"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" 0084U|EAP|0300|.BC DNA GNOTYP 10 BLD GRO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||5.32||| 0084U|EAP|0300|.BC DNA GNOTYP 10 BLD GRO|Medicare|MEDICARE ACUTE|||||5.32||| 100|DRG||SEIZURES W MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|21,202.25|12564.92|13379.24|9950.74|||| 100|DRG||SEIZURES W MCC|Medicare|MEDICARE ACUTE|57,537.75|13379.24|13379.24|9950.74|||| 100|DRG||SEIZURES W MCC|Humana Medicare Advantage|HUMANA MA|38,439.89|9950.74|13379.24|9950.74|||| 101|DRG||SEIZURES W/O MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|18,906.60|4384.65|7688.41|4384.65|||| 101|DRG||SEIZURES W/O MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|36,087.80|5351.4|7688.41|4384.65|||| 101|DRG||SEIZURES W/O MCC|Medicare|MEDICARE ACUTE|44,519.05|7688.41|7688.41|4384.65|||| 101|DRG||SEIZURES W/O MCC|Humana Medicare Advantage|HUMANA MA|286.75|7688.41|7688.41|4384.65|||| 101|DRG||SEIZURES W/O MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|46,460.85|7688.41|7688.41|4384.65|||| 101|DRG||SEIZURES W/O MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|46,863.63|7631.125|7688.41|4384.65|||| 103|DRG||HEADACHES W/O MCC|Medicare|MEDICARE ACUTE|44,278.90|7047.2|7047.2|3920.28|||| 103|DRG||HEADACHES W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|19,925.55|3920.28|7047.2|3920.28|||| 12|DRG||TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY W CC|Aenta Medicare Advantage|AETNA MEDICARE MA|115,724.40|25455.19|25455.19|25455.19|||| 123|DRG||NEUROLOGICAL EYE DISORDERS|Blue Cross HMO Specialty|BCBSTX HMO|46,979.05|3210.37|3210.37|3210.37|||| 125|DRG||OTHER DISORDERS OF THE EYE W/O MCC|Managed Medicaid|MEDICAID AMERIGROUP|21,417.20|4811.74|4811.74|4811.74|||| 13|DRG||TRACHEOSTOMY FOR FACE, MOUTH & NECK DIAGNOSES OR LARYNGECTOMY W/O CC/MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|58,499.05|17418.45|17418.45|17418.45|||| 134|DRG||OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES W/O CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|20,843.55|5880.11|5880.11|5880.11|||| 137|DRG||MOUTH PROCEDURES W CC/MCC|Humana Medicare Advantage|HUMANA MA|48,838.85|10529.7|10529.7|10529.7|||| 149|DRG||DYSEQUILIBRIUM|Medicare|MEDICARE ACUTE|25,802.65|6620.62|7298.43|748.65|||| 149|DRG||DYSEQUILIBRIUM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|76,209.10|6633.18|7298.43|748.65|||| 149|DRG||DYSEQUILIBRIUM|United Healthcare|TML GROUP BENEFITS|41,633.40|7298.43|7298.43|748.65|||| 149|DRG||DYSEQUILIBRIUM|Humana Medicare Advantage|HUMANA MA|49,226.45|748.65|7298.43|748.65|||| 151|DRG||EPISTAXIS W/O MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|54,519.45|6407.08|6407.08|6407.08|||| 152|DRG||OTITIS MEDIA & URI W MCC|Humana Medicare Advantage|HUMANA MA|32,188.65|8512.66|8512.66|8512.66|||| 153|DRG||OTITIS MEDIA & URI W/O MCC|Managed Medicaid|MEDICAID SUPERIOR|10,762.50|3187.22|6480.47|1259.53|||| 153|DRG||OTITIS MEDIA & URI W/O MCC|Medicare|MEDICARE ACUTE|20,563.50|6480.47|6480.47|1259.53|||| 153|DRG||OTITIS MEDIA & URI W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|33,872.55|3571.1|6480.47|1259.53|||| 153|DRG||OTITIS MEDIA & URI W/O MCC|Medicaid|MEDICAID|30,557.15|1259.53|6480.47|1259.53|||| 153|DRG||OTITIS MEDIA & URI W/O MCC|Tricare|TRICARE EAST REGION|154.40|1873.45|6480.47|1259.53|||| 158|DRG||DENTAL & ORAL DISEASES W CC|Medicare|MEDICARE ACUTE|154.35|7585.59|7585.59|7585.59|||| 166|DRG||OTHER RESP SYSTEM O.R. PROCEDURES W MCC|Medicare|MEDICARE ACUTE|125,122.65|22435.19|22435.19|5694.23|||| 166|DRG||OTHER RESP SYSTEM O.R. PROCEDURES W MCC|Medicaid|MEDICAID|63,962.70|5694.23|22435.19|5694.23|||| 166|DRG||OTHER RESP SYSTEM O.R. PROCEDURES W MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|158,513.80|11209.44|22435.19|5694.23|||| 175|DRG||PULMONARY EMBOLISM W MCC OR ACUTE COR PULMONALE|Aenta Medicare Advantage|AETNA MEDICARE MA|58,017.75|11024.01|11140.935|11024.01|||| 175|DRG||PULMONARY EMBOLISM W MCC OR ACUTE COR PULMONALE|Medicare|MEDICARE ACUTE|47,238.75|11140.935|11140.935|11024.01|||| 175|DRG||PULMONARY EMBOLISM W MCC OR ACUTE COR PULMONALE|Humana Medicare Advantage|HUMANA MA|910.53|11056.51|11140.935|11024.01|||| 176|DRG||PULMONARY EMBOLISM W/O MCC|Humana Medicare Advantage|HUMANA MA|645.24|7341.97|7470.78|3833.34|||| 176|DRG||PULMONARY EMBOLISM W/O MCC|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|282.34|3833.34|7470.78|3833.34|||| 176|DRG||PULMONARY EMBOLISM W/O MCC|Managed Medicare|BCBS MEDICARE PPO MA|470.98|7470.78|7470.78|3833.34|||| 176|DRG||PULMONARY EMBOLISM W/O MCC|Medicare|MEDICARE ACUTE|41,853.80|7331.97|7470.78|3833.34|||| 176|DRG||PULMONARY EMBOLISM W/O MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|105,168.03|7331.97|7470.78|3833.34|||| 176|DRG||PULMONARY EMBOLISM W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|46,709.50|4510.28|7470.78|3833.34|||| 176|DRG||PULMONARY EMBOLISM W/O MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|40,002.30|4678.4|7470.78|3833.34|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|138,839.50|16254.48|34802.88|8908.2|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|United Healthcare|UMR UNITED MEDICAL RESOURCES|36,466.10|18894.98|34802.88|8908.2|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|29,034.50|8908.2|34802.88|8908.2|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Tricare|TRICARE EAST REGION|26,162.05|13073.63|34802.88|8908.2|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Medicare|MEDICARE PART B ONLY IP|29,664.75|15957.55|34802.88|8908.2|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|22,919.65|14951.8|34802.88|8908.2|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Workers Compensation|UT EMPLOYEE INJURY|23,154.25|23243.92|34802.88|8908.2|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Blue Cross PPO Specialty|BCBSTX PPO|46,353.20|9235.29|34802.88|8908.2|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|68,485.85|16254.48|34802.88|8908.2|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Medicare|MEDICARE ACUTE|57,916.50|14049.15|34802.88|8908.2|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|24,793.75|16254.48|34802.88|8908.2|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Humana Medicare Advantage|HUMANA MA|57,291.25|14969.53|34802.88|8908.2|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|57,910.51|12227.58|34802.88|8908.2|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Aetna|AETNA PPO|15,301.75|10573.51|34802.88|8908.2|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Managed Medicare|BCBS MEDICARE PPO MA|65,270.38|13934.11|34802.88|8908.2|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Managed Medicaid|MEDICAID SUPERIOR|27,060.38|12043.415|34802.88|8908.2|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Cigna|CIGNA|80,529.80|34802.88|34802.88|8908.2|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Managed Medicare|HEALTHSPRING MA|65,594.25|16254.48|34802.88|8908.2|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Veterans Affairs|VETERANS ADMINISTRATION|82,654.38|16254.48|34802.88|8908.2|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Blue Cross HMO Specialty|BCBSTX HMO|48,346.55||||||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|117,888.30||||||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|590.52|15023.135|34802.88|8908.2|||| 178|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W CC|Aenta Medicare Advantage|AETNA MEDICARE MA|343.52|12726.85|12726.85|6393.66|||| 178|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|345.43|11721.97|12726.85|6393.66|||| 178|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W CC|Medicare|MEDICARE ACUTE|32,337.33|9961.94|12726.85|6393.66|||| 178|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W CC|Managed Medicare|HEALTHSPRING MA|41,849.85|9588.61|12726.85|6393.66|||| 178|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W CC|Blue Cross PPO Specialty|BCBSTX PPO|30,548.50|6393.66|12726.85|6393.66|||| 178|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W CC|Humana Medicare Advantage|HUMANA MA|21,558.64|10686.845|12726.85|6393.66|||| 178|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W CC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|21,527.75|8908.2|12726.85|6393.66|||| 178|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|44,468.50|9588.61|12726.85|6393.66|||| 179|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W/O CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|32,818.55|4711.38|7468.87|4623.17|||| 179|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W/O CC/MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|44,803.50|4681.18|7468.87|4623.17|||| 179|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|31,279.75|4623.17|7468.87|4623.17|||| 179|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W/O CC/MCC|Medicare|MEDICARE ACUTE|36,163.75|7468.87|7468.87|4623.17|||| 180|DRG||RESPIRATORY NEOPLASMS W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|51,593.65|12795.39|13000.06|8404.92|||| 180|DRG||RESPIRATORY NEOPLASMS W MCC|Managed Medicare|HOSPICE OF EAST TEXAS|4,790.50|13000.06|13000.06|8404.92|||| 180|DRG||RESPIRATORY NEOPLASMS W MCC|Medicare|MEDICARE ACUTE|90,288.28|13000.06|13000.06|8404.92|||| 180|DRG||RESPIRATORY NEOPLASMS W MCC|Medicaid|MOLINA HEALTHCARE OF TEXAS|42,481.50|8404.92|13000.06|8404.92|||| 180|DRG||RESPIRATORY NEOPLASMS W MCC|Managed Medicare|HEALTHSPRING MA|134,500.56|13000.06|13000.06|8404.92|||| 181|DRG||RESPIRATORY NEOPLASMS W CC|Medicaid|MEDICAID|36,621.80|5694.23|5694.23|5694.23|||| 184|DRG||MAJOR CHEST TRAUMA W CC|Veterans Affairs|VETERANS ADMINISTRATION|47,062.55|8541.94|8541.94|8411.97|||| 184|DRG||MAJOR CHEST TRAUMA W CC|Medicare|MEDICARE ACUTE|31,012.30|8411.97|8541.94|8411.97|||| 185|DRG||MAJOR CHEST TRAUMA W/O CC/MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|26,950.85|6760.59|7333.39|6760.59|||| 185|DRG||MAJOR CHEST TRAUMA W/O CC/MCC|United Healthcare|UNITED HEALTHCARE OTHER|48,768.60|7333.39|7333.39|6760.59|||| 186|DRG||PLEURAL EFFUSION W MCC|Medicare|MEDICARE ACUTE|98,278.95|11662.34|11662.34|11662.34|||| 187|DRG||PLEURAL EFFUSION W CC|Medicare|MEDICARE ACUTE|26,712.30|8045.94|8045.94|8045.94|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|84,643.55|9787.85|12146.06|77.22|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Blue Cross HMO Specialty|BCBSTX HMO|96,576.75|5267.32|12146.06|77.22|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Humana Medicare Advantage|HUMANA MA|42,783.53|9626.78|12146.06|77.22|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Aenta Medicare Advantage|AETNA MEDICARE MA|45,368.55|9607.28|12146.06|77.22|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|United Medicare Advantage|UHC MEDICARE GOLD MA|31,710.20|9607.28|12146.06|77.22|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|40,428.25|8158.66|12146.06|77.22|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|35,156.60|9102.48|12146.06|77.22|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Managed Medicare|HEALTHSPRING MA|44,411.80|9634.56|12146.06|77.22|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Medicare|MEDICARE PART B ONLY IP|71.80|77.22|12146.06|77.22|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Veterans Affairs|VETERANS ADMINISTRATION|47,439.50|96.35|12146.06|77.22|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Blue Cross PPO Specialty|BCBSTX PPO|37,566.50|6197.5|12146.06|77.22|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|United Healthcare|UNITED HEALTHCARE|25,307.50|12146.06|12146.06|77.22|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|489.61|9646.28|12146.06|77.22|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Medicare|MEDICARE ACUTE|54,878.25|9634.56|12146.06|77.22|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Medicaid|MOLINA HEALTHCARE OF TEXAS|28,987.25|5131.23|12146.06|77.22|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Humana Medicare Advantage|HUMANA MA|42,103.05|9172.87|11429.7|764.85|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|45,953.25|9174.82|11429.7|764.85|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Medicare|MEDICARE ACUTE|36,422.05|9190.4|11429.7|764.85|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|50,007.75|9335.53|11429.7|764.85|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|United Healthcare|UNITED HEALTHCARE|25,847.75|11429.7|11429.7|764.85|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Managed Medicare|HEALTHSPRING MA|37,768.30|5098.09|11429.7|764.85|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Managed Medicaid|MEDICAID SUPERIOR|57,087.80|8292.66|11429.7|764.85|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|28,373.20|8292.66|11429.7|764.85|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|575.25|9335.53|11429.7|764.85|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Veterans Affairs|VETERANS ADMINISTRATION|290.44|9190.4|11429.7|764.85|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|341.26|8292.66|11429.7|764.85|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Blue Cross PPO Specialty|BCBSTX PPO|56,077.75|5973.74|11429.7|764.85|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Cigna|CIGNA|32,371.25|3597.75|11429.7|764.85|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Cigna|CIGNA|25,024.75|764.85|11429.7|764.85|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|40,732.93|9177.2|11429.7|764.85|||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|Medicare|MEDICARE ACUTE|34,291.25|7635.15|32749.59|76.93|||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|36,596.25|7750.85|32749.59|76.93|||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|Veterans Affairs|VETERANS ADMINISTRATION|30,937.28|7634.71|32749.59|76.93|||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|Managed Medicare|HEALTHSPRING MA|36,924.25|7750.85|32749.59|76.93|||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|United Medicare Advantage|UHC MEDICARE GOLD MA|81,975.25|7643.95|32749.59|76.93|||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|41,034.13|76.93|32749.59|76.93|||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|Cigna|CIGNA|75,707.65|32749.59|32749.59|76.93|||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|25,839.18|6122.96|32749.59|76.93|||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|Managed Medicaid|MEDICAID AMERIGROUP|55,615.30|6122.96|32749.59|76.93|||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|Aenta Medicare Advantage|AETNA MEDICARE MA|50,315.25|835.51|32749.59|76.93|||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|ChampVA|CHAMPVA CENTER|19,870.25|3052.27|32749.59|76.93|||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|Humana Medicare Advantage|HUMANA MA|32,247.75|7632.99|32749.59|76.93|||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|42,035.85|4718.3|32749.59|76.93|||| 192|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC|Tricare|TRICARE EAST REGION|255.79|3571.15|6643.195|3087.56|||| 192|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|19,548.25|5507.725|6643.195|3087.56|||| 192|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|28,366.28|6643.195|6643.195|3087.56|||| 192|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|11,408.75|3632.81|6643.195|3087.56|||| 192|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|42,238.80|6478.27|6643.195|3087.56|||| 192|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC|Medicare|MEDICARE ACUTE|28,936.50|6497.81|6643.195|3087.56|||| 192|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|29,566.75|4892.49|6643.195|3087.56|||| 192|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC|Blue Cross HMO Specialty|BCBSTX HMO|245.90|3087.56|6643.195|3087.56|||| 192|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC|Veterans Affairs|VETERANS ADMINISTRATION|33,852.50|6544.785|6643.195|3087.56|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Blue Cross PPO Specialty|BCBSTX PPO|41,710.30|6605.88|17969.1|103.37|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Managed Medicare|HEALTHSPRING MA|53,301.35|10348.51|17969.1|103.37|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|64,675.84|17969.1|17969.1|103.37|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|39,874.05|103.37|17969.1|103.37|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Managed Medicaid|MEDICAID AMERIGROUP|22,615.50|3217.09|17969.1|103.37|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|418.71|8847.01|17969.1|103.37|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|United Healthcare|UNITED HEALTHCARE|141,881.76|133.23|17969.1|103.37|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|45,000.75|10365.16|17969.1|103.37|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Humana Medicare Advantage|HUMANA MA|41,761.25|10351.4|17969.1|103.37|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Managed Medicaid|MEDICAID SUPERIOR|44,531.25|8042.73|17969.1|103.37|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|421.22|8847.01|17969.1|103.37|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Medicare|MEDICARE ACUTE|42,208.13|10364.28|17969.1|103.37|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|55,801.41|10368.6|17969.1|103.37|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|336.97|10339.155|17969.1|103.37|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Medicaid|HENDERSON COUNTY INDIGENT|26,572.38|4339.46|17969.1|103.37|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Veterans Affairs|VETERANS ADMINISTRATION|45,910.50|10448.065|17969.1|103.37|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|35,132.33|7724.37|23445.65|3105.24|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|Veterans Affairs|VETERANS ADMINISTRATION|25,053.25|7666.76|23445.65|3105.24|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|NON CONTRACTED|COMMERCIAL OTHER 1|40,775.05|23445.65|23445.65|3105.24|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|Medicare|MEDICARE ACUTE|40,635.82|7608.27|23445.65|3105.24|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|36,243.75|7609.15|23445.65|3105.24|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|Managed Medicare|BCBS MEDICARE PPO MA|343.28|7609.15|23445.65|3105.24|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|United Medicare Advantage|UHC MEDICARE GOLD MA|29,206.65|7724.37|23445.65|3105.24|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|Managed Medicaid|MEDICAID SUPERIOR|28,392.30|3105.24|23445.65|3105.24|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|34,162.23|4952.47|23445.65|3105.24|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|Humana Medicare Advantage|HUMANA MA|35,212.50|7612.99|23445.65|3105.24|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|40,154.25|4952.47|23445.65|3105.24|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|36,241.38|4684.64|23445.65|3105.24|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|Blue Cross PPO Specialty|BCBSTX PPO|24,087.50|4516.3|23445.65|3105.24|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|Managed Medicaid|MEDICAID AMERIGROUP|18,118.28|4028.855|23445.65|3105.24|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|Aenta Medicare Advantage|AETNA MEDICARE MA|368.22|7580.99|23445.65|3105.24|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|15,615.25|3574.11|10231.5|1952.98|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|Managed Medicare|HEALTHSPRING MA|58,890.30|6329.94|10231.5|1952.98|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|218.51|6555.22|10231.5|1952.98|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|Managed Medicaid|MEDICAID SUPERIOR|21,133.25|3105.24|10231.5|1952.98|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|38,278.45|4952.47|10231.5|1952.98|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|33,248.05|3445.68|10231.5|1952.98|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|22,719.75|6312.34|10231.5|1952.98|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|Managed Medicaid|MEDICAID AMERIGROUP|28,656.25|3105.24|10231.5|1952.98|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|NON CONTRACTED|COMMERCIAL OTHER 1|19,732.25|10231.5|10231.5|1952.98|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|United Healthcare|UNITED HEALTHCARE|304.15|6814.86|10231.5|1952.98|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|Medicaid|MEDICAID|16,667.75|1952.98|10231.5|1952.98|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|Medicare|MEDICARE ACUTE|34,520.33|6329.94|10231.5|1952.98|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|24,063.25|6301.78|10231.5|1952.98|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|30,300.25|6303.78|10231.5|1952.98|||| 196|DRG||INTERSTITIAL LUNG DISEASE W MCC|Medicare|MEDICARE ACUTE|41,931.18|11697.605|11697.605|11697.605|||| 200|DRG||PNEUMOTHORAX W CC|Humana Medicare Advantage|HUMANA MA|49,497.75|8812.15|8945.04|5234.41|||| 200|DRG||PNEUMOTHORAX W CC|Medicare|MEDICARE ACUTE|47,401.50|8945.04|8945.04|5234.41|||| 200|DRG||PNEUMOTHORAX W CC|Blue Cross PPO Specialty|BCBSTX PPO|51,938.35|5234.41|8945.04|5234.41|||| 202|DRG||BRONCHITIS & ASTHMA W CC/MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|16,753.80|8099.08|23882.34|1832.85|||| 202|DRG||BRONCHITIS & ASTHMA W CC/MCC|Medicare|MEDICARE ACUTE|39,797.50|7977.11|23882.34|1832.85|||| 202|DRG||BRONCHITIS & ASTHMA W CC/MCC|Blue Cross HMO Specialty|BCBSTX HMO|13,969.25|3882.72|23882.34|1832.85|||| 202|DRG||BRONCHITIS & ASTHMA W CC/MCC|Cigna|CIGNA|21,786.38|1832.85|23882.34|1832.85|||| 202|DRG||BRONCHITIS & ASTHMA W CC/MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|39,061.09|4872.92|23882.34|1832.85|||| 202|DRG||BRONCHITIS & ASTHMA W CC/MCC|Managed Medicaid|MEDICAID SUPERIOR|7,291.25|6473.57|23882.34|1832.85|||| 202|DRG||BRONCHITIS & ASTHMA W CC/MCC|Aetna|AETNA PPO|41,534.50|23882.34|23882.34|1832.85|||| 202|DRG||BRONCHITIS & ASTHMA W CC/MCC|Veterans Affairs|VETERANS ADMINISTRATION|24,834.75|7976.23|23882.34|1832.85|||| 202|DRG||BRONCHITIS & ASTHMA W CC/MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|24,842.50|11209.44|23882.34|1832.85|||| 202|DRG||BRONCHITIS & ASTHMA W CC/MCC|Managed Medicaid|MEDICAID AMERIGROUP|19,105.50|3734.75|23882.34|1832.85|||| 202|DRG||BRONCHITIS & ASTHMA W CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|192.02|4716.48|23882.34|1832.85|||| 203|DRG||BRONCHITIS & ASTHMA W/O CC/MCC|Managed Medicaid|MEDICAID SUPERIOR|135.88|2473.17|22317.91|674.01|||| 203|DRG||BRONCHITIS & ASTHMA W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|34,492.25|674.01|22317.91|674.01|||| 203|DRG||BRONCHITIS & ASTHMA W/O CC/MCC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|27,223.25|6626.33|22317.91|674.01|||| 203|DRG||BRONCHITIS & ASTHMA W/O CC/MCC|Managed Medicaid|MEDICAID AMERIGROUP|17,489.88|2473.17|22317.91|674.01|||| 203|DRG||BRONCHITIS & ASTHMA W/O CC/MCC|Aetna|AETNA PPO|38,813.75|22317.91|22317.91|674.01|||| 203|DRG||BRONCHITIS & ASTHMA W/O CC/MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|40,538.30|6393.75|22317.91|674.01|||| 203|DRG||BRONCHITIS & ASTHMA W/O CC/MCC|Medicaid|MEDICAID HMO|13,095.75|1555.45|22317.91|674.01|||| 203|DRG||BRONCHITIS & ASTHMA W/O CC/MCC|United Healthcare|UNITED HEALTHCARE|19,462.75|6931.76|22317.91|674.01|||| 204|DRG||RESPIRATORY SIGNS & SYMPTOMS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|247.86|4872.92|7109.57|4872.92|||| 204|DRG||RESPIRATORY SIGNS & SYMPTOMS|Medicare|MEDICARE ACUTE|416.41|7109.57|7109.57|4872.92|||| 205|DRG||OTHER RESPIRATORY SYSTEM DIAGNOSES W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|143,931.60|12207.5|12207.5|12207.5|||| 206|DRG||OTHER RESPIRATORY SYSTEM DIAGNOSES W/O MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|10,697.75|7622.8|7622.8|4308.48|||| 206|DRG||OTHER RESPIRATORY SYSTEM DIAGNOSES W/O MCC|Humana Medicare Advantage|HUMANA MA|408.04|7481.24|7622.8|4308.48|||| 206|DRG||OTHER RESPIRATORY SYSTEM DIAGNOSES W/O MCC|Medicaid|MOLINA HEALTHCARE OF TEXAS|26,620.50|4308.48|7622.8|4308.48|||| 207|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS|Medicare|MEDICARE ACUTE|202,119.85|35287.12|62997.01|35287.12|||| 207|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|271,400.80|35646.85|62997.01|35287.12|||| 207|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|581,420.90|62997.01|62997.01|35287.12|||| 207|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|255,629.50|37634.89|62997.01|35287.12|||| 207|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS|Humana Medicare Advantage|HUMANA MA|229,096.16|36121.83|62997.01|35287.12|||| 208|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS|Medicare|MEDICARE ACUTE|59,374.75|17433.61|17789.4|9697.93|||| 208|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS|Managed Medicaid|MEDICAID AMERIGROUP|130,105.80|17231.45|17789.4|9697.93|||| 208|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS|UTMB|UTMB CORRECTIONAL MANAGED CARE|78,333.05|13226.37|17789.4|9697.93|||| 208|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS|Blue Cross HMO Specialty|BCBSTX HMO|916.44|10393.07|17789.4|9697.93|||| 208|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS|Humana Medicare Advantage|HUMANA MA|123,889.25|17497.14|17789.4|9697.93|||| 208|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS|United Medicare Advantage|UHC MEDICARE GOLD MA|106,548.30|17490.64|17789.4|9697.93|||| 208|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS|Aenta Medicare Advantage|AETNA MEDICARE MA|50,252.75|9697.93|17789.4|9697.93|||| 208|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|817.67|17231.45|17789.4|9697.93|||| 208|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|131,565.53|17789.4|17789.4|9697.93|||| 208|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|46,132.35|13506.67|17789.4|9697.93|||| 239|DRG||AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|66,606.30|31043.45|31043.45|31043.45|||| 240|DRG||AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W CC|Managed Medicare|BCBS MEDICARE PPO MA|75,144.05|14492.42|19529.88|14492.42|||| 240|DRG||AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|81,630.10|19529.88|19529.88|14492.42|||| 240|DRG||AMPUTATION FOR CIRC SYS DISORDERS EXC UPPER LIMB & TOE W CC|Medicare|MEDICARE ACUTE|34,680.15|14520.09|19529.88|14492.42|||| 242|DRG||PERMANENT CARDIAC PACEMAKER IMPLANT W MCC|Medicare|MEDICARE ACUTE|100,840.50|25529.78|25529.78|25529.78|||| 243|DRG||PERMANENT CARDIAC PACEMAKER IMPLANT W CC|Managed Medicare|HEALTHSPRING MA|69,412.60|18075.17|18075.17|17772.55|||| 243|DRG||PERMANENT CARDIAC PACEMAKER IMPLANT W CC|Medicare|MEDICARE ACUTE|51,039.80|17772.55|18075.17|17772.55|||| 244|DRG||PERMANENT CARDIAC PACEMAKER IMPLANT W/O CC/MCC|Medicare|MEDICARE ACUTE|44,720.93|15085.645|15085.645|15085.645|||| 252|DRG||OTHER VASCULAR PROCEDURES W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|23,774.14|10077.66|10077.66|10077.66|||| 255|DRG||UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W MCC|NON CONTRACTED|COMMERCIAL OTHER 1|80,937.70|80937.7|80937.7|80937.7|||| 256|DRG||UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W CC|Medicare|MEDICARE ACUTE|42,727.80|10611.41|10925.53|8773.23|||| 256|DRG||UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W CC|Blue Cross PPO Specialty|BCBSTX PPO|28,537.55|8773.23|10925.53|8773.23|||| 256|DRG||UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|41,371.50|10925.53|10925.53|8773.23|||| 257|DRG||UPPER LIMB & TOE AMPUTATION FOR CIRC SYSTEM DISORDERS W/O CC/MCC|Medicare|MEDICARE ACUTE|443.02|9274.97|9274.97|9274.97|||| 264|DRG||OTHER CIRCULATORY SYSTEM O.R. PROCEDURES|Medicare|MEDICARE ACUTE|312,921.15|24798.04|24798.04|24798.04|||| 280|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC|Blue Cross HMO Specialty|BCBSTX HMO|88,955.93|7065.87|12407.08|4697.11|||| 280|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC|Medicare|MEDICARE ACUTE|45,633.03|12179.32|12407.08|4697.11|||| 280|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC|Managed Medicare|HEALTHSPRING MA|55,342.50|12207.48|12407.08|4697.11|||| 280|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC|Blue Cross PPO Specialty|BCBSTX PPO|39,985.80|6650.94|12407.08|4697.11|||| 280|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|68,631.61|12407.08|12407.08|4697.11|||| 280|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC|Veterans Affairs|VETERANS ADMINISTRATION|137.99|12207.48|12407.08|4697.11|||| 280|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|52,170.38|9574.015|12407.08|4697.11|||| 280|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|66,611.79|12179.32|12407.08|4697.11|||| 280|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|76,693.65|12208.12|12407.08|4697.11|||| 280|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|47,089.70|4697.11|12407.08|4697.11|||| 280|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|544.50|7907.18|12407.08|4697.11|||| 280|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC|Humana Medicare Advantage|HUMANA MA|70,214.40|12194.07|12407.08|4697.11|||| 281|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|404.86|8104.47|14530.5|2030.04|||| 281|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC|Tricare|TRICARE EAST REGION|33,192.75|6778.59|14530.5|2030.04|||| 281|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC|NON CONTRACTED|COMMERCIAL OTHER 1|270.31|14530.5|14530.5|2030.04|||| 281|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC|Medicaid|MOLINA HEALTHCARE OF TEXAS|260.50|2030.04|14530.5|2030.04|||| 281|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC|Medicare|MEDICARE ACUTE|34,564.30|8104.47|14530.5|2030.04|||| 281|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC|Veterans Affairs|VETERANS ADMINISTRATION|41,090.75|8229.68|14530.5|2030.04|||| 281|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|78,918.50|8241.18|14530.5|2030.04|||| 281|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|22,782.50|6720.34|14530.5|2030.04|||| 281|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC|United Medicare Advantage|UHC MEDICARE GOLD MA|56,607.76|8158.715|14530.5|2030.04|||| 281|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|34,620.35|2475.38|14530.5|2030.04|||| 281|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC|Humana Medicare Advantage|HUMANA MA|37,709.33|8088.69|14530.5|2030.04|||| 281|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC|Managed Medicaid|MEDICAID AMERIGROUP|49,977.75|6132.76|14530.5|2030.04|||| 281|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|44,120.95|5097.84|14530.5|2030.04|||| 282|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|23,005.30|3757.73|11068.5|1948.9|||| 282|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|18,954.25|1948.9|11068.5|1948.9|||| 282|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|39,745.63|6710.715|11068.5|1948.9|||| 282|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC|Medicare|MEDICARE ACUTE|28,558.25|6675.6|11068.5|1948.9|||| 282|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|31,876.88|6658.94|11068.5|1948.9|||| 282|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W/O CC/MCC|NON CONTRACTED|COMMERCIAL OTHER 1|31,557.40|11068.5|11068.5|1948.9|||| 283|DRG||ACUTE MYOCARDIAL INFARCTION, EXPIRED W MCC|Medicare|MEDICARE ACUTE|57,703.04|13348.455|13494.93|13252.26|||| 283|DRG||ACUTE MYOCARDIAL INFARCTION, EXPIRED W MCC|Humana Medicare Advantage|HUMANA MA|14,698.75|13494.93|13494.93|13252.26|||| 283|DRG||ACUTE MYOCARDIAL INFARCTION, EXPIRED W MCC|Managed Medicare|HOSPICE ETMC|6,789.75|13252.26|13494.93|13252.26|||| 284|DRG||ACUTE MYOCARDIAL INFARCTION, EXPIRED W CC|Medicare|MEDICARE ACUTE|32,820.50|6583.04|6583.04|6583.04|||| 287|DRG||CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|84,708.25|8380.33|9213.91|8380.33|||| 287|DRG||CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W/O MCC|Medicare|MEDICARE ACUTE|61,861.65|9213.91|9213.91|8380.33|||| 289|DRG||ACUTE & SUBACUTE ENDOCARDITIS W CC|Medicare|MEDICARE ACUTE|89,991.15|12396.77|12614.63|12396.77|||| 289|DRG||ACUTE & SUBACUTE ENDOCARDITIS W CC|Humana Medicare Advantage|HUMANA MA|786.31|12614.63|12614.63|12396.77|||| 291|DRG||HEART FAILURE & SHOCK W MCC|MTC Medical|VAN ZANDT COUNTY INMATE|449.92|12750.86|12750.86|78.16|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Aetna|AETNA PPO|48,367.25|12205.12|12750.86|78.16|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|46,394.61|10524.97|12750.86|78.16|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|50,449.50|7239.185|12750.86|78.16|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Humana Medicare Advantage|HUMANA MA|44,540.63|10413.21|12750.86|78.16|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Managed Medicare|HEALTHSPRING MA|39,359.75|10441.37|12750.86|78.16|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Managed Medicare|BCBS MEDICARE PPO MA|43,502.50|10421.385|12750.86|78.16|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Blue Cross PPO Specialty|BCBSTX PPO|37,293.75|4853.74|12750.86|78.16|||| 291|DRG||HEART FAILURE & SHOCK W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|75,428.68|10526.49|12750.86|78.16|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|70,836.80|9037.91|12750.86|78.16|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Medicare|MEDICARE ACUTE|39,999.50|10440.49|12750.86|78.16|||| 291|DRG||HEART FAILURE & SHOCK W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|34,918.06|10339.215|12750.86|78.16|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Managed Medicare|VAN ZANDT COUNTY INMATE|449.92|12750.86|12750.86|78.16|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Medicare|MEDICARE PART B ONLY IP|90,033.50|78.16|12750.86|78.16|||| 291|DRG||HEART FAILURE & SHOCK W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|31,240.38|10415.71|12750.86|78.16|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Veterans Affairs|VETERANS ADMINISTRATION|100,317.61|10440.49|12750.86|78.16|||| 292|DRG||HEART FAILURE & SHOCK W CC|United Medicare Advantage|UHC MEDICARE GOLD MA|37,217.35|7830.98|7830.98|563.07|||| 292|DRG||HEART FAILURE & SHOCK W CC|Medicare|MEDICARE ACUTE|29,789.85|7712.96|7830.98|563.07|||| 292|DRG||HEART FAILURE & SHOCK W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|48,885.73|7712.96|7830.98|563.07|||| 292|DRG||HEART FAILURE & SHOCK W CC|Medicaid|MEDICAID|30,653.75|3857.08|7830.98|563.07|||| 292|DRG||HEART FAILURE & SHOCK W CC|Veterans Affairs|VETERANS ADMINISTRATION|28,242.80|7712.96|7830.98|563.07|||| 292|DRG||HEART FAILURE & SHOCK W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|40,776.72|7772.41|7830.98|563.07|||| 292|DRG||HEART FAILURE & SHOCK W CC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|27,175.75|6132.76|7830.98|563.07|||| 292|DRG||HEART FAILURE & SHOCK W CC|Blue Cross PPO Specialty|BCBSTX PPO|34,707.77|4614.64|7830.98|563.07|||| 292|DRG||HEART FAILURE & SHOCK W CC|Blue Cross HMO Specialty|BCBSTX HMO|14,613.25|3922.03|7830.98|563.07|||| 292|DRG||HEART FAILURE & SHOCK W CC|Managed Medicaid|MEDICAID AMERIGROUP|41,385.25|7049.95|7830.98|563.07|||| 292|DRG||HEART FAILURE & SHOCK W CC|Medicare|MEDICARE PART B ONLY IP|12,178.25|563.07|7830.98|563.07|||| 292|DRG||HEART FAILURE & SHOCK W CC|Aenta Medicare Advantage|AETNA MEDICARE MA|40,323.13|840.235|7830.98|563.07|||| 292|DRG||HEART FAILURE & SHOCK W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|58,970.51|6132.76|7830.98|563.07|||| 292|DRG||HEART FAILURE & SHOCK W CC|Managed Medicare|HEALTHSPRING MA|40,012.56|7707.74|7830.98|563.07|||| 292|DRG||HEART FAILURE & SHOCK W CC|Humana Medicare Advantage|HUMANA MA|36,083.25|7830.98|7830.98|563.07|||| 292|DRG||HEART FAILURE & SHOCK W CC|Aetna|AETNA PPO|32,343.75|7830.98|7830.98|563.07|||| 293|DRG||HEART FAILURE & SHOCK W/O CC/MCC|Managed Medicaid|MEDICAID AMERIGROUP|21,954.25|6842.23|8308.57|699.94|||| 293|DRG||HEART FAILURE & SHOCK W/O CC/MCC|Veterans Affairs|VETERANS ADMINISTRATION|52,218.85|6163.91|8308.57|699.94|||| 293|DRG||HEART FAILURE & SHOCK W/O CC/MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|32,601.39|8308.57|8308.57|699.94|||| 293|DRG||HEART FAILURE & SHOCK W/O CC/MCC|Medicaid|MEDICAID|44,725.25|3183.64|8308.57|699.94|||| 293|DRG||HEART FAILURE & SHOCK W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|338.27|699.94|8308.57|699.94|||| 293|DRG||HEART FAILURE & SHOCK W/O CC/MCC|Medicare|MEDICARE ACUTE|28,908.78|6163.91|8308.57|699.94|||| 299|DRG||PERIPHERAL VASCULAR DISORDERS W MCC|Humana Medicare Advantage|HUMANA MA|22,570.34|6809.28|7276.66|6809.28|||| 299|DRG||PERIPHERAL VASCULAR DISORDERS W MCC|Blue Cross PPO Specialty|BCBSTX PPO|31,232.50|7276.66|7276.66|6809.28|||| 300|DRG||PERIPHERAL VASCULAR DISORDERS W CC|United Medicare Advantage|UHC MEDICARE GOLD MA|65,851.50|8246.83|8601.23|6242.28|||| 300|DRG||PERIPHERAL VASCULAR DISORDERS W CC|Humana Medicare Advantage|HUMANA MA|463.41|8468.04|8601.23|6242.28|||| 300|DRG||PERIPHERAL VASCULAR DISORDERS W CC|Medicare|MEDICARE ACUTE|33,170.88|8366.955|8601.23|6242.28|||| 300|DRG||PERIPHERAL VASCULAR DISORDERS W CC|Managed Medicaid|MEDICAID SUPERIOR|26,358.25|6242.28|8601.23|6242.28|||| 300|DRG||PERIPHERAL VASCULAR DISORDERS W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|46,373.77|8601.23|8601.23|6242.28|||| 301|DRG||PERIPHERAL VASCULAR DISORDERS W/O CC/MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|24,303.35|6281.17|6600.64|6281.17|||| 301|DRG||PERIPHERAL VASCULAR DISORDERS W/O CC/MCC|Medicare|MEDICARE ACUTE|31,457.05|6600.64|6600.64|6281.17|||| 302|DRG||ATHEROSCLEROSIS W MCC|Medicare|MEDICARE ACUTE|30,985.25|8891.02|8891.02|8891.02|||| 303|DRG||ATHEROSCLEROSIS W/O MCC|Aetna|AETNA PPO|31,436.75|18076.13|18076.13|307.94|||| 303|DRG||ATHEROSCLEROSIS W/O MCC|Medicaid|MEDICAID|32,858.05|2758.41|18076.13|307.94|||| 303|DRG||ATHEROSCLEROSIS W/O MCC|Medicare|MEDICARE ACUTE|30,551.50|6290.28|18076.13|307.94|||| 303|DRG||ATHEROSCLEROSIS W/O MCC|Medicare|MEDICARE PART B ONLY IP|20,370.75|307.94|18076.13|307.94|||| 303|DRG||ATHEROSCLEROSIS W/O MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|26,058.80|1731.63|18076.13|307.94|||| 303|DRG||ATHEROSCLEROSIS W/O MCC|Veterans Affairs|VETERANS ADMINISTRATION|281.36|6289.4|18076.13|307.94|||| 304|DRG||HYPERTENSION W MCC|Medicare|MEDICARE ACUTE|54,806.05|8865.17|18702.67|8857.39|||| 304|DRG||HYPERTENSION W MCC|Humana Medicare Advantage|HUMANA MA|41,414.60|8857.39|18702.67|8857.39|||| 304|DRG||HYPERTENSION W MCC|Aetna|AETNA PPO|32,526.38|18702.67|18702.67|8857.39|||| 305|DRG||HYPERTENSION W/O MCC|Humana Medicare Advantage|HUMANA MA|39,409.50|6611.66|7411.01|3069.65|||| 305|DRG||HYPERTENSION W/O MCC|Blue Cross HMO Specialty|BCBSTX HMO|28,839.75|3069.65|7411.01|3069.65|||| 305|DRG||HYPERTENSION W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|42,561.30|3611.74|7411.01|3069.65|||| 305|DRG||HYPERTENSION W/O MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|28,196.78|3365.06|7411.01|3069.65|||| 305|DRG||HYPERTENSION W/O MCC|Veterans Affairs|VETERANS ADMINISTRATION|28,182.75|6635.08|7411.01|3069.65|||| 305|DRG||HYPERTENSION W/O MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|54,174.92|7411.01|7411.01|3069.65|||| 305|DRG||HYPERTENSION W/O MCC|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|281.35|6635.96|7411.01|3069.65|||| 305|DRG||HYPERTENSION W/O MCC|Medicare|MEDICARE ACUTE|40,521.25|6733.33|7411.01|3069.65|||| 305|DRG||HYPERTENSION W/O MCC|Medicaid|COUNTY INDIGENT HEALTH OTHER|33,663.75|3281.77|7411.01|3069.65|||| 307|DRG||CARDIAC CONGENITAL & VALVULAR DISORDERS W/O MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|31,786.50|7569.5|7683.99|7569.5|||| 307|DRG||CARDIAC CONGENITAL & VALVULAR DISORDERS W/O MCC|Medicare|MEDICARE ACUTE|18,764.75|7683.99|7683.99|7569.5|||| 308|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|44,083.50|9433.81|9536.585|1757.16|||| 308|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC|Blue Cross PPO Specialty|BCBSTX PPO|107,491.96|6038.46|9536.585|1757.16|||| 308|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|35,692.75|6020.94|9536.585|1757.16|||| 308|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC|Medicare|MEDICARE ACUTE|525.21|9461.09|9536.585|1757.16|||| 308|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|132,174.13|9463.05|9536.585|1757.16|||| 308|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC|Humana Medicare Advantage|HUMANA MA|69,104.10|9466.31|9536.585|1757.16|||| 308|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|16,296.51|1757.16|9536.585|1757.16|||| 308|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|53,635.03|9536.585|9536.585|1757.16|||| 308|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC|Medicaid|MOLINA HEALTHCARE OF TEXAS|106,905.23|3419.15|9536.585|1757.16|||| 308|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|480.32|9465.21|9536.585|1757.16|||| 309|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC|United Healthcare|UNITED HEALTHCARE|251.93|7556.19|38141.25|68.4|||| 309|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC|NON CONTRACTED|COMMERCIAL OTHER 1|38,141.25|38141.25|38141.25|68.4|||| 309|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|44,242.52|6775.51|38141.25|68.4|||| 309|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC|Medicare|MEDICARE ACUTE|32,034.60|6839.68|38141.25|68.4|||| 309|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC|Humana Medicare Advantage|HUMANA MA|39,339.15|68.4|38141.25|68.4|||| 309|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|31,356.25|6789.59|38141.25|68.4|||| 309|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC|Managed Medicaid|MEDICAID SUPERIOR|97,702.09|8821.91|38141.25|68.4|||| 309|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|36,199.50|4404.24|38141.25|68.4|||| 309|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC|Veterans Affairs|VETERANS ADMINISTRATION|31,064.88|6788.71|38141.25|68.4|||| 309|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|220.06|7039.74|38141.25|68.4|||| 309|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC|Managed Medicare|HEALTHSPRING MA|78,240.25|6780.13|38141.25|68.4|||| 310|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC|Managed Medicaid|MEDICAID SUPERIOR|62,693.28|4404.24|5666.34|2821.06|||| 310|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|46,533.75|3760.4|5666.34|2821.06|||| 310|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|39,224.75|5551.47|5666.34|2821.06|||| 310|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|224.50|5569.23|5666.34|2821.06|||| 310|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|35,677.80|2821.06|5666.34|2821.06|||| 310|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC|Medicaid|HENDERSON COUNTY INDIGENT|20,282.96|3339.88|5666.34|2821.06|||| 310|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|32,174.72|5666.34|5666.34|2821.06|||| 310|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC|Medicare|MEDICARE ACUTE|30,755.75|5569.23|5666.34|2821.06|||| 310|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|44,968.28|2926.21|5666.34|2821.06|||| 310|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC|Veterans Affairs|VETERANS ADMINISTRATION|19,249.25|5647.03|5666.34|2821.06|||| 311|DRG||ANGINA PECTORIS|Medicare|MEDICARE ACUTE|40,475.90|6439.98|6439.98|6439.98|||| 312|DRG||SYNCOPE & COLLAPSE|Cigna|CIGNA OTHER|29,722.80|29722.8|29722.8|1188.3|||| 312|DRG||SYNCOPE & COLLAPSE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|21,159.75|3417.6|29722.8|1188.3|||| 312|DRG||SYNCOPE & COLLAPSE|Managed Medicare|MA PART B ONLY IP|64,097.60|7134.97|29722.8|1188.3|||| 312|DRG||SYNCOPE & COLLAPSE|Humana Medicare Advantage|HUMANA MA|447.48|7134.97|29722.8|1188.3|||| 312|DRG||SYNCOPE & COLLAPSE|Veterans Affairs|VETERANS ADMINISTRATION|29,847.75|7163.13|29722.8|1188.3|||| 312|DRG||SYNCOPE & COLLAPSE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|404.13|3639.53|29722.8|1188.3|||| 312|DRG||SYNCOPE & COLLAPSE|Managed Medicare|HEALTHSPRING MA|72,019.75|2309.98|29722.8|1188.3|||| 312|DRG||SYNCOPE & COLLAPSE|Blue Cross PPO Specialty|BCBSTX PPO|43,535.50|4021.13|29722.8|1188.3|||| 312|DRG||SYNCOPE & COLLAPSE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|611.64|1188.3|29722.8|1188.3|||| 312|DRG||SYNCOPE & COLLAPSE|Medicare|MEDICARE ACUTE|32,881.50|7163.13|29722.8|1188.3|||| 313|DRG||CHEST PAIN|NON CONTRACTED|COMMERCIAL OTHER 1|22,974.30|15875.24|15875.24|517.28|||| 313|DRG||CHEST PAIN|Managed Medicaid|MEDICAID SUPERIOR|36,818.10|5177.63|15875.24|517.28|||| 313|DRG||CHEST PAIN|Humana Medicare Advantage|HUMANA MA|62,171.50|6541.93|15875.24|517.28|||| 313|DRG||CHEST PAIN|Veterans Affairs|VETERANS ADMINISTRATION|32,742.75|6578.88|15875.24|517.28|||| 313|DRG||CHEST PAIN|Medicaid|MEDICAID|47,459.60|3256.37|15875.24|517.28|||| 313|DRG||CHEST PAIN|Medicare|MEDICARE ACUTE|32,063.63|6631.11|15875.24|517.28|||| 313|DRG||CHEST PAIN|Medicare|MEDICARE PART B ONLY IP|15,537.25|517.28|15875.24|517.28|||| 313|DRG||CHEST PAIN|United Healthcare|UNITED HEALTHCARE|53,842.75|7146.56|15875.24|517.28|||| 313|DRG||CHEST PAIN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|33,751.75|6753.91|15875.24|517.28|||| 313|DRG||CHEST PAIN|Blue Cross PPO Specialty|BCBSTX PPO|24,887.60|1774.26|15875.24|517.28|||| 313|DRG||CHEST PAIN|Blue Cross HMO Specialty|BCBSTX HMO|37,921.25|3015.93|15875.24|517.28|||| 313|DRG||CHEST PAIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|32,436.27|3680.79|15875.24|517.28|||| 314|DRG||OTHER CIRCULATORY SYSTEM DIAGNOSES W MCC|Medicare|MEDICARE ACUTE|45,308.75|14675.8|14675.8|6268.77|||| 314|DRG||OTHER CIRCULATORY SYSTEM DIAGNOSES W MCC|Medicaid|HENDERSON COUNTY INDIGENT|100,069.55|6268.77|14675.8|6268.77|||| 315|DRG||OTHER CIRCULATORY SYSTEM DIAGNOSES W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|603.40|8346.04|8346.04|4764.29|||| 315|DRG||OTHER CIRCULATORY SYSTEM DIAGNOSES W CC|Blue Cross PPO Specialty|BCBSTX PPO|17,646.90|4764.29|8346.04|4764.29|||| 315|DRG||OTHER CIRCULATORY SYSTEM DIAGNOSES W CC|Medicare|MEDICARE ACUTE|34,032.53|7245.875|8346.04|4764.29|||| 315|DRG||OTHER CIRCULATORY SYSTEM DIAGNOSES W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|32,265.03|8178.135|8346.04|4764.29|||| 316|DRG||OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC/MCC|Medicare|MEDICARE ACUTE|26,761.58|6751.515|6751.515|3769.27|||| 316|DRG||OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|32,885.75|3769.27|6751.515|3769.27|||| 326|DRG||STOMACH, ESOPHAGEAL & DUODENAL PROC W MCC|Medicare|MEDICARE ACUTE|69,319.85|34753.72|34753.72|14920.81|||| 326|DRG||STOMACH, ESOPHAGEAL & DUODENAL PROC W MCC|Managed Medicare|HEALTHSPRING MA|865.42|34752.84|34753.72|14920.81|||| 326|DRG||STOMACH, ESOPHAGEAL & DUODENAL PROC W MCC|Medicaid|MOLINA HEALTHCARE OF TEXAS|138,463.90|14920.81|34753.72|14920.81|||| 326|DRG||STOMACH, ESOPHAGEAL & DUODENAL PROC W MCC|Blue Cross PPO Specialty|BCBSTX PPO|80,351.35|26368.85|34753.72|14920.81|||| 329|DRG||MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC|Humana Medicare Advantage|HUMANA MA|151,593.54|28415.87|63963.3|28415.87|||| 329|DRG||MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC|Cigna|CIGNA OTHER|1,293.23|63963.3|63963.3|28415.87|||| 329|DRG||MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|351,218.71|31738.9|63963.3|28415.87|||| 329|DRG||MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC|Medicare|MEDICARE ACUTE|196,499.58|32489.11|63963.3|28415.87|||| 329|DRG||MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|106,278.80|33075.24|63963.3|28415.87|||| 329|DRG||MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC|Managed Medicare|BCBS MEDICARE PPO MA|165,463.22|32502.31|63963.3|28415.87|||| 330|DRG||MAJOR SMALL & LARGE BOWEL PROCEDURES W CC|Blue Cross PPO Specialty|BCBSTX PPO|93,270.90|12659.4|28171.65|12659.4|||| 330|DRG||MAJOR SMALL & LARGE BOWEL PROCEDURES W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|63,231.80|13131.25|28171.65|12659.4|||| 330|DRG||MAJOR SMALL & LARGE BOWEL PROCEDURES W CC|Humana Medicare Advantage|HUMANA MA|106,083.03|17745.41|28171.65|12659.4|||| 330|DRG||MAJOR SMALL & LARGE BOWEL PROCEDURES W CC|Medicare|MEDICARE ACUTE|67,186.70|17756.44|28171.65|12659.4|||| 330|DRG||MAJOR SMALL & LARGE BOWEL PROCEDURES W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|121,352.95|17775.82|28171.65|12659.4|||| 330|DRG||MAJOR SMALL & LARGE BOWEL PROCEDURES W CC|United Healthcare|UNITED HEALTHCARE|71,694.30|25245.26|28171.65|12659.4|||| 330|DRG||MAJOR SMALL & LARGE BOWEL PROCEDURES W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|122,092.75|28171.65|28171.65|12659.4|||| 331|DRG||MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|63,046.80|8489.6|17707.58|7341.65|||| 331|DRG||MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|67,202.25|17707.58|17707.58|7341.65|||| 331|DRG||MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC|Medicare|MEDICARE ACUTE|74,812.93|12554.54|17707.58|7341.65|||| 331|DRG||MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC|Medicaid|MEDICAID|66,446.65|7341.65|17707.58|7341.65|||| 335|DRG||PERITONEAL ADHESIOLYSIS W MCC|Medicare|MEDICARE ACUTE|131,001.63|27162.3|27162.3|27162.3|||| 336|DRG||PERITONEAL ADHESIOLYSIS W CC|Medicare|MEDICARE ACUTE|141,655.85|16142.1|22641.6|11530.07|||| 336|DRG||PERITONEAL ADHESIOLYSIS W CC|Blue Cross PPO Specialty|BCBSTX PPO|114,535.20|11530.07|22641.6|11530.07|||| 336|DRG||PERITONEAL ADHESIOLYSIS W CC|United Healthcare|TML GROUP BENEFITS|42,142.55|22641.6|22641.6|11530.07|||| 337|DRG||PERITONEAL ADHESIOLYSIS W/O CC/MCC|Medicare|MEDICARE ACUTE|93,534.20|12462.59|12462.59|12462.59|||| 339|DRG||APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC|Tricare|TRICARE EAST REGION|138,189.35|11859.04|11859.04|8732.59|||| 339|DRG||APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC|Blue Cross PPO Specialty|BCBSTX PPO|68,669.15|8732.59|11859.04|8732.59|||| 340|DRG||APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC/MCC|Managed Medicare|BCBS MEDICARE PPO MA|55,949.65|9925.37|9925.37|6669.37|||| 340|DRG||APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC/MCC|Medicare|MEDICARE ACUTE|70,014.70|9925.37|9925.37|6669.37|||| 340|DRG||APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC/MCC|Managed Medicaid|MEDICAID SUPERIOR|471.05|6669.37|9925.37|6669.37|||| 341|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W MCC|Veterans Affairs|VETERANS ADMINISTRATION|76,104.25|17951.2|17951.2|17951.2|||| 342|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC|Veterans Affairs|VETERANS ADMINISTRATION|49,947.85|12277.12|12277.12|5956.29|||| 342|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC|Medicare|MEDICARE ACUTE|64,572.85|12079.85|12277.12|5956.29|||| 342|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC|Blue Cross HMO Specialty|BCBSTX HMO|51,253.95|6049.76|12277.12|5956.29|||| 342|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|58,631.71|7461.33|12277.12|5956.29|||| 342|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC|Blue Cross PPO Specialty|BCBSTX PPO|70,770.60|7118.12|12277.12|5956.29|||| 342|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|41,076.10|9470.5|12277.12|5956.29|||| 342|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC|Managed Medicaid|MEDICAID SUPERIOR|54,545.85|9470.5|12277.12|5956.29|||| 342|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC|Medicaid|LAW ENFORCEMENT OTHER|55,369.80|5956.29|12277.12|5956.29|||| 343|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|71,900.40|9383.47|37912.11|4627.72|||| 343|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC|Medicaid|MEDICAID|81,459.90|5135.84|37912.11|4627.72|||| 343|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|69,690.85|9210.19|37912.11|4627.72|||| 343|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC|Aetna|AETNA PPO|65,934.10|37912.11|37912.11|4627.72|||| 343|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|45,571.50|5444.95|37912.11|4627.72|||| 343|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC|Medicare|MEDICARE ACUTE|38,434.05|9303.715|37912.11|4627.72|||| 343|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|47,996.10|5647.9|37912.11|4627.72|||| 343|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|54,131.05|9795.61|37912.11|4627.72|||| 343|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC|Blue Cross HMO Specialty|BCBSTX HMO|42,934.73|4627.72|37912.11|4627.72|||| 345|DRG||MINOR SMALL & LARGE BOWEL PROCEDURES W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|52,899.30|12222.34|12222.34|12222.34|||| 347|DRG||ANAL & STOMAL PROCEDURES W MCC|Medicare|MEDICARE ACUTE|66,902.95|18408.09|18408.09|18408.09|||| 348|DRG||ANAL & STOMAL PROCEDURES W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|68,544.55|11009.14|11009.14|11009.14|||| 350|DRG||INGUINAL & FEMORAL HERNIA PROCEDURES W MCC|Medicare|MEDICARE ACUTE|71,762.76|17360.59|17360.59|17360.59|||| 351|DRG||INGUINAL & FEMORAL HERNIA PROCEDURES W CC|Medicare|MEDICARE ACUTE|48,438.40|11318.26|11318.26|11318.26|||| 352|DRG||INGUINAL & FEMORAL HERNIA PROCEDURES W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|44,352.55|5285.41|5285.41|5285.41|||| 355|DRG||HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W/O CC/MCC|Medicare|MEDICARE ACUTE|41,014.20|10605.26|10605.26|10605.26|||| 357|DRG||OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC|Aenta Medicare Advantage|AETNA MEDICARE MA|64,968.55|16016.94|16315.13|16016.94|||| 357|DRG||OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|30,373.60|16315.13|16315.13|16016.94|||| 36415|EAP|0300|ROUTINE DRAW|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Managed Medicare|WELLCARE CHOICE MA|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Managed Medicare|HOSPICE ETMC|||||0.82||| 36415|EAP|0300|VENIPUNCTURE FOR ETOH|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Managed Medicaid|MEDICAID SUPERIOR|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Managed Medicare|BCBS MEDICARE PPO MA|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Managed Medicaid|MEDICAID AMERIGROUP|0.82||||0.82||| 36415|EAP|0300|VENIPUNCTURE FOR ETOH|Managed Medicare|OTHER INSTITUTIONS|||||68.50||| 36415|EAP|0300|ROUTINE DRAW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Managed Medicare|MEDICARE RAILROAD|||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Cigna|CIGNA OTHER|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Humana Medicare Advantage|HUMANA MA|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Managed Medicare|MA PART B ONLY IP|0.82||||||| 36415|EAP|0300|ROUTINE DRAW|Blue Cross HMO Specialty|BCBSTX HMO|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Managed Medicare|OTHER INSTITUTIONS|||||19.75||| 36415|EAP|0300|ROUTINE DRAW|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Brinson Benefits|THE HEALTH PLAN SMITH CO|||||0.82||| 36415|EAP|0300|ROUTINE DRAW|ChampVA|CHAMPVA CENTER|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Managed Medicare|VAN ZANDT COUNTY INMATE|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||0.82||| 36415|EAP|0300|ROUTINE DRAW|MTC Medical|VAN ZANDT COUNTY INMATE|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Managed Medicare|HEALTHSPRING MA|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Blue Cross PPO Specialty|BCBSTX PPO|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Access Direct Platinum|HEALTHFIRST TPA UMR|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Blue Cross PPO Specialty|BCBSTX OTHER|||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Managed Medicare|HOSPICE OF EAST TEXAS|0.82||||||| 36415|EAP|0300|ROUTINE DRAW|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Aetna|BOON CHAPMAN|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Aetna|AETNA OTHER|||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Cigna|CIGNA|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Aenta Medicare Advantage|AETNA MEDICARE MA|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Aetna|AETNA PPO|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Tricare|TRICARE EAST REGION|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|NON CONTRACTED|COMMERCIAL OTHER 1|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Multiplan|NALC|||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Medicare|MEDICARE ACUTE|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|UTMB|UTMB CORRECTIONAL MANAGED CARE|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|PHCS|HUMANA|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.82||| 36415|EAP|0300|ROUTINE DRAW|United Healthcare|UNITED HEALTHCARE|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|United Healthcare|UNITED HEALTHCARE OTHER|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Texas Workforce Commission|DIS DETER SERV (DDS)|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|United Healthcare|UMR UNITED MEDICAL RESOURCES|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|United Healthcare|GOLDEN RULE|||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Tricare|TRICARE FOR LIFE|||||0.82||| 36415|EAP|0300|ROUTINE DRAW|PHCS|MULTIPLAN PHCS OTHER|||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Medicaid|MOLINA HEALTHCARE OF TEXAS|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|PHCS|HUMANA INSURANCE|||||0.82||| 36415|EAP|0300|ROUTINE DRAW|United Healthcare|GEHA|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Medicaid|HENDERSON COUNTY INDIGENT|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|United Healthcare|TML GROUP BENEFITS|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Medicaid|MEDICAID HMO|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Medicaid Out of State|MEDICAID LOUISIANA|||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Medicare|MEDICARE PART B ONLY IP|0.82||||||| 36415|EAP|0300|ROUTINE DRAW|Medicaid|COUNTY INDIGENT HEALTH OTHER|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Medicaid|MEDICAID|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Veterans Affairs|VETERANS ADMINISTRATION|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Workers Compensation|UT EMPLOYEE INJURY|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Medicaid|MEDICAID TEXAS CHILDRENS|||||0.82||| 36415|EAP|0300|ROUTINE DRAW|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|United Medicare Advantage|UHC AARP MCR HMO MA|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Medicaid|LAW ENFORCEMENT OTHER|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|United Medicare Advantage|UHC MEDICARE GOLD MA|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|Workers Compensation|TEXAS MUTUAL INSURANCE|||||0.82||| 36415|EAP|0300|ROUTINE DRAW|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.82||||0.82||| 36415|EAP|0300|ROUTINE DRAW|United Medicare Advantage|UHC AARP WELLMED HMO MA|||||0.82||| 36430|EAP|0391|BLOOD TRANSFUSION SERVICE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,356.76||||10.27||| 36430|EAP|0391|BLOOD TRANSFUSION SERVICE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,356.76||||1,356.76||| 36430|EAP|0391|BLOOD TRANSFUSION SERVICE|Blue Cross PPO Specialty|BCBSTX PPO|||||10.27||| 36430|EAP|0391|BLOOD TRANSFUSION SERVICE|Cigna|CIGNA|||||1,356.76||| 36430|EAP|0391|BLOOD TRANSFUSION SERVICE|Humana Medicare Advantage|HUMANA MA|||||1,356.76||| 36430|EAP|0391|BLOOD TRANSFUSION SERVICE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1,356.76||||1,356.76||| 36430|EAP|0391|BLOOD TRANSFUSION SERVICE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1,356.76||||10.27||| 36430|EAP|0391|BLOOD TRANSFUSION SERVICE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1,356.76||||||| 36430|EAP|0391|BLOOD TRANSFUSION SERVICE|Managed Medicaid|MEDICAID SUPERIOR|1,356.76||||10.27||| 36430|EAP|0391|BLOOD TRANSFUSION SERVICE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||10.27||| 36430|EAP|0391|BLOOD TRANSFUSION SERVICE|Humana Medicare Advantage|HUMANA MA|||||10.27||| 36430|EAP|0391|BLOOD TRANSFUSION SERVICE|United Medicare Advantage|UHC AARP MCR HMO MA|||||1,356.76||| 36430|EAP|0391|BLOOD TRANSFUSION SERVICE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,356.76||| 36430|EAP|0391|BLOOD TRANSFUSION SERVICE|United Healthcare|UNITED HEALTHCARE OTHER|||||1,356.76||| 36430|EAP|0391|BLOOD TRANSFUSION SERVICE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||10.27||| 36430|EAP|0391|BLOOD TRANSFUSION SERVICE|United Healthcare|UNITED HEALTHCARE|||||1,356.76||| 36430|EAP|0391|BLOOD TRANSFUSION SERVICE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||10.27||| 36430|EAP|0391|BLOOD TRANSFUSION SERVICE|Medicaid|MEDICAID|||||1,356.76||| 36430|EAP|0391|BLOOD TRANSFUSION SERVICE|Managed Medicaid|MEDICAID AMERIGROUP|||||10.27||| 36430|EAP|0391|BLOOD TRANSFUSION SERVICE|Medicaid|MEDICAID HMO|1,356.76||||||| 36430|EAP|0391|BLOOD TRANSFUSION SERVICE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1,356.76||| 36430|EAP|0391|BLOOD TRANSFUSION SERVICE|Medicare|MEDICARE ACUTE|1,356.76||||1,356.76||| 36430|EAP|0391|BLOOD TRANSFUSION SERVICE|Medicare|MEDICARE ACUTE|1,356.76||||10.27||| 36556|EAP|0450|INSERT NON-TUNNEL CV CATH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2,317.50||| 36569|EAP|0761|PICC LINE INSERTION (NON|UTMB|UTMB CORRECTIONAL MANAGED CARE|20.98||||||| 36569|EAP|0761|PICC LINE INSERTION (NON|Tricare|TRICARE EAST REGION|20.98||||||| 36569|EAP|0761|PICC LINE INSERTION (NON|NON CONTRACTED|COMMERCIAL OTHER 1|20.98||||||| 36569|EAP|0761|PICC LINE INSERTION (NON|Managed Medicare|BCBS MEDICARE PPO MA|20.98||||||| 36569|EAP|0761|PICC LINE INSERTION (NON|Managed Medicare|HEALTHSPRING MA|20.98||||20.98||| 36569|EAP|0761|PICC LINE INSERTION (NON|Medicaid|MEDICAID|20.98||||||| 36569|EAP|0761|PICC LINE INSERTION (NON|United Medicare Advantage|AARP UHC WEST COMPLETE MA|20.98||||||| 36569|EAP|0761|PICC LINE INSERTION (NON|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|20.98||||20.98||| 36569|EAP|0761|PICC LINE INSERTION (NON|United Healthcare|UNITED HEALTHCARE|||||20.98||| 36569|EAP|0761|PICC LINE INSERTION (NON|United Healthcare|UNITED HEALTHCARE|20.98||||||| 36569|EAP|0761|PICC LINE INSERTION (NON|United Healthcare|TML GROUP BENEFITS|||||20.98||| 36569|EAP|0761|PICC LINE INSERTION (NON|Veterans Affairs|VETERANS ADMINISTRATION|||||20.98||| 36569|EAP|0761|PICC LINE INSERTION (NON|Aetna|BOON CHAPMAN|20.98||||||| 36569|EAP|0761|PICC LINE INSERTION (NON|Aetna|AETNA PPO|20.98||||||| 36569|EAP|0761|PICC LINE INSERTION (NON|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|20.98||||||| 36569|EAP|0761|PICC LINE INSERTION (NON|United Medicare Advantage|UHC MEDICARE GOLD MA|20.98||||||| 36569|EAP|0761|PICC LINE INSERTION (NON|Medicare|MEDICARE ACUTE|20.98||||20.98||| 36569|EAP|0761|PICC LINE INSERTION (NON|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|20.98||||||| 36569|EAP|0761|PICC LINE INSERTION (NON|Blue Cross PPO Specialty|BCBSTX PPO|20.98||||||| 36569|EAP|0761|PICC LINE INSERTION (NON|Managed Medicaid|MEDICAID AMERIGROUP|20.98||||||| 36569|EAP|0761|PICC LINE INSERTION (NON|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|20.98||||20.98||| 36569|EAP|0761|PICC LINE INSERTION (NON|Blue Cross HMO Specialty|BCBSTX HMO|20.98||||||| 36569|EAP|0761|PICC LINE INSERTION (NON|Cigna|CIGNA OTHER|20.98||||||| 36569|EAP|0761|PICC LINE INSERTION (NON|Medicaid|MOLINA HEALTHCARE OF TEXAS|20.98||||20.98||| 36569|EAP|0761|PICC LINE INSERTION (NON|Managed Medicaid|MEDICAID SUPERIOR|20.98||||||| 36569|EAP|0761|PICC LINE INSERTION (NON|Humana Medicare Advantage|HUMANA MA|20.98||||20.98||| 36569|EAP|0761|PICC LINE INSERTION (NON|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|20.98||||||| 36569|EAP|0761|PICC LINE INSERTION (NON|Managed Medicaid|MEDICAID UNITED HEALTHCARE|20.98||||||| 36598|EAP|0361|INJ W/FLURO CENTRAL VENOU|Blue Cross PPO Specialty|BCBSTX PPO|||||485.50||| 36598|EAP|0361|INJ W/FLURO CENTRAL VENOU|Medicare|MEDICARE ACUTE|||||485.50||| 36600|EAP|0300|ARTERIAL PUNCTURE|Medicare|MEDICARE ACUTE|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|United Medicare Advantage|UHC AARP MCR HMO MA|||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|Veterans Affairs|VETERANS ADMINISTRATION|||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|Workers Compensation|UT EMPLOYEE INJURY|933.25||||||| 36600|EAP|0300|ARTERIAL PUNCTURE|Veterans Affairs|VETERANS ADMINISTRATION|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|Medicaid|MOLINA HEALTHCARE OF TEXAS|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|Medicaid|MEDICAID HMO|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|Medicaid|MEDICAID|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|Medicaid|HENDERSON COUNTY INDIGENT|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|United Healthcare|UNITED HEALTHCARE|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|United Medicare Advantage|UHC MEDICARE GOLD MA|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|Medicare|MEDICARE PART B ONLY IP|933.25||||||| 36600|EAP|0300|ARTERIAL PUNCTURE|United Healthcare|UNITED HEALTHCARE|||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|Tricare|TRICARE EAST REGION|933.25||||||| 36600|EAP|0300|ARTERIAL PUNCTURE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|Managed Medicaid|MEDICAID SUPERIOR|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|United Healthcare|UMR UNITED MEDICAL RESOURCES|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|NON CONTRACTED|COMMERCIAL OTHER 1|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|UTMB|UTMB CORRECTIONAL MANAGED CARE|933.25||||||| 36600|EAP|0300|ARTERIAL PUNCTURE|Managed Medicare|BCBS MEDICARE PPO MA|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|Managed Medicare|HOSPICE OF EAST TEXAS|933.25||||||| 36600|EAP|0300|ARTERIAL PUNCTURE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|Medicaid|LAW ENFORCEMENT OTHER|||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|Managed Medicare|HEALTHSPRING MA|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|Managed Medicaid|MEDICAID AMERIGROUP|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|Managed Medicare|MA PART B ONLY IP|933.25||||||| 36600|EAP|0300|ARTERIAL PUNCTURE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|Managed Medicare|VAN ZANDT COUNTY INMATE|933.25||||||| 36600|EAP|0300|ARTERIAL PUNCTURE|MTC Medical|VAN ZANDT COUNTY INMATE|933.25||||||| 36600|EAP|0300|ARTERIAL PUNCTURE|Humana Medicare Advantage|HUMANA MA|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|Aetna|AETNA PPO|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|Aenta Medicare Advantage|AETNA MEDICARE MA|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|Blue Cross HMO Specialty|BCBSTX HMO|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|Aetna|AETNA OTHER|||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|Blue Cross PPO Specialty|BCBSTX PPO|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|Cigna|CIGNA OTHER|933.25||||||| 36600|EAP|0300|ARTERIAL PUNCTURE|Cigna|CIGNA|933.25||||||| 36600|EAP|0300|ARTERIAL PUNCTURE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|Cigna|CIGNA|933.25||||933.25||| 36600|EAP|0300|ARTERIAL PUNCTURE|United Healthcare|UNITED HEALTHCARE OTHER|||||933.25||| 368|DRG||MAJOR ESOPHAGEAL DISORDERS W MCC|Medicare|MEDICARE ACUTE|126,425.80|14127.38|14127.38|14127.38|||| 369|DRG||MAJOR ESOPHAGEAL DISORDERS W CC|Blue Cross PPO Specialty|BCBSTX PPO|32,985.10|5562.85|5562.85|5562.85|||| 371|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|44,943.25|12792.6|15015.95|8506.47|||| 371|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|24,341.05|15015.95|15015.95|8506.47|||| 371|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|66,569.50|13003.85|15015.95|8506.47|||| 371|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC|Medicaid|MEDICAID|222,430.40|10696.16|15015.95|8506.47|||| 371|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC|Blue Cross PPO Specialty|BCBSTX PPO|126,291.30|8506.47|15015.95|8506.47|||| 371|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC|Medicare|MEDICARE ACUTE|60,321.08|12778.96|15015.95|8506.47|||| 371|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC|Humana Medicare Advantage|HUMANA MA|154,988.10|12889.585|15015.95|8506.47|||| 372|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|35,350.35|5403.83|8569.06|4710.85|||| 372|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC|Blue Cross PPO Specialty|BCBSTX PPO|28,325.30|5209.65|8569.06|4710.85|||| 372|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC|Humana Medicare Advantage|HUMANA MA|30,765.53|8569.06|8569.06|4710.85|||| 372|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC|Medicare|MEDICARE ACUTE|44,212.16|8569.06|8569.06|4710.85|||| 372|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC|Tricare|TRICARE EAST REGION|75,579.75|4710.85|8569.06|4710.85|||| 373|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W/O CC/MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|34,650.45|6798.29|6798.29|6798.29|||| 374|DRG||DIGESTIVE MALIGNANCY W MCC|Managed Medicaid|MEDICAID SUPERIOR|87,353.20|13371.77|13371.77|13371.77|||| 375|DRG||DIGESTIVE MALIGNANCY W CC|Medicare|MEDICARE ACUTE|33,919.38|9734.85|9734.85|9587.74|||| 375|DRG||DIGESTIVE MALIGNANCY W CC|Humana Medicare Advantage|HUMANA MA|58,054.86|9587.74|9734.85|9587.74|||| 376|DRG||DIGESTIVE MALIGNANCY W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|58,082.25|8289.12|8289.12|8289.12|||| 377|DRG||G.I. HEMORRHAGE W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|29,509.18|9731.18|17683.07|7471.35|||| 377|DRG||G.I. HEMORRHAGE W MCC|Medicare|MEDICARE ACUTE|678.95|13054.03|17683.07|7471.35|||| 377|DRG||G.I. HEMORRHAGE W MCC|Humana Medicare Advantage|HUMANA MA|501.75|12269.03|17683.07|7471.35|||| 377|DRG||G.I. HEMORRHAGE W MCC|United Healthcare|UMR UNITED MEDICAL RESOURCES|112,244.51|17683.07|17683.07|7471.35|||| 377|DRG||G.I. HEMORRHAGE W MCC|Cigna|CIGNA|33,577.25|7471.35|17683.07|7471.35|||| 378|DRG||G.I. HEMORRHAGE W CC|Managed Medicaid|MEDICAID SUPERIOR|26,205.25|6221.48|42062.53|4968.34|||| 378|DRG||G.I. HEMORRHAGE W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|50,951.55|5153.52|42062.53|4968.34|||| 378|DRG||G.I. HEMORRHAGE W CC|Blue Cross PPO Specialty|BCBSTX PPO|36,107.75|4968.34|42062.53|4968.34|||| 378|DRG||G.I. HEMORRHAGE W CC|United Healthcare|UNITED HEALTHCARE|41,139.05|9872.11|42062.53|4968.34|||| 378|DRG||G.I. HEMORRHAGE W CC|NON CONTRACTED|COMMERCIAL OTHER 1|42,062.53|42062.53|42062.53|4968.34|||| 378|DRG||G.I. HEMORRHAGE W CC|Veterans Affairs|VETERANS ADMINISTRATION|52,989.05|8225.52|42062.53|4968.34|||| 378|DRG||G.I. HEMORRHAGE W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|66,555.80|8224.64|42062.53|4968.34|||| 378|DRG||G.I. HEMORRHAGE W CC|Humana Medicare Advantage|HUMANA MA|41,611.50|8211.02|42062.53|4968.34|||| 378|DRG||G.I. HEMORRHAGE W CC|Medicare|MEDICARE ACUTE|49,695.63|8225.52|42062.53|4968.34|||| 378|DRG||G.I. HEMORRHAGE W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|60,354.30|8224.64|42062.53|4968.34|||| 378|DRG||G.I. HEMORRHAGE W CC|United Medicare Advantage|UHC MEDICARE GOLD MA|49,980.75|8352.06|42062.53|4968.34|||| 379|DRG||G.I. HEMORRHAGE W/O CC/MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|36,913.35|6192.06|6192.06|5185.58|||| 379|DRG||G.I. HEMORRHAGE W/O CC/MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|370.19|5185.58|6192.06|5185.58|||| 379|DRG||G.I. HEMORRHAGE W/O CC/MCC|Medicare|MEDICARE ACUTE|28,932.25|6104.45|6192.06|5185.58|||| 380|DRG||COMPLICATED PEPTIC ULCER W MCC|Humana Medicare Advantage|HUMANA MA|54,575.99|13776.05|13776.05|11530.355|||| 380|DRG||COMPLICATED PEPTIC ULCER W MCC|Medicare|MEDICARE ACUTE|44,850.05|11530.355|13776.05|11530.355|||| 381|DRG||COMPLICATED PEPTIC ULCER W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|36,243.75|6356.69|8987.13|6356.69|||| 381|DRG||COMPLICATED PEPTIC ULCER W CC|Humana Medicare Advantage|HUMANA MA|33,551.50|8756.21|8987.13|6356.69|||| 381|DRG||COMPLICATED PEPTIC ULCER W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|107,506.52|8987.13|8987.13|6356.69|||| 381|DRG||COMPLICATED PEPTIC ULCER W CC|Medicare|MEDICARE ACUTE|79,243.15|8910.97|8987.13|6356.69|||| 382|DRG||COMPLICATED PEPTIC ULCER W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|56,232.80|6990.35|6990.35|6990.35|||| 384|DRG||UNCOMPLICATED PEPTIC ULCER W/O MCC|Humana Medicare Advantage|HUMANA MA|29,508.35|7462.62|7462.62|7462.62|||| 386|DRG||INFLAMMATORY BOWEL DISEASE W CC|Blue Cross PPO Specialty|BCBSTX PPO|57,133.65|4917.16|4917.16|4917.16|||| 387|DRG||INFLAMMATORY BOWEL DISEASE W/O CC/MCC|Managed Medicaid|MEDICAID SUPERIOR|43,211.10|4970.49|4970.49|3495.34|||| 387|DRG||INFLAMMATORY BOWEL DISEASE W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|27,642.58|3495.34|4970.49|3495.34|||| 388|DRG||G.I. OBSTRUCTION W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|77,633.20|883.56|11552.07|883.56|||| 388|DRG||G.I. OBSTRUCTION W MCC|Medicare|MEDICARE ACUTE|89,714.65|11552.07|11552.07|883.56|||| 389|DRG||G.I. OBSTRUCTION W CC|Managed Medicare|HEALTHSPRING MA|46,146.15|7415.89|49860.75|4230.33|||| 389|DRG||G.I. OBSTRUCTION W CC|Medicare|MEDICARE ACUTE|42,966.68|7360.62|49860.75|4230.33|||| 389|DRG||G.I. OBSTRUCTION W CC|Humana Medicare Advantage|HUMANA MA|47,925.50|7355.83|49860.75|4230.33|||| 389|DRG||G.I. OBSTRUCTION W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|59,063.15|4601.86|49860.75|4230.33|||| 389|DRG||G.I. OBSTRUCTION W CC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|56,872.80|5899.03|49860.75|4230.33|||| 389|DRG||G.I. OBSTRUCTION W CC|NON CONTRACTED|COMMERCIAL OTHER 1|62,214.70|49860.75|49860.75|4230.33|||| 389|DRG||G.I. OBSTRUCTION W CC|Blue Cross PPO Specialty|BCBSTX PPO|31,974.10|4230.33|49860.75|4230.33|||| 389|DRG||G.I. OBSTRUCTION W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|36,172.55|4324.34|49860.75|4230.33|||| 389|DRG||G.I. OBSTRUCTION W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|54,061.83|7292.71|49860.75|4230.33|||| 390|DRG||G.I. OBSTRUCTION W/O CC/MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|36,966.55|5694.1|5790.78|623.31|||| 390|DRG||G.I. OBSTRUCTION W/O CC/MCC|Cigna|CIGNA|24,788.85|623.31|5790.78|623.31|||| 390|DRG||G.I. OBSTRUCTION W/O CC/MCC|Managed Medicare|HEALTHSPRING MA|48,951.30|5694.98|5790.78|623.31|||| 390|DRG||G.I. OBSTRUCTION W/O CC/MCC|United Healthcare|UMR UNITED MEDICAL RESOURCES|25,338.15|5790.78|5790.78|623.31|||| 390|DRG||G.I. OBSTRUCTION W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|27,178.95|2965.05|5790.78|623.31|||| 390|DRG||G.I. OBSTRUCTION W/O CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|23,018.80|3075.56|5790.78|623.31|||| 390|DRG||G.I. OBSTRUCTION W/O CC/MCC|Medicaid|MEDICAID|42,877.85|3710.08|5790.78|623.31|||| 390|DRG||G.I. OBSTRUCTION W/O CC/MCC|Blue Cross HMO Specialty|BCBSTX HMO|25,071.60|2520.02|5790.78|623.31|||| 390|DRG||G.I. OBSTRUCTION W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|31,027.80|5775.08|5790.78|623.31|||| 390|DRG||G.I. OBSTRUCTION W/O CC/MCC|Medicare|MEDICARE ACUTE|36,439.60|5694.1|5790.78|623.31|||| 390|DRG||G.I. OBSTRUCTION W/O CC/MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|25,051.75|5694.98|5790.78|623.31|||| 391|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC|Medicare|MEDICARE ACUTE|56,376.68|9740.91|14068.08|9740.91|||| 391|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC|Humana Medicare Advantage|HUMANA MA|133,820.94|9759.33|14068.08|9740.91|||| 391|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|106,453.16|14068.08|14068.08|9740.91|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Veterans Affairs|VETERANS ADMINISTRATION|41,683.58|6821.35|33227.55|904.16|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Cigna|CIGNA OTHER|0.00||||||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|50,549.95|6821.79|33227.55|904.16|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|93,839.43|6894.085|33227.55|904.16|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|United Healthcare|UNITED HEALTHCARE|71,009.50|7608.15|33227.55|904.16|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|NON CONTRACTED|COMMERCIAL OTHER 1|33,227.55|33227.55|33227.55|904.16|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Medicare|MEDICARE PART B ONLY IP|22,416.30|904.16|33227.55|904.16|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Medicaid|HENDERSON COUNTY INDIGENT|25,638.30|3261.37|33227.55|904.16|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Medicare|MEDICARE ACUTE|36,189.80|6821.79|33227.55|904.16|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|43,683.84|3888.855|33227.55|904.16|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|55,177.30|6793.63|33227.55|904.16|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|28,399.05|7075.99|33227.55|904.16|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|35,661.05|3789.84|33227.55|904.16|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Blue Cross HMO Specialty|BCBSTX HMO|24,545.78|3221.03|33227.55|904.16|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|40,586.80|6869.955|33227.55|904.16|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Cigna|CIGNA|43,135.60|14781.36|33227.55|904.16|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Medicaid|MOLINA HEALTHCARE OF TEXAS|31,575.55|3261.37|33227.55|904.16|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Managed Medicare|HEALTHSPRING MA|38,565.45|6922.58|33227.55|904.16|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|United Healthcare|UMR UNITED MEDICAL RESOURCES|35,156.35|7608.15|33227.55|904.16|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|53,012.15|6621.04|33227.55|904.16|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|43,177.65|6304.7|33227.55|904.16|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Tricare|TRICARE EAST REGION|42,894.50|3956.63|33227.55|904.16|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Humana Medicare Advantage|HUMANA MA|57,286.50|6806.63|33227.55|904.16|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|36,997.35|6922.58|33227.55|904.16|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Managed Medicaid|MEDICAID AMERIGROUP|43,361.41|4726.68|33227.55|904.16|||| 393|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC|Humana Medicare Advantage|HUMANA MA|55,876.35|748.65|18126.84|748.65|||| 393|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|61,355.20|6539.015|18126.84|748.65|||| 393|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|46,960.25|12169.77|18126.84|748.65|||| 393|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC|Medicare|MEDICARE ACUTE|31,004.25|12366.7|18126.84|748.65|||| 393|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC|Managed Medicare|HEALTHSPRING MA|189,263.15|18126.84|18126.84|748.65|||| 394|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W CC|NON CONTRACTED|COMMERCIAL OTHER 1|74,921.65|51695.94|51695.94|4390.45|||| 394|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W CC|Medicaid|MEDICAID|42,159.80|4390.45|51695.94|4390.45|||| 394|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|46,650.05|8036.63|51695.94|4390.45|||| 394|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W CC|United Medicare Advantage|UHC MEDICARE GOLD MA|311.95|8036.63|51695.94|4390.45|||| 394|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W CC|Medicare|MEDICARE ACUTE|54,047.10|7915.34|51695.94|4390.45|||| 394|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W CC|Aenta Medicare Advantage|AETNA MEDICARE MA|40,365.05|7899.12|51695.94|4390.45|||| 394|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W CC|Aetna|AETNA PPO|78,325.46|45037.14|51695.94|4390.45|||| 394|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W CC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|36,302.85|4816.63|51695.94|4390.45|||| 394|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W CC|Humana Medicare Advantage|HUMANA MA|58,708.25|7976.775|51695.94|4390.45|||| 394|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W CC|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|21,807.25|8036.63|51695.94|4390.45|||| 395|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|46,812.85|6143.18|6202.645|2462.48|||| 395|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W/O CC/MCC|Managed Medicaid|MEDICAID AMERIGROUP|30,217.25|3915.34|6202.645|2462.48|||| 395|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W/O CC/MCC|Blue Cross HMO Specialty|BCBSTX HMO|25,439.10|2884.6|6202.645|2462.48|||| 395|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W/O CC/MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|41,861.30|6145.78|6202.645|2462.48|||| 395|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W/O CC/MCC|Medicare|MEDICARE ACUTE|47,588.38|6202.645|6202.645|2462.48|||| 395|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W/O CC/MCC|Medicaid|MEDICAID|28,703.20|2462.48|6202.645|2462.48|||| 4|DRG||TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R.