MCR HMO MA|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|United Medicare Advantage|SECURE HORIZONS MA|||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|United Medicare Advantage|UHC MEDICARE GOLD MA|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|United Medicare Advantage|UHC AARP MCR HMO MA|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Workers Compensation|LIBERTY MUTUAL INSURANCE WKCP|||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|PHCS|HUMANA INSURANCE|194.75||||||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Texas Workforce Commission|VOC REHAB SERV (TWC)|||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Veterans Affairs|VETERANS ADMINISTRATION|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|NON CONTRACTED|COMMERCIAL OTHER 1|194.75||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Veterans Affairs|VETERANS ADMINISTRATION|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Tricare|TRICARE EAST REGION|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Tricare|TRICARE FOR LIFE|||||194.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Tricare|TRICARE EAST REGION|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Workers Compensation|ZURICH COMPANY|||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Workers Compensation|WORKERS COMPENSATION OTHER|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Workers Compensation|UT EMPLOYEE INJURY|||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Workers Compensation|TRAVELERS INSURANCE COMPANY|||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Workers Compensation|TEXAS MUTUAL INSURANCE|194.75||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Workers Compensation|STATE OFFICE OF RISK MANAGEMNT|||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Workers Compensation|GALLAGHER BASSETT|||||194.75||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Workers Compensation|BROOKSHIRES WORKERS COMP|||||194.75||| 97112|EAP|0430|NEUROMUSCULAR|Blue Cross PPO Specialty|BCBSTX OTHER|||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|194.75||||||| 97112|EAP|0420|NEUROMUSCULAR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|194.75||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Cigna|CIGNA OTHER|||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Cigna|CIGNA|194.75||||194.75||| 97112|EAP|0430|NEUROMUSCULAR|Cigna|CIGNA|194.75||||||| 97112|EAP|0420|NEUROMUSCULAR|Aenta Medicare Advantage|AETNA MEDICARE MA|194.75||||194.75||| 97112|EAP|0430|NEUROMUSCULAR|Aenta Medicare Advantage|AETNA MEDICARE MA|194.75||||||| 97112|EAP|0420|NEUROMUSCULAR|Blue Cross HMO Specialty|BCBSTX HMO|194.75||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Humana Medicare Advantage|HUMANA MA|194.75||||194.75||| 97112|EAP|0430|NEUROMUSCULAR|Humana Medicare Advantage|HUMANA MA|194.75||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|194.75||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|194.75||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Managed Medicaid|MEDICAID SUPERIOR|||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Managed Medicaid|MEDICAID AMERIGROUP|||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Aetna|AETNA PPO|194.75||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Aetna|AETNA OTHER|||||194.75||| 97112|EAP|0430|NEUROMUSCULAR|Aetna|AETNA PPO|194.75||||||| 97112|EAP|0430|NEUROMUSCULAR|Access Direct Platinum|HEALTHFIRST TPA UMR|194.75||||||| 97112|EAP|0430|NEUROMUSCULAR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|194.75||||194.75||| 97112|EAP|0430|NEUROMUSCULAR|Access Direct Platinum|HEALTHFIRST TPA|194.75||||||| 97112|EAP|0420|NEUROMUSCULAR|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|194.75||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Managed Medicare|HEALTHSPRING MA|194.75||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Managed Medicare|BCBS MEDICARE PPO MA|194.75||||194.75||| 97112|EAP|0430|NEUROMUSCULAR|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|194.75||||||| 97112|EAP|0430|NEUROMUSCULAR|Managed Medicare|BCBS MEDICARE PPO MA|194.75||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Medicaid|LAW ENFORCEMENT OTHER|||||194.75||| 97112|EAP|0430|NEUROMUSCULAR|Managed Medicaid|MEDICAID SUPERIOR|||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Medicaid|MEDICAID|||||194.75||| 97112|EAP|0430|NEUROMUSCULAR|Medicaid|MEDICAID|194.75||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Blue Cross PPO Specialty|BCBSTX PPO|194.75||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Blue Cross PPO Specialty|BCBSTX OTHER|194.75||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|NON CONTRACTED|COMMERCIAL OTHER 2|||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|NON CONTRACTED|COMMERCIAL OTHER 1|194.75||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|PHCS|HUMANA INSURANCE|194.75||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|United Medicare Advantage|UHC MEDICARE GOLD MA|194.75||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Access Direct Platinum|HEALTHFIRST TPA UMR|||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|United Medicare Advantage|UHC AARP MCR HMO MA|194.75||||194.75||| 97112|EAP|0430|NEUROMUSCULAR|United Medicare Advantage|UHC MEDICARE GOLD MA|194.75||||194.75||| 97112|EAP|0430|NEUROMUSCULAR|United Medicare Advantage|UHC AARP MCR HMO MA|194.75||||||| 97112|EAP|0420|NEUROMUSCULAR|Texas Workforce Commission|VOC REHAB SERV (TWC)|||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|||||194.75||| 97112|EAP|0430|NEUROMUSCULAR|Texas Workforce Commission|VOC REHAB SERV (TWC)|||||194.75||| 97112|EAP|0430|NEUROMUSCULAR|Cigna|CIGNA OTHER|||||194.75||| 97112|EAP|0430|NEUROMUSCULAR|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Veterans Affairs|VETERANS ADMINISTRATION|||||194.75||| 97112|EAP|0430|NEUROMUSCULAR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|194.75||||194.75||| 97112|EAP|0430|NEUROMUSCULAR|Veterans Affairs|VETERANS ADMINISTRATION|194.75||||||| 97112|EAP|0420|NEUROMUSCULAR|Tricare|TRICARE EAST REGION|||||194.75||| 97112|EAP|0430|NEUROMUSCULAR|Tricare|TRICARE EAST REGION|||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Workers Compensation|WORKERS COMPENSATION OTHER|||||194.75||| 97112|EAP|0430|NEUROMUSCULAR|Blue Cross PPO Specialty|BCBSTX PPO|194.75||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Workers Compensation|UT EMPLOYEE INJURY|||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Workers Compensation|TRAVELERS INSURANCE COMPANY|||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|Workers Compensation|TEXAS MUTUAL INSURANCE|194.75||||194.75||| 97112|EAP|0430|NEUROMUSCULAR|Workers Compensation|LIBERTY MUTUAL INSURANCE WKCP|||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|United Healthcare|UNITED HEALTHCARE OTHER|194.75||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|United Healthcare|UNITED HEALTHCARE|194.75||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|United Healthcare|AARP|||||194.75||| 97112|EAP|0420|NEUROMUSCULAR|United Healthcare|GEHA|||||194.75||| 97112|EAP|0430|NEUROMUSCULAR|United Healthcare|UNITED HEALTHCARE OTHER|194.75||||||| 97112|EAP|0420|NEUROMUSCULAR|Medicare|MEDICARE ACUTE|194.75||||194.75||| 97112|EAP|0430|NEUROMUSCULAR|Medicare|MEDICARE ACUTE|194.75||||194.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|NON CONTRACTED|COMMERCIAL OTHER 1|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|United Medicare Advantage|UHC MEDICARE GOLD MA|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|United Medicare Advantage|UHC AARP WELLMED HMO MA|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|United Medicare Advantage|UHC AARP MCR HMO MA|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Workers Compensation|TEXAS MUTUAL INSURANCE|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Veterans Affairs|VETERANS ADMINISTRATION|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Tricare|TRICARE EAST REGION|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Workers Compensation|UT EMPLOYEE INJURY|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Workers Compensation|STATE OFFICE OF RISK MANAGEMNT|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|United Healthcare|UNITED HEALTHCARE|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|United Healthcare|UNITED HEALTHCARE OTHER|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Medicare|MEDICARE ACUTE|||||272.75||| 97113|EAP|0430|AQUATIC THERAPY, INDIVIDU|Medicare|MEDICARE ACUTE|272.75||||||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Brinson Benefits|THE HEALTH PLAN SMITH CO|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Cigna|CIGNA OTHER|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|United Healthcare|UNITED HEALTHCARE|272.75||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Cigna|CIGNA|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Aenta Medicare Advantage|AETNA MEDICARE MA|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Blue Cross HMO Specialty|BCBSTX HMO|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Humana Medicare Advantage|HUMANA MA|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Workers Compensation|WORKERS COMPENSATION OTHER|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Access Direct Platinum|HEALTHFIRST TPA UMR|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Access Direct Platinum|HEALTHFIRST TPA|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Managed Medicaid|MEDICAID SUPERIOR|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Managed Medicaid|MEDICAID AMERIGROUP|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Aetna|AETNA PPO|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Aetna|AETNA OTHER|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Managed Medicare|HEALTHSPRING MA|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Managed Medicare|BCBS MEDICARE PPO MA|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Blue Cross PPO Specialty|BCBSTX PPO|||||272.75||| 97113|EAP|0420|AQUATIC THERAPY, INDIVIDU|Blue Cross PPO Specialty|BCBSTX OTHER|||||272.75||| 97116|EAP|0420|GAIT TRAINING|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|2.34||||||| 97116|EAP|0420|GAIT TRAINING|Managed Medicare|BCBS MEDICARE PPO MA|2.34||||2.34||| 97116|EAP|0420|GAIT TRAINING|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.34||||2.34||| 97116|EAP|0420|GAIT TRAINING|Cigna|CIGNA OTHER|2.34||||2.34||| 97116|EAP|0420|GAIT TRAINING|Aenta Medicare Advantage|AETNA MEDICARE MA|2.34||||||| 97116|EAP|0420|GAIT TRAINING|Blue Cross HMO Specialty|BCBSTX HMO|2.34||||||| 97116|EAP|0420|GAIT TRAINING|Humana Medicare Advantage|HUMANA MA|2.34||||2.34||| 97116|EAP|0420|GAIT TRAINING|Access Direct Platinum|HEALTHFIRST TPA UMR|||||2.34||| 97116|EAP|0420|GAIT TRAINING|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.34||||||| 97116|EAP|0420|GAIT TRAINING|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|2.34||||||| 97116|EAP|0420|GAIT TRAINING|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.34||||2.34||| 97116|EAP|0420|GAIT TRAINING|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.34||||2.34||| 97116|EAP|0420|GAIT TRAINING|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.34||||||| 