|United Medicare Advantage|AARP UHC WEST COMPLETE MA|456,046.45|75019.19|86629.9|75019.19|||| 4|DRG||TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R.|Humana Medicare Advantage|HUMANA MA|732,207.99|86629.9|86629.9|75019.19|||| 40|DRG||PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W MCC|Humana Medicare Advantage|HUMANA MA|200,158.05|26976.29|26976.29|26485.99|||| 40|DRG||PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|175,470.10|26485.99|26976.29|26485.99|||| 41|DRG||PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W CC OR PERIPH NEUROSTIM|Medicare|MEDICARE ACUTE|54,934.83|16497.89|16497.89|16497.89|||| 417|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|240,477.48|17326.35|17326.35|17171.895|||| 417|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W MCC|Medicare|MEDICARE ACUTE|141,128.65|17171.895|17326.35|17171.895|||| 417|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|93,006.75|17326.35|17326.35|17171.895|||| 418|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|52,854.75|8440.97|29250.17|6637.04|||| 418|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC|Blue Cross PPO Specialty|BCBSTX PPO|94,716.30|8349.29|29250.17|6637.04|||| 418|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC|Blue Cross HMO Specialty|BCBSTX HMO|38,185.20|7278.88|29250.17|6637.04|||| 418|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC|Humana Medicare Advantage|HUMANA MA|56,186.60|12445.72|29250.17|6637.04|||| 418|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC|Medicare|MEDICARE ACUTE|83,100.60|12442.88|29250.17|6637.04|||| 418|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC|Medicaid|MEDICAID|44,930.90|6637.04|29250.17|6637.04|||| 418|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC|Texas Workforce Commission|DIS DETER SERV (DDS)|97,500.55|29250.17|29250.17|6637.04|||| 418|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC|Managed Medicaid|MEDICAID AMERIGROUP|71,503.65|10552.89|29250.17|6637.04|||| 418|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|53,325.05|12442.88|29250.17|6637.04|||| 419|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|63,731.68|10185.7|43450.45|5561.11|||| 419|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC|NON CONTRACTED|COMMERCIAL OTHER 1|43,450.45|43450.45|43450.45|5561.11|||| 419|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC|United Healthcare|UNITED HEALTHCARE OTHER|63,557.60|13056.24|43450.45|5561.11|||| 419|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC|Managed Medicaid|MEDICAID SUPERIOR|55,974.98|9258.79|43450.45|5561.11|||| 419|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC|Managed Medicare|HEALTHSPRING MA|73,248.55|12442.88|43450.45|5561.11|||| 419|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC|Medicare|MEDICARE ACUTE|48,135.65|10362.54|43450.45|5561.11|||| 419|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC|Blue Cross HMO Specialty|BCBSTX HMO|42,818.60|5561.11|43450.45|5561.11|||| 419|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|45,839.83|6543.17|43450.45|5561.11|||| 419|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|50,936.85|6787.06|43450.45|5561.11|||| 419|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|64,445.40|10280.72|43450.45|5561.11|||| 421|DRG||HEPATOBILIARY DIAGNOSTIC PROCEDURES W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|79,663.40|13748.12|13748.12|13748.12|||| 432|DRG||CIRRHOSIS & ALCOHOLIC HEPATITIS W MCC|Humana Medicare Advantage|HUMANA MA|99,864.39|13404.3|13404.3|8421.15|||| 432|DRG||CIRRHOSIS & ALCOHOLIC HEPATITIS W MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|70,780.75|8421.15|13404.3|8421.15|||| 432|DRG||CIRRHOSIS & ALCOHOLIC HEPATITIS W MCC|Medicare|MEDICARE ACUTE|59,203.97|13399.08|13404.3|8421.15|||| 433|DRG||CIRRHOSIS & ALCOHOLIC HEPATITIS W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|43,633.25|8496.58|8628.99|5422.38|||| 433|DRG||CIRRHOSIS & ALCOHOLIC HEPATITIS W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|41,560.26|8556.78|8628.99|5422.38|||| 433|DRG||CIRRHOSIS & ALCOHOLIC HEPATITIS W CC|Medicare|MEDICARE ACUTE|43,517.08|8628.99|8628.99|5422.38|||| 433|DRG||CIRRHOSIS & ALCOHOLIC HEPATITIS W CC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|83,518.18|5422.38|8628.99|5422.38|||| 434|DRG||CIRRHOSIS & ALCOHOLIC HEPATITIS W/O CC/MCC|Managed Medicare|HEALTHSPRING MA|29,966.55|6067.64|18062.1|6067.64|||| 434|DRG||CIRRHOSIS & ALCOHOLIC HEPATITIS W/O CC/MCC|Aetna|AETNA PPO|31,412.35|18062.1|18062.1|6067.64|||| 435|DRG||MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W MCC|Medicare|MEDICARE ACUTE|53,691.58|12720.69|14678.21|12720.69|||| 435|DRG||MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|255,064.05|14678.21|14678.21|12720.69|||| 436|DRG||MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W CC|Medicare|MEDICARE ACUTE|59,570.04|9148.99|9148.99|9049.74|||| 436|DRG||MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W CC|Humana Medicare Advantage|HUMANA MA|35,404.45|9049.74|9148.99|9049.74|||| 43762|EAP|0450|CATH/TUBE CARE/TREATMENT|United Medicare Advantage|UHC AARP MCR HMO MA|||||277.50||| 43762|EAP|0450|CATH/TUBE CARE/TREATMENT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||277.50||| 43762|EAP|0450|CATH/TUBE CARE/TREATMENT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|277.50||||||| 43762|EAP|0450|CATH/TUBE CARE/TREATMENT|Medicare|MEDICARE PART B ONLY IP|277.50||||||| 43762|EAP|0450|CATH/TUBE CARE/TREATMENT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|277.50||||||| 43762|EAP|0450|CATH/TUBE CARE/TREATMENT|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||277.50||| 43762|EAP|0450|CATH/TUBE CARE/TREATMENT|Medicare|MEDICARE ACUTE|277.50||||277.50||| 43762|EAP|0450|CATH/TUBE CARE/TREATMENT|NON CONTRACTED|COMMERCIAL OTHER 1|277.50||||||| 43762|EAP|0450|CATH/TUBE CARE/TREATMENT|Blue Cross PPO Specialty|BCBSTX PPO|277.50||||277.50||| 43762|EAP|0450|CATH/TUBE CARE/TREATMENT|Medicaid|MEDICAID|277.50||||277.50||| 43762|EAP|0450|CATH/TUBE CARE/TREATMENT|Blue Cross HMO Specialty|BCBSTX HMO|||||277.50||| 43762|EAP|0450|CATH/TUBE CARE/TREATMENT|Managed Medicaid|MEDICAID AMERIGROUP|277.50||||||| 43762|EAP|0450|CATH/TUBE CARE/TREATMENT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|277.50||||277.50||| 43762|EAP|0450|CATH/TUBE CARE/TREATMENT|Blue Cross PPO Specialty|BCBSTX OTHER|||||277.50||| 43762|EAP|0450|CATH/TUBE CARE/TREATMENT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||277.50||| 43762|EAP|0450|CATH/TUBE CARE/TREATMENT|Humana Medicare Advantage|HUMANA MA|277.50||||||| 43762|EAP|0450|CATH/TUBE CARE/TREATMENT|Managed Medicare|HEALTHSPRING MA|277.50||||277.50||| 438|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC|Humana Medicare Advantage|HUMANA MA|174,019.25|14426.535|16368.26|8218.85|||| 438|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC|Managed Medicare|HOSPICE ETMC|3,518.75|12252.44|16368.26|8218.85|||| 438|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC|Blue Cross PPO Specialty|BCBSTX PPO|69,036.35|8218.85|16368.26|8218.85|||| 438|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC|Medicaid|MEDICAID|220,852.99|13726.25|16368.26|8218.85|||| 438|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|50,416.15|12453.77|16368.26|8218.85|||| 438|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC|Medicare|MEDICARE ACUTE|65,266.75|12453.77|16368.26|8218.85|||| 438|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC|United Healthcare|UNITED HEALTHCARE|114,707.20|16368.26|16368.26|8218.85|||| 439|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC|Veterans Affairs|VETERANS ADMINISTRATION|26,121.91|7351.79|8464.38|4258.07|||| 439|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|58,320.85|7463.19|8464.38|4258.07|||| 439|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC|Medicaid|MEDICAID|56,338.67|5176.255|8464.38|4258.07|||| 439|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC|Managed Medicare|HEALTHSPRING MA|34,592.50|7352.67|8464.38|4258.07|||| 439|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC|Humana Medicare Advantage|HUMANA MA|56,057.80|7476.69|8464.38|4258.07|||| 439|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC|Blue Cross PPO Specialty|BCBSTX PPO|31,402.55|4326.16|8464.38|4258.07|||| 439|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|32,382.75|7352.67|8464.38|4258.07|||| 439|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC|United Healthcare|TML GROUP BENEFITS|47,345.10|8464.38|8464.38|4258.07|||| 439|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC|Managed Medicaid|MEDICAID AMERIGROUP|72,032.25|7352.67|8464.38|4258.07|||| 439|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC|Medicare|MEDICARE ACUTE|37,311.41|7463.19|8464.38|4258.07|||| 439|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|53,979.35|6770.33|8464.38|4258.07|||| 439|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC|Managed Medicaid|MEDICAID SUPERIOR|41,372.55|5197.22|8464.38|4258.07|||| 439|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC|Medicaid|HENDERSON COUNTY INDIGENT|64,791.30|4258.07|8464.38|4258.07|||| 440|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|56,332.33|6770.33|20153.66|3117.06|||| 440|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|52,241.23|3454.075|20153.66|3117.06|||| 440|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC|Managed Medicare|HEALTHSPRING MA|27,455.10|6002.18|20153.66|3117.06|||| 440|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|27,177.45|6002.18|20153.66|3117.06|||| 440|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC|Aetna|AETNA PPO|35,049.85|20153.66|20153.66|3117.06|||| 440|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC|Managed Medicaid|MEDICAID SUPERIOR|50,527.70|5197.22|20153.66|3117.06|||| 440|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC|Medicaid|MEDICAID|22,995.91|3268.69|20153.66|3117.06|||| 440|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|19,641.10|3117.06|20153.66|3117.06|||| 440|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC|Medicare|MEDICARE ACUTE|698.28|6002.18|20153.66|3117.06|||| 440|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC|Medicaid|HENDERSON COUNTY INDIGENT|79,668.71|3268.69|20153.66|3117.06|||| 440|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|23,561.80|3233.25|20153.66|3117.06|||| 441|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W MCC|Medicare|MEDICARE PART B ONLY IP|30,001.75|2033.2|18488.35|2033.2|||| 441|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W MCC|United Healthcare|UNITED HEALTHCARE|61,046.49|18488.35|18488.35|2033.2|||| 441|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W MCC|Medicare|MEDICARE ACUTE|85,594.74|13516.55|18488.35|2033.2|||| 441|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W MCC|Medicaid|MEDICAID|24,766.25|3404.91|18488.35|2033.2|||| 441|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|102,774.52|13565.68|18488.35|2033.2|||| 441|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|80,404.71|9664.87|18488.35|2033.2|||| 441|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W MCC|Managed Medicare|HEALTHSPRING MA|874.76|11860.05|18488.35|2033.2|||| 442|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|41,956.19|8517.21|8995.98|3404.91|||| 442|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W CC|Humana Medicare Advantage|HUMANA MA|36,933.12|7945.74|8995.98|3404.91|||| 442|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W CC|Managed Medicaid|MEDICAID SUPERIOR|39,885.21|8995.98|8995.98|3404.91|||| 442|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|34,557.75|4886.04|8995.98|3404.91|||| 442|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W CC|Veterans Affairs|VETERANS ADMINISTRATION|35,195.75|8006.98|8995.98|3404.91|||| 442|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|45,505.50|7879.5|8995.98|3404.91|||| 442|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W CC|Medicare|MEDICARE ACUTE|44,120.55|7886.66|8995.98|3404.91|||| 442|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W CC|Medicaid|MEDICAID|70,273.33|3404.91|8995.98|3404.91|||| 442|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|43,218.53|7752.05|8995.98|3404.91|||| 442|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W CC|Managed Medicare|HEALTHSPRING MA|279.70|7946.82|8995.98|3404.91|||| 442|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W CC|Blue Cross PPO Specialty|BCBSTX PPO|25,272.81|4710.46|8995.98|3404.91|||| 443|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W/O CC/MCC|Medicare|MEDICARE ACUTE|39,677.55|6410.33|6410.33|2276.61|||| 443|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|259.77|6410.33|6410.33|2276.61|||| 443|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W/O CC/MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|57,442.50|3619.81|6410.33|2276.61|||| 443|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W/O CC/MCC|Medicaid|MEDICAID|42,650.75|2276.61|6410.33|2276.61|||| 444|DRG||DISORDERS OF THE BILIARY TRACT W MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|27,758.55|3533.85|12276.83|3533.85|||| 444|DRG||DISORDERS OF THE BILIARY TRACT W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|69,011.16|12162.33|12276.83|3533.85|||| 444|DRG||DISORDERS OF THE BILIARY TRACT W MCC|Medicare|MEDICARE ACUTE|68,959.73|12276.83|12276.83|3533.85|||| 444|DRG||DISORDERS OF THE BILIARY TRACT W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|75,404.05|12177.74|12276.83|3533.85|||| 445|DRG||DISORDERS OF THE BILIARY TRACT W CC|Aetna|AETNA PPO|445.07|25591.52|25591.52|6682.81|||| 445|DRG||DISORDERS OF THE BILIARY TRACT W CC|Humana Medicare Advantage|HUMANA MA|57,021.75|8732.57|25591.52|6682.81|||| 445|DRG||DISORDERS OF THE BILIARY TRACT W CC|Medicare|MEDICARE ACUTE|24,850.35|8760.73|25591.52|6682.81|||| 445|DRG||DISORDERS OF THE BILIARY TRACT W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|122,197.09|8759.85|25591.52|6682.81|||| 445|DRG||DISORDERS OF THE BILIARY TRACT W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|15,444.25|6682.81|25591.52|6682.81|||| 445|DRG||DISORDERS OF THE BILIARY TRACT W CC|Veterans Affairs|VETERANS ADMINISTRATION|65,590.25|8897.09|25591.52|6682.81|||| 446|DRG||DISORDERS OF THE BILIARY TRACT W/O CC/MCC|Managed Medicare|HEALTHSPRING MA|55,102.30|7245.55|7245.55|1129.96|||| 446|DRG||DISORDERS OF THE BILIARY TRACT W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|35,930.63|4065.895|7245.55|1129.96|||| 446|DRG||DISORDERS OF THE BILIARY TRACT W/O CC/MCC|Blue Cross HMO Specialty|BCBSTX HMO|36,699.80|1129.96|7245.55|1129.96|||| 446|DRG||DISORDERS OF THE BILIARY TRACT W/O CC/MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|31,403.05|6503.31|7245.55|1129.96|||| 469|DRG||MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W MCC OR TOTAL ANKLE REPLACE|Medicare|MEDICARE ACUTE|110,143.98|21540.76|21540.76|21540.76|||| 470|DRG||MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|40,338.78|10354.92|21534.35|8115.42|||| 470|DRG||MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|36,884.55|14270.02|21534.35|8115.42|||| 470|DRG||MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|46,137.55|16503.4|21534.35|8115.42|||| 470|DRG||MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC|Aetna|AETNA PPO|37,451.05|21534.35|21534.35|8115.42|||| 470|DRG||MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|39,133.90|16354.21|21534.35|8115.42|||| 470|DRG||MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC|ChampVA|CHAMPVA CENTER|35,215.30|11590.7|21534.35|8115.42|||| 470|DRG||MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC|Blue Cross HMO Specialty|BCBSTX HMO|41,429.80|8484.51|21534.35|8115.42|||| 470|DRG||MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|50,754.55|12312.15|21534.35|8115.42|||| 470|DRG||MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|40,495.25|8115.42|21534.35|8115.42|||| 470|DRG||MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC|Managed Medicaid|MEDICAID SUPERIOR|61,313.25|11461.34|21534.35|8115.42|||| 470|DRG||MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|50,468.63|15239.495|21534.35|8115.42|||| 470|DRG||MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|41,750.90|14297.3|21534.35|8115.42|||| 470|DRG||MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|49,073.80|14536.16|21534.35|8115.42|||| 470|DRG||MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC|United Healthcare|UNITED HEALTHCARE|33,149.80|19666.28|21534.35|8115.42|||| 470|DRG||MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC|United Healthcare|UNITED HEALTHCARE|37,067.10|19666.28|21534.35|8115.42|||| 470|DRG||MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC|Humana Medicare Advantage|HUMANA MA|55,887.85|14289.52|21534.35|8115.42|||| 470|DRG||MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC|Medicare|MEDICARE ACUTE|47,930.28|14298.18|21534.35|8115.42|||| 470|DRG||MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC|Managed Medicare|HEALTHSPRING MA|52,667.08|14416.73|21534.35|8115.42|||| 477|DRG||BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|109,455.36|34973.18|34973.18|34973.18|||| 480|DRG||HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W MCC|Humana Medicare Advantage|HUMANA MA|127,164.35|20680.06|20680.06|20502.2|||| 480|DRG||HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W MCC|Medicare|MEDICARE ACUTE|77,120.60|20502.2|20680.06|20502.2|||| 481|DRG||HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC|Managed Medicaid|MEDICAID SUPERIOR|80,892.85|11334.51|15163.615|10732.21|||| 481|DRG||HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC|United Medicare Advantage|UHC MEDICARE GOLD MA|64,978.62|15030.8|15163.615|10732.21|||| 481|DRG||HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC|Medicare|MEDICARE ACUTE|63,279.90|15036.96|15163.615|10732.21|||| 481|DRG||HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|48,384.60|14690.13|15163.615|10732.21|||| 481|DRG||HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|57,467.60|15163.615|15163.615|10732.21|||| 481|DRG||HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC|Humana Medicare Advantage|HUMANA MA|56,994.20|15050.43|15163.615|10732.21|||| 481|DRG||HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|92,043.95|12772.76|15163.615|10732.21|||| 481|DRG||HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|43,205.05|12772.76|15163.615|10732.21|||| 481|DRG||HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|66,531.05|10732.21|15163.615|10732.21|||| 481|DRG||HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|65,820.80|15163.615|15163.615|10732.21|||| 482|DRG||HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W/O CC/MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|43,547.75|12509.42|14690.13|12276.12|||| 482|DRG||HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W/O CC/MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|56,640.10|14690.13|14690.13|12276.12|||| 482|DRG||HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W/O CC/MCC|Medicare|MEDICARE ACUTE|51,704.78|12397.295|14690.13|12276.12|||| 482|DRG||HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W/O CC/MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|55,837.83|12276.12|14690.13|12276.12|||| 483|DRG||MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES|Humana Medicare Advantage|HUMANA MA|46,500.55|17056.88|17056.88|17056.88|||| 486|DRG||KNEE PROCEDURES W PDX OF INFECTION W CC|Humana Medicare Advantage|HUMANA MA|30,352.30|15685.55|15685.55|15685.55|||| 486|DRG||KNEE PROCEDURES W PDX OF INFECTION W CC|Medicare|MEDICARE ACUTE|72,916.60|15685.55|15685.55|15685.55|||| 492|DRG||LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|64,519.19|20011.36|20011.36|19652.32|||| 492|DRG||LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR W MCC|Humana Medicare Advantage|HUMANA MA|61,889.90|19652.32|20011.36|19652.32|||| 493|DRG||LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR W CC|Medicare|MEDICARE ACUTE|59,612.04|16336.58|16488.305|16336.58|||| 493|DRG||LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|53,058.28|16488.305|16488.305|16336.58|||| 494|DRG||LOWER EXTREM & HUMER PROC EXCEPT HIP, FOOT, FEMUR W/O CC/MCC|Aetna|AETNA PPO|49,303.35|28349.43|28349.43|28349.43|||| 501|DRG||SOFT TISSUE PROCEDURES W CC|Humana Medicare Advantage|HUMANA MA|38,627.79|12704.22|12704.22|8465.69|||| 501|DRG||SOFT TISSUE PROCEDURES W CC|Blue Cross PPO Specialty|BCBSTX PPO|45,516.55|8465.69|12704.22|8465.69|||| 502|DRG||SOFT TISSUE PROCEDURES W/O CC/MCC|Medicare|MEDICARE ACUTE|25,510.05|9756.19|9756.19|9756.19|||| 512|DRG||SHOULDER, ELBOW OR FOREARM PROC, EXC MAJOR JOINT PROC W/O CC/MCC|Medicare|MEDICARE ACUTE|52,785.85|11668.37|11668.37|11668.37|||| 513|DRG||HAND OR WRIST PROC, EXCEPT MAJOR THUMB OR JOINT PROC W CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|38,089.70|8225.87|8225.87|8225.87|||| 515|DRG||OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W MCC|Veterans Affairs|VETERANS ADMINISTRATION|92,508.10|21642.63|21642.63|21642.63|||| 51600|EAP|0320|INJ FOR CYSTO BLADDER XRA|Blue Cross PPO Specialty|BCBSTX PPO|||||591.75||| 51600|EAP|0320|INJ FOR CYSTO BLADDER XRA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|591.75||||||| 51600|EAP|0320|INJ FOR CYSTO BLADDER XRA|United Medicare Advantage|UHC AARP MCR HMO MA|||||591.75||| 51600|EAP|0320|INJ FOR CYSTO BLADDER XRA|Veterans Affairs|VETERANS ADMINISTRATION|||||591.75||| 51600|EAP|0320|INJ FOR CYSTO BLADDER XRA|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||591.75||| 51600|EAP|0320|INJ FOR CYSTO BLADDER XRA|Medicare|MEDICARE ACUTE|591.75||||591.75||| 51600|EAP|0320|INJ FOR CYSTO BLADDER XRA|United Healthcare|UNITED HEALTHCARE|||||591.75||| 51600|EAP|0320|INJ FOR CYSTO BLADDER XRA|Aetna|AETNA PPO|||||591.75||| 51600|EAP|0320|INJ FOR CYSTO BLADDER XRA|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|591.75||||||| 51600|EAP|0320|INJ FOR CYSTO BLADDER XRA|Managed Medicare|BCBS MEDICARE PPO MA|||||591.75||| 517|DRG||OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W/O CC/MCC|Medicare|MEDICARE ACUTE|386.78|10871.01|10871.01|10871.01|||| 51701|EAP|0450|INSERT BLADDER CATHETER|Managed Medicare|HEALTHSPRING MA|||||2.95||| 51701|EAP|0450|INSERT BLADDER CATHETER|Medicare|MEDICARE ACUTE|||||2.95||| 535|DRG||FRACTURES OF HIP & PELVIS W MCC|Humana Medicare Advantage|HUMANA MA|43,251.60|11290.67|11290.67|11290.67|||| 536|DRG||FRACTURES OF HIP & PELVIS W/O MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|25,320.05|5418.89|14179.89|5418.89|||| 536|DRG||FRACTURES OF HIP & PELVIS W/O MCC|Medicare|MEDICARE ACUTE|24,646.80|6788.68|14179.89|5418.89|||| 536|DRG||FRACTURES OF HIP & PELVIS W/O MCC|Humana Medicare Advantage|HUMANA MA|20,866.30|6113.595|14179.89|5418.89|||| 536|DRG||FRACTURES OF HIP & PELVIS W/O MCC|Cigna|CIGNA|46,333.15|14179.89|14179.89|5418.89|||| 536|DRG||FRACTURES OF HIP & PELVIS W/O MCC|Managed Medicare|HEALTHSPRING MA|26,748.05|6121.155|14179.89|5418.89|||| 538|DRG||SPRAINS, STRAINS, & DISLOCATIONS OF HIP, PELVIS & THIGH W/O CC/MCC|Medicaid|HENDERSON COUNTY INDIGENT|52,265.80|6524.67|6524.67|6524.67|||| 539|DRG||OSTEOMYELITIS W MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|68,045.35|12096.04|12096.04|12096.04|||| 542|DRG||PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|54,392.05|13187.07|13187.07|10970.33|||| 542|DRG||PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W MCC|Medicare|MEDICARE ACUTE|47,678.55|10970.33|13187.07|10970.33|||| 543|DRG||PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W CC|Medicare|MEDICARE ACUTE|33,726.35|6689.095|6689.095|3191.7|||| 543|DRG||PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W CC|Medicaid|MEDICAID|62,080.91|3191.7|6689.095|3191.7|||| 543|DRG||PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W CC|Humana Medicare Advantage|HUMANA MA|34,266.74|4601.485|6689.095|3191.7|||| 544|DRG||PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W/O CC/MCC|Medicaid|MEDICAID|49,580.40|4682.53|4682.53|4682.53|||| 551|DRG||MEDICAL BACK PROBLEMS W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|52,604.35|11929.24|11929.24|11055.4|||| 551|DRG||MEDICAL BACK PROBLEMS W MCC|Medicare|MEDICARE ACUTE|71,809.06|11055.4|11929.24|11055.4|||| 552|DRG||MEDICAL BACK PROBLEMS W/O MCC|Humana Medicare Advantage|HUMANA MA|26,855.28|7908.085|7908.085|4520.32|||| 552|DRG||MEDICAL BACK PROBLEMS W/O MCC|Medicare|MEDICARE ACUTE|37,821.80|7753.48|7908.085|4520.32|||| 552|DRG||MEDICAL BACK PROBLEMS W/O MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|48,845.10|7871.35|7908.085|4520.32|||| 552|DRG||MEDICAL BACK PROBLEMS W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|437.67|4520.32|7908.085|4520.32|||| 554|DRG||BONE DISEASES & ARTHROPATHIES W/O MCC|Medicare|MEDICARE ACUTE|29,414.15|7032.41|7032.41|7032.41|||| 556|DRG||SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W/O MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|34,276.30|3995.11|6985.54|3995.11|||| 556|DRG||SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE W/O MCC|Medicare|MEDICARE ACUTE|44,908.53|6985.54|6985.54|3995.11|||| 557|DRG||TENDONITIS, MYOSITIS & BURSITIS W MCC|Medicare|MEDICARE ACUTE|796.08|11317.61|11317.61|11317.61|||| 558|DRG||TENDONITIS, MYOSITIS & BURSITIS W/O MCC|Medicare|MEDICARE ACUTE|29,981.33|6477.825|6477.825|6477.825|||| 560|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC|Managed Medicare|MA PART B ONLY IP|57,716.45|465.85|465.85|465.85|||| 562|DRG||FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|49,172.55|9020.19|10448.53|924.38|||| 562|DRG||FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W MCC|Medicare|MEDICARE ACUTE|38,221.01|10448.53|10448.53|924.38|||| 562|DRG||FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W MCC|Humana Medicare Advantage|HUMANA MA|51,710.75|924.38|10448.53|924.38|||| 563|DRG||FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W/O MCC|Humana Medicare Advantage|HUMANA MA|66,489.10|944.29|7394.36|486.16|||| 563|DRG||FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W/O MCC|Medicare|MEDICARE PART B ONLY IP|15,509.25|486.16|7394.36|486.16|||| 563|DRG||FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W/O MCC|Medicare|MEDICARE ACUTE|25,996.50|7394.36|7394.36|486.16|||| 563|DRG||FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W/O MCC|Managed Medicaid|MEDICAID SUPERIOR|43,832.20|5505.6|7394.36|486.16|||| 564|DRG||OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W MCC|Medicare|MEDICARE ACUTE|147,633.90|11442.76|11456.37|3323.74|||| 564|DRG||OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W MCC|Humana Medicare Advantage|HUMANA MA|544.97|11456.37|11456.37|3323.74|||| 564|DRG||OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|371.07|3323.74|11456.37|3323.74|||| 565|DRG||OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W CC|Medicare|MEDICARE ACUTE|40,821.50|8304.1|8304.1|8304.1|||| 566|DRG||OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W/O CC/MCC|Medicare|MEDICARE ACUTE|47,934.80|6798.25|6798.25|6798.25|||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|50,791.75|5399.74|9604.19|5399.74|||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|Humana Medicare Advantage|HUMANA MA|248,416.73|5714.875|9604.19|5399.74|||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|Medicare|MEDICARE ACUTE|367.86|9604.19|9604.19|5399.74|||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|19,314.50|7998.06|9604.19|5399.74|||| 570|DRG||SKIN DEBRIDEMENT W MCC|Medicare|MEDICARE ACUTE|85,833.10|18939.37|18939.37|18939.37|||| 571|DRG||SKIN DEBRIDEMENT W CC|Managed Medicare|HEALTHSPRING MA|104,254.60|15492.53|15492.53|8543.45|||| 571|DRG||SKIN DEBRIDEMENT W CC|Blue Cross PPO Specialty|BCBSTX PPO|35,928.60|8543.45|15492.53|8543.45|||| 571|DRG||SKIN DEBRIDEMENT W CC|Medicare|MEDICARE ACUTE|39,021.48|12668.24|15492.53|8543.45|||| 579|DRG||OTHER SKIN, SUBCUT TISS & BREAST PROC W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|54,192.80|20574.38|20574.38|20574.38|||| 580|DRG||OTHER SKIN, SUBCUT TISS & BREAST PROC W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|30,904.30|8273.32|13448.25|8273.32|||| 580|DRG||OTHER SKIN, SUBCUT TISS & BREAST PROC W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|56,610.25|13448.25|13448.25|8273.32|||| 580|DRG||OTHER SKIN, SUBCUT TISS & BREAST PROC W CC|Humana Medicare Advantage|HUMANA MA|38,705.55|12074.3|13448.25|8273.32|||| 580|DRG||OTHER SKIN, SUBCUT TISS & BREAST PROC W CC|Managed Medicaid|MEDICAID SUPERIOR|26,292.30|9811.92|13448.25|8273.32|||| 580|DRG||OTHER SKIN, SUBCUT TISS & BREAST PROC W CC|Medicare|MEDICARE ACUTE|47,980.28|12154.42|13448.25|8273.32|||| 580|DRG||OTHER SKIN, SUBCUT TISS & BREAST PROC W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|69,837.80|12069.96|13448.25|8273.32|||| 580|DRG||OTHER SKIN, SUBCUT TISS & BREAST PROC W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|69,425.83|12055.88|13448.25|8273.32|||| 580|DRG||OTHER SKIN, SUBCUT TISS & BREAST PROC W CC|United Medicare Advantage|UHC MEDICARE GOLD MA|50,039.02|12267.04|13448.25|8273.32|||| 581|DRG||OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC/MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|25,241.75|10034.49|10034.49|6037.99|||| 581|DRG||OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC/MCC|Medicaid|MEDICAID HMO|34,455.05|6171.02|10034.49|6037.99|||| 581|DRG||OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC/MCC|Medicare|MEDICARE ACUTE|41,415.55|9877.64|10034.49|6037.99|||| 581|DRG||OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC/MCC|Managed Medicare|HEALTHSPRING MA|34,453.35|9861.96|10034.49|6037.99|||| 581|DRG||OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|33,090.55|6037.99|10034.49|6037.99|||| 582|DRG||MASTECTOMY FOR MALIGNANCY W CC/MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|41,759.35|169.35|11884.11|169.35|||| 582|DRG||MASTECTOMY FOR MALIGNANCY W CC/MCC|Veterans Affairs|VETERANS ADMINISTRATION|54,654.80|11884.11|11884.11|169.35|||| 59050|EAP|0720|FETAL MONITOR PER DAY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.13||||3.13||| 59050|EAP|0720|FETAL MONITOR PER DAY|Aetna|AETNA PPO|3.13||||3.13||| 59050|EAP|0720|FETAL MONITOR PER DAY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|3.13||||3.13||| 59050|EAP|0720|FETAL MONITOR PER DAY|ChampVA|CHAMPVA CENTER|3.13||||3.13||| 59050|EAP|0720|FETAL MONITOR PER DAY|Blue Cross PPO Specialty|BCBSTX PPO|3.13||||3.13||| 59050|EAP|0720|FETAL MONITOR PER DAY|Blue Cross HMO Specialty|BCBSTX HMO|3.13||||3.13||| 59050|EAP|0720|FETAL MONITOR PER DAY|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3.13||| 59050|EAP|0720|FETAL MONITOR PER DAY|NON CONTRACTED|COMMERCIAL OTHER 1|3.13||||3.13||| 59050|EAP|0720|FETAL MONITOR PER DAY|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||3.13||| 59050|EAP|0720|FETAL MONITOR PER DAY|Medicaid|MEDICAID|3.13||||3.13||| 59050|EAP|0720|FETAL MONITOR PER DAY|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3.13||| 59050|EAP|0720|FETAL MONITOR PER DAY|Managed Medicare|VAN ZANDT COUNTY INMATE|||||3.13||| 59050|EAP|0720|FETAL MONITOR PER DAY|Medicaid|LAW ENFORCEMENT OTHER|||||3.13||| 59050|EAP|0720|FETAL MONITOR PER DAY|Medicaid|MEDICAID HMO|3.13||||3.13||| 59050|EAP|0720|FETAL MONITOR PER DAY|Medicaid|MOLINA HEALTHCARE OF TEXAS|3.13||||3.13||| 59050|EAP|0720|FETAL MONITOR PER DAY|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|3.13||||3.13||| 59050|EAP|0720|FETAL MONITOR PER DAY|United Healthcare|TML GROUP BENEFITS|3.13||||||| 59050|EAP|0720|FETAL MONITOR PER DAY|United Healthcare|GEHA|3.13||||||| 59050|EAP|0720|FETAL MONITOR PER DAY|Tricare|TRICARE EAST REGION|3.13||||3.13||| 59050|EAP|0720|FETAL MONITOR PER DAY|United Healthcare|UMR UNITED MEDICAL RESOURCES|3.13||||3.13||| 59050|EAP|0720|FETAL MONITOR PER DAY|United Healthcare|UNITED HEALTHCARE|3.13||||||| 59050|EAP|0720|FETAL MONITOR PER DAY|Medicare|MEDICARE ACUTE|3.13||||3.13||| 59050|EAP|0720|FETAL MONITOR PER DAY|United Healthcare|UNITED HEALTHCARE|3.13||||3.13||| 59050|EAP|0720|FETAL MONITOR PER DAY|MTC Medical|VAN ZANDT COUNTY INMATE|||||3.13||| 59050|EAP|0720|FETAL MONITOR PER DAY|Cigna|CIGNA|3.13||||3.13||| 59050|EAP|0720|FETAL MONITOR PER DAY|Cigna|CIGNA OTHER|3.13||||||| 59050|EAP|0720|FETAL MONITOR PER DAY|Cigna|CIGNA|3.13||||||| 59050|EAP|0720|FETAL MONITOR PER DAY|Managed Medicaid|MEDICAID AMERIGROUP|3.13||||3.13||| 59050|EAP|0720|FETAL MONITOR PER DAY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.13||||3.13||| 59050|EAP|0720|FETAL MONITOR PER DAY|PHCS|HUMANA|3.13||||||| 59050|EAP|0720|FETAL MONITOR PER DAY|Managed Medicaid|MEDICAID SUPERIOR|3.13||||3.13||| 59050|EAP|0720|FETAL MONITOR PER DAY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|3.13||||3.13||| 592|DRG||SKIN ULCERS W MCC|Medicare|MEDICARE ACUTE|101,473.69|13266.255|13266.255|13266.255|||| 593|DRG||SKIN ULCERS W CC|Humana Medicare Advantage|HUMANA MA|63,895.60|1643.77|1643.77|1643.77|||| 595|DRG||MAJOR SKIN DISORDERS W MCC|Humana Medicare Advantage|HUMANA MA|49,524.05|14941.17|14941.17|14941.17|||| 596|DRG||MAJOR SKIN DISORDERS W/O MCC|Medicare|MEDICARE ACUTE|26,789.30|8110.64|8110.64|8110.64|||| 598|DRG||MALIGNANT BREAST DISORDERS W CC|Medicare|MEDICARE ACUTE|39,484.70|8848.08|8848.08|8848.08|||| 60|DRG||MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|29,852.85|7557.73|7557.73|7557.73|||| 600|DRG||NON-MALIGNANT BREAST DISORDERS W CC/MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|23,592.50|8169.74|8169.74|8169.74|||| 601|DRG||NON-MALIGNANT BREAST DISORDERS W/O CC/MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|23,444.55|5936.93|5936.93|5936.93|||| 602|DRG||CELLULITIS W MCC|Managed Medicare|HEALTHSPRING MA|74,878.25|11050.095|11138.47|10462.005|||| 602|DRG||CELLULITIS W MCC|Humana Medicare Advantage|HUMANA MA|42,054.30|11138.47|11138.47|10462.005|||| 602|DRG||CELLULITIS W MCC|Medicare|MEDICARE ACUTE|45,908.65|10462.005|11138.47|10462.005|||| 603|DRG||CELLULITIS W/O MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|39,648.77|4066.815|24165.99|2141.92|||| 603|DRG||CELLULITIS W/O MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|25,685.50|7306.66|24165.99|2141.92|||| 603|DRG||CELLULITIS W/O MCC|NON CONTRACTED|COMMERCIAL OTHER 1|33,062.65|12652.5|24165.99|2141.92|||| 603|DRG||CELLULITIS W/O MCC|Medicaid|MOLINA HEALTHCARE OF TEXAS|60,996.30|3549.99|24165.99|2141.92|||| 603|DRG||CELLULITIS W/O MCC|Medicare|MEDICARE ACUTE|36,488.05|7328.88|24165.99|2141.92|||| 603|DRG||CELLULITIS W/O MCC|Medicaid|MEDICAID|22,238.75|2141.92|24165.99|2141.92|||| 603|DRG||CELLULITIS W/O MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|251.67|4359.525|24165.99|2141.92|||| 603|DRG||CELLULITIS W/O MCC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|28,669.88|7769.825|24165.99|2141.92|||| 603|DRG||CELLULITIS W/O MCC|Cigna|CIGNA|39,661.30|12066.78|24165.99|2141.92|||| 603|DRG||CELLULITIS W/O MCC|Managed Medicaid|MEDICAID AMERIGROUP|21,799.75|3405.65|24165.99|2141.92|||| 603|DRG||CELLULITIS W/O MCC|Veterans Affairs|VETERANS ADMINISTRATION|38,593.38|7379.54|24165.99|2141.92|||| 603|DRG||CELLULITIS W/O MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|29,125.05|5644.48|24165.99|2141.92|||| 603|DRG||CELLULITIS W/O MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|42,313.27|5644.48|24165.99|2141.92|||| 603|DRG||CELLULITIS W/O MCC|Humana Medicare Advantage|HUMANA MA|26,807.50|7380.48|24165.99|2141.92|||| 603|DRG||CELLULITIS W/O MCC|Blue Cross HMO Specialty|BCBSTX HMO|57,723.60|3614.59|24165.99|2141.92|||| 603|DRG||CELLULITIS W/O MCC|Managed Medicaid|MEDICAID SUPERIOR|26,817.25|5644.48|24165.99|2141.92|||| 603|DRG||CELLULITIS W/O MCC|Managed Medicare|HEALTHSPRING MA|42,705.03|7439.86|24165.99|2141.92|||| 603|DRG||CELLULITIS W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|22,162.50|4252.91|24165.99|2141.92|||| 603|DRG||CELLULITIS W/O MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|23,201.25|7301.6|24165.99|2141.92|||| 603|DRG||CELLULITIS W/O MCC|Aetna|AETNA PPO|42,027.80|24165.99|24165.99|2141.92|||| 605|DRG||TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W/O MCC|Humana Medicare Advantage|HUMANA MA|36,953.40|4107.01|7642.99|4107.01|||| 605|DRG||TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W/O MCC|Medicare|MEDICARE ACUTE|161.07|7642.99|7642.99|4107.01|||| 607|DRG||MINOR SKIN DISORDERS W/O MCC|Medicare|MEDICARE ACUTE|396.38|7193.81|7193.81|7193.81|||| 617|DRG||AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|50,817.80|13390.14|73704.85|8537.98|||| 617|DRG||AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS W CC|Humana Medicare Advantage|HUMANA MA|73,479.27|14862.07|73704.85|8537.98|||| 617|DRG||AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|662.14|14811.73|73704.85|8537.98|||| 617|DRG||AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS W CC|United Medicare Advantage|UHC MEDICARE GOLD MA|82,328.12|14820.53|73704.85|8537.98|||| 617|DRG||AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|38,807.55|8537.98|73704.85|8537.98|||| 617|DRG||AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS W CC|NON CONTRACTED|COMMERCIAL OTHER 1|73,704.85|73704.85|73704.85|8537.98|||| 617|DRG||AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS W CC|Medicaid|HENDERSON COUNTY INDIGENT|78,633.65|12359.36|73704.85|8537.98|||| 617|DRG||AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|62,679.45|10791.01|73704.85|8537.98|||| 617|DRG||AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS W CC|Medicare|MEDICARE ACUTE|40,338.24|13948.72|73704.85|8537.98|||| 622|DRG||SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W MCC|Blue Cross HMO Specialty|BCBSTX HMO|73,622.30|16194.67|16194.67|16194.67|||| 623|DRG||SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W CC|Medicare|MEDICARE ACUTE|33,513.58|12638.43|14436.49|1550.2|||| 623|DRG||SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W CC|Medicaid|MEDICAID|103,174.24|4350.81|14436.49|1550.2|||| 623|DRG||SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|24,447.55|1550.2|14436.49|1550.2|||| 623|DRG||SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W CC|Humana Medicare Advantage|HUMANA MA|32,088.30|14436.49|14436.49|1550.2|||| 623|DRG||SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W CC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|43,516.80|9009.55|14436.49|1550.2|||| 623|DRG||SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|36,523.05|10008.33|14436.49|1550.2|||| 623|DRG||SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W CC|Blue Cross PPO Specialty|BCBSTX PPO|41,188.75|9648.69|14436.49|1550.2|||| 637|DRG||DIABETES W MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|72,344.35|7188.29|10860.27|7188.29|||| 637|DRG||DIABETES W MCC|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|328.39|10860.27|10860.27|7188.29|||| 637|DRG||DIABETES W MCC|Medicare|MEDICARE ACUTE|44,300.75|10688.09|10860.27|7188.29|||| 638|DRG||DIABETES W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|67,786.85|7695.99|16257.15|3022.4|||| 638|DRG||DIABETES W CC|Medicaid|MOLINA HEALTHCARE OF TEXAS|45,505.80|3022.4|16257.15|3022.4|||| 638|DRG||DIABETES W CC|Medicare|MEDICARE ACUTE|311.93|7695.99|16257.15|3022.4|||| 638|DRG||DIABETES W CC|United Medicare Advantage|UHC MEDICARE GOLD MA|61,007.13|7584.79|16257.15|3022.4|||| 638|DRG||DIABETES W CC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|27,904.75|3565.35|16257.15|3022.4|||| 638|DRG||DIABETES W CC|Humana Medicare Advantage|HUMANA MA|23,639.88|7455.305|16257.15|3022.4|||| 638|DRG||DIABETES W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|42,720.15|5361.56|16257.15|3022.4|||| 638|DRG||DIABETES W CC|Managed Medicare|HEALTHSPRING MA|56,876.18|7581.27|16257.15|3022.4|||| 638|DRG||DIABETES W CC|Blue Cross PPO Specialty|BCBSTX PPO|31,651.45|4375.83|16257.15|3022.4|||| 638|DRG||DIABETES W CC|Veterans Affairs|VETERANS ADMINISTRATION|21,373.55|7580.39|16257.15|3022.4|||| 638|DRG||DIABETES W CC|Cigna|CIGNA|48,220.25|16257.15|16257.15|3022.4|||| 638|DRG||DIABETES W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|44,284.50|4538.93|16257.15|3022.4|||| 639|DRG||DIABETES W/O CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|24,489.25|3288.41|6126.48|3170.24|||| 639|DRG||DIABETES W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|40,976.35|3170.24|6126.48|3170.24|||| 639|DRG||DIABETES W/O CC/MCC|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|34,079.75|5903.11|6126.48|3170.24|||| 639|DRG||DIABETES W/O CC/MCC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|33,058.10|5987.04|6126.48|3170.24|||| 639|DRG||DIABETES W/O CC/MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|47,982.20|4805.62|6126.48|3170.24|||| 639|DRG||DIABETES W/O CC/MCC|United Healthcare|UNITED HEALTHCARE|292.88|6126.48|6126.48|3170.24|||| 639|DRG||DIABETES W/O CC/MCC|Medicare|MEDICARE ACUTE|34,749.52|5903.11|6126.48|3170.24|||| 639|DRG||DIABETES W/O CC/MCC|United Healthcare|UMR UNITED MEDICAL RESOURCES|38,511.60|6126.48|6126.48|3170.24|||| 639|DRG||DIABETES W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|44,463.65|5891.455|6126.48|3170.24|||| 639|DRG||DIABETES W/O CC/MCC|Managed Medicaid|MEDICAID SUPERIOR|24,738.75|4805.62|6126.48|3170.24|||| 64|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|83,869.50|13945.71|13945.71|3125.93|||| 64|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC|United Medicare Advantage|UHC AARP MCR HMO MA|34,258.75|12907.72|13945.71|3125.93|||| 64|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|39,198.45|13945.71|13945.71|3125.93|||| 64|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC|Medicare|MEDICARE ACUTE|63,510.25|13690.21|13945.71|3125.93|||| 64|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC|Medicaid|MEDICAID|59,493.15|8861.7|13945.71|3125.93|||| 64|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC|Humana Medicare Advantage|HUMANA MA|61,203.05|13722.71|13945.71|3125.93|||| 64|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC|Managed Medicare|HOSPICE OF EAST TEXAS|23,225.50|13696.71|13945.71|3125.93|||| 64|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC|Blue Cross HMO Specialty|BCBSTX HMO|766.15|7970.27|13945.71|3125.93|||| 64|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC|Blue Cross PPO Specialty|BCBSTX PPO|37,598.36|3125.93|13945.71|3125.93|||| 640|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W MCC|Managed Medicare|BCBS MEDICARE PPO MA|27,222.55|9607.78|10684.845|39.08|||| 640|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W MCC|Humana Medicare Advantage|HUMANA MA|68,099.45|9711.185|10684.845|39.08|||| 640|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|42,312.25|39.08|10684.845|39.08|||| 640|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W MCC|Medicare|MEDICARE ACUTE|65,634.70|9702.265|10684.845|39.08|||| 640|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|59,353.18|10684.845|10684.845|39.08|||| 640|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|55,180.88|9625.26|10684.845|39.08|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|29,481.65|6891.66|6891.66|39.08|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|39,203.45|6784.96|6891.66|39.08|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|55,761.65|6791.43|6891.66|39.08|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Medicare|MEDICARE ACUTE|27,204.75|6791.43|6891.66|39.08|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Medicaid|MEDICAID|27,340.96|3095.13|6891.66|39.08|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|34,723.60|3912.89|6891.66|39.08|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|31,975.50|6790.55|6891.66|39.08|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|41,027.05|3772.28|6891.66|39.08|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|41,824.25|3044.66|6891.66|39.08|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|42,278.30|39.08|6891.66|39.08|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Veterans Affairs|VETERANS ADMINISTRATION|471.10|6791.43|6891.66|39.08|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Humana Medicare Advantage|HUMANA MA|36,177.57|6779.52|6891.66|39.08|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Managed Medicaid|MEDICAID AMERIGROUP|26,221.21|2587.59|6891.66|39.08|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Managed Medicaid|MEDICAID SUPERIOR|19,057.60|3450.94|6891.66|39.08|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Managed Medicare|BCBS MEDICARE PPO MA|23,061.75|6791.43|6891.66|39.08|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Managed Medicare|HEALTHSPRING MA|102,044.29|6891.66|6891.66|39.08|||| 643|DRG||ENDOCRINE DISORDERS W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|25,160.25|8128.47|8128.47|8128.47|||| 644|DRG||ENDOCRINE DISORDERS W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|71,448.75|8445.14|8472.42|2457.86|||| 644|DRG||ENDOCRINE DISORDERS W CC|Medicare|MEDICARE ACUTE|52,944.85|8472.42|8472.42|2457.86|||| 644|DRG||ENDOCRINE DISORDERS W CC|Medicaid|HENDERSON COUNTY INDIGENT|50,012.36|2457.86|8472.42|2457.86|||| 645|DRG||ENDOCRINE DISORDERS W/O CC/MCC|Medicare|MEDICARE ACUTE|32,638.05|6843.84|6843.84|6843.84|||| 65|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS|Humana Medicare Advantage|HUMANA MA|55,333.50|8601.86|16696.2|5175.04|||| 65|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|46,881.25|9597.76|16696.2|5175.04|||| 65|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|38,464.75|5815.735|16696.2|5175.04|||| 65|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS|Blue Cross PPO Specialty|BCBSTX PPO|63,377.25|5175.04|16696.2|5175.04|||| 65|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS|Cigna|CIGNA|515.77|16696.2|16696.2|5175.04|||| 65|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|46,021.50|5367.93|16696.2|5175.04|||| 65|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS|Veterans Affairs|VETERANS ADMINISTRATION|56,076.25|8470.82|16696.2|5175.04|||| 65|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|45,758.39|8464.4|16696.2|5175.04|||| 65|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|43,962.50|8601.86|16696.2|5175.04|||| 65|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS|Medicaid|LAW ENFORCEMENT OTHER|164.98|6036.33|16696.2|5175.04|||| 65|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS|Medicare|MEDICARE ACUTE|49,801.75|8470.82|16696.2|5175.04|||| 654|DRG||MAJOR BLADDER PROCEDURES W CC|Medicare|MEDICARE ACUTE|52,466.85|14091.46|19289.77|14091.46|||| 654|DRG||MAJOR BLADDER PROCEDURES W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|78,927.75|14095.46|19289.77|14091.46|||| 654|DRG||MAJOR BLADDER PROCEDURES W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|65,680.65|19289.77|19289.77|14091.46|||| 655|DRG||MAJOR BLADDER PROCEDURES W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|28,591.30|14865.33|14865.33|9928.79|||| 655|DRG||MAJOR BLADDER PROCEDURES W/O CC/MCC|Managed Medicaid|MEDICAID SUPERIOR|27,165.80|9928.79|14865.33|9928.79|||| 657|DRG||KIDNEY & URETER PROCEDURES FOR NEOPLASM W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|89,947.05|14085.46|14320.42|7975.84|||| 657|DRG||KIDNEY & URETER PROCEDURES FOR NEOPLASM W CC|Humana Medicare Advantage|HUMANA MA|37,566.85|14320.42|14320.42|7975.84|||| 657|DRG||KIDNEY & URETER PROCEDURES FOR NEOPLASM W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|42,352.15|10134.27|14320.42|7975.84|||| 657|DRG||KIDNEY & URETER PROCEDURES FOR NEOPLASM W CC|Medicaid|HENDERSON COUNTY INDIGENT|25,696.30|7975.84|14320.42|7975.84|||| 658|DRG||KIDNEY & URETER PROCEDURES FOR NEOPLASM W/O CC/MCC|Managed Medicare|HEALTHSPRING MA|33,492.55|11828.71|12022.27|7038.41|||| 658|DRG||KIDNEY & URETER PROCEDURES FOR NEOPLASM W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|42,380.55|12022.27|12022.27|7038.41|||| 658|DRG||KIDNEY & URETER PROCEDURES FOR NEOPLASM W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|35,216.20|7858.63|12022.27|7038.41|||| 658|DRG||KIDNEY & URETER PROCEDURES FOR NEOPLASM W/O CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|41,166.55|8151.55|12022.27|7038.41|||| 658|DRG||KIDNEY & URETER PROCEDURES FOR NEOPLASM W/O CC/MCC|Medicare|MEDICARE ACUTE|36,079.25|11829.59|12022.27|7038.41|||| 658|DRG||KIDNEY & URETER PROCEDURES FOR NEOPLASM W/O CC/MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|33,982.55|11829.59|12022.27|7038.41|||| 658|DRG||KIDNEY & URETER PROCEDURES FOR NEOPLASM W/O CC/MCC|Medicaid|HENDERSON COUNTY INDIGENT|32,255.55|7038.41|12022.27|7038.41|||| 659|DRG||KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|63,795.05|19023.94|19023.94|19023.94|||| 659|DRG||KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W MCC|Medicare|MEDICARE ACUTE|114,954.90|19023.94|19023.94|19023.94|||| 659|DRG||KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W MCC|Humana Medicare Advantage|HUMANA MA|62,829.70|19023.94|19023.94|19023.94|||| 659|DRG||KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W MCC|Managed Medicare|BCBS MEDICARE PPO MA|92,593.11|19023.94|19023.94|19023.94|||| 66|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC|United Healthcare|UNITED HEALTHCARE|63,957.31|7163.55|26438.21|6528.37|||| 66|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|45,902.75|6528.37|26438.21|6528.37|||| 66|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC|Veterans Affairs|VETERANS ADMINISTRATION|54,045.80|6641.85|26438.21|6528.37|||| 66|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC|Medicare|MEDICARE ACUTE|44,051.50|6641.85|26438.21|6528.37|||| 66|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|43,402.25|6530.97|26438.21|6528.37|||| 66|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC|Managed Medicare|HEALTHSPRING MA|31,589.95|6641.85|26438.21|6528.37|||| 66|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|41,550.25|6641.85|26438.21|6528.37|||| 66|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC|Aetna|AETNA PPO|45,979.50|26438.21|26438.21|6528.37|||| 660|DRG||KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|105,411.70|11081.06|11671.66|7533.31|||| 660|DRG||KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|41,238.60|10904.46|11671.66|7533.31|||| 660|DRG||KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W CC|Medicare|MEDICARE ACUTE|53,691.55|11081.06|11671.66|7533.31|||| 660|DRG||KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W CC|Humana Medicare Advantage|HUMANA MA|352.09|10872.44|11671.66|7533.31|||| 660|DRG||KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|38,481.30|7533.31|11671.66|7533.31|||| 660|DRG||KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W CC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|17,387.05|11671.66|11671.66|7533.31|||| 661|DRG||KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|67,181.70|5382.24|10891.19|5382.24|||| 661|DRG||KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W/O CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|25,798.95|5582.85|10891.19|5382.24|||| 661|DRG||KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W/O CC/MCC|United Healthcare|UNITED HEALTHCARE|41,836.48|10891.19|10891.19|5382.24|||| 661|DRG||KIDNEY & URETER PROCEDURES FOR NON-NEOPLASM W/O CC/MCC|Medicare|MEDICARE ACUTE|42,138.05|8995.5|10891.19|5382.24|||| 663|DRG||MINOR BLADDER PROCEDURES W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|100,854.30|21680.75|21680.75|21680.75|||| 664|DRG||MINOR BLADDER PROCEDURES W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|20,323.05|9099.6|9099.6|9099.6|||| 664|DRG||MINOR BLADDER PROCEDURES W/O CC/MCC|Medicare|MEDICARE ACUTE|53,065.30|9099.6|9099.6|9099.6|||| 666|DRG||PROSTATECTOMY W CC|Medicare|MEDICARE ACUTE|68,587.50|13062.69|13062.69|13062.69|||| 669|DRG||TRANSURETHRAL PROCEDURES W CC|Medicare|MEDICARE ACUTE|34,003.30|11679.68|11869.61|11679.68|||| 669|DRG||TRANSURETHRAL PROCEDURES W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|90,685.85|11869.61|11869.61|11679.68|||| 670|DRG||TRANSURETHRAL PROCEDURES W/O CC/MCC|Medicare|MEDICARE ACUTE|26,437.85|8167.28|8167.28|8167.28|||| 68|DRG||NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT W/O MCC|Humana Medicare Advantage|HUMANA MA|51,829.53|7502.425|7502.425|7502.425|||| 682|DRG||RENAL FAILURE W MCC|Veterans Affairs|VETERANS ADMINISTRATION|39,620.83|11350.965|11442.52|7519.46|||| 682|DRG||RENAL FAILURE W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|35,216.85|8623.94|11442.52|7519.46|||| 682|DRG||RENAL FAILURE W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|52,752.83|11350.965|11442.52|7519.46|||| 682|DRG||RENAL FAILURE W MCC|Medicare|MEDICARE ACUTE|44,498.03|11232.13|11442.52|7519.46|||| 682|DRG||RENAL FAILURE W MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|36,659.25|11232.13|11442.52|7519.46|||| 682|DRG||RENAL FAILURE W MCC|Managed Medicare|HEALTHSPRING MA|53,013.53|9867.17|11442.52|7519.46|||| 682|DRG||RENAL FAILURE W MCC|Humana Medicare Advantage|HUMANA MA|73,620.48|11264.63|11442.52|7519.46|||| 682|DRG||RENAL FAILURE W MCC|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|39,537.25|11442.52|11442.52|7519.46|||| 682|DRG||RENAL FAILURE W MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|88,289.22|7519.46|11442.52|7519.46|||| 683|DRG||RENAL FAILURE W CC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|21,884.80|3715.88|7779.25|3103.555|||| 683|DRG||RENAL FAILURE W CC|Blue Cross PPO Specialty|BCBSTX PPO|355.89|4610.62|7779.25|3103.555|||| 683|DRG||RENAL FAILURE W CC|Aenta Medicare Advantage|AETNA MEDICARE MA|44,146.75|7634.88|7779.25|3103.555|||| 683|DRG||RENAL FAILURE W CC|Medicare|MEDICARE ACUTE|34,478.19|7662.16|7779.25|3103.555|||| 683|DRG||RENAL FAILURE W CC|United Medicare Advantage|UHC AARP MCR HMO MA|30,838.13|7779.25|7779.25|3103.555|||| 683|DRG||RENAL FAILURE W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|33,937.03|7721.145|7779.25|3103.555|||| 683|DRG||RENAL FAILURE W CC|Managed Medicaid|MEDICAID AMERIGROUP|151.71|3715.88|7779.25|3103.555|||| 683|DRG||RENAL FAILURE W CC|United Medicare Advantage|UHC MEDICARE GOLD MA|23,797.05|7779.25|7779.25|3103.555|||| 683|DRG||RENAL FAILURE W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|40,461.78|7779.25|7779.25|3103.555|||| 683|DRG||RENAL FAILURE W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|463.21|3715.88|7779.25|3103.555|||| 683|DRG||RENAL FAILURE W CC|Humana Medicare Advantage|HUMANA MA|31,797.50|3103.555|7779.25|3103.555|||| 683|DRG||RENAL FAILURE W CC|Managed Medicaid|MEDICAID SUPERIOR|35,697.65|3185.04|7779.25|3103.555|||| 683|DRG||RENAL FAILURE W CC|Managed Medicare|HEALTHSPRING MA|48,757.80|7662.16|7779.25|3103.555|||| 684|DRG||RENAL FAILURE W/O CC/MCC|Veterans Affairs|VETERANS ADMINISTRATION|42,525.10|5916.14|6000.3|326.22|||| 684|DRG||RENAL FAILURE W/O CC/MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|289.25|5887.98|6000.3|326.22|||| 684|DRG||RENAL FAILURE W/O CC/MCC|Medicare|MEDICARE ACUTE|29,678.55|5916.14|6000.3|326.22|||| 684|DRG||RENAL FAILURE W/O CC/MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|40,574.50|5880.29|6000.3|326.22|||| 684|DRG||RENAL FAILURE W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|20,754.50|3109.54|6000.3|326.22|||| 684|DRG||RENAL FAILURE W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|32,384.25|326.22|6000.3|326.22|||| 684|DRG||RENAL FAILURE W/O CC/MCC|Managed Medicaid|MEDICAID AMERIGROUP|37,616.60|6000.3|6000.3|326.22|||| 687|DRG||KIDNEY & URINARY TRACT NEOPLASMS W CC|Humana Medicare Advantage|HUMANA MA|43,460.80|8758.94|8758.94|5483.45|||| 687|DRG||KIDNEY & URINARY TRACT NEOPLASMS W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|51,221.47|5483.45|8758.94|5483.45|||| 687|DRG||KIDNEY & URINARY TRACT NEOPLASMS W CC|Medicare|MEDICARE ACUTE|225.20|8596.91|8758.94|5483.45|||| 689|DRG||KIDNEY & URINARY TRACT INFECTIONS W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|32,972.78|9175.3|29835.33|282.85|||| 689|DRG||KIDNEY & URINARY TRACT INFECTIONS W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|32,890.80|9175.3|29835.33|282.85|||| 689|DRG||KIDNEY & URINARY TRACT INFECTIONS W MCC|Veterans Affairs|VETERANS ADMINISTRATION|16,506.75|9175.3|29835.33|282.85|||| 689|DRG||KIDNEY & URINARY TRACT INFECTIONS W MCC|Medicare|MEDICARE PART B ONLY IP|24,003.25|282.85|29835.33|282.85|||| 689|DRG||KIDNEY & URINARY TRACT INFECTIONS W MCC|Medicare|MEDICARE ACUTE|34,431.90|9033.05|29835.33|282.85|||| 689|DRG||KIDNEY & URINARY TRACT INFECTIONS W MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|51,462.16|7791.845|29835.33|282.85|||| 689|DRG||KIDNEY & URINARY TRACT INFECTIONS W MCC|Humana Medicare Advantage|HUMANA MA|39,697.80|9034.57|29835.33|282.85|||| 689|DRG||KIDNEY & URINARY TRACT INFECTIONS W MCC|Managed Medicare|BCBS MEDICARE PPO MA|37,264.80|9175.3|29835.33|282.85|||| 689|DRG||KIDNEY & URINARY TRACT INFECTIONS W MCC|Cigna|CIGNA|72,250.55|29835.33|29835.33|282.85|||| 689|DRG||KIDNEY & URINARY TRACT INFECTIONS W MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|54,560.25|7199.485|29835.33|282.85|||| 69|DRG||TRANSIENT ISCHEMIA W/O THROMBOLYTIC|Humana Medicare Advantage|HUMANA MA|775.37|833.09|7041.17|833.09|||| 69|DRG||TRANSIENT ISCHEMIA W/O THROMBOLYTIC|Managed Medicare|WELLCARE CHOICE MA|417.85|7041.17|7041.17|833.09|||| 69|DRG||TRANSIENT ISCHEMIA W/O THROMBOLYTIC|Managed Medicare|HEALTHSPRING MA|48,963.28|6937.81|7041.17|833.09|||| 69|DRG||TRANSIENT ISCHEMIA W/O THROMBOLYTIC|Blue Cross HMO Specialty|BCBSTX HMO|20,535.05|3264.09|7041.17|833.09|||| 69|DRG||TRANSIENT ISCHEMIA W/O THROMBOLYTIC|Veterans Affairs|VETERANS ADMINISTRATION|34,488.54|6989.71|7041.17|833.09|||| 69|DRG||TRANSIENT ISCHEMIA W/O THROMBOLYTIC|Medicare|MEDICARE ACUTE|50,750.75|6937.37|7041.17|833.09|||| 69|DRG||TRANSIENT ISCHEMIA W/O THROMBOLYTIC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|109,329.60|1779.87|7041.17|833.09|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|43,536.63|6709.865|17111.02|2762.59|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|36,141.25|7107.41|17111.02|2762.59|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|Aetna|AETNA PPO|29,758.30|17111.02|17111.02|2762.59|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|46,308.68|8320.325|17111.02|2762.59|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|44,763.15|7280.26|17111.02|2762.59|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|Medicare|MEDICARE ACUTE|34,667.03|7003.3|17111.02|2762.59|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|25,011.20|4600.835|17111.02|2762.59|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|Managed Medicare|HEALTHSPRING MA|30,396.13|7055.355|17111.02|2762.59|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|Managed Medicare|MA PART B ONLY IP|47,268.25|6975.14|17111.02|2762.59|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|34,453.35|7002.42|17111.02|2762.59|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|26,761.60|5024.32|17111.02|2762.59|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|579.04|4503.36|17111.02|2762.59|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|Humana Medicare Advantage|HUMANA MA|39,935.55|6985.14|17111.02|2762.59|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|Managed Medicaid|MEDICAID SUPERIOR|31,784.60|2762.59|17111.02|2762.59|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|NON CONTRACTED|COMMERCIAL OTHER 1|24,185.45|13805.125|17111.02|2762.59|||| 694|DRG||URINARY STONES W/O MCC|Humana Medicare Advantage|HUMANA MA|44,783.89|6675.92|7397.34|4016.45|||| 694|DRG||URINARY STONES W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|24,753.15|4016.45|7397.34|4016.45|||| 694|DRG||URINARY STONES W/O MCC|United Healthcare|UNITED HEALTHCARE|33,819.15|7397.34|7397.34|4016.45|||| 694|DRG||URINARY STONES W/O MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|45,685.85|6789.46|7397.34|4016.45|||| 696|DRG||KIDNEY & URINARY TRACT SIGNS & SYMPTOMS W/O MCC|Medicare|MEDICARE ACUTE|37,547.25|6404.65|6404.65|6404.65|||| 697|DRG||URETHRAL STRICTURE|United Healthcare|TML GROUP BENEFITS|78,114.40|9730.23|9730.23|9730.23|||| 698|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|49,147.75|513.71|24813.57|513.71|||| 698|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC|Cigna|CIGNA OTHER|62,480.95|24813.57|24813.57|513.71|||| 698|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC|Humana Medicare Advantage|HUMANA MA|80,040.29|12124.02|24813.57|513.71|||| 698|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|48,673.83|12342.955|24813.57|513.71|||| 698|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|65,774.29|12216.315|24813.57|513.71|||| 698|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC|Medicare|MEDICARE ACUTE|42,385.01|12130.41|24813.57|513.71|||| 698|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|37,886.85|12329.5|24813.57|513.71|||| 699|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC|Veterans Affairs|VETERANS ADMINISTRATION|16,731.25|8633.4|42832.16|8422.43|||| 699|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|41,451.50|8633.4|42832.16|8422.43|||| 699|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC|Medicare|MEDICARE ACUTE|31,767.28|8473.63|42832.16|8422.43|||| 699|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|65,907.02|8422.43|42832.16|8422.43|||| 699|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC|Humana Medicare Advantage|HUMANA MA|32,807.30|8499.53|42832.16|8422.43|||| 699|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|55,250.75|8966.69|42832.16|8422.43|||| 699|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC|Aetna|BOON CHAPMAN|89,886.93|42832.16|42832.16|8422.43|||| 70|DRG||NONSPECIFIC CEREBROVASCULAR DISORDERS W MCC|Humana Medicare Advantage|HUMANA MA|90,379.18|12672.03|12672.03|12466.77|||| 70|DRG||NONSPECIFIC CEREBROVASCULAR DISORDERS W MCC|Medicare|MEDICARE ACUTE|50,846.25|12466.77|12672.03|12466.77|||| 700|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W/O CC/MCC|Veterans Affairs|VETERANS ADMINISTRATION|25,245.88|6694.51|6699.14|6694.51|||| 700|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W/O CC/MCC|Medicare|MEDICARE ACUTE|29,396.90|6699.14|6699.14|6694.51|||| 70100|EAP|0320|LATERAL FACE|Blue Cross PPO Specialty|BCBSTX PPO|||||487.75||| 70100|EAP|0320|LATERAL FACE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||487.75||| 70100|EAP|0320|LATERAL FACE|Managed Medicaid|MEDICAID AMERIGROUP|||||487.75||| 70100|EAP|0320|LATERAL FACE|Humana Medicare Advantage|HUMANA MA|||||487.75||| 70100|EAP|0320|LATERAL FACE|United Healthcare|UNITED HEALTHCARE|||||487.75||| 70110|EAP|0320|MANDIBLE|Medicare|MEDICARE ACUTE|||||540.50||| 70110|EAP|0320|MANDIBLE|Managed Medicaid|MEDICAID AMERIGROUP|||||540.50||| 70110|EAP|0320|MANDIBLE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||540.50||| 70110|EAP|0320|MANDIBLE|Blue Cross HMO Specialty|BCBSTX HMO|||||540.50||| 70110|EAP|0320|MANDIBLE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||540.50||| 70110|EAP|0320|MANDIBLE|Humana Medicare Advantage|HUMANA MA|||||540.50||| 70150|EAP|0320|FACIAL BONES COMPLETE|Cigna|CIGNA|||||540.50||| 70150|EAP|0320|FACIAL BONES COMPLETE|Managed Medicaid|MEDICAID AMERIGROUP|||||540.50||| 70150|EAP|0320|FACIAL BONES COMPLETE|Managed Medicaid|MEDICAID SUPERIOR|||||540.50||| 70150|EAP|0320|FACIAL BONES COMPLETE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||540.50||| 70150|EAP|0320|FACIAL BONES COMPLETE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||540.50||| 70150|EAP|0320|FACIAL BONES 3 VIEWS|Tricare|TRICARE EAST REGION|||||540.50||| 70150|EAP|0320|FACIAL BONES COMPLETE|Medicare|MEDICARE ACUTE|||||540.50||| 70150|EAP|0320|FACIAL BONES COMPLETE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||540.50||| 70160|EAP|0320|NOSE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||540.50||| 70160|EAP|0320|NOSE|Tricare|TRICARE EAST REGION|||||540.50||| 70160|EAP|0320|NOSE|Medicare|MEDICARE ACUTE|||||540.50||| 70160|EAP|0320|NOSE|Managed Medicaid|MEDICAID AMERIGROUP|||||540.50||| 70160|EAP|0320|NOSE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||540.50||| 70160|EAP|0320|NOSE|Managed Medicaid|MEDICAID SUPERIOR|||||540.50||| 70160|EAP|0320|NOSE|United Healthcare|UNITED HEALTHCARE|||||540.50||| 70160|EAP|0320|NOSE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||540.50||| 70160|EAP|0320|NOSE|Veterans Affairs|VETERANS ADMINISTRATION|||||540.50||| 70160|EAP|0320|NOSE|Blue Cross HMO Specialty|BCBSTX HMO|||||540.50||| 70200|EAP|0320|ORBITS|Aetna|AETNA PPO|||||592.75||| 70200|EAP|0320|ORBITS|Veterans Affairs|VETERANS ADMINISTRATION|||||592.75||| 70200|EAP|0320|ORBITS|Medicare|MEDICARE ACUTE|||||592.75||| 70220|EAP|0320|SINUSES PARANASAL|Medicare|MEDICARE ACUTE|540.50||||540.50||| 70220|EAP|0320|SINUSES PARANASAL|Blue Cross PPO Specialty|BCBSTX PPO|||||540.50||| 70220|EAP|0320|SINUSES PARANASAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||540.50||| 70220|EAP|0320|SINUSES PARANASAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||540.50||| 70260|EAP|0320|SKULL (4 VIEWS)|Humana Medicare Advantage|HUMANA MA|||||4.02||| 70260|EAP|0320|SKULL (4 VIEWS)|Managed Medicaid|MEDICAID SUPERIOR|||||4.02||| 70260|EAP|0320|SKULL (4 VIEWS)|Managed Medicaid|MEDICAID AMERIGROUP|||||4.02||| 70260|EAP|0320|SKULL (4 VIEWS)|Blue Cross PPO Specialty|BCBSTX PPO|||||4.02||| 70260|EAP|0320|SKULL (4 VIEWS)|Cigna|CIGNA|||||4.02||| 70260|EAP|0320|SKULL (4 VIEWS)|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.02||| 70260|EAP|0320|SKULL COMPLETE|United Healthcare|UNITED HEALTHCARE|||||7.13||| 70260|EAP|0320|SKULL (4 VIEWS)|United Healthcare|UNITED HEALTHCARE|||||4.02||| 70260|EAP|0320|SKULL (4 VIEWS)|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.02||| 70260|EAP|0320|SKULL (4 VIEWS)|Medicaid|MEDICAID|4.02||||4.02||| 70260|EAP|0320|SKULL (4 VIEWS)|Medicare|MEDICARE ACUTE|||||4.02||| 70260|EAP|0320|SKULL (4 VIEWS)|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.02||| 70260|EAP|0320|SKULL COMPLETE|Medicare|MEDICARE ACUTE|||||7.13||| 70260|EAP|0320|SKULL COMPLETE|NON CONTRACTED|COMMERCIAL OTHER 1|||||7.13||| 70360|EAP|0320|NECK SOFT TISSUE|Medicare|MEDICARE PART B ONLY IP|427.50||||||| 70360|EAP|0320|NECK SOFT TISSUE|Tricare|TRICARE EAST REGION|427.50||||||| 70360|EAP|0320|NECK SOFT TISSUE|Medicare|MEDICARE ACUTE|||||427.50||| 70360|EAP|0320|NECK SOFT TISSUE|Medicaid|MEDICAID|427.50||||||| 70360|EAP|0320|NECK SOFT TISSUE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||427.50||| 70360|EAP|0320|NECK SOFT TISSUE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||427.50||| 70360|EAP|0320|NECK SOFT TISSUE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||427.50||| 70360|EAP|0320|NECK SOFT TISSUE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||427.50||| 70360|EAP|0320|NECK SOFT TISSUE|NON CONTRACTED|COMMERCIAL OTHER 1|||||427.50||| 70360|EAP|0320|NECK SOFT TISSUE|United Healthcare|UNITED HEALTHCARE|||||427.50||| 70360|EAP|0320|NECK SOFT TISSUE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||427.50||| 70360|EAP|0320|NECK SOFT TISSUE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||427.50||| 70360|EAP|0320|NECK SOFT TISSUE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||427.50||| 70360|EAP|0320|NECK SOFT TISSUE|Cigna|CIGNA|||||427.50||| 70360|EAP|0320|NECK SOFT TISSUE|Blue Cross PPO Specialty|BCBSTX PPO|||||427.50||| 70360|EAP|0320|NECK SOFT TISSUE|Managed Medicaid|MEDICAID SUPERIOR|||||427.50||| 70360|EAP|0320|NECK SOFT TISSUE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||427.50||| 70360|EAP|0320|NECK SOFT TISSUE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||427.50||| 70360|EAP|0320|NECK SOFT TISSUE|Managed Medicaid|MEDICAID AMERIGROUP|||||427.50||| 70360|EAP|0320|NECK SOFT TISSUE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||427.50||| 70360|EAP|0320|NECK SOFT TISSUE|Humana Medicare Advantage|HUMANA MA|||||427.50||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Humana Medicare Advantage|HUMANA MA|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|MTC Medical|VAN ZANDT COUNTY INMATE|||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Managed Medicare|MA PART B ONLY IP|3,772.75||||||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Managed Medicare|VAN ZANDT COUNTY INMATE|||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Managed Medicare|BCBS MEDICARE PPO MA|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Managed Medicare|HEALTHSPRING MA|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Cigna|CIGNA|||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Blue Cross PPO Specialty|BCBSTX OTHER|||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Cigna|CIGNA|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Aetna|AETNA PPO|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UMR|||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Aetna|AETNA OTHER|||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Workers Compensation|WORKERS COMP PHYSICIAN|||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Workers Compensation|WORKERS COMPENSATION OTHER|||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Workers Compensation|TEXAS MUTUAL INSURANCE|||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|United Healthcare|UNITED HEALTHCARE OTHER|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|United Healthcare|UMR UNITED MEDICAL RESOURCES|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Cigna|CIGNA OTHER|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|United Medicare Advantage|UHC AARP MCR HMO MA|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Managed Medicare|WELLCARE CHOICE MA|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|United Healthcare|UNITED HEALTHCARE|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|ChampVA|CHAMPVA CENTER|||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|United Healthcare|GOLDEN RULE|||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|United Healthcare|GEHA|||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|United Healthcare|TML GROUP BENEFITS|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Medicaid|LAW ENFORCEMENT OTHER|||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Medicaid|COUNTY INDIGENT HEALTH OTHER|3,772.75||||||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Medicaid|HENDERSON COUNTY INDIGENT|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Managed Medicare|HOSPICE OF EAST TEXAS|3,772.75||||||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Medicaid|MOLINA HEALTHCARE OF TEXAS|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Medicaid|MEDICAID TEXAS CHILDRENS|||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Medicaid|MEDICAID|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Medicaid|MEDICAID HMO|||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Tricare|TRICARE FOR LIFE|||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Medicare|MEDICARE PART B ONLY IP|3,772.75||||||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Medicare|MEDICARE ACUTE|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 1|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|UTMB|UTMB CORRECTIONAL MANAGED CARE|||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Tricare|TRICARE EAST REGION|3,772.75||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 2|||||3,772.75||| 70450|EAP|0350|CT HEAD W/O CONTRAST|PHCS|HUMANA|||||3,772.75||| 70460|EAP|0350|CT HEAD W/CONTRAST|Medicare|MEDICARE ACUTE|4,928.25||||4,928.25||| 70460|EAP|0350|CT HEAD W/CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4,928.25||||4,928.25||| 70460|EAP|0350|CT HEAD W/CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4,928.25||||4,928.25||| 70460|EAP|0350|CT HEAD W/CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|||||4,928.25||| 70460|EAP|0350|CT HEAD W/CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4,928.25||| 70460|EAP|0350|CT HEAD W/CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|||||4,928.25||| 70460|EAP|0350|CT HEAD W/CONTRAST|Managed Medicare|HEALTHSPRING MA|4,928.25||||||| 70460|EAP|0350|CT HEAD W/CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4,928.25||| 70460|EAP|0350|CT HEAD W/CONTRAST|Medicaid|MEDICAID|4,928.25||||||| 70460|EAP|0350|CT HEAD W/CONTRAST|Humana Medicare Advantage|HUMANA MA|4,928.25||||4,928.25||| 70460|EAP|0350|CT HEAD W/CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|||||4,928.25||| 70470|EAP|0350|CT HEAD W&W/O CONTRAST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||55.89||| 70470|EAP|0350|CT HEAD W&W/O CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||55.89||| 70470|EAP|0350|CT HEAD W&W/O CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|||||55.89||| 70470|EAP|0350|CT HEAD W&W/O CONTRAST|Managed Medicare|HEALTHSPRING MA|||||55.89||| 70470|EAP|0350|CT HEAD W&W/O CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||55.89||| 70470|EAP|0350|CT HEAD W&W/O CONTRAST|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||55.89||| 70470|EAP|0350|CT HEAD W&W/O CONTRAST|Aetna|AETNA PPO|||||55.89||| 70470|EAP|0350|CT HEAD W&W/O CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|||||55.89||| 70470|EAP|0350|CT HEAD W&W/O CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|||||55.89||| 70470|EAP|0350|CT HEAD W&W/O CONTRAST|Humana Medicare Advantage|HUMANA MA|||||55.89||| 70470|EAP|0350|CT HEAD W&W/O CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|55.89||||55.89||| 70470|EAP|0350|CT HEAD W&W/O CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||55.89||| 70470|EAP|0350|CT HEAD W&W/O CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|||||55.89||| 70470|EAP|0350|CT HEAD W&W/O CONTRAST|United Healthcare|TML GROUP BENEFITS|||||55.89||| 70470|EAP|0350|CT HEAD W&W/O CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||55.89||| 70470|EAP|0350|CT HEAD W&W/O CONTRAST|United Healthcare|UNITED HEALTHCARE|||||55.89||| 70470|EAP|0350|CT HEAD W&W/O CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||55.89||| 70470|EAP|0350|CT HEAD W&W/O CONTRAST|Medicare|MEDICARE ACUTE|55.89||||55.89||| 70470|EAP|0350|CT HEAD W&W/O CONTRAST|United Medicare Advantage|UHC AARP MCR HMO MA|||||55.89||| 70480|EAP|0350|CT ORBITS/IAC W/O CONTRAS|Medicare|MEDICARE ACUTE|||||3,772.75||| 70480|EAP|0350|CT ORBITS/IAC W/O CONTRAS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3,772.75||| 70480|EAP|0350|CT ORBITS/IAC W/O CONTRAS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||3,772.75||| 70480|EAP|0350|CT ORBITS/IAC W/O CONTRAS|Blue Cross PPO Specialty|BCBSTX PPO|||||3,772.75||| 70480|EAP|0350|CT ORBITS/IAC W/O CONTRAS|Blue Cross HMO Specialty|BCBSTX HMO|||||3,772.75||| 70480|EAP|0350|CT ORBITS/IAC W/O CONTRAS|Cigna|CIGNA|||||3,772.75||| 70480|EAP|0350|CT ORBITS/IAC W/O CONTRAS|Medicaid|MEDICAID|||||3,772.75||| 70480|EAP|0350|CT ORBITS/IAC W/O CONTRAS|Managed Medicaid|MEDICAID AMERIGROUP|||||3,772.75||| 70480|EAP|0350|CT ORBITS/IAC W/O CONTRAS|Managed Medicare|HEALTHSPRING MA|||||3,772.75||| 70480|EAP|0350|CT ORBITS/IAC W/O CONTRAS|Humana Medicare Advantage|HUMANA MA|||||3,772.75||| 70480|EAP|0350|CT ORBITS/IAC W/O CONTRAS|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||3,772.75||| 70480|EAP|0350|CT ORBITS/IAC W/O CONTRAS|United Healthcare|UNITED HEALTHCARE|||||3,772.75||| 70481|EAP|0350|CT ORBITS/IAC W/CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|4,928.25||||||| 70481|EAP|0350|CT ORBITS/IAC W/CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|||||4,928.25||| 70481|EAP|0350|CT ORBITS/IAC W/CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4,928.25||| 70481|EAP|0350|CT ORBITS/IAC W/CONTRAST|Medicare|MEDICARE ACUTE|||||4,928.25||| 70481|EAP|0350|CT ORBITS/IAC W/CONTRAST|Medicaid|MEDICAID TEXAS CHILDRENS|||||4,928.25||| 70482|EAP|0350|CT ORBITS/IAC W&W/O CONTR|Aenta Medicare Advantage|AETNA MEDICARE MA|||||55.89||| 70482|EAP|0350|CT ORBITS W&W/O CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||55.89||| 70482|EAP|0350|CT ORBITS W&W/O CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|55.89||||||| 70482|EAP|0350|CT ORBITS W&W/O CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||55.89||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Medicaid|HENDERSON COUNTY INDIGENT|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Medicaid|MEDICAID|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Tricare|TRICARE EAST REGION|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|UTMB|UTMB CORRECTIONAL MANAGED CARE|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Medicaid|LAW ENFORCEMENT OTHER|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|NON CONTRACTED|COMMERCIAL OTHER 1|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Workers Compensation|TEXAS MUTUAL INSURANCE|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Workers Compensation|WORKERS COMP PHYSICIAN|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Veterans Affairs|VETERANS ADMINISTRATION|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3,772.75||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|United Healthcare|UNITED HEALTHCARE|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|United Medicare Advantage|UHC AARP MCR HMO MA|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Humana Medicare Advantage|HUMANA MA|3,772.75||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|MTC Medical|VAN ZANDT COUNTY INMATE|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Workers Compensation|WORKERS COMPENSATION OTHER|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Cigna|CIGNA|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Managed Medicare|BCBS MEDICARE PPO MA|3,772.75||||||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Medicaid|COUNTY INDIGENT HEALTH OTHER|3,772.75||||||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Medicare|MEDICARE ACUTE|3,772.75||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Managed Medicaid|MEDICAID SUPERIOR|3,772.75||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Managed Medicare|HEALTHSPRING MA|3,772.75||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Medicaid|MEDICAID TEXAS CHILDRENS|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Managed Medicare|VAN ZANDT COUNTY INMATE|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Blue Cross HMO Specialty|BCBSTX HMO|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Blue Cross PPO Specialty|BCBSTX OTHER|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Cigna|CIGNA OTHER|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Managed Medicaid|MEDICAID AMERIGROUP|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Blue Cross PPO Specialty|BCBSTX PPO|3,772.75||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3,772.75||| 70486|EAP|0350|CT MAXILLOFACIAL W/O CONT|Aetna|AETNA PPO|||||3,772.75||| 70487|EAP|0350|CT MAXILLOFACIAL W/CONTRA|Aetna|AETNA PPO|||||4,928.25||| 70487|EAP|0350|CT MAXILLOFACIAL W/CONTRA|Aetna|AETNA OTHER|||||4,928.25||| 70487|EAP|0350|CT MAXILLOFACIAL W/CONTRA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4,928.25||| 70487|EAP|0350|CT MAXILLOFACIAL W/CONTRA|Blue Cross HMO Specialty|BCBSTX HMO|||||4,928.25||| 70487|EAP|0350|CT MAXILLOFACIAL W/CONTRA|Blue Cross PPO Specialty|BCBSTX PPO|||||4,928.25||| 70487|EAP|0350|CT MAXILLOFACIAL W/CONTRA|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4,928.25||| 70487|EAP|0350|CT