97116|EAP|0420|GAIT TRAINING|Access Direct Platinum|HEALTHFIRST TPA|2.34||||||| 97116|EAP|0420|GAIT TRAINING|Aetna|AETNA PPO|2.34||||||| 97116|EAP|0420|GAIT TRAINING|Aetna|AETNA OTHER|2.34||||||| 97116|EAP|0420|GAIT TRAINING|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.34||||||| 97116|EAP|0420|GAIT TRAINING|Managed Medicare|HEALTHSPRING MA|2.34||||2.34||| 97116|EAP|0420|GAIT TRAINING|Medicaid|LAW ENFORCEMENT OTHER|||||2.34||| 97116|EAP|0420|GAIT TRAINING|Blue Cross PPO Specialty|BCBSTX PPO|2.34||||2.34||| 97116|EAP|0420|GAIT TRAINING|Blue Cross PPO Specialty|BCBSTX OTHER|2.34||||2.34||| 97116|EAP|0420|GAIT TRAINING|NON CONTRACTED|COMMERCIAL OTHER 1|2.34||||2.34||| 97116|EAP|0420|GAIT TRAINING|Cigna|CIGNA|2.34||||||| 97116|EAP|0420|GAIT TRAINING|PHCS|HUMANA INSURANCE|2.34||||||| 97116|EAP|0420|GAIT TRAINING|United Medicare Advantage|UHC MEDICARE GOLD MA|2.34||||2.34||| 97116|EAP|0420|GAIT TRAINING|United Medicare Advantage|UHC AARP MCR HMO MA|2.34||||||| 97116|EAP|0420|GAIT TRAINING|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|2.34||||||| 97116|EAP|0420|GAIT TRAINING|Veterans Affairs|VETERANS ADMINISTRATION|2.34||||2.34||| 97116|EAP|0420|GAIT TRAINING|Tricare|TRICARE EAST REGION|2.34||||||| 97116|EAP|0420|GAIT TRAINING|Workers Compensation|WORKERS COMPENSATION OTHER|2.34||||2.34||| 97116|EAP|0420|GAIT TRAINING|Workers Compensation|TEXAS MUTUAL INSURANCE|2.34||||||| 97116|EAP|0420|GAIT TRAINING|Workers Compensation|LIBERTY MUTUAL INSURANCE WKCP|||||2.34||| 97116|EAP|0420|GAIT TRAINING|United Healthcare|UNITED HEALTHCARE OTHER|2.34||||2.34||| 97116|EAP|0420|GAIT TRAINING|United Healthcare|UNITED HEALTHCARE|2.34||||2.34||| 97116|EAP|0420|GAIT TRAINING|United Healthcare|UNITED HEALTHCARE|2.34||||||| 97116|EAP|0420|GAIT TRAINING|Medicare|MEDICARE ACUTE|2.34||||2.34||| 97124|EAP|0430|MASSAGE|Medicare|MEDICARE ACUTE|194.75||||||| 97127|EAP|0440||Blue Cross PPO Specialty|BCBSTX OTHER|||||2.03||| 97127|EAP|0440||United Healthcare|TML GROUP BENEFITS|||||2.03||| 97129|EAP|0440|THER INV COGNITIVE FX (IN|United Healthcare|TML GROUP BENEFITS|||||2.03||| 97129|EAP|0430|THER INV COGNITIVE FX (IN|Medicare|MEDICARE ACUTE|2.03||||||| 97129|EAP|0440|THER INV COGNITIVE FX (IN|Medicare|MEDICARE ACUTE|2.03||||2.03||| 97129|EAP|0440|THER IVNTJ W/FOCUS COG FU|Blue Cross PPO Specialty|BCBSTX PPO|||||2.03||| 97129|EAP|0440|THER IVNTJ W/FOCUS COG FU|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.03||| 97129|EAP|0440|THER INV COGNITIVE FX (IN|Blue Cross PPO Specialty|BCBSTX PPO|||||2.03||| 97129|EAP|0440|THER INV COGNITIVE FX (IN|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.03||| 97129|EAP|0420|THER INV COGNITIVE FX (IN|Humana Medicare Advantage|HUMANA MA|2.03||||||| 97129|EAP|0440|THER INV COGNITIVE FX (IN|Humana Medicare Advantage|HUMANA MA|||||2.03||| 97129|EAP|0440|THER INV COGNITIVE FX (IN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.03||| 97130|EAP|0440|THER INV COGNITIVE FX (AD|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.03||| 97130|EAP|0440|THER INV COGNITIVE FX (AD|Humana Medicare Advantage|HUMANA MA|||||2.03||| 97130|EAP|0440|THER INV COGNITIVE FX (AD|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.03||| 97130|EAP|0440|THER INV COGNITIVE FX (AD|United Healthcare|TML GROUP BENEFITS|||||2.03||| 97130|EAP|0440|THER INV COGNITIVE FX (AD|Medicare|MEDICARE ACUTE|2.03||||2.03||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|NON CONTRACTED|COMMERCIAL OTHER 1|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|NON CONTRACTED|COMMERCIAL OTHER 1|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|PHCS|HUMANA INSURANCE|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|United Medicare Advantage|UHC MEDICARE GOLD MA|159.75||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|United Medicare Advantage|UHC AARP WELLMED HMO MA|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|United Medicare Advantage|UHC AARP MCR HMO MA|159.75||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|United Medicare Advantage|SECURE HORIZONS MA|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|United Medicare Advantage|UHC MEDICARE GOLD MA|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|United Medicare Advantage|UHC AARP MCR HMO MA|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|159.75||||||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Veterans Affairs|VETERANS ADMINISTRATION|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Veterans Affairs|VETERANS ADMINISTRATION|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Tricare|TRICARE EAST REGION|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Workers Compensation|LIBERTY MUTUAL INSURANCE WKCP|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Tricare|TRICARE EAST REGION|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Tricare|TRICARE FOR LIFE|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Workers Compensation|WORKERS COMPENSATION OTHER|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Workers Compensation|UT EMPLOYEE INJURY|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Workers Compensation|TRAVELERS INSURANCE COMPANY|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Workers Compensation|TEXAS MUTUAL INSURANCE|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Workers Compensation|STATE OFFICE OF RISK MANAGEMNT|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Workers Compensation|BROOKSHIRES WORKERS COMP|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Workers Compensation|ZURICH COMPANY|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Workers Compensation|WORKERS COMPENSATION OTHER|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Workers Compensation|TEXAS MUTUAL INSURANCE|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Workers Compensation|STATE OFFICE OF RISK MANAGEMNT|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Workers Compensation|LIBERTY MUTUAL INSURANCE WKCP|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|United Healthcare|AARP|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|United Healthcare|GEHA|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|United Healthcare|UNITED HEALTHCARE OTHER|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|United Healthcare|UNITED HEALTHCARE|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|United Healthcare|TML GROUP BENEFITS|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|United Healthcare|GEHA|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|United Healthcare|TML GROUP BENEFITS|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|United Healthcare|UNITED HEALTHCARE|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Medicare|MEDICARE ACUTE|159.75||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Medicare|MEDICARE ACUTE|159.75||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Blue Cross PPO Specialty|BCBSTX PPO|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Blue Cross PPO Specialty|BCBSTX OTHER|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Brinson Benefits|THE HEALTH PLAN SMITH CO|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|ChampVA|CHAMPVA CENTER|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|United Healthcare|UNITED HEALTHCARE OTHER|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Cigna|CIGNA OTHER|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Cigna|CIGNA|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Cigna|CIGNA OTHER|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Cigna|CIGNA|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Aenta Medicare Advantage|AETNA MEDICARE MA|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Aenta Medicare Advantage|AETNA MEDICARE MA|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Workers Compensation|BROOKSHIRES WORKERS COMP|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Workers Compensation|UT EMPLOYEE INJURY|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Blue Cross HMO Specialty|BCBSTX HMO|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Blue Cross HMO Specialty|BCBSTX HMO|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Humana Medicare Advantage|HUMANA MA|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Humana Medicare Advantage|HUMANA MA|159.75||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Workers Compensation|CLAIMS ADMINISTRATIVE WKCP|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Access Direct Platinum|HEALTHFIRST TPA UMR|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Access Direct Platinum|HEALTHFIRST TPA|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Managed Medicaid|MEDICAID SUPERIOR|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Managed Medicaid|MEDICAID AMERIGROUP|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|159.75||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Managed Medicaid|MEDICAID SUPERIOR|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Workers Compensation|CLAIMS ADMINISTRATIVE WKCP|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Aetna|AETNA PPO|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Managed Medicaid|MEDICAID AMERIGROUP|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Aetna|AETNA OTHER|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Aetna|AETNA PPO|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Aetna|AETNA OTHER|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Aetna|BOON CHAPMAN|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Aetna Value Network|AETNA VALUE NETWORK|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|NON CONTRACTED|COMMERCIAL OTHER 2|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Access Direct Platinum|HEALTHFIRST TPA UMR|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Managed Medicare|HEALTHSPRING MA|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Managed Medicare|BCBS MEDICARE PPO MA|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||159.75||| 97140|EAP|0430|MANUAL THERAPY EACH 15 MI|Managed Medicare|HEALTHSPRING MA|||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Blue Cross PPO Specialty|BCBSTX PPO|159.75||||159.75||| 97140|EAP|0420|MANUAL THERAPY EACH 15 MI|Blue Cross PPO Specialty|BCBSTX OTHER|||||159.75||| 97150|EAP|0430|GROUP EXERCISE|Blue Cross PPO Specialty|BCBSTX PPO|2.14||||||| 97150|EAP|0430|GROUP EXERCISE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.14||||||| 97150|EAP|0430|GROUP EXERCISE|Blue Cross HMO Specialty|BCBSTX HMO|2.14||||||| 97150|EAP|0430|GROUP EXERCISE|Humana Medicare Advantage|HUMANA MA|2.14||||||| 97150|EAP|0430|GROUP EXERCISE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.14||||||| 97150|EAP|0430|GROUP EXERCISE|United Medicare Advantage|UHC MEDICARE GOLD MA|2.14||||||| 97150|EAP|0430|GROUP EXERCISE|Veterans Affairs|VETERANS ADMINISTRATION|2.14||||||| 97150|EAP|0430|GROUP EXERCISE|Medicare|MEDICARE ACUTE|2.14||||||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Workers Compensation|STATE OFFICE OF RISK MANAGEMNT|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|United Medicare Advantage|UHC AARP WELLMED HMO MA|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|United Medicare Advantage|UHC AARP MCR HMO