MAXILLOFACIAL W/CONTRA|Managed Medicaid|MEDICAID SUPERIOR|4,928.25||||4,928.25||| 70487|EAP|0350|CT MAXILLOFACIAL W/CONTRA|Humana Medicare Advantage|HUMANA MA|4,928.25||||4,928.25||| 70487|EAP|0350|CT MAXILLOFACIAL W/CONTRA|Cigna|CIGNA|||||4,928.25||| 70487|EAP|0350|CT MAXILLOFACIAL W/CONTRA|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4,928.25||| 70487|EAP|0350|CT MAXILLOFACIAL W/CONTRA|United Healthcare|UNITED HEALTHCARE|||||4,928.25||| 70487|EAP|0350|CT MAXILLOFACIAL W/CONTRA|Medicare|MEDICARE ACUTE|4,928.25||||4,928.25||| 70487|EAP|0350|CT MAXILLOFACIAL W/CONTRA|Veterans Affairs|VETERANS ADMINISTRATION|||||4,928.25||| 70487|EAP|0350|CT MAXILLOFACIAL W/CONTRA|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4,928.25||| 70490|EAP|0350|CT SOFT TISSUE NECK W/O|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||3,772.75||| 70490|EAP|0350|CT SOFT TISSUE NECK W/O|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3,772.75||| 70490|EAP|0350|CT SOFT TISSUE NECK W/O|Medicare|MEDICARE ACUTE|3,772.75||||3,772.75||| 70490|EAP|0350|CT SOFT TISSUE NECK W/O|Veterans Affairs|VETERANS ADMINISTRATION|||||3,772.75||| 70490|EAP|0350|CT SOFT TISSUE NECK W/O|NON CONTRACTED|COMMERCIAL OTHER 1|||||3,772.75||| 70490|EAP|0350|CT SOFT TISSUE NECK W/O|Workers Compensation|WORKERS COMPENSATION OTHER|||||3,772.75||| 70490|EAP|0350|CT SOFT TISSUE NECK W/O|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3,772.75||| 70490|EAP|0350|CT SOFT TISSUE NECK W/O|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||3,772.75||| 70490|EAP|0350|CT SOFT TISSUE NECK W/O|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3,772.75||| 70490|EAP|0350|CT SOFT TISSUE NECK W/O|Managed Medicaid|MEDICAID AMERIGROUP|||||3,772.75||| 70490|EAP|0350|CT SOFT TISSUE NECK W/O|Blue Cross PPO Specialty|BCBSTX PPO|||||3,772.75||| 70490|EAP|0350|CT SOFT TISSUE NECK W/O|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3,772.75||| 70490|EAP|0350|CT SOFT TISSUE NECK W/O|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3,772.75||| 70490|EAP|0350|CT SOFT TISSUE NECK W/O|Managed Medicaid|MEDICAID SUPERIOR|||||3,772.75||| 70490|EAP|0350|CT SOFT TISSUE NECK W/O|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3,772.75||| 70490|EAP|0350|CT SOFT TISSUE NECK W/O|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||3,772.75||| 70490|EAP|0350|CT SOFT TISSUE NECK W/O|Managed Medicare|HEALTHSPRING MA|||||3,772.75||| 70490|EAP|0350|CT SOFT TISSUE NECK W/O|Humana Medicare Advantage|HUMANA MA|3,772.75||||3,772.75||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4,928.25||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||4,928.25||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|Aenta Medicare Advantage|AETNA MEDICARE MA|4,928.25||||4,928.25||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|Blue Cross PPO Specialty|BCBSTX PPO|4,928.25||||4,928.25||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4,928.25||||4,928.25||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|Managed Medicaid|MEDICAID AMERIGROUP|||||4,928.25||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4,928.25||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|Managed Medicare|HEALTHSPRING MA|||||4,928.25||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4,928.25||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|Managed Medicaid|MEDICAID SUPERIOR|||||4,928.25||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|Blue Cross HMO Specialty|BCBSTX HMO|||||4,928.25||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|Cigna|CIGNA|||||4,928.25||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|Aetna|AETNA PPO|||||4,928.25||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|Humana Medicare Advantage|HUMANA MA|||||4,928.25||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4,928.25||||4,928.25||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4,928.25||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|United Healthcare|UNITED HEALTHCARE|||||4,928.25||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4,928.25||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|United Medicare Advantage|UHC AARP MCR HMO MA|||||4,928.25||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|United Healthcare|UNITED HEALTHCARE OTHER|||||4,928.25||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|Veterans Affairs|VETERANS ADMINISTRATION|||||4,928.25||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|Tricare|TRICARE EAST REGION|||||4,928.25||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|Medicare|MEDICARE ACUTE|4,928.25||||4,928.25||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|NON CONTRACTED|COMMERCIAL OTHER 1|4,928.25||||4,928.25||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||4,928.25||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|Medicaid|MEDICAID HMO|4,928.25||||||| 70491|EAP|0350|CT SOFT TISSUE NECK W/|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||4,928.25||| 70492|EAP|0350|CT SOFT TISSUE NECK W&W/O|Medicare|MEDICARE ACUTE|||||55.89||| 70492|EAP|0350|CT SOFT TISSUE NECK W&W/O|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||55.89||| 70492|EAP|0350|CT SOFT TISSUE NECK W&W/O|Humana Medicare Advantage|HUMANA MA|||||55.89||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|6,249.25||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|6,249.25||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UMR|||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|6,249.25||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|6,249.25||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|6,249.25||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|6,249.25||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|Managed Medicare|HEALTHSPRING MA|6,249.25||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|Humana Medicare Advantage|HUMANA MA|6,249.25||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|Aetna|AETNA OTHER|||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|Cigna|CIGNA OTHER|||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|Managed Medicare|WELLCARE CHOICE MA|6,249.25||||||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|Managed Medicare|BCBS MEDICARE PPO MA|||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|Cigna|CIGNA|6,249.25||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|6,249.25||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|6,249.25||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|United Healthcare|GOLDEN RULE|||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|United Healthcare|UNITED HEALTHCARE|||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|United Healthcare|TML GROUP BENEFITS|6,249.25||||||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|United Medicare Advantage|UHC AARP MCR HMO MA|||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|6,249.25||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|6,249.25||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|Medicaid|MEDICAID|6,249.25||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|Medicare|MEDICARE ACUTE|6,249.25||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 1|||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|Aetna|AETNA PPO|6,249.25||||6,249.25||| 70496|EAP|0351|CTA HEAD W/WO CONTRAST|Tricare|TRICARE FOR LIFE|||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|United Medicare Advantage|UHC AARP MCR HMO MA|||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|Tricare|TRICARE FOR LIFE|||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|Medicaid|MEDICAID|6,249.25||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|6,249.25||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|Medicare|MEDICARE ACUTE|6,249.25||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|United Healthcare|GOLDEN RULE|||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|6,249.25||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|United Healthcare|UNITED HEALTHCARE|||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|6,249.25||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|Workers Compensation|WORKERS COMPENSATION OTHER|||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|6,249.25||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|Cigna|CIGNA|6,249.25||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|Humana Medicare Advantage|HUMANA MA|6,249.25||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|6,249.25||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|Managed Medicare|WELLCARE CHOICE MA|6,249.25||||||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|6,249.25||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|Managed Medicare|BCBS MEDICARE PPO MA|||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|United Healthcare|TML GROUP BENEFITS|6,249.25||||||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 1|||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|6,249.25||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|Aetna|AETNA PPO|6,249.25||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|Managed Medicare|HEALTHSPRING MA|6,249.25||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|Cigna|CIGNA OTHER|||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|6,249.25||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|Aetna|AETNA OTHER|||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|6,249.25||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|||||6,249.25||| 70498|EAP|0350|CTA NECK W/WO CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|6,249.25||||6,249.25||| 70543|EAP|0610|MRI ORBIT, FACE, AND NECK|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||8,230.75||| 70543|EAP|0610|MRI ORBIT, FACE, AND NECK|Blue Cross PPO Specialty|BCBSTX PPO|||||8,230.75||| 70543|EAP|0610|MRI ORBIT, FACE, AND NECK|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||8,230.75||| 70543|EAP|0610|MRI ORBIT, FACE, AND NECK|Managed Medicaid|MEDICAID SUPERIOR|||||8,230.75||| 70543|EAP|0610|MRI ORBIT, FACE, AND NECK|Humana Medicare Advantage|HUMANA MA|||||8,230.75||| 70543|EAP|0610|MRI ORBIT, FACE, AND NECK|Cigna|CIGNA|||||8,230.75||| 70543|EAP|0610|MRI ORBIT, FACE, AND NECK|Veterans Affairs|VETERANS ADMINISTRATION|||||8,230.75||| 70543|EAP|0610|MRI ORBIT, FACE, AND NECK|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||8,230.75||| 70543|EAP|0610|MRI ORBIT, FACE, AND NECK|Tricare|TRICARE EAST REGION|||||8,230.75||| 70543|EAP|0610|MRI ORBIT, FACE, AND NECK|Medicaid|MEDICAID|||||8,230.75||| 70543|EAP|0610|MRI ORBIT, FACE, AND NECK|Multiplan|NALC|||||8,230.75||| 70543|EAP|0610|MRI ORBIT, FACE, AND NECK|Medicaid|COUNTY INDIGENT HEALTH OTHER|8,230.75||||||| 70543|EAP|0610|MRI ORBIT, FACE, AND NECK|Managed Medicare|HEALTHSPRING MA|||||8,230.75||| 70543|EAP|0610|MRI ORBIT, FACE, AND NECK|Medicare|MEDICARE ACUTE|||||8,230.75||| 70544|EAP|0615|MRA HEAD WO/CONTRAST|Medicare|MEDICARE ACUTE|7,463.25||||7,463.25||| 70544|EAP|0615|MRA HEAD WO/CONTRAST|Medicaid|MEDICAID|7,463.25||||||| 70544|EAP|0615|MRA HEAD WO/CONTRAST|Managed Medicare|HEALTHSPRING MA|7,463.25||||||| 70544|EAP|0615|MRA HEAD WO/CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|7,463.25||||7,463.25||| 70544|EAP|0615|MRA HEAD WO/CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|7,463.25||||||| 70544|EAP|0615|MRA HEAD WO/CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|||||7,463.25||| 70544|EAP|0615|MRA HEAD WO/CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|7,463.25||||||| 70544|EAP|0615|MRA HEAD WO/CONTRAST|Cigna|CIGNA OTHER|||||7,463.25||| 70544|EAP|0615|MRA HEAD WO/CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||7,463.25||| 70544|EAP|0615|MRA HEAD WO/CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||7,463.25||| 70544|EAP|0615|MRA HEAD WO/CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||7,463.25||| 70544|EAP|0615|MRA HEAD WO/CONTRAST|Humana Medicare Advantage|HUMANA MA|7,463.25||||7,463.25||| 70544|EAP|0615|MRA HEAD WO/CONTRAST|Aetna|AETNA PPO|||||7,463.25||| 70544|EAP|0615|MRA HEAD WO/CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||7,463.25||| 70544|EAP|0615|MRA HEAD WO/CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|||||7,463.25||| 70544|EAP|0615|MRA HEAD WO/CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||7,463.25||| 70544|EAP|0615|MRA HEAD WO/CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|||||7,463.25||| 70544|EAP|0615|MRA HEAD WO/CONTRAST|United Healthcare|UNITED HEALTHCARE|||||7,463.25||| 70546|EAP|0615|MRA HEAD W&WO|Medicare|MEDICARE ACUTE|8,230.75||||||| 70547|EAP|0615|MRA NECK W/O CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|||||60.84||| 70547|EAP|0615|MRA NECK W/O CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||60.84||| 70547|EAP|0615|MRA NECK W/O CONTRAST|Humana Medicare Advantage|HUMANA MA|60.84||||60.84||| 70547|EAP|0615|MRA NECK W/O CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||60.84||| 70547|EAP|0615|MRA NECK W/O CONTRAST|Managed Medicare|HEALTHSPRING MA|60.84||||||| 70547|EAP|0615|MRA NECK W/O CONTRAST|Medicare|MEDICARE ACUTE|60.84||||60.84||| 70549|EAP|0615|MRA NECK W&WO|United Healthcare|UNITED HEALTHCARE|||||8,230.75||| 70549|EAP|0615|MRA NECK W&WO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|8,230.75||||||| 70549|EAP|0615|MRA NECK W&WO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||8,230.75||| 70549|EAP|0615|MRA NECK W&WO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||8,230.75||| 70549|EAP|0615|MRA NECK W&WO|Aetna|AETNA PPO|||||8,230.75||| 70549|EAP|0615|MRA NECK W&WO|Humana Medicare Advantage|HUMANA MA|||||8,230.75||| 70549|EAP|0615|MRA NECK W&WO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||8,230.75||| 70549|EAP|0615|MRA NECK W&WO|Blue Cross HMO Specialty|BCBSTX HMO|||||8,230.75||| 70549|EAP|0615|MRA NECK W&WO|Medicare|MEDICARE ACUTE|8,230.75||||8,230.75||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|60.84||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|60.84||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|60.84||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|60.84||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Humana Medicare Advantage|HUMANA MA|60.84||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Cigna|CIGNA OTHER|||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Cigna|CIGNA|||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Cigna|CIGNA|60.84||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Blue Cross PPO Specialty|BCBSTX OTHER|||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|60.84||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Aetna|AETNA PPO|60.84||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|60.84||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|60.84||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Workers Compensation|WORKERS COMPENSATION OTHER|||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|60.84||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|ChampVA|CHAMPVA CENTER|||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|60.84||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|United Medicare Advantage|UHC AARP MCR HMO MA|60.84||||||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|United Healthcare|UNITED HEALTHCARE|||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|United Healthcare|UNITED HEALTHCARE OTHER|||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|United Healthcare|UNITED HEALTHCARE|60.84||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Managed Medicare|BCBS MEDICARE PPO MA|||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Managed Medicare|OTHER INSTITUTIONS|||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Managed Medicare|WELLCARE CHOICE MA|60.84||||||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Managed Medicare|HEALTHSPRING MA|60.84||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Medicaid|MEDICAID|60.84||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Tricare|TRICARE EAST REGION|||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Medicare|MEDICARE ACUTE|60.84||||60.84||| 70551|EAP|0611|MRI BRAIN W/O CONTRAST|Medicare|MEDICARE PART B ONLY IP|60.84||||||| 70552|EAP|0611|MRI BRAIN W/CONTRAST|Medicare|MEDICARE ACUTE|72.40||||||| 70552|EAP|0611|MRI BRAIN W/CONTRAST|Managed Medicare|HEALTHSPRING MA|||||72.40||| 70552|EAP|0611|MRI BRAIN W/CONTRAST|Managed Medicare|BCBS MEDICARE PPO MA|||||72.40||| 70552|EAP|0611|MRI BRAIN W/CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||72.40||| 70552|EAP|0611|MRI BRAIN W/CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|||||72.40||| 70552|EAP|0611|MRI BRAIN W/CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|72.40||||72.40||| 70552|EAP|0611|MRI BRAIN W/CONTRAST|Humana Medicare Advantage|HUMANA MA|72.40||||72.40||| 70552|EAP|0611|MRI BRAIN W/CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||72.40||| 70552|EAP|0611|MRI BRAIN W/CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|72.40||||||| 70553|EAP|0611|MRI BRAIN W & WO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||8,230.75||| 70553|EAP|0611|MRI BRAIN W & WO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||8,230.75||| 70553|EAP|0611|MRI BRAIN W & WO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||8,230.75||| 70553|EAP|0611|MRI BRAIN W & WO|Aetna|AETNA PPO|||||8,230.75||| 70553|EAP|0611|MRI BRAIN W & WO|Access Direct Platinum|HEALTHFIRST TPA UMR|||||8,230.75||| 70553|EAP|0611|MRI BRAIN W & WO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|8,230.75||||8,230.75||| 70553|EAP|0611|MRI BRAIN W & WO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|8,230.75||||8,230.75||| 70553|EAP|0611|MRI BRAIN W & WO|Managed Medicaid|MEDICAID SUPERIOR|||||8,230.75||| 70553|EAP|0611|MRI BRAIN W & WO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|8,230.75||||8,230.75||| 70553|EAP|0611|MRI BRAIN W & WO|Humana Medicare Advantage|HUMANA MA|8,230.75||||8,230.75||| 70553|EAP|0611|MRI BRAIN W & WO|United Healthcare|UNITED HEALTHCARE|||||8,230.75||| 70553|EAP|0611|MRI BRAIN W & WO|United Healthcare|UNITED HEALTHCARE|8,230.75||||8,230.75||| 70553|EAP|0611|MRI BRAIN W & WO|Cigna|CIGNA|||||8,230.75||| 70553|EAP|0611|MRI BRAIN W & WO|United Healthcare|TML GROUP BENEFITS|8,230.75||||8,230.75||| 70553|EAP|0611|MRI BRAIN W & WO|Cigna|CIGNA OTHER|8,230.75||||||| 70553|EAP|0611|MRI BRAIN W & WO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|8,230.75||||8,230.75||| 70553|EAP|0611|MRI BRAIN W & WO|United Medicare Advantage|UHC MEDICARE GOLD MA|8,230.75||||8,230.75||| 70553|EAP|0611|MRI BRAIN W & WO|Veterans Affairs|VETERANS ADMINISTRATION|8,230.75||||8,230.75||| 70553|EAP|0611|MRI BRAIN W & WO|Blue Cross HMO Specialty|BCBSTX HMO|8,230.75||||8,230.75||| 70553|EAP|0611|MRI BRAIN W & WO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|8,230.75||||8,230.75||| 70553|EAP|0611|MRI BRAIN W & WO|Managed Medicare|HEALTHSPRING MA|||||8,230.75||| 70553|EAP|0611|MRI BRAIN W & WO|Medicaid|MEDICAID|8,230.75||||||| 70553|EAP|0611|MRI BRAIN W & WO|Medicare|MEDICARE ACUTE|8,230.75||||8,230.75||| 70553|EAP|0611|MRI BRAIN W & WO|Multiplan|NALC|||||8,230.75||| 70553|EAP|0611|MRI BRAIN W & WO|NON CONTRACTED|COMMERCIAL OTHER 1|||||8,230.75||| 70553|EAP|0611|MRI BRAIN W & WO|Blue Cross PPO Specialty|BCBSTX PPO|8,230.75||||8,230.75||| 707|DRG||MAJOR MALE PELVIC PROCEDURES W CC/MCC|Medicare|MEDICARE ACUTE|55,295.01|13914.79|13914.79|9129.44|||| 707|DRG||MAJOR MALE PELVIC PROCEDURES W CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|39,495.05|9129.44|13914.79|9129.44|||| 708|DRG||MAJOR MALE PELVIC PROCEDURES W/O CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|31,212.33|8394.425|18431.795|8394.425|||| 708|DRG||MAJOR MALE PELVIC PROCEDURES W/O CC/MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|48,033.90|11313.02|18431.795|8394.425|||| 708|DRG||MAJOR MALE PELVIC PROCEDURES W/O CC/MCC|Aetna|AETNA PPO|32,055.30|18431.795|18431.795|8394.425|||| 708|DRG||MAJOR MALE PELVIC PROCEDURES W/O CC/MCC|Veterans Affairs|VETERANS ADMINISTRATION|37,387.30|11099.24|18431.795|8394.425|||| 708|DRG||MAJOR MALE PELVIC PROCEDURES W/O CC/MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|48,226.85|11188.88|18431.795|8394.425|||| 708|DRG||MAJOR MALE PELVIC PROCEDURES W/O CC/MCC|Medicare|MEDICARE ACUTE|39,268.80|11099.24|18431.795|8394.425|||| 709|DRG||PENIS PROCEDURES W CC/MCC|Medicare|MEDICARE ACUTE|50,709.55|17005.63|17005.63|17005.63|||| 71|DRG||NONSPECIFIC CEREBROVASCULAR DISORDERS W CC|Medicare|MEDICARE ACUTE|38,967.13|8329.6|8329.6|5811.58|||| 71|DRG||NONSPECIFIC CEREBROVASCULAR DISORDERS W CC|Humana Medicare Advantage|HUMANA MA|61,347.50|8235.81|8329.6|5811.58|||| 71|DRG||NONSPECIFIC CEREBROVASCULAR DISORDERS W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|192.65|5811.58|8329.6|5811.58|||| 71045|EAP|0320|CHEST 1 VIEW|Tricare|TRICARE FOR LIFE|||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Tricare|TRICARE EAST REGION|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|PHCS|HUMANA|||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|UTMB|UTMB CORRECTIONAL MANAGED CARE|427.50||||||| 71045|EAP|0320|CHEST 1 VIEW|PHCS|MULTIPLAN PHCS OTHER|||||427.50||| 71045|EAP|0320|DECUBITUS|Medicare|MEDICARE ACUTE|427.50||||592.75||| 71045|EAP|0320|CHEST 1 VIEW|Medicare|MEDICARE PART B ONLY IP|427.50||||||| 71045|EAP|0320|CHEST 1 VIEW|Medicaid|MEDICAID PCCM|||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Medicaid|MOLINA HEALTHCARE OF TEXAS|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Medicaid|COUNTY INDIGENT HEALTH OTHER|427.50||||||| 71045|EAP|0320|CHEST 1 VIEW|Medicaid|HENDERSON COUNTY INDIGENT|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Medicaid|LAW ENFORCEMENT OTHER|||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Workers Compensation|GALLAGHER BASSETT|||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Workers Compensation|UT EMPLOYEE INJURY|427.50||||||| 71045|EAP|0320|CHEST 1 VIEW|Medicaid|MEDICAID|427.50||||427.50||| 71045|EAP|0320|DECUBITUS|Veterans Affairs|VETERANS ADMINISTRATION|427.50||||592.75||| 71045|EAP|0320|CHEST 1 VIEW|Veterans Affairs|VETERANS ADMINISTRATION|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|United Healthcare|UNITED HEALTHCARE|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|United Healthcare|GOLDEN RULE|||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|United Medicare Advantage|UHC AARP WELLMED HMO MA|||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|United Healthcare|UNITED HEALTHCARE OTHER|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Medicaid|MEDICAID TEXAS CHILDRENS|||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|United Healthcare|UMR UNITED MEDICAL RESOURCES|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|United Medicare Advantage|AARP UHC WEST COMPLETE MA|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|United Medicare Advantage|UHC MEDICARE GOLD MA|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|United Healthcare|TML GROUP BENEFITS|||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Blue Cross PPO Specialty|BCBSTX OTHER|||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|United Medicare Advantage|UHC AARP MCR HMO MA|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Cigna|CIGNA|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Blue Cross PPO Specialty|BCBSTX PPO|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|PHCS|HUMANA INSURANCE|||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Workers Compensation|WORKERS COMPENSATION OTHER|||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Blue Cross HMO Specialty|BCBSTX HMO|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|ChampVA|CHAMPVA CENTER|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Cigna|CIGNA OTHER|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Medicaid Out of State|MEDICAID LOUISIANA|||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Access Direct Platinum|HEALTHFIRST TPA UMR|||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Aetna|AETNA PPO|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Medicaid|MEDICAID HMO|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Aetna|AETNA OTHER|||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Aenta Medicare Advantage|AETNA MEDICARE MA|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|NON CONTRACTED|COMMERCIAL OTHER 1|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Managed Medicare|BCBS MEDICARE PPO MA|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Managed Medicare|HEALTHSPRING MA|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Managed Medicaid|MEDICAID AMERIGROUP|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Managed Medicare|WELLCARE CHOICE MA|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Managed Medicare|HOSPICE OF EAST TEXAS|427.50||||||| 71045|EAP|0320|CHEST 1 VIEW|Managed Medicare|MA PART B ONLY IP|427.50||||||| 71045|EAP|0320|CHEST 1 VIEW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Managed Medicare|REFERRAL BILLING OTHER|||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Multiplan|NALC|||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Medicare|MEDICARE ACUTE|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Managed Medicare|VAN ZANDT COUNTY INMATE|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Managed Medicare|OTHER INSTITUTIONS|||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|MTC Medical|VAN ZANDT COUNTY INMATE|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Humana Medicare Advantage|HUMANA MA|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Managed Medicaid|MEDICAID SUPERIOR|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|427.50||||427.50||| 71045|EAP|0320|CHEST 1 VIEW|Managed Medicare|HOSPICE ETMC|427.50||||427.50||| 71046|EAP|0320|CHEST 2 VIEWS|Humana Medicare Advantage|HUMANA MA|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|MTC Medical|VAN ZANDT COUNTY INMATE|||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Managed Medicare|REFERRAL BILLING OTHER|||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Managed Medicare|OTHER INSTITUTIONS|||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Managed Medicare|VAN ZANDT COUNTY INMATE|||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||340.75||| 71046|EAP|0320|CHEST 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UMR|||||340.75||| 71046|EAP|0320|CHEST 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||340.75||| 71046|EAP|0320|CHEST 2 VIEWS|Aetna|AETNA OTHER|||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Cigna|CIGNA OTHER|||||340.75||| 71046|EAP|0320|CHEST 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Blue Cross PPO Specialty|BCBSTX OTHER|||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Cigna|CIGNA|||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Cigna|CIGNA|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|ChampVA|CHAMPVA CENTER|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|United Healthcare|TML GROUP BENEFITS|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|487.75||||193.75||| 71046|EAP|0320|CHEST 2 VIEWS|United Healthcare|UNITED HEALTHCARE|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|United Medicare Advantage|UHC AARP MCR HMO MA|||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Aetna|AETNA PPO|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||193.75||| 71046|EAP|0320|CHEST 2 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Workers Compensation|TEXAS MUTUAL INSURANCE|||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Medicaid|MEDICAID PCCM|||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Managed Medicare|BCBS MEDICARE PPO MA|||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Multiplan|NALC|||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|PHCS|MULTIPLAN PHCS OTHER|||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Managed Medicare|HEALTHSPRING MA|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Medicaid|HENDERSON COUNTY INDIGENT|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Texas Workforce Commission|DIS DETER SERV (DDS)|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Medicaid|MEDICAID|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|PHCS|HUMANA|||||193.75||| 71046|EAP|0320|CHEST 2 VIEWS|PHCS|HUMANA INSURANCE|||||193.75||| 71046|EAP|0320|CHEST 2 VIEWS|Tricare|TRICARE EAST REGION|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Medicare|MEDICARE ACUTE|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Medicaid|MEDICAID HMO|487.75||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 2|||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Texas Workforce Commission|VOC REHAB SERV (TWC)|||||487.75||| 71046|EAP|0320|CHEST 2 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|487.75||||||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Medicare|MEDICARE ACUTE|487.75||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Medicaid|LAW ENFORCEMENT OTHER|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|United Healthcare|UNITED HEALTHCARE OTHER|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Workers Compensation|WORKERS COMPENSATION OTHER|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|United Healthcare|UNITED HEALTHCARE|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|United Medicare Advantage|UHC MEDICARE GOLD MA|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Cigna|CIGNA|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Blue Cross HMO Specialty|BCBSTX HMO|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Blue Cross PPO Specialty|BCBSTX PPO|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Blue Cross PPO Specialty|BCBSTX OTHER|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Aetna|AETNA PPO|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|United Medicare Advantage|UHC AARP MCR HMO MA|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Aenta Medicare Advantage|AETNA MEDICARE MA|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Veterans Affairs|VETERANS ADMINISTRATION|487.75||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Tricare|TRICARE FOR LIFE|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Managed Medicaid|MEDICAID AMERIGROUP|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Managed Medicare|WELLCARE CHOICE MA|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|487.75||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Managed Medicare|HEALTHSPRING MA|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Managed Medicare|VAN ZANDT COUNTY INMATE|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Medicaid|MEDICAID|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Managed Medicaid|MEDICAID SUPERIOR|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|Humana Medicare Advantage|HUMANA MA|||||487.75||| 71101|EAP|0320|RIBS UNILATERAL W/1 VIEW|MTC Medical|VAN ZANDT COUNTY INMATE|||||487.75||| 71110|EAP|0320|RIBS ROUTINE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||540.50||| 71110|EAP|0320|RIBS ROUTINE|Blue Cross PPO Specialty|BCBSTX PPO|||||540.50||| 71110|EAP|0320|RIBS ROUTINE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||540.50||| 71110|EAP|0320|RIBS ROUTINE|Medicare|MEDICARE ACUTE|||||540.50||| 71111|EAP|0320|RIBS BILATERAL W/1VIEW CH|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||301.50||| 71111|EAP|0320|RIBS BILATERAL W/1VIEW CH|Humana Medicare Advantage|HUMANA MA|||||301.50||| 71111|EAP|0320|RIBS BILATERAL W/1VIEW CH|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||301.50||| 71120|EAP|0320|STERNUM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||487.75||| 71120|EAP|0320|STERNUM|United Healthcare|UNITED HEALTHCARE|||||487.75||| 71120|EAP|0320|STERNUM|Humana Medicare Advantage|HUMANA MA|||||487.75||| 71120|EAP|0320|STERNUM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||487.75||| 712|DRG||TESTES PROCEDURES W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|26,181.85|8396.21|8396.21|8396.21|||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Medicaid|MOLINA HEALTHCARE OF TEXAS|3,772.75||||||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Medicaid|MEDICAID TEXAS CHILDRENS|||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Medicaid|MEDICAID|||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Medicare|MEDICARE PART B ONLY IP|||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Tricare|TRICARE EAST REGION|||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 1|3,772.75||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|PHCS|HUMANA|||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|3,772.75||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|United Healthcare|UNITED HEALTHCARE OTHER|||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|United Healthcare|UNITED HEALTHCARE|||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|United Healthcare|GOLDEN RULE|||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|3,772.75||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|United Healthcare|UMR UNITED MEDICAL RESOURCES|3,772.75||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3,772.75||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|United Medicare Advantage|UHC AARP MCR HMO MA|||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|ChampVA|CHAMPVA CENTER|||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3,772.75||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|3,772.75||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Multiplan|UNION PACIFIC RAILROAD|||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|3,772.75||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Blue Cross PPO Specialty|BCBSTX OTHER|||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|United Healthcare|UNITED HEALTHCARE|3,772.75||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UMR|||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|3,772.75||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Medicare|MEDICARE ACUTE|3,772.75||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3,772.75||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|3,772.75||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Cigna|CIGNA|||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|3,772.75||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Managed Medicare|HEALTHSPRING MA|3,772.75||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Humana Medicare Advantage|HUMANA MA|3,772.75||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Managed Medicare|BCBS MEDICARE PPO MA|3,772.75||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|3,772.75||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Aetna|AETNA PPO|3,772.75||||3,772.75||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3,772.75||| 71260|EAP|0350|CT THORAX W/CONTRAST|Cigna|CIGNA|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Humana Medicare Advantage|HUMANA MA|4,928.25||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Managed Medicare|OTHER INSTITUTIONS|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Managed Medicare|HEALTHSPRING MA|4,928.25||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Managed Medicare|BCBS MEDICARE PPO MA|4,928.25||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Aetna|AETNA PPO|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UMR|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Aetna|AETNA OTHER|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|4,928.25||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4,928.25||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Blue Cross PPO Specialty|BCBSTX OTHER|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|United Healthcare|UNITED HEALTHCARE OTHER|4,928.25||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|4,928.25||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|United Healthcare|UNITED HEALTHCARE|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|United Healthcare|TML GROUP BENEFITS|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|United Healthcare|UNITED HEALTHCARE|4,928.25||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4,928.25||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|United Medicare Advantage|UHC AARP MCR HMO MA|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4,928.25||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4,928.25||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4,928.25||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|4,928.25||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Workers Compensation|WORKERS COMPENSATION OTHER|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Cigna|CIGNA OTHER|4,928.25||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Medicare|MEDICARE ACUTE|4,928.25||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 1|4,928.25||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|UTMB|UTMB CORRECTIONAL MANAGED CARE|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|PHCS|HUMANA|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Tricare|TRICARE EAST REGION|4,928.25||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 2|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Medicaid|MEDICAID TEXAS CHILDRENS|||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Medicaid|MEDICAID|4,928.25||||4,928.25||| 71260|EAP|0350|CT THORAX W/CONTRAST|Medicaid|HENDERSON COUNTY INDIGENT|4,928.25||||4,928.25||| 71270|EAP|0350|CT THORAX W&W/O CONTRAST|Medicaid|MEDICAID|55.89||||||| 71270|EAP|0350|CT THORAX W&W/O CONTRAST|Medicare|MEDICARE ACUTE|55.89||||55.89||| 71270|EAP|0350|CT THORAX W&W/O CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||55.89||| 71270|EAP|0350|CT THORAX W&W/O CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|55.89||||55.89||| 71270|EAP|0350|CT THORAX W&W/O CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|||||55.89||| 71270|EAP|0350|CT THORAX W&W/O CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|||||55.89||| 71270|EAP|0350|CT THORAX W&W/O CONTRAST|Humana Medicare Advantage|HUMANA MA|55.89||||55.89||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|6,249.25||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|6,249.25||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Managed Medicare|BCBS MEDICARE PPO MA|6,249.25||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|6,249.25||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Cigna|CIGNA|6,249.25||||||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Cigna|CIGNA|6,249.25||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Cigna|CIGNA OTHER|||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|6,249.25||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Aetna|AETNA PPO|6,249.25||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|6,249.25||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Aetna|AETNA OTHER|||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|6,249.25||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|6,249.25||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|6,249.25||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|6,249.25||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|6,249.25||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Workers Compensation|WORKERS COMPENSATION OTHER|||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Workers Compensation|UT EMPLOYEE INJURY|6,249.25||||||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|United Healthcare|GOLDEN RULE|||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Humana Medicare Advantage|HUMANA MA|6,249.25||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|6,249.25||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|United Healthcare|UNITED HEALTHCARE|||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|6,249.25||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|United Healthcare|TML GROUP BENEFITS|||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|6,249.25||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|United Medicare Advantage|UHC AARP MCR HMO MA|||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|United Healthcare|UNITED HEALTHCARE OTHER|||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|United Healthcare|UNITED HEALTHCARE|6,249.25||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|6,249.25||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Managed Medicare|HEALTHSPRING MA|6,249.25||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Tricare|TRICARE EAST REGION|6,249.25||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 1|||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Tricare|TRICARE FOR LIFE|||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Medicare|MEDICARE ACUTE|6,249.25||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Medicaid|MOLINA HEALTHCARE OF TEXAS|6,249.25||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Medicaid|MEDICAID|6,249.25||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Medicaid|MEDICAID HMO|||||6,249.25||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Medicaid|HENDERSON COUNTY INDIGENT|6,249.25||||||| 71275|EAP|0350|CTA CHEST W/WO CONTRAST|Medicaid|COUNTY INDIGENT HEALTH OTHER|6,249.25||||||| 713|DRG||TRANSURETHRAL PROSTATECTOMY W CC/MCC|Medicare|MEDICARE ACUTE|20,794.60|11341.59|11341.59|11341.59|||| 713|DRG||TRANSURETHRAL PROSTATECTOMY W CC/MCC|Veterans Affairs|VETERANS ADMINISTRATION|148,345.15|11341.59|11341.59|11341.59|||| 713|DRG||TRANSURETHRAL PROSTATECTOMY W CC/MCC|Managed Medicare|BCBS MEDICARE PPO MA|21,638.05|11341.59|11341.59|11341.59|||| 714|DRG||TRANSURETHRAL PROSTATECTOMY W/O CC/MCC|Medicare|MEDICARE ACUTE|28,472.03|7893.42|7893.42|7893.42|||| 71552|EAP|0610|MRI CHEST W&WO CONTRAST|Medicare|MEDICARE ACUTE|||||60.84||| 718|DRG||OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY W/O CC/MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|54,746.30|9657.48|9657.48|9657.48|||| 72|DRG||NONSPECIFIC CEREBROVASCULAR DISORDERS W/O CC/MCC|Medicare|MEDICARE ACUTE|27,283.25|6679.31|6679.31|6679.31|||| 72020|EAP|0320|SPINE 1 VIEW SPECIFY LEVE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||427.50||| 72020|EAP|0320|SPINE 1 VIEW SPECIFY LEVE|Managed Medicaid|MEDICAID AMERIGROUP|||||427.50||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||267.50||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||267.50||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||267.50||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|United Medicare Advantage|UHC AARP MCR HMO MA|||||487.75||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||487.75||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||267.50||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||377.63||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|United Healthcare|TML GROUP BENEFITS|||||487.75||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||267.50||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||267.50||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Medicare|MEDICARE ACUTE|487.75||||487.75||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Tricare|TRICARE EAST REGION|||||487.75||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Medicaid|HENDERSON COUNTY INDIGENT|||||487.75||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Medicaid|MEDICAID HMO|||||487.75||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|MTC Medical|VAN ZANDT COUNTY INMATE|||||487.75||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||267.50||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||487.75||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Managed Medicare|HEALTHSPRING MA|||||267.50||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||487.75||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|487.75||||487.75||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||487.75||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Workers Compensation|TEXAS MUTUAL INSURANCE|||||487.75||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||487.75||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||267.50||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Managed Medicare|VAN ZANDT COUNTY INMATE|||||487.75||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||487.75||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Cigna|CIGNA OTHER|||||487.75||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Cigna|CIGNA|||||267.50||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||267.50||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||487.75||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||267.50||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||487.75||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||267.50||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Aetna|AETNA PPO|||||377.63||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||267.50||| 72040|EAP|0320|SPINE / CERVICAL 2 VIEWS|Aetna|AETNA OTHER|||||487.75||| 72050|EAP|0320|SPINE CERVICAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||382.75||| 72050|EAP|0320|SPINE CERVICAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||267.50||| 72050|EAP|0320|SPINE CERVICAL|Blue Cross PPO Specialty|BCBSTX PPO|||||267.50||| 72050|EAP|0320|SPINE CERVICAL|Managed Medicaid|MEDICAID SUPERIOR|||||267.50||| 72050|EAP|0320|SPINE CERVICAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||267.50||| 72050|EAP|0320|SPINE CERVICAL|Managed Medicare|HEALTHSPRING MA|||||267.50||| 72050|EAP|0320|SPINE CERVICAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||267.50||| 72050|EAP|0320|SPINE CERVICAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||267.50||| 72050|EAP|0320|SPINE CERVICAL|Humana Medicare Advantage|HUMANA MA|||||267.50||| 72050|EAP|0320|SPINE CERVICAL|Medicare|MEDICARE ACUTE|||||267.50||| 72050|EAP|0320|SPINE CERVICAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||267.50||| 72050|EAP|0320|SPINE CERVICAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||267.50||| 72052|EAP|0320|SPINE CERVICAL COMPLETE W|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.44||| 72052|EAP|0320|SPINE CERVICAL COMPLETE W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.44||| 72072|EAP|0320|SPINE DORSAL COMPLETE|Workers Compensation|UT EMPLOYEE INJURY|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|Workers Compensation|TEXAS MUTUAL INSURANCE|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|United Healthcare|UNITED HEALTHCARE OTHER|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|United Healthcare|UNITED HEALTHCARE|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|Medicaid|HENDERSON COUNTY INDIGENT|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|Medicaid|MEDICAID|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|Texas Workforce Commission|DIS DETER SERV (DDS)|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|NON CONTRACTED|COMMERCIAL OTHER 1|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|Medicare|MEDICARE ACUTE|540.50||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|Blue Cross HMO Specialty|BCBSTX HMO|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|Cigna|CIGNA OTHER|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|Blue Cross PPO Specialty|BCBSTX PPO|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|Workers Compensation|WORKERS COMPENSATION OTHER|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|Aetna|AETNA PPO|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|MTC Medical|VAN ZANDT COUNTY INMATE|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|Humana Medicare Advantage|HUMANA MA|540.50||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|Managed Medicaid|MEDICAID AMERIGROUP|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|Managed Medicare|VAN ZANDT COUNTY INMATE|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|Managed Medicare|HEALTHSPRING MA|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|540.50||||540.50||| 72072|EAP|0320|SPINE DORSAL COMPLETE|Managed Medicaid|MEDICAID SUPERIOR|||||540.50||| 72081|EAP|0320|SCOLIOSIS|Managed Medicaid|MEDICAID SUPERIOR|||||487.75||| 72081|EAP|0320|SCOLIOSIS|Managed Medicaid|MEDICAID AMERIGROUP|||||487.75||| 72081|EAP|0320|SCOLIOSIS|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||487.75||| 72081|EAP|0320|SCOLIOSIS|Cigna|CIGNA|||||487.75||| 72081|EAP|0320|SCOLIOSIS|Blue Cross PPO Specialty|BCBSTX PPO|||||487.75||| 72081|EAP|0320|SCOLIOSIS|Medicaid|MEDICAID HMO|||||487.75||| 72081|EAP|0320|SCOLIOSIS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||487.75||| 72081|EAP|0320|SCOLIOSIS|United Healthcare|UNITED HEALTHCARE|||||487.75||| 72082|EAP|0320|SCOLIOSIS 2-3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||485.50||| 72082|EAP|0320|SCOLIOSIS 2-3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||485.50||| 72082|EAP|0320|SCOLIOSIS 2-3 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||485.50||| 72082|EAP|0320|SCOLIOSIS 2-3 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||485.50||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|MTC Medical|VAN ZANDT COUNTY INMATE|||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Managed Medicare|HEALTHSPRING MA|||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|487.75||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Managed Medicare|BCBS MEDICARE PPO MA|||||267.50||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|487.75||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Managed Medicare|VAN ZANDT COUNTY INMATE|||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||267.50||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Aetna|AETNA OTHER|||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|487.75||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Aetna|AETNA PPO|||||267.50||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||377.63||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|487.75||||267.50||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Cigna|CIGNA OTHER|||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Cigna|CIGNA|||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||267.50||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Texas Workforce Commission|DIS DETER SERV (DDS)|||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Managed Medicare|OTHER INSTITUTIONS|||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 2|||||267.50||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Medicare|MEDICARE ACUTE|487.75||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Medicaid|MEDICAID|||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Medicaid|HENDERSON COUNTY INDIGENT|||||377.63||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||377.63||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Medicaid|MEDICAID HMO|||||267.50||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||267.50||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Humana Medicare Advantage|HUMANA MA|487.75||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Workers Compensation|TEXAS MUTUAL INSURANCE|||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Workers Compensation|UT EMPLOYEE INJURY|||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|United Medicare Advantage|UHC AARP MCR HMO MA|||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|United Healthcare|TML GROUP BENEFITS|||||267.50||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|487.75||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||487.75||| 72100|EAP|0320|SPINE L-S/ 3 VIEWS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|487.75||||487.75||| 72110|EAP|0320|SPINE LUMBAR COMPLETE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||267.50||| 72110|EAP|0320|SPINE LUMBAR COMPLETE|United Healthcare|UNITED HEALTHCARE OTHER|||||267.50||| 72110|EAP|0320|SPINE LUMBAR COMPLETE|Veterans Affairs|VETERANS ADMINISTRATION|||||267.50||| 72110|EAP|0320|SPINE LUMBAR COMPLETE|United Healthcare|UNITED HEALTHCARE|||||267.50||| 72110|EAP|0320|SPINE LUMBAR COMPLETE|Medicare|MEDICARE ACUTE|||||267.50||| 72110|EAP|0320|SPINE LUMBAR COMPLETE|Blue Cross PPO Specialty|BCBSTX PPO|||||267.50||| 72110|EAP|0320|SPINE LUMBAR COMPLETE|Cigna|CIGNA|||||267.50||| 72110|EAP|0320|SPINE LUMBAR COMPLETE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||267.50||| 72110|EAP|0320|SPINE LUMBAR COMPLETE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||549.63||| 72110|EAP|0320|SPINE LUMBAR COMPLETE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||267.50||| 72110|EAP|0320|SPINE LUMBAR COMPLETE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||267.50||| 72110|EAP|0320|SPINE LUMBAR COMPLETE|Managed Medicaid|MEDICAID AMERIGROUP|||||267.50||| 72110|EAP|0320|SPINE LUMBAR COMPLETE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||267.50||| 72110|EAP|0320|SPINE LUMBAR COMPLETE|Managed Medicaid|MEDICAID SUPERIOR|||||267.50||| 72110|EAP|0320|SPINE LUMBAR COMPLETE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||267.50||| 72110|EAP|0320|SPINE LUMBAR COMPLETE|Managed Medicare|HEALTHSPRING MA|||||267.50||| 72110|EAP|0320|SPINE LUMBAR COMPLETE|Humana Medicare Advantage|HUMANA MA|||||267.50||| 72114|EAP|0320|LUMBAR COMPLETE W/FLEX EX|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||276.50||| 72114|EAP|0320|LUMBAR COMPLETE W/FLEX EX|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||276.50||| 72114|EAP|0320|LUMBAR COMPLETE W/FLEX EX|Managed Medicare|HEALTHSPRING MA|||||276.50||| 72114|EAP|0320|LUMBAR COMPLETE W/FLEX EX|Humana Medicare Advantage|HUMANA MA|||||276.50||| 72114|EAP|0320|LUMBAR COMPLETE W/FLEX EX|Managed Medicaid|MEDICAID SUPERIOR|||||276.50||| 72114|EAP|0320|LUMBAR COMPLETE W/FLEX EX|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||276.50||| 72114|EAP|0320|LUMBAR COMPLETE W/FLEX EX|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||276.50||| 72114|EAP|0320|LUMBAR COMPLETE W/FLEX EX|Aetna|AETNA PPO|||||276.50||| 72114|EAP|0320|LUMBAR COMPLETE W/FLEX EX|Blue Cross PPO Specialty|BCBSTX PPO|||||276.50||| 72114|EAP|0320|LUMBAR COMPLETE W/FLEX EX|Medicare|MEDICARE ACUTE|||||276.50||| 72114|EAP|0320|LUMBAR COMPLETE W/FLEX EX|Veterans Affairs|VETERANS ADMINISTRATION|||||276.50||| 72114|EAP|0320|LUMBAR COMPLETE W/FLEX EX|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||276.50||| 72114|EAP|0320|LUMBAR COMPLETE W/FLEX EX|United Medicare Advantage|UHC MEDICARE GOLD MA|||||276.50||| 72114|EAP|0320|LUMBAR COMPLETE W/FLEX EX|United Healthcare|UNITED HEALTHCARE|||||276.50||| 72120|EAP|0320|L SPINE FLEXION & EXTENSI|United Medicare Advantage|UHC MEDICARE GOLD MA|||||180.50||| 72120|EAP|0320|L SPINE FLEXION & EXTENSI|Blue Cross PPO Specialty|BCBSTX PPO|||||180.50||| 72120|EAP|0320|L SPINE FLEXION & EXTENSI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||180.50||| 72120|EAP|0320|L SPINE FLEXION & EXTENSI|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||180.50||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Managed Medicare|BCBS MEDICARE PPO MA|3,772.75||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3,772.75||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|3,772.75||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Managed Medicare|VAN ZANDT COUNTY INMATE|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|3,772.75||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Managed Medicare|HEALTHSPRING MA|3,772.75||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|MTC Medical|VAN ZANDT COUNTY INMATE|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Cigna|CIGNA|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Humana Medicare Advantage|HUMANA MA|3,772.75||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Cigna|CIGNA OTHER|3,772.75||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|3,772.75||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Aetna|AETNA PPO|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UMR|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|3,772.75||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Blue Cross PPO Specialty|BCBSTX OTHER|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|3,772.75||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Medicaid|MEDICAID HMO|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Medicaid|MEDICAID TEXAS CHILDRENS|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Medicaid|MEDICAID|3,772.75||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Medicaid|HENDERSON COUNTY INDIGENT|3,772.75||||||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Medicaid|LAW ENFORCEMENT OTHER|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|3,772.75||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Medicare|MEDICARE ACUTE|3,772.75||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Tricare|TRICARE EAST REGION|3,772.75||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|UTMB|UTMB CORRECTIONAL MANAGED CARE|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 1|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 2|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Workers Compensation|WORKERS COMPENSATION OTHER|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|3,772.75||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Workers Compensation|WORKERS COMP PHYSICIAN|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|Workers Compensation|TEXAS MUTUAL INSURANCE|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3,772.75||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|United Medicare Advantage|UHC AARP MCR HMO MA|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|3,772.75||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|United Healthcare|UMR UNITED MEDICAL RESOURCES|3,772.75||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|United Healthcare|UNITED HEALTHCARE|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|United Healthcare|TML GROUP BENEFITS|||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|United Healthcare|UNITED HEALTHCARE OTHER|3,772.75||||3,772.75||| 72125|EAP|0350|CT C-SPINE W/O CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3,772.75||||3,772.75||| 72126|EAP|0350|CT C-SPINE W/CONTRAST|Medicare|MEDICARE ACUTE|4,928.25||||4,928.25||| 72126|EAP|0350|CT C-SPINE W/CONTRAST|Medicaid|MEDICAID|4,928.25||||||| 72126|EAP|0350|CT C-SPINE W/CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|||||4,928.25||| 72126|EAP|0350|CT C-SPINE W/CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4,928.25||| 72126|EAP|0350|CT C-SPINE W/CONTRAST|Humana Medicare Advantage|HUMANA MA|||||4,928.25||| 72127|EAP|0350|CT C-SPINE W&W/O CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|||||55.89||| 72127|EAP|0350|CT C-SPINE W&W/O CONTRAST|United Healthcare|UNITED HEALTHCARE|||||55.89||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Medicaid|MEDICAID HMO|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Medicaid|MEDICAID|3,772.75||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 2|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Medicare|MEDICARE ACUTE|3,772.75||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|3,772.75||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Workers Compensation|TEXAS MUTUAL INSURANCE|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Workers Compensation|WORKERS COMPENSATION OTHER|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|United Healthcare|UNITED HEALTHCARE OTHER|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|United Healthcare|UNITED HEALTHCARE|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Managed Medicare|BCBS MEDICARE PPO MA|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Workers Compensation|UT EMPLOYEE INJURY|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 1|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Managed Medicare|HEALTHSPRING MA|3,772.75||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Cigna|CIGNA|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Humana Medicare Advantage|HUMANA MA|3,772.75||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Cigna|CIGNA OTHER|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Aetna|AETNA PPO|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Blue Cross PPO Specialty|BCBSTX OTHER|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|3,772.75||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||3,772.75||| 72128|EAP|0350|CT T-SPINE W/O CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|3,772.75||||3,772.75||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|4,928.25||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|Aetna|AETNA PPO|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|Cigna|CIGNA|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|Humana Medicare Advantage|HUMANA MA|4,928.25||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|Managed Medicare|BCBS MEDICARE PPO MA|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UMR|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|Blue Cross PPO Specialty|BCBSTX OTHER|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|United Healthcare|UNITED HEALTHCARE OTHER|4,928.25||||||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|United Healthcare|UNITED HEALTHCARE|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|United Medicare Advantage|UHC AARP MCR HMO MA|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|United Healthcare|TML GROUP BENEFITS|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|Workers Compensation|WORKERS COMPENSATION OTHER|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 1|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 2|||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|Tricare|TRICARE EAST REGION|4,928.25||||||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|Medicare|MEDICARE ACUTE|4,928.25||||4,928.25||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|Medicaid|MEDICAID|4,928.25||||||| 72129|EAP|0350|CT T-SPINE W/CONTRAST|Medicaid|HENDERSON COUNTY INDIGENT|4,928.25||||||| 72130|EAP|0350|CT T-SPINE W&W/O CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||55.89||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Medicaid|MEDICAID|3,772.75||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Medicaid|MEDICAID HMO|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 2|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Medicare|MEDICARE ACUTE|3,772.75||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 1|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Tricare|TRICARE EAST REGION|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|PHCS|HUMANA|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Workers Compensation|TEXAS MUTUAL INSURANCE|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|3,772.75||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Workers Compensation|UT EMPLOYEE INJURY|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3,772.75||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|United Healthcare|UNITED HEALTHCARE|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|United Healthcare|UNITED HEALTHCARE OTHER|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3,772.75||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Aetna|AETNA PPO|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Workers Compensation|WORKERS COMPENSATION OTHER|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|3,772.75||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Blue Cross PPO Specialty|BCBSTX OTHER|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Medicaid|HENDERSON COUNTY INDIGENT|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|3,772.75||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Cigna|CIGNA|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Cigna|CIGNA OTHER|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Humana Medicare Advantage|HUMANA MA|3,772.75||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|MTC Medical|VAN ZANDT COUNTY INMATE|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Managed Medicare|BCBS MEDICARE PPO MA|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Managed Medicare|HEALTHSPRING MA|3,772.75||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Managed Medicare|VAN ZANDT COUNTY INMATE|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|||||3,772.75||| 72131|EAP|0350|CT L-SPINE W/O CONTRAST|Managed Medicare|OTHER INSTITUTIONS|||||3,772.75||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|Managed Medicare|BCBS MEDICARE PPO MA|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|Humana Medicare Advantage|HUMANA MA|4,928.25||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|Blue Cross PPO Specialty|BCBSTX OTHER|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|4,928.25||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UMR|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|Aetna|AETNA PPO|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|Cigna|CIGNA|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|4,928.25||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|United Healthcare|UNITED HEALTHCARE OTHER|4,928.25||||||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|United Medicare Advantage|UHC AARP MCR HMO MA|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|United Healthcare|TML GROUP BENEFITS|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|United Healthcare|UNITED HEALTHCARE|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|Workers Compensation|WORKERS COMPENSATION OTHER|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|Medicare|MEDICARE ACUTE|4,928.25||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 2|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|Tricare|TRICARE EAST REGION|4,928.25||||||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 1|||||4,928.25||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|Medicaid|MEDICAID|4,928.25||||||| 72132|EAP|0350|CT L-SPINE W/CONTRAST|Medicaid|HENDERSON COUNTY INDIGENT|4,928.25||||||| 72133|EAP|0350|CT L-SPINE W&W/O CONTRAST|Medicare|MEDICARE ACUTE|||||55.89||| 72133|EAP|0350|CT L-SPINE W&W/O CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||55.89||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|Aenta Medicare Advantage|AETNA MEDICARE MA|||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|Aetna|AETNA PPO|||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|Blue Cross PPO Specialty|BCBSTX PPO|60.84||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|ChampVA|CHAMPVA CENTER|||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|Humana Medicare Advantage|HUMANA MA|||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|Cigna|CIGNA|||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|Managed Medicaid|MEDICAID SUPERIOR|||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|Managed Medicaid|MEDICAID AMERIGROUP|||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|Blue Cross HMO Specialty|BCBSTX HMO|||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|United Medicare Advantage|UHC MEDICARE GOLD MA|||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|Workers Compensation|WORKERS COMPENSATION OTHER|||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|United Medicare Advantage|UHC AARP MCR HMO MA|||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|Veterans Affairs|VETERANS ADMINISTRATION|||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|United Healthcare|UNITED HEALTHCARE|||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|United Healthcare|UMR UNITED MEDICAL RESOURCES|60.84||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|Managed Medicare|HEALTHSPRING MA|60.84||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|Medicaid|MEDICAID|||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|NON CONTRACTED|COMMERCIAL OTHER 1|||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|Tricare|TRICARE EAST REGION|||||60.84||| 72141|EAP|0612|MRI SP CANAL CERVICAL W/O|Medicare|MEDICARE ACUTE|60.84||||60.84||| 72146|EAP|0612|MRI SP CANAL THORAC W/O|NON CONTRACTED|COMMERCIAL OTHER 1|||||60.84||| 72146|EAP|0612|MRI SP CANAL THORAC W/O|Medicare|MEDICARE ACUTE|60.84||||60.84||| 72146|EAP|0612|MRI SP CANAL THORAC W/O|Managed Medicare|HEALTHSPRING MA|||||60.84||| 72146|EAP|0612|MRI SP CANAL THORAC W/O|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||60.84||| 72146|EAP|0612|MRI SP CANAL THORAC W/O|United Healthcare|UNITED HEALTHCARE|||||60.84||| 72146|EAP|0612|MRI SP CANAL THORAC W/O|Tricare|TRICARE EAST REGION|||||60.84||| 72146|EAP|0612|MRI SP CANAL THORAC W/O|United Healthcare|UMR UNITED MEDICAL RESOURCES|60.84||||60.84||| 72146|EAP|0612|MRI SP CANAL THORAC W/O|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||60.84||| 72146|EAP|0612|MRI SP CANAL THORAC W/O|Veterans Affairs|VETERANS ADMINISTRATION|||||60.84||| 72146|EAP|0612|MRI SP CANAL THORAC W/O|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||60.84||| 72146|EAP|0612|MRI SP CANAL THORAC W/O|United Medicare Advantage|UHC MEDICARE GOLD MA|||||60.84||| 72146|EAP|0612|MRI SP CANAL THORAC W/O|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||60.84||| 72146|EAP|0612|MRI SP CANAL THORAC W/O|Managed Medicaid|MEDICAID AMERIGROUP|||||60.84||| 72146|EAP|0612|MRI SP CANAL THORAC W/O|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||60.84||| 72146|EAP|0612|MRI SP CANAL THORAC W/O|Humana Medicare Advantage|HUMANA MA|60.84||||60.84||| 72146|EAP|0612|MRI SP CANAL THORAC W/O|Blue Cross PPO Specialty|BCBSTX PPO|||||60.84||| 72146|EAP|0612|MRI SP CANAL THORAC W/O|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||60.84||| 72146|EAP|0612|MRI SP CANAL THORAC W/O|Blue Cross HMO Specialty|BCBSTX HMO|||||60.84||| 72146|EAP|0612|MRI SP CANAL THORAC W/O|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||60.84||| 72146|EAP|0612|MRI SP CANAL THORAC W/O|Aetna|AETNA PPO|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|Aetna|AETNA PPO|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|Aenta Medicare Advantage|AETNA MEDICARE MA|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|Blue Cross HMO Specialty|BCBSTX HMO|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|ChampVA|CHAMPVA CENTER|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|Blue Cross PPO Specialty|BCBSTX PPO|60.84||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|Humana Medicare Advantage|HUMANA MA|60.84||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|Managed Medicaid|MEDICAID SUPERIOR|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|Managed Medicaid|MEDICAID UNITED HEALTHCARE|60.84||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|Managed Medicaid|MEDICAID AMERIGROUP|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|United Medicare Advantage|UHC MEDICARE GOLD MA|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|Cigna|CIGNA|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|60.84||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|United Medicare Advantage|UHC AARP MCR HMO MA|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|Workers Compensation|WORKERS COMPENSATION OTHER|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|Workers Compensation|UT EMPLOYEE INJURY|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|Veterans Affairs|VETERANS ADMINISTRATION|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|United Healthcare|UNITED HEALTHCARE|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|United Healthcare|UNITED HEALTHCARE OTHER|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|Medicaid|MEDICAID|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|Managed Medicare|BCBS MEDICARE PPO MA|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|Medicaid|HENDERSON COUNTY INDIGENT|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|Medicaid|MEDICAID HMO|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|Managed Medicare|HEALTHSPRING MA|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|Texas Workforce Commission|VOC REHAB SERV (TWC)|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|Tricare|TRICARE EAST REGION|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|NON CONTRACTED|COMMERCIAL OTHER 1|||||60.84||| 72148|EAP|0612|MRI SP CANAL L/SP W/O CON|Medicare|MEDICARE ACUTE|60.84||||60.84||| 72149|EAP|0612|MRI SP CANAL L/SP W/CONTR|Medicare|MEDICARE ACUTE|||||72.40||| 72149|EAP|0612|MRI SP CANAL L/SP W/CONTR|Medicaid|MEDICAID|||||72.40||| 72149|EAP|0612|MRI SP CANAL L/SP W/CONTR|Workers Compensation|WORKERS COMPENSATION OTHER|||||72.40||| 72156|EAP|0612|MRI C SPINE W AND W/O CON|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||8,230.75||| 72156|EAP|0612|MRI C SPINE W AND W/O CON|Humana Medicare Advantage|HUMANA MA|||||8,230.75||| 72156|EAP|0612|MRI C SPINE W AND W/O CON|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||8,230.75||| 72156|EAP|0612|MRI C SPINE W AND W/O CON|Blue Cross PPO Specialty|BCBSTX PPO|||||8,230.75||| 72156|EAP|0612|MRI C SPINE W AND W/O CON|Blue Cross HMO Specialty|BCBSTX HMO|8,230.75||||||| 72156|EAP|0612|MRI C SPINE W AND W/O CON|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||8,230.75||| 72156|EAP|0612|MRI C SPINE W AND W/O CON|Aetna|AETNA PPO|||||8,230.75||| 72156|EAP|0612|MRI C SPINE W AND W/O CON|United Healthcare|UNITED HEALTHCARE|||||8,230.75||| 72156|EAP|0612|MRI C SPINE W AND W/O CON|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||8,230.75||| 72156|EAP|0612|MRI C SPINE W AND W/O CON|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||8,230.75||| 72156|EAP|0612|MRI C SPINE W AND W/O CON|Managed Medicare|HEALTHSPRING MA|||||8,230.75||| 72156|EAP|0612|MRI C SPINE W AND W/O CON|Medicare|MEDICARE ACUTE|8,230.75||||8,230.75||| 72156|EAP|0612|MRI C SPINE W AND W/O CON|Multiplan|NALC|||||8,230.75||| 72157|EAP|0612|MRI T SPINE W AND W/O CON|Medicare|MEDICARE ACUTE|8,230.75||||8,230.75||| 72157|EAP|0612|MRI T SPINE W AND W/O CON|Managed Medicare|HEALTHSPRING MA|||||8,230.75||| 72157|EAP|0612|MRI T SPINE W AND W/O CON|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||8,230.75||| 72157|EAP|0612|MRI T SPINE W AND W/O CON|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||8,230.75||| 72157|EAP|0612|MRI T SPINE W AND W/O CON|United Healthcare|UNITED HEALTHCARE|||||8,230.75||| 72157|EAP|0612|MRI T SPINE W AND W/O CON|Blue Cross PPO Specialty|BCBSTX PPO|||||8,230.75||| 72157|EAP|0612|MRI T SPINE W AND W/O CON|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||8,230.75||| 72157|EAP|0612|MRI T SPINE W AND W/O CON|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||8,230.75||| 72157|EAP|0612|MRI T SPINE W AND W/O CON|Managed Medicaid|MEDICAID AMERIGROUP|||||8,230.75||| 72158|EAP|0612|MRI L SPINE W AND W/O CON|Humana Medicare Advantage|HUMANA MA|||||8,230.75||| 72158|EAP|0612|MRI L SPINE W AND W/O CON|Managed Medicaid|MEDICAID UNITED HEALTHCARE|8,230.75||||8,230.75||| 72158|EAP|0612|MRI L SPINE W AND W/O CON|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||8,230.75||| 72158|EAP|0612|MRI L SPINE W AND W/O CON|Aenta Medicare Advantage|AETNA MEDICARE MA|||||8,230.75||| 72158|EAP|0612|MRI L SPINE W AND W/O CON|Managed Medicaid|MEDICAID AMERIGROUP|||||8,230.75||| 72158|EAP|0612|MRI L SPINE W AND W/O CON|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||8,230.75||| 72158|EAP|0612|MRI L SPINE W AND W/O CON|Aetna|AETNA PPO|||||8,230.75||| 72158|EAP|0612|MRI L SPINE W AND W/O CON|Blue Cross HMO Specialty|BCBSTX HMO|||||8,230.75||| 72158|EAP|0612|MRI L SPINE W AND W/O CON|Blue Cross PPO Specialty|BCBSTX PPO|||||8,230.75||| 72158|EAP|0612|MRI L SPINE W AND W/O CON|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||8,230.75||| 72158|EAP|0612|MRI L SPINE W AND W/O CON|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||8,230.75||| 72158|EAP|0612|MRI L SPINE W AND W/O CON|United Medicare Advantage|UHC AARP MCR HMO MA|||||8,230.75||| 72158|EAP|0612|MRI L SPINE W AND W/O CON|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||8,230.75||| 72158|EAP|0612|MRI L SPINE W AND W/O CON|Veterans Affairs|VETERANS ADMINISTRATION|8,230.75||||||| 72158|EAP|0612|MRI L SPINE W AND W/O CON|Managed Medicare|HEALTHSPRING MA|||||8,230.75||| 72158|EAP|0612|MRI L SPINE W AND W/O CON|Medicare|MEDICARE ACUTE|8,230.75||||8,230.75||| 72170|EAP|0320|PELVIS /1 VIEW|Medicare|MEDICARE ACUTE|487.75||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|NON CONTRACTED|COMMERCIAL OTHER 1|||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|Tricare|TRICARE EAST REGION|||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|Medicaid|MEDICAID TEXAS CHILDRENS|||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|Medicaid|MEDICAID|487.75||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|United Medicare Advantage|UHC AARP MCR HMO MA|||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|United Medicare Advantage|AARP UHC WEST COMPLETE MA|487.75||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|487.75||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|United Healthcare|UNITED HEALTHCARE|||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|Veterans Affairs|VETERANS ADMINISTRATION|||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|Workers Compensation|WORKERS COMPENSATION OTHER|||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|Veterans Affairs|VETERANS ADMINISTRATION|487.75||||||| 72170|EAP|0320|PELVIS /1 VIEW|Blue Cross PPO Specialty|BCBSTX PPO|487.75||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|United Medicare Advantage|UHC MEDICARE GOLD MA|487.75||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|Cigna|CIGNA|487.75||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|Blue Cross PPO Specialty|BCBSTX OTHER|||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|Medicaid|HENDERSON COUNTY INDIGENT|487.75||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|Blue Cross HMO Specialty|BCBSTX HMO|487.75||||||| 72170|EAP|0320|PELVIS /1 VIEW|Aetna|AETNA PPO|||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|487.75||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|Aenta Medicare Advantage|AETNA MEDICARE MA|||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|NON CONTRACTED|COMMERCIAL OTHER 2|||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|Managed Medicare|HEALTHSPRING MA|||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|487.75||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|Managed Medicare|BCBS MEDICARE PPO MA|487.75||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|Managed Medicaid|MEDICAID SUPERIOR|||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|487.75||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|Managed Medicaid|MEDICAID AMERIGROUP|||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||487.75||| 72170|EAP|0320|PELVIS /1 VIEW|Humana Medicare Advantage|HUMANA MA|487.75||||487.75||| 72192|EAP|0350|CT PELVIS WO CONTRAST|Cigna|CIGNA|3,772.75||||||| 72192|EAP|0350|CT PELVIS WO CONTRAST|MTC Medical|VAN ZANDT COUNTY INMATE|||||3,772.75||| 72192|EAP|0350|CT PELVIS WO CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3,772.75||| 72192|EAP|0350|CT PELVIS WO CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3,772.75||| 72192|EAP|0350|CT PELVIS WO CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|3,772.75||||3,772.75||| 72192|EAP|0350|CT PELVIS WO CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|||||3,772.75||| 72192|EAP|0350|CT PELVIS WO CONTRAST|Managed Medicare|BCBS MEDICARE PPO MA|||||3,772.75||| 72192|EAP|0350|CT PELVIS WO CONTRAST|Managed Medicare|VAN ZANDT COUNTY INMATE|||||3,772.75||| 72192|EAP|0350|CT PELVIS WO CONTRAST|Managed Medicare|HEALTHSPRING MA|3,772.75||||3,772.75||| 72192|EAP|0350|CT PELVIS WO CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3,772.75||| 72192|EAP|0350|CT PELVIS WO CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3,772.75||| 72192|EAP|0350|CT PELVIS WO CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|3,772.75||||||| 72192|EAP|0350|CT PELVIS WO CONTRAST|Humana Medicare Advantage|HUMANA MA|3,772.75||||3,772.75||| 72192|EAP|0350|CT PELVIS WO CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|3,772.75||||3,772.75||| 72192|EAP|0350|CT PELVIS WO CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|||||3,772.75||| 72192|EAP|0350|CT PELVIS WO CONTRAST|Workers Compensation|WORKERS COMPENSATION OTHER|||||3,772.75||| 72192|EAP|0350|CT