MA|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|United Medicare Advantage|SECURE HORIZONS MA|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Veterans Affairs|VETERANS ADMINISTRATION|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Tricare|TRICARE FOR LIFE|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Workers Compensation|ZURICH COMPANY|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Workers Compensation|WORKERS COMPENSATION OTHER|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Workers Compensation|UT EMPLOYEE INJURY|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Workers Compensation|TEXAS MUTUAL INSURANCE|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Workers Compensation|LIBERTY MUTUAL INSURANCE WKCP|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Workers Compensation|CLAIMS ADMINISTRATIVE WKCP|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|United Healthcare|UNITED HEALTHCARE OTHER|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|United Healthcare|TML GROUP BENEFITS|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|United Healthcare|AARP|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|United Healthcare|UNITED HEALTHCARE ERS|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|United Healthcare|UNITED HEALTHCARE|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|United Healthcare|GEHA|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Medicare|MEDICARE ACUTE|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Brinson Benefits|THE HEALTH PLAN SMITH CO|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|ChampVA|CHAMPVA CENTER|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Cigna|CIGNA OTHER|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Cigna|CIGNA|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Managed Medicare|BCBS MEDICARE PPO MA|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Workers Compensation|BROOKSHIRES WORKERS COMP|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Workers Compensation|TRAVELERS INSURANCE COMPANY|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Blue Cross HMO Specialty|BCBSTX HMO|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Humana Medicare Advantage|HUMANA MA|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Managed Medicaid|MEDICAID SUPERIOR|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Tricare|TRICARE EAST REGION|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Managed Medicaid|MEDICAID AMERIGROUP|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Access Direct Platinum|HEALTHFIRST TPA UMR|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Aetna|AETNA PPO|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|PHCS|HUMANA INSURANCE|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Aetna|AETNA OTHER|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Access Direct Platinum|HEALTHFIRST TPA|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Aetna Value Network|AETNA VALUE NETWORK|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Managed Medicare|HEALTHSPRING MA|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Medicaid|LAW ENFORCEMENT OTHER|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Medicaid|MEDICAID HMO|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Medicaid|MEDICAID|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Blue Cross PPO Specialty|BCBSTX PPO|||||3.96||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Blue Cross PPO Specialty|BCBSTX OTHER|||||3.96||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Cigna|CIGNA|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Cigna|CIGNA OTHER|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Aenta Medicare Advantage|AETNA MEDICARE MA|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Blue Cross HMO Specialty|BCBSTX HMO|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Humana Medicare Advantage|HUMANA MA|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Managed Medicaid|MEDICAID AMERIGROUP|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Medicaid|MEDICAID|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Aetna|AETNA OTHER|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Access Direct Platinum|HEALTHFIRST TPA UMR|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Managed Medicare|HEALTHSPRING MA|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Managed Medicare|BCBS MEDICARE PPO MA|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Medicaid|MEDICAID CSHCN|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Medicaid|MEDICAID HMO|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Access Direct Platinum|HEALTHFIRST TPA|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Aetna|AETNA PPO|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Blue Cross PPO Specialty|BCBSTX PPO|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Blue Cross PPO Specialty|BCBSTX OTHER|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|NON CONTRACTED|COMMERCIAL OTHER 2|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|NON CONTRACTED|COMMERCIAL OTHER 1|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Managed Medicaid|MEDICAID SUPERIOR|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|United Medicare Advantage|UHC MEDICARE GOLD MA|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|United Medicare Advantage|UHC AARP MCR HMO MA|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Veterans Affairs|VETERANS ADMINISTRATION|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Tricare|TRICARE EAST REGION|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Workers Compensation|WORKERS COMPENSATION OTHER|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Workers Compensation|UT EMPLOYEE INJURY|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Workers Compensation|TEXAS MUTUAL INSURANCE|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|ChampVA|CHAMPVA CENTER|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Workers Compensation|STATE OFFICE OF RISK MANAGEMNT|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Workers Compensation|CLAIMS ADMINISTRATIVE WKCP|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Workers Compensation|LIBERTY MUTUAL INSURANCE WKCP|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|United Healthcare|UNITED HEALTHCARE|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|United Healthcare|AARP|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|United Healthcare|TML GROUP BENEFITS|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|United Healthcare|UNITED HEALTHCARE OTHER|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|United Healthcare|ZZZZZ UNITED HEALTHCARE|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|United Healthcare|GEHA|||||5.09||| 97162|EAP|0420|PHYSICAL THERAPY EVAL/MOD|Medicare|MEDICARE ACUTE|||||5.09||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|NON CONTRACTED|COMMERCIAL OTHER 1|6.22||||6.22||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|PHCS|HUMANA INSURANCE|6.22||||||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|United Medicare Advantage|UHC AARP MCR HMO MA|6.22||||||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|6.22||||||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Veterans Affairs|VETERANS ADMINISTRATION|6.22||||6.22||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Workers Compensation|WORKERS COMPENSATION OTHER|6.22||||6.22||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Workers Compensation|TRAVELERS INSURANCE COMPANY|||||6.22||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Workers Compensation|TEXAS MUTUAL INSURANCE|6.22||||||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Workers Compensation|CLAIMS ADMINISTRATIVE WKCP|||||6.22||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|United Healthcare|UNITED HEALTHCARE|6.22||||||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|United Healthcare|TML GROUP BENEFITS|6.22||||||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|United Healthcare|UNITED HEALTHCARE OTHER|6.22||||||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Medicare|MEDICARE ACUTE|6.22||||6.22||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Blue Cross PPO Specialty|BCBSTX OTHER|6.22||||6.22||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|6.22||||||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|6.22||||6.22||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Cigna|CIGNA OTHER|6.22||||||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Cigna|CIGNA|6.22||||||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Aenta Medicare Advantage|AETNA MEDICARE MA|6.22||||||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Blue Cross HMO Specialty|BCBSTX HMO|6.22||||||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Tricare|TRICARE EAST REGION|6.22||||||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Humana Medicare Advantage|HUMANA MA|6.22||||6.22||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|6.22||||6.22||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Managed Medicaid|MEDICAID SUPERIOR|||||6.22||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|6.22||||6.22||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|United Medicare Advantage|UHC MEDICARE GOLD MA|6.22||||6.22||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Aetna|AETNA OTHER|6.22||||||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Aetna|AETNA PPO|6.22||||6.22||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Access Direct Platinum|HEALTHFIRST TPA|6.22||||||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Access Direct Platinum|HEALTHFIRST TPA UMR|6.22||||||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|6.22||||||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|6.22||||6.22||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|6.22||||||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|6.22||||||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Managed Medicare|HEALTHSPRING MA|6.22||||||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Managed Medicare|BCBS MEDICARE PPO MA|6.22||||||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Medicaid|MEDICAID|6.22||||||| 97163|EAP|0420|PHYSICAL THERAPY EVAL/HIG|Blue Cross PPO Specialty|BCBSTX PPO|6.22||||6.22||| 97164|EAP|0420|RE-EVALUATION OF PHYSICAL|Blue Cross PPO Specialty|BCBSTX PPO|||||2.20||| 97164|EAP|0420|RE-EVALUATION OF PHYSICAL|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.20||| 97164|EAP|0420|RE-EVALUATION OF PHYSICAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.20||| 97164|EAP|0420|RE-EVALUATION OF PHYSICAL|Cigna|CIGNA|||||2.20||| 97164|EAP|0420|RE-EVALUATION OF PHYSICAL|Cigna|CIGNA OTHER|||||2.20||| 97164|EAP|0420|RE-EVALUATION OF PHYSICAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.20||| 97164|EAP|0420|RE-EVALUATION OF PHYSICAL|Humana Medicare Advantage|HUMANA MA|||||2.20||| 97164|EAP|0420|RE-EVALUATION OF PHYSICAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.20||| 97164|EAP|0420|RE-EVALUATION OF PHYSICAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.20||| 97164|EAP|0420|RE-EVALUATION OF PHYSICAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.20||| 