PELVIS WO CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3,772.75||||3,772.75||| 72192|EAP|0350|CT PELVIS WO CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3,772.75||| 72192|EAP|0350|CT PELVIS WO CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3,772.75||||3,772.75||| 72192|EAP|0350|CT PELVIS WO CONTRAST|United Healthcare|UNITED HEALTHCARE|||||3,772.75||| 72192|EAP|0350|CT PELVIS WO CONTRAST|United Medicare Advantage|UHC AARP MCR HMO MA|||||3,772.75||| 72192|EAP|0350|CT PELVIS WO CONTRAST|Medicaid|HENDERSON COUNTY INDIGENT|||||3,772.75||| 72192|EAP|0350|CT PELVIS WO CONTRAST|PHCS|HUMANA|||||3,772.75||| 72192|EAP|0350|CT PELVIS WO CONTRAST|Tricare|TRICARE EAST REGION|||||3,772.75||| 72192|EAP|0350|CT PELVIS WO CONTRAST|Medicare|MEDICARE ACUTE|3,772.75||||3,772.75||| 72193|EAP|0350|CT PELVIS W/CONTRAST|Medicare|MEDICARE ACUTE|||||4,928.25||| 72193|EAP|0350|CT PELVIS W/CONTRAST|Medicaid|MEDICAID|||||4,928.25||| 72193|EAP|0350|CT PELVIS W/CONTRAST|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4,928.25||| 72193|EAP|0350|CT PELVIS W/CONTRAST|United Healthcare|UNITED HEALTHCARE|||||4,928.25||| 72193|EAP|0350|CT PELVIS W/CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4,928.25||| 72193|EAP|0350|CT PELVIS W/CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4,928.25||| 72193|EAP|0350|CT PELVIS W/CONTRAST|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4,928.25||| 72193|EAP|0350|CT PELVIS W/CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|4,928.25||||4,928.25||| 72193|EAP|0350|CT PELVIS W/CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4,928.25||||4,928.25||| 72193|EAP|0350|CT PELVIS W/CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|||||4,928.25||| 72193|EAP|0350|CT PELVIS W/CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4,928.25||| 72193|EAP|0350|CT PELVIS W/CONTRAST|Managed Medicare|HEALTHSPRING MA|||||4,928.25||| 72193|EAP|0350|CT PELVIS W/CONTRAST|Humana Medicare Advantage|HUMANA MA|||||4,928.25||| 72194|EAP|0350|CT PELVIS W&W/O CONTRAST|Medicare|MEDICARE ACUTE|||||55.89||| 72195|EAP|0610|MRI PELVIS WO|Managed Medicaid|MEDICAID SUPERIOR|60.84||||60.84||| 72195|EAP|0610|MRI PELVIS WO|Managed Medicaid|MEDICAID AMERIGROUP|||||60.84||| 72195|EAP|0610|MRI PELVIS WO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||60.84||| 72195|EAP|0610|MRI PELVIS WO|Blue Cross PPO Specialty|BCBSTX PPO|||||60.84||| 72195|EAP|0610|MRI PELVIS WO|Veterans Affairs|VETERANS ADMINISTRATION|||||60.84||| 72195|EAP|0610|MRI PELVIS WO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|60.84||||||| 72195|EAP|0610|MRI PELVIS WO|Workers Compensation|WORKERS COMPENSATION OTHER|||||60.84||| 72195|EAP|0610|MRI PELVIS WO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||60.84||| 72195|EAP|0610|MRI PELVIS WO|Medicaid|MEDICAID|60.84||||||| 72195|EAP|0610|MRI PELVIS WO|Medicare|MEDICARE ACUTE|60.84||||60.84||| 72195|EAP|0610|MRI PELVIS WO|Tricare|TRICARE EAST REGION|||||60.84||| 72196|EAP|0612|MRI PELVIS W|Medicare|MEDICARE ACUTE|72.40||||||| 72196|EAP|0612|MRI PELVIS W|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|72.40||||||| 72196|EAP|0612|MRI PELVIS W|Veterans Affairs|VETERANS ADMINISTRATION|||||72.40||| 72196|EAP|0612|MRI PELVIS W|Aenta Medicare Advantage|AETNA MEDICARE MA|72.40||||||| 72196|EAP|0612|MRI PELVIS W|Humana Medicare Advantage|HUMANA MA|72.40||||||| 72196|EAP|0612|MRI PELVIS W|Managed Medicaid|MEDICAID SUPERIOR|72.40||||||| 72196|EAP|0612|MRI PELVIS W|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|72.40||||||| 72197|EAP|0610|MRI PELVIS W/WO|Humana Medicare Advantage|HUMANA MA|8,230.75||||8,230.75||| 72197|EAP|0610|MRI PELVIS W/WO|Blue Cross PPO Specialty|BCBSTX PPO|||||8,230.75||| 72197|EAP|0610|MRI PELVIS W/WO|Blue Cross HMO Specialty|BCBSTX HMO|||||8,230.75||| 72197|EAP|0610|MRI PELVIS W/WO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||8,230.75||| 72197|EAP|0610|MRI PELVIS W/WO|Aetna|AETNA PPO|||||8,230.75||| 72197|EAP|0610|MRI PELVIS W/WO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||8,230.75||| 72197|EAP|0610|MRI PELVIS W/WO|United Healthcare|UNITED HEALTHCARE OTHER|||||8,230.75||| 72197|EAP|0610|MRI PELVIS W/WO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||8,230.75||| 72197|EAP|0610|MRI PELVIS W/WO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||8,230.75||| 72197|EAP|0610|MRI PELVIS W/WO|United Medicare Advantage|UHC AARP MCR HMO MA|||||8,230.75||| 72197|EAP|0610|MRI PELVIS W/WO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||8,230.75||| 72197|EAP|0610|MRI PELVIS W/WO|Medicare|MEDICARE ACUTE|8,230.75||||8,230.75||| 72197|EAP|0610|MRI PELVIS W/WO|NON CONTRACTED|COMMERCIAL OTHER 1|||||8,230.75||| 72200|EAP|0320|SACRO-ILIAC JOINTS|Medicaid|MEDICAID|||||487.75||| 72200|EAP|0320|SACRO-ILIAC JOINTS|Medicare|MEDICARE ACUTE|||||487.75||| 72200|EAP|0320|SACRO-ILIAC JOINTS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||487.75||| 72200|EAP|0320|SACRO-ILIAC JOINTS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||487.75||| 72200|EAP|0320|SACRO-ILIAC JOINTS|Managed Medicare|HEALTHSPRING MA|||||487.75||| 72200|EAP|0320|SACRO-ILIAC JOINTS|Managed Medicaid|MEDICAID AMERIGROUP|||||487.75||| 72200|EAP|0320|SACRO-ILIAC JOINTS|Humana Medicare Advantage|HUMANA MA|||||487.75||| 72220|EAP|0320|SACRUM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||487.75||| 72220|EAP|0320|SACRUM|Managed Medicaid|MEDICAID AMERIGROUP|||||487.75||| 72220|EAP|0320|SACRUM|Managed Medicaid|MEDICAID SUPERIOR|||||487.75||| 72220|EAP|0320|SACRUM|Humana Medicare Advantage|HUMANA MA|||||487.75||| 72220|EAP|0320|SACRUM|Blue Cross HMO Specialty|BCBSTX HMO|||||487.75||| 72220|EAP|0320|SACRUM|Blue Cross PPO Specialty|BCBSTX PPO|||||487.75||| 72220|EAP|0320|SACRUM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||487.75||| 72220|EAP|0320|SACRUM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||487.75||| 72220|EAP|0320|SACRUM|Aetna|AETNA PPO|||||487.75||| 72220|EAP|0320|SACRUM|Veterans Affairs|VETERANS ADMINISTRATION|||||487.75||| 72220|EAP|0320|SACRUM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||487.75||| 72220|EAP|0320|SACRUM|United Healthcare|TML GROUP BENEFITS|||||487.75||| 72220|EAP|0320|SACRUM|United Healthcare|UNITED HEALTHCARE OTHER|||||487.75||| 72220|EAP|0320|SACRUM|Medicare|MEDICARE ACUTE|||||487.75||| 72220|EAP|0320|SACRUM|PHCS|HUMANA|||||487.75||| 723|DRG||MALIGNANCY, MALE REPRODUCTIVE SYSTEM W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|91,788.32|9104.64|9104.64|9104.64|||| 727|DRG||INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W MCC|Humana Medicare Advantage|HUMANA MA|97,865.60|10918.06|11122.69|10918.06|||| 727|DRG||INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W MCC|Medicare|MEDICARE ACUTE|400.02|11122.69|11122.69|10918.06|||| 728|DRG||INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W/O MCC|Medicare|MEDICARE ACUTE|29,441.25|7181.21|7181.21|3374.53|||| 728|DRG||INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W/O MCC|Blue Cross HMO Specialty|BCBSTX HMO|13,453.75|3374.53|7181.21|3374.53|||| 73000|EAP|0320|CLAVICLE|Managed Medicaid|MEDICAID SUPERIOR|487.75||||487.75||| 73000|EAP|0320|CLAVICLE|Managed Medicaid|MEDICAID AMERIGROUP|||||487.75||| 73000|EAP|0320|CLAVICLE|Humana Medicare Advantage|HUMANA MA|||||487.75||| 73000|EAP|0320|CLAVICLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||487.75||| 73000|EAP|0320|CLAVICLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||487.75||| 73000|EAP|0320|CLAVICLE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||487.75||| 73000|EAP|0320|CLAVICLE|Aetna|AETNA PPO|||||487.75||| 73000|EAP|0320|CLAVICLE|Blue Cross PPO Specialty|BCBSTX PPO|||||487.75||| 73000|EAP|0320|CLAVICLE|Blue Cross PPO Specialty|BCBSTX OTHER|||||487.75||| 73000|EAP|0320|CLAVICLE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||487.75||| 73000|EAP|0320|CLAVICLE|Cigna|CIGNA|||||487.75||| 73000|EAP|0320|CLAVICLE|United Medicare Advantage|UHC AARP MCR HMO MA|||||487.75||| 73000|EAP|0320|CLAVICLE|United Healthcare|UNITED HEALTHCARE|||||487.75||| 73000|EAP|0320|CLAVICLE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||487.75||| 73000|EAP|0320|CLAVICLE|Medicare|MEDICARE ACUTE|||||487.75||| 73000|EAP|0320|CLAVICLE|Medicaid|MEDICAID|||||487.75||| 73010|EAP|0320|SCAPULA 2 VIEWS/COMPLETE|Medicaid|MEDICAID|||||487.75||| 73010|EAP|0320|SCAPULA 2 VIEWS/COMPLETE|Medicare|MEDICARE ACUTE|487.75||||487.75||| 73010|EAP|0320|SCAPULA 2 VIEWS/COMPLETE|Tricare|TRICARE EAST REGION|||||487.75||| 73010|EAP|0320|SCAPULA 2 VIEWS/COMPLETE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||487.75||| 73010|EAP|0320|SCAPULA 2 VIEWS/COMPLETE|Blue Cross PPO Specialty|BCBSTX PPO|||||487.75||| 73010|EAP|0320|SCAPULA 2 VIEWS/COMPLETE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||487.75||| 73010|EAP|0320|SCAPULA 2 VIEWS/COMPLETE|Aetna|AETNA PPO|||||487.75||| 73010|EAP|0320|SCAPULA 2 VIEWS/COMPLETE|Managed Medicaid|MEDICAID AMERIGROUP|||||487.75||| 73010|EAP|0320|SCAPULA 2 VIEWS/COMPLETE|Managed Medicaid|MEDICAID SUPERIOR|||||487.75||| 73020|EAP|0320|SHOULDER 1 VIEW|Humana Medicare Advantage|HUMANA MA|||||427.50||| 73020|EAP|0320|SHOULDER 1 VIEW|Managed Medicaid|MEDICAID AMERIGROUP|||||427.50||| 73020|EAP|0320|SHOULDER 1 VIEW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|427.50||||||| 73020|EAP|0320|SHOULDER 1 VIEW|Aenta Medicare Advantage|AETNA MEDICARE MA|427.50||||||| 73020|EAP|0320|SHOULDER 1 VIEW|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||427.50||| 73020|EAP|0320|SHOULDER 1 VIEW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||427.50||| 73020|EAP|0320|SHOULDER 1 VIEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||427.50||| 73020|EAP|0320|SHOULDER 1 VIEW|Cigna|CIGNA|||||427.50||| 73020|EAP|0320|SHOULDER 1 VIEW|Blue Cross HMO Specialty|BCBSTX HMO|||||427.50||| 73020|EAP|0320|SHOULDER 1 VIEW|Blue Cross PPO Specialty|BCBSTX PPO|||||427.50||| 73020|EAP|0320|SHOULDER 1 VIEW|Workers Compensation|WORKERS COMPENSATION OTHER|||||427.50||| 73020|EAP|0320|SHOULDER 1 VIEW|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||427.50||| 73020|EAP|0320|SHOULDER 1 VIEW|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||427.50||| 73020|EAP|0320|SHOULDER 1 VIEW|United Healthcare|UNITED HEALTHCARE|||||427.50||| 73020|EAP|0320|SHOULDER 1 VIEW|United Medicare Advantage|UHC MEDICARE GOLD MA|||||427.50||| 73020|EAP|0320|SHOULDER 1 VIEW|Medicare|MEDICARE ACUTE|427.50||||427.50||| 73020|EAP|0320|SHOULDER 1 VIEW|Texas Workforce Commission|DIS DETER SERV (DDS)|||||427.50||| 73030|EAP|0320|SHOULDER 2 VIEWS|Medicaid|HENDERSON COUNTY INDIGENT|487.75||||||| 73030|EAP|0320|SHOULDER 2 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Medicaid|MEDICAID|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Medicare|MEDICARE ACUTE|487.75||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Tricare|TRICARE FOR LIFE|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Tricare|TRICARE EAST REGION|487.75||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 2|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|487.75||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|United Medicare Advantage|UHC AARP MCR HMO MA|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Workers Compensation|TEXAS MUTUAL INSURANCE|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|487.75||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Workers Compensation|UT EMPLOYEE INJURY|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Blue Cross PPO Specialty|BCBSTX OTHER|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|United Healthcare|TML GROUP BENEFITS|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|PHCS|MULTIPLAN PHCS OTHER|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|ChampVA|CHAMPVA CENTER|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Cigna|CIGNA|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Cigna|CIGNA|487.75||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|487.75||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Aetna|AETNA PPO|487.75||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Aetna|AETNA OTHER|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Managed Medicare|HEALTHSPRING MA|487.75||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Managed Medicare|BCBS MEDICARE PPO MA|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|487.75||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|487.75||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|487.75||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Managed Medicare|VAN ZANDT COUNTY INMATE|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|MTC Medical|VAN ZANDT COUNTY INMATE|||||487.75||| 73030|EAP|0320|SHOULDER 2 VIEWS|Humana Medicare Advantage|HUMANA MA|487.75||||487.75||| 73060|EAP|0320|HUMERUS|Humana Medicare Advantage|HUMANA MA|487.75||||487.75||| 73060|EAP|0320|HUMERUS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||487.75||| 73060|EAP|0320|HUMERUS|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||487.75||| 73060|EAP|0320|HUMERUS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||487.75||| 73060|EAP|0320|HUMERUS|Managed Medicaid|MEDICAID SUPERIOR|||||487.75||| 73060|EAP|0320|HUMERUS|Managed Medicare|VAN ZANDT COUNTY INMATE|||||487.75||| 73060|EAP|0320|HUMERUS|Managed Medicaid|MEDICAID AMERIGROUP|||||487.75||| 73060|EAP|0320|HUMERUS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||487.75||| 73060|EAP|0320|HUMERUS|Aetna|AETNA PPO|||||487.75||| 73060|EAP|0320|HUMERUS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||487.75||| 73060|EAP|0320|HUMERUS|Aetna|AETNA OTHER|||||487.75||| 73060|EAP|0320|HUMERUS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||487.75||| 73060|EAP|0320|HUMERUS|Aenta Medicare Advantage|AETNA MEDICARE MA|487.75||||||| 73060|EAP|0320|HUMERUS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||487.75||| 73060|EAP|0320|HUMERUS|Blue Cross PPO Specialty|BCBSTX PPO|||||487.75||| 73060|EAP|0320|HUMERUS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||487.75||| 73060|EAP|0320|HUMERUS|Blue Cross HMO Specialty|BCBSTX HMO|||||487.75||| 73060|EAP|0320|HUMERUS|Cigna|CIGNA|||||487.75||| 73060|EAP|0320|HUMERUS|Workers Compensation|WORKERS COMPENSATION OTHER|||||487.75||| 73060|EAP|0320|HUMERUS|Managed Medicare|HEALTHSPRING MA|||||487.75||| 73060|EAP|0320|HUMERUS|Veterans Affairs|VETERANS ADMINISTRATION|487.75||||487.75||| 73060|EAP|0320|HUMERUS|United Medicare Advantage|UHC AARP MCR HMO MA|||||487.75||| 73060|EAP|0320|HUMERUS|MTC Medical|VAN ZANDT COUNTY INMATE|||||487.75||| 73060|EAP|0320|HUMERUS|United Healthcare|UNITED HEALTHCARE OTHER|487.75||||332.38||| 73060|EAP|0320|HUMERUS|United Healthcare|UNITED HEALTHCARE|||||487.75||| 73060|EAP|0320|HUMERUS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||487.75||| 73060|EAP|0320|HUMERUS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||487.75||| 73060|EAP|0320|HUMERUS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.77||| 73060|EAP|0320|HUMERUS|United Healthcare|TML GROUP BENEFITS|||||487.75||| 73060|EAP|0320|HUMERUS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||487.75||| 73060|EAP|0320|HUMERUS|Medicare|MEDICARE PART B ONLY IP|487.75||||||| 73060|EAP|0320|HUMERUS|Medicare|MEDICARE ACUTE|487.75||||487.75||| 73060|EAP|0320|HUMERUS|NON CONTRACTED|COMMERCIAL OTHER 1|||||487.75||| 73060|EAP|0320|HUMERUS|Tricare|TRICARE EAST REGION|487.75||||||| 73060|EAP|0320|HUMERUS|Medicaid|MEDICAID|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Medicaid|MEDICAID HMO|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Medicaid|MEDICAID|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Medicaid|MEDICAID PCCM|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Medicaid|HENDERSON COUNTY INDIGENT|487.75||||||| 73070|EAP|0320|ELBOW 2 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Medicare|MEDICARE ACUTE|487.75||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Tricare|TRICARE EAST REGION|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|United Healthcare|TML GROUP BENEFITS|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|United Medicare Advantage|UHC AARP MCR HMO MA|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|487.75||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Workers Compensation|UT EMPLOYEE INJURY|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Cigna|CIGNA|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 2|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|487.75||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Aetna|AETNA OTHER|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Aetna|BOON CHAPMAN|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Aetna|AETNA PPO|487.75||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|487.75||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Managed Medicare|BCBS MEDICARE PPO MA|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Managed Medicare|VAN ZANDT COUNTY INMATE|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|MTC Medical|VAN ZANDT COUNTY INMATE|||||487.75||| 73070|EAP|0320|ELBOW 2 VIEWS|Humana Medicare Advantage|HUMANA MA|487.75||||487.75||| 73080|EAP|0320|ELBOW 3/VIEW|Humana Medicare Advantage|HUMANA MA|||||540.50||| 73080|EAP|0320|ELBOW 3/VIEW|Managed Medicaid|MEDICAID AMERIGROUP|||||540.50||| 73080|EAP|0320|ELBOW 3/VIEW|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||540.50||| 73080|EAP|0320|ELBOW 3/VIEW|Managed Medicaid|MEDICAID SUPERIOR|||||540.50||| 73080|EAP|0320|ELBOW 3/VIEW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||540.50||| 73080|EAP|0320|ELBOW 3/VIEW|Aetna|AETNA PPO|||||540.50||| 73080|EAP|0320|ELBOW 3/VIEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||540.50||| 73080|EAP|0320|ELBOW 3/VIEW|Aenta Medicare Advantage|AETNA MEDICARE MA|||||540.50||| 73080|EAP|0320|ELBOW 3/VIEW|Blue Cross PPO Specialty|BCBSTX PPO|||||540.50||| 73080|EAP|0320|ELBOW 3/VIEW|Blue Cross HMO Specialty|BCBSTX HMO|||||540.50||| 73080|EAP|0320|ELBOW 3/VIEW|United Medicare Advantage|UHC MEDICARE GOLD MA|||||540.50||| 73080|EAP|0320|ELBOW 3/VIEW|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||540.50||| 73080|EAP|0320|ELBOW 3/VIEW|United Healthcare|UNITED HEALTHCARE|||||540.50||| 73080|EAP|0320|ELBOW 3/VIEW|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||540.50||| 73080|EAP|0320|ELBOW 3/VIEW|NON CONTRACTED|COMMERCIAL OTHER 1|||||540.50||| 73080|EAP|0320|ELBOW 3/VIEW|Medicare|MEDICARE ACUTE|540.50||||540.50||| 73090|EAP|0320|FOREARM 2 VIEWS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|Medicaid|MEDICAID|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.77||| 73090|EAP|0320|FOREARM 2 VIEWS|Tricare|TRICARE EAST REGION|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 2|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|Medicare|MEDICARE PART B ONLY IP|487.75||||||| 73090|EAP|0320|FOREARM 2 VIEWS|Tricare|TRICARE FOR LIFE|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|Workers Compensation|UT EMPLOYEE INJURY|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|United Healthcare|TML GROUP BENEFITS|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|487.75||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|Medicare|MEDICARE ACUTE|487.75||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||332.38||| 73090|EAP|0320|FOREARM 2 VIEWS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|Cigna|CIGNA|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|Blue Cross PPO Specialty|BCBSTX OTHER|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|ChampVA|CHAMPVA CENTER|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|Medicaid|MEDICAID HMO|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|Aetna|AETNA OTHER|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|Aetna|AETNA PPO|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|487.75||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|487.75||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||487.75||| 73090|EAP|0320|FOREARM 2 VIEWS|Humana Medicare Advantage|HUMANA MA|487.75||||487.75||| 73100|EAP|0320|WRIST 2/VIEW|Humana Medicare Advantage|HUMANA MA|||||487.75||| 73100|EAP|0320|WRIST 2/VIEW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||487.75||| 73100|EAP|0320|WRIST 2/VIEW|Managed Medicaid|MEDICAID AMERIGROUP|||||487.75||| 73100|EAP|0320|WRIST 2/VIEW|Managed Medicaid|MEDICAID SUPERIOR|||||487.75||| 73100|EAP|0320|WRIST 2/VIEW|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||487.75||| 73100|EAP|0320|WRIST 2/VIEW|Aetna|AETNA OTHER|||||487.75||| 73100|EAP|0320|WRIST 2/VIEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||487.75||| 73100|EAP|0320|WRIST 2/VIEW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||487.75||| 73100|EAP|0320|WRIST 2/VIEW|Blue Cross PPO Specialty|BCBSTX PPO|||||487.75||| 73100|EAP|0320|WRIST 2/VIEW|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||487.75||| 73100|EAP|0320|WRIST 2/VIEW|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||487.75||| 73100|EAP|0320|WRIST 2/VIEW|United Healthcare|UNITED HEALTHCARE|||||487.75||| 73100|EAP|0320|WRIST 2/VIEW|United Medicare Advantage|UHC MEDICARE GOLD MA|||||487.75||| 73100|EAP|0320|WRIST 2/VIEW|Workers Compensation|WORKERS COMPENSATION OTHER|||||487.75||| 73100|EAP|0320|WRIST 2/VIEW|NON CONTRACTED|COMMERCIAL OTHER 1|||||487.75||| 73100|EAP|0320|WRIST 2/VIEW|Medicare|MEDICARE ACUTE|487.75||||487.75||| 73100|EAP|0320|WRIST 2/VIEW|Medicaid|MEDICAID HMO|||||487.75||| 73110|EAP|0320|WRIST 3 VIEWS|Medicaid|MEDICAID|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Medicaid|HENDERSON COUNTY INDIGENT|||||358.75||| 73110|EAP|0320|WRIST 3 VIEWS|Medicaid|MEDICAID HMO|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|UTMB|UTMB CORRECTIONAL MANAGED CARE|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Medicare|MEDICARE ACUTE|540.50||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 2|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Tricare|TRICARE EAST REGION|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Workers Compensation|UT EMPLOYEE INJURY|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|540.50||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|540.50||||358.75||| 73110|EAP|0320|WRIST 3 VIEWS|United Medicare Advantage|UHC AARP MCR HMO MA|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Blue Cross PPO Specialty|BCBSTX OTHER|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Cigna|CIGNA|||||358.75||| 73110|EAP|0320|WRIST 3 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|540.50||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|540.50||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|ChampVA|CHAMPVA CENTER|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Cigna|CIGNA OTHER|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Aetna|AETNA PPO|540.50||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Aetna|AETNA OTHER|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Managed Medicare|HEALTHSPRING MA|||||1.77||| 73110|EAP|0320|WRIST 3 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Managed Medicare|BCBS MEDICARE PPO MA|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|540.50||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|540.50||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Managed Medicare|OTHER INSTITUTIONS|||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|540.50||||540.50||| 73110|EAP|0320|WRIST 3 VIEWS|Humana Medicare Advantage|HUMANA MA|540.50||||540.50||| 73120|EAP|0320|HAND 2 VIEWS|Managed Medicare|HEALTHSPRING MA|||||487.75||| 73120|EAP|0320|HAND 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||487.75||| 73120|EAP|0320|HAND 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||487.75||| 73120|EAP|0320|HAND 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|487.75||||487.75||| 73120|EAP|0320|HAND 2 VIEWS|Cigna|CIGNA|||||487.75||| 73120|EAP|0320|HAND 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|487.75||||487.75||| 73120|EAP|0320|HAND 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||487.75||| 73120|EAP|0320|HAND 2 VIEWS|Medicare|MEDICARE ACUTE|487.75||||487.75||| 73130|EAP|0320|HAND 3 VIEWS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Medicaid|MEDICAID HMO|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Medicaid|LAW ENFORCEMENT OTHER|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Medicaid|HENDERSON COUNTY INDIGENT|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Tricare|TRICARE EAST REGION|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.77||| 73130|EAP|0320|HAND 3 VIEWS|Medicare|MEDICARE ACUTE|540.50||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Workers Compensation|UT EMPLOYEE INJURY|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|540.50||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|United Medicare Advantage|UHC AARP MCR HMO MA|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Cigna|CIGNA OTHER|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|540.50||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Cigna|CIGNA|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|ChampVA|CHAMPVA CENTER|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Workers Compensation|WORKERS COMP PHYSICIAN|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Blue Cross PPO Specialty|BCBSTX OTHER|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Aetna|AETNA PPO|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Medicaid|MEDICAID|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Aetna|AETNA OTHER|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|540.50||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Humana Medicare Advantage|HUMANA MA|540.50||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|MTC Medical|VAN ZANDT COUNTY INMATE|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|540.50||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Managed Medicare|HEALTHSPRING MA|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Managed Medicare|VAN ZANDT COUNTY INMATE|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|540.50||||540.50||| 73130|EAP|0320|HAND 3 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|540.50||||540.50||| 73140|EAP|0320|FINGER 2 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Aetna|AETNA PPO|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Aetna|AETNA OTHER|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UMR|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Cigna|CIGNA|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.77||| 73140|EAP|0320|FINGER 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Workers Compensation|BROOKSHIRES WORKERS COMP|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Tricare|TRICARE EAST REGION|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Medicare|MEDICARE ACUTE|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Managed Medicare|HEALTHSPRING MA|||||332.38||| 73140|EAP|0320|FINGER 2 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Medicaid|MEDICAID BCBSTX|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Medicaid|MEDICAID HMO|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Medicaid|HENDERSON COUNTY INDIGENT|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Medicaid|MEDICAID|||||487.75||| 73140|EAP|0320|FINGER 2 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||487.75||| 73200|EAP|0350|CT UPPER EXTREMITY|Veterans Affairs|VETERANS ADMINISTRATION|||||3,772.75||| 73200|EAP|0350|CT UPPER EXTREMITY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3,772.75||||3,772.75||| 73200|EAP|0350|CT UPPER EXTREMITY|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3,772.75||| 73200|EAP|0350|CT UPPER EXTREMITY|Medicare|MEDICARE ACUTE|3,772.75||||3,772.75||| 73200|EAP|0350|CT UPPER EXTREMITY|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||3,772.75||| 73200|EAP|0350|CT UPPER EXTREMITY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3,772.75||||3,772.75||| 73200|EAP|0350|CT UPPER EXTREMITY|Blue Cross PPO Specialty|BCBSTX PPO|||||3,772.75||| 73200|EAP|0350|CT UPPER EXTREMITY|Blue Cross HMO Specialty|BCBSTX HMO|||||3,772.75||| 73200|EAP|0350|CT UPPER EXTREMITY|Access Direct Platinum|HEALTHFIRST TPA UMR|||||3,772.75||| 73200|EAP|0350|CT UPPER EXTREMITY|Aetna|AETNA PPO|3,772.75||||3,772.75||| 73200|EAP|0350|CT UPPER EXTREMITY|Cigna|CIGNA|||||3,772.75||| 73200|EAP|0350|CT UPPER EXTREMITY|Humana Medicare Advantage|HUMANA MA|3,772.75||||3,772.75||| 73200|EAP|0350|CT UPPER EXTREMITY|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||3,772.75||| 73200|EAP|0350|CT UPPER EXTREMITY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3,772.75||| 73200|EAP|0350|CT UPPER EXTREMITY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3,772.75||| 73200|EAP|0350|CT UPPER EXTREMITY|Managed Medicaid|MEDICAID AMERIGROUP|||||3,772.75||| 73201|EAP|0350|CT UPPER EXTR W/CONTRAST|Humana Medicare Advantage|HUMANA MA|||||4,928.25||| 73201|EAP|0350|CT UPPER EXTR W/CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|4,928.25||||||| 73201|EAP|0350|CT UPPER EXTR W/CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4,928.25||| 73201|EAP|0350|CT UPPER EXTR W/CONTRAST|Medicare|MEDICARE ACUTE|4,928.25||||4,928.25||| 73206|EAP|0350|CTA UPPER EXTREMITY W/WO|Aetna|AETNA PPO|||||6,249.25||| 73206|EAP|0350|CTA UPPER EXTREMITY W/WO|Blue Cross PPO Specialty|BCBSTX PPO|||||6,249.25||| 73206|EAP|0350|CTA UPPER EXTREMITY W/WO|Humana Medicare Advantage|HUMANA MA|||||6,249.25||| 73218|EAP|0610|MRI UPPER EXT NOT JOINT W|United Healthcare|UNITED HEALTHCARE OTHER|||||60.84||| 73218|EAP|0610|MRI UPPER EXT NOT JOINT W|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||60.84||| 73218|EAP|0610|MRI UPPER EXT NOT JOINT W|Managed Medicare|HEALTHSPRING MA|||||60.84||| 73218|EAP|0610|MRI UPPER EXT NOT JOINT W|Medicare|MEDICARE ACUTE|||||60.84||| 73218|EAP|0610|MRI UPPER EXT NOT JOINT W|NON CONTRACTED|COMMERCIAL OTHER 1|||||60.84||| 73218|EAP|0610|MRI UPPER EXT NOT JOINT W|Managed Medicaid|MEDICAID AMERIGROUP|||||60.84||| 73218|EAP|0610|MRI UPPER EXT NOT JOINT W|Managed Medicaid|MEDICAID SUPERIOR|||||60.84||| 73218|EAP|0610|MRI UPPER EXT NOT JOINT W|Humana Medicare Advantage|HUMANA MA|||||60.84||| 73218|EAP|0610|MRI UPPER EXT NOT JOINT W|Blue Cross PPO Specialty|BCBSTX PPO|||||60.84||| 73218|EAP|0610|MRI UPPER EXT NOT JOINT W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||60.84||| 73218|EAP|0610|MRI UPPER EXT NOT JOINT W|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||60.84||| 73219|EAP|0610|MRI UPPER EXT NOT JOINT W|Medicare|MEDICARE ACUTE|72.40||||||| 73220|EAP|0610|MRI UPPER EXT/NDT JOINT W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||8,230.75||| 73220|EAP|0610|MRI UPPER EXT/NDT JOINT W|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||8,230.75||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|Workers Compensation|UT EMPLOYEE INJURY|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|Veterans Affairs|VETERANS ADMINISTRATION|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|United Medicare Advantage|UHC MEDICARE GOLD MA|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|Workers Compensation|WORKERS COMPENSATION OTHER|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|United Healthcare|UNITED HEALTHCARE|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|United Healthcare|TML GROUP BENEFITS|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|Managed Medicare|BCBS MEDICARE PPO MA|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|Managed Medicare|HEALTHSPRING MA|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|NON CONTRACTED|COMMERCIAL OTHER 1|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|Medicare|MEDICARE ACUTE|60.84||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|Workers Compensation|TEXAS MUTUAL INSURANCE|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|Tricare|TRICARE EAST REGION|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|Cigna|CIGNA|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|Humana Medicare Advantage|HUMANA MA|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|Managed Medicaid|MEDICAID SUPERIOR|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|Managed Medicaid|MEDICAID AMERIGROUP|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|Aetna|AETNA OTHER|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|Aenta Medicare Advantage|AETNA MEDICARE MA|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|Access Direct Platinum|HEALTHFIRST TPA UMR|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|Aetna|AETNA PPO|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|Blue Cross PPO Specialty|BCBSTX PPO|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|60.84||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|ChampVA|CHAMPVA CENTER|||||60.84||| 73221|EAP|0610|MRI UPPER EXT ANY JOINT W|Blue Cross HMO Specialty|BCBSTX HMO|||||60.84||| 73222|EAP|0610|MRI UPPER EXT ANY JOINT W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||72.40||| 73222|EAP|0610|MRI UPPER EXT ANY JOINT W|Aenta Medicare Advantage|AETNA MEDICARE MA|72.40||||||| 73223|EAP|0610|MRI UPPER EXT ANY JOINT W|Medicare|MEDICARE ACUTE|||||8,230.75||| 73223|EAP|0610|MRI UPPER EXT ANY JOINT W|United Healthcare|UNITED HEALTHCARE|||||8,230.75||| 73223|EAP|0610|MRI UPPER EXT ANY JOINT W|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||8,230.75||| 73223|EAP|0610|MRI UPPER EXT ANY JOINT W|Aetna|AETNA PPO|||||8,230.75||| 73501|EAP|0320|HIP 1 VIEW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|427.50||||||| 73501|EAP|0320|HIP 1 VIEW|Managed Medicare|MA PART B ONLY IP|427.50||||||| 73501|EAP|0320|HIP 1 VIEW|Managed Medicare|HEALTHSPRING MA|427.50||||427.50||| 73501|EAP|0320|HIP 1 VIEW|Managed Medicare|BCBS MEDICARE PPO MA|||||427.50||| 73501|EAP|0320|HIP 1 VIEW|Managed Medicaid|MEDICAID SUPERIOR|427.50||||427.50||| 73501|EAP|0320|HIP 1 VIEW|Humana Medicare Advantage|HUMANA MA|427.50||||427.50||| 73501|EAP|0320|HIP 1 VIEW|Blue Cross PPO Specialty|BCBSTX PPO|427.50||||427.50||| 73501|EAP|0320|HIP 1 VIEW|Aetna|AETNA PPO|427.50||||427.50||| 73501|EAP|0320|HIP 1 VIEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|427.50||||427.50||| 73501|EAP|0320|HIP 1 VIEW|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|427.50||||427.50||| 73501|EAP|0320|HIP 1 VIEW|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||427.50||| 73501|EAP|0320|HIP 1 VIEW|Medicare|MEDICARE ACUTE|427.50||||427.50||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Medicaid|MEDICAID|487.75||||332.38||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Medicaid|HENDERSON COUNTY INDIGENT|||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.77||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Tricare|TRICARE EAST REGION|487.75||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Tricare|TRICARE FOR LIFE|||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Texas Workforce Commission|DIS DETER SERV (DDS)|||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.77||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|487.75||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||1.77||| 73502|EAP|0320|HIP JOINT 2 VIEWS|United Healthcare|TML GROUP BENEFITS|||||1.77||| 73502|EAP|0320|HIP JOINT 2 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|487.75||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||332.38||| 73502|EAP|0320|HIP JOINT 2 VIEWS|United Medicare Advantage|UHC AARP MCR HMO MA|||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.77||| 73502|EAP|0320|HIP JOINT 2 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|487.75||||1.77||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|487.75||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Aetna|AETNA PPO|487.75||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|487.75||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|PHCS|HUMANA|||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|487.75||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|487.75||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Cigna|CIGNA OTHER|||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Cigna|CIGNA|||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|ChampVA|CHAMPVA CENTER|||||1.77||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Cigna|CIGNA|487.75||||1.77||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Humana Medicare Advantage|HUMANA MA|487.75||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|487.75||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Medicare|MEDICARE ACUTE|487.75||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|487.75||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Managed Medicare|BCBS MEDICARE PPO MA|||||332.38||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Managed Medicare|OTHER INSTITUTIONS|||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Managed Medicare|HEALTHSPRING MA|487.75||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|487.75||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|487.75||||487.75||| 73502|EAP|0320|HIP JOINT 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|487.75||||487.75||| 73523|EAP|0320|HIP JOINT BILATERAL|Managed Medicaid|MEDICAID AMERIGROUP|||||612.50||| 73523|EAP|0320|HIP JOINT BILATERAL|Managed Medicaid|MEDICAID SUPERIOR|||||612.50||| 73523|EAP|0320|HIP JOINT BILATERAL|Managed Medicare|HEALTHSPRING MA|||||612.50||| 73523|EAP|0320|HIP JOINT BILATERAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|612.50||||612.50||| 73523|EAP|0320|HIP JOINT BILATERAL|Humana Medicare Advantage|HUMANA MA|||||612.50||| 73523|EAP|0320|HIP JOINT BILATERAL|Blue Cross HMO Specialty|BCBSTX HMO|||||612.50||| 73523|EAP|0320|HIP JOINT BILATERAL|Blue Cross PPO Specialty|BCBSTX PPO|612.50||||612.50||| 73523|EAP|0320|HIP JOINT BILATERAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||612.50||| 73523|EAP|0320|HIP JOINT BILATERAL|Aetna|AETNA PPO|||||612.50||| 73523|EAP|0320|HIP JOINT BILATERAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||612.50||| 73523|EAP|0320|HIP JOINT BILATERAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|612.50||||612.50||| 73523|EAP|0320|HIP JOINT BILATERAL|Medicare|MEDICARE ACUTE|612.50||||612.50||| 73551|EAP|0320|FEMUR ONE VIEW|Medicare|MEDICARE ACUTE|||||487.75||| 73551|EAP|0320|FEMUR ONE VIEW|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||487.75||| 73552|EAP|0320|FEMUR 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UMR|||||487.75||| 73552|EAP|0320|FEMUR 2 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.77||| 73552|EAP|0320|FEMUR 2 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|487.75||||||| 73552|EAP|0320|FEMUR 2 VIEWS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||487.75||| 73552|EAP|0320|FEMUR 2 VIEWS|Blue Cross PPO Specialty|BCBSTX OTHER|||||487.75||| 73552|EAP|0320|FEMUR 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|487.75||||487.75||| 73552|EAP|0320|FEMUR 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|487.75||||487.75||| 73552|EAP|0320|FEMUR 2 VIEWS|Humana Medicare Advantage|HUMANA MA|487.75||||487.75||| 73552|EAP|0320|FEMUR 2 VIEWS|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||487.75||| 73552|EAP|0320|FEMUR 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||487.75||| 73552|EAP|0320|FEMUR 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|487.75||||487.75||| 73552|EAP|0320|FEMUR 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||487.75||| 73552|EAP|0320|FEMUR 2 VIEWS|Cigna|CIGNA|487.75||||487.75||| 73552|EAP|0320|FEMUR 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||487.75||| 73552|EAP|0320|FEMUR 2 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||487.75||| 73552|EAP|0320|FEMUR 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||487.75||| 73552|EAP|0320|FEMUR 2 VIEWS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|487.75||||487.75||| 73552|EAP|0320|FEMUR 2 VIEWS|Aetna|AETNA PPO|487.75||||||| 73552|EAP|0320|FEMUR 2 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||487.75||| 73552|EAP|0320|FEMUR 2 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||487.75||| 73552|EAP|0320|FEMUR 2 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|487.75||||332.38||| 73552|EAP|0320|FEMUR 2 VIEWS|United Medicare Advantage|UHC AARP MCR HMO MA|||||487.75||| 73552|EAP|0320|FEMUR 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||1.77||| 73552|EAP|0320|FEMUR 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||487.75||| 73552|EAP|0320|FEMUR 2 VIEWS|Medicaid|MEDICAID HMO|||||487.75||| 73552|EAP|0320|FEMUR 2 VIEWS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||487.75||| 73552|EAP|0320|FEMUR 2 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||487.75||| 73552|EAP|0320|FEMUR 2 VIEWS|Multiplan|NALC|||||1.77||| 73552|EAP|0320|FEMUR 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||332.38||| 73552|EAP|0320|FEMUR 2 VIEWS|Medicare|MEDICARE ACUTE|487.75||||487.75||| 73560|EAP|0320|KNEE 2 VIEWS|Tricare|TRICARE EAST REGION|||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|Medicare|MEDICARE ACUTE|427.50||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|Texas Workforce Commission|DIS DETER SERV (DDS)|||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|Medicaid|MEDICAID|||||1.77||| 73560|EAP|0320|KNEE 2 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|Medicaid|MEDICAID BCBSTX|||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|Medicaid|MEDICAID HMO|||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.77||| 73560|EAP|0320|KNEE 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|427.50||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|United Healthcare|UNITED HEALTHCARE|427.50||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|427.50||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|United Healthcare|GEHA|||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|427.50||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|United Healthcare|TML GROUP BENEFITS|||||1.77||| 73560|EAP|0320|KNEE 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|Workers Compensation|WORKERS COMP PHYSICIAN|||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|United Medicare Advantage|UHC AARP MCR HMO MA|||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|Workers Compensation|GALLAGHER BASSETT|||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|Workers Compensation|TEXAS MUTUAL INSURANCE|||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|Managed Medicare|BCBS MEDICARE PPO MA|427.50||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|Managed Medicare|HEALTHSPRING MA|427.50||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|United Healthcare|UNITED HEALTHCARE|427.50||||||| 73560|EAP|0320|KNEE 2 VIEWS|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|427.50||||||| 73560|EAP|0320|KNEE 2 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|427.50||||1.77||| 73560|EAP|0320|KNEE 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|427.50||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||302.25||| 73560|EAP|0320|KNEE 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|427.50||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|Humana Medicare Advantage|HUMANA MA|427.50||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|427.50||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|Cigna|CIGNA|||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|427.50||||1.77||| 73560|EAP|0320|KNEE 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|427.50||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||302.25||| 73560|EAP|0320|KNEE 2 VIEWS|Cigna|CIGNA|||||302.25||| 73560|EAP|0320|KNEE 2 VIEWS|ChampVA|CHAMPVA CENTER|427.50||||||| 73560|EAP|0320|KNEE 2 VIEWS|Aetna|AETNA PPO|||||1.77||| 73560|EAP|0320|KNEE 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|427.50||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|427.50||||427.50||| 73560|EAP|0320|KNEE 2 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|427.50||||427.50||| 73562|EAP|0320|KNEE 3 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Aetna|AETNA PPO|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Cigna|CIGNA OTHER|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Cigna|CIGNA|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Humana Medicare Advantage|HUMANA MA|540.50||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|540.50||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Managed Medicare|BCBS MEDICARE PPO MA|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Managed Medicare|HEALTHSPRING MA|540.50||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|540.50||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|540.50||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|540.50||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Workers Compensation|WORKERS COMP PHYSICIAN|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Workers Compensation|UT EMPLOYEE INJURY|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|United Medicare Advantage|UHC AARP WELLMED HMO MA|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|540.50||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|540.50||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|United Healthcare|TML GROUP BENEFITS|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|United Medicare Advantage|UHC AARP MCR HMO MA|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Medicaid|MEDICAID HMO|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Medicaid|MEDICAID|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Medicaid Out of State|MEDICAID LOUISIANA|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Medicaid|LAW ENFORCEMENT OTHER|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Tricare|TRICARE FOR LIFE|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Tricare|TRICARE EAST REGION|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||540.50||| 73562|EAP|0320|KNEE 3 VIEWS|Medicare|MEDICARE ACUTE|540.50||||540.50||| 73564|EAP|0320|KNEE RT 4 OR MORE VIEWS|Medicare|MEDICARE ACUTE|||||6.63||| 73564|EAP|0320|KNEE RT 4 OR MORE VIEWS|United Healthcare|UNITED HEALTHCARE|||||6.63||| 73564|EAP|0320|KNEE RT 4 OR MORE VIEWS|Managed Medicare|HEALTHSPRING MA|||||6.63||| 73564|EAP|0320|KNEE RT 4 OR MORE VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||6.63||| 73590|EAP|0320|LEG 2 VIEWS|Aetna|AETNA PPO|487.75||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UMR|||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|487.75||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|Cigna|CIGNA|487.75||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|Cigna|CIGNA|||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|Humana Medicare Advantage|HUMANA MA|487.75||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|Managed Medicare|HEALTHSPRING MA|487.75||||332.38||| 73590|EAP|0320|LEG 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|487.75||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|Blue Cross PPO Specialty|BCBSTX OTHER|||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|United Healthcare|TML GROUP BENEFITS|||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|487.75||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|487.75||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|487.75||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|United Medicare Advantage|UHC AARP MCR HMO MA|||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.77||| 73590|EAP|0320|LEG 2 VIEWS|Medicaid|MEDICAID HMO|||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|Medicaid|MEDICAID|487.75||||||| 73590|EAP|0320|LEG 2 VIEWS|Medicaid|HENDERSON COUNTY INDIGENT|||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|Medicaid Out of State|MEDICAID LOUISIANA|||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|Medicare|MEDICARE ACUTE|487.75||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||487.75||| 73590|EAP|0320|LEG 2 VIEWS|Multiplan|NALC|||||1.77||| 73590|EAP|0320|LEG 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 2|||||487.75||| 73600|EAP|0320|ANKLE 2 VIEWS|Medicare|MEDICARE ACUTE|487.75||||487.75||| 73600|EAP|0320|ANKLE 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||487.75||| 73600|EAP|0320|ANKLE 2 VIEWS|Medicaid|MEDICAID HMO|||||487.75||| 73600|EAP|0320|ANKLE 2 VIEWS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||487.75||| 73600|EAP|0320|ANKLE 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||487.75||| 73600|EAP|0320|ANKLE 2 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||487.75||| 73600|EAP|0320|ANKLE 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||487.75||| 73600|EAP|0320|ANKLE 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||487.75||| 73600|EAP|0320|ANKLE 2 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||487.75||| 73600|EAP|0320|ANKLE 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||487.75||| 73600|EAP|0320|ANKLE 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||487.75||| 73600|EAP|0320|ANKLE 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||487.75||| 73600|EAP|0320|ANKLE 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||487.75||| 73600|EAP|0320|ANKLE 2 VIEWS|Managed Medicare|HEALTHSPRING MA|487.75||||||| 73600|EAP|0320|ANKLE 2 VIEWS|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||487.75||| 73600|EAP|0320|ANKLE 2 VIEWS|Humana Medicare Advantage|HUMANA MA|487.75||||487.75||| 73600|EAP|0320|ANKLE 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||487.75||| 73600|EAP|0320|ANKLE 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||166.75||| 73600|EAP|0320|ANKLE 2 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|487.75||||||| 73600|EAP|0320|ANKLE 2 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||487.75||| 73610|EAP|0320|ANKLE 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UMR|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Aetna|AETNA PPO|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Cigna|CIGNA|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Cigna|CIGNA|||||358.75||| 73610|EAP|0320|ANKLE 3 VIEWS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|ChampVA|CHAMPVA CENTER|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|540.50||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Blue Cross PPO Specialty|BCBSTX OTHER|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|540.50||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Humana Medicare Advantage|HUMANA MA|540.50||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Managed Medicare|BCBS MEDICARE PPO MA|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Managed Medicare|VAN ZANDT COUNTY INMATE|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|540.50||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|540.50||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Managed Medicare|WELLCARE CHOICE MA|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Managed Medicare|HEALTHSPRING MA|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Workers Compensation|GALLAGHER BASSETT|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Workers Compensation|TEXAS MUTUAL INSURANCE|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Workers Compensation|WORKERS COMP PHYSICIAN|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|MTC Medical|VAN ZANDT COUNTY INMATE|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Workers Compensation|UT EMPLOYEE INJURY|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|United Medicare Advantage|UHC AARP MCR HMO MA|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Cigna|CIGNA OTHER|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|United Healthcare|TML GROUP BENEFITS|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|540.50||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|540.50||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|540.50||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Medicaid|MEDICAID HMO|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Medicaid Out of State|MEDICAID LOUISIANA|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||358.75||| 73610|EAP|0320|ANKLE 3 VIEWS|Medicaid|MEDICAID BCBSTX|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Medicaid|MEDICAID|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|PHCS|HUMANA INSURANCE|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|PHCS|MULTIPLAN PHCS OTHER|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Tricare|TRICARE EAST REGION|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Texas Workforce Commission|VOC REHAB SERV (TWC)|||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|Medicare|MEDICARE ACUTE|540.50||||540.50||| 73610|EAP|0320|ANKLE 3 VIEWS|PHCS|HUMANA|||||358.75||| 73620|EAP|0320|FOOT 2 VIEWS|Tricare|TRICARE EAST REGION|487.75||||||| 73620|EAP|0320|FOOT 2 VIEWS|Medicare|MEDICARE ACUTE|487.75||||487.75||| 73620|EAP|0320|FOOT 2 VIEWS|Medicaid|MEDICAID HMO|||||487.75||| 73620|EAP|0320|FOOT 2 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||487.75||| 73620|EAP|0320|FOOT 2 VIEWS|Managed Medicare|HEALTHSPRING MA|487.75||||||| 73620|EAP|0320|FOOT 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||487.75||| 73620|EAP|0320|FOOT 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||487.75||| 73620|EAP|0320|FOOT 2 VIEWS|Cigna|CIGNA|||||487.75||| 73620|EAP|0320|FOOT 2 VIEWS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||487.75||| 73620|EAP|0320|FOOT 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||487.75||| 73620|EAP|0320|FOOT 2 VIEWS|Aetna|AETNA PPO|||||487.75||| 73630|EAP|0320|FOOT 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.77||| 73630|EAP|0320|FOOT 3 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.77||| 73630|EAP|0320|FOOT 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UMR|||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Aetna|AETNA PPO|||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|540.50||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|540.50||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Cigna|CIGNA|||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|540.50||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Blue Cross PPO Specialty|BCBSTX OTHER|||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Humana Medicare Advantage|HUMANA MA|540.50||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Managed Medicare|BCBS MEDICARE PPO MA|||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|540.50||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|540.50||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Managed Medicare|HEALTHSPRING MA|540.50||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Managed Medicare|WELLCARE CHOICE MA|||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Workers Compensation|UT EMPLOYEE INJURY|||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Workers Compensation|WORKERS COMP PHYSICIAN|||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|540.50||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|540.50||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|540.50||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|ChampVA|CHAMPVA CENTER|||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|United Medicare Advantage|UHC AARP MCR HMO MA|||||358.75||| 73630|EAP|0320|FOOT 3 VIEWS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|540.50||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|United Healthcare|TML GROUP BENEFITS|||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Medicaid|HENDERSON COUNTY INDIGENT|540.50||||||| 73630|EAP|0320|FOOT 3 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.77||| 73630|EAP|0320|FOOT 3 VIEWS|Medicaid|MEDICAID HMO|||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Medicaid|MEDICAID|540.50||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Medicaid|MEDICAID PCCM|||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.77||| 73630|EAP|0320|FOOT 3 VIEWS|PHCS|HUMANA|||||1.77||| 73630|EAP|0320|FOOT 3 VIEWS|Tricare|TRICARE EAST REGION|540.50||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|540.50||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|Medicare|MEDICARE ACUTE|540.50||||540.50||| 73630|EAP|0320|FOOT 3 VIEWS|PHCS|HUMANA INSURANCE|||||358.75||| 73650|EAP|0320|OS CALCIS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||487.75||| 73650|EAP|0320|OS CALCIS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||487.75||| 73650|EAP|0320|OS CALCIS|United Healthcare|UNITED HEALTHCARE|||||487.75||| 73650|EAP|0320|OS CALCIS|Veterans Affairs|VETERANS ADMINISTRATION|||||487.75||| 73650|EAP|0320|OS CALCIS|Managed Medicare|HEALTHSPRING MA|||||487.75||| 73650|EAP|0320|OS CALCIS|Managed Medicaid|MEDICAID SUPERIOR|||||487.75||| 73650|EAP|0320|OS CALCIS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||487.75||| 73660|EAP|0320|TOES|Aetna|AETNA PPO|||||487.75||| 73660|EAP|0320|TOES|Aetna|AETNA OTHER|||||487.75||| 73660|EAP|0320|TOES|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||487.75||| 73660|EAP|0320|TOES|Cigna|CIGNA|||||487.75||| 73660|EAP|0320|TOES|Blue Cross HMO Specialty|BCBSTX HMO|||||487.75||| 73660|EAP|0320|TOES|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||487.75||| 73660|EAP|0320|TOES|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||487.75||| 73660|EAP|0320|TOES|Humana Medicare Advantage|HUMANA MA|||||332.38||| 73660|EAP|0320|TOES|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||487.75||| 73660|EAP|0320|TOES|Blue Cross PPO Specialty|BCBSTX PPO|||||487.75||| 73660|EAP|0320|TOES|Managed Medicaid|MEDICAID AMERIGROUP|||||487.75||| 73660|EAP|0320|TOES|Managed Medicaid|MEDICAID UNITED HEALTHCARE|487.75||||487.75||| 73660|EAP|0320|TOES|Managed Medicare|HEALTHSPRING MA|||||1.77||| 73660|EAP|0320|TOES|Managed Medicaid|MEDICAID SUPERIOR|||||487.75||| 73660|EAP|0320|TOES|NON CONTRACTED|COMMERCIAL OTHER 1|487.75||||487.75||| 73660|EAP|0320|TOES|Medicare|MEDICARE ACUTE|||||487.75||| 73660|EAP|0320|TOES|Medicaid|MEDICAID|||||487.75||| 73660|EAP|0320|TOES|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||487.75||| 73660|EAP|0320|TOES|Medicaid|MEDICAID TEXAS CHILDRENS|||||487.75||| 73660|EAP|0320|TOES|Workers Compensation|WORKERS COMPENSATION OTHER|||||487.75||| 73660|EAP|0320|TOES|Veterans Affairs|VETERANS ADMINISTRATION|||||487.75||| 73660|EAP|0320|TOES|United Medicare Advantage|UHC MEDICARE GOLD MA|||||487.75||| 73660|EAP|0320|TOES|United Medicare Advantage|AARP UHC WEST COMPLETE MA|487.75||||487.75||| 73660|EAP|0320|TOES|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|487.75||||||| 73660|EAP|0320|TOES|United Healthcare|UNITED HEALTHCARE OTHER|||||487.75||| 73660|EAP|0320|TOES|United Healthcare|UNITED HEALTHCARE|||||487.75||| 737|DRG||UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY W CC|Medicare|MEDICARE ACUTE|274,293.72|17133.34|17133.34|17133.34|||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||3,772.75||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|Managed Medicare|HEALTHSPRING MA|3,772.75||||3,772.75||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|3,772.75||||3,772.75||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|Managed Medicare|BCBS MEDICARE PPO MA|||||3,772.75||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3,772.75||||3,772.75||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|3,772.75||||3,772.75||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|Humana Medicare Advantage|HUMANA MA|3,772.75||||3,772.75||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|MTC Medical|VAN ZANDT COUNTY INMATE|||||3,772.75||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|3,772.75||||3,772.75||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|3,772.75||||3,772.75||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||3,772.75||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3,772.75||||3,772.75||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3,772.75||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3,772.75||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|Aetna|AETNA PPO|||||3,772.75||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|Managed Medicare|VAN ZANDT COUNTY INMATE|||||3,772.75||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||3,772.75||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3,772.75||||3,772.75||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3,772.75||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3,772.75||||3,772.75||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|Workers Compensation|WORKERS COMPENSATION OTHER|||||3,772.75||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|Workers Compensation|TEXAS MUTUAL INSURANCE|||||3,772.75||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|Medicare|MEDICARE ACUTE|3,772.75||||3,772.75||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|Medicaid|HENDERSON COUNTY INDIGENT|3,772.75||||3,772.75||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|Medicaid|MEDICAID HMO|||||3,772.75||| 73700|EAP|0350|CT LOW EXTR W/O CONTRAST|Medicaid|MEDICAID|||||3,772.75||| 73701|EAP|0350|CT LOW EXTR W/CONTRAST|Medicare|MEDICARE ACUTE|4,928.25||||4,928.25||| 73701|EAP|0350|CT LOW EXTR W/CONTRAST|Workers Compensation|WORKERS COMPENSATION OTHER|||||4,928.25||| 73701|EAP|0350|CT LOW EXTR W/CONTRAST|United Healthcare|TML GROUP BENEFITS|||||4,928.25||| 73701|EAP|0350|CT LOW EXTR W/CONTRAST|Medicaid|MEDICAID|||||4,928.25||| 73701|EAP|0350|CT LOW EXTR W/CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4,928.25||||4,928.25||| 73701|EAP|0350|CT LOW EXTR W/CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4,928.25||| 73701|EAP|0350|CT LOW EXTR W/CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4,928.25||| 73701|EAP|0350|CT LOW EXTR W/CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|4,928.25||||4,928.25||| 73701|EAP|0350|CT LOW EXTR W/CONTRAST|Humana Medicare Advantage|HUMANA MA|||||4,928.25||| 73701|EAP|0350|CT LOW EXTR W/CONTRAST|Cigna|CIGNA|||||4,928.25||| 73701|EAP|0350|CT LOW EXTR W/CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|4,928.25||||4,928.25||| 73701|EAP|0350|CT LOW EXTR W/CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4,928.25||||||| 73701|EAP|0350|CT LOW EXTR W/CONTRAST|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||4,928.25||| 73701|EAP|0350|CT LOW EXTR W/CONTRAST|Managed Medicare|HEALTHSPRING MA|4,928.25||||||| 73701|EAP|0350|CT LOW EXTR W/CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|||||4,928.25||| 73702|EAP|0350|CT LOW EXTR W&W/O CONTRAS|Managed Medicaid|MEDICAID AMERIGROUP|55.89||||||| 73702|EAP|0350|CT LOW EXTR W&W/O CONTRAS|Humana Medicare Advantage|HUMANA MA|55.89||||55.89||| 73702|EAP|0350|CT LOW EXTR W&W/O CONTRAS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|55.89||||||| 73702|EAP|0350|CT LOW EXTR W&W/O CONTRAS|Blue Cross PPO Specialty|BCBSTX PPO|||||55.89||| 73702|EAP|0350|CT LOW EXTR W&W/O CONTRAS|Medicare|MEDICARE ACUTE|55.89||||55.89||| 73702|EAP|0350|CT LOW EXTR W&W/O CONTRAS|Medicaid|LAW ENFORCEMENT OTHER|55.89||||||| 73706|EAP|0350|CTA LOWER EXTREMITY W/WO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||7,628.25||| 73706|EAP|0350|CTA LOWER EXTREMITY W/WO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|7,628.25||||||| 73706|EAP|0350|CTA LOWER EXTREMITY W/WO|NON CONTRACTED|COMMERCIAL OTHER 1|||||7,628.25||| 73706|EAP|0350|CTA LOWER EXTREMITY W/WO|Medicare|MEDICARE ACUTE|7,628.25||||7,628.25||| 73706|EAP|0350|CTA LOWER EXTREMITY W/WO|Aetna|AETNA PPO|7,628.25||||||| 73706|EAP|0350|CTA LOWER EXTREMITY W/WO|Blue Cross PPO Specialty|BCBSTX PPO|||||7,628.25||| 73706|EAP|0350|CTA LOWER EXTREMITY W/WO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||7,628.25||| 73706|EAP|0350|CTA LOWER EXTREMITY W/WO|Blue Cross HMO Specialty|BCBSTX HMO|||||7,628.25||| 73718|EAP|0610|MRI LOWER EXT NOT JOINT W|Cigna|CIGNA|||||60.84||| 73718|EAP|0610|MRI LOWER EXT NOT JOINT W|Managed Medicaid|MEDICAID UNITED HEALTHCARE|60.84||||60.84||| 73718|EAP|0610|MRI LOWER EXT NOT JOINT W|Managed Medicaid|MEDICAID SUPERIOR|||||60.84||| 73718|EAP|0610|MRI LOWER EXT NOT JOINT W|Managed Medicaid|MEDICAID AMERIGROUP|||||60.84||| 73718|EAP|0610|MRI LOWER EXT NOT JOINT W|Humana Medicare Advantage|HUMANA MA|60.84||||60.84||| 73718|EAP|0610|MRI LOWER EXT NOT JOINT W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|60.84||||||| 73718|EAP|0610|MRI LOWER EXT NOT JOINT W|Blue Cross PPO Specialty|BCBSTX PPO|60.84||||60.84||| 73718|EAP|0610|MRI LOWER EXT NOT JOINT W|Blue Cross HMO Specialty|BCBSTX HMO|||||60.84||| 73718|EAP|0610|MRI LOWER EXT NOT JOINT W|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||60.84||| 73718|EAP|0610|MRI LOWER EXT NOT JOINT W|Aetna|AETNA PPO|||||60.84||| 73718|EAP|0610|MRI LOWER EXT NOT JOINT W|Managed Medicare|HEALTHSPRING MA|60.84||||||| 73718|EAP|0610|MRI LOWER EXT NOT JOINT W|Medicare|MEDICARE ACUTE|60.84||||60.84||| 73718|EAP|0610|MRI LOWER EXT NOT JOINT W|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||60.84||| 73718|EAP|0610|MRI LOWER EXT NOT JOINT W|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|60.84||||||| 73718|EAP|0610|MRI LOWER EXT NOT JOINT W|United Healthcare|UNITED HEALTHCARE|||||60.84||| 73719|EAP|0610|MRI LOWER EXT NOT JOINT W|Medicare|MEDICARE ACUTE|72.40||||||| 73719|EAP|0610|MRI LOWER EXT NOT JOINT W|Medicaid|MEDICAID|72.40||||||| 73720|EAP|0610|MRI LOWER EXT/NDT JOINT W|Blue Cross PPO Specialty|BCBSTX PPO|8,230.75||||8,230.75||| 73720|EAP|0610|MRI LOWER EXT/NDT JOINT W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|8,230.75||||||| 73720|EAP|0610|MRI LOWER EXT/NDT JOINT W|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||8,230.75||| 73720|EAP|0610|MRI LOWER EXT/NDT JOINT W|Humana Medicare Advantage|HUMANA MA|||||8,230.75||| 73720|EAP|0610|MRI LOWER EXT/NDT JOINT W|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||8,230.75||| 73720|EAP|0610|MRI LOWER EXT/NDT JOINT W|United Medicare Advantage|UHC MEDICARE GOLD MA|8,230.75||||||| 73720|EAP|0610|MRI LOWER EXT/NDT JOINT W|NON CONTRACTED|COMMERCIAL OTHER 1|8,230.75||||||| 73720|EAP|0610|MRI LOWER EXT/NDT JOINT W|Medicare|MEDICARE ACUTE|8,230.75||||8,230.75||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Managed Medicare|HEALTHSPRING MA|60.84||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Medicaid|HENDERSON COUNTY INDIGENT|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Medicaid|MEDICAID HMO|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Managed Medicare|MA PART B ONLY IP|60.84||||||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Tricare|TRICARE EAST REGION|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Medicare|MEDICARE ACUTE|60.84||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|NON CONTRACTED|COMMERCIAL OTHER 1|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Texas Workforce Commission|DIS DETER SERV (DDS)|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|United Healthcare|UNITED HEALTHCARE OTHER|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|United Healthcare|UNITED HEALTHCARE|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|United Medicare Advantage|AARP UHC WEST COMPLETE MA|60.84||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|United Healthcare|TML GROUP BENEFITS|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Veterans Affairs|VETERANS ADMINISTRATION|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Workers Compensation|WORKERS COMPENSATION OTHER|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|United Medicare Advantage|UHC MEDICARE GOLD MA|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Humana Medicare Advantage|HUMANA MA|60.84||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Cigna|CIGNA|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Managed Medicaid|MEDICAID AMERIGROUP|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Managed Medicaid|MEDICAID SUPERIOR|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Medicaid|MEDICAID|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Aetna|BOON CHAPMAN|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Aetna|AETNA PPO|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Aenta Medicare Advantage|AETNA MEDICARE MA|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|ChampVA|CHAMPVA CENTER|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Blue Cross HMO Specialty|BCBSTX HMO|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Blue Cross PPO Specialty|BCBSTX PPO|||||60.84||| 73721|EAP|0610|MRI LOWER EXT ANY JOINT W|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||60.84||| 73722|EAP|0610|MRI LOWER EXT ANY JOINT W|Medicare|MEDICARE ACUTE|72.40||||||| 73723|EAP|0610|MRI LOWER EXT ANY JOINT W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||8,230.75||| 73723|EAP|0610|MRI LOWER EXT ANY JOINT W|Humana Medicare Advantage|HUMANA MA|8,230.75||||8,230.75||| 73723|EAP|0610|MRI LOWER EXT ANY JOINT W|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||8,230.75||| 73723|EAP|0610|MRI LOWER EXT ANY JOINT W|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||8,230.75||| 73723|EAP|0610|MRI LOWER EXT ANY JOINT W|United Healthcare|TML GROUP BENEFITS|||||8,230.75||| 73723|EAP|0610|MRI LOWER EXT ANY JOINT W|Medicare|MEDICARE ACUTE|||||8,230.75||| 74|DRG||CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC|Medicare|MEDICARE ACUTE|28,978.25|8288.79|8288.79|3660.05|||| 74|DRG||CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC|Medicaid|MEDICAID|22,568.75|3660.05|8288.79|3660.05|||| 74|DRG||CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|49,856.75|8197.36|8288.79|3660.05|||| 74|DRG||CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC|Humana Medicare Advantage|HUMANA MA|89,805.15|8197.36|8288.79|3660.05|||| 740|DRG||UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W CC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|61,451.60|14210.72|14210.72|14210.72|||| 74018|EAP|0320|KUB|Veterans Affairs|VETERANS ADMINISTRATION|427.50||||427.50||| 74018|EAP|0320|KUB|United Healthcare|UNITED HEALTHCARE|427.50||||427.50||| 74018|EAP|0320|KUB|United Healthcare|UNITED HEALTHCARE OTHER|||||427.50||| 74018|EAP|0320|KUB|United Medicare Advantage|AARP UHC WEST COMPLETE MA|427.50||||427.50||| 74018|EAP|0320|KUB|United Medicare Advantage|UHC AARP MCR HMO MA|||||427.50||| 74018|EAP|0320|KUB|United Medicare Advantage|UHC MEDICARE GOLD MA|427.50||||427.50||| 74018|EAP|0320|KUB|United Healthcare|UNITED HEALTHCARE|||||427.50||| 74018|EAP|0320|KUB|United Healthcare|UMR UNITED MEDICAL RESOURCES|427.50||||427.50||| 74018|EAP|0320|KUB|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|427.50||||427.50||| 74018|EAP|0320|KUB|NON CONTRACTED|COMMERCIAL OTHER 1|427.50||||427.50||| 74018|EAP|0320|KUB|Medicare|MEDICARE ACUTE|427.50||||427.50||| 74018|EAP|0320|KUB|Texas Workforce Commission|DIS DETER SERV (DDS)|427.50||||||| 74018|EAP|0320|KUB|Medicaid|MEDICAID HMO|||||427.50||| 74018|EAP|0320|KUB|Medicaid|MOLINA HEALTHCARE OF TEXAS|427.50||||427.50||| 74018|EAP|0320|KUB|Medicaid|HENDERSON COUNTY INDIGENT|427.50||||||| 74018|EAP|0320|KUB|Medicaid|MEDICAID|427.50||||427.50||| 74018|EAP|0320|KUB|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||427.50||| 74018|EAP|0320|KUB|Medicaid|MEDICAID TEXAS CHILDRENS|||||427.50||| 74018|EAP|0320|KUB|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|427.50||||427.50||| 74018|EAP|0320|KUB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|427.50||||427.50||| 74018|EAP|0320|KUB|Managed Medicaid|MEDICAID SUPERIOR|427.50||||427.50||| 74018|EAP|0320|KUB|Medicaid|LAW ENFORCEMENT OTHER|||||427.50||| 74018|EAP|0320|KUB|Managed Medicare|HEALTHSPRING MA|427.50||||427.50||| 74018|EAP|0320|KUB|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|427.50||||427.50||| 74018|EAP|0320|KUB|Tricare|TRICARE EAST REGION|||||427.50||| 74018|EAP|0320|KUB|Managed Medicare|BCBS MEDICARE PPO MA|427.50||||427.50||| 74018|EAP|0320|KUB|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||427.50||| 74018|EAP|0320|KUB|Managed Medicare|VAN ZANDT COUNTY INMATE|||||427.50||| 74018|EAP|0320|KUB|Managed Medicaid|MEDICAID AMERIGROUP|427.50||||427.50||| 74018|EAP|0320|KUB|United Healthcare|TML GROUP BENEFITS|427.50||||427.50||| 74018|EAP|0320|KUB|Humana Medicare Advantage|HUMANA MA|427.50||||427.50||| 74018|EAP|0320|KUB|MTC Medical|VAN ZANDT COUNTY INMATE|||||427.50||| 74018|EAP|0320|KUB|Cigna|CIGNA|427.50||||427.50||| 74018|EAP|0320|KUB|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||326.88||| 74018|EAP|0320|KUB|Blue Cross PPO Specialty|BCBSTX PPO|427.50||||427.50||| 74018|EAP|0320|KUB|Cigna|CIGNA|||||427.50||| 74018|EAP|0320|KUB|Cigna|CIGNA OTHER|427.50||||||| 74018|EAP|0320|KUB|Blue Cross PPO Specialty|BCBSTX OTHER|||||427.50||| 74018|EAP|0320|KUB|ChampVA|CHAMPVA CENTER|||||226.25||| 74018|EAP|0320|KUB|Blue Cross HMO Specialty|BCBSTX HMO|427.50||||427.50||| 74018|EAP|0320|KUB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|427.50||||427.50||| 74018|EAP|0320|KUB|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|427.50||||427.50||| 74018|EAP|0320|KUB|Aetna|AETNA PPO|427.50||||427.50||| 74018|EAP|0320|KUB|Aetna|AETNA OTHER|||||427.50||| 74018|EAP|0320|KUB|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||427.50||| 74018|EAP|0320|KUB|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||427.50||| 74018|EAP|0320|KUB|Aenta Medicare Advantage|AETNA MEDICARE MA|427.50||||427.50||| 74019|EAP|0320|ABDOMEN 2 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|487.75||||226.25||| 74019|EAP|0320|ABDOMEN 2 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|487.75||||487.75||| 74019|EAP|0320|ABDOMEN 2 VIEWS|Aetna|AETNA PPO|||||3.57||| 74019|EAP|0320|ABDOMEN 2 VIEWS|Cigna|CIGNA|487.75||||487.75||| 74019|EAP|0320|ABDOMEN 2 VIEWS|ChampVA|CHAMPVA CENTER|||||226.25||| 74019|EAP|0320|ABDOMEN 2 VIEWS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||487.75||| 74019|EAP|0320|ABDOMEN 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|487.75||||487.75||| 74019|EAP|0320|ABDOMEN 2 VIEWS|Humana Medicare Advantage|HUMANA MA|487.75||||487.75||| 74019|EAP|0320|ABDOMEN 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||487.75||| 74019|EAP|0320|ABDOMEN 2 VIEWS|Managed Medicare|HEALTHSPRING MA|487.75||||226.25||| 74019|EAP|0320|ABDOMEN 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|487.75||||226.25||| 74019|EAP|0320|ABDOMEN 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|487.75||||487.75||| 74019|EAP|0320|ABDOMEN 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|487.75||||487.75||| 74019|EAP|0320|ABDOMEN 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||487.75||| 74019|EAP|0320|ABDOMEN 2 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||226.25||| 74019|EAP|0320|ABDOMEN 2 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||487.75||| 74019|EAP|0320|ABDOMEN 2 VIEWS|Medicaid|MEDICAID HMO|||||3.57||| 74019|EAP|0320|ABDOMEN 2 VIEWS|Medicaid|MEDICAID|487.75||||487.75||| 74019|EAP|0320|ABDOMEN 2 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||487.75||| 74019|EAP|0320|ABDOMEN 2 VIEWS|Medicaid|HENDERSON COUNTY INDIGENT|||||487.75||| 74019|EAP|0320|ABDOMEN 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||487.75||| 74019|EAP|0320|ABDOMEN 2 VIEWS|PHCS|HUMANA|||||487.75||| 74019|EAP|0320|ABDOMEN 2 VIEWS|Medicare|MEDICARE ACUTE|487.75||||487.75||| 74019|EAP|0320|ABDOMEN 2 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|487.75||||487.75||| 74019|EAP|0320|ABDOMEN 2 VIEWS|United Healthcare|UNITED HEALTHCARE|487.75||||487.75||| 74019|EAP|0320|ABDOMEN 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|487.75||||487.75||| 74019|EAP|0320|ABDOMEN 2 VIEWS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|487.75||||226.25||| 74019|EAP|0320|ABDOMEN 2 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||226.25||| 74019|EAP|0320|ABDOMEN 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||487.75||| 74019|EAP|0320|ABDOMEN 2 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||487.75||| 741|DRG||UTERINE, ADNEXA PROC FOR NON-OVARIAN/ADNEXAL MALIG W/O CC/MCC|Medicare|MEDICARE ACUTE|38,662.65|10505.74|10505.74|10505.74|||| 74150|EAP|0350|CT ABD W/O CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3,772.75||| 74150|EAP|0350|CT ABD W/O CONTRAST|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||3,772.75||| 74150|EAP|0350|CT ABD W/O CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3,772.75||| 74150|EAP|0350|CT ABD W/O CONTRAST|Humana Medicare Advantage|HUMANA MA|||||3,772.75||| 74150|EAP|0350|CT ABD W/O CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3,772.75||| 74150|EAP|0350|CT ABD W/O CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|||||3,772.75||| 74150|EAP|0350|CT ABD W/O CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3,772.75||| 74150|EAP|0350|CT ABD W/O CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|||||3,772.75||| 74150|EAP|0350|CT ABD W/O CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3,772.75||| 74150|EAP|0350|CT ABD W/O CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3,772.75||| 74150|EAP|0350|CT ABD W/O CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3,772.75||||3,772.75||| 74150|EAP|0350|CT ABD W/O CONTRAST|Medicare|MEDICARE ACUTE|3,772.75||||3,772.75||| 74160|EAP|0350|CT ABD W/CONTRAST|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||4,928.25||| 74160|EAP|0350|CT ABD W/CONTRAST|PHCS|HUMANA|||||4,928.25||| 74160|EAP|0350|CT ABD W/CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4,928.25||| 74160|EAP|0350|CT ABD W/CONTRAST|Medicare|MEDICARE ACUTE|||||4,928.25||| 74160|EAP|0350|CT ABD W/CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|||||4,928.25||| 74160|EAP|0350|CT ABD W/CONTRAST|Aetna|AETNA PPO|||||4,928.25||| 74160|EAP|0350|CT ABD W/CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|||||4,928.25||| 74160|EAP|0350|CT ABD W/CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|||||4,928.25||| 74160|EAP|0350|CT ABD W/CONTRAST|Cigna|CIGNA|||||4,928.25||| 74160|EAP|0350|CT ABD W/CONTRAST|Humana Medicare Advantage|HUMANA MA|4,928.25||||4,928.25||| 74160|EAP|0350|CT ABD W/CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4,928.25||| 74160|EAP|0350|CT ABD W/CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4,928.25||| 74160|EAP|0350|CT ABD W/CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|||||4,928.25||| 74160|EAP|0350|CT ABD W/CONTRAST|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||4,928.25||| 74160|EAP|0350|CT ABD W/CONTRAST|Managed Medicare|HEALTHSPRING MA|||||4,928.25||| 74160|EAP|0350|CT ABD W/CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|||||4,928.25||| 74160|EAP|0350|CT ABD W/CONTRAST|Managed Medicare|BCBS MEDICARE PPO MA|||||4,928.25||| 74170|EAP|0350|CT ABD W&W/O CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|||||55.89||| 74170|EAP|0350|CT ABD W&W/O CONTRAST|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||55.89||| 74170|EAP|0350|CT ABD W&W/O CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||55.89||| 74170|EAP|0350|CT ABD W&W/O CONTRAST|Managed Medicare|HEALTHSPRING MA|||||55.89||| 74170|EAP|0350|CT ABD W&W/O CONTRAST|Cigna|CIGNA|||||55.89||| 74170|EAP|0350|CT ABD W&W/O CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|||||55.89||| 74170|EAP|0350|CT ABD W&W/O CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||55.89||| 74170|EAP|0350|CT ABD W&W/O CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||55.89||| 74170|EAP|0350|CT ABD W&W/O CONTRAST|Medicare|MEDICARE ACUTE|||||55.89||| 74170|EAP|0350|CT ABD W&W/O CONTRAST|Medicaid|HENDERSON COUNTY INDIGENT|55.89||||||| 74174|EAP|0350|CTA ABD & PELVIS W/WO CON|Medicaid|COUNTY INDIGENT HEALTH OTHER|2,846.50||||||| 74174|EAP|0350|CTA ABD & PELVIS W/WO CON|Medicare|MEDICARE ACUTE|2,846.50||||2,846.50||| 74174|EAP|0350|CTA ABD & PELVIS W/WO CON|Tricare|TRICARE EAST REGION|||||2,846.50||| 74174|EAP|0350|CTA ABD & PELVIS W/WO CON|Veterans Affairs|VETERANS ADMINISTRATION|2,846.50||||||| 74174|EAP|0350|CTA ABD & PELVIS W/WO CON|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2,846.50||| 74174|EAP|0350|CTA ABD & PELVIS W/WO CON|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2,846.50||||2,846.50||| 74174|EAP|0350|CTA ABD & PELVIS W/WO CON|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2,846.50||| 74174|EAP|0350|CTA ABD & PELVIS W/WO CON|United