97164|EAP|0420|RE-EVALUATION OF PHYSICAL|Managed Medicare|BCBS MEDICARE PPO MA|||||2.20||| 97164|EAP|0420|RE-EVALUATION OF PHYSICAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.20||| 97164|EAP|0420|RE-EVALUATION OF PHYSICAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.20||| 97164|EAP|0420|RE-EVALUATION OF PHYSICAL|United Medicare Advantage|UHC AARP MCR HMO MA|||||2.20||| 97164|EAP|0420|RE-EVALUATION OF PHYSICAL|Veterans Affairs|VETERANS ADMINISTRATION|||||2.20||| 97164|EAP|0420|RE-EVALUATION OF PHYSICAL|Tricare|TRICARE EAST REGION|||||2.20||| 97164|EAP|0420|RE-EVALUATION OF PHYSICAL|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.20||| 97164|EAP|0420|RE-EVALUATION OF PHYSICAL|Workers Compensation|UT EMPLOYEE INJURY|||||2.20||| 97164|EAP|0420|RE-EVALUATION OF PHYSICAL|Workers Compensation|TEXAS MUTUAL INSURANCE|||||2.20||| 97164|EAP|0420|RE-EVALUATION OF PHYSICAL|Workers Compensation|CLAIMS ADMINISTRATIVE WKCP|||||2.20||| 97164|EAP|0420|RE-EVALUATION OF PHYSICAL|Workers Compensation|TRAVELERS INSURANCE COMPANY|||||2.20||| 97164|EAP|0420|RE-EVALUATION OF PHYSICAL|United Healthcare|UNITED HEALTHCARE OTHER|||||2.20||| 97164|EAP|0420|RE-EVALUATION OF PHYSICAL|United Healthcare|UNITED HEALTHCARE|||||2.20||| 97164|EAP|0420|RE-EVALUATION OF PHYSICAL|Medicare|MEDICARE ACUTE|||||2.20||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|United Medicare Advantage|UHC AARP MCR HMO MA|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Veterans Affairs|VETERANS ADMINISTRATION|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Tricare|TRICARE FOR LIFE|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Tricare|TRICARE EAST REGION|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Workers Compensation|ZURICH COMPANY|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Workers Compensation|UT EMPLOYEE INJURY|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Workers Compensation|TRAVELERS INSURANCE COMPANY|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Workers Compensation|TEXAS MUTUAL INSURANCE|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Workers Compensation|STATE OFFICE OF RISK MANAGEMNT|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Workers Compensation|CLAIMS ADMINISTRATIVE WKCP|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|United Healthcare|TML GROUP BENEFITS|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|United Healthcare|GEHA|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|United Healthcare|UNITED HEALTHCARE|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|United Healthcare|UNITED HEALTHCARE OTHER|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Medicare|MEDICARE ACUTE|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Blue Cross PPO Specialty|BCBSTX PPO|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Blue Cross PPO Specialty|BCBSTX OTHER|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Medicaid|MEDICAID|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Cigna|CIGNA OTHER|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Workers Compensation|WORKERS COMPENSATION OTHER|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Cigna|CIGNA|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Blue Cross HMO Specialty|BCBSTX HMO|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Humana Medicare Advantage|HUMANA MA|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Workers Compensation|LIBERTY MUTUAL INSURANCE WKCP|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Managed Medicaid|MEDICAID SUPERIOR|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Managed Medicaid|MEDICAID AMERIGROUP|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Aetna|BOON CHAPMAN|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Aetna|AETNA PPO|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Aetna|AETNA OTHER|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Managed Medicare|HEALTHSPRING MA|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Managed Medicare|BCBS MEDICARE PPO MA|||||3.96||| 97165|EAP|0430|OCCUPATIONAL THERAPY EVAL|Medicaid|LAW ENFORCEMENT OTHER|||||3.96||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|Blue Cross PPO Specialty|BCBSTX PPO|||||5.09||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|Blue Cross PPO Specialty|BCBSTX OTHER|||||5.09||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||5.09||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|Brinson Benefits|THE HEALTH PLAN SMITH CO|||||5.09||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||5.09||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|Cigna|CIGNA|||||5.09||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||5.09||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|Blue Cross HMO Specialty|BCBSTX HMO|||||5.09||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|Humana Medicare Advantage|HUMANA MA|||||5.09||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|Managed Medicare|BCBS MEDICARE PPO MA|||||5.09||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||5.09||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|Managed Medicaid|MEDICAID SUPERIOR|||||5.09||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||5.09||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|Managed Medicare|HEALTHSPRING MA|||||5.09||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|Medicaid|MEDICAID HMO|||||5.09||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||5.09||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|Texas Workforce Commission|VOC REHAB SERV (TWC)|||||5.09||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|||||5.09||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|Veterans Affairs|VETERANS ADMINISTRATION|||||5.09||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|Workers Compensation|WORKERS COMPENSATION OTHER|||||5.09||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|Workers Compensation|BROOKSHIRES WORKERS COMP|||||5.09||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|United Healthcare|UNITED HEALTHCARE|||||5.09||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|United Healthcare|UNITED HEALTHCARE OTHER|||||5.09||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|United Healthcare|TML GROUP BENEFITS|||||5.09||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|United Healthcare|GEHA|||||5.09||| 97166|EAP|0430|OCCUPATIONAL THERAPY EVAL|Medicare|MEDICARE ACUTE|||||5.09||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|NON CONTRACTED|COMMERCIAL OTHER 1|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|PHCS|HUMANA INSURANCE|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|United Medicare Advantage|UHC AARP MCR HMO MA|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Veterans Affairs|VETERANS ADMINISTRATION|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Workers Compensation|WORKERS COMPENSATION OTHER|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Workers Compensation|TEXAS MUTUAL INSURANCE|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|United Healthcare|TML GROUP BENEFITS|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|United Healthcare|UNITED HEALTHCARE OTHER|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|United Healthcare|UNITED HEALTHCARE|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Medicare|MEDICARE ACUTE|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Blue Cross PPO Specialty|BCBSTX PPO|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Blue Cross PPO Specialty|BCBSTX OTHER|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Cigna|CIGNA OTHER|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Tricare|TRICARE EAST REGION|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Cigna|CIGNA|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Aenta Medicare Advantage|AETNA MEDICARE MA|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Blue Cross HMO Specialty|BCBSTX HMO|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Humana Medicare Advantage|HUMANA MA|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|United Medicare Advantage|UHC MEDICARE GOLD MA|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|6.22||||6.22||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Aetna|AETNA PPO|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Aetna|AETNA OTHER|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Access Direct Platinum|HEALTHFIRST TPA|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Access Direct Platinum|HEALTHFIRST TPA UMR|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Managed Medicare|HEALTHSPRING MA|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Managed Medicare|BCBS MEDICARE PPO MA|6.22||||||| 97167|EAP|0430|OCCUPATIONAL THERAPY EVAL|Medicaid|MEDICAID|6.22||||||| 97168|EAP|0430|RE-EVALUATION OCCUPATIONA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.20||| 97168|EAP|0430|RE-EVALUATION OCCUPATIONA|Humana Medicare Advantage|HUMANA MA|||||2.20||| 97168|EAP|0430|RE-EVALUATION OCCUPATIONA|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.20||| 97168|EAP|0430|RE-EVALUATION OCCUPATIONA|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|||||2.20||| 97168|EAP|0430|RE-EVALUATION OCCUPATIONA|Veterans Affairs|VETERANS ADMINISTRATION|||||2.20||| 97168|EAP|0430|RE-EVALUATION OCCUPATIONA|Workers Compensation|TEXAS MUTUAL INSURANCE|||||2.20||| 97168|EAP|0430|RE-EVALUATION OCCUPATIONA|Medicare|MEDICARE ACUTE|||||2.20||| 974|DRG||HIV W MAJOR RELATED CONDITION W MCC|Medicare|MEDICARE ACUTE|68.07|2142.48|2142.48|2142.48|||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|NON CONTRACTED|COMMERCIAL OTHER 1|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|NON CONTRACTED|COMMERCIAL OTHER 1|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|PHCS|HUMANA INSURANCE|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|PHCS|HUMANA INSURANCE|2.34||||||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Workers Compensation|BROOKSHIRES WORKERS COMP|||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|United Medicare Advantage|UHC MEDICARE GOLD MA|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|United Medicare Advantage|UHC MEDICARE GOLD MA|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|United Medicare Advantage|UHC AARP MCR HMO MA|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Veterans Affairs|VETERANS ADMINISTRATION|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Veterans Affairs|VETERANS ADMINISTRATION|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Tricare|TRICARE FOR LIFE|||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Tricare|TRICARE EAST REGION|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Workers Compensation|WORKERS COMPENSATION OTHER|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Workers Compensation|UT EMPLOYEE INJURY|||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Workers Compensation|TRAVELERS INSURANCE COMPANY|||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Workers Compensation|TEXAS MUTUAL INSURANCE|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Workers Compensation|STATE OFFICE OF RISK MANAGEMNT|||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Workers Compensation|GALLAGHER BASSETT|||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Workers Compensation|BROOKSHIRES WORKERS COMP|||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Workers Compensation|ZURICH COMPANY|||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Workers Compensation|WORKERS COMPENSATION OTHER|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Workers Compensation|STATE OFFICE OF RISK MANAGEMNT|||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Workers Compensation|LIBERTY MUTUAL INSURANCE WKCP|||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|United Healthcare|AARP|||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|United Healthcare|UNITED HEALTHCARE|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|United Healthcare|GEHA|||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|United Healthcare|TML GROUP BENEFITS|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|United Healthcare|GEHA|||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|United Healthcare|TML GROUP BENEFITS|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|United Healthcare|UNITED HEALTHCARE OTHER|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|United Healthcare|UNITED HEALTHCARE|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Workers Compensation|LIBERTY MUTUAL INSURANCE WKCP|||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Medicare|MEDICARE ACUTE|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Medicare|MEDICARE ACUTE|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Blue Cross PPO Specialty|BCBSTX OTHER|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Blue Cross PPO Specialty|BCBSTX PPO|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Blue Cross PPO Specialty|BCBSTX OTHER|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|2.34||||||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|2.34||||||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Brinson Benefits|THE HEALTH PLAN SMITH CO|||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Brinson Benefits|THE HEALTH PLAN SMITH CO|||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Blue Cross PPO Specialty|BCBSTX PPO|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|ChampVA|CHAMPVA CENTER|||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Cigna|CIGNA|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|United Healthcare|UNITED HEALTHCARE|2.34||||||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Cigna|CIGNA OTHER|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Cigna|CIGNA OTHER|2.34||||||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Cigna|CIGNA|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Aenta Medicare Advantage|AETNA MEDICARE MA|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|United Healthcare|UNITED HEALTHCARE OTHER|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Aenta Medicare Advantage|AETNA MEDICARE MA|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Blue Cross HMO Specialty|BCBSTX HMO|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Blue Cross HMO Specialty|BCBSTX HMO|2.34||||||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Humana Medicare Advantage|HUMANA MA|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Workers Compensation|TEXAS MUTUAL INSURANCE|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Humana Medicare Advantage|HUMANA MA|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Managed Medicaid|MEDICAID SUPERIOR|||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Workers Compensation|CLAIMS ADMINISTRATIVE WKCP|||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Managed Medicaid|MEDICAID AMERIGROUP|||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.34||||||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Aetna|AETNA PPO|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Aetna|AETNA OTHER|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Tricare|TRICARE EAST REGION|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Access Direct Platinum|HEALTHFIRST TPA UMR|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Aetna|AETNA PPO|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Access Direct Platinum|HEALTHFIRST TPA|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Aetna|AETNA OTHER|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|United Medicare Advantage|UHC AARP MCR HMO MA|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Aetna Value Network|AETNA VALUE NETWORK|||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|2.34||||||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Access Direct Platinum|HEALTHFIRST TPA|2.34||||||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Access Direct Platinum|HEALTHFIRST TPA UMR|2.34||||||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Managed Medicare|HEALTHSPRING MA|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Managed Medicare|BCBS MEDICARE PPO MA|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Managed Medicare|HEALTHSPRING MA|2.34||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Managed Medicare|BCBS MEDICARE PPO MA|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Medicaid|MEDICAID|2.34||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Medicaid|LAW ENFORCEMENT OTHER|||||2.34||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES, I|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Medicaid|LAW ENFORCEMENT OTHER|||||2.34||| 97530|EAP|0430|THERAPEUTIC ACTIVITIES IN|Medicaid|MEDICAID|2.34||||||| 97533|EAP|0430|SENSORY INTEGRATION 15 MI|Medicare|MEDICARE ACUTE|216.50||||||| 97535|EAP|0420|ACTIVITIES OF DAILY LIVIN|Blue Cross PPO Specialty|BCBSTX PPO|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Blue Cross PPO Specialty|BCBSTX PPO|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Blue Cross PPO Specialty|BCBSTX OTHER|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.14||||2.14||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Cigna|CIGNA OTHER|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Cigna|CIGNA|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Aenta Medicare Advantage|AETNA MEDICARE MA|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Blue Cross HMO Specialty|BCBSTX HMO|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Humana Medicare Advantage|HUMANA MA|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Aetna|AETNA PPO|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Aetna|AETNA OTHER|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Access Direct Platinum|HEALTHFIRST TPA|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Access Direct Platinum|HEALTHFIRST TPA UMR|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Managed Medicare|HEALTHSPRING MA|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Managed Medicare|BCBS MEDICARE PPO MA|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Medicaid|MEDICAID|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|NON CONTRACTED|COMMERCIAL OTHER 1|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Workers Compensation|TEXAS MUTUAL INSURANCE|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|PHCS|HUMANA INSURANCE|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|United Medicare Advantage|UHC MEDICARE GOLD MA|2.14||||2.14||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|United Medicare Advantage|UHC AARP MCR HMO MA|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Veterans Affairs|VETERANS ADMINISTRATION|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Tricare|TRICARE EAST REGION|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Workers Compensation|WORKERS COMPENSATION OTHER|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|United Healthcare|UNITED HEALTHCARE OTHER|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|United Healthcare|UNITED HEALTHCARE|2.14||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Medicare|MEDICARE ACUTE|2.14||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|NON CONTRACTED|COMMERCIAL OTHER 1|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|PHCS|HUMANA INSURANCE|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|United Medicare Advantage|UHC AARP MCR HMO MA|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|Workers Compensation|TEXAS MUTUAL INSURANCE|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|Veterans Affairs|VETERANS ADMINISTRATION|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|Tricare|TRICARE EAST REGION|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|Workers Compensation|WORKERS COMPENSATION OTHER|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|United Healthcare|UNITED HEALTHCARE OTHER|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|United Healthcare|UNITED HEALTHCARE|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|Medicare|MEDICARE ACUTE|175.50||||||| 97542|EAP|0430|WHEELCHAIR MANAGEMENT|Medicare|MEDICARE ACUTE|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|Blue Cross PPO Specialty|BCBSTX PPO|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|Cigna|CIGNA|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|Aenta Medicare Advantage|AETNA MEDICARE MA|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|Blue Cross HMO Specialty|BCBSTX HMO|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|United Medicare Advantage|UHC MEDICARE GOLD MA|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|Humana Medicare Advantage|HUMANA MA|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|Aetna|AETNA PPO|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|Aetna|AETNA OTHER|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|Access Direct Platinum|HEALTHFIRST TPA|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|Access Direct Platinum|HEALTHFIRST TPA UMR|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|Managed Medicare|HEALTHSPRING MA|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|Managed Medicare|BCBS MEDICARE PPO MA|175.50||||||| 97542|EAP|0420|WHEELCHAIR MANAGEMENT|Medicaid|MEDICAID|175.50||||||| 97545|EAP|0420|WORK CONDITIONING|Workers Compensation|WORKERS COMPENSATION OTHER|||||506.50||| 97545|EAP|0420|WORK CONDITIONING|Workers Compensation|BROOKSHIRES WORKERS COMP|||||506.50||| 97545|EAP|0430|WORK HARD CONDITION|Workers Compensation|TEXAS MUTUAL INSURANCE|||||506.50||| 97545|EAP|0430|WORK HARD CONDITION|Workers Compensation|STATE OFFICE OF RISK MANAGEMNT|||||506.50||| 97546|EAP|0420|WORK CONDITION-EACH ADDIO|Workers Compensation|WORKERS COMPENSATION OTHER|||||253.25||| 97546|EAP|0420|WORK CONDITION-EACH ADDIO|Workers Compensation|BROOKSHIRES WORKERS COMP|||||253.25||| 97546|EAP|0430|WORK HARD CON-EACH ADDITI|Workers Compensation|TEXAS MUTUAL INSURANCE|||||253.25||| 97546|EAP|0430|WORK HARD CON-EACH ADDITI|Workers Compensation|STATE OFFICE OF RISK MANAGEMNT|||||253.25||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Blue Cross PPO Specialty|BCBSTX PPO|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Cigna|CIGNA OTHER|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Managed Medicaid|MEDICAID SUPERIOR|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Aetna|AETNA PPO|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Aetna|AETNA OTHER|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Access