Medicare Advantage|UHC AARP MCR HMO MA|||||2,846.50||| 74174|EAP|0350|CTA ABD & PELVIS W/WO CON|Medicaid|MEDICAID|||||2,846.50||| 74174|EAP|0350|CTA ABD & PELVIS W/WO CON|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2,846.50||| 74174|EAP|0350|CTA ABD & PELVIS W/WO CON|Aetna|AETNA PPO|||||2,846.50||| 74174|EAP|0350|CTA ABD & PELVIS W/WO CON|Blue Cross PPO Specialty|BCBSTX PPO|||||2,846.50||| 74174|EAP|0350|CTA ABD & PELVIS W/WO CON|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|2,846.50||||2,846.50||| 74174|EAP|0350|CTA ABD & PELVIS W/WO CON|Blue Cross PPO Specialty|BCBSTX OTHER|||||2,846.50||| 74174|EAP|0350|CTA ABD & PELVIS W/WO CON|Blue Cross HMO Specialty|BCBSTX HMO|||||2,846.50||| 74174|EAP|0350|CTA ABD & PELVIS W/WO CON|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2,846.50||| 74174|EAP|0350|CTA ABD & PELVIS W/WO CON|Humana Medicare Advantage|HUMANA MA|2,846.50||||2,846.50||| 74174|EAP|0350|CTA ABD & PELVIS W/WO CON|Cigna|CIGNA|||||2,846.50||| 74174|EAP|0350|CTA ABD & PELVIS W/WO CON|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2,846.50||||||| 74174|EAP|0350|CTA ABD & PELVIS W/WO CON|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2,846.50||| 74174|EAP|0350|CTA ABD & PELVIS W/WO CON|Managed Medicare|HEALTHSPRING MA|||||2,846.50||| 74175|EAP|0350|CTA ABDOMEN W/WO CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||6,249.25||| 74175|EAP|0350|CTA ABDOMEN W/WO CONTRAST|Humana Medicare Advantage|HUMANA MA|||||6,249.25||| 74175|EAP|0350|CTA ABDOMEN W/WO CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|6,249.25||||6,249.25||| 74175|EAP|0350|CTA ABDOMEN W/WO CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|||||6,249.25||| 74175|EAP|0350|CTA ABDOMEN W/WO CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||6,249.25||| 74175|EAP|0350|CTA ABDOMEN W/WO CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||6,249.25||| 74175|EAP|0350|CTA ABDOMEN W/WO CONTRAST|Medicare|MEDICARE ACUTE|||||6,249.25||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Medicaid|HENDERSON COUNTY INDIGENT|75.45||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Medicaid|MEDICAID HMO|||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Medicaid|LAW ENFORCEMENT OTHER|75.45||||||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Medicaid|MEDICAID TEXAS CHILDRENS|||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Medicaid|MEDICAID|75.45||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|PHCS|MULTIPLAN PHCS OTHER|||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Tricare|TRICARE EAST REGION|75.45||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|NON CONTRACTED|COMMERCIAL OTHER 1|75.45||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Tricare|TRICARE FOR LIFE|||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Multiplan|UNION PACIFIC RAILROAD|||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Workers Compensation|WORKERS COMPENSATION OTHER|||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Veterans Affairs|VETERANS ADMINISTRATION|75.45||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|United Medicare Advantage|AARP UHC WEST COMPLETE MA|75.45||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|United Medicare Advantage|UHC AARP MCR HMO MA|||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|United Healthcare|TML GROUP BENEFITS|||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|75.45||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|United Medicare Advantage|UHC MEDICARE GOLD MA|75.45||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|United Healthcare|UNITED HEALTHCARE|||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|United Healthcare|UNITED HEALTHCARE|75.45||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|United Healthcare|UMR UNITED MEDICAL RESOURCES|75.45||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|United Healthcare|UNITED HEALTHCARE OTHER|||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Aetna|AETNA PPO|75.45||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Aetna|AETNA OTHER|||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|PHCS|HUMANA|||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Aenta Medicare Advantage|AETNA MEDICARE MA|75.45||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Blue Cross PPO Specialty|BCBSTX OTHER|||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|ChampVA|CHAMPVA CENTER|75.45||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Blue Cross HMO Specialty|BCBSTX HMO|75.45||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Medicare|MEDICARE ACUTE|75.45||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Blue Cross PPO Specialty|BCBSTX PPO|75.45||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|75.45||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Humana Medicare Advantage|HUMANA MA|75.45||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Cigna|CIGNA|||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Cigna|CIGNA OTHER|75.45||||||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Managed Medicaid|MEDICAID UNITED HEALTHCARE|75.45||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Managed Medicaid|MEDICAID SUPERIOR|75.45||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Managed Medicaid|MEDICAID AMERIGROUP|75.45||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Managed Medicare|BCBS MEDICARE PPO MA|75.45||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Managed Medicare|MA PART B ONLY IP|75.45||||||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Managed Medicare|HEALTHSPRING MA|75.45||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Managed Medicare|OTHER INSTITUTIONS|||||75.45||| 74176|EAP|0350|CT ABD AND PELVIS, WO CON|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|75.45||||75.45||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Managed Medicaid|MEDICAID SUPERIOR|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Managed Medicaid|MEDICAID AMERIGROUP|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Managed Medicare|BCBS MEDICARE PPO MA|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Managed Medicare|MA PART B ONLY IP|9,856.50||||||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Managed Medicare|HEALTHSPRING MA|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Cigna|CIGNA OTHER|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Cigna|CIGNA|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Humana Medicare Advantage|HUMANA MA|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Blue Cross PPO Specialty|BCBSTX OTHER|||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Blue Cross PPO Specialty|BCBSTX PPO|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|ChampVA|CHAMPVA CENTER|||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Access Direct Platinum|HEALTHFIRST TPA UMR|||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Aenta Medicare Advantage|AETNA MEDICARE MA|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Aetna|AETNA OTHER|||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Aetna|AETNA PPO|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|United Medicare Advantage|UHC MEDICARE GOLD MA|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|United Medicare Advantage|UHC AARP MCR HMO MA|||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|United Healthcare|GOLDEN RULE|||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Aetna|BOON CHAPMAN|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Blue Cross HMO Specialty|BCBSTX HMO|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|United Healthcare|TML GROUP BENEFITS|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|United Healthcare|ZZZZZ UNITED HEALTHCARE|||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|United Healthcare|UNITED HEALTHCARE OTHER|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|United Healthcare|UNITED HEALTHCARE|||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|United Healthcare|GEHA|||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|United Healthcare|UNITED HEALTHCARE|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|United Healthcare|UMR UNITED MEDICAL RESOURCES|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Workers Compensation|WORKERS COMPENSATION OTHER|||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Veterans Affairs|VETERANS ADMINISTRATION|||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Managed Medicare|OTHER INSTITUTIONS|||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Veterans Affairs|VETERANS ADMINISTRATION|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|NON CONTRACTED|COMMERCIAL OTHER 2|||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Texas Workforce Commission|DIS DETER SERV (DDS)|||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|NON CONTRACTED|COMMERCIAL OTHER 1|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Medicare|MEDICARE PART B ONLY IP|9,856.50||||||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Medicare|MEDICARE ACUTE|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Tricare|TRICARE EAST REGION|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|PHCS|HUMANA|||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Medicaid|HENDERSON COUNTY INDIGENT|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Medicaid|MEDICAID HMO|||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Medicaid|MOLINA HEALTHCARE OF TEXAS|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Medicaid|MEDICAID|9,856.50||||9,856.50||| 74177|EAP|0350|CT ABD & PELVIS W/CONTRAS|Medicaid|LAW ENFORCEMENT OTHER|||||9,856.50||| 74178|EAP|0350|CT ABD & PELVIS W&WO CONT|Medicaid|MEDICAID|||||11,177.50||| 74178|EAP|0350|CT ABD & PELVIS W&WO CONT|NON CONTRACTED|COMMERCIAL OTHER 1|||||11,177.50||| 74178|EAP|0350|CT ABD & PELVIS W&WO CONT|Medicare|MEDICARE ACUTE|11,177.50||||11,177.50||| 74178|EAP|0350|CT ABD & PELVIS W&WO CONT|Veterans Affairs|VETERANS ADMINISTRATION|11,177.50||||||| 74178|EAP|0350|CT ABD & PELVIS W&WO CONT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|11,177.50||||11,177.50||| 74178|EAP|0350|CT ABD & PELVIS W&WO CONT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||11,177.50||| 74178|EAP|0350|CT ABD & PELVIS W&WO CONT|United Healthcare|UNITED HEALTHCARE|||||11,177.50||| 74178|EAP|0350|CT ABD & PELVIS W&WO CONT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||11,177.50||| 74178|EAP|0350|CT ABD & PELVIS W&WO CONT|United Healthcare|TML GROUP BENEFITS|11,177.50||||||| 74178|EAP|0350|CT ABD & PELVIS W&WO CONT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||11,177.50||| 74178|EAP|0350|CT ABD & PELVIS W&WO CONT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|11,177.50||||||| 74178|EAP|0350|CT ABD & PELVIS W&WO CONT|Aenta Medicare Advantage|AETNA MEDICARE MA|||||11,177.50||| 74178|EAP|0350|CT ABD & PELVIS W&WO CONT|Aetna|AETNA PPO|||||11,177.50||| 74178|EAP|0350|CT ABD & PELVIS W&WO CONT|Blue Cross HMO Specialty|BCBSTX HMO|||||11,177.50||| 74178|EAP|0350|CT ABD & PELVIS W&WO CONT|Blue Cross PPO Specialty|BCBSTX PPO|11,177.50||||11,177.50||| 74178|EAP|0350|CT ABD & PELVIS W&WO CONT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||11,177.50||| 74178|EAP|0350|CT ABD & PELVIS W&WO CONT|Humana Medicare Advantage|HUMANA MA|11,177.50||||11,177.50||| 74178|EAP|0350|CT ABD & PELVIS W&WO CONT|Cigna|CIGNA|||||11,177.50||| 74178|EAP|0350|CT ABD & PELVIS W&WO CONT|Managed Medicare|HEALTHSPRING MA|||||11,177.50||| 74178|EAP|0350|CT ABD & PELVIS W&WO CONT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||11,177.50||| 74178|EAP|0350|CT ABD & PELVIS W&WO CONT|Managed Medicaid|MEDICAID SUPERIOR|||||11,177.50||| 74178|EAP|0350|CT ABD & PELVIS W&WO CONT|Managed Medicaid|MEDICAID AMERIGROUP|||||11,177.50||| 74178|EAP|0350|CT ABD & PELVIS W&WO CONT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||11,177.50||| 74181|EAP|0610|MRI ABD WO|Managed Medicaid|MEDICAID SUPERIOR|60.84||||60.84||| 74181|EAP|0610|MRI ABD WO|Cigna|CIGNA|||||60.84||| 74181|EAP|0610|MRI ABD WO|Humana Medicare Advantage|HUMANA MA|||||60.84||| 74181|EAP|0610|MRI ABD WO|Blue Cross HMO Specialty|BCBSTX HMO|60.84||||||| 74181|EAP|0610|MRI ABD WO|Blue Cross PPO Specialty|BCBSTX PPO|||||60.84||| 74181|EAP|0610|MRI ABD WO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||60.84||| 74181|EAP|0610|MRI ABD WO|United Healthcare|UNITED HEALTHCARE|||||60.84||| 74181|EAP|0610|MRI ABD WO|Veterans Affairs|VETERANS ADMINISTRATION|60.84||||||| 74181|EAP|0610|MRI ABD WO|Medicare|MEDICARE ACUTE|60.84||||60.84||| 74181|EAP|0610|MRI ABD WO|Managed Medicare|HEALTHSPRING MA|||||60.84||| 74181|EAP|0610|MRI ABD WO|Medicaid|MEDICAID|60.84||||||| 74182|EAP|0610|MRI ABD W|Medicaid|HENDERSON COUNTY INDIGENT|72.40||||72.40||| 74182|EAP|0610|MRI ABD W|Managed Medicare|HEALTHSPRING MA|72.40||||||| 74182|EAP|0610|MRI ABD W|Medicare|MEDICARE ACUTE|72.40||||||| 74182|EAP|0610|MRI ABD W|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|72.40||||||| 74182|EAP|0610|MRI ABD W|Aenta Medicare Advantage|AETNA MEDICARE MA|72.40||||||| 74182|EAP|0610|MRI ABD W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|72.40||||||| 74182|EAP|0610|MRI ABD W|Blue Cross PPO Specialty|BCBSTX PPO|72.40||||72.40||| 74182|EAP|0610|MRI ABD W|Cigna|CIGNA OTHER|72.40||||||| 74182|EAP|0610|MRI ABD W|Humana Medicare Advantage|HUMANA MA|72.40||||72.40||| 74182|EAP|0610|MRI ABD W|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|72.40||||||| 74182|EAP|0610|MRI ABD W|Managed Medicaid|MEDICAID AMERIGROUP|72.40||||||| 74183|EAP|0610|MRI ABD W/WO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|8,230.75||||8,230.75||| 74183|EAP|0610|MRI ABD W/WO|Humana Medicare Advantage|HUMANA MA|8,230.75||||8,230.75||| 74183|EAP|0610|MRI ABD W/WO|Blue Cross PPO Specialty|BCBSTX PPO|||||8,230.75||| 74183|EAP|0610|MRI ABD W/WO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|8,230.75||||8,230.75||| 74183|EAP|0610|MRI ABD W/WO|Cigna|CIGNA|||||8,230.75||| 74183|EAP|0610|MRI ABD W/WO|Blue Cross HMO Specialty|BCBSTX HMO|||||8,230.75||| 74183|EAP|0610|MRI ABD W/WO|Aenta Medicare Advantage|AETNA MEDICARE MA|8,230.75||||||| 74183|EAP|0610|MRI ABD W/WO|Aetna|AETNA PPO|||||8,230.75||| 74183|EAP|0610|MRI ABD W/WO|United Healthcare|UNITED HEALTHCARE|||||8,230.75||| 74183|EAP|0610|MRI ABD W/WO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||8,230.75||| 74183|EAP|0610|MRI ABD W/WO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||8,230.75||| 74183|EAP|0610|MRI ABD W/WO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||8,230.75||| 74183|EAP|0610|MRI ABD W/WO|Veterans Affairs|VETERANS ADMINISTRATION|||||8,230.75||| 74183|EAP|0610|MRI ABD W/WO|NON CONTRACTED|COMMERCIAL OTHER 1|||||8,230.75||| 74183|EAP|0610|MRI ABD W/WO|Medicare|MEDICARE ACUTE|8,230.75||||8,230.75||| 74183|EAP|0610|MRI ABD W/WO|Managed Medicare|HEALTHSPRING MA|||||8,230.75||| 742|DRG||UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC/MCC|Medicare|MEDICARE ACUTE|70,771.93|12570.04|12570.04|7462.345|||| 742|DRG||UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|33,428.80|8919.66|12570.04|7462.345|||| 742|DRG||UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|34,538.67|8599.14|12570.04|7462.345|||| 742|DRG||UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC/MCC|Managed Medicaid|MEDICAID SUPERIOR|32,790.45|7462.345|12570.04|7462.345|||| 74220|EAP|0320|ESOPHAGUS BARIUM SW|Managed Medicaid|MEDICAID SUPERIOR|5.54||||5.54||| 74220|EAP|0320|ESOPHAGUS BARIUM SW|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|5.54||||5.54||| 74220|EAP|0320|ESOPHAGUS BARIUM SW|Managed Medicare|BCBS MEDICARE PPO MA|5.54||||5.54||| 74220|EAP|0320|ESOPHAGUS BARIUM SW|Managed Medicare|OTHER INSTITUTIONS|||||5.54||| 74220|EAP|0320|ESOPHAGUS BARIUM SW|Humana Medicare Advantage|HUMANA MA|5.54||||5.54||| 74220|EAP|0320|ESOPHAGUS BARIUM SW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||5.54||| 74220|EAP|0320|ESOPHAGUS BARIUM SW|Blue Cross HMO Specialty|BCBSTX HMO|||||5.54||| 74220|EAP|0320|ESOPHAGUS BARIUM SW|Blue Cross PPO Specialty|BCBSTX PPO|5.54||||5.54||| 74220|EAP|0320|ESOPHAGUS BARIUM SW|Aenta Medicare Advantage|AETNA MEDICARE MA|||||5.54||| 74220|EAP|0320|ESOPHAGUS BARIUM SW|Veterans Affairs|VETERANS ADMINISTRATION|||||5.54||| 74220|EAP|0320|ESOPHAGUS BARIUM SW|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||5.54||| 74220|EAP|0320|ESOPHAGUS BARIUM SW|United Medicare Advantage|UHC AARP MCR HMO MA|5.54||||||| 74220|EAP|0320|ESOPHAGUS BARIUM SW|United Medicare Advantage|UHC MEDICARE GOLD MA|||||5.54||| 74220|EAP|0320|ESOPHAGUS BARIUM SW|United Healthcare|UNITED HEALTHCARE|5.54||||5.54||| 74220|EAP|0320|ESOPHAGUS BARIUM SW|United Healthcare|UNITED HEALTHCARE|||||5.54||| 74220|EAP|0320|ESOPHAGUS BARIUM SW|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||5.54||| 74220|EAP|0320|ESOPHAGUS BARIUM SW|United Medicare Advantage|AARP UHC WEST COMPLETE MA|5.54||||5.54||| 74220|EAP|0320|ESOPHAGUS BARIUM SW|Medicare|MEDICARE ACUTE|5.54||||5.54||| 74220|EAP|0320|ESOPHAGUS BARIUM SW|Tricare|TRICARE EAST REGION|||||5.54||| 74220|EAP|0320|ESOPHAGUS BARIUM SW|Medicaid|MEDICAID|5.54||||||| 74230|EAP|0320|MODIFIED BARIUM SWALLOW W|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|5.54||||5.54||| 74230|EAP|0320|MODIFIED BARIUM SWALLOW W|United Medicare Advantage|UHC MEDICARE GOLD MA|5.54||||5.54||| 74230|EAP|0320|MODIFIED BARIUM SWALLOW W|United Medicare Advantage|AARP UHC WEST COMPLETE MA|5.54||||5.54||| 74230|EAP|0320|MODIFIED BARIUM SWALLOW W|Veterans Affairs|VETERANS ADMINISTRATION|5.54||||5.54||| 74230|EAP|0320|MODIFIED BARIUM SWALLOW W|Aenta Medicare Advantage|AETNA MEDICARE MA|||||5.54||| 74230|EAP|0320|MODIFIED BARIUM SWALLOW W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||5.54||| 74230|EAP|0320|MODIFIED BARIUM SWALLOW W|Humana Medicare Advantage|HUMANA MA|5.54||||5.54||| 74230|EAP|0320|MODIFIED BARIUM SWALLOW W|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|5.54||||5.54||| 74230|EAP|0320|MODIFIED BARIUM SWALLOW W|Managed Medicare|HEALTHSPRING MA|5.54||||||| 74230|EAP|0320|MODIFIED BARIUM SWALLOW W|Managed Medicare|BCBS MEDICARE PPO MA|||||5.54||| 74230|EAP|0320|MODIFIED BARIUM SWALLOW W|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.54||||5.54||| 74230|EAP|0320|MODIFIED BARIUM SWALLOW W|Medicaid|MOLINA HEALTHCARE OF TEXAS|5.54||||||| 74230|EAP|0320|MODIFIED BARIUM SWALLOW W|Medicaid|MEDICAID|5.54||||||| 74230|EAP|0320|MODIFIED BARIUM SWALLOW W|Medicare|MEDICARE ACUTE|5.54||||5.54||| 74230|EAP|0320|MODIFIED BARIUM SWALLOW W|NON CONTRACTED|COMMERCIAL OTHER 1|||||5.54||| 74240|EAP|0320|UGI AND SM BOWEL FOLLOW T|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,224.25||| 74240|EAP|0320|UGI AND SM BOWEL FOLLOW T|Blue Cross PPO Specialty|BCBSTX PPO|||||1,224.25||| 74240|EAP|0521|X-RAY XM UPR GI TRC 1CNTR|United Healthcare|UNITED HEALTHCARE|||||4.92||| 74240|EAP|0521|X-RAY XM UPR GI TRC 1CNTR|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.92||| 74240|EAP|0320|UGI AND SM BOWEL FOLLOW T|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,224.25||| 74240|EAP|0521|X-RAY XM UPR GI TRC 1CNTR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.92||| 74240|EAP|0521|X-RAY XM UPR GI TRC 1CNTR|Medicaid|MEDICAID|||||4.92||| 74240|EAP|0320|UGI AND SM BOWEL FOLLOW T|Managed Medicare|HEALTHSPRING MA|||||1,224.25||| 74240|EAP|0521|X-RAY XM UPR GI TRC 1CNTR|Managed Medicaid|MEDICAID SUPERIOR|||||4.92||| 74240|EAP|0320|UGI AND SM BOWEL FOLLOW T|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,224.25||| 74240|EAP|0320|UGI AND SM BOWEL FOLLOW T|Humana Medicare Advantage|HUMANA MA|||||1,224.25||| 74240|EAP|0521|X-RAY XM UPR GI TRC 1CNTR|Medicare|MEDICARE ACUTE|||||4.92||| 74240|EAP|0320|UGI AND SM BOWEL FOLLOW T|Medicare|MEDICARE ACUTE|||||1,224.25||| 74240|EAP|0521|X-RAY XM UPR GI TRC 1CNTR|Humana Medicare Advantage|HUMANA MA|||||4.92||| 74245|EAP|0320||United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1,224.25||| 74245|EAP|0320||Managed Medicaid|MEDICAID SUPERIOR|||||1,224.25||| 74245|EAP|0320||Medicare|MEDICARE ACUTE|1,224.25||||||| 74245|EAP|0320||Access Direct Platinum|HEALTHFIRST TPA UMR|||||1,224.25||| 74245|EAP|0320||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,224.25||| 74246|EAP|0320|X-RAY XM UPR GI TRC 2CNTR|Medicaid|MEDICAID|||||4.92||| 74246|EAP|0320|UPPER GI SERIES|Blue Cross PPO Specialty|BCBSTX PPO|||||10.67||| 74246|EAP|0320|UPPER GI SERIES|Managed Medicare|HEALTHSPRING MA|10.67||||||| 74246|EAP|0320|X-RAY XM UPR GI TRC 2CNTR|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.92||| 74246|EAP|0320|X-RAY XM UPR GI TRC 2CNTR|Managed Medicaid|MEDICAID SUPERIOR|4.92||||4.92||| 74246|EAP|0320|UPPER GI SERIES|Managed Medicaid|MEDICAID AMERIGROUP|4.92||||10.67||| 74246|EAP|0320|X-RAY XM UPR GI TRC 2CNTR|United Healthcare|UNITED HEALTHCARE OTHER|||||4.92||| 74246|EAP|0320|X-RAY XM UPR GI TRC 2CNTR|Humana Medicare Advantage|HUMANA MA|4.92||||4.92||| 74246|EAP|0320|X-RAY XM UPR GI TRC 2CNTR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.92||| 74246|EAP|0320|UPPER GI SERIES|NON CONTRACTED|COMMERCIAL OTHER 1|||||10.67||| 74246|EAP|0320|UPPER GI SERIES|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||10.67||| 74246|EAP|0320|X-RAY XM UPR GI TRC 2CNTR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.92||| 74246|EAP|0320|X-RAY XM UPR GI TRC 2CNTR|Cigna|CIGNA|||||4.92||| 74246|EAP|0320|UPPER GI SERIES|Humana Medicare Advantage|HUMANA MA|10.67||||10.67||| 74246|EAP|0320|UPPER GI SERIES|Blue Cross HMO Specialty|BCBSTX HMO|||||10.67||| 74246|EAP|0320|UPPER GI SERIES|United Healthcare|UNITED HEALTHCARE|||||10.67||| 74246|EAP|0320|X-RAY XM UPR GI TRC 2CNTR|Medicare|MEDICARE ACUTE|4.92||||4.92||| 74246|EAP|0320|X-RAY XM UPR GI TRC 2CNTR|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.92||| 74246|EAP|0320|UPPER GI SERIES|Cigna|CIGNA|||||10.67||| 74246|EAP|0320|X-RAY XM UPR GI TRC 2CNTR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.92||| 74246|EAP|0320|X-RAY XM UPR GI TRC 2CNTR|Blue Cross HMO Specialty|BCBSTX HMO|||||4.92||| 74246|EAP|0320|UPPER GI SERIES|Tricare|TRICARE EAST REGION|||||10.67||| 74246|EAP|0320|UPPER GI SERIES|Aetna|AETNA PPO|||||10.67||| 74246|EAP|0320|UPPER GI SERIES|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||10.67||| 74246|EAP|0320|UPPER GI SERIES|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||10.67||| 74246|EAP|0320|X-RAY XM UPR GI TRC 2CNTR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.92||| 74246|EAP|0320|X-RAY XM UPR GI TRC 2CNTR|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4.92||| 74246|EAP|0320|X-RAY XM UPR GI TRC 2CNTR|Blue Cross PPO Specialty|BCBSTX PPO|||||4.92||| 74246|EAP|0320|UPPER GI SERIES|United Medicare Advantage|UHC MEDICARE GOLD MA|||||10.67||| 74246|EAP|0320|X-RAY XM UPR GI TRC 2CNTR|Managed Medicaid|MEDICAID AMERIGROUP|4.92||||4.92||| 74246|EAP|0320|UPPER GI SERIES|Medicare|MEDICARE ACUTE|10.67||||10.67||| 74246|EAP|0320|UPPER GI SERIES|United Healthcare|UNITED HEALTHCARE|10.67||||||| 74247|EAP|0320|UPPER GI SERIES W/KUB|Medicare|MEDICARE ACUTE|||||11.92||| 74248|EAP|0320|X-RAY SM INT F-THRU STD|Managed Medicaid|MEDICAID AMERIGROUP|2.50||||||| 74248|EAP|0320|X-RAY SM INT F-THRU STD|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.50||| 74248|EAP|0320|X-RAY SM INT F-THRU STD|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.50||| 74248|EAP|0320|X-RAY SM INT F-THRU STD|Humana Medicare Advantage|HUMANA MA|2.50||||2.50||| 74248|EAP|0320|X-RAY SM INT F-THRU STD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.50||| 74248|EAP|0320|X-RAY SM INT F-THRU STD|Medicare|MEDICARE ACUTE|2.50||||2.50||| 74248|EAP|0320|X-RAY SM INT F-THRU STD|Blue Cross PPO Specialty|BCBSTX PPO|||||2.50||| 74248|EAP|0320|X-RAY SM INT F-THRU STD|Managed Medicare|HEALTHSPRING MA|||||2.50||| 74248|EAP|0320|X-RAY SM INT F-THRU STD|Medicaid|MEDICAID|||||2.50||| 74248|EAP|0320|X-RAY SM INT F-THRU STD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.50||| 74248|EAP|0320|X-RAY SM INT F-THRU STD|Blue Cross HMO Specialty|BCBSTX HMO|||||2.50||| 74248|EAP|0320|X-RAY SM INT F-THRU STD|Veterans Affairs|VETERANS ADMINISTRATION|2.50||||||| 74249|EAP|0320|UGI AND SMALL BOWEL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1,224.25||| 74249|EAP|0320|UGI AND SMALL BOWEL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,224.25||||||| 74249|EAP|0320|UGI AND SMALL BOWEL|Blue Cross PPO Specialty|BCBSTX PPO|||||1,224.25||| 74249|EAP|0320|UGI AND SMALL BOWEL|Medicare|MEDICARE ACUTE|1,224.25||||||| 74250|EAP|0320|SMALL BOWEL|Managed Medicare|HEALTHSPRING MA|900.50||||||| 74250|EAP|0320|SMALL BOWEL|Humana Medicare Advantage|HUMANA MA|900.50||||||| 74250|EAP|0320|SMALL BOWEL|Medicaid|MEDICAID|900.50||||||| 74250|EAP|0320|SMALL BOWEL|United Healthcare|UNITED HEALTHCARE|||||900.50||| 74250|EAP|0320|SMALL BOWEL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|900.50||||900.50||| 74250|EAP|0320|SMALL BOWEL|Blue Cross PPO Specialty|BCBSTX PPO|900.50||||||| 74250|EAP|0320|SMALL BOWEL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|900.50||||||| 74250|EAP|0320|SMALL BOWEL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|900.50||||900.50||| 74250|EAP|0320|SMALL BOWEL|Medicare|MEDICARE ACUTE|900.50||||900.50||| 74250|EAP|0320|SMALL BOWEL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|900.50||||||| 74250|EAP|0320|SMALL BOWEL|NON CONTRACTED|COMMERCIAL OTHER 1|900.50||||||| 74280|EAP|0320|COLON W/AIR CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|||||10.96||| 74280|EAP|0320|COLON W/AIR CONTRAST|Humana Medicare Advantage|HUMANA MA|||||10.96||| 74280|EAP|0320|COLON W/AIR CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|||||10.96||| 74280|EAP|0320|COLON W/AIR CONTRAST|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||10.96||| 74280|EAP|0320|COLON W/AIR CONTRAST|Medicare|MEDICARE ACUTE|10.96||||10.96||| 74280|EAP|0320|COLON W/AIR CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||10.96||| 743|DRG||UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|29,960.80|5805.58|23300.09|4756.92|||| 743|DRG||UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|23,563.10|6105.84|23300.09|4756.92|||| 743|DRG||UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC|Blue Cross HMO Specialty|BCBSTX HMO|27,014.80|4756.92|23300.09|4756.92|||| 743|DRG||UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC|United Healthcare|UNITED HEALTHCARE|26,042.55|11474.66|23300.09|4756.92|||| 743|DRG||UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC|NON CONTRACTED|COMMERCIAL OTHER 1|32,938.15|18939.44|23300.09|4756.92|||| 743|DRG||UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|26,729.85|5596.97|23300.09|4756.92|||| 743|DRG||UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC|Texas Workforce Commission|DIS DETER SERV (DDS)|38,639.85|11591.95|23300.09|4756.92|||| 743|DRG||UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC|Medicare|MEDICARE ACUTE|26,723.80|9363.92|23300.09|4756.92|||| 743|DRG||UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|45,219.60|9363.92|23300.09|4756.92|||| 743|DRG||UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC|Access Direct Platinum|HEALTHFIRST TPA UMR|21,790.55|9544.63|23300.09|4756.92|||| 743|DRG||UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC|Managed Medicaid|MEDICAID AMERIGROUP|27,037.90|6105.84|23300.09|4756.92|||| 743|DRG||UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC|Aetna|AETNA PPO|40,521.90|23300.09|23300.09|4756.92|||| 74300|EAP|0320|CHOLANGIOGRAM OPER|Medicare|MEDICARE ACUTE|8.57||||8.57||| 74300|EAP|0320|CHOLANGIOGRAM OPER|Humana Medicare Advantage|HUMANA MA|8.57||||||| 74300|EAP|0320|CHOLANGIOGRAM OPER|Blue Cross PPO Specialty|BCBSTX PPO|8.57||||8.57||| 74300|EAP|0320|CHOLANGIOGRAM OPER|United Healthcare|TML GROUP BENEFITS|||||8.57||| 74300|EAP|0320|CHOLANGIOGRAM OPER|United Medicare Advantage|AARP UHC WEST COMPLETE MA|8.57||||||| 74300|EAP|0320|CHOLANGIOGRAM OPER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|8.57||||||| 74300|EAP|0320|CHOLANGIOGRAM OPER|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|8.57||||||| 74300|EAP|0320|CHOLANGIOGRAM OPER|Managed Medicaid|MEDICAID SUPERIOR|||||8.57||| 74300|EAP|0320|CHOLANGIOGRAM OPER|Aenta Medicare Advantage|AETNA MEDICARE MA|8.57||||||| 74328|EAP|0320|ERCP BILIARY DUCTAL SYSTE|Managed Medicaid|MEDICAID AMERIGROUP|11.17||||||| 74328|EAP|0320|ERCP BILIARY DUCTAL SYSTE|Humana Medicare Advantage|HUMANA MA|11.17||||||| 74328|EAP|0320|ERCP BILIARY DUCTAL SYSTE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|11.17||||||| 74328|EAP|0320|ERCP BILIARY DUCTAL SYSTE|United Medicare Advantage|UHC MEDICARE GOLD MA|11.17||||||| 74328|EAP|0320|ERCP BILIARY DUCTAL SYSTE|Veterans Affairs|VETERANS ADMINISTRATION|11.17||||||| 74328|EAP|0320|ERCP BILIARY DUCTAL SYSTE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|11.17||||||| 74328|EAP|0320|ERCP BILIARY DUCTAL SYSTE|Medicare|MEDICARE ACUTE|11.17||||11.17||| 74328|EAP|0320|ERCP BILIARY DUCTAL SYSTE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|11.17||||||| 74328|EAP|0320|ERCP BILIARY DUCTAL SYSTE|Blue Cross PPO Specialty|BCBSTX PPO|11.17||||||| 74328|EAP|0320|ERCP BILIARY DUCTAL SYSTE|Aenta Medicare Advantage|AETNA MEDICARE MA|11.17||||||| 74328|EAP|0320|ERCP BILIARY DUCTAL SYSTE|Medicaid|HENDERSON COUNTY INDIGENT|||||11.17||| 74330|EAP|0320|ERCP COMBINED BILIARY/PAC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|11.17||||||| 74330|EAP|0320|ERCP COMBINED BILIARY/PAC|Blue Cross PPO Specialty|BCBSTX PPO|11.17||||||| 74330|EAP|0320|ERCP COMBINED BILIARY/PAC|United Medicare Advantage|UHC MEDICARE GOLD MA|11.17||||||| 74330|EAP|0320|ERCP COMBINED BILIARY/PAC|Humana Medicare Advantage|HUMANA MA|11.17||||||| 74330|EAP|0320|ERCP COMBINED BILIARY/PAC|Medicare|MEDICARE ACUTE|11.17||||||| 744|DRG||D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION W CC/MCC|Medicare|MEDICARE ACUTE|60,682.25|13098.48|13098.48|13098.48|||| 74400|EAP|0320|IVP|Medicare|MEDICARE ACUTE|804.50||||804.50||| 74400|EAP|0320|IVP|Managed Medicaid|MEDICAID SUPERIOR|||||804.50||| 74400|EAP|0320|IVP|Humana Medicare Advantage|HUMANA MA|||||804.50||| 74400|EAP|0320|IVP|Blue Cross PPO Specialty|BCBSTX PPO|||||804.50||| 74400|EAP|0320|IVP|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||804.50||| 74400|EAP|0320|IVP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||804.50||| 74420|EAP|0320|PYELOGRAM RETRO|Blue Cross HMO Specialty|BCBSTX HMO|||||869.50||| 74420|EAP|0320|PYELOGRAM RETRO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||869.50||| 74420|EAP|0320|PYELOGRAM RETRO|United Healthcare|TML GROUP BENEFITS|||||869.50||| 74420|EAP|0320|PYELOGRAM RETRO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|869.50||||||| 74420|EAP|0320|PYELOGRAM RETRO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|869.50||||||| 74420|EAP|0320|PYELOGRAM RETRO|Medicare|MEDICARE ACUTE|869.50||||869.50||| 74420|EAP|0320|PYELOGRAM RETRO|NON CONTRACTED|COMMERCIAL OTHER 1|||||869.50||| 74420|EAP|0320|PYELOGRAM RETRO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||869.50||| 74420|EAP|0320|PYELOGRAM RETRO|Blue Cross PPO Specialty|BCBSTX PPO|869.50||||869.50||| 74420|EAP|0320|PYELOGRAM RETRO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||869.50||| 74420|EAP|0320|PYELOGRAM RETRO|Cigna|CIGNA|||||869.50||| 74420|EAP|0320|PYELOGRAM RETRO|Managed Medicaid|MEDICAID SUPERIOR|||||869.50||| 74420|EAP|0320|PYELOGRAM RETRO|Managed Medicare|BCBS MEDICARE PPO MA|869.50||||869.50||| 74420|EAP|0320|PYELOGRAM RETRO|Humana Medicare Advantage|HUMANA MA|869.50||||869.50||| 74420|EAP|0320|PYELOGRAM RETRO|United Medicare Advantage|UHC MEDICARE GOLD MA|869.50||||869.50||| 74420|EAP|0320|PYELOGRAM RETRO|United Healthcare|UNITED HEALTHCARE|||||869.50||| 74420|EAP|0320|PYELOGRAM RETRO|Managed Medicaid|MEDICAID AMERIGROUP|||||869.50||| 74430|EAP|0320|CYSTOGRAM 4 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|810.50||||||| 74430|EAP|0320|CYSTOGRAM 4 VIEWS|Managed Medicare|BCBS MEDICARE PPO MA|||||810.50||| 74430|EAP|0320|CYSTOGRAM 4 VIEWS|Aetna|AETNA PPO|||||810.50||| 74430|EAP|0320|CYSTOGRAM 4 VIEWS|Medicare|MEDICARE ACUTE|810.50||||810.50||| 74430|EAP|0320|CYSTOGRAM 4 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||810.50||| 74430|EAP|0320|CYSTOGRAM 4 VIEWS|United Medicare Advantage|UHC AARP MCR HMO MA|||||810.50||| 74430|EAP|0320|CYSTOGRAM 4 VIEWS|United Healthcare|UNITED HEALTHCARE|||||810.50||| 74430|EAP|0320|CYSTOGRAM 4 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|810.50||||||| 74430|EAP|0320|CYSTOGRAM 4 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||810.50||| 74450|EAP|0320|URETHROGRAM|Medicare|MEDICARE ACUTE|||||504.50||| 74455|EAP|0320|CYSTOGRAM W/VOIDING|Medicare|MEDICARE ACUTE|||||768.50||| 74455|EAP|0320|CYSTOGRAM W/VOIDING|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||768.50||| 74455|EAP|0320|CYSTOGRAM W/VOIDING|Blue Cross PPO Specialty|BCBSTX PPO|||||768.50||| 745|DRG||D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|28,154.30|5365.18|5365.18|5365.18|||| 746|DRG||VAGINA, CERVIX & VULVA PROCEDURES W CC/MCC|Humana Medicare Advantage|HUMANA MA|31,833.50|12407.72|12407.72|12407.72|||| 747|DRG||VAGINA, CERVIX & VULVA PROCEDURES W/O CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|31,858.38|4829.17|4829.17|4829.17|||| 74740|EAP|0320|SALPINGOGRAM|Blue Cross PPO Specialty|BCBSTX PPO|||||696.25||| 748|DRG||FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES|Aenta Medicare Advantage|AETNA MEDICARE MA|38,842.80|10456.53|10456.53|64.92|||| 748|DRG||FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES|Tricare|TRICARE EAST REGION|35,472.05|9331.86|10456.53|64.92|||| 748|DRG||FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES|Medicare|MEDICARE ACUTE|29,757.35|10292.08|10456.53|64.92|||| 748|DRG||FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|38,800.15|10373.865|10456.53|64.92|||| 748|DRG||FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES|Humana Medicare Advantage|HUMANA MA|33,340.35|10456.53|10456.53|64.92|||| 748|DRG||FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES|Blue Cross PPO Specialty|BCBSTX PPO|33,958.43|64.92|10456.53|64.92|||| 75563|EAP|0610|MRI CARDIAC MORPHOLOGY W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||6,266.50||| 75574|EAP|0350|CCT HEART WO CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4,102.75||| 75574|EAP|0350|CCT HEART WO CONTRAST|Medicare|MEDICARE ACUTE|4,102.75||||4,102.75||| 75574|EAP|0350|CCT HEART WO CONTRAST|Managed Medicare|VAN ZANDT COUNTY INMATE|4,102.75||||||| 75574|EAP|0350|CCT HEART WO CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4,102.75||| 75574|EAP|0350|CCT HEART WO CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4,102.75||| 75574|EAP|0350|CCT HEART WO CONTRAST|MTC Medical|VAN ZANDT COUNTY INMATE|4,102.75||||||| 75574|EAP|0350|CCT HEART WO CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|||||4,102.75||| 75574|EAP|0350|CCT HEART WO CONTRAST|Humana Medicare Advantage|HUMANA MA|||||4,102.75||| 75574|EAP|0350|CCT HEART WO CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4,102.75||| 75574|EAP|0350|CCT HEART WO CONTRAST|Aetna|AETNA PPO|||||4,102.75||| 75574|EAP|0350|CCT HEART WO CONTRAST|Aetna|AETNA OTHER|||||4,102.75||| 75574|EAP|0350|CCT HEART WO CONTRAST|Managed Medicare|HEALTHSPRING MA|||||4,102.75||| 75635|EAP|0350|CTA AORTO ILIOFEMORAL RUN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|7,628.25||||||| 75635|EAP|0350|CTA AORTO ILIOFEMORAL RUN|Blue Cross PPO Specialty|BCBSTX PPO|||||7,628.25||| 75635|EAP|0350|CTA AORTO ILIOFEMORAL RUN|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||7,628.25||| 75635|EAP|0350|CTA AORTO ILIOFEMORAL RUN|Managed Medicare|HEALTHSPRING MA|||||7,628.25||| 75635|EAP|0350|CTA AORTO ILIOFEMORAL RUN|Humana Medicare Advantage|HUMANA MA|7,628.25||||7,628.25||| 75635|EAP|0350|CTA AORTO ILIOFEMORAL RUN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||7,628.25||| 75635|EAP|0350|CTA AORTO ILIOFEMORAL RUN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||7,628.25||| 75635|EAP|0350|CTA AORTO ILIOFEMORAL RUN|Cigna|CIGNA|||||7,628.25||| 75635|EAP|0350|CTA AORTO ILIOFEMORAL RUN|Managed Medicaid|MEDICAID SUPERIOR|7,628.25||||7,628.25||| 75635|EAP|0350|CTA AORTO ILIOFEMORAL RUN|Aenta Medicare Advantage|AETNA MEDICARE MA|||||7,628.25||| 75635|EAP|0350|CTA AORTO ILIOFEMORAL RUN|Managed Medicare|BCBS MEDICARE PPO MA|7,628.25||||||| 75635|EAP|0350|CTA AORTO ILIOFEMORAL RUN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||7,628.25||| 75635|EAP|0350|CTA AORTO ILIOFEMORAL RUN|United Healthcare|TML GROUP BENEFITS|||||7,628.25||| 75635|EAP|0350|CTA AORTO ILIOFEMORAL RUN|United Medicare Advantage|UHC MEDICARE GOLD MA|7,628.25||||||| 75635|EAP|0350|CTA AORTO ILIOFEMORAL RUN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||7,628.25||| 75635|EAP|0350|CTA AORTO ILIOFEMORAL RUN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|7,628.25||||7,628.25||| 75635|EAP|0350|CTA AORTO ILIOFEMORAL RUN|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||7,628.25||| 75635|EAP|0350|CTA AORTO ILIOFEMORAL RUN|Medicare|MEDICARE ACUTE|7,628.25||||7,628.25||| 75635|EAP|0350|CTA AORTO ILIOFEMORAL RUN|Tricare|TRICARE EAST REGION|||||7,628.25||| 759|DRG||INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W/O CC/MCC|Managed Medicaid|MEDICAID SUPERIOR|285.72|4173.56|5100.53|3565.58|||| 759|DRG||INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W/O CC/MCC|Managed Medicaid|MEDICAID AMERIGROUP|35,912.65|5100.53|5100.53|3565.58|||| 759|DRG||INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|42,229.55|3565.58|5100.53|3565.58|||| 75989|EAP|0350|CT GUIDANCE PERCUTANEOUS|Tricare|TRICARE EAST REGION|94.24||||||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|Humana Medicare Advantage|HUMANA MA|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|ChampVA|CHAMPVA CENTER|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|758.25||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|Managed Medicare|BCBS MEDICARE PPO MA|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|Managed Medicare|HEALTHSPRING MA|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|758.25||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|United Healthcare|UNITED HEALTHCARE|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|Blue Cross HMO Specialty|BCBSTX HMO|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|United Healthcare|UNITED HEALTHCARE OTHER|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|Managed Medicaid|MEDICAID AMERIGROUP|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|Medicare|MEDICARE ACUTE|758.25||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|Aetna|AETNA PPO|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|Managed Medicaid|MEDICAID SUPERIOR|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|NON CONTRACTED|COMMERCIAL OTHER 1|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|Medicaid|MEDICAID|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|United Healthcare|TML GROUP BENEFITS|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|Veterans Affairs|VETERANS ADMINISTRATION|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|Tricare|TRICARE EAST REGION|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|Blue Cross PPO Specialty|BCBSTX PPO|||||758.25||| 76536|EAP|0402|SONOGRAM SOFT TISSUE|Cigna|CIGNA|||||758.25||| 76604|EAP|0402|US SOFT TISSUE CHEST|Medicare|MEDICARE ACUTE|||||4.50||| 76604|EAP|0402|US SOFT TISSUE CHEST|Managed Medicare|HEALTHSPRING MA|||||4.50||| 76604|EAP|0402|US SOFT TISSUE CHEST|Managed Medicaid|MEDICAID AMERIGROUP|||||4.50||| 76604|EAP|0402|US SOFT TISSUE CHEST|Humana Medicare Advantage|HUMANA MA|||||4.50||| 76604|EAP|0402|US SOFT TISSUE CHEST|United Healthcare|UNITED HEALTHCARE|||||4.50||| 76604|EAP|0402|US SOFT TISSUE CHEST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.50||| 76604|EAP|0402|US SOFT TISSUE CHEST|Aetna|AETNA PPO|||||4.50||| 76604|EAP|0402|US SOFT TISSUE CHEST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.50||| 76604|EAP|0402|US SOFT TISSUE CHEST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.50||| 76604|EAP|0402|US SOFT TISSUE CHEST|Blue Cross PPO Specialty|BCBSTX PPO|||||4.50||| 76641|EAP|0402|SONOGRAM BREAST|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|Tricare|TRICARE EAST REGION|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|PHCS|HUMANA|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|Medicare|MEDICARE ACUTE|1,002.25||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|PHCS|HUMANA INSURANCE|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|Access Direct Platinum|HEALTHFIRST TPA UMR|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|Aetna|AETNA OTHER|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|Blue Cross PPO Specialty|BCBSTX PPO|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|ChampVA|CHAMPVA CENTER|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|United Healthcare|UNITED HEALTHCARE|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1,002.25||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|Medicaid|HENDERSON COUNTY INDIGENT|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|Managed Medicaid|MEDICAID AMERIGROUP|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|Managed Medicare|OTHER INSTITUTIONS|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|Blue Cross HMO Specialty|BCBSTX HMO|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|Cigna|CIGNA|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|Humana Medicare Advantage|HUMANA MA|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|Medicaid|MEDICAID|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|Managed Medicare|HEALTHSPRING MA|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|Managed Medicare|BCBS MEDICARE PPO MA|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|United Healthcare|UNITED HEALTHCARE OTHER|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|Aetna|AETNA PPO|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|Managed Medicaid|MEDICAID SUPERIOR|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,002.25||| 76641|EAP|0402|SONOGRAM BREAST|Medicaid|MEDICAID HMO|||||1,002.25||| 76700|EAP|0402|SONOGRAM COMP ABD|Tricare|TRICARE EAST REGION|14.32||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Multiplan|NALC|||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|NON CONTRACTED|COMMERCIAL OTHER 1|||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Medicaid|HENDERSON COUNTY INDIGENT|14.32||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|United Healthcare|UNITED HEALTHCARE|14.32||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Workers Compensation|WORKERS COMPENSATION OTHER|||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Medicaid|MEDICAID TEXAS CHILDRENS|||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|United Medicare Advantage|AARP UHC WEST COMPLETE MA|14.32||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Medicare|MEDICARE ACUTE|14.32||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|United Medicare Advantage|UHC AARP MCR HMO MA|||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|United Healthcare|UNITED HEALTHCARE OTHER|14.32||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|14.32||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|United Medicare Advantage|UHC MEDICARE GOLD MA|14.32||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Cigna|CIGNA|||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Managed Medicare|BCBS MEDICARE PPO MA|||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|United Healthcare|TML GROUP BENEFITS|||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|United Healthcare|UMR UNITED MEDICAL RESOURCES|14.32||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Medicaid|MOLINA HEALTHCARE OF TEXAS|14.32||||||| 76700|EAP|0402|SONOGRAM COMP ABD|United Healthcare|UNITED HEALTHCARE|||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Managed Medicare|HEALTHSPRING MA|14.32||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|United Healthcare|GOLDEN RULE|||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|14.32||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Veterans Affairs|VETERANS ADMINISTRATION|||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Managed Medicaid|MEDICAID SUPERIOR|14.32||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Humana Medicare Advantage|HUMANA MA|14.32||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Medicaid|MEDICAID|14.32||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Blue Cross HMO Specialty|BCBSTX HMO|14.32||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Medicaid|MEDICAID HMO|||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|14.32||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Aenta Medicare Advantage|AETNA MEDICARE MA|14.32||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|14.32||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Access Direct Platinum|HEALTHFIRST TPA UMR|||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Aetna|AETNA PPO|||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|14.32||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Managed Medicaid|MEDICAID AMERIGROUP|14.32||||14.32||| 76700|EAP|0402|SONOGRAM COMP ABD|Blue Cross PPO Specialty|BCBSTX PPO|14.32||||14.32||| 76705|EAP|0402|SONOGRAM G B|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1,545.25||| 76705|EAP|0402|SONOGRAM ABD LIMITED|Blue Cross HMO Specialty|BCBSTX HMO|1,545.25||||10.14||| 76705|EAP|0402|SONOGRAM ABD LIMITED|Access Direct Platinum|HEALTHFIRST TPA UMR|||||10.14||| 76705|EAP|0402|SONOGRAM G B|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||1,545.25||| 76705|EAP|0402|SONOGRAM G B|Aetna|AETNA PPO|1,545.25||||10.14||| 76705|EAP|0402|SONOGRAM ABD LIMITED|Aenta Medicare Advantage|AETNA MEDICARE MA|10.14||||10.14||| 76705|EAP|0402|SONOGRAM G B|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1,545.25||| 76705|EAP|0402|SONOGRAM G B|Aenta Medicare Advantage|AETNA MEDICARE MA|1,545.25||||1,545.25||| 76705|EAP|0402|SONOGRAM ABD LIMITED|Managed Medicaid|MEDICAID AMERIGROUP|1,545.25||||10.14||| 76705|EAP|0402|SONOGRAM ABD LIMITED|Aetna|AETNA PPO|10.14||||10.14||| 76705|EAP|0402|SONOGRAM G B|Aetna|AETNA OTHER|||||1,545.25||| 76705|EAP|0402|SONOGRAM G B|Blue Cross PPO Specialty|BCBSTX PPO|1,545.25||||1,545.25||| 76705|EAP|0402|SONOGRAM G B|Blue Cross HMO Specialty|BCBSTX HMO|1,545.25||||1,545.25||| 76705|EAP|0402|SONOGRAM G B|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|1,545.25||||||| 76705|EAP|0402|SONOGRAM G B|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,545.25||||1,545.25||| 76705|EAP|0402|SONOGRAM G B|Managed Medicare|HEALTHSPRING MA|1,545.25||||10.14||| 76705|EAP|0402|SONOGRAM G B|Managed Medicaid|MEDICAID AMERIGROUP|1,545.25||||1,545.25||| 76705|EAP|0402|SONOGRAM ABD LIMITED|Managed Medicare|HEALTHSPRING MA|10.14||||10.14||| 76705|EAP|0402|SONOGRAM ABD LIMITED|Managed Medicaid|MEDICAID SUPERIOR|10.14||||10.14||| 76705|EAP|0402|SONOGRAM G B|Cigna|CIGNA|||||1,545.25||| 76705|EAP|0402|SONOGRAM G B|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1,545.25||||1,545.25||| 76705|EAP|0402|SONOGRAM ABD LIMITED|Cigna|CIGNA|||||10.14||| 76705|EAP|0402|SONOGRAM ABD LIMITED|Humana Medicare Advantage|HUMANA MA|10.14||||10.14||| 76705|EAP|0402|SONOGRAM ABD LIMITED|Managed Medicaid|MEDICAID UNITED HEALTHCARE|10.14||||10.14||| 76705|EAP|0402|SONOGRAM G B|Humana Medicare Advantage|HUMANA MA|1,545.25||||1,545.25||| 76705|EAP|0402|SONOGRAM ABD LIMITED|ChampVA|CHAMPVA CENTER|||||10.14||| 76705|EAP|0402|SONOGRAM ABD LIMITED|Blue Cross PPO Specialty|BCBSTX PPO|10.14||||10.14||| 76705|EAP|0402|SONOGRAM G B|Managed Medicaid|MEDICAID SUPERIOR|1,545.25||||1,545.25||| 76705|EAP|0402|SONOGRAM ABD LIMITED|United Healthcare|UNITED HEALTHCARE|||||10.14||| 76705|EAP|0402|SONOGRAM G B|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1,545.25||| 76705|EAP|0402|SONOGRAM ABD LIMITED|United Medicare Advantage|UHC MEDICARE GOLD MA|10.14||||10.14||| 76705|EAP|0402|SONOGRAM ABD LIMITED|United Medicare Advantage|AARP UHC WEST COMPLETE MA|10.14||||10.14||| 76705|EAP|0402|SONOGRAM G B|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1,545.25||||1,545.25||| 76705|EAP|0402|SONOGRAM G B|United Healthcare|TML GROUP BENEFITS|1,545.25||||10.14||| 76705|EAP|0402|SONOGRAM ABD LIMITED|United Healthcare|GOLDEN RULE|||||10.14||| 76705|EAP|0402|SONOGRAM ABD LIMITED|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|10.14||||10.14||| 76705|EAP|0402|SONOGRAM G B|United Healthcare|UNITED HEALTHCARE|||||1,545.25||| 76705|EAP|0402|SONOGRAM ABD LIMITED|Medicaid|MEDICAID|||||10.14||| 76705|EAP|0402|SONOGRAM ABD LIMITED|Veterans Affairs|VETERANS ADMINISTRATION|10.14||||10.14||| 76705|EAP|0402|SONOGRAM ABD LIMITED|Medicaid|HENDERSON COUNTY INDIGENT|1,545.25||||10.14||| 76705|EAP|0402|SONOGRAM ABD LIMITED|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|10.14||||10.14||| 76705|EAP|0402|SONOGRAM G B|Veterans Affairs|VETERANS ADMINISTRATION|1,545.25||||10.14||| 76705|EAP|0402|SONOGRAM G B|Tricare|TRICARE EAST REGION|1,545.25||||1,545.25||| 76705|EAP|0402|SONOGRAM ABD LIMITED|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||10.14||| 76705|EAP|0402|SONOGRAM ABD LIMITED|NON CONTRACTED|COMMERCIAL OTHER 1|||||10.14||| 76705|EAP|0402|SONOGRAM ABD LIMITED|Medicare|MEDICARE ACUTE|10.14||||10.14||| 76705|EAP|0402|SONOGRAM G B|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,545.25||| 76705|EAP|0402|SONOGRAM G B|Medicare|MEDICARE ACUTE|1,545.25||||1,545.25||| 76705|EAP|0402|SONOGRAM G B|Medicaid|MEDICAID|||||1,545.25||| 76705|EAP|0402|SONOGRAM ABD LIMITED|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|10.14||||10.14||| 76705|EAP|0402|SONOGRAM ABD LIMITED|Tricare|TRICARE EAST REGION|1,545.25||||10.14||| 76705|EAP|0402|SONOGRAM ABD LIMITED|United Healthcare|TML GROUP BENEFITS|10.14||||10.14||| 76705|EAP|0402|SONOGRAM G B|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,545.25||||1,545.25||| 76706|EAP|0402|AAA SCREENING ULTRASOUND|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||15.75||| 76706|EAP|0402|AAA SCREENING ULTRASOUND|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||15.75||| 76706|EAP|0402|AAA SCREENING ULTRASOUND|United Healthcare|UNITED HEALTHCARE|||||15.75||| 76706|EAP|0402|AAA SCREENING ULTRASOUND|United Medicare Advantage|UHC MEDICARE GOLD MA|||||15.75||| 76706|EAP|0402|AAA SCREENING ULTRASOUND|Managed Medicare|BCBS MEDICARE PPO MA|||||15.75||| 76706|EAP|0402|AAA SCREENING ULTRASOUND|Humana Medicare Advantage|HUMANA MA|||||15.75||| 76706|EAP|0402|AAA SCREENING ULTRASOUND|Blue Cross PPO Specialty|BCBSTX PPO|||||15.75||| 76706|EAP|0402|AAA SCREENING ULTRASOUND|Aenta Medicare Advantage|AETNA MEDICARE MA|||||15.75||| 76706|EAP|0402|AAA SCREENING ULTRASOUND|Managed Medicare|HEALTHSPRING MA|||||15.75||| 76706|EAP|0402|AAA SCREENING ULTRASOUND|Medicare|MEDICARE ACUTE|||||15.75||| 76706|EAP|0402|AAA SCREENING ULTRASOUND|Veterans Affairs|VETERANS ADMINISTRATION|||||15.75||| 76706|EAP|0402|AAA SCREENING ULTRASOUND|Aetna|AETNA PPO|||||15.75||| 76706|EAP|0402|AAA SCREENING ULTRASOUND|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||15.75||| 76706|EAP|0402|AAA SCREENING ULTRASOUND|United Medicare Advantage|UHC AARP MCR HMO MA|||||15.75||| 76770|EAP|0402|US RENAL VASCULAR|Managed Medicaid|MEDICAID SUPERIOR|1,390.50||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|Blue Cross PPO Specialty|BCBSTX PPO|1,390.50||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|Access Direct Platinum|HEALTHFIRST TPA UMR|||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|Aetna|AETNA OTHER|||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|Managed Medicare|BCBS MEDICARE PPO MA|1,390.50||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|ChampVA|CHAMPVA CENTER|||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,390.50||| 76770|EAP|0402|SONOGRAM ABD AORTA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,390.50||||830.50||| 76770|EAP|0402|US RENAL VASCULAR|Aetna|AETNA PPO|1,390.50||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|1,390.50||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|Aenta Medicare Advantage|AETNA MEDICARE MA|1,390.50||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|United Medicare Advantage|UHC AARP MCR HMO MA|1,390.50||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1,390.50||||1,390.50||| 76770|EAP|0402|SONOGRAM ABD AORTA|Humana Medicare Advantage|HUMANA MA|1,390.50||||830.50||| 76770|EAP|0402|US RENAL VASCULAR|Cigna|CIGNA|||||1,390.50||| 76770|EAP|0402|SONOGRAM ABD AORTA|Managed Medicare|HEALTHSPRING MA|1,390.50||||830.50||| 76770|EAP|0402|US RENAL VASCULAR|Humana Medicare Advantage|HUMANA MA|1,390.50||||1,390.50||| 76770|EAP|0402|SONOGRAM ABD AORTA|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1,390.50||||830.50||| 76770|EAP|0402|US RENAL VASCULAR|Cigna|CIGNA|1,390.50||||1,390.50||| 76770|EAP|0402|SONOGRAM ABD AORTA|United Healthcare|UNITED HEALTHCARE|||||830.50||| 76770|EAP|0402|US RENAL VASCULAR|Managed Medicare|HEALTHSPRING MA|1,390.50||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,390.50||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|Managed Medicaid|MEDICAID AMERIGROUP|||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|Blue Cross PPO Specialty|BCBSTX OTHER|||||1,390.50||| 76770|EAP|0402|SONOGRAM ABD AORTA|Blue Cross HMO Specialty|BCBSTX HMO|1,390.50||||830.50||| 76770|EAP|0402|SONOGRAM ABD AORTA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,390.50||||830.50||| 76770|EAP|0402|US RENAL VASCULAR|Veterans Affairs|VETERANS ADMINISTRATION|1,390.50||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|United Healthcare|UNITED HEALTHCARE|||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|Workers Compensation|WORKERS COMPENSATION OTHER|||||1,390.50||| 76770|EAP|0402|SONOGRAM ABD AORTA|Medicare|MEDICARE ACUTE|1,390.50||||830.50||| 76770|EAP|0402|US RENAL VASCULAR|Medicaid|MEDICAID|1,390.50||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|United Healthcare|UMR UNITED MEDICAL RESOURCES|1,390.50||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|United Healthcare|UNITED HEALTHCARE OTHER|||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1,390.50||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|Blue Cross HMO Specialty|BCBSTX HMO|1,390.50||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|Medicare|MEDICARE ACUTE|1,390.50||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,390.50||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|Medicaid|HENDERSON COUNTY INDIGENT|1,390.50||||1,390.50||| 76770|EAP|0402|SONOGRAM ABD AORTA|United Medicare Advantage|UHC MEDICARE GOLD MA|||||830.50||| 76770|EAP|0402|US RENAL VASCULAR|NON CONTRACTED|COMMERCIAL OTHER 1|1,390.50||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|Tricare|TRICARE EAST REGION|||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|Tricare|TRICARE FOR LIFE|||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|PHCS|HUMANA INSURANCE|||||1,390.50||| 76770|EAP|0402|US RENAL VASCULAR|Medicaid|MEDICAID TEXAS CHILDRENS|||||1,390.50||| 768|DRG||VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C|Medicaid|MEDICAID|30,679.64|2184.64|5676.23|34.65|||| 768|DRG||VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C|Managed Medicaid|MEDICAID SUPERIOR|19,841.51|3473.58|5676.23|34.65|||| 768|DRG||VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C|Managed Medicaid|MEDICAID AMERIGROUP|23,413.28|3148.98|5676.23|34.65|||| 768|DRG||VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C|Cigna|CIGNA|22,339.05|34.65|5676.23|34.65|||| 768|DRG||VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C|Medicaid|MEDICAID HMO|39,405.26|2184.64|5676.23|34.65|||| 768|DRG||VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C|Blue Cross PPO Specialty|BCBSTX PPO|28,597.47|5676.23|5676.23|34.65|||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|Aetna|AETNA PPO|||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|Blue Cross HMO Specialty|BCBSTX HMO|||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|Aetna|AETNA OTHER|||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|Brinson Benefits|THE HEALTH PLAN SMITH CO|||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|Managed Medicaid|MEDICAID SUPERIOR|||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|Blue Cross PPO Specialty|BCBSTX OTHER|||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|Medicare|MEDICARE ACUTE|||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|Blue Cross PPO Specialty|BCBSTX PPO|1,312.75||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|Cigna|CIGNA|||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|Medicaid|MEDICAID|1,312.75||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|MTC Medical|VAN ZANDT COUNTY INMATE|||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|United Healthcare|UNITED HEALTHCARE|1,312.75||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|United Healthcare|UNITED HEALTHCARE OTHER|||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|United Healthcare|UNITED HEALTHCARE|||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|Tricare|TRICARE EAST REGION|||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|Managed Medicare|VAN ZANDT COUNTY INMATE|||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|Managed Medicaid|MEDICAID AMERIGROUP|||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|Medicaid|MEDICAID HMO|||||1,312.75||| 76801|EAP|0402|US OB<14 WKS PG SINGLE FE|Medicaid Out of State|MEDICAID LOUISIANA|||||1,312.75||| 76802|EAP|0402|US OB<14 WKS PG ADDN FETU|Medicaid|MEDICAID|||||1,312.75||| 76802|EAP|0402|US OB<14 WKS PG ADDN FETU|Managed Medicaid|MEDICAID AMERIGROUP|1,312.75||||1,312.75||| 76802|EAP|0402|US OB<14 WKS PG ADDN FETU|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|ChampVA|CHAMPVA CENTER|||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|MTC Medical|VAN ZANDT COUNTY INMATE|||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|Blue Cross HMO Specialty|BCBSTX HMO|||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|Managed Medicaid|MEDICAID SUPERIOR|1,312.75||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|Blue Cross PPO Specialty|BCBSTX PPO|1,312.75||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|Managed Medicare|VAN ZANDT COUNTY INMATE|||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|Managed Medicaid|MEDICAID AMERIGROUP|1,312.75||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1,312.75||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|United Healthcare|UMR UNITED MEDICAL RESOURCES|1,312.75||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|Cigna|CIGNA|||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|United Healthcare|UNITED HEALTHCARE OTHER|||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|United Healthcare|UNITED HEALTHCARE|||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|United Healthcare|UNITED HEALTHCARE|1,312.75||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|Medicare|MEDICARE ACUTE|||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|Medicaid|MOLINA HEALTHCARE OF TEXAS|1,312.75||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|Tricare|TRICARE EAST REGION|||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|Medicaid|MEDICAID|1,312.75||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|Medicaid|MEDICAID HMO|1,312.75||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|Medicaid|HENDERSON COUNTY INDIGENT|||||1,312.75||| 76805|EAP|0402|US OB>14 WKS PG SINGLE FE|Aetna|AETNA PPO|||||1,312.75||| 76810|EAP|0402|US OB>14WKS PG ADD FETUS|Medicaid|MEDICAID HMO|||||1,312.75||| 76810|EAP|0402|US OB>14WKS PG ADD FETUS|Managed Medicaid|MEDICAID SUPERIOR|||||1,312.75||| 76810|EAP|0402|US OB>14WKS PG ADD FETUS|Medicaid|MEDICAID|1,312.75||||||| 76810|EAP|0402|US OB>14WKS PG ADD FETUS|Managed Medicaid|MEDICAID AMERIGROUP|1,312.75||||1,312.75||| 76810|EAP|0402|US OB>14WKS PG ADD FETUS|Blue Cross PPO Specialty|BCBSTX PPO|||||1,312.75||| 76810|EAP|0402|US OB>14WKS PG ADD FETUS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,312.75||| 76815|EAP|0402|SONOGRAM PLACENTAL|Managed Medicaid|MEDICAID SUPERIOR|1,035.25||||1,035.25||| 76816|EAP|0402|US OB FOLLOW UP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||652.50||| 76816|EAP|0402|US OB FOLLOW UP|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||652.50||| 76816|EAP|0402|US OB FOLLOW UP|Managed Medicaid|MEDICAID AMERIGROUP|652.50||||652.50||| 76817|EAP|0402|TRANSVAGINAL US OBSTETRIC|Managed Medicaid|MEDICAID SUPERIOR|||||3.03||| 76817|EAP|0402|TRANSVAGINAL US OBSTETRIC|Managed Medicaid|MEDICAID AMERIGROUP|||||3.03||| 76817|EAP|0402|TRANSVAGINAL US OBSTETRIC|Blue Cross PPO Specialty|BCBSTX PPO|||||3.03||| 76817|EAP|0402|TRANSVAGINAL US OBSTETRIC|United Healthcare|UNITED HEALTHCARE|||||3.03||| 76817|EAP|0402|TRANSVAGINAL US OBSTETRIC|Medicaid|MEDICAID|||||3.03||| 76818|EAP|0402|FETAL BIOPHYSICAL PROFILE|Medicaid|MEDICAID|496.50||||496.50||| 76818|EAP|0402|FETAL BIOPHYSICAL PROFILE|United Healthcare|UNITED HEALTHCARE|496.50||||||| 76818|EAP|0402|FETAL BIOPHYSICAL PROFILE|Aetna|AETNA PPO|||||496.50||| 76818|EAP|0402|FETAL BIOPHYSICAL PROFILE|Medicaid|MEDICAID HMO|496.50||||496.50||| 76818|EAP|0402|FETAL BIOPHYSICAL PROFILE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||496.50||| 76818|EAP|0402|FETAL BIOPHYSICAL PROFILE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||496.50||| 76818|EAP|0402|FETAL BIOPHYSICAL PROFILE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||496.50||| 76818|EAP|0402|FETAL BIOPHYSICAL PROFILE|ChampVA|CHAMPVA CENTER|||||496.50||| 76818|EAP|0402|FETAL BIOPHYSICAL PROFILE|Blue Cross PPO Specialty|BCBSTX PPO|496.50||||496.50||| 76818|EAP|0402|FETAL BIOPHYSICAL PROFILE|Tricare|TRICARE EAST REGION|||||496.50||| 76818|EAP|0402|FETAL BIOPHYSICAL PROFILE|Cigna|CIGNA|||||496.50||| 76818|EAP|0402|FETAL BIOPHYSICAL PROFILE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||496.50||| 76818|EAP|0402|FETAL BIOPHYSICAL PROFILE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||496.50||| 76818|EAP|0402|FETAL BIOPHYSICAL PROFILE|Managed Medicaid|MEDICAID SUPERIOR|496.50||||496.50||| 76818|EAP|0402|FETAL BIOPHYSICAL PROFILE|Managed Medicaid|MEDICAID AMERIGROUP|496.50||||496.50||| 76820|EAP|0402|US CORD DOPPLER|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.55||| 76820|EAP|0402|US CORD DOPPLER|Managed Medicaid|MEDICAID AMERIGROUP|1.55||||1.55||| 76820|EAP|0402|US CORD DOPPLER|Managed Medicaid|MEDICAID SUPERIOR|1.55||||1.55||| 76820|EAP|0402|US CORD DOPPLER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.55||| 76820|EAP|0402|US CORD DOPPLER|Medicaid|MEDICAID HMO|1.55||||1.55||| 76820|EAP|0402|US CORD DOPPLER|Tricare|TRICARE EAST REGION|||||1.55||| 76820|EAP|0402|US CORD DOPPLER|Blue Cross PPO Specialty|BCBSTX PPO|1.55||||1.55||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|United Medicare Advantage|UHC AARP MCR HMO MA|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|United Healthcare|UNITED HEALTHCARE|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|United Healthcare|UNITED HEALTHCARE OTHER|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Blue Cross HMO Specialty|BCBSTX HMO|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Tricare|TRICARE EAST REGION|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Medicare|MEDICARE ACUTE|14.15||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Aetna|AETNA PPO|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Access Direct Platinum|HEALTHFIRST TPA UMR|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|United Healthcare|GOLDEN RULE|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Medicaid|MEDICAID HMO|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Aetna|AETNA OTHER|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Aetna|BOON CHAPMAN|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Medicaid|MEDICAID|14.15||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Blue Cross PPO Specialty|BCBSTX PPO|14.15||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Cigna|CIGNA OTHER|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Humana Medicare Advantage|HUMANA MA|14.15||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|MTC Medical|VAN ZANDT COUNTY INMATE|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Cigna|CIGNA|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Managed Medicare|HEALTHSPRING MA|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Managed Medicaid|MEDICAID AMERIGROUP|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Managed Medicaid|MEDICAID SUPERIOR|14.15||||14.15||| 76830|EAP|0402|SONOGRAM TRANSVAGINAL|Managed Medicare|VAN ZANDT COUNTY INMATE|||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|14.15||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Managed Medicare|HEALTHSPRING MA|14.15||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Managed Medicaid|MEDICAID SUPERIOR|14.15||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Cigna|CIGNA|||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Cigna|CIGNA OTHER|||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Blue Cross PPO Specialty|BCBSTX PPO|14.15||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Blue Cross HMO Specialty|BCBSTX HMO|||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Humana Medicare Advantage|HUMANA MA|14.15||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Managed Medicaid|MEDICAID AMERIGROUP|14.15||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Aetna|AETNA PPO|||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Medicaid|MEDICAID HMO|||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Medicaid Out of State|MEDICAID LOUISIANA|||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|NON CONTRACTED|COMMERCIAL OTHER 1|||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|14.15||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Tricare|TRICARE EAST REGION|||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Medicare|MEDICARE ACUTE|14.15||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Medicaid|MEDICAID|14.15||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|Veterans Affairs|VETERANS ADMINISTRATION|||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|United Healthcare|GOLDEN RULE|||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|United Healthcare|UNITED HEALTHCARE|||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||14.15||| 76856|EAP|0402|SONOGRAM PELVIC MASS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||14.15||| 76870|EAP|0402|SONOGRAM TESTICULAR|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|NON CONTRACTED|COMMERCIAL OTHER 1|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|United Healthcare|UNITED HEALTHCARE|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|11.13||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Veterans Affairs|VETERANS ADMINISTRATION|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Tricare|TRICARE FOR LIFE|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Tricare|TRICARE EAST REGION|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Medicaid|HENDERSON COUNTY INDIGENT|11.13||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Medicaid|MEDICAID|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Access Direct Platinum|HEALTHFIRST TPA UMR|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Aetna|AETNA PPO|11.13||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Medicaid|MEDICAID TEXAS CHILDRENS|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Aetna|AETNA OTHER|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Workers Compensation|WORKERS COMPENSATION OTHER|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Medicare|MEDICARE ACUTE|11.13||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Blue Cross PPO Specialty|BCBSTX PPO|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Cigna|CIGNA|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Managed Medicare|HEALTHSPRING MA|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Blue Cross PPO Specialty|BCBSTX OTHER|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Managed Medicaid|MEDICAID SUPERIOR|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|United Healthcare|UNITED HEALTHCARE OTHER|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Blue Cross HMO Specialty|BCBSTX HMO|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Managed Medicaid|MEDICAID AMERIGROUP|||||11.13||| 76870|EAP|0402|SONOGRAM TESTICULAR|Humana Medicare Advantage|HUMANA MA|||||11.13||| 76881|EAP|0402|SONOGRAM EXTREMITY|Managed Medicaid|MEDICAID AMERIGROUP|||||6.52||| 76881|EAP|0402|SONOGRAM EXTREMITY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||6.52||| 76881|EAP|0402|SONOGRAM EXTREMITY|Managed Medicaid|MEDICAID SUPERIOR|||||6.52||| 76881|EAP|0402|SONOGRAM EXTREMITY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|6.52||||||| 76881|EAP|0402|SONOGRAM EXTREMITY|Managed Medicare|HEALTHSPRING MA|||||6.52||| 76881|EAP|0402|SONOGRAM EXTREMITY|Humana Medicare Advantage|HUMANA MA|||||6.52||| 76881|EAP|0402|SONOGRAM EXTREMITY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||6.52||| 76881|EAP|0402|SONOGRAM EXTREMITY|Blue Cross PPO Specialty|BCBSTX PPO|||||6.52||| 76881|EAP|0402|SONOGRAM EXTREMITY|Tricare|TRICARE EAST REGION|||||6.52||| 76881|EAP|0402|SONOGRAM EXTREMITY|Blue Cross HMO Specialty|BCBSTX HMO|||||6.52||| 76881|EAP|0402|SONOGRAM EXTREMITY|Aetna|AETNA PPO|||||6.52||| 76881|EAP|0402|SONOGRAM EXTREMITY|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|6.52||||||| 76881|EAP|0402|SONOGRAM EXTREMITY|Medicaid|MEDICAID|6.52||||||| 76881|EAP|0402|SONOGRAM EXTREMITY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|6.52||||6.52||| 76881|EAP|0402|SONOGRAM EXTREMITY|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||6.52||| 76881|EAP|0402|SONOGRAM EXTREMITY|Cigna|CIGNA|6.52||||||| 76881|EAP|0402|SONOGRAM EXTREMITY|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||6.52||| 76881|EAP|0402|SONOGRAM EXTREMITY|NON CONTRACTED|COMMERCIAL OTHER 1|||||6.52||| 76881|EAP|0402|SONOGRAM EXTREMITY|Workers Compensation|WORKERS COMPENSATION OTHER|||||6.52||| 76881|EAP|0402|SONOGRAM EXTREMITY|Medicare|MEDICARE ACUTE|6.52||||6.52||| 76881|EAP|0402|SONOGRAM EXTREMITY|Aenta Medicare Advantage|AETNA MEDICARE MA|6.52||||6.52||| 76881|EAP|0402|SONOGRAM EXTREMITY|United Healthcare|GOLDEN RULE|||||6.52||| 76881|EAP|0402|SONOGRAM EXTREMITY|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|6.52||||6.52||| 76881|EAP|0402|SONOGRAM EXTREMITY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||6.52||| 76881|EAP|0402|SONOGRAM EXTREMITY|United Healthcare|UNITED HEALTHCARE|||||6.52||| 769|DRG||POSTPARTUM & POST ABORTION DIAGNOSES W O.R. PROCEDURE|Managed Medicaid|MEDICAID SUPERIOR|53,602.15|13273.88|13273.88|13273.88|||| 76942|EAP|0402|SONOGRAM NEEDLE BIOPSY|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,041.50||| 76942|EAP|0402|SONOGRAM NEEDLE BIOPSY|Medicare|MEDICARE ACUTE|||||1,041.50||| 76942|EAP|0402|SONOGRAM NEEDLE BIOPSY|Aetna|AETNA PPO|||||1,041.50||| 76942|EAP|0402|SONOGRAM NEEDLE BIOPSY|Blue Cross HMO Specialty|BCBSTX HMO|||||1,041.50||| 76942|EAP|0402|SONOGRAM NEEDLE BIOPSY|Humana Medicare Advantage|HUMANA MA|||||1,041.50||| 76942|EAP|0402|SONOGRAM NEEDLE BIOPSY|Managed Medicaid|MEDICAID SUPERIOR|||||1,041.50||| 76942|EAP|0402|SONOGRAM NEEDLE BIOPSY|United Healthcare|UNITED HEALTHCARE|||||1,041.50||| 76942|EAP|0402|SONOGRAM NEEDLE BIOPSY|Blue Cross PPO Specialty|BCBSTX PPO|||||1,041.50||| 76999|EAP|0402|ULTRASOUND PELVIC LIMITED|Blue Cross HMO Specialty|BCBSTX HMO|||||758.25||| 76999|EAP|0402|ULTRASOUND PELVIC LIMITED|Medicare|MEDICARE ACUTE|||||758.25||| 76999|EAP|0402|ULTRASOUND PELVIC LIMITED|Managed Medicaid|MEDICAID SUPERIOR|758.25||||||| 77|DRG||HYPERTENSIVE ENCEPHALOPATHY W MCC|Medicare|MEDICARE ACUTE|55,625.13|6737.45|6737.45|6737.45|||| 770|DRG||ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY|Managed Medicaid|MEDICAID SUPERIOR|31,586.35|3933.09|3933.09|2651.395|||| 770|DRG||ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY|Medicaid|MEDICAID|29,381.25|2651.395|3933.09|2651.395|||| 77002|EAP|0320|NEEDLE LOCALIZATION BY XR|Managed Medicare|HEALTHSPRING MA|||||1,391.25||| 77002|EAP|0320|NEEDLE LOCALIZATION BY XR|Medicare|MEDICARE ACUTE|||||1,391.25||| 77002|EAP|0320|NEEDLE LOCALIZATION BY XR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,391.25||| 77002|EAP|0320|NEEDLE LOCALIZATION BY XR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,391.25||| 77065|EAP|0401|DIGITAL MAMMO UNILATERAL|Humana Medicare Advantage|HUMANA MA|||||450.75||| 77065|EAP|0401|DIGITAL MAMMO UNILATERAL|Cigna|CIGNA|||||450.75||| 77065|EAP|0401|DIGITAL MAMMO UNILATERAL|Managed Medicaid|MEDICAID AMERIGROUP|||||450.75||| 77065|EAP|0401|DIGITAL MAMMO UNILATERAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||450.75||| 77065|EAP|0401|DIGITAL MAMMO UNILATERAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||450.75||| 77065|EAP|0401|DIGITAL MAMMO UNILATERAL|Blue Cross PPO Specialty|BCBSTX PPO|||||450.75||| 77065|EAP|0401|DIGITAL MAMMO UNILATERAL|Managed Medicaid|MEDICAID SUPERIOR|||||450.75||| 77065|EAP|0401|DIGITAL MAMMO UNILATERAL|ChampVA|CHAMPVA CENTER|||||450.75||| 77065|EAP|0401|DIGITAL MAMMO UNILATERAL|Blue Cross HMO Specialty|BCBSTX HMO|||||450.75||| 77065|EAP|0401|DIGITAL MAMMO UNILATERAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||450.75||| 77065|EAP|0401|DIGITAL MAMMO UNILATERAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||450.75||| 77065|EAP|0401|DIGITAL MAMMO UNILATERAL|Managed Medicare|BCBS MEDICARE PPO MA|||||450.75||| 77065|EAP|0401|DIGITAL MAMMO UNILATERAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||450.75||| 77065|EAP|0401|DIGITAL MAMMO UNILATERAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||450.75||| 77065|EAP|0401|DIGITAL MAMMO UNILATERAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||450.75||| 77065|EAP|0401|DIGITAL MAMMO UNILATERAL|United Healthcare|UNITED HEALTHCARE|||||450.75||| 77065|EAP|0401|DIGITAL MAMMO UNILATERAL|Medicaid|MEDICAID|||||450.75||| 77065|EAP|0401|DIGITAL MAMMO UNILATERAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||450.75||| 77065|EAP|0401|DIGITAL MAMMO UNILATERAL|PHCS|HUMANA|||||450.75||| 77065|EAP|0401|DIGITAL MAMMO UNILATERAL|Medicare|MEDICARE ACUTE|450.75||||450.75||| 77065|EAP|0401|DIGITAL MAMMO UNILATERAL|Managed Medicare|HEALTHSPRING MA|||||450.75||| 77066|EAP|0401|DIGITAL MAMMO BILATERAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||589.50||| 77066|EAP|0401|DIGITAL MAMMO BILATERAL|Tricare|TRICARE EAST REGION|||||589.50||| 77066|EAP|0401|DIGITAL MAMMO BILATERAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||589.50||| 77066|EAP|0401|DIGITAL MAMMO BILATERAL|PHCS|HUMANA INSURANCE|||||589.50||| 77066|EAP|0401|DIGITAL MAMMO BILATERAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||589.50||| 77066|EAP|0401|DIGITAL MAMMO BILATERAL|Medicare|MEDICARE ACUTE|||||589.50||| 77066|EAP|0401|DIGITAL MAMMO BILATERAL|Blue Cross PPO Specialty|BCBSTX PPO|||||589.50||| 77066|EAP|0401|DIGITAL MAMMO BILATERAL|United Healthcare|UNITED HEALTHCARE|||||589.50||| 77066|EAP|0401|DIGITAL MAMMO BILATERAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||589.50||| 77066|EAP|0401|DIGITAL MAMMO BILATERAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||589.50||| 77066|EAP|0401|DIGITAL MAMMO BILATERAL|Blue Cross HMO Specialty|BCBSTX HMO|||||589.50||| 77066|EAP|0401|DIGITAL MAMMO BILATERAL|Managed Medicare|OTHER INSTITUTIONS|||||589.50||| 77066|EAP|0401|DIGITAL MAMMO BILATERAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||589.50||| 77066|EAP|0401|DIGITAL MAMMO BILATERAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||589.50||| 77066|EAP|0401|DIGITAL MAMMO BILATERAL|Aetna|AETNA OTHER|||||589.50||| 77066|EAP|0401|DIGITAL MAMMO BILATERAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||589.50||| 77066|EAP|0401|DIGITAL MAMMO BILATERAL|Aetna|AETNA PPO|||||589.50||| 77066|EAP|0401|DIGITAL MAMMO BILATERAL|Managed Medicaid|MEDICAID AMERIGROUP|||||589.50||| 77066|EAP|0401|DIGITAL MAMMO BILATERAL|Medicaid|MEDICAID|||||589.50||| 77066|EAP|0401|DIGITAL MAMMO BILATERAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||589.50||| 77066|EAP|0401|DIGITAL MAMMO BILATERAL|Managed Medicare|HEALTHSPRING MA|||||589.50||| 77066|EAP|0401|DIGITAL MAMMO BILATERAL|Managed Medicaid|MEDICAID SUPERIOR|||||589.50||| 77066|EAP|0401|DIGITAL MAMMO BILATERAL|Humana Medicare Advantage|HUMANA MA|||||589.50||| 77066|EAP|0401|DIGITAL MAMMO BILATERAL|Cigna|CIGNA|||||589.50||| 77066|EAP|0401|DIGITAL MAMMO BILATERAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||589.50||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Humana Medicare Advantage|HUMANA MA|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Managed Medicaid|MEDICAID SUPERIOR|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Cigna|CIGNA|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Managed Medicaid|MEDICAID AMERIGROUP|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Access Direct Platinum|HEALTHFIRST TPA UMR|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Managed Medicare|HEALTHSPRING MA|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Managed Medicare|BCBS MEDICARE PPO MA|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Aetna|AETNA OTHER|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Blue Cross PPO Specialty|BCBSTX PPO|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Blue Cross HMO Specialty|BCBSTX HMO|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Veterans Affairs|VETERANS ADMINISTRATION|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|United Medicare Advantage|UHC AARP MCR HMO MA|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Blue Cross PPO Specialty|BCBSTX OTHER|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|United Healthcare|GEHA|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|ChampVA|CHAMPVA CENTER|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|United Healthcare|TML GROUP BENEFITS|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|United Healthcare|GOLDEN RULE|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|United Healthcare|UNITED HEALTHCARE OTHER|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Aetna|AETNA PPO|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|United Healthcare|AARP|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Medicaid|MEDICAID|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|United Healthcare|UNITED HEALTHCARE|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Tricare|TRICARE EAST REGION|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||5.02||| 77067|EAP|0403|SCREENING MAMMO BILATERAL|Medicare|MEDICARE ACUTE|||||5.02||| 77072|EAP|0320|BONE AGE COMPLETE|Managed Medicaid|MEDICAID AMERIGROUP|||||487.75||| 77072|EAP|0320|BONE AGE COMPLETE|Cigna|CIGNA|||||487.75||| 77072|EAP|0320|BONE AGE COMPLETE|Managed Medicaid|MEDICAID SUPERIOR|||||487.75||| 77072|EAP|0320|BONE AGE COMPLETE|United Healthcare|UNITED HEALTHCARE OTHER|||||487.75||| 77072|EAP|0320|BONE AGE COMPLETE|Blue Cross PPO Specialty|BCBSTX PPO|||||487.75||| 77072|EAP|0320|BONE AGE COMPLETE|Tricare|TRICARE EAST REGION|||||487.75||| 77075|EAP|0320|SKELETAL SURVEY|Humana Medicare Advantage|HUMANA MA|||||1,011.75||| 77075|EAP|0320|SKELETAL SURVEY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1,011.75||| 77075|EAP|0320|SKELETAL SURVEY|Medicare|MEDICARE ACUTE|||||1,011.75||| 77075|EAP|0320|SKELETAL SURVEY|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1,011.75||| 77075|EAP|0320|SKELETAL SURVEY|Medicaid|MEDICAID|||||1,011.75||| 77075|EAP|0320|SKELETAL SURVEY|Blue Cross PPO Specialty|BCBSTX PPO|||||1,011.75||| 77075|EAP|0320|SKELETAL SURVEY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,011.75||| 77075|EAP|0320|SKELETAL SURVEY|Managed Medicaid|MEDICAID SUPERIOR|||||1,011.75||| 77078|EAP|0359|CT BONE DENSITY AXIAL SKE|Medicare|MEDICARE ACUTE|||||356.75||| 77078|EAP|0359|CT BONE DENSITY AXIAL SKE|Medicaid|HENDERSON COUNTY INDIGENT|||||356.75||| 77078|EAP|0359|CT BONE DENSITY AXIAL SKE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||356.75||| 77078|EAP|0359|CT