Direct Platinum|HEALTHFIRST TPA|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Managed Medicare|HEALTHSPRING MA|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Managed Medicare|BCBS MEDICARE PPO MA|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Workers Compensation|BROOKSHIRES WORKERS COMP|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|United Medicare Advantage|UHC AARP MCR HMO MA|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Humana Medicare Advantage|HUMANA MA|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Veterans Affairs|VETERANS ADMINISTRATION|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Tricare|TRICARE EAST REGION|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Workers Compensation|UT EMPLOYEE INJURY|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Workers Compensation|TEXAS MUTUAL INSURANCE|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Workers Compensation|STATE OFFICE OF RISK MANAGEMNT|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Workers Compensation|LIBERTY MUTUAL INSURANCE WKCP|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Workers Compensation|CLAIMS ADMINISTRATIVE WKCP|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|United Healthcare|UNITED HEALTHCARE OTHER|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|United Healthcare|TML GROUP BENEFITS|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|United Healthcare|UNITED HEALTHCARE|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|United Healthcare|GEHA|||||1.99||| 97750|EAP|0420|PHYSICAL PERFORMANCE TEST|Medicare|MEDICARE ACUTE|||||1.99||| 97760|EAP|0430|ORTHOTIC MANAGEMENT|Workers Compensation|BROOKSHIRES WORKERS COMP|||||1.36||| 97760|EAP|0430|ORTHOTIC MANAGEMENT|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.36||| 97761|EAP|0420|PROSTHETIC TRAINING UPPER|Medicare|MEDICARE ACUTE|2.14||||||| 97763|EAP|0420|ORTHC/PROSTC MGMT SBSQ EN|Blue Cross PPO Specialty|BCBSTX PPO|||||3.39||| 97763|EAP|0430|ORTHC/PROSTC MGMT SBSQ EN|Blue Cross PPO Specialty|BCBSTX PPO|||||3.00||| 97763|EAP|0430|ORTHC/PROSTC MGMT SBSQ EN|Humana Medicare Advantage|HUMANA MA|||||3.00||| 97763|EAP|0430|ORTHC/PROSTC MGMT SBSQ EN|Managed Medicaid|MEDICAID AMERIGROUP|||||3.00||| 97763|EAP|0430|ORTHC/PROSTC MGMT SBSQ EN|Aetna|AETNA PPO|||||3.00||| 97763|EAP|0430|ORTHC/PROSTC MGMT SBSQ EN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||3.00||| 97763|EAP|0430|ORTHC/PROSTC MGMT SBSQ EN|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.00||| 97763|EAP|0430|ORTHC/PROSTC MGMT SBSQ EN|United Medicare Advantage|UHC AARP MCR HMO MA|||||3.00||| 97763|EAP|0430|ORTHC/PROSTC MGMT SBSQ EN|Workers Compensation|BROOKSHIRES WORKERS COMP|||||3.00||| 97763|EAP|0430|ORTHC/PROSTC MGMT SBSQ EN|United Healthcare|UNITED HEALTHCARE|||||3.00||| 97763|EAP|0430|ORTHC/PROSTC MGMT SBSQ EN|Medicare|MEDICARE ACUTE|||||3.00||| 98|DRG||NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W CC|Medicare|MEDICARE ACUTE|122,768.75|24891.28|24891.28|24891.28|||| 981|DRG||EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W MCC|Blue Cross PPO Specialty|BCBSTX PPO|269,121.74|232.2|31145.88|232.2|||| 981|DRG||EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W MCC|Medicare|MEDICARE ACUTE|239,046.93|31145.88|31145.88|232.2|||| 987|DRG||NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W MCC|Blue Cross HMO Specialty|BCBSTX HMO|82,837.60|86.96|393.2|86.96|||| 987|DRG||NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W MCC|Aetna|AETNA PPO|269,248.70|393.2|393.2|86.96|||| 988|DRG||NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W CC|Medicare|MEDICARE ACUTE|226,332.33|24783.09|24783.09|24783.09|||| 98960|EAP|0420|SELF MGMT, EDUCATION & TR|United Medicare Advantage|UHC MEDICARE GOLD MA|1.36||||||| 98960|EAP|0420|SELF MGMT, EDUCATION & TR|Medicare|MEDICARE ACUTE|1.36||||||| 98960|EAP|0420|SELF MGMT, EDUCATION & TR|Blue Cross PPO Specialty|BCBSTX PPO|1.36||||||| 98960|EAP|0420|SELF MGMT, EDUCATION & TR|Cigna|CIGNA|1.36||||||| 98960|EAP|0420|SELF MGMT, EDUCATION & TR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.36||||||| 98960|EAP|0420|SELF MGMT, EDUCATION & TR|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.36||||||| 98960|EAP|0420|SELF MGMT, EDUCATION & TR|Managed Medicare|HEALTHSPRING MA|1.36||||||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Medicare|MEDICARE ACUTE|1,436.50||||||| 99284|EAP|0450|ER VISIT LEVEL 4|Medicare|MEDICARE ACUTE|20.00||||||| 99285|EAP|0450|ER LEVEL VISIT 5|Blue Cross PPO Specialty|BCBSTX PPO|24.72||||||| A9502|EAP|0343|TC99M MYOVIEW PER STUDY|Medicare|MEDICARE ACUTE|520.50||||||| A9576|EAP|0255|PROHANCE 20ML NDC0270-111|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.24||||||| A9576|EAP|0255|PROHANCE 15ML VIAL/ML NDC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.87||||||| A9576|EAP|0255|PROHANCE 15ML VIAL/ML NDC|Blue Cross HMO Specialty|BCBSTX HMO|9.87||||||| A9576|EAP|0255|PROHANCE 15ML VIAL/ML NDC|Managed Medicare|HEALTHSPRING MA|9.87||||||| A9576|EAP|0255|PROHANCE 15ML VIAL/ML NDC|Blue Cross PPO Specialty|BCBSTX PPO|9.87||||||| A9576|EAP|0255|PROHANCE 20ML NDC0270-111|United Medicare Advantage|UHC AARP MCR HMO MA|9.24||||||| A9576|EAP|0255|PROHANCE 20ML NDC0270-111|Medicare|MEDICARE ACUTE|9.24||||||| A9576|EAP|0255|PROHANCE 15ML VIAL/ML NDC|Medicare|MEDICARE ACUTE|9.87||||||| A9576|EAP|0255|PROHANCE 20ML NDC0270-111|Workers Compensation|WORKERS COMPENSATION OTHER|9.24||||||| C1750|EAP|0270|CATHETER - HICKMAN DIALYS|Medicare|MEDICARE ACUTE|2,814.75||||||| C1750|EAP|0270|CATHETER - HICKMAN DIALYS|Humana Medicare Advantage|HUMANA MA|2,814.75||||||| C1769|EAP|0272|GUIDEWIRE JAGTOME RX44|Humana Medicare Advantage|HUMANA MA|2,047.50||||||| C1769|EAP|0272|GUIDE WIRE|United Medicare Advantage|UHC MEDICARE GOLD MA|218.75||||||| C1769|EAP|0272|GUIDE - AMPLATZ/GLIDE|United Medicare Advantage|UHC MEDICARE GOLD MA|417.75||||||| C1769|EAP|0272|SYNCHRO GUIDEWIRE 300CM|Medicare|MEDICARE ACUTE|38.64||||||| C1769|EAP|0272|GUIDE - AMPLATZ/GLIDE|Medicare|MEDICARE ACUTE|417.75||||||| C1769|EAP|0272|GUIDE WIRE|Medicare|MEDICARE ACUTE|218.75||||||| C1830|EAP|0350|ONCONTROL BIOPSY SYSTEM T|Medicare|MEDICARE ACUTE|43.40||||||| G0009|EAP|0771|ADMIN PNEUMOCOCCAL VACCIN|Medicare|MEDICARE ACUTE|0.69||||||| G0237|EAP|0410|THERAP PROCEDURE ONE ON O|ChampVA|CHAMPVA CENTER|||||2.34||| G0237|EAP|0410|THERAP PROCEDURE ONE ON O|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.34||| G0237|EAP|0410|THERAP PROCEDURE ONE ON O|Cigna|CIGNA|||||2.34||| G0237|EAP|0410|THERAP PROCEDURE ONE ON O|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.34||| G0237|EAP|0410|THERAP PROCEDURE ONE ON O|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.34||| G0237|EAP|0410|THERAP PROCEDURE ONE ON O|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.34||| G0237|EAP|0410|THERAP PROCEDURE ONE ON O|Humana Medicare Advantage|HUMANA MA|||||2.34||| G0237|EAP|0410|THERAP PROCEDURE ONE ON O|Aetna|AETNA PPO|||||2.34||| G0237|EAP|0410|THERAP PROCEDURE ONE ON O|Blue Cross PPO Specialty|BCBSTX PPO|||||2.34||| G0237|EAP|0410|THERAP PROCEDURE ONE ON O|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.34||| G0237|EAP|0410|THERAP PROCEDURE ONE ON O|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.34||| G0237|EAP|0410|THERAP PROCEDURE ONE ON O|Veterans Affairs|VETERANS ADMINISTRATION|||||2.34||| G0237|EAP|0410|THERAP PROCEDURE ONE ON O|United Healthcare|UNITED HEALTHCARE OTHER|||||2.34||| G0237|EAP|0410|THERAP PROCEDURE ONE ON O|Medicare|MEDICARE ACUTE|||||2.34||| G0238|EAP|0410|THERAPEUTIC PROCEDURE EDU|Veterans Affairs|VETERANS ADMINISTRATION|||||2.14||| G0238|EAP|0410|THERAPEUTIC PROCEDURE EDU|Medicare|MEDICARE ACUTE|||||2.14||| G0238|EAP|0410|THERAPEUTIC PROCEDURE EDU|Cigna|CIGNA|||||2.14||| G0238|EAP|0410|THERAPEUTIC PROCEDURE EDU|Humana Medicare Advantage|HUMANA MA|||||2.14||| G0238|EAP|0410|THERAPEUTIC PROCEDURE EDU|Blue Cross PPO Specialty|BCBSTX PPO|||||2.14||| G0238|EAP|0410|THERAPEUTIC PROCEDURE EDU|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.14||| G0239|EAP|0910|THERAPEUTIC PROCEDURE GRO|Blue Cross PPO Specialty|BCBSTX PPO|||||255.75||| G0239|EAP|0910|THERAPEUTIC PROCEDURE GRO|Blue Cross PPO Specialty|BCBSTX OTHER|||||255.75||| G0239|EAP|0948||Blue Cross PPO Specialty|BCBSTX PPO|||||255.75||| G0239|EAP|0910|THERAPEUTIC PROCEDURE GRO|ChampVA|CHAMPVA CENTER|||||255.75||| G0239|EAP|0910|THERAPEUTIC PROCEDURE GRO|Cigna|CIGNA|||||255.75||| G0239|EAP|0948||Cigna|CIGNA|||||255.75||| G0239|EAP|0948||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||255.75||| G0239|EAP|0910|THERAPEUTIC PROCEDURE GRO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||255.75||| G0239|EAP|0948||Aenta Medicare Advantage|AETNA MEDICARE MA|||||255.75||| G0239|EAP|0910|THERAPEUTIC PROCEDURE GRO|Humana Medicare Advantage|HUMANA MA|||||255.75||| G0239|EAP|0948||Humana Medicare Advantage|HUMANA MA|||||255.75||| G0239|EAP|0948||ChampVA|CHAMPVA CENTER|||||255.75||| G0239|EAP|0910|THERAPEUTIC PROCEDURE GRO|Aetna|AETNA PPO|||||255.75||| G0239|EAP|0948||Aetna|AETNA PPO|||||255.75||| G0239|EAP|0910|THERAPEUTIC PROCEDURE GRO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||255.75||| G0239|EAP|0910|THERAPEUTIC PROCEDURE GRO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||255.75||| G0239|EAP|0948||Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||255.75||| G0239|EAP|0910|THERAPEUTIC PROCEDURE GRO|Medicare|MEDICARE ACUTE|||||255.75||| G0239|EAP|0948||Medicare|MEDICARE ACUTE|||||255.75||| G0239|EAP|0910|THERAPEUTIC PROCEDURE GRO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||255.75||| G0239|EAP|0948||United Medicare Advantage|UHC MEDICARE GOLD MA|||||255.75||| G0239|EAP|0910|THERAPEUTIC PROCEDURE GRO|Veterans Affairs|VETERANS ADMINISTRATION|||||255.75||| G0239|EAP|0948||Veterans Affairs|VETERANS ADMINISTRATION|||||255.75||| G0239|EAP|0910|THERAPEUTIC PROCEDURE GRO|United Healthcare|UNITED HEALTHCARE OTHER|||||255.75||| G0239|EAP|0948||United Healthcare|UNITED HEALTHCARE OTHER|||||255.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|NON CONTRACTED|COMMERCIAL OTHER 1|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|United Medicare Advantage|UHC MEDICARE GOLD MA|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|United Medicare Advantage|UHC AARP MCR HMO MA|||||116.75||| G0283|EAP|0430|ELECTRICAL STIMULATION, U|United Medicare Advantage|UHC MEDICARE GOLD MA|||||116.75||| G0283|EAP|0430|ELECTRICAL STIMULATION, U|Texas Workforce Commission|VOC REHAB SERV (TWC)|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|Tricare|TRICARE EAST REGION|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|Workers Compensation|WORKERS COMPENSATION OTHER|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|Workers Compensation|TEXAS MUTUAL INSURANCE|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|Workers Compensation|LIBERTY MUTUAL INSURANCE WKCP|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|Workers Compensation|CLAIMS ADMINISTRATIVE WKCP|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|United Healthcare|UNITED HEALTHCARE OTHER|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|Medicare|MEDICARE ACUTE|||||116.75||| G0283|EAP|0430|ELECTRICAL STIMULATION, U|Medicare|MEDICARE ACUTE|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|United Healthcare|UNITED HEALTHCARE|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|Blue Cross PPO Specialty|BCBSTX PPO|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|Blue Cross PPO Specialty|BCBSTX OTHER|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|Workers Compensation|UT EMPLOYEE INJURY|||||116.75||| G0283|EAP|0430|ELECTRICAL STIMULATION, U|Blue Cross PPO Specialty|BCBSTX PPO|||||116.75||| G0283|EAP|0430|ELECTRICAL STIMULATION, U|Blue Cross PPO Specialty|BCBSTX OTHER|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|Cigna|CIGNA|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|Aenta Medicare Advantage|AETNA MEDICARE MA|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|Blue Cross HMO Specialty|BCBSTX HMO|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|Humana Medicare Advantage|HUMANA MA|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|Managed Medicaid|MEDICAID SUPERIOR|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|Managed Medicaid|MEDICAID AMERIGROUP|||||116.75||| G0283|EAP|0430|ELECTRICAL STIMULATION, U|Managed Medicaid|MEDICAID SUPERIOR|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|Aetna|AETNA OTHER|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|Aetna Value Network|AETNA VALUE NETWORK|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|Managed Medicare|HEALTHSPRING MA|||||116.75||| G0283|EAP|0420|ELECTRICAL STIMULATION, U|Managed Medicare|BCBS MEDICARE PPO MA|||||116.75||| G0364|EAP|0361|CT-BONE MARROW ASPIRATE|Medicare|MEDICARE ACUTE|18.55||||||| G0422|EAP|0943|INTENSIVE CARDIAC REHAB E|Blue Cross PPO Specialty|BCBSTX PPO|||||6.41||| G0422|EAP|0943|INTENSIVE CARDIAC REHAB E|Blue Cross PPO Specialty|BCBSTX OTHER|||||6.41||| G0422|EAP|0943|INTENSIVE CARDIAC REHAB E|Cigna|CIGNA OTHER|||||6.41||| G0422|EAP|0943|INTENSIVE CARDIAC REHAB E|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||6.41||| G0422|EAP|0943|INTENSIVE CARDIAC REHAB E|Aenta Medicare Advantage|AETNA MEDICARE MA|||||6.41||| G0422|EAP|0943|INTENSIVE CARDIAC REHAB E|Blue Cross HMO Specialty|BCBSTX HMO|||||6.41||| G0422|EAP|0943|INTENSIVE CARDIAC REHAB E|Humana Medicare Advantage|HUMANA MA|||||6.41||| G0422|EAP|0943|INTENSIVE CARDIAC REHAB E|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||6.41||| G0422|EAP|0943|INTENSIVE CARDIAC REHAB E|Cigna|CIGNA|||||6.41||| G0422|EAP|0943|INTENSIVE CARDIAC REHAB E|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||6.41||| G0422|EAP|0943|INTENSIVE CARDIAC REHAB E|Managed Medicare|HEALTHSPRING MA|||||6.41||| G0422|EAP|0943|INTENSIVE CARDIAC REHAB E|Managed Medicare|BCBS MEDICARE PPO MA|||||6.41||| G0422|EAP|0943|INTENSIVE CARDIAC REHAB E|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||6.41||| G0422|EAP|0943|INTENSIVE CARDIAC REHAB E|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||6.41||| G0422|EAP|0943|INTENSIVE CARDIAC REHAB E|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||6.41||| G0422|EAP|0943|INTENSIVE CARDIAC REHAB E|Access Direct Platinum|HEALTHFIRST TPA|||||6.41||| G0422|EAP|0943|INTENSIVE CARDIAC REHAB E|Medicare|MEDICARE ACUTE|||||6.41||| G0422|EAP|0943|INTENSIVE CARDIAC REHAB E|NON CONTRACTED|COMMERCIAL OTHER 1|||||6.41||| G0422|EAP|0943|INTENSIVE CARDIAC REHAB E|United Medicare Advantage|UHC MEDICARE GOLD MA|||||6.41||| G0422|EAP|0943|INTENSIVE CARDIAC REHAB E|United Medicare Advantage|UHC AARP MCR HMO MA|||||6.41||| G0422|EAP|0943|INTENSIVE CARDIAC REHAB E|Veterans Affairs|VETERANS ADMINISTRATION|||||6.41||| G0422|EAP|0943|INTENSIVE CARDIAC REHAB E|United Healthcare|UNITED HEALTHCARE OTHER|||||6.41||| G0422|EAP|0943|INTENSIVE CARDIAC REHAB E|United Healthcare|UNITED HEALTHCARE|||||6.41||| G0423|EAP|0943|INTENSIVE CARDIAC REHAB E|Medicare|MEDICARE ACUTE|||||6.41||| G0423|EAP|0943|INTENSIVE CARDIAC REHAB E|NON CONTRACTED|COMMERCIAL OTHER 1|||||6.41||| G0423|EAP|0943|INTENSIVE CARDIAC REHAB E|United Medicare Advantage|UHC MEDICARE GOLD MA|||||6.41||| G0423|EAP|0943|INTENSIVE CARDIAC REHAB E|United Medicare Advantage|UHC AARP MCR HMO MA|||||6.41||| G0423|EAP|0943|INTENSIVE CARDIAC REHAB E|Veterans Affairs|VETERANS ADMINISTRATION|||||6.41||| G0423|EAP|0943|INTENSIVE CARDIAC REHAB E|United Healthcare|UNITED HEALTHCARE OTHER|||||6.41||| G0423|EAP|0943|INTENSIVE CARDIAC REHAB E|United Healthcare|UNITED HEALTHCARE|||||6.41||| G0423|EAP|0943|INTENSIVE CARDIAC REHAB E|Blue Cross PPO Specialty|BCBSTX PPO|||||6.41||| G0423|EAP|0943|INTENSIVE CARDIAC REHAB E|Blue Cross PPO Specialty|BCBSTX OTHER|||||6.41||| G0423|EAP|0943|INTENSIVE CARDIAC REHAB E|Cigna|CIGNA|||||6.41||| G0423|EAP|0943|INTENSIVE CARDIAC REHAB E|Cigna|CIGNA OTHER|||||6.41||| G0423|EAP|0943|INTENSIVE CARDIAC REHAB E|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||6.41||| G0423|EAP|0943|INTENSIVE CARDIAC REHAB E|Aenta Medicare Advantage|AETNA MEDICARE MA|||||6.41||| G0423|EAP|0943|INTENSIVE CARDIAC REHAB E|Blue Cross HMO Specialty|BCBSTX HMO|||||6.41||| G0423|EAP|0943|INTENSIVE CARDIAC REHAB E|Humana Medicare Advantage|HUMANA MA|||||6.41||| G0423|EAP|0943|INTENSIVE CARDIAC REHAB E|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||6.41||| G0423|EAP|0943|INTENSIVE CARDIAC REHAB E|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||6.41||| G0423|EAP|0943|INTENSIVE CARDIAC REHAB E|Managed Medicare|HEALTHSPRING MA|||||6.41||| G0423|EAP|0943|INTENSIVE CARDIAC REHAB E|Managed Medicare|BCBS MEDICARE PPO MA|||||6.41||| G0423|EAP|0943|INTENSIVE CARDIAC REHAB E|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||6.41||| G0423|EAP|0943|INTENSIVE CARDIAC REHAB E|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||6.41||| G0423|EAP|0943|INTENSIVE CARDIAC REHAB E|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||6.41||| G0423|EAP|0943|INTENSIVE CARDIAC REHAB E|Access Direct Platinum|HEALTHFIRST TPA|||||6.41||| G0424|EAP|0948|PULM REH INCL EXER/MONITO|Blue Cross PPO Specialty|BCBSTX PPO|||||504.50||| G0424|EAP|0948|PULM REH INCL EXER/MONITO|Blue Cross PPO Specialty|BCBSTX OTHER|||||504.50||| G0424|EAP|0948|PULM REH INCL EXER/MONITO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||504.50||| G0424|EAP|0948|PULM REH INCL EXER/MONITO|Humana Medicare Advantage|HUMANA MA|||||504.50||| G0424|EAP|0948|PULM REH INCL EXER/MONITO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||504.50||| G0424|EAP|0948|PULM REH INCL EXER/MONITO|Medicare|MEDICARE ACUTE|||||504.50||| G0424|EAP|0948|PULM REH INCL EXER/MONITO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||504.50||| G0424|EAP|0948|PULM REH INCL EXER/MONITO|Veterans Affairs|VETERANS ADMINISTRATION|||||504.50||| G0515|EAP|0440|COGNITIVE SKILLS DEVELOPM|Medicare|MEDICARE ACUTE|||||2.04||| G0515|EAP|0440|COGNITIVE SKILLS DEVELOPM|Humana Medicare Advantage|HUMANA MA|||||2.04||| G0515|EAP|0440|COGNITIVE SKILLS DEVELOPM|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.04||| G8984|EAP|0430|CARRY, CURRENT STATUS 40-|Workers Compensation|UT EMPLOYEE INJURY|||||0.01||| G8985|EAP|0430|CARRY, GOAL STATUS 1-19%|Workers Compensation|UT EMPLOYEE INJURY|||||0.01||| J0834|ERX|0636|COSYNTROPIN 0.25MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|549.97||||||| J0834|ERX|0636|COSYNTROPIN 0.25MG VIAL|Blue Cross PPO Specialty|BCBSTX OTHER|549.97||||||| J0834|ERX|0636|COSYNTROPIN 0.25MG VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|549.97||||||| J0834|ERX|0636|COSYNTROPIN 0.25MG VIAL|Medicare|MEDICARE ACUTE|549.97||||||| J0878|ERX|0636|DAPTOMYCIN 500MG VIAL|Medicare|MEDICARE ACUTE|3.81||||||| J1447|ERX|0636|TBO-FILGRASTIM 480MCG/0.8|Blue Cross PPO Specialty|BCBSTX PPO|4.63||||||| J1447|ERX|0636|TBO-FILGRASTIM 300MCG/0.5|Blue Cross HMO Specialty|BCBSTX HMO|4.62||||||| J1447|ERX|0636|TBO-FILGRASTIM 300MCG/0.5|Medicare|MEDICARE ACUTE|4.62||||||| J1568|ERX|0636|OCTAGAM(5%) 5 GM/100 ML V|Medicare|MEDICARE ACUTE|340.20||||||| J1568|ERX|0636|OCTAGAM (5%) 10 GM/200 ML|Medicare|MEDICARE ACUTE|301.70||||||| J1610|ERX|0250|GLUCAGON 1MG VIAL|Humana Medicare Advantage|HUMANA MA|891.50||||||| J1610|ERX|0250|GLUCAGON 1MG VIAL|United Medicare Advantage|UHC AARP MCR HMO MA|891.50||||||| J1756|ERX|0636|IRON SUCROSE COMPL. 100/M|Medicare|MEDICARE ACUTE|635.50||||||| J1756|ERX|0636|IRON SUCROSE COMPL. 100/M|Blue Cross PPO Specialty|BCBSTX PPO|||||635.50||| J1953|ERX|0636|LEVETIRACETAM 500MG IN 10|Medicare|MEDICARE ACUTE|2.61||||||| J1953|ERX|0636|LEVETIRACETAM 500MG IN 10|United Medicare Advantage|UHC AARP MCR HMO MA|2.61||||||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|Blue Cross PPO Specialty|BCBSTX PPO|4.80||||||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.80||||||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|Medicare|MEDICARE ACUTE|4.80||||||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Medicare|MEDICARE ACUTE|15.50||||||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|United Medicare Advantage|UHC AARP MCR HMO MA|0.16||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Humana Medicare Advantage|HUMANA MA|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Aetna|AETNA PPO|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Medicare|MEDICARE ACUTE|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|United Medicare Advantage|UHC AARP MCR HMO MA|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Tricare|TRICARE EAST REGION|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Workers Compensation|WORKERS COMPENSATION OTHER|16.80||||||| J2997|ERX|0250|ALTEPLASE 2MG VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|436.50||||||| J2997|ERX|0250|ALTEPLASE 2MG VIAL|United Medicare Advantage|UHC AARP MCR HMO MA|436.50||||||| J2997|ERX|0250|ALTEPLASE 2MG VIAL|Medicare|MEDICARE ACUTE|436.50||||||| J2997|ERX|0250|ALTEPLASE 2MG VIAL|Tricare|TRICARE EAST REGION|436.50||||||| J2997|ERX|0250|ALTEPLASE 2MG VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|436.50||||||| J2997|ERX|0250|ALTEPLASE 2MG VIAL|Humana Medicare Advantage|HUMANA MA|436.50||||||| J2997|ERX|0250|ALTEPLASE 2MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|436.50||||||| J3262|ERX|0636|TOCILIZUMAB 400 MG/20 ML|United Medicare Advantage|UHC MEDICARE GOLD MA|19.92||||||| J3490|ERX|0250|LIDOCAINE AMPS 1.5% 20ML|Medicare|MEDICARE ACUTE|1.01||||||| J7508|ERX|0636|TACROLIMUS XL 0.5 MG CAPS|Medicare|MEDICARE ACUTE|19.78||||||| J7508|ERX|0636|TACROLIMUS XL 1 MG CAPSUL|Medicare|MEDICARE ACUTE|0.35||||||| L3702|EAP|0274|EO W/O JOINTS CF|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||545.25||| L3763|EAP|0274|EWHO RIGID W/O JOINTS CF|United Medicare Advantage|UHC AARP MCR HMO MA|||||1,453.25||| L3763|EAP|0274|EWHO RIGID W/O JOINTS CF|United Healthcare|GEHA|||||1,453.25||| L3763|EAP|0274|EWHO RIGID W/O JOINTS CF|Aetna|AETNA PPO|||||1,453.25||| L3806|EAP|0274|WHFO W/JOINTS CUSTOM FAB|Blue Cross PPO Specialty|BCBSTX OTHER|||||862.75||| L3806|EAP|0274|WHFO W/JOINTS CUSTOM FAB|United Medicare Advantage|UHC AARP MCR HMO MA|||||862.75||| L3806|EAP|0274|WHFO W/JOINTS CUSTOM FAB|Medicare|MEDICARE ACUTE|||||862.75||| L3808|EAP|0274|WHFO RIGID W/O JOINTS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||681.50||| L3808|EAP|0274|WHFO RIGID W/O JOINTS|Medicare|MEDICARE ACUTE|||||681.50||| L3808|EAP|0274|WHFO