BONE DENSITY AXIAL SKE|United Medicare Advantage|UHC AARP MCR HMO MA|||||356.75||| 77078|EAP|0359|CT BONE DENSITY AXIAL SKE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||356.75||| 77078|EAP|0359|CT BONE DENSITY AXIAL SKE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||356.75||| 77078|EAP|0359|CT BONE DENSITY AXIAL SKE|United Healthcare|UNITED HEALTHCARE|||||356.75||| 77078|EAP|0359|CT BONE DENSITY AXIAL SKE|Medicaid|MEDICAID|||||356.75||| 77078|EAP|0359|CT BONE DENSITY AXIAL SKE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||356.75||| 77078|EAP|0359|CT BONE DENSITY AXIAL SKE|Aetna|AETNA PPO|||||356.75||| 77078|EAP|0359|CT BONE DENSITY AXIAL SKE|Managed Medicare|HEALTHSPRING MA|||||356.75||| 77078|EAP|0359|CT BONE DENSITY AXIAL SKE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||356.75||| 77078|EAP|0359|CT BONE DENSITY AXIAL SKE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||356.75||| 77078|EAP|0359|CT BONE DENSITY AXIAL SKE|Tricare|TRICARE EAST REGION|||||356.75||| 77078|EAP|0359|CT BONE DENSITY AXIAL SKE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||356.75||| 77078|EAP|0359|CT BONE DENSITY AXIAL SKE|Blue Cross PPO Specialty|BCBSTX PPO|||||356.75||| 77078|EAP|0359|CT BONE DENSITY AXIAL SKE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||356.75||| 77078|EAP|0359|CT BONE DENSITY AXIAL SKE|Managed Medicare|BCBS MEDICARE PPO MA|||||356.75||| 77078|EAP|0359|CT BONE DENSITY AXIAL SKE|Humana Medicare Advantage|HUMANA MA|||||356.75||| 77078|EAP|0359|CT BONE DENSITY AXIAL SKE|Cigna|CIGNA|||||356.75||| 77080|EAP|0320|DXA HIP, PELVIS, SPINE|Humana Medicare Advantage|HUMANA MA|||||4.01||| 77080|EAP|0320|DXA HIP, PELVIS, SPINE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.01||| 77080|EAP|0320|DXA HIP, PELVIS, SPINE|Managed Medicaid|MEDICAID AMERIGROUP|||||4.01||| 77080|EAP|0320|DXA HIP, PELVIS, SPINE|Managed Medicare|HEALTHSPRING MA|||||4.01||| 77080|EAP|0320|DXA HIP, PELVIS, SPINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.01||| 77080|EAP|0320|DXA HIP, PELVIS, SPINE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.01||| 77080|EAP|0320|DXA HIP, PELVIS, SPINE|Blue Cross HMO Specialty|BCBSTX HMO|||||4.01||| 77080|EAP|0320|DXA HIP, PELVIS, SPINE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.01||| 77080|EAP|0320|DXA HIP, PELVIS, SPINE|Cigna|CIGNA|||||4.01||| 77080|EAP|0320|DXA HIP, PELVIS, SPINE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.01||| 77080|EAP|0320|DXA HIP, PELVIS, SPINE|Blue Cross PPO Specialty|BCBSTX PPO|||||4.01||| 77080|EAP|0320|DXA HIP, PELVIS, SPINE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.01||| 77080|EAP|0320|DXA HIP, PELVIS, SPINE|Aetna|AETNA PPO|||||4.01||| 77080|EAP|0320|DXA HIP, PELVIS, SPINE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.01||| 77080|EAP|0320|DXA HIP, PELVIS, SPINE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.01||| 77080|EAP|0320|DXA HIP, PELVIS, SPINE|United Healthcare|AARP|||||4.01||| 77080|EAP|0320|DXA HIP, PELVIS, SPINE|Medicare|MEDICARE ACUTE|||||4.01||| 77080|EAP|0320|DXA HIP, PELVIS, SPINE|Tricare|TRICARE EAST REGION|||||4.01||| 77080|EAP|0320|DXA HIP, PELVIS, SPINE|United Healthcare|UNITED HEALTHCARE|||||4.01||| 77080|EAP|0320|DXA HIP, PELVIS, SPINE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.01||| 77081|EAP|0320|DXA BONE DENSITY, RADIUS,|Medicare|MEDICARE ACUTE|||||4.01||| 77280|EAP|0333|RADIATION THERAPY SIMULAT|Managed Medicare|HEALTHSPRING MA|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPY SIMULAT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPUTIC SIMU|Humana Medicare Advantage|HUMANA MA|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPY SIMULAT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPUTIC SIMU|Blue Cross HMO Specialty|BCBSTX HMO|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPUTIC SIMU|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPUTIC SIMU|Blue Cross PPO Specialty|BCBSTX PPO|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPY SIMULAT|Blue Cross PPO Specialty|BCBSTX PPO|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPUTIC SIMU|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPUTIC SIMU|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPUTIC SIMU|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPY SIMULAT|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPY SIMULAT|Blue Cross HMO Specialty|BCBSTX HMO|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPUTIC SIMU|Managed Medicare|BCBS MEDICARE PPO MA|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPUTIC SIMU|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPUTIC SIMU|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPY SIMULAT|Humana Medicare Advantage|HUMANA MA|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPUTIC SIMU|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPY SIMULAT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPUTIC SIMU|NON CONTRACTED|COMMERCIAL OTHER 2|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPUTIC SIMU|Medicare|MEDICARE ACUTE|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPY SIMULAT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPY SIMULAT|Medicaid|MEDICAID|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPY SIMULAT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPY SIMULAT|Medicare|MEDICARE ACUTE|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPUTIC SIMU|Cigna|CIGNA|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPY SIMULAT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPUTIC SIMU|United Healthcare|UNITED HEALTHCARE|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPUTIC SIMU|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPY SIMULAT|United Medicare Advantage|UHC AARP MCR HMO MA|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPUTIC SIMU|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1,146.25||| 77280|EAP|0333|RADIATION THERAPY SIMULAT|United Healthcare|TML GROUP BENEFITS|||||1,146.25||| 77285|EAP|0333|RADIATION THERAPUTIC SIMU|Humana Medicare Advantage|HUMANA MA|||||1,682.25||| 77285|EAP|0333|RADIATION THERAPUTIC SIMU|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1,682.25||| 77285|EAP|0333|RADIATION THERAPY SIMULAT|Medicare|MEDICARE ACUTE|||||1,682.25||| 77285|EAP|0333|RADIATION THERAPUTIC SIMU|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,682.25||| 77285|EAP|0333|RADIATION THERAPUTIC SIMU|Medicare|MEDICARE ACUTE|||||1,682.25||| 77285|EAP|0333|RADIATION THERAPUTIC SIMU|Managed Medicare|HEALTHSPRING MA|||||1,682.25||| 77285|EAP|0333|RADIATION THERAPY SIMULAT|Veterans Affairs|VETERANS ADMINISTRATION|||||1,682.25||| 77290|EAP|0333|RADIATION THERPY SIMULATI|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2,153.50||| 77290|EAP|0333|RADIATION THERAPUTIC SIMU|Aetna|AETNA PPO|||||2,153.50||| 77290|EAP|0333|RADIATION THERAPUTIC SIMU|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2,153.50||| 77290|EAP|0333|RADIATION THERPY SIMULATI|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2,153.50||| 77290|EAP|0333|RADIATION THERAPUTIC SIMU|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2,153.50||| 77290|EAP|0333|RADIATION THERPY SIMULATI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2,153.50||| 77290|EAP|0333|RADIATION THERPY SIMULATI|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2,153.50||| 77290|EAP|0333|RADIATION THERAPUTIC SIMU|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2,153.50||| 77290|EAP|0333|RADIATION THERPY SIMULATI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2,153.50||| 77290|EAP|0333|RADIATION THERAPUTIC SIMU|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2,153.50||| 77290|EAP|0333|RADIATION THERAPUTIC SIMU|Managed Medicare|BCBS MEDICARE PPO MA|||||2,153.50||| 77290|EAP|0333|RADIATION THERPY SIMULATI|Managed Medicare|HEALTHSPRING MA|||||2,153.50||| 77290|EAP|0333|RADIATION THERAPUTIC SIMU|Blue Cross PPO Specialty|BCBSTX PPO|||||2,153.50||| 77290|EAP|0333|RADIATION THERPY SIMULATI|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2,153.50||| 77290|EAP|0333|RADIATION THERAPUTIC SIMU|Cigna|CIGNA|||||2,153.50||| 77290|EAP|0333|RADIATION THERAPUTIC SIMU|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2,153.50||| 77290|EAP|0333|RADIATION THERPY SIMULATI|Humana Medicare Advantage|HUMANA MA|||||2,153.50||| 77290|EAP|0333|RADIATION THERAPUTIC SIMU|Humana Medicare Advantage|HUMANA MA|||||2,153.50||| 77290|EAP|0333|RADIATION THERPY SIMULATI|Cigna|CIGNA OTHER|||||2,153.50||| 77290|EAP|0333|RADIATION THERAPUTIC SIMU|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2,153.50||| 77290|EAP|0333|RADIATION THERAPUTIC SIMU|United Healthcare|UNITED HEALTHCARE|||||2,153.50||| 77290|EAP|0333|RADIATION THERAPUTIC SIMU|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2,153.50||| 77290|EAP|0333|RADIATION THERAPUTIC SIMU|Medicare|MEDICARE ACUTE|||||2,153.50||| 77290|EAP|0333|RADIATION THERAPUTIC SIMU|United Healthcare|UNITED HEALTHCARE OTHER|||||2,153.50||| 77290|EAP|0333|RADIATION THERAPUTIC SIMU|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2,153.50||| 77290|EAP|0333|RADIATION THERAPUTIC SIMU|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2,153.50||| 77290|EAP|0333|RADIATION THERAPUTIC SIMU|Medicaid|MEDICAID|||||2,153.50||| 77290|EAP|0333|RADIATION THERPY SIMULATI|Medicare|MEDICARE ACUTE|||||2,153.50||| 77290|EAP|0333|RADIATION THERAPUTIC SIMU|Managed Medicare|HEALTHSPRING MA|||||2,153.50||| 77290|EAP|0333|RADIATION THERAPUTIC SIMU|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2,153.50||| 77290|EAP|0333|RADIATION THERPY SIMULATI|Blue Cross PPO Specialty|BCBSTX PPO|||||2,153.50||| 77290|EAP|0333|RADIATION THERPY SIMULATI|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2,153.50||| 77290|EAP|0333|RADIATION THERPY SIMULATI|United Healthcare|TML GROUP BENEFITS|||||2,153.50||| 77290|EAP|0333|RADIATION THERAPUTIC SIMU|Veterans Affairs|VETERANS ADMINISTRATION|||||2,153.50||| 77290|EAP|0333|RADIATION THERAPUTIC SIMU|Tricare|TRICARE FOR LIFE|||||2,153.50||| 77290|EAP|0333|RADIATION THERPY SIMULATI|Medicaid|MEDICAID|||||2,153.50||| 77290|EAP|0333|RADIATION THERAPUTIC SIMU|Blue Cross HMO Specialty|BCBSTX HMO|||||2,153.50||| 77290|EAP|0333|RADIATION THERPY SIMULATI|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2,153.50||| 77290|EAP|0333|RADIATION THERAPUTIC SIMU|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2,153.50||| 77293|EAP|0333|RESPIRATOR MOTION MGMT SI|Veterans Affairs|VETERANS ADMINISTRATION|||||2,143.75||| 77293|EAP|0333|RESPIRATOR MOTION MGMT SI|Medicare|MEDICARE ACUTE|||||2,143.75||| 77293|EAP|0333|RESPIRATOR MOTION MGMT SI|United Healthcare|UNITED HEALTHCARE|||||2,143.75||| 77293|EAP|0333|RESPIRATOR MOTION MGMT SI|United Medicare Advantage|UHC AARP MCR HMO MA|||||2,143.75||| 77293|EAP|0333|RESPIRATOR MOTION MGMT SI|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2,143.75||| 77293|EAP|0333|RESPIRATOR MOTION MGMT SI|United Healthcare|UNITED HEALTHCARE OTHER|||||2,143.75||| 77293|EAP|0333|RESPIRATOR MOTION MGMT SI|Humana Medicare Advantage|HUMANA MA|||||2,143.75||| 77293|EAP|0333|RESPIRATOR MOTION MGMT SI|Managed Medicare|HEALTHSPRING MA|||||2,143.75||| 77293|EAP|0333|RESPIRATOR MOTION MGMT SI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2,143.75||| 77293|EAP|0333|RESPIRATOR MOTION MGMT SI|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2,143.75||| 77293|EAP|0333|RESPIRATOR MOTION MGMT SI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2,143.75||| 77293|EAP|0333|RESPIRATOR MOTION MGMT SI|Blue Cross PPO Specialty|BCBSTX PPO|||||2,143.75||| 77293|EAP|0333|RESPIRATOR MOTION MGMT SI|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2,143.75||| 77295|EAP|0333|RADIATION THERAPY 3D PLAN|Aetna|AETNA PPO|||||55.12||| 77295|EAP|0333|RADIATION THERAPY 3D PLAN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||55.12||| 77295|EAP|0333|RADIATION THERAPY 3D PLAN|Blue Cross PPO Specialty|BCBSTX PPO|||||55.12||| 77295|EAP|0333|RADIATION THERAPY 3D PLAN|Aenta Medicare Advantage|AETNA MEDICARE MA|||||55.12||| 77295|EAP|0333|RADIATION THERAPY 3D PLAN|Cigna|CIGNA|||||55.12||| 77295|EAP|0333|RADIATION THERAPY 3D PLAN|Managed Medicare|BCBS MEDICARE PPO MA|||||55.12||| 77295|EAP|0333|RADIATION THERAPY 3D PLAN|Blue Cross HMO Specialty|BCBSTX HMO|||||55.12||| 77295|EAP|0333|RADIATION THERAPY 3D PLAN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||55.12||| 77295|EAP|0333|RADIATION THERAPY 3D PLAN|Managed Medicare|HEALTHSPRING MA|||||55.12||| 77295|EAP|0333|RADIATION THERAPY 3D PLAN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||55.12||| 77295|EAP|0333|RADIATION THERAPY 3D PLAN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||55.12||| 77295|EAP|0333|RADIATION THERAPY 3D PLAN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||55.12||| 77295|EAP|0333|RADIATION THERAPY 3D PLAN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||55.12||| 77295|EAP|0333|RADIATION THERAPY 3D PLAN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||55.12||| 77295|EAP|0333|RADIATION THERAPY 3D PLAN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||55.12||| 77295|EAP|0333|RADIATION THERAPY 3D PLAN|United Medicare Advantage|UHC MEDICARE GOLD MA|||||55.12||| 77295|EAP|0333|RADIATION THERAPY 3D PLAN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||55.12||| 77295|EAP|0333|RADIATION THERAPY 3D PLAN|United Healthcare|UNITED HEALTHCARE OTHER|||||55.12||| 77295|EAP|0333|RADIATION THERAPY 3D PLAN|Veterans Affairs|VETERANS ADMINISTRATION|||||55.12||| 77295|EAP|0333|RADIATION THERAPY 3D PLAN|Humana Medicare Advantage|HUMANA MA|||||55.12||| 77295|EAP|0333|RADIATION THERAPY 3D PLAN|Medicaid|MEDICAID|||||55.12||| 77295|EAP|0333|RADIATION THERAPY 3D PLAN|Tricare|TRICARE FOR LIFE|||||55.12||| 77295|EAP|0333|RADIATION THERAPY 3D PLAN|United Healthcare|TML GROUP BENEFITS|||||55.12||| 77295|EAP|0333|RADIATION THERAPY 3D PLAN|Medicare|MEDICARE ACUTE|||||55.12||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|NON CONTRACTED|COMMERCIAL OTHER 2|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|Medicaid|MEDICAID|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|Medicare|MEDICARE ACUTE|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|Veterans Affairs|VETERANS ADMINISTRATION|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|Medicaid|HENDERSON COUNTY INDIGENT|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|United Medicare Advantage|UHC AARP MCR HMO MA|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|Tricare|TRICARE FOR LIFE|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|United Healthcare|UNITED HEALTHCARE OTHER|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|Humana Medicare Advantage|HUMANA MA|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|Managed Medicaid|MEDICAID AMERIGROUP|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|United Medicare Advantage|UHC MEDICARE GOLD MA|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|Managed Medicare|BCBS MEDICARE PPO MA|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|Managed Medicare|HEALTHSPRING MA|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|Blue Cross PPO Specialty|BCBSTX PPO|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|Cigna|CIGNA|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|Blue Cross HMO Specialty|BCBSTX HMO|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|United Healthcare|TML GROUP BENEFITS|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|NON CONTRACTED|COMMERCIAL OTHER 1|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|Blue Cross PPO Specialty|BCBSTX OTHER|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|Access Direct Platinum|HEALTHFIRST TPA UMR|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|Aenta Medicare Advantage|AETNA MEDICARE MA|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|Aetna|AETNA PPO|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|United Healthcare|UNITED HEALTHCARE|||||264.75||| 77300|EAP|0333|RADIATION THERAPY DOSE CA|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||264.75||| 77301|EAP|0333|RADIATION PLAN INTEN MODU|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||55.12||| 77301|EAP|0333|RADIATION PLAN INTEN MODU|Aenta Medicare Advantage|AETNA MEDICARE MA|||||55.12||| 77301|EAP|0333|RADIOTHRPY PLAN INTENSITY|Aenta Medicare Advantage|AETNA MEDICARE MA|||||55.12||| 77301|EAP|0333|RADIATION PLAN INTEN MODU|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||55.12||| 77301|EAP|0333|RADIATION PLAN INTEN MODU|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||55.12||| 77301|EAP|0333|RADIOTHRPY PLAN INTENSITY|Blue Cross PPO Specialty|BCBSTX PPO|||||55.12||| 77301|EAP|0333|RADIATION PLAN INTEN MODU|Blue Cross PPO Specialty|BCBSTX PPO|||||55.12||| 77301|EAP|0333|RADIATION PLAN INTEN MODU|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||55.12||| 77301|EAP|0333|RADIATION PLAN INTEN MODU|Humana Medicare Advantage|HUMANA MA|||||55.12||| 77301|EAP|0333|RADIATION PLAN INTEN MODU|Blue Cross HMO Specialty|BCBSTX HMO|||||55.12||| 77301|EAP|0333|RADIATION PLAN INTEN MODU|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||55.12||| 77301|EAP|0333|RADIOTHRPY PLAN INTENSITY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||55.12||| 77301|EAP|0333|RADIOTHRPY PLAN INTENSITY|Managed Medicare|HEALTHSPRING MA|||||55.12||| 77301|EAP|0333|RADIATION PLAN INTEN MODU|Managed Medicare|BCBS MEDICARE PPO MA|||||55.12||| 77301|EAP|0333|RADIOTHRPY PLAN INTENSITY|Blue Cross HMO Specialty|BCBSTX HMO|||||55.12||| 77301|EAP|0333|RADIOTHRPY PLAN INTENSITY|Aetna|AETNA PPO|||||55.12||| 77301|EAP|0333|RADIATION PLAN INTEN MODU|Managed Medicare|HEALTHSPRING MA|||||55.12||| 77301|EAP|0333|RADIOTHRPY PLAN INTENSITY|Blue Cross PPO Specialty|BCBSTX OTHER|||||55.12||| 77301|EAP|0333|RADIATION PLAN INTEN MODU|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||55.12||| 77301|EAP|0333|RADIATION PLAN INTEN MODU|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||55.12||| 77301|EAP|0333|RADIOTHRPY PLAN INTENSITY|Humana Medicare Advantage|HUMANA MA|||||55.12||| 77301|EAP|0333|RADIATION PLAN INTEN MODU|United Healthcare|UNITED HEALTHCARE OTHER|||||55.12||| 77301|EAP|0333|RADIATION PLAN INTEN MODU|United Healthcare|UNITED HEALTHCARE|||||55.12||| 77301|EAP|0333|RADIATION PLAN INTEN MODU|United Medicare Advantage|UHC AARP MCR HMO MA|||||55.12||| 77301|EAP|0333|RADIOTHRPY PLAN INTENSITY|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||55.12||| 77301|EAP|0333|RADIATION PLAN INTEN MODU|United Medicare Advantage|UHC MEDICARE GOLD MA|||||55.12||| 77301|EAP|0333|RADIOTHRPY PLAN INTENSITY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||55.12||| 77301|EAP|0333|RADIOTHRPY PLAN INTENSITY|United Medicare Advantage|UHC MEDICARE GOLD MA|||||55.12||| 77301|EAP|0333|RADIATION PLAN INTEN MODU|Veterans Affairs|VETERANS ADMINISTRATION|||||55.12||| 77301|EAP|0333|RADIATION PLAN INTEN MODU|NON CONTRACTED|COMMERCIAL OTHER 1|||||55.12||| 77301|EAP|0333|RADIOTHRPY PLAN INTENSITY|Medicare|MEDICARE ACUTE|||||55.12||| 77301|EAP|0333|RADIATION PLAN INTEN MODU|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||55.12||| 77301|EAP|0333|RADIATION PLAN INTEN MODU|Medicaid|MEDICAID|||||55.12||| 77301|EAP|0333|RADIATION PLAN INTEN MODU|Medicare|MEDICARE ACUTE|||||55.12||| 77301|EAP|0333|RADIOTHRPY PLAN INTENSITY|United Medicare Advantage|UHC AARP MCR HMO MA|||||55.12||| 77301|EAP|0333|RADIATION PLAN INTEN MODU|NON CONTRACTED|COMMERCIAL OTHER 2|||||55.12||| 77301|EAP|0333|RADIATION PLAN INTEN MODU|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||55.12||| 77301|EAP|0333|RADIOTHRPY PLAN INTENSITY|NON CONTRACTED|COMMERCIAL OTHER 1|||||55.12||| 77301|EAP|0333|RADIATION PLAN INTEN MODU|Aetna|AETNA PPO|||||55.12||| 77307|EAP|0333|TELETHRPY ISODOSE PLAN CO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||525.75||| 77307|EAP|0333|TELETHRPY ISODOSE PLAN CO|Medicare|MEDICARE ACUTE|||||525.75||| 77307|EAP|0333|TELETHRPY ISODO PLAN INTE|Medicare|MEDICARE ACUTE|||||525.75||| 77307|EAP|0333|TELETHRPY ISODO PLAN INTE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||525.75||| 77307|EAP|0333|TELETHRPY ISODO PLAN INTE|United Healthcare|UNITED HEALTHCARE|||||525.75||| 77307|EAP|0333|TELETHRPY ISODO PLAN INTE|Humana Medicare Advantage|HUMANA MA|||||525.75||| 77307|EAP|0333|TELETHRPY ISODOSE PLAN CO|Humana Medicare Advantage|HUMANA MA|||||525.75||| 77307|EAP|0333|TELETHRPY ISODOSE PLAN CO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||525.75||| 77307|EAP|0333|TELETHRPY ISODO PLAN INTE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||525.75||| 77307|EAP|0333|TELETHRPY ISODOSE PLAN CO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||525.75||| 77307|EAP|0333|TELETHRPY ISODO PLAN INTE|Blue Cross PPO Specialty|BCBSTX PPO|||||525.75||| 77307|EAP|0333|TELETHRPY ISODO PLAN INTE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||525.75||| 77307|EAP|0333|TELETHRPY ISODOSE PLAN CO|Cigna|CIGNA OTHER|||||525.75||| 77307|EAP|0333|TELETHRPY ISODOSE PLAN CO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||525.75||| 77321|EAP|0333|SPECIAL TELETHERAPY PORT|Medicare|MEDICARE ACUTE|||||7.96||| 77321|EAP|0333|SPECIAL TELETHERAPY PORT|Aenta Medicare Advantage|AETNA MEDICARE MA|||||7.96||| 77321|EAP|0333|SPECIAL TELETHRPY PORT PL|Managed Medicare|HEALTHSPRING MA|||||7.96||| 77321|EAP|0333|SPECIAL TELETHRPY PORT PL|Humana Medicare Advantage|HUMANA MA|||||7.96||| 77321|EAP|0333|SPECIAL TELETHERAPY PORT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||7.96||| 77321|EAP|0333|SPECIAL TELETHRPY PORT PL|Medicare|MEDICARE ACUTE|||||7.96||| 77331|EAP|0333|SPECIAL RADITATION DOSIME|Medicare|MEDICARE ACUTE|||||99.25||| 77334|EAP|0333|RADIATION THERAPY TX DEVI|Humana Medicare Advantage|HUMANA MA|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|Humana Medicare Advantage|HUMANA MA|||||640.50||| 77334|EAP|0333|RADIATION THERAPY TX DEVI|Managed Medicare|HEALTHSPRING MA|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|Managed Medicare|HEALTHSPRING MA|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|Managed Medicare|OTHER INSTITUTIONS|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|Managed Medicare|BCBS MEDICARE PPO MA|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||640.50||| 77334|EAP|0333|RADIATION THERAPY TX DEVI|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||640.50||| 77334|EAP|0333|RADIATION THERAPY TX DEVI|Blue Cross PPO Specialty|BCBSTX PPO|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|Blue Cross HMO Specialty|BCBSTX HMO|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|Cigna|CIGNA|||||640.50||| 77334|EAP|0333|RADIATION THERAPY TX DEVI|Blue Cross HMO Specialty|BCBSTX HMO|||||640.50||| 77334|EAP|0333|RADIATION THERAPY TX DEVI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||640.50||| 77334|EAP|0333|RADIATION THERAPY TX DEVI|Cigna|CIGNA OTHER|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|Blue Cross PPO Specialty|BCBSTX PPO|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|Aetna|AETNA OTHER|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|Aenta Medicare Advantage|AETNA MEDICARE MA|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|Aetna|AETNA PPO|||||640.50||| 77334|EAP|0333|RADIATION THERAPY TX DEVI|Blue Cross PPO Specialty|BCBSTX OTHER|||||640.50||| 77334|EAP|0333|RADIATION THERAPY TX DEVI|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||640.50||| 77334|EAP|0333|RADIATION THERAPY TX DEVI|Aetna|AETNA PPO|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|Veterans Affairs|VETERANS ADMINISTRATION|||||640.50||| 77334|EAP|0333|RADIATION THERAPY TX DEVI|Aenta Medicare Advantage|AETNA MEDICARE MA|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|United Healthcare|UNITED HEALTHCARE OTHER|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|United Healthcare|UNITED HEALTHCARE|||||640.50||| 77334|EAP|0333|RADIATION THERAPY TX DEVI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||640.50||| 77334|EAP|0333|RADIATION THERAPY TX DEVI|United Healthcare|TML GROUP BENEFITS|||||640.50||| 77334|EAP|0333|RADIATION THERAPY TX DEVI|United Medicare Advantage|UHC AARP MCR HMO MA|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|United Medicare Advantage|UHC MEDICARE GOLD MA|||||640.50||| 77334|EAP|0333|RADIATION THERAPY TX DEVI|United Medicare Advantage|UHC MEDICARE GOLD MA|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|Medicaid|MEDICAID|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|NON CONTRACTED|COMMERCIAL OTHER 2|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|NON CONTRACTED|COMMERCIAL OTHER 1|||||640.50||| 77334|EAP|0333|RADIATION THERAPY TX DEVI|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|Tricare|TRICARE FOR LIFE|||||640.50||| 77334|EAP|0333|RADIATION THERAPY TX DEVI|Medicare|MEDICARE ACUTE|||||640.50||| 77334|EAP|0333|RADIATION THERAPY TX DEVI|NON CONTRACTED|COMMERCIAL OTHER 1|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|Medicare|MEDICARE ACUTE|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|United Medicare Advantage|UHC AARP MCR HMO MA|||||640.50||| 77334|EAP|0333|RADIATION THERAPY TX DEVI|Medicaid|MEDICAID|||||640.50||| 77334|EAP|0333|RADIATION THERAPY TX DEVI|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||640.50||| 77334|EAP|0333|RADIATION TREATMENT AID C|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||640.50||| 77334|EAP|0333|RADIATION THERAPY TX DEVI|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||640.50||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|Medicare|MEDICARE ACUTE|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|NON CONTRACTED|COMMERCIAL OTHER 1|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|NON CONTRACTED|COMMERCIAL OTHER 2|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|Medicaid|MEDICAID|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|United Healthcare|TML GROUP BENEFITS|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|United Healthcare|UNITED HEALTHCARE OTHER|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|United Healthcare|UNITED HEALTHCARE|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|United Medicare Advantage|UHC AARP MCR HMO MA|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|Access Direct Platinum|HEALTHFIRST TPA UMR|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|Aetna|AETNA PPO|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|Aenta Medicare Advantage|AETNA MEDICARE MA|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|Blue Cross PPO Specialty|BCBSTX PPO|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|Cigna|CIGNA|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|Blue Cross HMO Specialty|BCBSTX HMO|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|Blue Cross PPO Specialty|BCBSTX OTHER|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|Veterans Affairs|VETERANS ADMINISTRATION|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|Managed Medicare|BCBS MEDICARE PPO MA|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|Managed Medicare|HEALTHSPRING MA|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|Managed Medicaid|MEDICAID AMERIGROUP|||||587.75||| 77336|EAP|0333|RADIATION PHYSICS CONSULT|Humana Medicare Advantage|HUMANA MA|||||587.75||| 77338|EAP|0333|DESIGN AND CONSTRUCTION O|Managed Medicare|HEALTHSPRING MA|||||808.50||| 77338|EAP|0333|DESIGN AND CONSTRUCTION O|Humana Medicare Advantage|HUMANA MA|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|Humana Medicare Advantage|HUMANA MA|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|Managed Medicare|HEALTHSPRING MA|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|Managed Medicare|BCBS MEDICARE PPO MA|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|Managed Medicaid|MEDICAID AMERIGROUP|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||808.50||| 77338|EAP|0333|DESIGN AND CONSTRUCTION O|Blue Cross PPO Specialty|BCBSTX OTHER|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|Blue Cross PPO Specialty|BCBSTX PPO|||||808.50||| 77338|EAP|0333|DESIGN AND CONSTRUCTION O|Blue Cross PPO Specialty|BCBSTX PPO|||||808.50||| 77338|EAP|0333|DESIGN AND CONSTRUCTION O|Blue Cross HMO Specialty|BCBSTX HMO|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||808.50||| 77338|EAP|0333|DESIGN AND CONSTRUCTION O|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||808.50||| 77338|EAP|0333|DESIGN AND CONSTRUCTION O|Aenta Medicare Advantage|AETNA MEDICARE MA|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|Veterans Affairs|VETERANS ADMINISTRATION|||||808.50||| 77338|EAP|0333|DESIGN AND CONSTRUCTION O|United Medicare Advantage|UHC MEDICARE GOLD MA|||||808.50||| 77338|EAP|0333|DESIGN AND CONSTRUCTION O|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|Blue Cross HMO Specialty|BCBSTX HMO|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|United Healthcare|UNITED HEALTHCARE|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||808.50||| 77338|EAP|0333|DESIGN AND CONSTRUCTION O|United Medicare Advantage|UHC AARP MCR HMO MA|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|United Healthcare|UNITED HEALTHCARE OTHER|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|Medicaid|MEDICAID|||||808.50||| 77338|EAP|0333|DESIGN AND CONSTRUCTION O|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||808.50||| 77338|EAP|0333|DESIGN AND CONSTRUCTION O|Medicare|MEDICARE ACUTE|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|NON CONTRACTED|COMMERCIAL OTHER 2|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|NON CONTRACTED|COMMERCIAL OTHER 1|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|Access Direct Platinum|HEALTHFIRST TPA UMR|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|Medicare|MEDICARE ACUTE|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|Aenta Medicare Advantage|AETNA MEDICARE MA|||||808.50||| 77338|EAP|0333|DESIGN AND CONSTRUCTION O|NON CONTRACTED|COMMERCIAL OTHER 1|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|United Medicare Advantage|UHC AARP MCR HMO MA|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|Aetna|AETNA PPO|||||808.50||| 77338|EAP|0333|DESIGN AND CONSTRUCTION O|Aetna|AETNA PPO|||||808.50||| 77338|EAP|0333|DESIGN MLC DEVICE FOR IMR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||808.50||| 77370|EAP|0333|SPECIAL MEDICAL RAD PHYSI|United Healthcare|UNITED HEALTHCARE OTHER|||||6.89||| 77370|EAP|0333|SPECIAL MEDICAL RAD PHYSI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||6.89||| 77370|EAP|0333|SPECIAL MEDICAL RAD PHYSI|Blue Cross PPO Specialty|BCBSTX PPO|||||6.89||| 77370|EAP|0333|SPECIAL MEDICAL RAD PHYSI|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||6.89||| 77370|EAP|0333|SPECIAL RADIATION PHYSICS|Humana Medicare Advantage|HUMANA MA|||||6.89||| 77370|EAP|0333|SPECIAL MEDICAL RAD PHYSI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||6.89||| 77370|EAP|0333|SPECIAL MEDICAL RAD PHYSI|Blue Cross HMO Specialty|BCBSTX HMO|||||6.89||| 77370|EAP|0333|SPECIAL MEDICAL RAD PHYSI|Humana Medicare Advantage|HUMANA MA|||||6.89||| 77370|EAP|0333|SPECIAL RADIATION PHYSICS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||6.89||| 77370|EAP|0333|SPECIAL MEDICAL RAD PHYSI|United Medicare Advantage|UHC MEDICARE GOLD MA|||||6.89||| 77370|EAP|0333|SPECIAL MEDICAL RAD PHYSI|Medicare|MEDICARE ACUTE|||||6.89||| 77370|EAP|0333|SPECIAL MEDICAL RAD PHYSI|Aetna|AETNA PPO|||||6.89||| 77372|EAP|0333|SRS LINEAR BASED|Humana Medicare Advantage|HUMANA MA|||||19,897.50||| 77372|EAP|0333|SRS LINEAR BASED|Blue Cross HMO Specialty|BCBSTX HMO|||||19,897.50||| 77372|EAP|0333|SRS LINEAR BASED|Blue Cross PPO Specialty|BCBSTX PPO|||||19,897.50||| 77372|EAP|0333|SRS LINEAR BASED|United Medicare Advantage|UHC MEDICARE GOLD MA|||||19,897.50||| 77372|EAP|0333|SRS LINEAR BASED|Medicare|MEDICARE ACUTE|||||19,897.50||| 77372|EAP|0333|SRS LINEAR BASED|United Healthcare|UNITED HEALTHCARE OTHER|||||19,897.50||| 77373|EAP|0333|SBRT DELIVERY|Medicaid|MEDICAID|||||10,644.25||| 77373|EAP|0333|SBRT DELIVERY|Medicare|MEDICARE ACUTE|||||10,644.25||| 77373|EAP|0333|SBRT DELIVERY|Veterans Affairs|VETERANS ADMINISTRATION|||||10,644.25||| 77373|EAP|0333|SBRT DELIVERY|United Medicare Advantage|UHC MEDICARE GOLD MA|||||10,644.25||| 77373|EAP|0333|SBRT DELIVERY|Aetna|AETNA PPO|||||10,644.25||| 77373|EAP|0333|SBRT DELIVERY|Blue Cross PPO Specialty|BCBSTX PPO|||||10,644.25||| 77373|EAP|0333|SBRT DELIVERY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||10,644.25||| 77373|EAP|0333|SBRT DELIVERY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||10,644.25||| 77373|EAP|0333|SBRT DELIVERY|Managed Medicare|HEALTHSPRING MA|||||10,644.25||| 77373|EAP|0333|SBRT DELIVERY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||10,644.25||| 77373|EAP|0333|SBRT DELIVERY|Humana Medicare Advantage|HUMANA MA|||||10,644.25||| 77385|EAP|0333|NTSTY MODUL RAD TX DLVR S|Humana Medicare Advantage|HUMANA MA|||||2,722.75||| 77385|EAP|0333|RADTN TX DELV INTENSITY M|Humana Medicare Advantage|HUMANA MA|||||2,722.75||| 77385|EAP|0333|NTSTY MODUL RAD TX DLVR S|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2,722.75||| 77385|EAP|0333|NTSTY MODUL RAD TX DLVR S|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2,722.75||| 77385|EAP|0333|NTSTY MODUL RAD TX DLVR S|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2,722.75||| 77385|EAP|0333|NTSTY MODUL RAD TX DLVR S|Blue Cross PPO Specialty|BCBSTX PPO|||||2,722.75||| 77385|EAP|0333|NTSTY MODUL RAD TX DLVR S|Managed Medicare|HEALTHSPRING MA|||||2,722.75||| 77385|EAP|0333|NTSTY MODUL RAD TX DLVR S|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2,722.75||| 77385|EAP|0333|RADTN TX DELV INTENSITY M|Blue Cross HMO Specialty|BCBSTX HMO|||||2,722.75||| 77385|EAP|0333|RADTN TX DELV INTENSITY M|Blue Cross PPO Specialty|BCBSTX PPO|||||2,722.75||| 77385|EAP|0333|NTSTY MODUL RAD TX DLVR S|Aetna|AETNA PPO|||||2,722.75||| 77385|EAP|0333|RADTN TX DELV INTENSITY M|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2,722.75||| 77385|EAP|0333|NTSTY MODUL RAD TX DLVR S|Blue Cross HMO Specialty|BCBSTX HMO|||||2,722.75||| 77385|EAP|0333|RADTN TX DELV INTENSITY M|Blue Cross PPO Specialty|BCBSTX OTHER|||||2,722.75||| 77385|EAP|0333|RADTN TX DELV INTENSITY M|Aetna|AETNA PPO|||||2,722.75||| 77385|EAP|0333|NTSTY MODUL RAD TX DLVR S|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2,722.75||| 77385|EAP|0333|RADTN TX DELV INTENSITY M|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2,722.75||| 77385|EAP|0333|NTSTY MODUL RAD TX DLVR S|United Medicare Advantage|UHC AARP MCR HMO MA|||||2,722.75||| 77385|EAP|0333|NTSTY MODUL RAD TX DLVR S|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2,722.75||| 77385|EAP|0333|RADTN TX DELV INTENSITY M|United Healthcare|UNITED HEALTHCARE OTHER|||||2,722.75||| 77385|EAP|0333|RADTN TX DELV INTENSITY M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2,722.75||| 77385|EAP|0333|NTSTY MODUL RAD TX DLVR S|United Healthcare|UNITED HEALTHCARE OTHER|||||2,722.75||| 77385|EAP|0333|NTSTY MODUL RAD TX DLVR S|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2,722.75||| 77385|EAP|0333|NTSTY MODUL RAD TX DLVR S|United Healthcare|UNITED HEALTHCARE|||||2,722.75||| 77385|EAP|0333|NTSTY MODUL RAD TX DLVR S|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2,722.75||| 77385|EAP|0333|RADTN TX DELV INTENSITY M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2,722.75||| 77385|EAP|0333|NTSTY MODUL RAD TX DLVR S|Veterans Affairs|VETERANS ADMINISTRATION|||||2,722.75||| 77385|EAP|0333|NTSTY MODUL RAD TX DLVR S|NON CONTRACTED|COMMERCIAL OTHER 2|||||2,722.75||| 77385|EAP|0333|NTSTY MODUL RAD TX DLVR S|Medicare|MEDICARE ACUTE|||||2,722.75||| 77385|EAP|0333|RADTN TX DELV INTENSITY M|Medicare|MEDICARE ACUTE|||||2,722.75||| 77385|EAP|0333|NTSTY MODUL RAD TX DLVR S|Medicaid|MEDICAID|||||2,722.75||| 77386|EAP|0333|NTSTY MODUL RAD TX DLVR C|NON CONTRACTED|COMMERCIAL OTHER 1|||||2,722.75||| 77386|EAP|0333|NTSTY MODUL RAD TX DLVR C|Medicare|MEDICARE ACUTE|2,722.75||||2,722.75||| 77386|EAP|0333|NTSTY MODUL RAD TX DLVR C|Veterans Affairs|VETERANS ADMINISTRATION|||||2,722.75||| 77386|EAP|0333|NTSTY MODUL RAD TX DLVR C|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2,722.75||| 77386|EAP|0333|NTSTY MODUL RAD TX DLVR C|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2,722.75||| 77386|EAP|0333|NTSTY MODUL RAD TX DLVR C|United Healthcare|UNITED HEALTHCARE OTHER|||||2,722.75||| 77386|EAP|0333|NTSTY MODUL RAD TX DLVR C|United Medicare Advantage|UHC AARP MCR HMO MA|||||2,722.75||| 77386|EAP|0333|NTSTY MODUL RAD TX DLVR C|United Healthcare|UNITED HEALTHCARE|||||2,722.75||| 77386|EAP|0333|NTSTY MODUL RAD TX DLVR C|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2,722.75||| 77386|EAP|0333|NTSTY MODUL RAD TX DLVR C|Aetna|AETNA PPO|||||2,722.75||| 77386|EAP|0333|NTSTY MODUL RAD TX DLVR C|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2,722.75||| 77386|EAP|0333|NTSTY MODUL RAD TX DLVR C|Access Direct Platinum|HEALTHFIRST TPA UMR|||||2,722.75||| 77386|EAP|0333|NTSTY MODUL RAD TX DLVR C|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2,722.75||| 77386|EAP|0333|NTSTY MODUL RAD TX DLVR C|Blue Cross PPO Specialty|BCBSTX PPO|||||2,722.75||| 77386|EAP|0333|NTSTY MODUL RAD TX DLVR C|Blue Cross HMO Specialty|BCBSTX HMO|||||2,722.75||| 77386|EAP|0333|NTSTY MODUL RAD TX DLVR C|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2,722.75||| 77386|EAP|0333|NTSTY MODUL RAD TX DLVR C|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2,722.75||| 77386|EAP|0333|NTSTY MODUL RAD TX DLVR C|Blue Cross PPO Specialty|BCBSTX OTHER|||||2,722.75||| 77386|EAP|0333|NTSTY MODUL RAD TX DLVR C|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2,722.75||| 77386|EAP|0333|NTSTY MODUL RAD TX DLVR C|Managed Medicaid|MEDICAID AMERIGROUP|||||2,722.75||| 77386|EAP|0333|NTSTY MODUL RAD TX DLVR C|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2,722.75||| 77386|EAP|0333|NTSTY MODUL RAD TX DLVR C|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2,722.75||| 77386|EAP|0333|NTSTY MODUL RAD TX DLVR C|Managed Medicare|BCBS MEDICARE PPO MA|||||2,722.75||| 77386|EAP|0333|NTSTY MODUL RAD TX DLVR C|Humana Medicare Advantage|HUMANA MA|||||2,722.75||| 77386|EAP|0333|NTSTY MODUL RAD TX DLVR C|Managed Medicare|HEALTHSPRING MA|||||2,722.75||| 77412|EAP|0333|RADIATION TREATMENT DELIV|Humana Medicare Advantage|HUMANA MA|||||461.25||| 77412|EAP|0333|RADIATION TREATMENT DELIV|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||461.25||| 77412|EAP|0333|RADIATION TREATMENT DELIV|Managed Medicare|HEALTHSPRING MA|||||461.25||| 77412|EAP|0333|RAD TRMT DELV CMPX UP TO|Managed Medicare|HEALTHSPRING MA|||||461.25||| 77412|EAP|0333|RADIATION TREATMENT DELIV|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||461.25||| 77412|EAP|0333|RAD TRMT DELV CMPX UP TO|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||461.25||| 77412|EAP|0333|RADIATION TREATMENT DELIV|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||461.25||| 77412|EAP|0333|RADIATION TREATMENT DELIV|Managed Medicare|BCBS MEDICARE PPO MA|||||461.25||| 77412|EAP|0333|RADIATION TREATMENT DELIV|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||461.25||| 77412|EAP|0333|RAD TRMT DELV CMPX UP TO|Blue Cross HMO Specialty|BCBSTX HMO|||||461.25||| 77412|EAP|0333|RADIATION TREATMENT DELIV|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||461.25||| 77412|EAP|0333|RADIATION TREATMENT DELIV|Cigna|CIGNA|||||461.25||| 77412|EAP|0333|RADIATION TREATMENT DELIV|Blue Cross PPO Specialty|BCBSTX PPO|||||461.25||| 77412|EAP|0333|RAD TRMT DELV CMPX UP TO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||461.25||| 77412|EAP|0333|RAD TRMT DELV CMPX UP TO|Blue Cross PPO Specialty|BCBSTX PPO|||||461.25||| 77412|EAP|0333|RAD TRMT DELV CMPX UP TO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||461.25||| 77412|EAP|0333|RADIATION TREATMENT DELIV|Blue Cross HMO Specialty|BCBSTX HMO|||||461.25||| 77412|EAP|0333|RADIATION TREATMENT DELIV|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||461.25||| 77412|EAP|0333|RADIATION TREATMENT DELIV|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||461.25||| 77412|EAP|0333|RAD TRMT DELV CMPX UP TO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||461.25||| 77412|EAP|0333|RADIATION TREATMENT DELIV|Aenta Medicare Advantage|AETNA MEDICARE MA|||||461.25||| 77412|EAP|0333|RAD TRMT DELV CMPX UP TO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||461.25||| 77412|EAP|0333|RADIATION TREATMENT DELIV|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||461.25||| 77412|EAP|0333|RAD TRMT DELV CMPX UP TO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||461.25||| 77412|EAP|0333|RADIATION TREATMENT DELIV|United Healthcare|UNITED HEALTHCARE|||||461.25||| 77412|EAP|0333|RAD TRMT DELV CMPX UP TO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||461.25||| 77412|EAP|0333|RADIATION TREATMENT DELIV|United Medicare Advantage|UHC MEDICARE GOLD MA|||||461.25||| 77412|EAP|0333|RAD TRMT DELV CMPX UP TO|Humana Medicare Advantage|HUMANA MA|||||461.25||| 77412|EAP|0333|RAD TRMT DELV CMPX UP TO|United Medicare Advantage|UHC AARP MCR HMO MA|||||461.25||| 77412|EAP|0333|RAD TRMT DELV CMPX UP TO|United Healthcare|TML GROUP BENEFITS|||||461.25||| 77412|EAP|0333|RAD TRMT DELV CMPX UP TO|Veterans Affairs|VETERANS ADMINISTRATION|||||461.25||| 77412|EAP|0333|RADIATION TREATMENT DELIV|Veterans Affairs|VETERANS ADMINISTRATION|||||461.25||| 77412|EAP|0333|RADIATION TREATMENT DELIV|Medicaid|MEDICAID|||||461.25||| 77412|EAP|0333|RAD TRMT DELV CMPX UP TO|Medicaid|HENDERSON COUNTY INDIGENT|||||461.25||| 77412|EAP|0333|RAD TRMT DELV CMPX UP TO|Medicare|MEDICARE ACUTE|||||461.25||| 77412|EAP|0333|RADIATION TREATMENT DELIV|Medicare|MEDICARE ACUTE|||||461.25||| 77412|EAP|0333|RADIATION TREATMENT DELIV|NON CONTRACTED|COMMERCIAL OTHER 2|||||461.25||| 77417|EAP|0333|THERAPEUTIC RADIOLOGY POR|Medicare|MEDICARE ACUTE|||||116.75||| 77417|EAP|0333|THERAPEUTIC RADIOLOGY POR|Medicaid|MEDICAID|||||116.75||| 77417|EAP|0333|THERAPEUTIC RADIOLOGY POR|Medicaid|HENDERSON COUNTY INDIGENT|||||116.75||| 77417|EAP|0333|THERAPEUTIC RADIOLOGY POR|Veterans Affairs|VETERANS ADMINISTRATION|||||116.75||| 77417|EAP|0333|THERAPEUTIC RADIOLOGY POR|United Medicare Advantage|UHC AARP MCR HMO MA|||||116.75||| 77417|EAP|0333|THERAPEUTIC RADIOLOGY POR|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||116.75||| 77417|EAP|0333|THERAPEUTIC RADIOLOGY POR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||116.75||| 77417|EAP|0333|THERAPEUTIC RADIOLOGY POR|United Healthcare|UNITED HEALTHCARE|||||116.75||| 77417|EAP|0333|THERAPEUTIC RADIOLOGY POR|United Healthcare|TML GROUP BENEFITS|||||116.75||| 77417|EAP|0333|THERAPEUTIC RADIOLOGY POR|Aenta Medicare Advantage|AETNA MEDICARE MA|||||116.75||| 77417|EAP|0333|THERAPEUTIC RADIOLOGY POR|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||116.75||| 77417|EAP|0333|THERAPEUTIC RADIOLOGY POR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||116.75||| 77417|EAP|0333|THERAPEUTIC RADIOLOGY POR|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||116.75||| 77417|EAP|0333|THERAPEUTIC RADIOLOGY POR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||116.75||| 77417|EAP|0333|THERAPEUTIC RADIOLOGY POR|Cigna|CIGNA|||||116.75||| 77417|EAP|0333|THERAPEUTIC RADIOLOGY POR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||116.75||| 77417|EAP|0333|THERAPEUTIC RADIOLOGY POR|Managed Medicare|BCBS MEDICARE PPO MA|||||116.75||| 77417|EAP|0333|THERAPEUTIC RADIOLOGY POR|Humana Medicare Advantage|HUMANA MA|||||116.75||| 77417|EAP|0333|THERAPEUTIC RADIOLOGY POR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||116.75||| 77417|EAP|0333|THERAPEUTIC RADIOLOGY POR|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||116.75||| 77417|EAP|0333|THERAPEUTIC RADIOLOGY POR|Blue Cross HMO Specialty|BCBSTX HMO|||||116.75||| 77417|EAP|0333|THERAPEUTIC RADIOLOGY POR|Managed Medicare|HEALTHSPRING MA|||||116.75||| 77417|EAP|0333|THERAPEUTIC RADIOLOGY POR|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||116.75||| 77417|EAP|0333|THERAPEUTIC RADIOLOGY POR|Blue Cross PPO Specialty|BCBSTX PPO|||||116.75||| 77470|EAP|0333|SPECIAL RADIATION TREATME|Humana Medicare Advantage|HUMANA MA|||||2,195.50||| 77470|EAP|0333|SPECIAL RADIATION TREATME|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2,195.50||| 77470|EAP|0333|SPECIAL RADIATION TREATME|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2,195.50||| 77470|EAP|0333|SPECIAL RADIATION TREATME|Managed Medicare|OTHER INSTITUTIONS|||||2,195.50||| 77470|EAP|0333|SPECIAL RADIATION TREATME|Blue Cross HMO Specialty|BCBSTX HMO|||||2,195.50||| 77470|EAP|0333|SPECIAL RADIATION TREATME|Blue Cross PPO Specialty|BCBSTX PPO|||||2,195.50||| 77470|EAP|0333|SPECIAL RADIATION TREATME|Cigna|CIGNA|||||2,195.50||| 77470|EAP|0333|SPECIAL RADIATION TREATME|Managed Medicare|HEALTHSPRING MA|||||2,195.50||| 77470|EAP|0333|SPECIAL RADIATION TREATME|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2,195.50||| 77470|EAP|0333|SPECIAL RADIATION TREATME|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2,195.50||| 77470|EAP|0333|SPECIAL RADIATION TREATME|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2,195.50||| 77470|EAP|0333|SPECIAL RADIATION TREATME|Managed Medicare|BCBS MEDICARE PPO MA|||||2,195.50||| 77470|EAP|0333|SPECIAL RADIATION TREATME|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2,195.50||| 77470|EAP|0333|SPECIAL RADIATION TREATME|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2,195.50||| 77470|EAP|0519||Aetna|AETNA PPO|||||391.50||| 77470|EAP|0333|SPECIAL RADIATION TREATME|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2,195.50||| 77470|EAP|0333|SPECIAL RADIATION TREATME|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2,195.50||| 77470|EAP|0333|SPECIAL RADIATION TREATME|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2,195.50||| 77470|EAP|0333|SPECIAL RADIATION TREATME|United Healthcare|UNITED HEALTHCARE OTHER|||||2,195.50||| 77470|EAP|0333|SPECIAL RADIATION TREATME|United Medicare Advantage|UHC AARP MCR HMO MA|||||2,195.50||| 77470|EAP|0333|SPECIAL RADIATION TREATME|United Healthcare|UNITED HEALTHCARE|||||2,195.50||| 77470|EAP|0333|SPECIAL RADIATION TREATME|Veterans Affairs|VETERANS ADMINISTRATION|||||2,195.50||| 77470|EAP|0333|SPECIAL RADIATION TREATME|Medicaid|MEDICAID|||||2,195.50||| 77470|EAP|0333|SPECIAL RADIATION TREATME|Aetna|AETNA PPO|||||2,195.50||| 77470|EAP|0333|SPECIAL RADIATION TREATME|NON CONTRACTED|COMMERCIAL OTHER 1|||||2,195.50||| 77470|EAP|0333|SPECIAL RADIATION TREATME|Medicare|MEDICARE ACUTE|||||2,195.50||| 77470|EAP|0333|SPECIAL RADIATION TREATME|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2,195.50||| 776|DRG||POSTPARTUM & POST ABORTION DIAGNOSES W/O O.R. PROCEDURE|Blue Cross PPO Specialty|BCBSTX PPO|85,548.50|3306.2|3753.2|3103.395|||| 776|DRG||POSTPARTUM & POST ABORTION DIAGNOSES W/O O.R. PROCEDURE|Managed Medicaid|MEDICAID AMERIGROUP|40,336.75|3753.2|3753.2|3103.395|||| 776|DRG||POSTPARTUM & POST ABORTION DIAGNOSES W/O O.R. PROCEDURE|Managed Medicaid|MEDICAID SUPERIOR|30,408.93|3103.395|3753.2|3103.395|||| 78012|EAP|0341|SCAN, THYROID UPTAKE & SC|Managed Medicare|HEALTHSPRING MA|||||16.03||| 78012|EAP|0341|SCAN, THYROID UPTAKE & SC|Medicare|MEDICARE ACUTE|||||16.03||| 78012|EAP|0341|SCAN, THYROID UPTAKE & SC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||16.03||| 78012|EAP|0341|SCAN, THYROID UPTAKE & SC|United Healthcare|UNITED HEALTHCARE|||||16.03||| 78012|EAP|0341|SCAN, THYROID UPTAKE & SC|Humana Medicare Advantage|HUMANA MA|||||16.03||| 78012|EAP|0341|SCAN, THYROID UPTAKE & SC|Cigna|CIGNA|||||16.03||| 78012|EAP|0341|SCAN, THYROID UPTAKE & SC|Blue Cross PPO Specialty|BCBSTX PPO|||||16.03||| 78070|EAP|0341|PARATHYROID IMAGING|Blue Cross PPO Specialty|BCBSTX PPO|||||1,560.25||| 78070|EAP|0341|PARATHYROID IMAGING|Medicare|MEDICARE ACUTE|||||1,560.25||| 78070|EAP|0341|PARATHYROID IMAGING|Humana Medicare Advantage|HUMANA MA|||||1,560.25||| 78070|EAP|0341|PARATHYROID IMAGING|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,560.25||| 78226|EAP|0341|SCAN, LIVER/BILE DUCT|Medicaid|HENDERSON COUNTY INDIGENT|||||2,070.75||| 78226|EAP|0341|SCAN, LIVER/BILE DUCT|Tricare|TRICARE EAST REGION|2,070.75||||||| 78226|EAP|0341|SCAN, LIVER/BILE DUCT|Medicare|MEDICARE ACUTE|2,070.75||||2,070.75||| 78226|EAP|0341|SCAN, LIVER/BILE DUCT|Veterans Affairs|VETERANS ADMINISTRATION|2,070.75||||||| 78226|EAP|0341|SCAN, LIVER/BILE DUCT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2,070.75||||||| 78226|EAP|0341|SCAN, LIVER/BILE DUCT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2,070.75||||||| 78226|EAP|0341|SCAN, LIVER/BILE DUCT|Managed Medicare|HEALTHSPRING MA|2,070.75||||||| 78226|EAP|0341|SCAN, LIVER/BILE DUCT|Blue Cross PPO Specialty|BCBSTX PPO|2,070.75||||2,070.75||| 78226|EAP|0341|SCAN, LIVER/BILE DUCT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2,070.75||| 78226|EAP|0341|SCAN, LIVER/BILE DUCT|Humana Medicare Advantage|HUMANA MA|2,070.75||||||| 78226|EAP|0341|SCAN, LIVER/BILE DUCT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2,070.75||||||| 78226|EAP|0341|SCAN, LIVER/BILE DUCT|United Healthcare|UNITED HEALTHCARE|||||2,070.75||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2,070.75||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2,070.75||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2,070.75||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|Access Direct Platinum|HEALTHFIRST TPA UMR|||||2,070.75||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|Blue Cross PPO Specialty|BCBSTX PPO|||||2,070.75||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|Blue Cross HMO Specialty|BCBSTX HMO|||||2,070.75||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|Cigna|CIGNA|||||2,070.75||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|Humana Medicare Advantage|HUMANA MA|||||2,070.75||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2,070.75||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2,070.75||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|Managed Medicaid|MEDICAID SUPERIOR|2,070.75||||2,070.75||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2,070.75||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2,070.75||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|Managed Medicare|BCBS MEDICARE PPO MA|||||2,070.75||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|Managed Medicare|HEALTHSPRING MA|2,070.75||||2,070.75||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2,070.75||||2,070.75||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|United Healthcare|UNITED HEALTHCARE OTHER|2,070.75||||||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|United Healthcare|UNITED HEALTHCARE|||||2,070.75||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2,070.75||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2,070.75||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2,070.75||||2,070.75||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|United Healthcare|TML GROUP BENEFITS|||||2,070.75||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|Tricare|TRICARE EAST REGION|||||2,070.75||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|NON CONTRACTED|COMMERCIAL OTHER 1|||||2,070.75||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|Medicare|MEDICARE ACUTE|2,070.75||||2,070.75||| 78227|EAP|0341|SCAN GB PROV/KINEVAC EF|Medicaid|HENDERSON COUNTY INDIGENT|2,070.75||||||| 78264|EAP|0341|SCAN, GASTRIC EMPTYING|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,685.50||| 78264|EAP|0341|SCAN, GASTRIC EMPTYING|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1,685.50||| 78264|EAP|0341|SCAN, GASTRIC EMPTYING|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,685.50||| 78264|EAP|0341|SCAN, GASTRIC EMPTYING|Medicare|MEDICARE ACUTE|||||1,685.50||| 78264|EAP|0341|SCAN, GASTRIC EMPTYING|Managed Medicaid|MEDICAID SUPERIOR|||||1,685.50||| 78264|EAP|0341|SCAN, GASTRIC EMPTYING|Humana Medicare Advantage|HUMANA MA|1,685.50||||||| 78264|EAP|0341|SCAN, GASTRIC EMPTYING|Blue Cross HMO Specialty|BCBSTX HMO|||||1,685.50||| 78264|EAP|0341|SCAN, GASTRIC EMPTYING|Cigna|CIGNA|||||1,685.50||| 78264|EAP|0341|SCAN, GASTRIC EMPTYING|Blue Cross PPO Specialty|BCBSTX PPO|||||1,685.50||| 78264|EAP|0341|SCAN, GASTRIC EMPTYING|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,685.50||| 78264|EAP|0341|SCAN, GASTRIC EMPTYING|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,685.50||| 78264|EAP|0341|SCAN, GASTRIC EMPTYING|Aetna|AETNA PPO|||||1,685.50||| 78264|EAP|0341|SCAN, GASTRIC EMPTYING|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1,685.50||| 78278|EAP|0341|SCAN, G I BLEEDING|Humana Medicare Advantage|HUMANA MA|20.90||||||| 78278|EAP|0341|SCAN, G I BLEEDING|Medicare|MEDICARE ACUTE|20.90||||||| 78290|EAP|0341|SCAN, MECKEL'S|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1,560.25||| 783|DRG||CESAREAN SECTION W STERILIZATION W MCC|Managed Medicaid|MEDICAID SUPERIOR|57,618.85|7262.26|7262.26|5051.59|||| 783|DRG||CESAREAN SECTION W STERILIZATION W MCC|Managed Medicaid|MEDICAID AMERIGROUP|26,250.10|5051.59|7262.26|5051.59|||| 78306|EAP|0341|SCAN, BONE|Veterans Affairs|VETERANS ADMINISTRATION|22.90||||22.90||| 78306|EAP|0341|SCAN, BONE|United Medicare Advantage|UHC AARP MCR HMO MA|||||22.90||| 78306|EAP|0341|SCAN, BONE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||22.90||| 78306|EAP|0341|SCAN, BONE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||22.90||| 78306|EAP|0341|SCAN, BONE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||22.90||| 78306|EAP|0341|SCAN, BONE|Aetna|AETNA PPO|||||22.90||| 78306|EAP|0341|SCAN, BONE|Cigna|CIGNA|||||22.90||| 78306|EAP|0341|SCAN, BONE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||22.90||| 78306|EAP|0341|SCAN, BONE|Managed Medicare|HEALTHSPRING MA|||||22.90||| 78306|EAP|0341|SCAN, BONE|Medicare|MEDICARE ACUTE|22.90||||22.90||| 78306|EAP|0341|SCAN, BONE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||22.90||| 78306|EAP|0341|SCAN, BONE|Managed Medicaid|MEDICAID SUPERIOR|||||22.90||| 78306|EAP|0341|SCAN, BONE|Managed Medicare|BCBS MEDICARE PPO MA|||||22.90||| 78306|EAP|0341|SCAN, BONE|Blue Cross PPO Specialty|BCBSTX PPO|||||22.90||| 78306|EAP|0341|SCAN, BONE|Humana Medicare Advantage|HUMANA MA|22.90||||22.90||| 78306|EAP|0341|SCAN, BONE|Blue Cross HMO Specialty|BCBSTX HMO|||||22.90||| 78306|EAP|0341|SCAN, BONE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||22.90||| 78306|EAP|0341|SCAN, BONE|United Healthcare|UNITED HEALTHCARE OTHER|||||22.90||| 78306|EAP|0341|SCAN, BONE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||22.90||| 78315|EAP|0341|SCAN, BONE 3-PHASE|Managed Medicare|HEALTHSPRING MA|||||3,011.75||| 78315|EAP|0341|SCAN, BONE 3-PHASE|Humana Medicare Advantage|HUMANA MA|||||3,011.75||| 78315|EAP|0341|SCAN, BONE 3-PHASE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3,011.75||| 78315|EAP|0341|SCAN, BONE 3-PHASE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||3,011.75||| 78315|EAP|0341|SCAN, BONE 3-PHASE|Medicare|MEDICARE ACUTE|3,011.75||||3,011.75||| 784|DRG||CESAREAN SECTION W STERILIZATION W CC|Medicaid|MEDICAID|32,287.20|3177.1|5962.68|37.8|||| 784|DRG||CESAREAN SECTION W STERILIZATION W CC|Medicaid|MEDICAID HMO|28,259.60|3177.1|5962.68|37.8|||| 784|DRG||CESAREAN SECTION W STERILIZATION W CC|Blue Cross HMO Specialty|BCBSTX HMO|13,543.85|4699.35|5962.68|37.8|||| 784|DRG||CESAREAN SECTION W STERILIZATION W CC|Blue Cross PPO Specialty|BCBSTX PPO|23,741.55|5529.24|5962.68|37.8|||| 784|DRG||CESAREAN SECTION W STERILIZATION W CC|Cigna|CIGNA|27,664.30|37.8|5962.68|37.8|||| 784|DRG||CESAREAN SECTION W STERILIZATION W CC|Managed Medicaid|MEDICAID AMERIGROUP|25,998.18|5051.59|5962.68|37.8|||| 784|DRG||CESAREAN SECTION W STERILIZATION W CC|Managed Medicaid|MEDICAID SUPERIOR|27,195.80|5051.59|5962.68|37.8|||| 784|DRG||CESAREAN SECTION W STERILIZATION W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|26,550.80|5962.68|5962.68|37.8|||| 78451|EAP|0341|MYO PERF/CARDIOLITE/STRES|Managed Medicaid|MEDICAID SUPERIOR|2,491.50||||2,491.50||| 78451|EAP|0341|MYO PER/CARDIOLITE REST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2,491.50||||||| 78451|EAP|0341|MYO PER/CARDIOLITE REST|Managed Medicaid|MEDICAID SUPERIOR|2,491.50||||2,491.50||| 78451|EAP|0341|MYO PERF/CARDIOLITE/STRES|Managed Medicare|HEALTHSPRING MA|2,491.50||||2,491.50||| 78451|EAP|0341|MYO PERF/CARDIOLITE/STRES|Humana Medicare Advantage|HUMANA MA|2,491.50||||2,491.50||| 78451|EAP|0341|MYO PER/CARDIOLITE REST|Humana Medicare Advantage|HUMANA MA|2,491.50||||2,491.50||| 78451|EAP|0341|MYO PERF/CARDIOLITE/STRES|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|2,491.50||||||| 78451|EAP|0341|MYO PERF/CARDIOLITE/STRES|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2,491.50||| 78451|EAP|0341|MYO PER/CARDIOLITE REST|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|2,491.50||||||| 78451|EAP|0341|MYO PER/CARDIOLITE REST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2,491.50||| 78451|EAP|0341|MYO PER/CARDIOLITE REST|Aenta Medicare Advantage|AETNA MEDICARE MA|2,491.50||||2,491.50||| 78451|EAP|0341|MYO PER/CARDIOLITE REST|Aetna|AETNA PPO|||||2,491.50||| 78451|EAP|0341|MYO PERF/CARDIOLITE/STRES|Aenta Medicare Advantage|AETNA MEDICARE MA|2,491.50||||2,491.50||| 78451|EAP|0341|MYO PER/CARDIOLITE REST|Blue Cross PPO Specialty|BCBSTX PPO|||||2,491.50||| 78451|EAP|0341|MYO PERF/CARDIOLITE/STRES|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2,491.50||| 78451|EAP|0341|MYO PERF/CARDIOLITE/STRES|Cigna|CIGNA|||||2,491.50||| 78451|EAP|0341|MYO PER/CARDIOLITE REST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2,491.50||| 78451|EAP|0341|MYO PERF/CARDIOLITE/STRES|Aetna|AETNA PPO|||||2,491.50||| 78451|EAP|0341|MYO PERF/CARDIOLITE/STRES|Blue Cross PPO Specialty|BCBSTX PPO|||||2,491.50||| 78451|EAP|0341|MYO PER/CARDIOLITE REST|Veterans Affairs|VETERANS ADMINISTRATION|2,491.50||||||| 78451|EAP|0341|MYO PERF/CARDIOLITE/STRES|Veterans Affairs|VETERANS ADMINISTRATION|2,491.50||||||| 78451|EAP|0341|MYO PERF/CARDIOLITE/STRES|United Medicare Advantage|UHC MEDICARE GOLD MA|2,491.50||||2,491.50||| 78451|EAP|0341|MYO PER/CARDIOLITE REST|United Healthcare|UNITED HEALTHCARE|||||2,491.50||| 78451|EAP|0341|MYO PERF/CARDIOLITE/STRES|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2,491.50||| 78451|EAP|0341|MYO PERF/CARDIOLITE/STRES|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2,491.50||||||| 78451|EAP|0341|MYO PERF/CARDIOLITE/STRES|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2,491.50||||||| 78451|EAP|0341|MYO PER/CARDIOLITE REST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2,491.50||| 78451|EAP|0341|MYO PER/CARDIOLITE REST|Managed Medicare|HEALTHSPRING MA|2,491.50||||2,491.50||| 78451|EAP|0341|MYO PER/CARDIOLITE REST|United Medicare Advantage|UHC MEDICARE GOLD MA|2,491.50||||2,491.50||| 78451|EAP|0341|MYO PERF/CARDIOLITE/STRES|United Healthcare|UNITED HEALTHCARE|||||2,491.50||| 78451|EAP|0341|MYO PER/CARDIOLITE REST|PHCS|HUMANA|||||2,491.50||| 78451|EAP|0341|MYO PERF/CARDIOLITE/STRES|NON CONTRACTED|COMMERCIAL OTHER 1|||||2,491.50||| 78451|EAP|0341|MYO PERF/CARDIOLITE/STRES|Medicare|MEDICARE ACUTE|2,491.50||||2,491.50||| 78451|EAP|0341|MYO PER/CARDIOLITE REST|NON CONTRACTED|COMMERCIAL OTHER 1|||||2,491.50||| 78451|EAP|0341|MYO PER/CARDIOLITE REST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2,491.50||| 78451|EAP|0341|MYO PER/CARDIOLITE REST|Medicare|MEDICARE ACUTE|2,491.50||||2,491.50||| 78451|EAP|0341|MYO PERF/CARDIOLITE/STRES|PHCS|HUMANA|||||2,491.50||| 78451|EAP|0341|MYO PERF/CARDIOLITE/STRES|Blue Cross HMO Specialty|BCBSTX HMO|2,491.50||||2,491.50||| 78451|EAP|0341|MYO PER/CARDIOLITE REST|Medicaid|HENDERSON COUNTY INDIGENT|||||2,491.50||| 78451|EAP|0341|MYO PER/CARDIOLITE REST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2,491.50||||||| 78451|EAP|0341|MYO PERF/CARDIOLITE/STRES|Medicaid|HENDERSON COUNTY INDIGENT|||||2,491.50||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R D|Medicare|MEDICARE ACUTE|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|Medicaid|MEDICAID|4,153.75||||||| 78452|EAP|0341|MYOCARDIO PERFUSON S&R TR|Tricare|TRICARE EAST REGION|||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|NON CONTRACTED|COMMERCIAL OTHER 1|||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSON S&R TR|Medicare|MEDICARE ACUTE|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|Medicare|MEDICARE ACUTE|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|Medicare|MEDICARE PART B ONLY IP|4,153.75||||||| 78452|EAP|0341|MYOCARDIO PERFUSON S&R TR|United Healthcare|UNITED HEALTHCARE|||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|United Healthcare|UNITED HEALTHCARE|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R D|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSON S&R TR|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|United Healthcare|UNITED HEALTHCARE|||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSON S&R TR|United Healthcare|UNITED HEALTHCARE|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|United Medicare Advantage|UHC AARP MCR HMO MA|||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|Medicaid|HENDERSON COUNTY INDIGENT|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSON S&R TR|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSON S&R TR|United Medicare Advantage|UHC MEDICARE GOLD MA|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|Veterans Affairs|VETERANS ADMINISTRATION|4,153.75||||||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|Veterans Affairs|VETERANS ADMINISTRATION|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSON S&R TR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSON S&R TR|Blue Cross PPO Specialty|BCBSTX PPO|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R D|Blue Cross PPO Specialty|BCBSTX PPO|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|Blue Cross HMO Specialty|BCBSTX HMO|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|Blue Cross PPO Specialty|BCBSTX PPO|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|Cigna|CIGNA OTHER|||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|Tricare|TRICARE EAST REGION|||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSON S&R TR|Cigna|CIGNA|||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSON S&R TR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSON S&R TR|Blue Cross HMO Specialty|BCBSTX HMO|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R D|Blue Cross HMO Specialty|BCBSTX HMO|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|Cigna|CIGNA|||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSON S&R TR|NON CONTRACTED|COMMERCIAL OTHER 1|||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSON S&R TR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|Aetna|AETNA OTHER|||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSON S&R TR|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|United Medicare Advantage|UHC MEDICARE GOLD MA|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSON S&R TR|Aetna|AETNA PPO|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSON S&R TR|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|Aetna|AETNA PPO|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|Humana Medicare Advantage|HUMANA MA|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSON S&R TR|Access Direct Platinum|HEALTHFIRST TPA UMR|||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSON S&R TR|Humana Medicare Advantage|HUMANA MA|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSON S&R TR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSON S&R TR|Managed Medicaid|MEDICAID AMERIGROUP|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|Managed Medicaid|MEDICAID SUPERIOR|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R D|Managed Medicare|HEALTHSPRING MA|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|Managed Medicare|BCBS MEDICARE PPO MA|||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSION S&R A|Managed Medicare|HEALTHSPRING MA|4,153.75||||4,153.75||| 78452|EAP|0341|MYOCARDIO PERFUSON S&R TR|Managed Medicare|HEALTHSPRING MA|4,153.75||||4,153.75||| 785|DRG||CESAREAN SECTION W STERILIZATION W/O CC/MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|197.57|3809.5|9350.25|37.8|||| 785|DRG||CESAREAN SECTION W STERILIZATION W/O CC/MCC|Managed Medicaid|MEDICAID AMERIGROUP|21,400.80|3809.5|9350.25|37.8|||| 785|DRG||CESAREAN SECTION W STERILIZATION W/O CC/MCC|Managed Medicaid|MEDICAID SUPERIOR|22,751.93|3809.5|9350.25|37.8|||| 785|DRG||CESAREAN SECTION W STERILIZATION W/O CC/MCC|Aetna|AETNA PPO|16,261.30|9350.25|9350.25|37.8|||| 785|DRG||CESAREAN SECTION W STERILIZATION W/O CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|294.95|4399.98|9350.25|37.8|||| 785|DRG||CESAREAN SECTION W STERILIZATION W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|21,096.85|4241.87|9350.25|37.8|||| 785|DRG||CESAREAN SECTION W STERILIZATION W/O CC/MCC|United Healthcare|UNITED HEALTHCARE|20,277.60|73.28|9350.25|37.8|||| 785|DRG||CESAREAN SECTION W STERILIZATION W/O CC/MCC|Medicaid|MEDICAID|15,893.80|2395.91|9350.25|37.8|||| 785|DRG||CESAREAN SECTION W STERILIZATION W/O CC/MCC|Medicaid|MOLINA HEALTHCARE OF TEXAS|23,087.25|3063.03|9350.25|37.8|||| 785|DRG||CESAREAN SECTION W STERILIZATION W/O CC/MCC|Medicaid|MEDICAID HMO|22,661.33|2395.91|9350.25|37.8|||| 785|DRG||CESAREAN SECTION W STERILIZATION W/O CC/MCC|Cigna|CIGNA|21,159.80|37.8|9350.25|37.8|||| 78580|EAP|0341|SCAN, LUNG STATIC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2,461.50||| 78580|EAP|0341|SCAN, LUNG STATIC|Medicare|MEDICARE ACUTE|2,461.50||||||| 78580|EAP|0341|SCAN, LUNG STATIC|Managed Medicare|BCBS MEDICARE PPO MA|2,461.50||||||| 786|DRG||CESAREAN SECTION W/O STERILIZATION W MCC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|23,082.30|12606.55|12606.55|3177.1|||| 786|DRG||CESAREAN SECTION W/O STERILIZATION W MCC|Managed Medicaid|MEDICAID SUPERIOR|27,101.55|7262.26|12606.55|3177.1|||| 786|DRG||CESAREAN SECTION W/O STERILIZATION W MCC|Managed Medicaid|MEDICAID AMERIGROUP|23,429.20|5051.59|12606.55|3177.1|||| 786|DRG||CESAREAN SECTION W/O STERILIZATION W MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|37,287.65|7262.26|12606.55|3177.1|||| 786|DRG||CESAREAN SECTION W/O STERILIZATION W MCC|Medicaid|MEDICAID|27,246.80|3177.1|12606.55|3177.1|||| 787|DRG||CESAREAN SECTION W/O STERILIZATION W CC|United Healthcare|UNITED HEALTHCARE|53,066.25|73.28|9055.92|73.28|||| 787|DRG||CESAREAN SECTION W/O STERILIZATION W CC|Medicaid|MEDICAID|33,140.30|3177.1|9055.92|73.28|||| 787|DRG||CESAREAN SECTION W/O STERILIZATION W CC|Medicaid|MEDICAID HMO|28,308.80|3177.1|9055.92|73.28|||| 787|DRG||CESAREAN SECTION W/O STERILIZATION W CC|Managed Medicaid|MEDICAID AMERIGROUP|30,768.55|5051.59|9055.92|73.28|||| 787|DRG||CESAREAN SECTION W/O STERILIZATION W CC|Managed Medicaid|MEDICAID SUPERIOR|21,904.55|5051.59|9055.92|73.28|||| 787|DRG||CESAREAN SECTION W/O STERILIZATION W CC|Blue Cross PPO Specialty|BCBSTX PPO|26,447.30|5423.88|9055.92|73.28|||| 787|DRG||CESAREAN SECTION W/O STERILIZATION W CC|ChampVA|CHAMPVA CENTER|20,785.90|5965.48|9055.92|73.28|||| 787|DRG||CESAREAN SECTION W/O STERILIZATION W CC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|20,681.55|9055.92|9055.92|73.28|||| 78707|EAP|0341|SCAN, RENAL W/PHARM|Blue Cross PPO Specialty|BCBSTX PPO|||||18.71||| 78707|EAP|0341|SCAN, RENAL COMP|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||18.71||| 78707|EAP|0341|SCAN, RENAL W/PHARM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||18.71||| 78707|EAP|0341|SCAN, RENAL W/PHARM|United Medicare Advantage|UHC MEDICARE GOLD MA|||||18.71||| 78707|EAP|0341|SCAN, RENAL COMP|Medicare|MEDICARE ACUTE|18.71||||18.71||| 78707|EAP|0341|SCAN, RENAL W/PHARM|Medicare|MEDICARE ACUTE|18.71||||18.71||| 78707|EAP|0341|SCAN, RENAL W/PHARM|Humana Medicare Advantage|HUMANA MA|||||18.71||| 78707|EAP|0341|SCAN, RENAL W/PHARM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||18.71||| 78707|EAP|0341|SCAN, RENAL COMP|Blue Cross PPO Specialty|BCBSTX PPO|||||18.71||| 788|DRG||CESAREAN SECTION W/O STERILIZATION W/O CC/MCC|Medicaid|MEDICAID|21,180.30|2395.91|13283.205|37.8|||| 788|DRG||CESAREAN SECTION W/O STERILIZATION W/O CC/MCC|United Healthcare|UMR UNITED MEDICAL RESOURCES|25,380.60|73.28|13283.205|37.8|||| 788|DRG||CESAREAN SECTION W/O STERILIZATION W/O CC/MCC|United Healthcare|UNITED HEALTHCARE|21,098.30|73.28|13283.205|37.8|||| 788|DRG||CESAREAN SECTION W/O STERILIZATION W/O CC/MCC|Tricare|TRICARE EAST REGION|22,570.55|4678.14|13283.205|37.8|||| 788|DRG||CESAREAN SECTION W/O STERILIZATION W/O CC/MCC|Medicaid|MEDICAID HMO|19,889.55|2395.91|13283.205|37.8|||| 788|DRG||CESAREAN SECTION W/O STERILIZATION W/O CC/MCC|United Healthcare|UNITED HEALTHCARE|24,309.05|73.28|13283.205|37.8|||| 788|DRG||CESAREAN SECTION W/O STERILIZATION W/O CC/MCC|NON CONTRACTED|COMMERCIAL OTHER 1|20,261.38|13283.205|13283.205|37.8|||| 788|DRG||CESAREAN SECTION W/O STERILIZATION W/O CC/MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|25,803.05|3809.5|13283.205|37.8|||| 788|DRG||CESAREAN SECTION W/O STERILIZATION W/O CC/MCC|Managed Medicaid|MEDICAID AMERIGROUP|23,681.90|3809.5|13283.205|37.8|||| 788|DRG||CESAREAN SECTION W/O STERILIZATION W/O CC/MCC|Managed Medicaid|MEDICAID SUPERIOR|22,438.05|3809.5|13283.205|37.8|||| 788|DRG||CESAREAN SECTION W/O STERILIZATION W/O CC/MCC|Aetna|AETNA PPO|204.91|11782.32|13283.205|37.8|||| 788|DRG||CESAREAN SECTION W/O STERILIZATION W/O CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|21,438.80|4687.24|13283.205|37.8|||| 788|DRG||CESAREAN SECTION W/O STERILIZATION W/O CC/MCC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|25,459.35|8084.78|13283.205|37.8|||| 788|DRG||CESAREAN SECTION W/O STERILIZATION W/O CC/MCC|Cigna|CIGNA|23,456.47|37.8|13283.205|37.8|||| 788|DRG||CESAREAN SECTION W/O STERILIZATION W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|23,191.58|4518.81|13283.205|37.8|||| 788|DRG||CESAREAN SECTION W/O STERILIZATION W/O CC/MCC|Blue Cross HMO Specialty|BCBSTX HMO|20,741.80|3840.58|13283.205|37.8|||| 789|DRG||NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY|Blue Cross HMO Specialty|BCBSTX HMO|8,472.35|20.42|1282.48|10.72|||| 789|DRG||NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|16,553.85|10.72|1282.48|10.72|||| 789|DRG||NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY|Managed Medicaid|MEDICAID AMERIGROUP|7,021.60|1282.48|1282.48|10.72|||| 789|DRG||NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY|Managed Medicaid|MEDICAID SUPERIOR|7,699.23|1282.48|1282.48|10.72|||| 789|DRG||NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY|Medicaid|MEDICAID|14,521.13|874.73|1282.48|10.72|||| 789|DRG||NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY|Medicaid|MEDICAID HMO|6,588.60|725.435|1282.48|10.72|||| 791|DRG||PREMATURITY W MAJOR PROBLEMS|Medicaid|MEDICAID HMO|34,452.50|9922.66|9922.66|9922.66|||| 792|DRG||PREMATURITY W/O MAJOR PROBLEMS|Managed Medicaid|MEDICAID SUPERIOR|5,521.48|849.615|17528.5|32.16|||| 792|DRG||PREMATURITY W/O MAJOR PROBLEMS|Managed Medicaid|MEDICAID AMERIGROUP|6,638.60|1176.62|17528.5|32.16|||| 792|DRG||PREMATURITY W/O MAJOR PROBLEMS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|9,975.60|17528.5|17528.5|32.16|||| 792|DRG||PREMATURITY W/O MAJOR PROBLEMS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|16,001.10|32.16|17528.5|32.16|||| 792|DRG||PREMATURITY W/O MAJOR PROBLEMS|Medicaid|MEDICAID|6,862.85|561.455|17528.5|32.16|||| 792|DRG||PREMATURITY W/O MAJOR PROBLEMS|Blue Cross PPO Specialty|BCBSTX PPO|7,328.60|3664.5|17528.5|32.16|||| 793|DRG||FULL TERM NEONATE W MAJOR PROBLEMS|United Healthcare|UMR UNITED MEDICAL RESOURCES|10,483.60|23.72|3383.03|23.72|||| 793|DRG||FULL TERM NEONATE W MAJOR PROBLEMS|Managed Medicaid|MEDICAID AMERIGROUP|19,265.85|3383.03|3383.03|23.72|||| 793|DRG||FULL TERM NEONATE W MAJOR PROBLEMS|Managed Medicaid|MEDICAID SUPERIOR|13,229.73|2419.945|3383.03|23.72|||| 794|DRG||NEONATE W OTHER SIGNIFICANT PROBLEMS|Medicaid|MEDICAID|5,368.35|618.47|1527.96|5.5|||| 794|DRG||NEONATE W OTHER SIGNIFICANT PROBLEMS|Cigna|CIGNA|3,750.10|5.5|1527.96|5.5|||| 794|DRG||NEONATE W OTHER SIGNIFICANT PROBLEMS|Managed Medicaid|MEDICAID SUPERIOR|6,777.73|1019.99|1527.96|5.5|||| 794|DRG||NEONATE W OTHER SIGNIFICANT PROBLEMS|Managed Medicaid|MEDICAID AMERIGROUP|6,751.10|1019.99|1527.96|5.5|||| 794|DRG||NEONATE W OTHER SIGNIFICANT PROBLEMS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9,542.50|21.44|1527.96|5.5|||| 794|DRG||NEONATE W OTHER SIGNIFICANT PROBLEMS|Medicaid|MEDICAID HMO|5,500.85|382.9|1527.96|5.5|||| 794|DRG||NEONATE W OTHER SIGNIFICANT PROBLEMS|United Healthcare|TML GROUP BENEFITS|4,913.10|39.04|1527.96|5.5|||| 794|DRG||NEONATE W OTHER SIGNIFICANT PROBLEMS|Blue Cross PPO Specialty|BCBSTX PPO|5,232.85|27.42|1527.96|5.5|||| 794|DRG||NEONATE W OTHER SIGNIFICANT PROBLEMS|Tricare|TRICARE EAST REGION|6,536.85|1527.96|1527.96|5.5|||| 795|DRG||NORMAL NEWBORN|United Healthcare|UNITED HEALTHCARE|4,272.98|12.36|3072.91|5.5|||| 795|DRG||NORMAL NEWBORN|Tricare|TRICARE EAST REGION|4,942.80|7.86|3072.91|5.5|||| 795|DRG||NORMAL NEWBORN|NON CONTRACTED|COMMERCIAL OTHER 1|4,032.35|2809.5|3072.91|5.5|||| 795|DRG||NORMAL NEWBORN|United Healthcare|UNITED HEALTHCARE|5,147.10|16.48|3072.91|5.5|||| 795|DRG||NORMAL NEWBORN|United Healthcare|UMR UNITED MEDICAL RESOURCES|6,474.10|16.48|3072.91|5.5|||| 795|DRG||NORMAL NEWBORN|PHCS|HUMANA|4,884.10|2809.5|3072.91|5.5|||| 795|DRG||NORMAL NEWBORN|Medicaid|MEDICAID HMO|5,114.10|382.9|3072.91|5.5|||| 795|DRG||NORMAL NEWBORN|Cigna|CIGNA OTHER|0.00||||||| 795|DRG||NORMAL NEWBORN|Medicaid|MEDICAID|5,030.98|382.9|3072.91|5.5|||| 795|DRG||NORMAL NEWBORN|Managed Medicaid|MEDICAID AMERIGROUP|5,155.48|608.81|3072.91|5.5|||| 795|DRG||NORMAL NEWBORN|Managed Medicaid|MEDICAID SUPERIOR|5,067.85|608.81|3072.91|5.5|||| 795|DRG||NORMAL NEWBORN|Aetna|AETNA PPO|5,013.85|2882.96|3072.91|5.5|||| 795|DRG||NORMAL NEWBORN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4,995.35|3072.91|3072.91|5.5|||| 795|DRG||NORMAL NEWBORN|Blue Cross HMO Specialty|BCBSTX HMO|4,937.85|786.28|3072.91|5.5|||| 795|DRG||NORMAL NEWBORN|Cigna|CIGNA|5,008.10|11|3072.91|5.5|||| 795|DRG||NORMAL NEWBORN|Cigna|CIGNA|3,074.35|5.5|3072.91|5.5|||| 795|DRG||NORMAL NEWBORN|Blue Cross PPO Specialty|BCBSTX PPO|5,023.48|925.13|3072.91|5.5|||| 795|DRG||NORMAL NEWBORN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5,340.85|959.62|3072.91|5.5|||| 796|DRG||VAGINAL DELIVERY W STERILIZATION/D&C W MCC|Managed Medicaid|MEDICAID SUPERIOR|29,163.05|3384.86|3384.86|3384.86|||| 798|DRG||VAGINAL DELIVERY W STERILIZATION/D&C W/O CC/MCC|Medicaid|MEDICAID|21,667.05|2047.26|4248.9|2047.26|||| 798|DRG||VAGINAL DELIVERY W STERILIZATION/D&C W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|23,169.43|4248.9|4248.9|2047.26|||| 798|DRG||VAGINAL DELIVERY W STERILIZATION/D&C W/O CC/MCC|Managed Medicaid|MEDICAID AMERIGROUP|32,646.55|3384.86|4248.9|2047.26|||| 798|DRG||VAGINAL DELIVERY W STERILIZATION/D&C W/O CC/MCC|Managed Medicaid|MEDICAID SUPERIOR|27,877.80|3255.14|4248.9|2047.26|||| 80048|EAP|0300|BASIC METABOLIC PANEL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Managed Medicaid|MEDICAID SUPERIOR|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Managed Medicaid|MEDICAID AMERIGROUP|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Managed Medicare|HEALTHSPRING MA|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Managed Medicare|WELLCARE CHOICE MA|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Managed Medicare|VAN ZANDT COUNTY INMATE|337.25||||||| 80048|EAP|0300|BASIC METABOLIC PANEL|Humana Medicare Advantage|HUMANA MA|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Managed Medicare|BCBS MEDICARE PPO MA|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Aenta Medicare Advantage|AETNA MEDICARE MA|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Aetna|BOON CHAPMAN|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Access Direct Platinum|HEALTHFIRST TPA UMR|||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Aetna|AETNA PPO|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Managed Medicare|MA PART B ONLY IP|337.25||||||| 80048|EAP|0300|BASIC METABOLIC PANEL|Cigna|CIGNA|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Blue Cross HMO Specialty|BCBSTX HMO|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|ChampVA|CHAMPVA CENTER|||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Blue Cross PPO Specialty|BCBSTX PPO|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Cigna|CIGNA OTHER|337.25||||||| 80048|EAP|0300|BASIC METABOLIC PANEL|MTC Medical|VAN ZANDT COUNTY INMATE|337.25||||||| 80048|EAP|0300|BASIC METABOLIC PANEL|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Veterans Affairs|VETERANS ADMINISTRATION|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Workers Compensation|WORKERS COMPENSATION OTHER|||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Workers Compensation|UT EMPLOYEE INJURY|337.25||||||| 80048|EAP|0300|BASIC METABOLIC PANEL|United Medicare Advantage|UHC AARP MCR HMO MA|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|United Medicare Advantage|UHC MEDICARE GOLD MA|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Tricare|TRICARE EAST REGION|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|UTMB|UTMB CORRECTIONAL MANAGED CARE|337.25||||||| 80048|EAP|0300|BASIC METABOLIC PANEL|Veterans Affairs|VETERANS ADMINISTRATION|337.25||||||| 80048|EAP|0300|BASIC METABOLIC PANEL|NON CONTRACTED|COMMERCIAL OTHER 1|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Medicare|MEDICARE PART B ONLY IP|337.25||||||| 80048|EAP|0300|BASIC METABOLIC PANEL|Managed Medicare|OTHER INSTITUTIONS|||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Texas Workforce Commission|DIS DETER SERV (DDS)|337.25||||||| 80048|EAP|0300|BASIC METABOLIC PANEL|United Healthcare|UNITED HEALTHCARE OTHER|337.25||||||| 80048|EAP|0300|BASIC METABOLIC PANEL|United Healthcare|UNITED HEALTHCARE|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Medicare|MEDICARE ACUTE|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|PHCS|HUMANA|||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|United Healthcare|TML GROUP BENEFITS|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|United Healthcare|UMR UNITED MEDICAL RESOURCES|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Medicaid|MEDICAID TEXAS CHILDRENS|||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Medicaid|LAW ENFORCEMENT OTHER|337.25||||||| 80048|EAP|0300|BASIC METABOLIC PANEL|Medicaid|MEDICAID|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Medicaid|MEDICAID HMO|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Medicaid|MOLINA HEALTHCARE OF TEXAS|337.25||||337.25||| 80048|EAP|0300|BASIC METABOLIC PANEL|Medicaid|COUNTY INDIGENT HEALTH OTHER|337.25||||||| 80048|EAP|0300|BASIC METABOLIC PANEL|Medicaid|HENDERSON COUNTY INDIGENT|337.25||||337.25||| 80051|EAP|0300|ELECTROLYTES PANEL|Managed Medicaid|MEDICAID SUPERIOR|279.50||||||| 80051|EAP|0300|ELECTROLYTES PANEL|Medicaid|MEDICAID HMO|||||279.50||| 80051|EAP|0300|ELECTROLYTES PANEL|Medicare|MEDICARE ACUTE|279.50||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Blue Cross PPO Specialty|BCBSTX PPO|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Cigna|CIGNA|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Brinson Benefits|THE HEALTH PLAN SMITH CO|||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Aenta Medicare Advantage|AETNA MEDICARE MA|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Aetna|BOON CHAPMAN|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Aetna|AETNA PPO|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Access Direct Platinum|HEALTHFIRST TPA UMR|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Cigna|CIGNA OTHER|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Aetna|AETNA OTHER|||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Humana Medicare Advantage|HUMANA MA|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Managed Medicaid|MEDICAID SUPERIOR|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Managed Medicare|HEALTHSPRING MA|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Managed Medicaid|MEDICAID UNITED HEALTHCARE|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Managed Medicaid|MEDICAID AMERIGROUP|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Blue Cross HMO Specialty|BCBSTX HMO|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Managed Medicare|WELLCARE CHOICE MA|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Managed Medicare|OTHER INSTITUTIONS|||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Managed Medicare|BCBS MEDICARE PPO MA|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Managed Medicare|HOSPICE OF EAST TEXAS|421.50||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|United Medicare Advantage|AARP UHC WEST COMPLETE MA|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|United Medicare Advantage|UHC MEDICARE GOLD MA|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Workers Compensation|WORKERS COMPENSATION OTHER|||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Workers Compensation|TEXAS MUTUAL INSURANCE|||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Veterans Affairs|VETERANS ADMINISTRATION|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Workers Compensation|UT EMPLOYEE INJURY|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Texas Workforce Commission|DIS DETER SERV (DDS)|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|PHCS|MULTIPLAN PHCS OTHER|||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|United Healthcare|UNITED HEALTHCARE OTHER|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Managed Medicare|HOSPICE ETMC|||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Managed Medicare|VAN ZANDT COUNTY INMATE|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|United Healthcare|GEHA|||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|United Medicare Advantage|UHC AARP WELLMED HMO MA|||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Tricare|TRICARE FOR LIFE|||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Blue Cross PPO Specialty|BCBSTX OTHER|||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|MTC Medical|VAN ZANDT COUNTY INMATE|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Managed Medicare|MA PART B ONLY IP|421.50||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|PHCS|HUMANA INSURANCE|||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|United Healthcare|GOLDEN RULE|||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|ChampVA|CHAMPVA CENTER|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|United Healthcare|UNITED HEALTHCARE|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Multiplan|NALC|||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|United Healthcare|UMR UNITED MEDICAL RESOURCES|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Medicare|MEDICARE PART B ONLY IP|421.50||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Tricare|TRICARE EAST REGION|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|NON CONTRACTED|COMMERCIAL OTHER 1|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|United Healthcare|TML GROUP BENEFITS|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Medicare|MEDICARE ACUTE|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|UTMB|UTMB CORRECTIONAL MANAGED CARE|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|NON CONTRACTED|COMMERCIAL OTHER 2|||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|PHCS|HUMANA|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|United Medicare Advantage|UHC AARP MCR HMO MA|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Medicaid|MEDICAID HMO|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Medicaid|MOLINA HEALTHCARE OF TEXAS|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Medicaid|LAW ENFORCEMENT OTHER|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Medicaid Out of State|MEDICAID LOUISIANA|||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Medicaid|MEDICAID TEXAS CHILDRENS|||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Medicaid|HENDERSON COUNTY INDIGENT|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Medicaid|MEDICAID|421.50||||421.50||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Medicaid|COUNTY INDIGENT HEALTH OTHER|421.50||||421.50||| 80061|EAP|0300|LIPID PANEL|Medicaid|MEDICAID|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|Medicaid|MOLINA HEALTHCARE OF TEXAS|5.34||||||| 80061|EAP|0300|LIPID PANEL|Medicaid|COUNTY INDIGENT HEALTH OTHER|5.34||||||| 80061|EAP|0300|LIPID PANEL|Tricare|TRICARE EAST REGION|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|United Healthcare|UMR UNITED MEDICAL RESOURCES|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|Medicare|MEDICARE ACUTE|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|Medicare|MEDICARE PART B ONLY IP|5.34||||||| 80061|EAP|0300|LIPID PANEL|UTMB|UTMB CORRECTIONAL MANAGED CARE|5.34||||||| 80061|EAP|0300|LIPID PANEL|United Healthcare|GEHA|||||5.34||| 80061|EAP|0300|LIPID PANEL|Veterans Affairs|VETERANS ADMINISTRATION|5.34||||||| 80061|EAP|0300|LIPID PANEL|United Medicare Advantage|UHC MEDICARE GOLD MA|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|Managed Medicaid|MEDICAID SUPERIOR|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|Managed Medicaid|MEDICAID AMERIGROUP|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|Managed Medicare|OTHER INSTITUTIONS|||||5.34||| 80061|EAP|0300|LIPID PANEL|NON CONTRACTED|COMMERCIAL OTHER 1|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|Managed Medicare|HEALTHSPRING MA|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|United Medicare Advantage|UHC AARP MCR HMO MA|||||5.34||| 80061|EAP|0300|LIPID PANEL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|Managed Medicare|WELLCARE CHOICE MA|5.34||||||| 80061|EAP|0300|LIPID PANEL|Managed Medicare|BCBS MEDICARE PPO MA|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|Humana Medicare Advantage|HUMANA MA|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|PHCS|HUMANA|||||5.34||| 80061|EAP|0300|LIPID PANEL|Aenta Medicare Advantage|AETNA MEDICARE MA|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||5.34||| 80061|EAP|0300|LIPID PANEL|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||5.34||| 80061|EAP|0300|LIPID PANEL|Aetna|AETNA PPO|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|United Healthcare|UNITED HEALTHCARE|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|Medicaid|HENDERSON COUNTY INDIGENT|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|Cigna|CIGNA OTHER|||||5.34||| 80061|EAP|0300|LIPID PANEL|Blue Cross PPO Specialty|BCBSTX PPO|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|Veterans Affairs|VETERANS ADMINISTRATION|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|Blue Cross HMO Specialty|BCBSTX HMO|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|ChampVA|CHAMPVA CENTER|||||5.34||| 80061|EAP|0300|LIPID PANEL|United Healthcare|UNITED HEALTHCARE OTHER|||||5.34||| 80061|EAP|0300|LIPID PANEL|Cigna|CIGNA|5.34||||5.34||| 80061|EAP|0300|LIPID PANEL|Blue Cross PPO Specialty|BCBSTX OTHER|||||5.34||| 80061|EAP|0300|LIPID PANEL|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||5.34||| 80061|EAP|0300|LIPID PANEL|Cigna|CIGNA|5.34||||||| 80061|EAP|0300|LIPID PANEL|United Healthcare|TML GROUP BENEFITS|5.34||||5.34||| 80069|EAP|0300|RENAL FUNCTION PANEL|Blue Cross PPO Specialty|BCBSTX PPO|||||3.46||| 80069|EAP|0300|RENAL FUNCTION PANEL|Aenta Medicare Advantage|AETNA MEDICARE MA|3.46||||3.46||| 80069|EAP|0300|RENAL FUNCTION PANEL|Aetna|AETNA PPO|||||3.46||| 80069|EAP|0300|RENAL FUNCTION PANEL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.46||| 80069|EAP|0300|RENAL FUNCTION PANEL|Humana Medicare Advantage|HUMANA MA|3.46||||3.46||| 80069|EAP|0300|RENAL FUNCTION PANEL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.46||| 80069|EAP|0300|RENAL FUNCTION PANEL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.46||| 80069|EAP|0300|RENAL FUNCTION PANEL|Managed Medicare|BCBS MEDICARE PPO MA|||||3.46||| 80069|EAP|0300|RENAL FUNCTION PANEL|Managed Medicare|MEDICARE RAILROAD|||||3.46||| 80069|EAP|0300|RENAL FUNCTION PANEL|Managed Medicare|HEALTHSPRING MA|3.46||||3.46||| 80069|EAP|0300|RENAL FUNCTION PANEL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3.46||||3.46||| 80069|EAP|0300|RENAL FUNCTION PANEL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3.46||||3.46||| 80069|EAP|0300|RENAL FUNCTION PANEL|United Medicare Advantage|UHC MEDICARE GOLD MA|3.46||||3.46||| 80069|EAP|0300|RENAL FUNCTION PANEL|United Medicare Advantage|UHC AARP MCR HMO MA|3.46||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|Tricare|TRICARE EAST REGION|||||3.46||| 80069|EAP|0300|RENAL FUNCTION PANEL|Medicare|MEDICARE ACUTE|3.46||||3.46||| 80069|EAP|0300|RENAL FUNCTION PANEL|Medicaid|MEDICAID|||||3.46||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|United Healthcare|UNITED HEALTHCARE|||||325.50||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|NON CONTRACTED|COMMERCIAL OTHER 1|||||325.50||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Veterans Affairs|VETERANS ADMINISTRATION|325.50||||||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||325.50||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Medicare|MEDICARE ACUTE|325.50||||325.50||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||325.50||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|325.50||||325.50||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|United Medicare Advantage|UHC AARP MCR HMO MA|||||325.50||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|325.50||||||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Managed Medicare|HEALTHSPRING MA|325.50||||325.50||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||325.50||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Managed Medicaid|MEDICAID SUPERIOR|325.50||||325.50||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Medicaid|MEDICAID|325.50||||||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||325.50||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Humana Medicare Advantage|HUMANA MA|325.50||||325.50||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||325.50||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||325.50||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||325.50||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|325.50||||325.50||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||325.50||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||325.50||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Aetna|BOON CHAPMAN|||||325.50||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Aetna|AETNA PPO|325.50||||325.50||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Aenta Medicare Advantage|AETNA MEDICARE MA|325.50||||325.50||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Blue Cross HMO Specialty|BCBSTX HMO|||||325.50||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Blue Cross PPO Specialty|BCBSTX PPO|325.50||||325.50||| 80103|EAP|0300|DRUG SCREEN INDUSTRIAL CO|Workers Compensation|WORKERS COMPENSATION OTHER|||||47.75||| 80103|EAP|0300|DRUG SCREEN INDUSTRIAL CO|Managed Medicare|OTHER INSTITUTIONS|||||47.75||| 80150|EAP|0300|AMIKACIN(AMIKIN)|Medicare|MEDICARE ACUTE|||||600.50||| 80156|EAP|0300|CARBAMEZAPINE(TEGRETAL)|Blue Cross HMO Specialty|BCBSTX HMO|||||580.25||| 80156|EAP|0300|CARBAMEZAPINE(TEGRETAL)|Humana Medicare Advantage|HUMANA MA|||||580.25||| 80156|EAP|0300|CARBAMEZAPINE(TEGRETAL)|Managed Medicare|WELLCARE CHOICE MA|||||580.25||| 80156|EAP|0300|CARBAMEZAPINE(TEGRETAL)|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||580.25||| 80156|EAP|0300|CARBAMEZAPINE(TEGRETAL)|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||580.25||| 80156|EAP|0300|CARBAMEZAPINE(TEGRETAL)|Medicaid|LAW ENFORCEMENT OTHER|||||580.25||| 80156|EAP|0300|CARBAMEZAPINE(TEGRETAL)|Medicare|MEDICARE ACUTE|580.25||||580.25||| 80156|EAP|0300|CARBAMEZAPINE(TEGRETAL)|Aenta Medicare Advantage|AETNA MEDICARE MA|||||580.25||| 80156|EAP|0300|CARBAMEZAPINE(TEGRETAL)|PHCS|HUMANA INSURANCE|||||580.25||| 80158|EAP|0300|CYCLOSPORIN (CYA)|Medicare|MEDICARE ACUTE|||||719.25||| 80158|EAP|0300|CYCLOSPORIN (CYA)|Humana Medicare Advantage|HUMANA MA|719.25||||||| 80162|EAP|0300|DIGOXIN (LANOXIN)|Aenta Medicare Advantage|AETNA MEDICARE MA|528.75||||||| 80162|EAP|0300|DIGOXIN (LANOXIN)|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|528.75||||||| 80162|EAP|0300|DIGOXIN (LANOXIN)|Blue Cross HMO Specialty|BCBSTX HMO|528.75||||528.75||| 80162|EAP|0300|DIGOXIN (LANOXIN)|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||528.75||| 80162|EAP|0300|DIGOXIN (LANOXIN)|Blue Cross PPO Specialty|BCBSTX PPO|528.75||||528.75||| 80162|EAP|0300|DIGOXIN (LANOXIN)|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||528.75||| 80162|EAP|0300|DIGOXIN (LANOXIN)|Managed Medicare|BCBS MEDICARE PPO MA|528.75||||||| 80162|EAP|0300|DIGOXIN (LANOXIN)|Managed Medicare|HEALTHSPRING MA|528.75||||528.75||| 80162|EAP|0300|DIGOXIN (LANOXIN)|Managed Medicaid|MEDICAID UNITED HEALTHCARE|528.75||||528.75||| 80162|EAP|0300|DIGOXIN (LANOXIN)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|528.75||||||| 80162|EAP|0300|DIGOXIN (LANOXIN)|Managed Medicaid|MEDICAID SUPERIOR|||||528.75||| 80162|EAP|0300|DIGOXIN (LANOXIN)|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|528.75||||528.75||| 80162|EAP|0300|DIGOXIN (LANOXIN)|Managed Medicaid|MEDICAID AMERIGROUP|528.75||||||| 80162|EAP|0300|DIGOXIN (LANOXIN)|Humana Medicare Advantage|HUMANA MA|528.75||||528.75||| 80162|EAP|0300|DIGOXIN (LANOXIN)|United Medicare Advantage|AARP UHC WEST COMPLETE MA|528.75||||528.75||| 80162|EAP|0300|DIGOXIN (LANOXIN)|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||528.75||| 80162|EAP|0300|DIGOXIN (LANOXIN)|Medicaid|MEDICAID|528.75||||528.75||| 80162|EAP|0300|DIGOXIN (LANOXIN)|United Medicare Advantage|UHC MEDICARE GOLD MA|528.75||||528.75||| 80162|EAP|0300|DIGOXIN (LANOXIN)|Medicare|MEDICARE ACUTE|528.75||||528.75||| 80162|EAP|0300|DIGOXIN (LANOXIN)|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|528.75||||528.75||| 80164|EAP|0300|VALPROIC|Medicare|MEDICARE ACUTE|5.40||||5.40||| 80164|EAP|0300|VALPROIC|United Healthcare|UNITED HEALTHCARE|||||5.40||| 80164|EAP|0300|VALPROIC|Medicaid|MEDICAID HMO|||||5.40||| 80164|EAP|0300|VALPROIC|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||5.40||| 80164|EAP|0300|VALPROIC|Veterans Affairs|VETERANS ADMINISTRATION|||||5.40||| 80164|EAP|0300|VALPROIC|United Medicare Advantage|UHC AARP MCR HMO MA|||||5.40||| 80164|EAP|0300|VALPROIC|United Medicare Advantage|UHC MEDICARE GOLD MA|5.40||||5.40||| 80164|EAP|0300|VALPROIC|Humana Medicare Advantage|HUMANA MA|5.40||||5.40||| 80164|EAP|0300|VALPROIC|Medicaid|MEDICAID|||||5.40||| 80164|EAP|0300|VALPROIC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.40||||5.40||| 80164|EAP|0300|VALPROIC|Managed Medicaid|MEDICAID SUPERIOR|||||5.40||| 80164|EAP|0300|VALPROIC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|5.40||||5.40||| 80164|EAP|0300|VALPROIC|Managed Medicare|HEALTHSPRING MA|5.40||||5.40||| 80164|EAP|0300|VALPROIC|Managed Medicare|WELLCARE CHOICE MA|||||5.40||| 80164|EAP|0300|VALPROIC|Blue Cross PPO Specialty|BCBSTX PPO|||||5.40||| 80164|EAP|0300|VALPROIC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|5.40||||5.40||| 80164|EAP|0300|VALPROIC|Blue Cross HMO Specialty|BCBSTX HMO|||||5.40||| 80164|EAP|0300|VALPROIC|Aenta Medicare Advantage|AETNA MEDICARE MA|||||5.40||| 80164|EAP|0300|VALPROIC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||5.40||| 80164|EAP|0300|VALPROIC|Aetna|AETNA PPO|||||5.40||| 80170|EAP|0300|GENTAMICIN PEAK|Cigna|CIGNA|6.53||||||| 80170|EAP|0300|GENTAMICIN, TROUGH|Cigna|CIGNA|6.53||||||| 80170|EAP|0300|GENTAMICIN, TROUGH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|6.53||||||| 80170|EAP|0300|GENTAMICIN, TROUGH|Managed Medicaid|MEDICAID SUPERIOR|6.53||||||| 80170|EAP|0300|GENTAMICIN, TROUGH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|6.53||||||| 80170|EAP|0300|GENTAMICIN (RANDOM)|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|6.53||||||| 80170|EAP|0300|GENTAMICIN, TROUGH|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|6.53||||||| 80170|EAP|0300|GENTAMICIN, TROUGH|Medicare|MEDICARE ACUTE|6.53||||||| 80175|EAP|0300|LAMOTRIGINE LEVEL|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||719.25||| 80178|EAP|0300|LITHIUM|Managed Medicare|HEALTHSPRING MA|||||263.50||| 80178|EAP|0300|LITHIUM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||263.50||| 80178|EAP|0300|LITHIUM|Cigna|CIGNA|||||263.50||| 80178|EAP|0300|LITHIUM|Managed Medicaid|MEDICAID AMERIGROUP|263.50||||||| 80178|EAP|0300|LITHIUM|Blue Cross PPO Specialty|BCBSTX PPO|||||263.50||| 80178|EAP|0300|LITHIUM|Veterans Affairs|VETERANS ADMINISTRATION|263.50||||||| 80178|EAP|0300|LITHIUM|United Medicare Advantage|UHC AARP MCR HMO MA|||||263.50||| 80178|EAP|0300|LITHIUM|Medicare|MEDICARE ACUTE|263.50||||263.50||| 80184|EAP|0300|PHENOBARBITAL|Medicare|MEDICARE PART B ONLY IP|456.50||||||| 80184|EAP|0300|PHENOBARBITAL|Medicare|MEDICARE ACUTE|456.50||||456.50||| 80184|EAP|0300|PHENOBARBITAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||456.50||| 80184|EAP|0300|PHENOBARBITAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||456.50||| 80184|EAP|0300|PHENOBARBITAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||456.50||| 80184|EAP|0300|PHENOBARBITAL|Blue Cross HMO Specialty|BCBSTX HMO|||||456.50||| 80184|EAP|0300|PHENOBARBITAL|Aetna|AETNA PPO|||||456.50||| 80184|EAP|0300|PHENOBARBITAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||456.50||| 80184|EAP|0300|PHENOBARBITAL|Humana Medicare Advantage|HUMANA MA|456.50||||||| 80184|EAP|0300|PHENOBARBITAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||456.50||| 80185|EAP|0300|DILANTIN (PHENYTOIN)|Managed Medicare|HEALTHSPRING MA|||||528.25||| 80185|EAP|0300|DILANTIN (PHENYTOIN)|Managed Medicaid|MEDICAID UNITED HEALTHCARE|528.25||||528.25||| 80185|EAP|0300|DILANTIN (PHENYTOIN)|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||528.25||| 80185|EAP|0300|DILANTIN (PHENYTOIN)|Humana Medicare Advantage|HUMANA MA|528.25||||528.25||| 80185|EAP|0300|DILANTIN (PHENYTOIN)|Blue Cross PPO Specialty|BCBSTX PPO|528.25||||||| 80185|EAP|0300|DILANTIN (PHENYTOIN)|United Medicare Advantage|AARP UHC WEST COMPLETE MA|528.25||||528.25||| 80185|EAP|0300|DILANTIN (PHENYTOIN)|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||528.25||| 80185|EAP|0300|DILANTIN (PHENYTOIN)|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||528.25||| 80185|EAP|0300|DILANTIN (PHENYTOIN)|Medicare|MEDICARE ACUTE|528.25||||528.25||| 80197|EAP|0300|TACROLIMAS (PROGAFT)|Medicare|MEDICARE ACUTE|546.75||||546.75||| 80197|EAP|0300|TACROLIMAS (PROGAFT)|Humana Medicare Advantage|HUMANA MA|546.75||||||| 80197|EAP|0300|TACROLIMAS (PROGAFT)|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||546.75||| 80197|EAP|0300|TACROLIMAS (PROGAFT)|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||546.75||| 80198|EAP|0300|THEOPHYLLINE LEVEL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||563.75||| 80198|EAP|0300|THEOPHYLLINE LEVEL|Medicare|MEDICARE ACUTE|||||563.75||| 80200|EAP|0300|TOBRAMYCIN TROUGH|Humana Medicare Advantage|HUMANA MA|642.25||||||| 80200|EAP|0300|TOBRAMYCIN TROUGH|Medicare|MEDICARE ACUTE|642.25||||||| 80200|EAP|0300|TOBRAMYCIN TROUGH|United Medicare Advantage|AARP UHC WEST COMPLETE MA|642.25||||||| 80201|EAP|0300|TOPAMAX|Medicaid|MEDICAID HMO|||||474.75||| 80201|EAP|0300|TOPAMAX|Tricare|TRICARE EAST REGION|||||474.75||| 80202|EAP|0300|VANCOMYCIN TROUGH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.40||||||| 80202|EAP|0300|VANCOMYCIN TROUGH|Aetna|AETNA PPO|5.40||||||| 80202|EAP|0300|VANCOMYCIN TROUGH|Aenta Medicare Advantage|AETNA MEDICARE MA|5.40||||||| 80202|EAP|0300|VANCOMYCIN TROUGH|Blue Cross HMO Specialty|BCBSTX HMO|5.40||||||| 80202|EAP|0300|VANCOMYCIN TROUGH|Cigna|CIGNA|5.40||||||| 80202|EAP|0300|VANCOMYCIN TROUGH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|5.40||||5.40||| 80202|EAP|0300|VANCOMYCIN TROUGH|Managed Medicaid|MEDICAID SUPERIOR|5.40||||5.40||| 80202|EAP|0300|VANCOMYCIN TROUGH|Managed Medicare|BCBS MEDICARE PPO MA|5.40||||||| 80202|EAP|0300|VANCOMYCIN TROUGH|Managed Medicaid|MEDICAID AMERIGROUP|5.40||||||| 80202|EAP|0300|VANCOMYCIN TROUGH|Blue Cross PPO Specialty|BCBSTX PPO|5.40||||||| 80202|EAP|0300|VANCOMYCIN TROUGH|Managed Medicare|HEALTHSPRING MA|5.40||||||| 80202|EAP|0300|VANCOMYCIN|Managed Medicare|HEALTHSPRING MA|5.40||||||| 80202|EAP|0300|VANCOMYCIN TROUGH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.40||||||| 80202|EAP|0300|VANCOMYCIN TROUGH|Humana Medicare Advantage|HUMANA MA|5.40||||||| 80202|EAP|0300|VANCOMYCIN TROUGH|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|5.40||||||| 80202|EAP|0300|VANCOMYCIN TROUGH|Cigna|CIGNA OTHER|5.40||||||| 80202|EAP|0300|VANCOMYCIN TROUGH|Veterans Affairs|VETERANS ADMINISTRATION|5.40||||||| 80202|EAP|0300|VANCOMYCIN TROUGH|United Medicare Advantage|AARP UHC WEST COMPLETE MA|5.40||||5.40||| 80202|EAP|0300|VANCOMYCIN|Humana Medicare Advantage|HUMANA MA|5.40||||||| 80202|EAP|0300|VANCOMYCIN TROUGH|United Medicare Advantage|UHC MEDICARE GOLD MA|5.40||||||| 80202|EAP|0300|VANCOMYCIN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|5.40||||5.40||| 80202|EAP|0300|VANCOMYCIN|NON CONTRACTED|COMMERCIAL OTHER 1|5.40||||5.40||| 80202|EAP|0300|VANCOMYCIN TROUGH|Tricare|TRICARE EAST REGION|5.40||||||| 80202|EAP|0300|VANCOMYCIN TROUGH|United Healthcare|UNITED HEALTHCARE|5.40||||||| 80202|EAP|0300|VANCOMYCIN TROUGH|United Healthcare|UMR UNITED MEDICAL RESOURCES|5.40||||||| 80202|EAP|0300|VANCOMYCIN PEAK|Medicare|MEDICARE ACUTE|5.40||||5.40||| 80202|EAP|0300|VANCOMYCIN TROUGH|NON CONTRACTED|COMMERCIAL OTHER 1|5.40||||5.40||| 80202|EAP|0300|VANCOMYCIN TROUGH|Medicare|MEDICARE ACUTE|5.40||||5.40||| 80202|EAP|0300|VANCOMYCIN TROUGH|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|5.40||||||| 80202|EAP|0300|VANCOMYCIN TROUGH|Medicaid|COUNTY INDIGENT HEALTH OTHER|5.40||||||| 80202|EAP|0300|VANCOMYCIN TROUGH|Medicaid|HENDERSON COUNTY INDIGENT|5.40||||||| 80202|EAP|0300|VANCOMYCIN TROUGH|Medicaid|MEDICAID|5.40||||||| 80202|EAP|0300|VANCOMYCIN TROUGH|Medicaid|MOLINA HEALTHCARE OF TEXAS|5.40||||||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Managed Medicaid|MEDICAID UNITED HEALTHCARE|806.25||||806.25||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Managed Medicaid|MEDICAID SUPERIOR|806.25||||806.25||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|806.25||||806.25||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|Managed Medicare|BCBS MEDICARE PPO MA|||||2.83||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|806.25||||806.25||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|548.75||||806.25||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Managed Medicare|WELLCARE CHOICE MA|||||548.75||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|Managed Medicare|HEALTHSPRING MA|2.83||||2.83||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|Managed Medicare|HOSPICE OF EAST TEXAS|2.83||||||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|Managed Medicare|WELLCARE CHOICE MA|||||2.83||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Managed Medicare|HEALTHSPRING MA|548.75||||548.75||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|Blue Cross PPO Specialty|BCBSTX PPO|2.83||||2.83||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|ChampVA|CHAMPVA CENTER|||||548.75||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Cigna|CIGNA OTHER|548.75||||806.25||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Blue Cross PPO Specialty|BCBSTX OTHER|||||806.25||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Blue Cross PPO Specialty|BCBSTX OTHER|||||548.75||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|548.75||||548.75||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Blue Cross HMO Specialty|BCBSTX HMO|548.75||||548.75||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Blue Cross PPO Specialty|BCBSTX PPO|548.75||||548.75||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|548.75||||806.25||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Blue Cross PPO Specialty|BCBSTX PPO|806.25||||806.25||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|ChampVA|CHAMPVA CENTER|||||806.25||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Cigna|CIGNA|||||548.75||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Cigna|CIGNA OTHER|548.75||||548.75||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Cigna|CIGNA|||||806.25||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|Cigna|CIGNA OTHER|548.75||||2.83||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|548.75||||806.25||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|548.75||||2.83||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Access Direct Platinum|HEALTHFIRST TPA UMR|||||548.75||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.83||||2.83||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|Aenta Medicare Advantage|AETNA MEDICARE MA|548.75||||2.83||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Managed Medicaid|MEDICAID AMERIGROUP|548.75||||548.75||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|548.75||||548.75||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|Aetna|AETNA OTHER|||||2.83||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|548.75||||548.75||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Managed Medicare|BCBS MEDICARE PPO MA|||||548.75||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||548.75||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Blue Cross HMO Specialty|BCBSTX HMO|548.75||||806.25||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Aetna|AETNA OTHER|||||548.75||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|Managed Medicaid|MEDICAID AMERIGROUP|2.83||||2.83||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Aetna|AETNA PPO|548.75||||548.75||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|Cigna|CIGNA|||||2.83||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||548.75||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Aenta Medicare Advantage|AETNA MEDICARE MA|548.75||||548.75||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Aenta Medicare Advantage|AETNA MEDICARE MA|548.75||||806.25||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|ChampVA|CHAMPVA CENTER|||||2.83||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Aetna|AETNA PPO|548.75||||806.25||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|Aetna|AETNA PPO|548.75||||2.83||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Aetna|AETNA OTHER|||||806.25||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|806.25||||806.25||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|Medicaid|MEDICAID|2.83||||2.83||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Medicaid|LAW ENFORCEMENT OTHER|||||548.75||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Medicaid|COUNTY INDIGENT HEALTH OTHER|548.75||||||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|Medicaid|MEDICAID HMO|548.75||||2.83||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Medicaid|MEDICAID|548.75||||548.75||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Medicaid|MEDICAID HMO|548.75||||806.25||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Medicaid|MEDICAID HMO|548.75||||548.75||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Medicaid|MOLINA HEALTHCARE OF TEXAS|548.75||||806.25||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Medicaid|HENDERSON COUNTY INDIGENT|548.75||||548.75||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Medicaid|MEDICAID TEXAS CHILDRENS|||||548.75||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Medicaid|MOLINA HEALTHCARE OF TEXAS|548.75||||548.75||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Medicaid|MEDICAID TEXAS CHILDRENS|||||806.25||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.83||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Medicaid|MEDICAID|806.25||||806.25||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|NON CONTRACTED|COMMERCIAL OTHER 1|||||548.75||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|United Healthcare|UMR UNITED MEDICAL RESOURCES|806.25||||806.25||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Multiplan|NALC|||||548.75||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|PHCS|HUMANA|548.75||||548.75||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|NON CONTRACTED|COMMERCIAL OTHER 1|||||806.25||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|United Healthcare|UNITED HEALTHCARE OTHER|548.75||||2.83||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Tricare|TRICARE EAST REGION|548.75||||806.25||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.83||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Tricare|TRICARE FOR LIFE|||||548.75||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Medicare|MEDICARE ACUTE|806.25||||806.25||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|Medicare|MEDICARE ACUTE|2.83||||2.83||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Medicare|MEDICARE ACUTE|548.75||||548.75||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|United Healthcare|UNITED HEALTHCARE|548.75||||806.25||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|United Healthcare|UMR UNITED MEDICAL RESOURCES|548.75||||548.75||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|United Healthcare|UNITED HEALTHCARE|548.75||||548.75||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Tricare|TRICARE EAST REGION|548.75||||548.75||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|United Healthcare|UMR UNITED MEDICAL RESOURCES|2.83||||2.83||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|United Medicare Advantage|UHC AARP MCR HMO MA|||||548.75||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|United Healthcare|UNITED HEALTHCARE OTHER|548.75||||548.75||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|United Medicare Advantage|UHC AARP MCR HMO MA|||||2.83||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|806.25||||806.25||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|United Medicare Advantage|UHC MEDICARE GOLD MA|806.25||||806.25||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|United Medicare Advantage|AARP UHC WEST COMPLETE MA|806.25||||806.25||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|United Medicare Advantage|UHC AARP MCR HMO MA|||||806.25||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|548.75||||548.75||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|United Healthcare|UNITED HEALTHCARE OTHER|548.75||||806.25||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|United Medicare Advantage|UHC MEDICARE GOLD MA|548.75||||548.75||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|United Medicare Advantage|UHC MEDICARE GOLD MA|2.83||||2.83||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|United Medicare Advantage|AARP UHC WEST COMPLETE MA|548.75||||548.75||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.83||||2.83||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|United Healthcare|UNITED HEALTHCARE|548.75||||2.83||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.83||||2.83||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Workers Compensation|UT EMPLOYEE INJURY|||||548.75||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Veterans Affairs|VETERANS ADMINISTRATION|548.75||||548.75||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Veterans Affairs|VETERANS ADMINISTRATION|806.25||||806.25||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Medicaid|LAW ENFORCEMENT OTHER|||||806.25||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|Veterans Affairs|VETERANS ADMINISTRATION|2.83||||2.83||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Workers Compensation|WORKERS COMPENSATION OTHER|||||548.75||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||548.75||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Humana Medicare Advantage|HUMANA MA|548.75||||548.75||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Humana Medicare Advantage|HUMANA MA|806.25||||806.25||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|Humana Medicare Advantage|HUMANA MA|2.83||||2.83||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|MTC Medical|VAN ZANDT COUNTY INMATE|||||548.75||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Managed Medicare|VAN ZANDT COUNTY INMATE|||||548.75||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Managed Medicaid|MEDICAID SUPERIOR|548.75||||548.75||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||806.25||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Managed Medicaid|MEDICAID UNITED HEALTHCARE|548.75||||548.75||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|548.75||||2.83||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|548.75||||548.75||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Managed Medicare|WELLCARE CHOICE MA|||||806.25||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|Medicaid|LAW ENFORCEMENT OTHER|||||2.83||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Managed Medicare|MA PART B ONLY IP|548.75||||||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Managed Medicare|HOSPICE OF EAST TEXAS|806.25||||||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Managed Medicaid|MEDICAID AMERIGROUP|806.25||||806.25||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|548.75||||548.75||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.83||||2.83||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.83||||2.83||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Managed Medicare|HEALTHSPRING MA|806.25||||806.25||| 80307|EAP|0300|ACETAMINOPHEN (TYLENOL)|Managed Medicare|BCBS MEDICARE PPO MA|||||806.25||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Managed Medicare|OTHER INSTITUTIONS|||||36.75||| 80307|EAP|0300|URINE DRUG SCREEN UNITS 7|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|548.75||||548.75||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|Managed Medicaid|MEDICAID SUPERIOR|548.75||||2.83||| 80307|EAP|0300|SALICYLATES (ASPIRIN)|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.83||||2.83||| 80320|EAP|0300|ALCOHOL(ETOH)|Blue Cross PPO Specialty|BCBSTX PPO|430.50||||430.50||| 80320|EAP|0300|ALCOHOL(ETOH)|Cigna|CIGNA|||||430.50||| 80320|EAP|0300|ALCOHOL(ETOH)|Blue Cross PPO Specialty|BCBSTX OTHER|||||430.50||| 80320|EAP|0300|ALCOHOL(ETOH)|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||430.50||| 80320|EAP|0300|ALCOHOL(ETOH)|Blue Cross HMO Specialty|BCBSTX HMO|430.50||||430.50||| 80320|EAP|0300|ALCOHOL(ETOH)|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||430.50||| 80320|EAP|0300|ALCOHOL(ETOH)|Managed Medicaid|MEDICAID SUPERIOR|430.50||||430.50||| 80320|EAP|0300|ALCOHOL(ETOH)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||430.50||| 80320|EAP|0300|ALCOHOL(ETOH)|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||430.50||| 80320|EAP|0300|ALCOHOL(ETOH)|Managed Medicaid|MEDICAID AMERIGROUP|430.50||||430.50||| 80320|EAP|0300|ALCOHOL(ETOH)|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||430.50||| 80320|EAP|0300|ALCOHOL(ETOH)|Medicare|MEDICARE ACUTE|||||430.50||| 80320|EAP|0300|ALCOHOL(ETOH)|Tricare|TRICARE EAST REGION|||||430.50||| 80320|EAP|0300|ALCOHOL(ETOH)|United Healthcare|UNITED HEALTHCARE|||||430.50||| 80320|EAP|0300|ALCOHOL(ETOH)|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||430.50||| 80320|EAP|0300|ALCOHOL(ETOH)|Medicaid|MEDICAID|430.50||||430.50||| 80320|EAP|0300|ALCOHOL(ETOH)|Medicaid|MEDICAID TEXAS CHILDRENS|||||430.50||| 80320|EAP|0300|ALCOHOL(ETOH)|Medicaid|MEDICAID HMO|||||430.50||| 80320|EAP|0300|ALCOHOL(ETOH)|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||430.50||| 80329|EAP|0300||Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2.83||| 80329|EAP|0300||Medicaid|MEDICAID HMO|||||2.83||| 80329|EAP|0300||Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.83||| 80329|EAP|0300||Medicaid|MEDICAID TEXAS CHILDRENS|||||2.83||| 80329|EAP|0300||Medicaid|MEDICAID|2.83||||2.83||| 80329|EAP|0300||Tricare|TRICARE EAST REGION|||||2.83||| 80329|EAP|0300||United Healthcare|UNITED HEALTHCARE|||||2.83||| 80329|EAP|0300||Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.83||| 80329|EAP|0300||Managed Medicaid|MEDICAID SUPERIOR|2.83||||2.83||| 80329|EAP|0300||Managed Medicaid|MEDICAID AMERIGROUP|2.83||||2.83||| 80329|EAP|0300||Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.83||| 80329|EAP|0300||Blue Cross PPO Specialty|BCBSTX OTHER|||||2.83||| 80329|EAP|0300||Blue Cross HMO Specialty|BCBSTX HMO|||||2.83||| 80329|EAP|0300||Blue Cross PPO Specialty|BCBSTX PPO|||||2.83||| 80329|EAP|0300||Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2.83||| 80329|EAP|0300||Cigna|CIGNA|||||2.83||| 80329|EAP|0300||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.83||| 80345|EAP|0300|UDS CONF-BARBITUATES|Managed Medicaid|MEDICAID SUPERIOR|527.75||||||| 80345|EAP|0300|UDS CONF-BARBITUATES|Medicaid|MEDICAID|527.75||||||| 80346|EAP|0300||United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|527.75||||||| 80346|EAP|0300||Medicare|MEDICARE ACUTE|527.75||||||| 80346|EAP|0300||Cigna|CIGNA|||||527.75||| 80346|EAP|0300||Blue Cross PPO Specialty|BCBSTX PPO|||||527.75||| 80346|EAP|0300||Managed Medicaid|MEDICAID UNITED HEALTHCARE|527.75||||||| 80346|EAP|0300||Managed Medicare|HEALTHSPRING MA|||||527.75||| 80346|EAP|0300||Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||527.75||| 80347|EAP|0300|UDS CONF-BENZOIN|Managed Medicare|OTHER INSTITUTIONS|||||52.50||| 80347|EAP|0300|UDS CONF-BENZOIN|Managed Medicaid|MEDICAID SUPERIOR|||||527.75||| 80347|EAP|0300|UDS CONF-BENZOIN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||527.75||| 80347|EAP|0300|UDS CONF-BENZOIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||527.75||| 80347|EAP|0300|UDS CONF-BENZOIN|Blue Cross PPO Specialty|BCBSTX PPO|||||527.75||| 80347|EAP|0300|UDS CONF-BENZOIN|Cigna|CIGNA|||||527.75||| 80347|EAP|0300|UDS CONF-BENZOIN|NON CONTRACTED|COMMERCIAL OTHER 1|||||527.75||| 80349|EAP|0300||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||719.25||| 80349|EAP|0300||Blue Cross PPO Specialty|BCBSTX PPO|||||719.25||| 80349|EAP|0300||Cigna|CIGNA|||||719.25||| 80349|EAP|0300||Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||719.25||| 80353|EAP|0300|GCMS CONFIRM COCAINE ON U|United Medicare Advantage|AARP UHC WEST COMPLETE MA|527.75||||||| 80353|EAP|0300|GCMS CONFIRM COCAINE ON U|Medicare|MEDICARE ACUTE|527.75||||||| 80353|EAP|0300|GCMS CONFIRM COCAINE ON U|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||527.75||| 80353|EAP|0300|GCMS CONFIRM COCAINE ON U|Cigna|CIGNA|||||527.75||| 80364|EAP|0300||Blue Cross PPO Specialty|BCBSTX PPO|||||527.75||| 80364|EAP|0300||Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||527.75||| 80364|EAP|0300||Managed Medicaid|MEDICAID AMERIGROUP|||||527.75||| 80364|EAP|0300||Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||527.75||| 80364|EAP|0300||NON CONTRACTED|COMMERCIAL OTHER 1|||||527.75||| 80375|EAP|0300||Medicaid|MEDICAID HMO|||||237.50||| 80375|EAP|0300||Medicaid|SUPERIOR HEALTHPLAN CHIP|||||237.50||| 80375|EAP|0300||Managed Medicaid|MEDICAID SUPERIOR|237.50||||237.50||| 80375|EAP|0300||Managed Medicaid|MEDICAID AMERIGROUP|||||237.50||| 80375|EAP|0300||Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||237.50||| 80375|EAP|0300||Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||237.50||| 80375|EAP|0300||Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||237.50||| 80375|EAP|0300||Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||237.50||| 80375|EAP|0300||Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||237.50||| 80375|EAP|0300||Cigna|CIGNA|||||237.50||| 80375|EAP|0300||Blue Cross PPO Specialty|BCBSTX PPO|||||237.50||| 805|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W MCC|Blue Cross PPO Specialty|BCBSTX PPO|16,013.93|5133.39|5133.39|2872.11|||| 805|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W MCC|Managed Medicaid|MEDICAID AMERIGROUP|19,276.30|2872.11|5133.39|2872.11|||| 805|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W MCC|Managed Medicaid|MEDICAID SUPERIOR|29,366.90|3598.09|5133.39|2872.11|||| 806|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W CC|Tricare|TRICARE EAST REGION|22,442.10|2921.24|4206.81|51.79|||| 806|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W CC|United Healthcare|UMR UNITED MEDICAL RESOURCES|18,288.50|51.79|4206.81|51.79|||| 806|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W CC|PHCS|HUMANA|17,261.75|106.38|4206.81|51.79|||| 806|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W CC|United Healthcare|UNITED HEALTHCARE|19,864.50|51.79|4206.81|51.79|||| 806|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W CC|Medicaid|MEDICAID HMO|16,470.35|1806.36|4206.81|51.79|||| 806|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W CC|Medicaid|MEDICAID|13,170.13|1806.36|4206.81|51.79|||| 806|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W CC|Managed Medicaid|MEDICAID SUPERIOR|17,412.50|2872.11|4206.81|51.79|||| 806|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W CC|Managed Medicaid|MEDICAID AMERIGROUP|16,730.25|2872.11|4206.81|51.79|||| 806|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|16,240.25|2872.11|4206.81|51.79|||| 806|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|14,038.50|4206.81|4206.81|51.79|||| 806|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W CC|Blue Cross PPO Specialty|BCBSTX PPO|16,486.45|3549.03|4206.81|51.79|||| 807|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC|Cigna|CIGNA OTHER|0.00||||||| 807|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC|Blue Cross HMO Specialty|BCBSTX HMO|170.00|2618.1|8773.475|29.4|||| 807|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC|Cigna|CIGNA|14,911.13|29.4|8773.475|29.4|||| 807|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC|Cigna|CIGNA|12,046.55|29.4|8773.475|29.4|||| 807|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|12,442.55|6136.92|8773.475|29.4|||| 807|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC|Aetna|AETNA PPO|139.28|8773.475|8773.475|29.4|||| 807|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|14,694.25|3195.26|8773.475|29.4|||| 807|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|145.46|6072.83|8773.475|29.4|||| 807|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|15,331.75|2777.125|8773.475|29.4|||| 807|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC|Managed Medicaid|MEDICAID AMERIGROUP|14,992.50|2404.03|8773.475|29.4|||| 807|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC|Managed Medicaid|MEDICAID SUPERIOR|14,703.75|2404.03|8773.475|29.4|||| 807|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC|Medicare|MEDICARE ACUTE|23,712.80|5979.53|8773.475|29.4|||| 807|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|14,855.63|3080.44|8773.475|29.4|||| 807|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC|Medicaid|MEDICAID|14,153.75|1511.97|8773.475|29.4|||| 807|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC|Medicaid|MOLINA HEALTHCARE OF TEXAS|201.62|1511.97|8773.475|29.4|||| 807|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC|Medicaid|MEDICAID HMO|145.63|1511.97|8773.475|29.4|||| 807|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC|NON CONTRACTED|COMMERCIAL OTHER 1|13,415.50|94.02|8773.475|29.4|||| 807|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC|United Healthcare|TML GROUP BENEFITS|15,894.25|51.79|8773.475|29.4|||| 807|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC|United Healthcare|UMR UNITED MEDICAL RESOURCES|17,687.50|51.79|8773.475|29.4|||| 807|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC|United Healthcare|UNITED HEALTHCARE|14,966.25|51.79|8773.475|29.4|||| 807|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC|Tricare|TRICARE EAST REGION|19,514.10|2232.19|8773.475|29.4|||| 807|DRG||VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC|United Healthcare|UNITED HEALTHCARE|11,121.25|51.79|8773.475|29.4|||| 808|DRG||MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W MCC|Medicare|MEDICARE ACUTE|1,480.19|15270.17|15270.17|15270.17|||| 809|DRG||MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W CC|ChampVA|CHAMPVA CENTER|35,292.85|4001.34|9789.1|4001.34|||| 809|DRG||MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W CC|United Medicare Advantage|UHC MEDICARE GOLD MA|41,624.55|9789.1|9789.1|4001.34|||| 809|DRG||MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W CC|Medicare|MEDICARE ACUTE|76,937.32|9712.44|9789.1|4001.34|||| 81001|EAP|0300|URINALYSIS W/MICRO|United Healthcare|GOLDEN RULE|||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Tricare|TRICARE FOR LIFE|||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|United Healthcare|GEHA|||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|PHCS|MULTIPLAN PHCS OTHER|||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|United Healthcare|UNITED HEALTHCARE OTHER|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|NON CONTRACTED|COMMERCIAL OTHER 1|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Medicare|MEDICARE ACUTE|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Medicare|MEDICARE PART B ONLY IP|117.50||||||| 81001|EAP|0300|URINALYSIS W/MICRO|United Healthcare|UNITED HEALTHCARE|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|PHCS|HUMANA|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Tricare|TRICARE EAST REGION|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|PHCS|HUMANA INSURANCE|||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|United Healthcare|UMR UNITED MEDICAL RESOURCES|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Medicaid|LAW ENFORCEMENT OTHER|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Medicaid Out of State|MEDICAID LOUISIANA|||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Medicaid|MEDICAID TEXAS CHILDRENS|||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Medicaid|MOLINA HEALTHCARE OF TEXAS|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Medicaid|MEDICAID|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Medicaid|COUNTY INDIGENT HEALTH OTHER|117.50||||||| 81001|EAP|0300|URINALYSIS W/MICRO|Medicaid|HENDERSON COUNTY INDIGENT|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Workers Compensation|TEXAS MUTUAL INSURANCE|||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Veterans Affairs|VETERANS ADMINISTRATION|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Workers Compensation|UT EMPLOYEE INJURY|||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|United Medicare Advantage|UHC AARP MCR HMO MA|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|United Medicare Advantage|UHC MEDICARE GOLD MA|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Humana Medicare Advantage|HUMANA MA|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Workers Compensation|WORKERS COMPENSATION OTHER|||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Medicaid|MEDICAID HMO|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|MTC Medical|VAN ZANDT COUNTY INMATE|||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Managed Medicare|BCBS MEDICARE PPO MA|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Managed Medicare|HEALTHSPRING MA|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Managed Medicare|HOSPICE OF EAST TEXAS|117.50||||||| 81001|EAP|0300|URINALYSIS W/MICRO|Medicaid|MEDICAID PCCM|||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Managed Medicare|OTHER INSTITUTIONS|||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Managed Medicaid|MEDICAID AMERIGROUP|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Managed Medicare|VAN ZANDT COUNTY INMATE|||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Managed Medicare|WELLCARE CHOICE MA|||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|NON CONTRACTED|COMMERCIAL OTHER 2|||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Managed Medicaid|MEDICAID SUPERIOR|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Managed Medicare|MA PART B ONLY IP|117.50||||||| 81001|EAP|0300|URINALYSIS W/MICRO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|UTMB|UTMB CORRECTIONAL MANAGED CARE|117.50||||||| 81001|EAP|0300|URINALYSIS W/MICRO|United Healthcare|TML GROUP BENEFITS|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Access Direct Platinum|HEALTHFIRST TPA UMR|||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Aetna|AETNA PPO|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Aetna|AETNA OTHER|||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Aenta Medicare Advantage|AETNA MEDICARE MA|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Aetna|BOON CHAPMAN|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Cigna|CIGNA|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Blue Cross PPO Specialty|BCBSTX OTHER|||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Blue Cross HMO Specialty|BCBSTX HMO|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Blue Cross PPO Specialty|BCBSTX PPO|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|ChampVA|CHAMPVA CENTER|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Brinson Benefits|THE HEALTH PLAN SMITH CO|||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Cigna|CIGNA OTHER|117.50||||117.50||| 81001|EAP|0300|URINALYSIS W/MICRO|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|117.50||||117.50||| 81002|EAP|0300|SPECIFIC GRAVITY|Blue Cross PPO Specialty|BCBSTX PPO|||||102.25||| 81002|EAP|0300|BILE URINE QUAL (DIPSTICK|Managed Medicaid|MEDICAID AMERIGROUP|||||102.25||| 81003|EAP|0300|PROTEIN QUAL URINE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||89.50||| 81003|EAP|0300|PROTEIN QUAL URINE|Medicare|MEDICARE ACUTE|89.50||||89.50||| 81003|EAP|0300|PROTEIN QUAL URINE|Humana Medicare Advantage|HUMANA MA|||||89.50||| 81003|EAP|0300|KETONE URINE|Managed Medicaid|MEDICAID SUPERIOR|||||89.50||| 81003|EAP|0300|PROTEIN QUAL URINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||89.50||| 81003|EAP|0300|PROTEIN QUAL URINE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||89.50||| 81003|EAP|0300|KETONE URINE|Managed Medicaid|MEDICAID AMERIGROUP|||||89.50||| 81015|EAP|0300|UA MICRO ONLY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||121.25||| 81015|EAP|0300|UA MICRO ONLY|Humana Medicare Advantage|HUMANA MA|||||121.25||| 81025|EAP|0300|UCG PREG.TEST|Medicaid|HENDERSON COUNTY INDIGENT|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Medicaid|MEDICAID HMO|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|United Healthcare|UNITED HEALTHCARE OTHER|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Tricare|TRICARE EAST REGION|2.52||||2.52||| 81025|EAP|0300|UCG PREG.TEST|United Healthcare|GEHA|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|United Healthcare|UNITED HEALTHCARE|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|United Healthcare|TML GROUP BENEFITS|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|NON CONTRACTED|COMMERCIAL OTHER 1|2.52||||2.52||| 81025|EAP|0300|UCG PREG.TEST|United Healthcare|UNITED HEALTHCARE|2.52||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Medicare|MEDICARE ACUTE|2.52||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Workers Compensation|UT EMPLOYEE INJURY|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Veterans Affairs|VETERANS ADMINISTRATION|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|United Medicare Advantage|UHC AARP MCR HMO MA|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Workers Compensation|WORKERS COMP PHYSICIAN|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Aetna|AETNA OTHER|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|United Healthcare|GOLDEN RULE|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.52||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Access Direct Platinum|HEALTHFIRST TPA UMR|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.52||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Aetna|AETNA PPO|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|PHCS|MULTIPLAN PHCS OTHER|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Blue Cross HMO Specialty|BCBSTX HMO|2.52||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Cigna|CIGNA|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Medicaid|MEDICAID|2.52||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|ChampVA|CHAMPVA CENTER|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Cigna|CIGNA OTHER|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Blue Cross PPO Specialty|BCBSTX PPO|2.52||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Humana Medicare Advantage|HUMANA MA|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|MTC Medical|VAN ZANDT COUNTY INMATE|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Managed Medicare|VAN ZANDT COUNTY INMATE|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Managed Medicare|HEALTHSPRING MA|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.52||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Managed Medicaid|MEDICAID SUPERIOR|2.52||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.52||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Managed Medicaid|MEDICAID AMERIGROUP|2.52||||2.52||| 81025|EAP|0300|UCG PREG.TEST|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||2.52||| 81050|EAP|0300|URIC ACID, 24 HR URINE (V|United Medicare Advantage|AARP UHC WEST COMPLETE MA|119.25||||||| 811|DRG||RED BLOOD CELL DISORDERS W MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|55,501.65|4359.37|10407.29|4359.37|||| 811|DRG||RED BLOOD CELL DISORDERS W MCC|UTMB|UTMB CORRECTIONAL MANAGED CARE|38,144.50|4629.42|10407.29|4359.37|||| 811|DRG||RED BLOOD CELL DISORDERS W MCC|Medicare|MEDICARE ACUTE|46,632.90|10407.29|10407.29|4359.37|||| 811|DRG||RED BLOOD CELL DISORDERS W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|43,768.25|10406.41|10407.29|4359.37|||| 812|DRG||RED BLOOD CELL DISORDERS W/O MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|52,550.40|7611.46|21182.7|925.08|||| 812|DRG||RED BLOOD CELL DISORDERS W/O MCC|Medicare|MEDICARE ACUTE|36,536.58|7498.26|21182.7|925.08|||| 812|DRG||RED BLOOD CELL DISORDERS W/O MCC|Medicaid|MEDICAID|31,715.25|2293.55|21182.7|925.08|||| 812|DRG||RED BLOOD CELL DISORDERS W/O MCC|NON CONTRACTED|COMMERCIAL OTHER 1|21,182.70|21182.7|21182.7|925.08|||| 812|DRG||RED BLOOD CELL DISORDERS W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|24,487.10|4431.01|21182.7|925.08|||| 812|DRG||RED BLOOD CELL DISORDERS W/O MCC|Cigna|CIGNA|22,666.80|925.08|21182.7|925.08|||| 812|DRG||RED BLOOD CELL DISORDERS W/O MCC|Aetna|AETNA PPO|20,075.06|11543.155|21182.7|925.08|||| 812|DRG||RED BLOOD CELL DISORDERS W/O MCC|Managed Medicare|HEALTHSPRING MA|122,616.05|13067.67|21182.7|925.08|||| 812|DRG||RED BLOOD CELL DISORDERS W/O MCC|Managed Medicaid|MEDICAID SUPERIOR|20,495.25|3646.74|21182.7|925.08|||| 812|DRG||RED BLOOD CELL DISORDERS W/O MCC|Humana Medicare Advantage|HUMANA MA|39,552.25|7476.6|21182.7|925.08|||| 812|DRG||RED BLOOD CELL DISORDERS W/O MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|40,989.81|5202.11|21182.7|925.08|||| 81219|EAP|0300|CALRETICULIN|Blue Cross HMO Specialty|BCBSTX HMO|||||13.05||| 81220|EAP|0300|CYSTIC FIBROSIS GENETIC T|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||405.50||| 81240|EAP|0300|PROTHROMBIN GENE|Medicare|MEDICARE ACUTE|10.43||||||| 81240|EAP|0300|PROTHROMBIN GENE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||10.43||| 81240|EAP|0300|PROTHROMBIN GENE|Managed Medicare|HEALTHSPRING MA|10.43||||||| 81240|EAP|0300|PROTHROMBIN GENE|Managed Medicare|BCBS MEDICARE PPO MA|||||10.43||| 81240|EAP|0300|PROTHROMBIN GENE|Managed Medicaid|MEDICAID AMERIGROUP|||||10.43||| 81240|EAP|0300|PROTHROMBIN GENE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|10.43||||||| 81240|EAP|0300|PROTHROMBIN GENE|Blue Cross HMO Specialty|BCBSTX HMO|||||10.43||| 81240|EAP|0300|PROTHROMBIN GENE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|10.43||||10.43||| 81240|EAP|0300|PROTHROMBIN GENE|Aenta Medicare Advantage|AETNA MEDICARE MA|10.43||||||| 81241|EAP|0300|LEIDEN V FACTOR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|8.07||||8.07||| 81241|EAP|0300|LEIDEN V FACTOR|Aenta Medicare Advantage|AETNA MEDICARE MA|8.07||||||| 81241|EAP|0300|LEIDEN V FACTOR|Aetna|AETNA PPO|||||8.07||| 81241|EAP|0300|LEIDEN V FACTOR|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|8.07||||||| 81241|EAP|0300|LEIDEN V FACTOR|Blue Cross HMO Specialty|BCBSTX HMO|||||8.07||| 81241|EAP|0300|LEIDEN V FACTOR|Managed Medicare|BCBS MEDICARE PPO MA|||||8.07||| 81241|EAP|0300|LEIDEN V FACTOR|Managed Medicaid|MEDICAID SUPERIOR|8.07||||||| 81241|EAP|0300|LEIDEN V FACTOR|Managed Medicaid|MEDICAID AMERIGROUP|||||8.07||| 81241|EAP|0300|LEIDEN V FACTOR|Managed Medicare|HEALTHSPRING MA|8.07||||||| 81241|EAP|0300|LEIDEN V FACTOR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||8.07||| 81241|EAP|0300|LEIDEN V FACTOR|Medicare|MEDICARE ACUTE|8.07||||8.07||| 81256|EAP|0300|HEREDITARY HEMOCHAROMATOS|Medicare|MEDICARE ACUTE|526.50||||||| 81256|EAP|0300|HEREDITARY HEMOCHAROMATOS|Blue Cross PPO Specialty|BCBSTX PPO|||||526.50||| 81270|EAP|0300|JAK 2|Cigna|CIGNA OTHER|1,081.50||||||| 81291|EAP|0300|MTHFR MUTATION PCR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||607.25||| 81291|EAP|0300|MTHFR MUTATION PCR|Medicaid|HENDERSON COUNTY INDIGENT|||||607.25||| 81291|EAP|0300|MTHFR MUTATION PCR|Medicare|MEDICARE ACUTE|||||607.25||| 81291|EAP|0300|MTHFR MUTATION PCR|Managed Medicaid|MEDICAID SUPERIOR|607.25||||||| 81291|EAP|0300|MTHFR MUTATION PCR|Managed Medicaid|MEDICAID AMERIGROUP|||||607.25||| 81291|EAP|0300|MTHFR MUTATION PCR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||607.25||| 81291|EAP|0300|MTHFR MUTATION PCR|Aetna|AETNA PPO|||||607.25||| 81291|EAP|0300|MTHFR MUTATION PCR|Blue Cross HMO Specialty|BCBSTX HMO|||||607.25||| 813|DRG||COAGULATION DISORDERS|Blue Cross PPO Specialty|BCBSTX PPO|701.33|8084.9|15837.73|8084.9|||| 813|DRG||COAGULATION DISORDERS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|128,197.70|8386.25|15837.73|8084.9|||| 813|DRG||COAGULATION DISORDERS|Humana Medicare Advantage|HUMANA MA|40,952.60|11901.21|15837.73|8084.9|||| 813|DRG||COAGULATION DISORDERS|United Healthcare|UNITED HEALTHCARE|39,790.25|15837.73|15837.73|8084.9|||| 813|DRG||COAGULATION DISORDERS|Medicare|MEDICARE ACUTE|67,064.03|11899.95|15837.73|8084.9|||| 81403|EAP|0300|MYELOPROLIFERATIVE LEUKEM|Blue Cross HMO Specialty|BCBSTX HMO|||||1,619.75||| 817|DRG||OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W MCC|Medicaid|MEDICAID HMO|34,527.65|10948.21|10948.21|10948.21|||| 818|DRG||OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W CC|Managed Medicaid|MEDICAID SUPERIOR|109.96|6666.31|6815.59|4192.65|||| 818|DRG||OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W CC|Blue Cross PPO Specialty|BCBSTX PPO|25,961.30|6815.59|6815.59|4192.65|||| 818|DRG||OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W CC|Medicaid|MEDICAID|35,296.25|4192.65|6815.59|4192.65|||| 819|DRG||OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W/O CC/MCC|United Healthcare|UNITED HEALTHCARE|36,872.85|12727.53|12727.53|2809.59|||| 819|DRG||OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W/O CC/MCC|Medicaid|MEDICAID|23,917.55|2809.59|12727.53|2809.59|||| 819|DRG||OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W/O CC/MCC|Managed Medicaid|MEDICAID SUPERIOR|14,764.25|4467.25|12727.53|2809.59|||| 820|DRG||LYMPHOMA & LEUKEMIA W MAJOR O.R. PROCEDURE W MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|180,127.14|37489.65|37489.65|37489.65|||| 82009|EAP|0300|ACETONE BLOOD|Veterans Affairs|VETERANS ADMINISTRATION|1.74||||1.74||| 82009|EAP|0300|ACETONE BLOOD|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.74||||1.74||| 82009|EAP|0300|ACETONE BLOOD|United Medicare Advantage|UHC MEDICARE GOLD MA|1.74||||1.74||| 82009|EAP|0300|ACETONE BLOOD|Medicaid|MEDICAID HMO|||||1.74||| 82009|EAP|0300|ACETONE BLOOD|Medicaid|MOLINA HEALTHCARE OF TEXAS|1.74||||1.74||| 82009|EAP|0300|ACETONE BLOOD|Medicaid|HENDERSON COUNTY INDIGENT|1.74||||||| 82009|EAP|0300|ACETONE BLOOD|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.74||| 82009|EAP|0300|ACETONE BLOOD|United Healthcare|UNITED HEALTHCARE|||||1.74||| 82009|EAP|0300|ACETONE BLOOD|United Healthcare|UNITED HEALTHCARE|1.74||||1.74||| 82009|EAP|0300|ACETONE BLOOD|Tricare|TRICARE EAST REGION|1.74||||1.74||| 82009|EAP|0300|ACETONE BLOOD|NON CONTRACTED|COMMERCIAL OTHER 1|1.74||||1.74||| 82009|EAP|0300|ACETONE BLOOD|Medicare|MEDICARE ACUTE|1.74||||1.74||| 82009|EAP|0300|ACETONE BLOOD|Managed Medicare|HEALTHSPRING MA|1.74||||1.74||| 82009|EAP|0300|ACETONE BLOOD|Medicaid|MEDICAID|1.74||||||| 82009|EAP|0300|ACETONE BLOOD|Managed Medicaid|MEDICAID AMERIGROUP|1.74||||1.74||| 82009|EAP|0300|ACETONE BLOOD|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|1.74||||1.74||| 82009|EAP|0300|ACETONE BLOOD|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.74||||1.74||| 82009|EAP|0300|ACETONE BLOOD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.74||||1.74||| 82009|EAP|0300|ACETONE BLOOD|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.74||||1.74||| 82009|EAP|0300|ACETONE BLOOD|Managed Medicaid|MEDICAID SUPERIOR|1.74||||1.74||| 82009|EAP|0300|ACETONE BLOOD|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.74||||1.74||| 82009|EAP|0300|ACETONE BLOOD|Managed Medicare|VAN ZANDT COUNTY INMATE|||||1.74||| 82009|EAP|0300|ACETONE BLOOD|Humana Medicare Advantage|HUMANA MA|1.74||||1.74||| 82009|EAP|0300|ACETONE BLOOD|MTC Medical|VAN ZANDT COUNTY INMATE|||||1.74||| 82009|EAP|0300|ACETONE BLOOD|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.74||| 82009|EAP|0300|ACETONE BLOOD|Blue Cross HMO Specialty|BCBSTX HMO|||||1.74||| 82009|EAP|0300|ACETONE BLOOD|Cigna|CIGNA|||||1.74||| 82009|EAP|0300|ACETONE BLOOD|Blue Cross PPO Specialty|BCBSTX PPO|1.74||||1.74||| 82009|EAP|0300|ACETONE BLOOD|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.74||| 82009|EAP|0300|ACETONE BLOOD|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.74||| 82009|EAP|0300|ACETONE BLOOD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.74||||1.74||| 82009|EAP|0300|ACETONE BLOOD|Aetna|AETNA PPO|||||1.74||| 82024|EAP|0300|ACTH(ADRENOCORTICOTROPIC)|Blue Cross PPO Specialty|BCBSTX PPO|13.82||||||| 82024|EAP|0300|ACTH(ADRENOCORTICOTROPIC)|Medicare|MEDICARE ACUTE|13.82||||||| 82024|EAP|0300|ACTH(ADRENOCORTICOTROPIC)|United Medicare Advantage|UHC MEDICARE GOLD MA|||||13.82||| 82040|EAP|0300|ALBUMIN (SERUM)|Veterans Affairs|VETERANS ADMINISTRATION|||||197.25||| 82040|EAP|0300|ALBUMIN (SERUM)|United Medicare Advantage|UHC MEDICARE GOLD MA|||||197.25||| 82040|EAP|0300|ALBUMIN (SERUM)|Medicare|MEDICARE ACUTE|197.25||||197.25||| 82040|EAP|0300|ALBUMIN (SERUM)|United Healthcare|UNITED HEALTHCARE|197.25||||||| 82040|EAP|0300|ALBUMIN (SERUM)|Humana Medicare Advantage|HUMANA MA|197.25||||||| 82040|EAP|0300|ALBUMIN (SERUM)|Managed Medicare|HEALTHSPRING MA|197.25||||||| 82040|EAP|0300|ALBUMIN (SERUM)|Managed Medicaid|MEDICAID SUPERIOR|197.25||||||| 82040|EAP|0300|ALBUMIN (SERUM)|Blue Cross PPO Specialty|BCBSTX PPO|||||197.25||| 82042|EAP|0300|ALBUMIN, BODY FLUID|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||145.50||| 82042|EAP|0300|ALBUMIN, BODY FLUID|Medicare|MEDICARE ACUTE|||||145.50||| 82043|EAP|0301|URINE MICROALBUMIN, RANDO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.25||| 82043|EAP|0301|URINE MICROALBUMIN, RANDO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.25||| 82043|EAP|0301|URINE MICROALBUMIN, RANDO|United Medicare Advantage|UHC AARP MCR HMO MA|||||0.25||| 82043|EAP|0301|URINE MICROALBUMIN, RANDO|United Healthcare|TML GROUP BENEFITS|||||0.25||| 82043|EAP|0301|URINE MICROALBUMIN, RANDO|United Healthcare|UNITED HEALTHCARE OTHER|||||0.25||| 82043|EAP|0300|URINE MICRO ALBUMIN RANDO|Veterans Affairs|VETERANS ADMINISTRATION|||||221.75||| 82043|EAP|0300|URINE MICRO ALBUMIN RANDO|Medicare|MEDICARE ACUTE|||||221.75||| 82043|EAP|0301|URINE MICROALBUMIN, RANDO|Tricare|TRICARE EAST REGION|||||0.25||| 82043|EAP|0301|URINE MICROALBUMIN, RANDO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.25||| 82043|EAP|0301|URINE MICROALBUMIN, RANDO|Medicare|MEDICARE ACUTE|||||0.25||| 82043|EAP|0301|URINE MICROALBUMIN, RANDO|Managed Medicare|BCBS MEDICARE PPO MA|||||0.25||| 82043|EAP|0301|URINE MICROALBUMIN, RANDO|Managed Medicare|HEALTHSPRING MA|||||0.25||| 82043|EAP|0301|URINE MICROALBUMIN, RANDO|Managed Medicaid|MEDICAID SUPERIOR|||||0.25||| 82043|EAP|0301|URINE MICROALBUMIN, RANDO|Managed Medicaid|MEDICAID AMERIGROUP|||||0.25||| 82043|EAP|0300|URINE MICRO ALBUMIN RANDO|Managed Medicare|HEALTHSPRING MA|||||221.75||| 82043|EAP|0301|URINE MICROALBUMIN, RANDO|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.25||| 82043|EAP|0301|URINE MICROALBUMIN, RANDO|Humana Medicare Advantage|HUMANA MA|0.25||||0.25||| 82043|EAP|0300|URINE MICRO ALBUMIN RANDO|Humana Medicare Advantage|HUMANA MA|||||221.75||| 82043|EAP|0301|URINE MICROALBUMIN, RANDO|Blue Cross PPO Specialty|BCBSTX PPO|||||0.25||| 82043|EAP|0301|URINE MICROALBUMIN, RANDO|Blue Cross HMO Specialty|BCBSTX HMO|||||0.25||| 82043|EAP|0300|URINE MICRO ALBUMIN RANDO|Blue Cross PPO Specialty|BCBSTX PPO|||||221.75||| 82043|EAP|0300|URINE MICRO ALBUMIN RANDO|Access Direct Platinum|HEALTHFIRST TPA UMR|||||221.75||| 82043|EAP|0301|URINE MICROALBUMIN, RANDO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.25||| 82043|EAP|0301|URINE MICROALBUMIN, RANDO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.25||| 82043|EAP|0301|URINE MICROALBUMIN, RANDO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.25||| 82088|EAP|0300|ALDOSTERONE|Humana Medicare Advantage|HUMANA MA|1,390.50||||||| 82088|EAP|0300|ALDOSTERONE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|1,390.50||||||| 82088|EAP|0300|ALDOSTERONE|Medicaid|HENDERSON COUNTY INDIGENT|||||1,390.50||| 82088|EAP|0300|ALDOSTERONE|Medicare|MEDICARE ACUTE|1,390.50||||||| 82088|EAP|0300|ALDOSTERONE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,390.50||| 82103|EAP|0300|ALPHA-1-ANTI-TRYPSIN (AAT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||5.35||| 82103|EAP|0300|ALPHA-1-ANTI-TRYPSIN (AAT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|5.35||||||| 82103|EAP|0300|ALPHA-1-ANTI-TRYPSIN (AAT|Medicare|MEDICARE ACUTE|5.35||||5.35||| 82103|EAP|0300|ALPHA-1-ANTI-TRYPSIN (AAT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||5.35||| 82103|EAP|0300|ALPHA-1-ANTI-TRYPSIN (AAT|Aetna|AETNA PPO|||||5.35||| 82103|EAP|0300|ALPHA-1-ANTI-TRYPSIN (AAT|Cigna|CIGNA|||||5.35||| 82103|EAP|0300|ALPHA-1-ANTI-TRYPSIN (AAT|Blue Cross PPO Specialty|BCBSTX PPO|||||5.35||| 82103|EAP|0300|ALPHA-1-ANTI-TRYPSIN (AAT|Managed Medicare|HEALTHSPRING MA|||||5.35||| 82103|EAP|0300|ALPHA-1-ANTI-TRYPSIN (AAT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|5.35||||||| 82103|EAP|0300|ALPHA-1-ANTI-TRYPSIN (AAT|Humana Medicare Advantage|HUMANA MA|5.35||||||| 82105|EAP|0300|ALPHA-FETOPROTEIN|Humana Medicare Advantage|HUMANA MA|668.25||||668.25||| 82105|EAP|0300|ALPHA-FETOPROTEIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|668.25||||668.25||| 82105|EAP|0300|ALPHA-FETOPROTEIN|Blue Cross HMO Specialty|BCBSTX HMO|||||668.25||| 82105|EAP|0300|ALPHA-FETOPROTEIN|Blue Cross PPO Specialty|BCBSTX PPO|||||668.25||| 82105|EAP|0300|ALPHA-FETOPROTEIN|Medicaid|MEDICAID|668.25||||||| 82105|EAP|0300|ALPHA-FETOPROTEIN|Medicare|MEDICARE ACUTE|668.25||||668.25||| 82105|EAP|0300|ALPHA-FETOPROTEIN|Workers Compensation|WORKERS COMPENSATION OTHER|||||668.25||| 82105|EAP|0300|ALPHA-FETOPROTEIN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||668.25||| 82105|EAP|0300|ALPHA-FETOPROTEIN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|668.25||||||| 82140|EAP|0300|AMMONIA (NH3)|United Medicare Advantage|UHC MEDICARE GOLD MA|580.75||||580.75||| 82140|EAP|0300|AMMONIA (NH3)|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|580.75||||580.75||| 82140|EAP|0300|AMMONIA (NH3)|United Medicare Advantage|AARP UHC WEST COMPLETE MA|580.75||||580.75||| 82140|EAP|0300|AMMONIA (NH3)|Medicare|MEDICARE ACUTE|580.75||||580.75||| 82140|EAP|0300|AMMONIA (NH3)|NON CONTRACTED|COMMERCIAL OTHER 1|||||580.75||| 82140|EAP|0300|AMMONIA (NH3)|United Healthcare|UNITED HEALTHCARE|||||580.75||| 82140|EAP|0300|AMMONIA (NH3)|Medicare|MEDICARE PART B ONLY IP|580.75||||||| 82140|EAP|0300|AMMONIA (NH3)|United Healthcare|UMR UNITED MEDICAL RESOURCES|580.75||||580.75||| 82140|EAP|0300|AMMONIA (NH3)|United Healthcare|UNITED HEALTHCARE|580.75||||580.75||| 82140|EAP|0300|AMMONIA (NH3)|United Healthcare|UNITED HEALTHCARE OTHER|||||580.75||| 82140|EAP|0300|AMMONIA (NH3)|Medicaid|MEDICAID|580.75||||580.75||| 82140|EAP|0300|AMMONIA (NH3)|Medicaid|HENDERSON COUNTY INDIGENT|580.75||||580.75||| 82140|EAP|0300|AMMONIA (NH3)|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||580.75||| 82140|EAP|0300|AMMONIA (NH3)|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||580.75||| 82140|EAP|0300|AMMONIA (NH3)|Veterans Affairs|VETERANS ADMINISTRATION|580.75||||580.75||| 82140|EAP|0300|AMMONIA (NH3)|Aetna|AETNA PPO|580.75||||580.75||| 82140|EAP|0300|AMMONIA (NH3)|Aenta Medicare Advantage|AETNA MEDICARE MA|||||580.75||| 82140|EAP|0300|AMMONIA (NH3)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|580.75||||580.75||| 82140|EAP|0300|AMMONIA (NH3)|Blue Cross PPO Specialty|BCBSTX PPO|580.75||||580.75||| 82140|EAP|0300|AMMONIA (NH3)|Blue Cross HMO Specialty|BCBSTX HMO|580.75||||||| 82140|EAP|0300|AMMONIA (NH3)|Managed Medicare|HEALTHSPRING MA|580.75||||580.75||| 82140|EAP|0300|AMMONIA (NH3)|Managed Medicare|HOSPICE OF EAST TEXAS|580.75||||||| 82140|EAP|0300|AMMONIA (NH3)|Managed Medicaid|MEDICAID AMERIGROUP|580.75||||580.75||| 82140|EAP|0300|AMMONIA (NH3)|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||580.75||| 82140|EAP|0300|AMMONIA (NH3)|Managed Medicare|BCBS MEDICARE PPO MA|||||580.75||| 82140|EAP|0300|AMMONIA (NH3)|Managed Medicaid|MEDICAID UNITED HEALTHCARE|580.75||||580.75||| 82140|EAP|0300|AMMONIA (NH3)|Managed Medicaid|MEDICAID SUPERIOR|580.75||||580.75||| 82140|EAP|0300|AMMONIA (NH3)|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|580.75||||580.75||| 82140|EAP|0300|AMMONIA (NH3)|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|580.75||||||| 82140|EAP|0300|AMMONIA (NH3)|Humana Medicare Advantage|HUMANA MA|580.75||||580.75||| 82150|EAP|0300|AMYLASE|Humana Medicare Advantage|HUMANA MA|2.58||||2.58||| 82150|EAP|0300|AMYLASE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.58||||2.58||| 82150|EAP|0300|AMYLASE|Managed Medicare|OTHER INSTITUTIONS|||||2.58||| 82150|EAP|0300|AMYLASE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.58||||2.58||| 82150|EAP|0300|AMYLASE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|2.58||||2.58||| 82150|EAP|0300|AMYLASE|Managed Medicaid|MEDICAID AMERIGROUP|2.58||||2.58||| 82150|EAP|0300|AMYLASE|Managed Medicaid|MEDICAID SUPERIOR|2.58||||2.58||| 82150|EAP|0300|AMYLASE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.58||||2.58||| 82150|EAP|0300|AMYLASE|ChampVA|CHAMPVA CENTER|||||2.58||| 82150|EAP|0300|AMYLASE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2.58||| 82150|EAP|0300|AMYLASE|Cigna|CIGNA OTHER|2.58||||2.58||| 82150|EAP|0300|AMYLASE|Cigna|CIGNA|||||2.58||| 82150|EAP|0300|AMYLASE|Cigna|CIGNA|2.58||||2.58||| 82150|EAP|0300|AMYLASE|Blue Cross PPO Specialty|BCBSTX PPO|2.58||||2.58||| 82150|EAP|0300|AMYLASE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.58||| 82150|EAP|0300|AMYLASE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.58||||2.58||| 82150|EAP|0300|AMYLASE|Aetna|AETNA PPO|2.58||||2.58||| 82150|EAP|0300|AMYLASE|Aetna|AETNA OTHER|||||2.58||| 82150|EAP|0300|AMYLASE|Aetna|BOON CHAPMAN|||||2.58||| 82150|EAP|0300|AMYLASE|Aenta Medicare Advantage|AETNA MEDICARE MA|2.58||||2.58||| 82150|EAP|0300|AMYLASE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.58||||2.58||| 82150|EAP|0300|AMYLASE|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.58||| 82150|EAP|0300|AMYLASE|Medicaid|MOLINA HEALTHCARE OF TEXAS|2.58||||2.58||| 82150|EAP|0300|AMYLASE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.58||| 82150|EAP|0300|AMYLASE|Medicaid|MEDICAID HMO|||||2.58||| 82150|EAP|0300|AMYLASE|Medicaid|HENDERSON COUNTY INDIGENT|2.58||||2.58||| 82150|EAP|0300|AMYLASE|Blue Cross HMO Specialty|BCBSTX HMO|2.58||||2.58||| 82150|EAP|0300|AMYLASE|Medicaid|LAW ENFORCEMENT OTHER|2.58||||2.58||| 82150|EAP|0300|AMYLASE|Medicaid|MEDICAID|2.58||||2.58||| 82150|EAP|0300|AMYLASE|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.58||| 82150|EAP|0300|AMYLASE|United Healthcare|UMR UNITED MEDICAL RESOURCES|2.58||||2.58||| 82150|EAP|0300|AMYLASE|Medicare|MEDICARE PART B ONLY IP|2.58||||||| 82150|EAP|0300|AMYLASE|Medicare|MEDICARE ACUTE|2.58||||2.58||| 82150|EAP|0300|AMYLASE|United Healthcare|TML GROUP BENEFITS|2.58||||2.58||| 82150|EAP|0300|AMYLASE|United Healthcare|UNITED HEALTHCARE OTHER|2.58||||2.58||| 82150|EAP|0300|AMYLASE|Managed Medicare|HEALTHSPRING MA|2.58||||2.58||| 82150|EAP|0300|AMYLASE|PHCS|HUMANA|||||2.58||| 82150|EAP|0300|AMYLASE|Tricare|TRICARE EAST REGION|2.58||||2.58||| 82150|EAP|0300|AMYLASE|United Healthcare|GOLDEN RULE|||||2.58||| 82150|EAP|0300|AMYLASE|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.58||| 82150|EAP|0300|AMYLASE|United Healthcare|UNITED HEALTHCARE|||||2.58||| 82150|EAP|0300|AMYLASE|United Healthcare|UNITED HEALTHCARE|2.58||||2.58||| 82150|EAP|0300|AMYLASE|NON CONTRACTED|COMMERCIAL OTHER 1|2.58||||2.58||| 82150|EAP|0300|AMYLASE|Veterans Affairs|VETERANS ADMINISTRATION|2.58||||2.58||| 82150|EAP|0300|AMYLASE|Managed Medicare|BCBS MEDICARE PPO MA|2.58||||2.58||| 82150|EAP|0300|AMYLASE|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.58||| 82150|EAP|0300|AMYLASE|United Medicare Advantage|UHC AARP MCR HMO MA|2.58||||2.58||| 82150|EAP|0300|AMYLASE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.58||||2.58||| 82150|EAP|0300|AMYLASE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.58||||2.58||| 82150|EAP|0300|AMYLASE|United Medicare Advantage|UHC MEDICARE GOLD MA|2.58||||2.58||| 82164|EAP|0300|ANGIOTENSION CONVERTING E|United Medicare Advantage|UHC MEDICARE GOLD MA|||||581.50||| 82164|EAP|0300|ANGIOTENSION CONVERTING E|Medicare|MEDICARE ACUTE|||||581.50||| 82164|EAP|0300|ANGIOTENSION CONVERTING E|Cigna|CIGNA|||||581.50||| 82172|EAP|0300|ASSAY OF APOLIPOPROTEIN|Managed Medicare|HEALTHSPRING MA|||||0.70||| 82172|EAP|0300|ASSAY OF APOLIPOPROTEIN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.70||| 82172|EAP|0300|ASSAY OF APOLIPOPROTEIN|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.70||| 82172|EAP|0300|ASSAY OF APOLIPOPROTEIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.70||| 82172|EAP|0300|ASSAY OF APOLIPOPROTEIN|Cigna|CIGNA|||||0.70||| 82172|EAP|0300|ASSAY OF APOLIPOPROTEIN|Blue Cross PPO Specialty|BCBSTX PPO|||||0.70||| 82172|EAP|0300|ASSAY OF APOLIPOPROTEIN|United Healthcare|UNITED HEALTHCARE|||||0.70||| 82172|EAP|0300|ASSAY OF APOLIPOPROTEIN|Medicare|MEDICARE ACUTE|||||0.70||| 82172|EAP|0300|ASSAY OF APOLIPOPROTEIN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.70||| 82175|EAP|0300|ARSENIC, BLOOD|Medicare|MEDICARE ACUTE|755.50||||||| 82180|EAP|0300|VITAMIN C|United Healthcare|UNITED HEALTHCARE|3.94||||128.25||| 822|DRG||LYMPHOMA & LEUKEMIA W MAJOR O.R. PROCEDURE W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|41,878.05|10095.07|10095.07|10095.07|||| 82232|EAP|0300|BETA-2 MICROGLOBIN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|644.50||||||| 82232|EAP|0300|BETA-2 MICROGLOBIN|Medicaid|MEDICAID|||||644.50||| 82232|EAP|0300|BETA-2 MICROGLOBIN|Medicare|MEDICARE ACUTE|644.50||||644.50||| 82232|EAP|0300|BETA-2 MICROGLOBIN|Humana Medicare Advantage|HUMANA MA|644.50||||||| 82239|EAP|0300|BILE ACIDS TOTAL|Managed Medicaid|MEDICAID SUPERIOR|682.50||||||| 82239|EAP|0300|BILE ACIDS TOTAL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||682.50||| 82247|EAP|0300|BILIRUBIN TOTAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.00||||||| 82247|EAP|0300|BILIRUBIN TOTAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.70||| 82247|EAP|0300|BILIRUBIN TOTAL|Medicare|MEDICARE ACUTE|2.00||||0.70||| 82247|EAP|0300|BILIRUBIN TOTAL|Tricare|TRICARE EAST REGION|||||2.00||| 82247|EAP|0300|BILIRUBIN TOTAL|Medicare|MEDICARE ACUTE|2.00||||2.00||| 82247|EAP|0300|BILIRUBIN TOTAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|2.00||||2.00||| 82247|EAP|0300|BILIRUBIN TOTAL|Medicaid|MEDICAID HMO|2.00||||2.00||| 82247|EAP|0300|BILIRUBIN TOTAL|Medicaid|HENDERSON COUNTY INDIGENT|2.00||||||| 82247|EAP|0300|BILIRUBIN TOTAL|Medicaid|MEDICAID|2.00||||2.00||| 82247|EAP|0300|BILIRUBIN TOTAL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.00||| 82247|EAP|0300|BILIRUBIN TOTAL|Blue Cross PPO Specialty|BCBSTX PPO|2.00||||2.00||| 82247|EAP|0300|BILIRUBIN TOTAL|Blue Cross HMO Specialty|BCBSTX HMO|2.00||||2.00||| 82247|EAP|0300|BILIRUBIN TOTAL|Cigna|CIGNA|||||2.00||| 82247|EAP|0300|BILIRUBIN TOTAL|United Healthcare|UNITED HEALTHCARE|||||0.70||| 82247|EAP|0300|BILIRUBIN TOTAL|United Healthcare|UNITED HEALTHCARE|||||2.00||| 82247|EAP|0300|BILIRUBIN TOTAL|Cigna|CIGNA|||||0.70||| 82247|EAP|0300|BILIRUBIN TOTAL|Blue Cross PPO Specialty|BCBSTX PPO|2.00||||0.70||| 82247|EAP|0300|BILIRUBIN TOTAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.70||| 82247|EAP|0300|BILIRUBIN TOTAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.00||||0.70||| 82247|EAP|0300|BILIRUBIN TOTAL|Aetna|AETNA PPO|2.00||||2.00||| 82247|EAP|0300|BILIRUBIN TOTAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.00||||||| 82247|EAP|0300|BILIRUBIN TOTAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.00||||2.00||| 82247|EAP|0300|BILIRUBIN TOTAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.00||||0.70||| 82247|EAP|0300|BILIRUBIN TOTAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.00||||2.00||| 82247|EAP|0300|BILIRUBIN TOTAL|Humana Medicare Advantage|HUMANA MA|2.00||||||| 82247|EAP|0300|BILIRUBIN TOTAL|Managed Medicaid|MEDICAID AMERIGROUP|2.00||||2.00||| 82247|EAP|0300|BILIRUBIN TOTAL|Managed Medicare|HEALTHSPRING MA|||||0.70||| 82247|EAP|0300|BILIRUBIN TOTAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.00||||||| 82247|EAP|0300|BILIRUBIN TOTAL|Managed Medicaid|MEDICAID SUPERIOR|2.00||||2.00||| 82248|EAP|0300|BILIRUBIN DIRECT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.00||||||| 82248|EAP|0300|BILIRUBIN DIRECT|Managed Medicaid|MEDICAID SUPERIOR|2.00||||2.00||| 82248|EAP|0300|BILIRUBIN DIRECT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.00||||2.00||| 82248|EAP|0300|BILIRUBIN DIRECT|Managed Medicaid|MEDICAID AMERIGROUP|2.00||||2.00||| 82248|EAP|0300|BILIRUBIN DIRECT|Humana Medicare Advantage|HUMANA MA|2.00||||2.00||| 82248|EAP|0300|BILIRUBIN DIRECT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.00||||||| 82248|EAP|0300|BILIRUBIN DIRECT|Aetna|AETNA PPO|2.00||||2.00||| 82248|EAP|0300|BILIRUBIN DIRECT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.00||||||| 82248|EAP|0300|BILIRUBIN DIRECT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.00||||||| 82248|EAP|0300|BILIRUBIN DIRECT|Aenta Medicare Advantage|AETNA MEDICARE MA|2.00||||||| 82248|EAP|0300|BILIRUBIN DIRECT|Blue Cross PPO Specialty|BCBSTX PPO|2.00||||2.00||| 82248|EAP|0300|BILIRUBIN DIRECT|Cigna|CIGNA|||||2.00||| 82248|EAP|0300|BILIRUBIN DIRECT|Medicaid|MEDICAID HMO|2.00||||2.00||| 82248|EAP|0300|BILIRUBIN DIRECT|Medicaid|HENDERSON COUNTY INDIGENT|2.00||||||| 82248|EAP|0300|BILIRUBIN DIRECT|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.00||| 82248|EAP|0300|BILIRUBIN DIRECT|Medicaid|MEDICAID|2.00||||2.00||| 82248|EAP|0300|BILIRUBIN DIRECT|Medicare|MEDICARE ACUTE|2.00||||2.00||| 82248|EAP|0300|BILIRUBIN DIRECT|Tricare|TRICARE EAST REGION|||||2.00||| 82248|EAP|0300|BILIRUBIN DIRECT|United Healthcare|UNITED HEALTHCARE|||||2.00||| 82248|EAP|0300|BILIRUBIN DIRECT|United Healthcare|TML GROUP BENEFITS|2.00||||||| 82248|EAP|0300|BILIRUBIN DIRECT|United Healthcare|UMR UNITED MEDICAL RESOURCES|2.00||||2.00||| 82248|EAP|0300|BILIRUBIN DIRECT|Veterans Affairs|VETERANS ADMINISTRATION|2.00||||2.00||| 82248|EAP|0300|BILIRUBIN DIRECT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.00||||||| 82248|EAP|0300|BILIRUBIN DIRECT|United