RIGID W/O JOINTS|Workers Compensation|WORKERS COMPENSATION OTHER|||||681.50||| L3808|EAP|0274|WHFO RIGID W/O JOINTS|Workers Compensation|BROOKSHIRES WORKERS COMP|||||681.50||| L3808|EAP|0274|WHFO RIGID W/O JOINTS|United Healthcare|UNITED HEALTHCARE|||||681.50||| L3808|EAP|0274|WHFO RIGID W/O JOINTS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||681.50||| L3808|EAP|0274|WHFO RIGID W/O JOINTS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||681.50||| L3808|EAP|0274|WHFO RIGID W/O JOINTS|Humana Medicare Advantage|HUMANA MA|||||681.50||| L3808|EAP|0274|WHFO RIGID W/O JOINTS|Blue Cross PPO Specialty|BCBSTX PPO|||||681.50||| L3905|EAP|0274|WHO W/NONTORSION JOINTS C|Blue Cross PPO Specialty|BCBSTX OTHER|||||18.16||| L3906|EAP|0274|WHO W/O JOINTS CF|Medicare|MEDICARE ACUTE|||||862.75||| L3906|EAP|0274|WHO W/O JOINTS CF|Workers Compensation|WORKERS COMPENSATION OTHER|||||862.75||| L3906|EAP|0274|WHO W/O JOINTS CF|United Healthcare|UNITED HEALTHCARE|||||862.75||| L3906|EAP|0274|WHO W/O JOINTS CF|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||862.75||| L3906|EAP|0274|WHO W/O JOINTS CF|Brinson Benefits|THE HEALTH PLAN SMITH CO|||||862.75||| L3906|EAP|0274|WHO W/O JOINTS CF|Aetna|AETNA OTHER|||||862.75||| L3906|EAP|0274|WHO W/O JOINTS CF|Blue Cross PPO Specialty|BCBSTX PPO|||||862.75||| L3913|EAP|0274|HFO W/O JOINTS CF|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||499.25||| L3913|EAP|0274|HFO W/O JOINTS CF|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||499.25||| L3913|EAP|0274|HFO W/O JOINTS CF|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||499.25||| L3913|EAP|0274|HFO W/O JOINTS CF|Cigna|CIGNA|||||499.25||| L3913|EAP|0274|HFO W/O JOINTS CF|Humana Medicare Advantage|HUMANA MA|||||499.25||| L3913|EAP|0274|HFO W/O JOINTS CF|Aetna|AETNA PPO|||||499.25||| L3913|EAP|0274|HFO W/O JOINTS CF|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||499.25||| L3913|EAP|0274|HFO W/O JOINTS CF|Blue Cross PPO Specialty|BCBSTX PPO|||||499.25||| L3913|EAP|0274|HFO W/O JOINTS CF|Medicare|MEDICARE ACUTE|||||499.25||| L3913|EAP|0274|HFO W/O JOINTS CF|Veterans Affairs|VETERANS ADMINISTRATION|||||499.25||| L3913|EAP|0274|HFO W/O JOINTS CF|Workers Compensation|WORKERS COMPENSATION OTHER|||||499.25||| L3913|EAP|0274|HFO W/O JOINTS CF|United Healthcare|TML GROUP BENEFITS|||||499.25||| L3919|EAP|0274|HO W/O JOINTS CF|Medicare|MEDICARE ACUTE|||||545.25||| L3919|EAP|0274|HO W/O JOINTS CF|Veterans Affairs|VETERANS ADMINISTRATION|||||545.25||| L3919|EAP|0274|HO W/O JOINTS CF|Managed Medicaid|MEDICAID SUPERIOR|||||545.25||| L3919|EAP|0274|HO W/O JOINTS CF|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||545.25||| L3921|EAP|0274|HFO W/JOINTS CF|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||635.50||| L3921|EAP|0274|HFO W/JOINTS CF|Blue Cross PPO Specialty|BCBSTX PPO|||||635.50||| L3921|EAP|0274|HFO W/JOINTS CF|United Healthcare|UNITED HEALTHCARE OTHER|||||635.50||| L3925|EAP|0274|FO PIP/DIP WITH JOINT/SPR|Workers Compensation|TEXAS MUTUAL INSURANCE|||||227.25||| L3925|EAP|0274|FO PIP/DIP WITH JOINT/SPR|Workers Compensation|BROOKSHIRES WORKERS COMP|||||227.25||| L3925|EAP|0274|FO PIP/DIP WITH JOINT/SPR|United Healthcare|UNITED HEALTHCARE|||||227.25||| L3925|EAP|0274|FO PIP/DIP WITH JOINT/SPR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||227.25||| L3925|EAP|0274|FO PIP/DIP WITH JOINT/SPR|Managed Medicare|HEALTHSPRING MA|||||227.25||| L3925|EAP|0274|FO PIP/DIP WITH JOINT/SPR|Blue Cross PPO Specialty|BCBSTX PPO|||||227.25||| L3927|EAP|0274|FO PIP/DIP W/O JOINT/SPRI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.36||| L3927|EAP|0274|FO PIP/DIP W/O JOINT/SPRI|Aetna|AETNA OTHER|||||1.36||| L3927|EAP|0274|FO PIP/DIP W/O JOINT/SPRI|Blue Cross PPO Specialty|BCBSTX PPO|||||1.36||| L3927|EAP|0274|FO PIP/DIP W/O JOINT/SPRI|United Healthcare|GEHA|||||1.36||| L3933|EAP|0274|FO W/O JOINTS CF|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.54||| L3933|EAP|0274|FO W/O JOINTS CF|Medicare|MEDICARE ACUTE|||||4.54||| L3933|EAP|0274|FO W/O JOINTS CF|United Healthcare|UNITED HEALTHCARE|||||4.54||| L3933|EAP|0274|FO W/O JOINTS CF|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.54||| L3933|EAP|0274|FO W/O JOINTS CF|Humana Medicare Advantage|HUMANA MA|||||4.54||| P9016|EAP|0390|BLOOD LEUKOREDUCED EACH|Cigna|CIGNA OTHER|6.53||||||| P9016|EAP|0390|BLOOD LEUKOREDUCED EACH|Humana Medicare Advantage|HUMANA MA|6.53||||||| P9016|EAP|0390|BLOOD LEUKOREDUCED EACH|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|6.53||||||| P9016|EAP|0390|BLOOD LEUKOREDUCED EACH|Managed Medicare|HEALTHSPRING MA|6.53||||||| P9016|EAP|0390|BLOOD LEUKOREDUCED EACH|Blue Cross PPO Specialty|BCBSTX PPO|6.53||||||| P9016|EAP|0390|BLOOD LEUKOREDUCED EACH|PHCS|HUMANA INSURANCE|6.53||||||| P9016|EAP|0390|BLOOD LEUKOREDUCED EACH|United Medicare Advantage|UHC AARP MCR HMO MA|6.53||||||| P9016|EAP|0390|BLOOD LEUKOREDUCED EACH|Workers Compensation|TEXAS MUTUAL INSURANCE|6.53||||||| P9016|EAP|0390|BLOOD LEUKOREDUCED EACH|Medicare|MEDICARE ACUTE|6.53||||||| P9040|EAP|0390|BLOOD LEUKOREDUCED IRRADI|Medicare|MEDICARE ACUTE|9.81||||||| P9045|ERX|0636|ALBUMIN 5% 12.5 G 250ML|Humana Medicare Advantage|HUMANA MA|821.75||||||| P9047|ERX|0636|ALBUMIN 25% 12.5G/50ML|Medicare|MEDICARE ACUTE|1,155.75||||||| P9047|ERX|0636|ALBUMIN 25% 12.5G/50ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|1,155.75||||||| P9047|ERX|0636|ALBUMIN 25% 12.5G/50ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,155.75||||||| P9047|ERX|0636|ALBUMIN 25% 12.5G/50ML|Humana Medicare Advantage|HUMANA MA|1,155.75||||||| P9047|ERX|0636|ALBUMIN 25% 12.5G/50ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1,155.75||||||| P9059|EAP|0390|FROZEN PLASMA|United Medicare Advantage|UHC MEDICARE GOLD MA|2.74||||||| Q2009|ERX|0636|FOSPHENYTOIN 100MG/2ML VI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|33.60||||||| Q2009|ERX|0636|FOSPHENYTOIN 100MG/2ML VI|Aenta Medicare Advantage|AETNA MEDICARE MA|33.60||||||| Q2009|ERX|0636|FOSPHENYTOIN 100MG/2ML VI|Medicare|MEDICARE ACUTE|33.60||||||| Q2037|ERX|0250||United Medicare Advantage|UHC MEDICARE GOLD MA|152.25||||||| Q2037|ERX|0250||Medicare|MEDICARE ACUTE|152.25||||||| Q2037|ERX|0250||Access Direct Platinum|HEALTHFIRST TPA UMR|152.25||||||| Q2037|ERX|0250||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|152.25||||||| Q2037|ERX|0250||Humana Medicare Advantage|HUMANA MA|152.25||||||| Q2037|ERX|0250||Managed Medicare|HEALTHSPRING MA|152.25||||||| Q2037|ERX|0250||Blue Cross PPO Specialty|BCBSTX PPO|152.25||||||| Q5105|ERX|0636|RETACRIT 10000 UNIT/1ML (|Blue Cross PPO Specialty|BCBSTX PPO|4.74||||||| Q5105|ERX|0636|RETACRIT 4000 UNIT/1ML (E|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|5.52||||||| Q5105|ERX|0636|RETACRIT 4000 UNIT/1ML (E|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.52||||||| Q5105|ERX|0636|RETACRIT 4000 UNIT/1ML (E|Blue Cross PPO Specialty|BCBSTX PPO|5.52||||||| Q5105|ERX|0636|RETACRIT 10000 UNIT/1ML (|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.74||||||| Q5105|ERX|0636|RETACRIT 4000 UNIT/1ML (E|Humana Medicare Advantage|HUMANA MA|5.52||||||| Q5105|ERX|0636|RETACRIT 10000 UNIT/1ML (|Humana Medicare Advantage|HUMANA MA|4.74||||||| Q5105|ERX|0636|RETACRIT 4000 UNIT/1ML (E|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|5.52||||||| Q5105|ERX|0636|RETACRIT 10000 UNIT/1ML (|Managed Medicare|HEALTHSPRING MA|4.74||||||| Q5105|ERX|0636|RETACRIT 10000 UNIT/1ML (|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.74||||||| Q5105|ERX|0636|RETACRIT 4000 UNIT/1ML (E|Medicare|MEDICARE ACUTE|5.52||||||| Q5105|ERX|0636|RETACRIT 10000 UNIT/1ML (|Medicare|MEDICARE ACUTE|4.74||||||| Q5105|ERX|0636|RETACRIT 4000 UNIT/1ML (E|United Medicare Advantage|UHC MEDICARE GOLD MA|5.52||||||| Q5105|ERX|0636|RETACRIT 10000 UNIT/1ML (|United Medicare Advantage|UHC MEDICARE GOLD MA|4.74||||||| Q5106|ERX|0636|RETACRIT 40000 UNIT/1ML (|Medicare|MEDICARE ACUTE|47.43||||||| Q5106|ERX|0636|RETACRIT 4000 UNIT/1ML (N|Medicare|MEDICARE ACUTE|55.15||||||| Q5106|ERX|0636|RETACRIT 10000 UNIT/1ML (|Medicare|MEDICARE ACUTE|47.43||||||| Q5106|ERX|0636|RETACRIT 10000 UNIT/1ML (|Blue Cross PPO Specialty|BCBSTX PPO|47.43||||||| Q5106|ERX|0636|RETACRIT 4000 UNIT/1ML (N|Blue Cross PPO Specialty|BCBSTX PPO|55.15||||||| Q5106|ERX|0636|RETACRIT 10000 UNIT/1ML (|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|47.43||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.75||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|Humana Medicare Advantage|HUMANA MA|2.75||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|Aetna|AETNA PPO|2.75||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|Managed Medicare|HEALTHSPRING MA|2.75||||||| Q9967|EAP|0255|ISOVUE 370 100/ML NDC 027|Managed Medicare|HEALTHSPRING MA|2.75||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|Blue Cross PPO Specialty|BCBSTX OTHER|2.75||||||| Q9967|EAP|0255|ISOVUE 300 50/ML NDC 0270|Blue Cross PPO Specialty|BCBSTX PPO|2.75||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|Blue Cross PPO Specialty|BCBSTX PPO|2.75||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|NON CONTRACTED|COMMERCIAL OTHER 1|2.75||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|United Medicare Advantage|UHC MEDICARE GOLD MA|2.75||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.75||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.75||||||| Q9967|EAP|0255|ISOVUE 300 50/ML NDC 0270|United Medicare Advantage|UHC MEDICARE GOLD MA|2.75||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|PHCS|HUMANA INSURANCE|2.75||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|Medicare|MEDICARE ACUTE|2.75||||||| Q9967|EAP|0255|ISOVUE 300 50/ML NDC 0270|Medicare|MEDICARE ACUTE|2.75||||||| Q9967|EAP|0255|ISOVUE 300 100/ML NDC 027|Medicare|MEDICARE ACUTE|2.75||||||| Q9967|EAP|0255|ISOVUE 300|Medicare|MEDICARE ACUTE|2.75||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|Texas Workforce Commission|DIS DETER SERV AND REHAB SRVCS|2.75||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|Veterans Affairs|VETERANS ADMINISTRATION|2.75||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|Tricare|TRICARE EAST REGION|2.75||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|Workers Compensation|WORKERS COMPENSATION OTHER|2.75||||||| Q9969|EAP|0636|NON-HEU TC-99 ADD-ON/DOSE|Medicare|MEDICARE ACUTE|0.25||||||| U0001|EAP|0300|COVID - 19PCR|Blue Cross PPO Specialty|BCBSTX PPO|1.80||||||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|United Medicare Advantage|UHC MEDICARE GOLD MA|1.54||||||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|United Medicare Advantage|UHC AARP MCR HMO MA|1.54||||||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Medicare|MEDICARE ACUTE|1.54||||||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|United Healthcare|UNITED HEALTHCARE|1.54||||||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|United Healthcare|UNITED HEALTHCARE OTHER|1.54||||||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Humana Medicare Advantage|HUMANA MA|1.54||||||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.54||||||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Blue Cross PPO Specialty|BCBSTX PPO|1.54|||||||