Medicare Advantage|UHC MEDICARE GOLD MA|2.00||||||| 82271|EAP|0300|OCCULT BLOOD STOOL|United Medicare Advantage|UHC MEDICARE GOLD MA|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|United Medicare Advantage|UHC AARP MCR HMO MA|||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|Veterans Affairs|VETERANS ADMINISTRATION|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|NON CONTRACTED|COMMERCIAL OTHER 1|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|United Healthcare|UNITED HEALTHCARE|||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|United Healthcare|TML GROUP BENEFITS|||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|United Healthcare|UNITED HEALTHCARE OTHER|||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|United Healthcare|UMR UNITED MEDICAL RESOURCES|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|Medicare|MEDICARE PART B ONLY IP|129.50||||||| 82271|EAP|0300|OCCULT BLOOD GASTRIC|Medicare|MEDICARE ACUTE|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD GASTRIC|NON CONTRACTED|COMMERCIAL OTHER 1|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|Medicare|MEDICARE ACUTE|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|Medicaid|HENDERSON COUNTY INDIGENT|||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|Medicaid|MEDICAID|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD GASTRIC|Medicaid|HENDERSON COUNTY INDIGENT|||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|ChampVA|CHAMPVA CENTER|129.50||||||| 82271|EAP|0300|OCCULT BLOOD STOOL|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|Cigna|CIGNA|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|Medicaid|MEDICAID HMO|||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|Blue Cross HMO Specialty|BCBSTX HMO|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|Cigna|CIGNA OTHER|||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|Cigna|CIGNA|||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|Blue Cross PPO Specialty|BCBSTX PPO|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|Tricare|TRICARE EAST REGION|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|Aenta Medicare Advantage|AETNA MEDICARE MA|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|Aetna|AETNA PPO|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|United Healthcare|UNITED HEALTHCARE|129.50||||||| 82271|EAP|0300|OCCULT BLOOD STOOL|Aetna|AETNA OTHER|||||129.50||| 82271|EAP|0300|OCCULT BLOOD GASTRIC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD GASTRIC|Humana Medicare Advantage|HUMANA MA|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|Humana Medicare Advantage|HUMANA MA|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD GASTRIC|Managed Medicaid|MEDICAID AMERIGROUP|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD URINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD URINE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|Managed Medicaid|MEDICAID SUPERIOR|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|Managed Medicaid|MEDICAID AMERIGROUP|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD GASTRIC|Managed Medicaid|MEDICAID SUPERIOR|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD GASTRIC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD GASTRIC|Managed Medicare|HEALTHSPRING MA|129.50||||129.50||| 82271|EAP|0300|OCCULT BLOOD STOOL|Managed Medicare|BCBS MEDICARE PPO MA|129.50||||||| 82271|EAP|0300|OCCULT BLOOD STOOL|Managed Medicare|HEALTHSPRING MA|129.50||||129.50||| 82306|EAP|0300|VITAMIN D, 25 HYDROXY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1,082.50||||||| 82306|EAP|0300|VITAMIN D, 25 HYDROXY|Humana Medicare Advantage|HUMANA MA|1,082.50||||1,082.50||| 82306|EAP|0300|VITAMIN D, 25 HYDROXY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1,082.50||| 82306|EAP|0300|VITAMIN D, 25 HYDROXY|Aetna|AETNA PPO|||||1,082.50||| 82306|EAP|0300|VITAMIN D, 25 HYDROXY|Managed Medicare|HEALTHSPRING MA|||||1,082.50||| 82306|EAP|0300|VITAMIN D, 25 HYDROXY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,082.50||||1,082.50||| 82306|EAP|0300|VITAMIN D, 25 HYDROXY|Aenta Medicare Advantage|AETNA MEDICARE MA|1,082.50||||1,082.50||| 82306|EAP|0300|VITAMIN D, 25 HYDROXY|Blue Cross PPO Specialty|BCBSTX PPO|||||1,082.50||| 82306|EAP|0300|VITAMIN D, 25 HYDROXY|Blue Cross HMO Specialty|BCBSTX HMO|1,082.50||||||| 82306|EAP|0300|VITAMIN D, 25 HYDROXY|Medicaid|MEDICAID|1,082.50||||1,082.50||| 82306|EAP|0300|VITAMIN D, 25 HYDROXY|Medicaid|HENDERSON COUNTY INDIGENT|1,082.50||||||| 82306|EAP|0300|VITAMIN D, 25 HYDROXY|Medicare|MEDICARE ACUTE|1,082.50||||1,082.50||| 82306|EAP|0300|VITAMIN D, 25 HYDROXY|United Healthcare|UNITED HEALTHCARE|1,082.50||||1,082.50||| 82306|EAP|0300|VITAMIN D, 25 HYDROXY|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,082.50||| 82306|EAP|0300|VITAMIN D, 25 HYDROXY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,082.50||||||| 82306|EAP|0300|VITAMIN D, 25 HYDROXY|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1,082.50||||||| 82308|EAP|0300|CALCITONIN|Medicare|MEDICARE ACUTE|10.67||||||| 82310|EAP|0300|CALCIUM|Blue Cross PPO Specialty|BCBSTX PPO|||||205.50||| 82310|EAP|0300|CALCIUM|Blue Cross HMO Specialty|BCBSTX HMO|||||205.50||| 82310|EAP|0300|CALCIUM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||205.50||| 82310|EAP|0300|CALCIUM|Humana Medicare Advantage|HUMANA MA|||||205.50||| 82310|EAP|0300|CALCIUM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||205.50||| 82310|EAP|0300|CALCIUM|Managed Medicare|HEALTHSPRING MA|||||205.50||| 82310|EAP|0300|CALCIUM|United Medicare Advantage|UHC MEDICARE GOLD MA|205.50||||205.50||| 82310|EAP|0300|CALCIUM|Medicare|MEDICARE ACUTE|205.50||||205.50||| 82310|EAP|0300|CALCIUM|NON CONTRACTED|COMMERCIAL OTHER 1|||||205.50||| 82330|EAP|0300|CALCIUM IONIZED FREE|Medicare|MEDICARE ACUTE|544.50||||||| 82330|EAP|0300|CALCIUM IONIZED FREE|NON CONTRACTED|COMMERCIAL OTHER 1|||||544.50||| 82330|EAP|0300|CALCIUM IONIZED FREE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|544.50||||||| 82330|EAP|0300|CALCIUM IONIZED FREE|Humana Medicare Advantage|HUMANA MA|544.50||||||| 82330|EAP|0300|CALCIUM IONIZED FREE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|544.50||||||| 82330|EAP|0300|CALCIUM IONIZED FREE|Aetna|AETNA PPO|544.50||||||| 82330|EAP|0300|CALCIUM IONIZED FREE|Blue Cross PPO Specialty|BCBSTX PPO|544.50||||||| 82330|EAP|0300|CALCIUM IONIZED FREE|Cigna|CIGNA|||||544.50||| 82378|EAP|0300|CARCINO EMBRYONIC ANTIGEN|Cigna|CIGNA OTHER|755.50||||||| 82378|EAP|0300|CARCINO EMBRYONIC ANTIGEN|Humana Medicare Advantage|HUMANA MA|755.50||||||| 82378|EAP|0300|CARCINO EMBRYONIC ANTIGEN|United Medicare Advantage|UHC MEDICARE GOLD MA|755.50||||||| 82378|EAP|0300|CARCINO EMBRYONIC ANTIGEN|Medicare|MEDICARE ACUTE|755.50||||755.50||| 82384|EAP|0300|EPINEPHRINE/NOREPINEPHRIN|Medicare|MEDICARE ACUTE|719.25||||||| 82384|EAP|0300|CATECHOLAMINE URINE|Medicare|MEDICARE ACUTE|1,006.50||||||| 82390|EAP|0300|CERULO PLASMA|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.28||||||| 82390|EAP|0300|CERULO PLASMA|Cigna|CIGNA|||||4.28||| 82397|EAP|0300|ANTI MULLERIAN HORMONE|Blue Cross PPO Specialty|BCBSTX PPO|||||2.70||| 82436|EAP|0300|CHLORIDE RANDOM URINE|Veterans Affairs|VETERANS ADMINISTRATION|200.25||||||| 82436|EAP|0300|CHLORIDE RANDOM URINE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|200.25||||||| 82436|EAP|0300|CHLORIDE RANDOM URINE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||200.25||| 82436|EAP|0300|CHLORIDE RANDOM URINE|Medicare|MEDICARE ACUTE|200.25||||||| 82436|EAP|0300|CHLORIDE 24 HR URINE|Humana Medicare Advantage|HUMANA MA|200.25||||200.25||| 82436|EAP|0300|CHLORIDE RANDOM URINE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|200.25||||||| 82438|EAP|0300|STOOL, CHLORIDE|Humana Medicare Advantage|HUMANA MA|1.95||||||| 82465|EAP|0300|CHOLESTEROL TOTAL|Medicare|MEDICARE ACUTE|1.74||||||| 82465|EAP|0300|CHOLESTEROL TOTAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.74||| 82465|EAP|0300|CHOLESTEROL TOTAL|Blue Cross PPO Specialty|BCBSTX PPO|||||1.74||| 82533|EAP|0300|CORTISOL PLASMA|Managed Medicaid|MEDICAID AMERIGROUP|649.75||||||| 82533|EAP|0300|CORTISOL PLASMA|Humana Medicare Advantage|HUMANA MA|649.75||||||| 82533|EAP|0300|CORTISOL PLASMA|Blue Cross PPO Specialty|BCBSTX PPO|649.75||||649.75||| 82533|EAP|0300|CORTISOL PLASMA|United Medicare Advantage|UHC MEDICARE GOLD MA|||||649.75||| 82533|EAP|0300|CORTISOL PLASMA|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|649.75||||||| 82533|EAP|0300|CORTISOL PLASMA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|649.75||||||| 82533|EAP|0300|CORTISOL PLASMA|United Healthcare|UNITED HEALTHCARE|649.75||||||| 82533|EAP|0300|CORTISOL PLASMA|Medicare|MEDICARE ACUTE|649.75||||649.75||| 82542|EAP|0300|GCMS CONFIRM CANNABIS|Medicaid|MEDICAID HMO|719.25||||719.25||| 82542|EAP|0300|GCMS CONFIRM CANNABIS|Medicaid|MEDICAID|719.25||||719.25||| 82542|EAP|0300|GCMS CONFIRM CANNABIS|Medicare|MEDICARE ACUTE|719.25||||||| 82542|EAP|0300|GCMS CONFIRM CANNABIS|United Healthcare|UNITED HEALTHCARE|719.25||||||| 82542|EAP|0300|KEPPRA LEVEL|Workers Compensation|WORKERS COMPENSATION OTHER|||||719.25||| 82542|EAP|0300|KEPPRA LEVEL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|719.25||||719.25||| 82542|EAP|0300|GCMS CONFIRM CANNABIS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|719.25||||719.25||| 82542|EAP|0300|KEPPRA LEVEL|Blue Cross PPO Specialty|BCBSTX PPO|719.25||||719.25||| 82542|EAP|0300|GCMS CONFIRM CANNABIS|Blue Cross PPO Specialty|BCBSTX PPO|719.25||||719.25||| 82542|EAP|0300|KEPPRA LEVEL|Managed Medicaid|MEDICAID SUPERIOR|719.25||||719.25||| 82542|EAP|0300|GCMS CONFIRM CANNABIS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||719.25||| 82542|EAP|0300|GCMS CONFIRM CANNABIS|Managed Medicaid|MEDICAID SUPERIOR|719.25||||719.25||| 82542|EAP|0300|GCMS CONFIRM CANNABIS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||719.25||| 82542|EAP|0300|GCMS CONFIRM CANNABIS|Managed Medicaid|MEDICAID AMERIGROUP|719.25||||719.25||| 82542|EAP|0300|GCMS CONFIRM CANNABIS|Managed Medicare|HEALTHSPRING MA|||||719.25||| 82542|EAP|0300|GCMS CONFIRM CANNABIS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||719.25||| 82550|EAP|0300|CPK|MTC Medical|VAN ZANDT COUNTY INMATE|||||259.75||| 82550|EAP|0300|CPK|Humana Medicare Advantage|HUMANA MA|259.75||||259.75||| 82550|EAP|0300|CPK|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|259.75||||259.75||| 82550|EAP|0300|CPK|Managed Medicaid|MEDICAID UNITED HEALTHCARE|259.75||||259.75||| 82550|EAP|0300|CPK|Managed Medicaid|MEDICAID SUPERIOR|259.75||||259.75||| 82550|EAP|0300|CPK|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|259.75||||259.75||| 82550|EAP|0300|CPK|Managed Medicare|BCBS MEDICARE PPO MA|259.75||||259.75||| 82550|EAP|0300|CPK|Managed Medicare|HEALTHSPRING MA|259.75||||259.75||| 82550|EAP|0300|CPK|Managed Medicare|VAN ZANDT COUNTY INMATE|||||259.75||| 82550|EAP|0300|CPK|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|259.75||||259.75||| 82550|EAP|0300|CPK|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||259.75||| 82550|EAP|0300|CPK|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||259.75||| 82550|EAP|0300|CPK|Aenta Medicare Advantage|AETNA MEDICARE MA|259.75||||259.75||| 82550|EAP|0300|CPK|Aetna|AETNA PPO|259.75||||259.75||| 82550|EAP|0300|CPK|Blue Cross PPO Specialty|BCBSTX OTHER|||||259.75||| 82550|EAP|0300|CPK|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||259.75||| 82550|EAP|0300|CPK|Cigna|CIGNA|||||259.75||| 82550|EAP|0300|CPK|ChampVA|CHAMPVA CENTER|||||259.75||| 82550|EAP|0300|CPK|Blue Cross HMO Specialty|BCBSTX HMO|259.75||||259.75||| 82550|EAP|0300|CPK|Cigna|CIGNA|259.75||||259.75||| 82550|EAP|0300|CPK|Cigna|CIGNA OTHER|||||259.75||| 82550|EAP|0300|CPK|Blue Cross PPO Specialty|BCBSTX PPO|259.75||||259.75||| 82550|EAP|0300|CPK|United Medicare Advantage|UHC MEDICARE GOLD MA|259.75||||259.75||| 82550|EAP|0300|CPK|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|259.75||||259.75||| 82550|EAP|0300|CPK|United Medicare Advantage|AARP UHC WEST COMPLETE MA|259.75||||259.75||| 82550|EAP|0300|CPK|United Medicare Advantage|UHC AARP MCR HMO MA|||||259.75||| 82550|EAP|0300|CPK|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|259.75||||259.75||| 82550|EAP|0300|CPK|Workers Compensation|WORKERS COMPENSATION OTHER|||||259.75||| 82550|EAP|0300|CPK|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||259.75||| 82550|EAP|0300|CPK|Workers Compensation|UT EMPLOYEE INJURY|259.75||||||| 82550|EAP|0300|CPK|Veterans Affairs|VETERANS ADMINISTRATION|259.75||||259.75||| 82550|EAP|0300|CPK|Workers Compensation|TEXAS MUTUAL INSURANCE|||||259.75||| 82550|EAP|0300|CPK|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||259.75||| 82550|EAP|0300|CPK|Tricare|TRICARE EAST REGION|259.75||||259.75||| 82550|EAP|0300|CPK|Medicare|MEDICARE ACUTE|259.75||||259.75||| 82550|EAP|0300|CPK|PHCS|HUMANA|||||259.75||| 82550|EAP|0300|CPK|United Healthcare|TML GROUP BENEFITS|||||259.75||| 82550|EAP|0300|CPK|Managed Medicaid|MEDICAID AMERIGROUP|259.75||||259.75||| 82550|EAP|0300|CPK|United Healthcare|GEHA|||||259.75||| 82550|EAP|0300|CPK|UTMB|UTMB CORRECTIONAL MANAGED CARE|259.75||||||| 82550|EAP|0300|CPK|United Healthcare|UNITED HEALTHCARE|||||259.75||| 82550|EAP|0300|CPK|United Healthcare|UNITED HEALTHCARE OTHER|||||259.75||| 82550|EAP|0300|CPK|NON CONTRACTED|COMMERCIAL OTHER 1|259.75||||259.75||| 82550|EAP|0300|CPK|Medicaid|HENDERSON COUNTY INDIGENT|259.75||||||| 82550|EAP|0300|CPK|Medicaid|MEDICAID|259.75||||259.75||| 82550|EAP|0300|CPK|Medicaid|MEDICAID HMO|||||259.75||| 82550|EAP|0300|CPK|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||259.75||| 82550|EAP|0300|CPK|Medicaid|MEDICAID TEXAS CHILDRENS|||||259.75||| 82552|EAP|0300|CK ISOENZYMES|Medicare|MEDICARE ACUTE|533.75||||||| 82552|EAP|0300|CK ISOENZYMES|Cigna|CIGNA|||||533.75||| 82552|EAP|0300|CK ISOENZYMES|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|533.75||||||| 82553|EAP|0300|CKMB FRACTION|Managed Medicaid|MEDICAID UNITED HEALTHCARE|245.25||||245.25||| 82553|EAP|0300|CKMB FRACTION|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|245.25||||||| 82553|EAP|0300|CKMB FRACTION|Managed Medicaid|MEDICAID AMERIGROUP|||||245.25||| 82553|EAP|0300|CKMB FRACTION|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|245.25||||||| 82553|EAP|0300|CKMB FRACTION|Humana Medicare Advantage|HUMANA MA|245.25||||245.25||| 82553|EAP|0300|CKMB FRACTION|Aenta Medicare Advantage|AETNA MEDICARE MA|245.25||||245.25||| 82553|EAP|0300|CKMB FRACTION|Aetna|AETNA PPO|245.25||||245.25||| 82553|EAP|0300|CKMB FRACTION|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|245.25||||245.25||| 82553|EAP|0300|CKMB FRACTION|Blue Cross HMO Specialty|BCBSTX HMO|||||245.25||| 82553|EAP|0300|CKMB FRACTION|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|245.25||||||| 82553|EAP|0300|CKMB FRACTION|Managed Medicare|HEALTHSPRING MA|245.25||||||| 82553|EAP|0300|CKMB FRACTION|Cigna|CIGNA OTHER|||||245.25||| 82553|EAP|0300|CKMB FRACTION|Cigna|CIGNA|||||245.25||| 82553|EAP|0300|CKMB FRACTION|Blue Cross PPO Specialty|BCBSTX PPO|245.25||||245.25||| 82553|EAP|0300|CKMB FRACTION|Veterans Affairs|VETERANS ADMINISTRATION|245.25||||245.25||| 82553|EAP|0300|CKMB FRACTION|Workers Compensation|WORKERS COMPENSATION OTHER|||||245.25||| 82553|EAP|0300|CKMB FRACTION|United Medicare Advantage|AARP UHC WEST COMPLETE MA|245.25||||245.25||| 82553|EAP|0300|CKMB FRACTION|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|245.25||||245.25||| 82553|EAP|0300|CKMB FRACTION|United Medicare Advantage|UHC MEDICARE GOLD MA|245.25||||245.25||| 82553|EAP|0300|CKMB FRACTION|Medicaid|HENDERSON COUNTY INDIGENT|245.25||||||| 82553|EAP|0300|CKMB FRACTION|Medicaid|MEDICAID|245.25||||||| 82553|EAP|0300|CKMB FRACTION|Medicare|MEDICARE ACUTE|245.25||||245.25||| 82553|EAP|0300|CKMB FRACTION|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||245.25||| 82553|EAP|0300|CKMB FRACTION|Tricare|TRICARE EAST REGION|245.25||||||| 82553|EAP|0300|CKMB FRACTION|NON CONTRACTED|COMMERCIAL OTHER 1|245.25||||||| 82553|EAP|0300|CKMB FRACTION|United Healthcare|TML GROUP BENEFITS|||||245.25||| 82565|EAP|0300|CREATININE|United Healthcare|UNITED HEALTHCARE|||||2.04||| 82565|EAP|0300|CREATININE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.04||| 82565|EAP|0300|CREATININE|United Healthcare|TML GROUP BENEFITS|||||2.04||| 82565|EAP|0300|CREATININE|United Healthcare|UNITED HEALTHCARE OTHER|||||2.04||| 82565|EAP|0300|CREATININE|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.04||| 82565|EAP|0300|CREATININE|Medicare|MEDICARE ACUTE|2.04||||2.04||| 82565|EAP|0300|CREATININE|Medicaid|MEDICAID|2.04||||||| 82565|EAP|0300|CREATININE|United Medicare Advantage|UHC AARP MCR HMO MA|||||2.04||| 82565|EAP|0300|CREATININE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.04||||2.04||| 82565|EAP|0300|CREATININE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.04||||2.04||| 82565|EAP|0300|CREATININE|ChampVA|CHAMPVA CENTER|||||2.04||| 82565|EAP|0300|CREATININE|Cigna|CIGNA|||||2.04||| 82565|EAP|0300|CREATININE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2.04||| 82565|EAP|0300|CREATININE|Veterans Affairs|VETERANS ADMINISTRATION|2.04||||2.04||| 82565|EAP|0300|CREATININE|Blue Cross HMO Specialty|BCBSTX HMO|2.04||||2.04||| 82565|EAP|0300|CREATININE|Cigna|CIGNA OTHER|2.04||||||| 82565|EAP|0300|CREATININE|Blue Cross PPO Specialty|BCBSTX PPO|2.04||||2.04||| 82565|EAP|0300|CREATININE|Aetna|AETNA PPO|||||2.04||| 82565|EAP|0300|CREATININE|United Medicare Advantage|UHC MEDICARE GOLD MA|2.04||||2.04||| 82565|EAP|0300|CREATININE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.04||||2.04||| 82565|EAP|0300|CREATININE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.04||| 82565|EAP|0300|CREATININE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.04||||||| 82565|EAP|0300|CREATININE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.04||| 82565|EAP|0300|CREATININE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||2.04||| 82565|EAP|0300|CREATININE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.04||| 82565|EAP|0300|CREATININE|Aetna|AETNA OTHER|||||2.04||| 82565|EAP|0300|CREATININE|Humana Medicare Advantage|HUMANA MA|2.04||||2.04||| 82565|EAP|0300|CREATININE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.04||||2.04||| 82565|EAP|0300|CREATININE|Managed Medicaid|MEDICAID SUPERIOR|2.04||||2.04||| 82565|EAP|0300|CREATININE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.04||||2.04||| 82565|EAP|0300|CREATININE|Managed Medicaid|MEDICAID AMERIGROUP|2.04||||2.04||| 82565|EAP|0300|CREATININE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||2.04||| 82565|EAP|0300|CREATININE|Managed Medicare|BCBS MEDICARE PPO MA|2.04||||2.04||| 82565|EAP|0300|CREATININE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.04||| 82565|EAP|0300|CREATININE|Managed Medicare|OTHER INSTITUTIONS|||||2.04||| 82565|EAP|0300|CREATININE|Managed Medicare|HEALTHSPRING MA|||||2.04||| 82570|EAP|0300|CREATININE RANDOM URINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.06||||2.06||| 82570|EAP|0300|CREATININE RANDOM URINE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.06||||2.06||| 82570|EAP|0300|CREATININE RANDOM URINE|Managed Medicaid|MEDICAID AMERIGROUP|2.06||||2.06||| 82570|EAP|0300|CREATININE RANDOM URINE|Managed Medicare|BCBS MEDICARE PPO MA|||||2.06||| 82570|EAP|0300|CREATININE RANDOM URINE|Humana Medicare Advantage|HUMANA MA|2.06||||2.06||| 82570|EAP|0300|CREATININE RANDOM URINE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.06||||2.06||| 82570|EAP|0300|CREATININE RANDOM URINE|Blue Cross PPO Specialty|BCBSTX PPO|2.06||||2.06||| 82570|EAP|0300|CREATININE RANDOM URINE|Veterans Affairs|VETERANS ADMINISTRATION|2.06||||2.06||| 82570|EAP|0300|CREATININE RANDOM URINE|Managed Medicaid|MEDICAID SUPERIOR|2.06||||2.06||| 82570|EAP|0300|CREATININE RANDOM URINE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.06||||2.06||| 82570|EAP|0300|CREATININE RANDOM URINE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.06||| 82570|EAP|0300|CREATININE RANDOM URINE|Medicaid|MOLINA HEALTHCARE OF TEXAS|2.06||||2.06||| 82570|EAP|0300|CREATININE RANDOM URINE|Medicaid|MEDICAID|2.06||||2.06||| 82570|EAP|0300|CREATININE RANDOM URINE|Medicaid|MEDICAID HMO|2.06||||2.06||| 82570|EAP|0300|CREATININE RANDOM URINE|Tricare|TRICARE EAST REGION|||||2.06||| 82570|EAP|0300|CREATININE RANDOM URINE|United Healthcare|UNITED HEALTHCARE|2.06||||2.06||| 82570|EAP|0300|CREATININE RANDOM URINE|United Healthcare|UMR UNITED MEDICAL RESOURCES|2.06||||||| 82570|EAP|0300|CREATININE RANDOM URINE|Medicare|MEDICARE ACUTE|2.06||||2.06||| 82575|EAP|0300|CREATININE CLEARANCE 24H|Medicare|MEDICARE ACUTE|3.76||||||| 82575|EAP|0300|CREATININE CLEARANCE 24H|Humana Medicare Advantage|HUMANA MA|||||3.76||| 82575|EAP|0300|CREATININE CLEARANCE 24H|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.76||| 82575|EAP|0300|CREATININE CLEARANCE 24H|Managed Medicaid|MEDICAID AMERIGROUP|||||3.76||| 82607|EAP|0300|B-12|Blue Cross HMO Specialty|BCBSTX HMO|600.50||||||| 82607|EAP|0300|B-12|Cigna|CIGNA|600.50||||||| 82607|EAP|0300|B-12|Cigna|CIGNA OTHER|||||600.50||| 82607|EAP|0300|B-12|Blue Cross PPO Specialty|BCBSTX PPO|600.50||||600.50||| 82607|EAP|0300|B-12|Aenta Medicare Advantage|AETNA MEDICARE MA|600.50||||600.50||| 82607|EAP|0300|B-12|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||600.50||| 82607|EAP|0300|B-12|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||600.50||| 82607|EAP|0300|B-12|Aetna|AETNA PPO|600.50||||||| 82607|EAP|0300|B-12|Managed Medicaid|MEDICAID UNITED HEALTHCARE|600.50||||||| 82607|EAP|0300|B-12|Managed Medicaid|MEDICAID SUPERIOR|600.50||||||| 82607|EAP|0300|B-12|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|600.50||||600.50||| 82607|EAP|0300|B-12|Managed Medicaid|MEDICAID AMERIGROUP|600.50||||||| 82607|EAP|0300|B-12|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||600.50||| 82607|EAP|0300|B-12|Managed Medicare|HEALTHSPRING MA|600.50||||600.50||| 82607|EAP|0300|B-12|Humana Medicare Advantage|HUMANA MA|600.50||||600.50||| 82607|EAP|0300|B-12|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|600.50||||600.50||| 82607|EAP|0300|B-12|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|600.50||||600.50||| 82607|EAP|0300|B-12|United Medicare Advantage|UHC MEDICARE GOLD MA|600.50||||600.50||| 82607|EAP|0300|B-12|United Medicare Advantage|AARP UHC WEST COMPLETE MA|600.50||||600.50||| 82607|EAP|0300|B-12|Veterans Affairs|VETERANS ADMINISTRATION|600.50||||||| 82607|EAP|0300|B-12|ChampVA|CHAMPVA CENTER|600.50||||||| 82607|EAP|0300|B-12|Medicaid|HENDERSON COUNTY INDIGENT|600.50||||||| 82607|EAP|0300|B-12|Medicaid|MOLINA HEALTHCARE OF TEXAS|600.50||||||| 82607|EAP|0300|B-12|Medicaid|MEDICAID|600.50||||600.50||| 82607|EAP|0300|B-12|Medicare|MEDICARE PART B ONLY IP|600.50||||||| 82607|EAP|0300|B-12|United Healthcare|UNITED HEALTHCARE|600.50||||600.50||| 82607|EAP|0300|B-12|UTMB|UTMB CORRECTIONAL MANAGED CARE|600.50||||||| 82607|EAP|0300|B-12|United Healthcare|UNITED HEALTHCARE|600.50||||||| 82607|EAP|0300|B-12|United Healthcare|TML GROUP BENEFITS|600.50||||||| 82607|EAP|0300|B-12|Tricare|TRICARE EAST REGION|||||600.50||| 82607|EAP|0300|B-12|Medicare|MEDICARE ACUTE|600.50||||600.50||| 82607|EAP|0300|B-12|NON CONTRACTED|COMMERCIAL OTHER 1|600.50||||600.50||| 82652|EAP|0300|VITAMIN D 125 DIHYDROXY|Medicare|MEDICARE ACUTE|||||6.89||| 82652|EAP|0300|VITAMIN D 125 DIHYDROXY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||6.89||| 82657|EAP|0300|ARYSULFATASE A|Medicare|MEDICARE ACUTE|||||496.50||| 82668|EAP|0300|ERYTHROPOEITIN ASSAY|Humana Medicare Advantage|HUMANA MA|749.25||||||| 82668|EAP|0300|ERYTHROPOEITIN ASSAY|Blue Cross HMO Specialty|BCBSTX HMO|749.25||||||| 82668|EAP|0300|ERYTHROPOEITIN ASSAY|Blue Cross PPO Specialty|BCBSTX PPO|749.25||||||| 82668|EAP|0300|ERYTHROPOEITIN ASSAY|Veterans Affairs|VETERANS ADMINISTRATION|749.25||||||| 82668|EAP|0300|ERYTHROPOEITIN ASSAY|Medicare|MEDICARE ACUTE|749.25||||||| 82670|EAP|0300|ESTRADIOL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1,113.25||| 82670|EAP|0300|ESTRADIOL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1,113.25||| 82670|EAP|0300|ESTRADIOL|Blue Cross PPO Specialty|BCBSTX PPO|||||1,113.25||| 82705|EAP|0300|FECAL FAT, QL|United Healthcare|UNITED HEALTHCARE|||||202.75||| 82705|EAP|0300|FECAL FAT, QL|Medicare|MEDICARE ACUTE|202.75||||||| 82705|EAP|0300|FECAL FAT, QL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||202.75||| 82705|EAP|0300|FECAL FAT, QL|Humana Medicare Advantage|HUMANA MA|202.75||||||| 82710|EAP|0300|FECAL FAT, QN|United Healthcare|UNITED HEALTHCARE|||||669.50||| 82728|EAP|0300|FERRITIN|Blue Cross PPO Specialty|BCBSTX PPO|542.25||||542.25||| 82728|EAP|0300|FERRITIN|Cigna|CIGNA|542.25||||542.25||| 82728|EAP|0300|FERRITIN|Cigna|CIGNA OTHER|||||542.25||| 82728|EAP|0300|FERRITIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|542.25||||542.25||| 82728|EAP|0300|FERRITIN|Aenta Medicare Advantage|AETNA MEDICARE MA|542.25||||542.25||| 82728|EAP|0300|FERRITIN|Aetna|AETNA PPO|542.25||||542.25||| 82728|EAP|0300|FERRITIN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||542.25||| 82728|EAP|0300|FERRITIN|Managed Medicaid|MEDICAID AMERIGROUP|542.25||||||| 82728|EAP|0300|FERRITIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|542.25||||542.25||| 82728|EAP|0300|FERRITIN|Managed Medicaid|MEDICAID SUPERIOR|542.25||||||| 82728|EAP|0300|FERRITIN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|542.25||||542.25||| 82728|EAP|0300|FERRITIN|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||542.25||| 82728|EAP|0300|FERRITIN|Managed Medicare|HEALTHSPRING MA|542.25||||542.25||| 82728|EAP|0300|FERRITIN|Humana Medicare Advantage|HUMANA MA|542.25||||542.25||| 82728|EAP|0300|FERRITIN|Workers Compensation|UT EMPLOYEE INJURY|542.25||||||| 82728|EAP|0300|FERRITIN|Veterans Affairs|VETERANS ADMINISTRATION|542.25||||||| 82728|EAP|0300|FERRITIN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|542.25||||542.25||| 82728|EAP|0300|FERRITIN|Blue Cross HMO Specialty|BCBSTX HMO|542.25||||542.25||| 82728|EAP|0300|FERRITIN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|542.25||||542.25||| 82728|EAP|0300|FERRITIN|United Medicare Advantage|UHC MEDICARE GOLD MA|542.25||||542.25||| 82728|EAP|0300|FERRITIN|Medicaid|MOLINA HEALTHCARE OF TEXAS|542.25||||||| 82728|EAP|0300|FERRITIN|Medicaid|MEDICAID|542.25||||542.25||| 82728|EAP|0300|FERRITIN|Medicaid|HENDERSON COUNTY INDIGENT|||||542.25||| 82728|EAP|0300|FERRITIN|UTMB|UTMB CORRECTIONAL MANAGED CARE|542.25||||||| 82728|EAP|0300|FERRITIN|Tricare|TRICARE EAST REGION|542.25||||||| 82728|EAP|0300|FERRITIN|Medicare|MEDICARE ACUTE|542.25||||542.25||| 82728|EAP|0300|FERRITIN|United Healthcare|UNITED HEALTHCARE|542.25||||542.25||| 82728|EAP|0300|FERRITIN|NON CONTRACTED|COMMERCIAL OTHER 1|542.25||||542.25||| 82728|EAP|0300|FERRITIN|United Healthcare|UMR UNITED MEDICAL RESOURCES|542.25||||542.25||| 82731|EAP|0300|FETAL FIBRONECTIN|Managed Medicaid|MEDICAID SUPERIOR|||||548.50||| 82731|EAP|0300|FETAL FIBRONECTIN|Managed Medicaid|MEDICAID AMERIGROUP|||||548.50||| 82731|EAP|0300|FETAL FIBRONECTIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||548.50||| 82731|EAP|0300|FETAL FIBRONECTIN|Blue Cross PPO Specialty|BCBSTX PPO|548.50||||548.50||| 82746|EAP|0300|FOLATE (FOLIC ACID)|NON CONTRACTED|COMMERCIAL OTHER 1|||||585.75||| 82746|EAP|0300|FOLATE (FOLIC ACID)|Tricare|TRICARE EAST REGION|||||585.75||| 82746|EAP|0300|FOLATE (FOLIC ACID)|United Healthcare|UNITED HEALTHCARE|585.75||||||| 82746|EAP|0300|FOLATE (FOLIC ACID)|United Healthcare|TML GROUP BENEFITS|585.75||||||| 82746|EAP|0300|FOLATE (FOLIC ACID)|Medicaid|HENDERSON COUNTY INDIGENT|585.75||||||| 82746|EAP|0300|FOLATE (FOLIC ACID)|Medicare|MEDICARE ACUTE|585.75||||585.75||| 82746|EAP|0300|FOLATE (FOLIC ACID)|Medicaid|MEDICAID|585.75||||||| 82746|EAP|0300|FOLATE (FOLIC ACID)|United Medicare Advantage|UHC MEDICARE GOLD MA|585.75||||||| 82746|EAP|0300|FOLATE (FOLIC ACID)|United Medicare Advantage|AARP UHC WEST COMPLETE MA|585.75||||||| 82746|EAP|0300|FOLATE (FOLIC ACID)|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|585.75||||585.75||| 82746|EAP|0300|FOLATE (FOLIC ACID)|Veterans Affairs|VETERANS ADMINISTRATION|585.75||||||| 82746|EAP|0300|FOLATE (FOLIC ACID)|Blue Cross HMO Specialty|BCBSTX HMO|585.75||||||| 82746|EAP|0300|FOLATE (FOLIC ACID)|Cigna|CIGNA OTHER|||||585.75||| 82746|EAP|0300|FOLATE (FOLIC ACID)|ChampVA|CHAMPVA CENTER|585.75||||||| 82746|EAP|0300|FOLATE (FOLIC ACID)|Blue Cross PPO Specialty|BCBSTX PPO|585.75||||||| 82746|EAP|0300|FOLATE (FOLIC ACID)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||585.75||| 82746|EAP|0300|FOLATE (FOLIC ACID)|Humana Medicare Advantage|HUMANA MA|585.75||||585.75||| 82746|EAP|0300|FOLATE (FOLIC ACID)|Managed Medicaid|MEDICAID UNITED HEALTHCARE|585.75||||||| 82746|EAP|0300|FOLATE (FOLIC ACID)|Managed Medicaid|MEDICAID SUPERIOR|585.75||||||| 82746|EAP|0300|FOLATE (FOLIC ACID)|Managed Medicaid|MEDICAID AMERIGROUP|585.75||||||| 82747|EAP|0300|RBC FOLATE|Managed Medicare|HEALTHSPRING MA|688.75||||||| 82784|EAP|0300|IGA|Medicaid|HENDERSON COUNTY INDIGENT|||||370.75||| 82784|EAP|0300|IGG|Medicaid|HENDERSON COUNTY INDIGENT|||||370.75||| 82784|EAP|0300|IMMUNOGLOBULIN PANEL I|Medicare|MEDICARE ACUTE|370.75||||370.75||| 82784|EAP|0300|IGM|Medicare|MEDICARE ACUTE|370.75||||370.75||| 82784|EAP|0300|IGG|Medicare|MEDICARE ACUTE|370.75||||370.75||| 82784|EAP|0300|IGA|Medicare|MEDICARE ACUTE|370.75||||370.75||| 82784|EAP|0300|IMMUNOGLOBULIN PANEL I|Blue Cross PPO Specialty|BCBSTX PPO|370.75||||||| 82784|EAP|0300|IGG|Humana Medicare Advantage|HUMANA MA|||||370.75||| 82784|EAP|0300|IGM|Managed Medicaid|MEDICAID AMERIGROUP|||||370.75||| 82784|EAP|0300|IGG|Managed Medicaid|MEDICAID AMERIGROUP|||||370.75||| 82785|EAP|0300|IGE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||656.25||| 82785|EAP|0300|IGE|Medicare|MEDICARE ACUTE|||||656.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Managed Medicare|HOSPICE OF EAST TEXAS|933.25||||||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Managed Medicaid|MEDICAID SUPERIOR|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Managed Medicaid|MEDICAID AMERIGROUP|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Managed Medicare|VAN ZANDT COUNTY INMATE|933.25||||||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Managed Medicare|MA PART B ONLY IP|933.25||||||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Managed Medicare|BCBS MEDICARE PPO MA|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Managed Medicare|HEALTHSPRING MA|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Humana Medicare Advantage|HUMANA MA|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Aenta Medicare Advantage|AETNA MEDICARE MA|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Aetna|AETNA OTHER|||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Aetna|AETNA PPO|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Blue Cross PPO Specialty|BCBSTX PPO|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Cigna|CIGNA|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Cigna|CIGNA OTHER|933.25||||||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Blue Cross HMO Specialty|BCBSTX HMO|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Medicaid|MEDICAID|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Medicaid|HENDERSON COUNTY INDIGENT|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Medicaid|MOLINA HEALTHCARE OF TEXAS|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Medicaid|LAW ENFORCEMENT OTHER|||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Medicaid|MEDICAID HMO|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|MTC Medical|VAN ZANDT COUNTY INMATE|933.25||||||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Medicare|MEDICARE PART B ONLY IP|933.25||||||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Medicare|MEDICARE ACUTE|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Tricare|TRICARE EAST REGION|933.25||||||| 82805|EAP|0301|ABG WITH OXYGEN SAT|UTMB|UTMB CORRECTIONAL MANAGED CARE|933.25||||||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|NON CONTRACTED|COMMERCIAL OTHER 1|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Veterans Affairs|VETERANS ADMINISTRATION|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Workers Compensation|UT EMPLOYEE INJURY|933.25||||||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Veterans Affairs|VETERANS ADMINISTRATION|||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|Workers Compensation|WORKERS COMPENSATION OTHER|||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|United Medicare Advantage|UHC MEDICARE GOLD MA|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|United Healthcare|UNITED HEALTHCARE OTHER|||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|United Medicare Advantage|UHC AARP MCR HMO MA|||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|United Healthcare|UNITED HEALTHCARE|933.25||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|United Healthcare|UNITED HEALTHCARE|||||933.25||| 82805|EAP|0301|ABG WITH OXYGEN SAT|United Healthcare|UMR UNITED MEDICAL RESOURCES|933.25||||933.25||| 82945|EAP|0300|SUGAR QUAN SP FL|Medicare|MEDICARE ACUTE|156.25||||156.25||| 82945|EAP|0300|SUGAR QUAN SP FL|Blue Cross PPO Specialty|BCBSTX PPO|156.25||||156.25||| 82945|EAP|0300|SUGAR QUAN SP FL|Managed Medicaid|MEDICAID SUPERIOR|156.25||||156.25||| 82947|EAP|0300|GLUCOSE|Humana Medicare Advantage|HUMANA MA|156.25||||||| 82947|EAP|0300|GLUCOSE|Managed Medicaid|MEDICAID SUPERIOR|156.25||||156.25||| 82947|EAP|0300|GLUCOSE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|156.25||||||| 82947|EAP|0300|GLUCOSE|Managed Medicaid|MEDICAID AMERIGROUP|156.25||||||| 82947|EAP|0300|GLUCOSE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||156.25||| 82947|EAP|0300|GLUCOSE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|156.25||||156.25||| 82947|EAP|0300|GLUCOSE|Cigna|CIGNA|156.25||||||| 82947|EAP|0300|GLUCOSE|Blue Cross PPO Specialty|BCBSTX PPO|156.25||||||| 82947|EAP|0300|GLUCOSE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||156.25||| 82947|EAP|0300|GLUCOSE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|156.25||||156.25||| 82947|EAP|0300|GLUCOSE|Medicaid|MEDICAID|156.25||||||| 82947|EAP|0300|GLUCOSE|Medicaid|MEDICAID HMO|||||156.25||| 82947|EAP|0300|GLUCOSE|Tricare|TRICARE EAST REGION|156.25||||||| 82947|EAP|0300|GLUCOSE|Medicare|MEDICARE ACUTE|156.25||||156.25||| 82955|EAP|0300|G-6-PD|Medicare|MEDICARE ACUTE|||||348.75||| 82955|EAP|0300|G-6-PD|Cigna|CIGNA|348.75||||||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Managed Medicaid|MEDICAID AMERIGROUP|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Managed Medicare|VAN ZANDT COUNTY INMATE|||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Managed Medicare|MA PART B ONLY IP|93.25||||||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Managed Medicaid|MEDICAID UNITED HEALTHCARE|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Managed Medicare|OTHER INSTITUTIONS|||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Managed Medicare|BCBS MEDICARE PPO MA|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Managed Medicare|HOSPICE CARING HEARTS|93.25||||||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|MTC Medical|VAN ZANDT COUNTY INMATE|||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Aetna|BOON CHAPMAN|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Aenta Medicare Advantage|AETNA MEDICARE MA|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|93.25||||||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Aetna|AETNA OTHER|||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Blue Cross HMO Specialty|BCBSTX HMO|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|ChampVA|CHAMPVA CENTER|93.25||||||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Brinson Benefits|THE HEALTH PLAN SMITH CO|||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Aetna|AETNA PPO|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Blue Cross PPO Specialty|BCBSTX OTHER|||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Cigna|CIGNA OTHER|||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Cigna|CIGNA|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Blue Cross PPO Specialty|BCBSTX PPO|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Veterans Affairs|VETERANS ADMINISTRATION|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Workers Compensation|WORKERS COMPENSATION OTHER|||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|United Medicare Advantage|AARP UHC WEST COMPLETE MA|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|United Medicare Advantage|UHC MEDICARE GOLD MA|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|United Medicare Advantage|UHC AARP MCR HMO MA|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Medicaid|MEDICAID|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Humana Medicare Advantage|HUMANA MA|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Managed Medicare|HEALTHSPRING MA|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Managed Medicaid|MEDICAID SUPERIOR|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Medicaid|MEDICAID TEXAS CHILDRENS|||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Medicaid|MEDICAID HMO|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Medicaid|HENDERSON COUNTY INDIGENT|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Medicaid|MOLINA HEALTHCARE OF TEXAS|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Medicaid|COUNTY INDIGENT HEALTH OTHER|93.25||||||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Medicaid|LAW ENFORCEMENT OTHER|93.25||||||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|United Healthcare|UMR UNITED MEDICAL RESOURCES|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|NON CONTRACTED|COMMERCIAL OTHER 1|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Tricare|TRICARE FOR LIFE|||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Medicare|MEDICARE PART B ONLY IP|93.25||||||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|UTMB|UTMB CORRECTIONAL MANAGED CARE|93.25||||||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|United Healthcare|UNITED HEALTHCARE|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|United Healthcare|TML GROUP BENEFITS|93.25||||||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Tricare|TRICARE EAST REGION|93.25||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|United Healthcare|UNITED HEALTHCARE OTHER|||||93.25||| 82962|EAP|0300|FINGERSTIK GLUCOMETER|Medicare|MEDICARE ACUTE|93.25||||93.25||| 82977|EAP|0300|GGT|Medicare|MEDICARE ACUTE|||||286.75||| 82977|EAP|0300|ASSAY OF GLUTAMYLTRASE GA|Medicare|MEDICARE ACUTE|||||0.70||| 82977|EAP|0300|ASSAY OF GLUTAMYLTRASE GA|United Healthcare|UNITED HEALTHCARE|||||0.70||| 82977|EAP|0300|ASSAY OF GLUTAMYLTRASE GA|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.70||| 82977|EAP|0300|ASSAY OF GLUTAMYLTRASE GA|Blue Cross PPO Specialty|BCBSTX PPO|||||0.70||| 82977|EAP|0300|ASSAY OF GLUTAMYLTRASE GA|Cigna|CIGNA|||||0.70||| 82977|EAP|0300|GGT|Aenta Medicare Advantage|AETNA MEDICARE MA|||||286.75||| 82977|EAP|0300|ASSAY OF GLUTAMYLTRASE GA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.70||| 82977|EAP|0300|ASSAY OF GLUTAMYLTRASE GA|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.70||| 82977|EAP|0300|ASSAY OF GLUTAMYLTRASE GA|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.70||| 82977|EAP|0300|GGT|Humana Medicare Advantage|HUMANA MA|||||286.75||| 82977|EAP|0300|ASSAY OF GLUTAMYLTRASE GA|Managed Medicare|HEALTHSPRING MA|||||0.70||| 83|DRG||TRAUMATIC STUPOR & COMA, COMA >1 HR W CC|Medicare|MEDICARE ACUTE|32,703.75|10305.08|10305.08|10305.08|||| 83001|EAP|0300|FSH|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||162.25||| 83001|EAP|0300|FSH|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||162.25||| 83001|EAP|0300|FSH|Blue Cross PPO Specialty|BCBSTX PPO|||||162.25||| 83001|EAP|0300|FSH|Medicare|MEDICARE ACUTE|740.75||||||| 83002|EAP|0300|LH(LUTENIZING HORMONE)|Medicare|MEDICARE ACUTE|7.38||||||| 83002|EAP|0300|LH(LUTENIZING HORMONE)|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||7.38||| 83002|EAP|0300|LH(LUTENIZING HORMONE)|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||7.38||| 83003|EAP|0300|HUMAN GROWTH HORMONE(HGH)|Medicare|MEDICARE ACUTE|6.64||||||| 83010|EAP|0300|ASSAY OF HAPTOGLOBIN QUAN|Managed Medicare|HEALTHSPRING MA|501.25||||0.70||| 83010|EAP|0300|HAPTAGLOBIN|Managed Medicaid|MEDICAID SUPERIOR|501.25||||501.25||| 83010|EAP|0300|HAPTAGLOBIN|Humana Medicare Advantage|HUMANA MA|501.25||||||| 83010|EAP|0300|ASSAY OF HAPTOGLOBIN QUAN|Blue Cross PPO Specialty|BCBSTX PPO|501.25||||0.70||| 83010|EAP|0300|HAPTAGLOBIN|Cigna|CIGNA|501.25||||||| 83010|EAP|0300|ASSAY OF HAPTOGLOBIN QUAN|Cigna|CIGNA|||||0.70||| 83010|EAP|0300|ASSAY OF HAPTOGLOBIN QUAN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.70||| 83010|EAP|0300|ASSAY OF HAPTOGLOBIN QUAN|Aenta Medicare Advantage|AETNA MEDICARE MA|501.25||||0.70||| 83010|EAP|0300|ASSAY OF HAPTOGLOBIN QUAN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.70||| 83010|EAP|0300|HAPTAGLOBIN|Veterans Affairs|VETERANS ADMINISTRATION|501.25||||||| 83010|EAP|0300|ASSAY OF HAPTOGLOBIN QUAN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.70||| 83010|EAP|0300|HAPTAGLOBIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|501.25||||||| 83010|EAP|0300|HAPTAGLOBIN|United Medicare Advantage|UHC MEDICARE GOLD MA|501.25||||||| 83010|EAP|0300|HAPTAGLOBIN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|501.25||||||| 83010|EAP|0300|HAPTAGLOBIN|Medicaid|MOLINA HEALTHCARE OF TEXAS|501.25||||||| 83010|EAP|0300|ASSAY OF HAPTOGLOBIN QUAN|Medicare|MEDICARE ACUTE|501.25||||0.70||| 83010|EAP|0300|HAPTAGLOBIN|Medicare|MEDICARE ACUTE|501.25||||501.25||| 83010|EAP|0300|ASSAY OF HAPTOGLOBIN QUAN|United Healthcare|UNITED HEALTHCARE|||||0.70||| 83020|EAP|0300|ELECTROPHORESIS HEMOGLOBI|Cigna|CIGNA|||||5.13||| 83020|EAP|0300|ELECTROPHORESIS HEMOGLOBI|Blue Cross PPO Specialty|BCBSTX PPO|||||5.13||| 83036|EAP|0300|GLYCOHEMOGLOBIN|United Healthcare|UNITED HEALTHCARE OTHER|||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|NON CONTRACTED|COMMERCIAL OTHER 1|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|United Healthcare|TML GROUP BENEFITS|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Medicare|MEDICARE ACUTE|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|UTMB|UTMB CORRECTIONAL MANAGED CARE|386.50||||||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Medicare|MEDICARE PART B ONLY IP|386.50||||||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Tricare|TRICARE EAST REGION|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Medicaid|MEDICAID HMO|||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Medicaid|COUNTY INDIGENT HEALTH OTHER|386.50||||||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Medicaid|MEDICAID|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Medicaid|MOLINA HEALTHCARE OF TEXAS|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|United Medicare Advantage|UHC AARP MCR HMO MA|||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|United Medicare Advantage|UHC MEDICARE GOLD MA|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Veterans Affairs|VETERANS ADMINISTRATION|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Humana Medicare Advantage|HUMANA MA|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Managed Medicare|HEALTHSPRING MA|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Medicaid|HENDERSON COUNTY INDIGENT|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|United Healthcare|UNITED HEALTHCARE|||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Managed Medicaid|MEDICAID SUPERIOR|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Managed Medicaid|MEDICAID AMERIGROUP|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Managed Medicare|BCBS MEDICARE PPO MA|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Managed Medicare|OTHER INSTITUTIONS|||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Access Direct Platinum|HEALTHFIRST TPA UMR|||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Aenta Medicare Advantage|AETNA MEDICARE MA|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Aetna|AETNA PPO|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Cigna|CIGNA|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Cigna|CIGNA OTHER|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Blue Cross PPO Specialty|BCBSTX PPO|386.50||||386.50||| 83036|EAP|0300|GLYCOHEMOGLOBIN|Blue Cross HMO Specialty|BCBSTX HMO|386.50||||386.50||| 83090|EAP|0300|HOMOCYSTINE|Managed Medicaid|MEDICAID SUPERIOR|6.72||||||| 83090|EAP|0300|HOMOCYSTINE|Medicare|MEDICARE ACUTE|||||6.72||| 831|DRG||OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W MCC|Managed Medicaid|MEDICAID SUPERIOR|9,069.80|889.06|889.06|889.06|||| 832|DRG||OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W CC|Medicaid|MEDICAID|38,694.98|1872.55|2977.35|15.75|||| 832|DRG||OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W CC|Cigna|CIGNA|23,002.80|15.75|2977.35|15.75|||| 832|DRG||OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7,296.75|935.16|2977.35|15.75|||| 832|DRG||OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W CC|Managed Medicaid|MEDICAID SUPERIOR|18,016.75|2977.35|2977.35|15.75|||| 833|DRG||OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W/O CC/MCC|Managed Medicaid|MEDICAID AMERIGROUP|24,777.55|2977.35|5316.21|803.22|||| 833|DRG||OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W/O CC/MCC|Managed Medicaid|MEDICAID SUPERIOR|10,960.25|2251.68|5316.21|803.22|||| 833|DRG||OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W/O CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5,450.30|833.16|5316.21|803.22|||| 833|DRG||OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|9,071.75|803.22|5316.21|803.22|||| 833|DRG||OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W/O CC/MCC|United Healthcare|GEHA|18,260.25|5316.21|5316.21|803.22|||| 833|DRG||OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W/O CC/MCC|Medicaid|MOLINA HEALTHCARE OF TEXAS|151.69|1416.15|5316.21|803.22|||| 834|DRG||ACUTE LEUKEMIA W/O MAJOR O.R. PROCEDURE W MCC|Medicare|MEDICARE ACUTE|101,356.95|38297.1|38297.1|38297.1|||| 83516|EAP|0300|TISSUE TRANSGLUTINESE AB|Blue Cross HMO Specialty|BCBSTX HMO|||||459.75||| 83516|EAP|0300|TISSUE TRANSGLUTINESE AB|Blue Cross PPO Specialty|BCBSTX PPO|||||459.75||| 83516|EAP|0300|MITOCHONDRIAL AB(AMA)|Blue Cross PPO Specialty|BCBSTX PPO|||||459.75||| 83516|EAP|0300|TISSUE TRANSGLUTINESE AB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||459.75||| 83516|EAP|0300|CELIAC PANEL|Aenta Medicare Advantage|AETNA MEDICARE MA|459.75||||||| 83516|EAP|0300|TISSUE TRANSGLUTINESE AB|Aetna|AETNA PPO|459.75||||||| 83516|EAP|0300|CELIAC PANEL|Managed Medicaid|MEDICAID SUPERIOR|||||459.75||| 83516|EAP|0300|MITOCHONDRIAL AB(AMA)|Managed Medicare|HEALTHSPRING MA|459.75||||||| 83516|EAP|0300|TISSUE TRANSGLUTINESE AB|Humana Medicare Advantage|HUMANA MA|459.75||||459.75||| 83516|EAP|0300|MITOCHONDRIAL AB(AMA)|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|459.75||||459.75||| 83516|EAP|0300|MITOCHONDRIAL AB(AMA)|United Medicare Advantage|AARP UHC WEST COMPLETE MA|459.75||||||| 83516|EAP|0300|TISSUE TRANSGLUTINESE AB|United Medicare Advantage|AARP UHC WEST COMPLETE MA|459.75||||||| 83516|EAP|0300|TISSUE TRANSGLUTINESE AB|United Healthcare|UNITED HEALTHCARE|||||459.75||| 83516|EAP|0300|TISSUE TRANSGLUTINESE AB|Medicare|MEDICARE ACUTE|459.75||||459.75||| 83516|EAP|0300|MITOCHONDRIAL AB(AMA)|Medicare|MEDICARE ACUTE|459.75||||459.75||| 83516|EAP|0300|CELIAC PANEL|NON CONTRACTED|COMMERCIAL OTHER 1|||||459.75||| 83516|EAP|0300|TISSUE TRANSGLUTINESE AB|Medicaid|MEDICAID|||||459.75||| 83519|EAP|0300|ACETYLCHOLRINE BLOCKING A|Medicare|MEDICARE ACUTE|||||538.75||| 83519|EAP|0300|ACETYLCHOLRINE BINDING AN|Medicare|MEDICARE ACUTE|||||538.75||| 83519|EAP|0300|ACETYLCHOLRINE BINDING AN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|538.75||||538.75||| 83519|EAP|0300|LAMBERT EATON P/Q BIND|United Medicare Advantage|AARP UHC WEST COMPLETE MA|538.75||||115.75||| 83519|EAP|0300|LAMBERT EATON N CALCIUM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|538.75||||115.75||| 83519|EAP|0300|ACETYLCHOLRINE BLOCKING A|United Medicare Advantage|AARP UHC WEST COMPLETE MA|538.75||||538.75||| 83519|EAP|0300|ACETYLCHOLRINE BINDING AN|Humana Medicare Advantage|HUMANA MA|538.75||||||| 83519|EAP|0300|ACETYLCHOLRINE BLOCKING A|Humana Medicare Advantage|HUMANA MA|538.75||||||| 83519|EAP|0300|ACETYLCHOLRINE BINDING AN|Blue Cross PPO Specialty|BCBSTX PPO|||||538.75||| 83520|EAP|0300|MAG SINGLE (IMMUNOASSAY)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.16||||||| 83520|EAP|0300|GLOMERULAR BASEMENT MEM (|Blue Cross HMO Specialty|BCBSTX HMO|||||5.16||| 83520|EAP|0300|MAG SINGLE (IMMUNOASSAY)|Blue Cross PPO Specialty|BCBSTX PPO|5.16||||||| 83520|EAP|0300|MAG SINGLE (IMMUNOASSAY)|Humana Medicare Advantage|HUMANA MA|5.16||||||| 83520|EAP|0300|MAG SINGLE (IMMUNOASSAY)|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|5.16||||||| 83520|EAP|0300|LAMBERT EATON STRIATED AB|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||110.75||| 83520|EAP|0300|FECAL ELASTACE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||5.06||| 83520|EAP|0250|ANTIPHOSPHATIDYLSERINE IG|Medicare|MEDICARE ACUTE|||||70.25||| 83520|EAP|0300|TRYPTASE|Tricare|TRICARE EAST REGION|||||5.16||| 83520|EAP|0300|FECAL ELASTACE|Medicare|MEDICARE ACUTE|||||5.06||| 83520|EAP|0300|TRYPTASE|Medicare|MEDICARE ACUTE|||||5.16||| 83525|EAP|0300|INSULIN LEVEL|NON CONTRACTED|COMMERCIAL OTHER 1|455.25||||||| 83525|EAP|0300|INSULIN LEVEL|Medicare|MEDICARE ACUTE|455.25||||||| 83525|EAP|0300|INSULIN LEVEL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|455.25||||||| 83525|EAP|0300|INSULIN LEVEL|United Medicare Advantage|UHC MEDICARE GOLD MA|455.25||||||| 83525|EAP|0300|INSULIN LEVEL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|455.25||||||| 83525|EAP|0300|INSULIN LEVEL|Managed Medicaid|MEDICAID AMERIGROUP|||||455.25||| 83525|EAP|0300|INSULIN LEVEL|Blue Cross HMO Specialty|BCBSTX HMO|455.25||||||| 83525|EAP|0300|INSULIN LEVEL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|455.25||||455.25||| 83540|EAP|0300|SERUM IRON|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.58||| 83540|EAP|0300|SERUM IRON|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.58||||2.58||| 83540|EAP|0300|SERUM IRON|Aenta Medicare Advantage|AETNA MEDICARE MA|2.58||||2.58||| 83540|EAP|0300|SERUM IRON|ChampVA|CHAMPVA CENTER|2.58||||||| 83540|EAP|0300|SERUM IRON|Cigna|CIGNA|2.58||||2.58||| 83540|EAP|0300|SERUM IRON|Cigna|CIGNA OTHER|||||2.58||| 83540|EAP|0300|SERUM IRON|Blue Cross HMO Specialty|BCBSTX HMO|2.58||||2.58||| 83540|EAP|0300|SERUM IRON|Blue Cross PPO Specialty|BCBSTX PPO|2.58||||2.58||| 83540|EAP|0300|SERUM IRON|Humana Medicare Advantage|HUMANA MA|2.58||||2.58||| 83540|EAP|0300|SERUM IRON|Managed Medicare|HEALTHSPRING MA|2.58||||2.58||| 83540|EAP|0300|SERUM IRON|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.58||||2.58||| 83540|EAP|0300|SERUM IRON|Managed Medicaid|MEDICAID SUPERIOR|2.58||||2.58||| 83540|EAP|0300|SERUM IRON|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.58||||2.58||| 83540|EAP|0300|SERUM IRON|Managed Medicaid|MEDICAID AMERIGROUP|2.58||||||| 83540|EAP|0300|SERUM IRON|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|2.58||||2.58||| 83540|EAP|0300|SERUM IRON|Aetna|AETNA PPO|2.58||||||| 83540|EAP|0300|SERUM IRON|Veterans Affairs|VETERANS ADMINISTRATION|2.58||||||| 83540|EAP|0300|SERUM IRON|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.58||||2.58||| 83540|EAP|0300|SERUM IRON|United Medicare Advantage|UHC MEDICARE GOLD MA|2.58||||2.58||| 83540|EAP|0300|SERUM IRON|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.58||||2.58||| 83540|EAP|0300|SERUM IRON|Medicaid|HENDERSON COUNTY INDIGENT|||||2.58||| 83540|EAP|0300|SERUM IRON|Medicaid|MEDICAID|2.58||||2.58||| 83540|EAP|0300|SERUM IRON|Medicaid|MOLINA HEALTHCARE OF TEXAS|2.58||||||| 83540|EAP|0300|SERUM IRON|Medicare|MEDICARE ACUTE|2.58||||2.58||| 83540|EAP|0300|SERUM IRON|NON CONTRACTED|COMMERCIAL OTHER 1|2.58||||||| 83540|EAP|0300|SERUM IRON|United Healthcare|UNITED HEALTHCARE|2.58||||2.58||| 83540|EAP|0300|SERUM IRON|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.58||| 83605|EAP|0300|LACTIC ACID|Medicare|MEDICARE ACUTE|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|United Healthcare|UNITED HEALTHCARE OTHER|||||425.50||| 83605|EAP|0300|LACTIC ACID|United Healthcare|TML GROUP BENEFITS|425.50||||||| 83605|EAP|0300|LACTIC ACID|Tricare|TRICARE EAST REGION|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|United Healthcare|UNITED HEALTHCARE|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|NON CONTRACTED|COMMERCIAL OTHER 1|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|UTMB|UTMB CORRECTIONAL MANAGED CARE|425.50||||||| 83605|EAP|0300|LACTIC ACID|United Healthcare|UMR UNITED MEDICAL RESOURCES|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|Medicaid|COUNTY INDIGENT HEALTH OTHER|425.50||||||| 83605|EAP|0300|LACTIC ACID|Medicaid|LAW ENFORCEMENT OTHER|||||425.50||| 83605|EAP|0300|LACTIC ACID|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||425.50||| 83605|EAP|0300|LACTIC ACID|Medicaid|HENDERSON COUNTY INDIGENT|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|Medicaid|MEDICAID|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|Medicaid|MOLINA HEALTHCARE OF TEXAS|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|United Medicare Advantage|UHC AARP MCR HMO MA|||||425.50||| 83605|EAP|0300|LACTIC ACID|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|United Medicare Advantage|UHC MEDICARE GOLD MA|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|United Medicare Advantage|AARP UHC WEST COMPLETE MA|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|Veterans Affairs|VETERANS ADMINISTRATION|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|Workers Compensation|UT EMPLOYEE INJURY|425.50||||||| 83605|EAP|0300|LACTIC ACID|Managed Medicaid|MEDICAID UNITED HEALTHCARE|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|Medicaid|MEDICAID HMO|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|Managed Medicaid|MEDICAID SUPERIOR|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|Managed Medicaid|MEDICAID AMERIGROUP|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|Managed Medicare|BCBS MEDICARE PPO MA|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|Medicaid|MEDICAID TEXAS CHILDRENS|||||425.50||| 83605|EAP|0300|LACTIC ACID|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|Managed Medicare|MA PART B ONLY IP|425.50||||||| 83605|EAP|0300|LACTIC ACID|Managed Medicare|HEALTHSPRING MA|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|Medicare|MEDICARE PART B ONLY IP|425.50||||||| 83605|EAP|0300|LACTIC ACID|Humana Medicare Advantage|HUMANA MA|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|Blue Cross HMO Specialty|BCBSTX HMO|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|Cigna|CIGNA|||||425.50||| 83605|EAP|0300|LACTIC ACID|United Healthcare|UNITED HEALTHCARE|||||425.50||| 83605|EAP|0300|LACTIC ACID|ChampVA|CHAMPVA CENTER|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|Cigna|CIGNA OTHER|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|Cigna|CIGNA|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|Blue Cross PPO Specialty|BCBSTX PPO|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|Blue Cross PPO Specialty|BCBSTX OTHER|||||425.50||| 83605|EAP|0300|LACTIC ACID|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|Aetna|AETNA PPO|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||425.50||| 83605|EAP|0300|LACTIC ACID|Aetna|AETNA OTHER|||||425.50||| 83605|EAP|0300|LACTIC ACID|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|425.50||||425.50||| 83605|EAP|0300|LACTIC ACID|Aenta Medicare Advantage|AETNA MEDICARE MA|425.50||||425.50||| 83615|EAP|0300|LACTIC DEHYDROGENASE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|240.50||||240.50||| 83615|EAP|0300|LACTIC DEHYDROGENASE|Aenta Medicare Advantage|AETNA MEDICARE MA|240.50||||||| 83615|EAP|0300|LACTIC DEHYDROGENASE|Aetna|AETNA PPO|||||240.50||| 83615|EAP|0300|LACTIC DEHYDROGENASE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||240.50||| 83615|EAP|0300|LDH, BODY FLUID|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|240.50||||240.50||| 83615|EAP|0300|LACTIC DEHYDROGENASE|ChampVA|CHAMPVA CENTER|240.50||||||| 83615|EAP|0300|LACTIC DEHYDROGENASE|Cigna|CIGNA|240.50||||||| 83615|EAP|0300|LACTIC DEHYDROGENASE|Blue Cross PPO Specialty|BCBSTX PPO|240.50||||240.50||| 83615|EAP|0300|LDH, BODY FLUID|Blue Cross PPO Specialty|BCBSTX PPO|240.50||||240.50||| 83615|EAP|0300|LDH, BODY FLUID|Humana Medicare Advantage|HUMANA MA|240.50||||240.50||| 83615|EAP|0300|LACTIC DEHYDROGENASE|Humana Medicare Advantage|HUMANA MA|240.50||||240.50||| 83615|EAP|0300|LACTIC DEHYDROGENASE|Managed Medicare|HEALTHSPRING MA|240.50||||240.50||| 83615|EAP|0300|LACTIC DEHYDROGENASE|Managed Medicare|OTHER INSTITUTIONS|||||240.50||| 83615|EAP|0300|LACTIC DEHYDROGENASE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|240.50||||||| 83615|EAP|0300|LACTIC DEHYDROGENASE|Managed Medicaid|MEDICAID SUPERIOR|240.50||||240.50||| 83615|EAP|0300|LACTIC DEHYDROGENASE|Blue Cross HMO Specialty|BCBSTX HMO|240.50||||240.50||| 83615|EAP|0300|LACTIC DEHYDROGENASE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|240.50||||||| 83615|EAP|0300|LACTIC DEHYDROGENASE|Managed Medicaid|MEDICAID AMERIGROUP|240.50||||240.50||| 83615|EAP|0300|LACTIC DEHYDROGENASE|Managed Medicare|BCBS MEDICARE PPO MA|240.50||||240.50||| 83615|EAP|0300|LDH, BODY FLUID|Managed Medicare|BCBS MEDICARE PPO MA|240.50||||240.50||| 83615|EAP|0300|LACTIC DEHYDROGENASE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||240.50||| 83615|EAP|0300|LACTIC DEHYDROGENASE|Workers Compensation|UT EMPLOYEE INJURY|240.50||||||| 83615|EAP|0300|LACTIC DEHYDROGENASE|Veterans Affairs|VETERANS ADMINISTRATION|240.50||||240.50||| 83615|EAP|0300|LACTIC DEHYDROGENASE|United Medicare Advantage|UHC MEDICARE GOLD MA|240.50||||240.50||| 83615|EAP|0300|LDH, BODY FLUID|United Medicare Advantage|AARP UHC WEST COMPLETE MA|240.50||||240.50||| 83615|EAP|0300|LACTIC DEHYDROGENASE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||240.50||| 83615|EAP|0300|LACTIC DEHYDROGENASE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|240.50||||||| 83615|EAP|0300|LACTIC DEHYDROGENASE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|240.50||||240.50||| 83615|EAP|0300|LACTIC DEHYDROGENASE|Medicaid|MEDICAID|240.50||||||| 83615|EAP|0300|LACTIC DEHYDROGENASE|Medicaid|MEDICAID HMO|||||240.50||| 83615|EAP|0300|LACTIC DEHYDROGENASE|Medicaid|MOLINA HEALTHCARE OF TEXAS|240.50||||240.50||| 83615|EAP|0300|LACTIC DEHYDROGENASE|Medicare|MEDICARE ACUTE|240.50||||240.50||| 83615|EAP|0300|LDH, BODY FLUID|Medicare|MEDICARE ACUTE|240.50||||240.50||| 83615|EAP|0300|LACTIC DEHYDROGENASE|United Healthcare|UMR UNITED MEDICAL RESOURCES|240.50||||||| 83615|EAP|0300|LACTIC DEHYDROGENASE|Tricare|TRICARE EAST REGION|240.50||||240.50||| 83615|EAP|0300|LACTIC DEHYDROGENASE|NON CONTRACTED|COMMERCIAL OTHER 1|240.50||||240.50||| 83615|EAP|0300|LACTIC DEHYDROGENASE|United Healthcare|UNITED HEALTHCARE|240.50||||||| 83630|EAP|0300|FECAL LACTOFERRIN|Medicare|MEDICARE ACUTE|347.25||||||| 83630|EAP|0300|FECAL LACTOFERRIN|United Medicare Advantage|UHC MEDICARE GOLD MA|||||347.25||| 83630|EAP|0300|FECAL LACTOFERRIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||347.25||| 83630|EAP|0300|FECAL LACTOFERRIN|Humana Medicare Advantage|HUMANA MA|347.25||||||| 83630|EAP|0300|FECAL LACTOFERRIN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||347.25||| 83655|EAP|0300|LEAD, BLOOD|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||482.25||| 83655|EAP|0300|LEAD, BLOOD|Medicare|MEDICARE ACUTE|482.25||||||| 83655|EAP|0300|HEAVY METALS,URINE(LEAD)|Medicare|MEDICARE ACUTE|482.25||||||| 83690|EAP|0300|LIPASE|Workers Compensation|WORKERS COMPENSATION OTHER|||||274.75||| 83690|EAP|0300|LIPASE|Veterans Affairs|VETERANS ADMINISTRATION|274.75||||274.75||| 83690|EAP|0300|LIPASE|United Medicare Advantage|UHC MEDICARE GOLD MA|274.75||||274.75||| 83690|EAP|0300|LIPASE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|274.75||||274.75||| 83690|EAP|0300|LIPASE|United Medicare Advantage|UHC AARP MCR HMO MA|274.75||||274.75||| 83690|EAP|0300|LIPASE|Medicaid|LAW ENFORCEMENT OTHER|274.75||||274.75||| 83690|EAP|0300|LIPASE|Medicaid|HENDERSON COUNTY INDIGENT|274.75||||274.75||| 83690|EAP|0300|LIPASE|Medicaid Out of State|MEDICAID LOUISIANA|||||274.75||| 83690|EAP|0300|LIPASE|Medicaid|MEDICAID TEXAS CHILDRENS|||||274.75||| 83690|EAP|0300|LIPASE|Medicaid|MEDICAID HMO|||||274.75||| 83690|EAP|0300|LIPASE|Medicaid|MEDICAID|274.75||||274.75||| 83690|EAP|0300|LIPASE|NON CONTRACTED|COMMERCIAL OTHER 2|||||274.75||| 83690|EAP|0300|LIPASE|PHCS|HUMANA INSURANCE|||||274.75||| 83690|EAP|0300|LIPASE|NON CONTRACTED|COMMERCIAL OTHER 1|274.75||||274.75||| 83690|EAP|0300|LIPASE|PHCS|HUMANA|||||274.75||| 83690|EAP|0300|LIPASE|United Healthcare|UNITED HEALTHCARE|274.75||||274.75||| 83690|EAP|0300|LIPASE|United Healthcare|UNITED HEALTHCARE|||||274.75||| 83690|EAP|0300|LIPASE|United Healthcare|GOLDEN RULE|||||274.75||| 83690|EAP|0300|LIPASE|Medicare|MEDICARE PART B ONLY IP|274.75||||||| 83690|EAP|0300|LIPASE|Medicare|MEDICARE ACUTE|274.75||||274.75||| 83690|EAP|0300|LIPASE|United Healthcare|UNITED HEALTHCARE OTHER|274.75||||274.75||| 83690|EAP|0300|LIPASE|Tricare|TRICARE EAST REGION|274.75||||274.75||| 83690|EAP|0300|LIPASE|United Healthcare|UMR UNITED MEDICAL RESOURCES|274.75||||274.75||| 83690|EAP|0300|LIPASE|United Healthcare|GEHA|||||274.75||| 83690|EAP|0300|LIPASE|MTC Medical|VAN ZANDT COUNTY INMATE|||||274.75||| 83690|EAP|0300|LIPASE|Humana Medicare Advantage|HUMANA MA|274.75||||274.75||| 83690|EAP|0300|LIPASE|Managed Medicare|HEALTHSPRING MA|274.75||||274.75||| 83690|EAP|0300|LIPASE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|274.75||||274.75||| 83690|EAP|0300|LIPASE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|274.75||||274.75||| 83690|EAP|0300|LIPASE|Managed Medicaid|MEDICAID SUPERIOR|274.75||||274.75||| 83690|EAP|0300|LIPASE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|274.75||||274.75||| 83690|EAP|0300|LIPASE|Managed Medicaid|MEDICAID AMERIGROUP|274.75||||274.75||| 83690|EAP|0300|LIPASE|United Healthcare|TML GROUP BENEFITS|274.75||||274.75||| 83690|EAP|0300|LIPASE|Medicaid|MOLINA HEALTHCARE OF TEXAS|274.75||||274.75||| 83690|EAP|0300|LIPASE|Managed Medicare|OTHER INSTITUTIONS|||||274.75||| 83690|EAP|0300|LIPASE|Managed Medicare|BCBS MEDICARE PPO MA|274.75||||274.75||| 83690|EAP|0300|LIPASE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|274.75||||274.75||| 83690|EAP|0300|LIPASE|Managed Medicare|WELLCARE CHOICE MA|||||274.75||| 83690|EAP|0300|LIPASE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||274.75||| 83690|EAP|0300|LIPASE|Managed Medicare|MA PART B ONLY IP|274.75||||||| 83690|EAP|0300|LIPASE|Managed Medicare|VAN ZANDT COUNTY INMATE|||||274.75||| 83690|EAP|0300|LIPASE|ChampVA|CHAMPVA CENTER|274.75||||274.75||| 83690|EAP|0300|LIPASE|Blue Cross PPO Specialty|BCBSTX OTHER|||||274.75||| 83690|EAP|0300|LIPASE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|274.75||||274.75||| 83690|EAP|0300|LIPASE|Cigna|CIGNA|274.75||||274.75||| 83690|EAP|0300|LIPASE|Blue Cross HMO Specialty|BCBSTX HMO|274.75||||274.75||| 83690|EAP|0300|LIPASE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|274.75||||274.75||| 83690|EAP|0300|LIPASE|Cigna|CIGNA OTHER|274.75||||274.75||| 83690|EAP|0300|LIPASE|Blue Cross PPO Specialty|BCBSTX PPO|274.75||||274.75||| 83690|EAP|0300|LIPASE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||274.75||| 83690|EAP|0300|LIPASE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|274.75||||274.75||| 83690|EAP|0300|LIPASE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||274.75||| 83690|EAP|0300|LIPASE|Aetna|AETNA PPO|274.75||||274.75||| 83690|EAP|0300|LIPASE|Aetna|AETNA OTHER|||||274.75||| 83690|EAP|0300|LIPASE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||274.75||| 83690|EAP|0300|LIPASE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|274.75||||274.75||| 83690|EAP|0300|LIPASE|Aetna|BOON CHAPMAN|274.75||||274.75||| 83690|EAP|0300|LIPASE|Aenta Medicare Advantage|AETNA MEDICARE MA|274.75||||274.75||| 83718|EAP|0300|HDL HIGH DENSITY LIP|Aenta Medicare Advantage|AETNA MEDICARE MA|||||326.25||| 83718|EAP|0300|HDL HIGH DENSITY LIP|Blue Cross PPO Specialty|BCBSTX PPO|||||326.25||| 83721|EAP|0300|LDL-DIRECT MEASUREMENT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.80||||||| 83721|EAP|0300|LDL-DIRECT MEASUREMENT|Blue Cross PPO Specialty|BCBSTX PPO|||||3.80||| 83735|EAP|0300|MAGNESIUM|United Healthcare|UNITED HEALTHCARE OTHER|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|United Healthcare|UMR UNITED MEDICAL RESOURCES|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|UTMB|UTMB CORRECTIONAL MANAGED CARE|267.25||||||| 83735|EAP|0300|MAGNESIUM|Tricare|TRICARE FOR LIFE|||||267.25||| 83735|EAP|0300|MAGNESIUM|PHCS|HUMANA|||||267.25||| 83735|EAP|0300|MAGNESIUM|United Healthcare|GOLDEN RULE|||||267.25||| 83735|EAP|0300|MAGNESIUM|Medicare|MEDICARE PART B ONLY IP|267.25||||||| 83735|EAP|0300|MAGNESIUM|Medicare|MEDICARE ACUTE|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|NON CONTRACTED|COMMERCIAL OTHER 1|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Multiplan|NALC|||||267.25||| 83735|EAP|0300|MAGNESIUM|Tricare|TRICARE EAST REGION|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Texas Workforce Commission|DIS DETER SERV (DDS)|267.25||||||| 83735|EAP|0300|MAGNESIUM|PHCS|MULTIPLAN PHCS OTHER|||||267.25||| 83735|EAP|0300|MAGNESIUM|Medicaid|COUNTY INDIGENT HEALTH OTHER|267.25||||||| 83735|EAP|0300|MAGNESIUM|Medicaid|HENDERSON COUNTY INDIGENT|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Medicaid|MOLINA HEALTHCARE OF TEXAS|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Medicaid|LAW ENFORCEMENT OTHER|||||267.25||| 83735|EAP|0300|MAGNESIUM|Medicaid|MEDICAID|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||267.25||| 83735|EAP|0300|MAGNESIUM|Medicaid Out of State|MEDICAID LOUISIANA|||||267.25||| 83735|EAP|0300|MAGNESIUM|Medicaid|MEDICAID TEXAS CHILDRENS|||||267.25||| 83735|EAP|0300|MAGNESIUM|United Medicare Advantage|UHC AARP MCR HMO MA|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|United Medicare Advantage|UHC AARP WELLMED HMO MA|||||267.25||| 83735|EAP|0300|MAGNESIUM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Workers Compensation|UT EMPLOYEE INJURY|267.25||||||| 83735|EAP|0300|MAGNESIUM|Workers Compensation|WORKERS COMPENSATION OTHER|||||267.25||| 83735|EAP|0300|MAGNESIUM|Veterans Affairs|VETERANS ADMINISTRATION|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|United Medicare Advantage|UHC MEDICARE GOLD MA|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Aetna|BOON CHAPMAN|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||267.25||| 83735|EAP|0300|MAGNESIUM|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Aetna|AETNA OTHER|||||267.25||| 83735|EAP|0300|MAGNESIUM|Aetna|AETNA PPO|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Medicaid|MEDICAID HMO|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Access Direct Platinum|HEALTHFIRST TPA UMR|||||267.25||| 83735|EAP|0300|MAGNESIUM|Aenta Medicare Advantage|AETNA MEDICARE MA|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|NON CONTRACTED|COMMERCIAL OTHER 2|||||267.25||| 83735|EAP|0300|MAGNESIUM|Blue Cross HMO Specialty|BCBSTX HMO|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Cigna|CIGNA OTHER|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|United Healthcare|UNITED HEALTHCARE|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Cigna|CIGNA|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Blue Cross PPO Specialty|BCBSTX OTHER|||||267.25||| 83735|EAP|0300|MAGNESIUM|ChampVA|CHAMPVA CENTER|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Blue Cross PPO Specialty|BCBSTX PPO|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|MTC Medical|VAN ZANDT COUNTY INMATE|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Humana Medicare Advantage|HUMANA MA|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|United Healthcare|TML GROUP BENEFITS|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Managed Medicare|MA PART B ONLY IP|267.25||||||| 83735|EAP|0300|MAGNESIUM|Managed Medicare|BCBS MEDICARE PPO MA|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Managed Medicare|HOSPICE OF EAST TEXAS|267.25||||||| 83735|EAP|0300|MAGNESIUM|Managed Medicare|HOSPICE ETMC|||||267.25||| 83735|EAP|0300|MAGNESIUM|Managed Medicare|HEALTHSPRING MA|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Managed Medicaid|MEDICAID SUPERIOR|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Managed Medicaid|MEDICAID AMERIGROUP|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Managed Medicare|WELLCARE CHOICE MA|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Managed Medicare|VAN ZANDT COUNTY INMATE|267.25||||267.25||| 83735|EAP|0300|MAGNESIUM|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|267.25||||267.25||| 83789|EAP|0300|LACOSAMIDE VIMPAT|Tricare|TRICARE EAST REGION|||||5.54||| 83825|EAP|0300|HEAVY METALS,URINE(MERCUR|Medicare|MEDICARE ACUTE|5.17||||||| 83835|EAP|0300|METANEPHRINE, FRACT URINE|Medicare|MEDICARE ACUTE|675.25||||||| 83874|EAP|0300|MYOGLOBIN SERUM|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|514.50||||||| 83874|EAP|0300|MYOGLOBIN SERUM|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||514.50||| 83874|EAP|0300|MYOGLOBIN SERUM|Humana Medicare Advantage|HUMANA MA|514.50||||514.50||| 83874|EAP|0300|MYOGLOBIN SERUM|Medicare|MEDICARE ACUTE|514.50||||||| 83880|EAP|0300|BNP|Veterans Affairs|VETERANS ADMINISTRATION|||||1,352.50||| 83880|EAP|0300|BNP|Workers Compensation|WORKERS COMPENSATION OTHER|||||1,352.50||| 83880|EAP|0300|BNP|Veterans Affairs|VETERANS ADMINISTRATION|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|United Medicare Advantage|UHC MEDICARE GOLD MA|1,352.50||||1,352.50||| 83880|EAP|0300|PRO-BNP|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,352.50||||197.50||| 83880|EAP|0300|BNP|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|United Medicare Advantage|UHC AARP MCR HMO MA|||||1,352.50||| 83880|EAP|0300|BNP|Medicaid|COUNTY INDIGENT HEALTH OTHER|1,352.50||||||| 83880|EAP|0300|BNP|Medicaid|HENDERSON COUNTY INDIGENT|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|Medicaid|MEDICAID|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|Medicaid|MEDICAID HMO|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|United Healthcare|TML GROUP BENEFITS|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|Tricare|TRICARE FOR LIFE|||||1,352.50||| 83880|EAP|0300|BNP|Tricare|TRICARE EAST REGION|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|Medicare|MEDICARE PART B ONLY IP|1,352.50||||||| 83880|EAP|0300|BNP|United Healthcare|UNITED HEALTHCARE|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|PHCS|HUMANA|||||1,352.50||| 83880|EAP|0300|BNP|UTMB|UTMB CORRECTIONAL MANAGED CARE|1,352.50||||||| 83880|EAP|0300|BNP|NON CONTRACTED|COMMERCIAL OTHER 2|||||1,352.50||| 83880|EAP|0300|BNP|NON CONTRACTED|COMMERCIAL OTHER 1|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|United Healthcare|UMR UNITED MEDICAL RESOURCES|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|United Healthcare|UNITED HEALTHCARE OTHER|||||1,352.50||| 83880|EAP|0300|BNP|Blue Cross PPO Specialty|BCBSTX PPO|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|Cigna|CIGNA|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|Blue Cross HMO Specialty|BCBSTX HMO|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|Cigna|CIGNA OTHER|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|ChampVA|CHAMPVA CENTER|||||1,352.50||| 83880|EAP|0300|BNP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|Medicare|MEDICARE ACUTE|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|Aenta Medicare Advantage|AETNA MEDICARE MA|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|Aetna|AETNA PPO|1,352.50||||1,352.50||| 83880|EAP|0300|PRO-BNP|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1,352.50||||197.50||| 83880|EAP|0300|PRO-BNP|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1,352.50||||197.50||| 83880|EAP|0300|BNP|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1,352.50||||||| 83880|EAP|0300|BNP|Aetna|AETNA OTHER|||||1,352.50||| 83880|EAP|0300|BNP|Medicaid|MOLINA HEALTHCARE OF TEXAS|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1,352.50||| 83880|EAP|0300|BNP|MTC Medical|VAN ZANDT COUNTY INMATE|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|Humana Medicare Advantage|HUMANA MA|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|Managed Medicare|HOSPICE OF EAST TEXAS|1,352.50||||||| 83880|EAP|0300|BNP|Managed Medicare|BCBS MEDICARE PPO MA|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|Workers Compensation|UT EMPLOYEE INJURY|1,352.50||||||| 83880|EAP|0300|BNP|Managed Medicare|HEALTHSPRING MA|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|Managed Medicare|MA PART B ONLY IP|1,352.50||||||| 83880|EAP|0300|BNP|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|Managed Medicaid|MEDICAID AMERIGROUP|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|Managed Medicaid|MEDICAID SUPERIOR|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|Managed Medicare|HOSPICE ETMC|||||1,352.50||| 83880|EAP|0300|BNP|Managed Medicare|WELLCARE CHOICE MA|||||1,352.50||| 83880|EAP|0300|BNP|Managed Medicare|VAN ZANDT COUNTY INMATE|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|Managed Medicare|OTHER INSTITUTIONS|||||1,352.50||| 83880|EAP|0300|BNP|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1,352.50||||1,352.50||| 83880|EAP|0300|BNP|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|1,352.50||||1,352.50||| 83883|EAP|0300|ASSAY NEPHELOMETRY NOT SP|Managed Medicare|HEALTHSPRING MA|||||0.70||| 83883|EAP|0300|ASSAY NEPHELOMETRY NOT SP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.70||| 83883|EAP|0300|ASSAY NEPHELOMETRY NOT SP|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.70||| 83883|EAP|0300|ASSAY NEPHELOMETRY NOT SP|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.70||| 83883|EAP|0300|ASSAY NEPHELOMETRY NOT SP|Cigna|CIGNA|||||0.70||| 83883|EAP|0300|ASSAY NEPHELOMETRY NOT SP|Blue Cross PPO Specialty|BCBSTX PPO|||||0.70||| 83883|EAP|0300|ASSAY NEPHELOMETRY NOT SP|United Healthcare|UNITED HEALTHCARE|||||0.70||| 83883|EAP|0300|ASSAY NEPHELOMETRY NOT SP|Medicare|MEDICARE ACUTE|||||0.70||| 83883|EAP|0300|ASSAY NEPHELOMETRY NOT SP|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.70||| 83891|EAP|0300|CYSTIC FIBROSIS GENETIC T|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||159.75||| 83903|EAP|0300|CYSTIC FIBROSIS GENETIC T|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||405.50||| 83912|EAP|0300|CYSTIC FIBROSIS GENETIC T|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||159.75||| 83915|EAP|0300|5'NUCLEOTIDASE|Medicare|MEDICARE ACUTE|||||444.50||| 83921|EAP|0300|METHYLMALONC ACID|Humana Medicare Advantage|HUMANA MA|13.12||||||| 83921|EAP|0300|METHYLMALONC ACID|Medicare|MEDICARE ACUTE|13.12||||||| 83930|EAP|0300|OSMOLALITY SERUM|United Medicare Advantage|UHC MEDICARE GOLD MA|196.25||||||| 83930|EAP|0300|OSMOLALITY SERUM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|196.25||||196.25||| 83930|EAP|0300|OSMOLALITY SERUM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|196.25||||196.25||| 83930|EAP|0300|OSMOLALITY SERUM|Medicare|MEDICARE ACUTE|196.25||||||| 83930|EAP|0300|OSMOLALITY SERUM|NON CONTRACTED|COMMERCIAL OTHER 1|||||196.25||| 83930|EAP|0300|OSMOLALITY SERUM|Cigna|CIGNA|196.25||||||| 83930|EAP|0300|OSMOLALITY SERUM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|196.25||||||| 83930|EAP|0300|OSMOLALITY SERUM|Managed Medicaid|MEDICAID AMERIGROUP|196.25||||||| 83930|EAP|0300|OSMOLALITY SERUM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|196.25||||||| 83930|EAP|0300|OSMOLALITY SERUM|Managed Medicaid|MEDICAID SUPERIOR|196.25||||||| 83930|EAP|0300|OSMOLALITY SERUM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|196.25||||||| 83930|EAP|0300|OSMOLALITY SERUM|Humana Medicare Advantage|HUMANA MA|196.25||||196.25||| 83935|EAP|0300|OSMOLALITY URINE|Humana Medicare Advantage|HUMANA MA|196.25||||||| 83935|EAP|0300|OSMOLALITY URINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|196.25||||||| 83935|EAP|0300|OSMOLALITY URINE|Managed Medicaid|MEDICAID SUPERIOR|196.25||||||| 83935|EAP|0300|OSMOLALITY URINE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|196.25||||||| 83935|EAP|0300|OSMOLALITY URINE|Managed Medicare|BCBS MEDICARE PPO MA|||||196.25||| 83935|EAP|0300|OSMOLALITY URINE|Cigna|CIGNA|196.25||||||| 83935|EAP|0300|OSMOLALITY URINE|Medicaid|HENDERSON COUNTY INDIGENT|196.25||||||| 83935|EAP|0300|OSMOLALITY URINE|Medicare|MEDICARE ACUTE|196.25||||||| 83935|EAP|0300|OSMOLALITY URINE|Veterans Affairs|VETERANS ADMINISTRATION|196.25||||||| 83935|EAP|0300|OSMOLALITY URINE|United Medicare Advantage|UHC MEDICARE GOLD MA|196.25||||||| 83935|EAP|0300|OSMOLALITY URINE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|196.25||||196.25||| 83935|EAP|0300|OSMOLALITY URINE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|196.25||||196.25||| 83970|EAP|0300|PARATHYROID HORMONE RELAT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1,392.50||||||| 83970|EAP|0300|PTH (PARATHYROID HORMONE)|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,392.50||| 83970|EAP|0300|PTH (PARATHYROID HORMONE)|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,392.50||||1,392.50||| 83970|EAP|0300|PTH (PARATHYROID HORMONE)|Veterans Affairs|VETERANS ADMINISTRATION|||||1,392.50||| 83970|EAP|0300|PTH (PARATHYROID HORMONE)|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,392.50||| 83970|EAP|0300|PTH (PARATHYROID HORMONE)|Medicare|MEDICARE ACUTE|1,392.50||||1,392.50||| 83970|EAP|0300|PTH (PARATHYROID HORMONE)|Medicaid|MEDICAID|1,392.50||||1,392.50||| 83970|EAP|0300|PTH (PARATHYROID HORMONE)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,392.50||||||| 83970|EAP|0300|PTH (PARATHYROID HORMONE)|Aenta Medicare Advantage|AETNA MEDICARE MA|1,392.50||||||| 83970|EAP|0300|PTH (PARATHYROID HORMONE)|Blue Cross PPO Specialty|BCBSTX PPO|||||1,392.50||| 83970|EAP|0300|PTH (PARATHYROID HORMONE)|Blue Cross HMO Specialty|BCBSTX HMO|||||1,392.50||| 83970|EAP|0300|PTH (PARATHYROID HORMONE)|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,392.50||| 83970|EAP|0300|PTH (PARATHYROID HORMONE)|Humana Medicare Advantage|HUMANA MA|1,392.50||||1,392.50||| 83986|EAP|0300|PH URINE|Medicare|MEDICARE ACUTE|142.25||||||| 83993|EAP|0300|CALPROTECTIN|Managed Medicaid|MEDICAID SUPERIOR|||||607.25||| 83993|EAP|0300|CALPROTECTIN|Cigna|CIGNA|||||607.25||| 83993|EAP|0300|CALPROTECTIN|Medicare|MEDICARE ACUTE|||||607.25||| 84|DRG||TRAUMATIC STUPOR & COMA, COMA >1 HR W/O CC/MCC|Veterans Affairs|VETERANS ADMINISTRATION|63,804.75|7779.25|7779.25|7665.48|||| 84|DRG||TRAUMATIC STUPOR & COMA, COMA >1 HR W/O CC/MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|35,261.50|7779.25|7779.25|7665.48|||| 84|DRG||TRAUMATIC STUPOR & COMA, COMA >1 HR W/O CC/MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|39,234.80|7665.48|7779.25|7665.48|||| 840|DRG||LYMPHOMA & NON-ACUTE LEUKEMIA W MCC|Medicare|MEDICARE ACUTE|113,928.15|21869.7|21869.7|21869.7|||| 84066|EAP|0300|PROSTATIC ACID PHOSPHATAS|Medicare|MEDICARE ACUTE|384.75||||||| 84075|EAP|0300|ALK PHOS|Humana Medicare Advantage|HUMANA MA|2.06||||||| 84075|EAP|0300|ALK PHOS|Managed Medicare|HEALTHSPRING MA|2.06||||||| 84075|EAP|0300|ALK PHOS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.06||||||| 84075|EAP|0300|ALK PHOSPHATASE|Medicaid|HENDERSON COUNTY INDIGENT|2.06||||||| 84075|EAP|0300|ALK PHOSPHATASE|Medicare|MEDICARE ACUTE|||||2.06||| 84080|EAP|0300|ALK POS W/ISOENZYMES|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|348.75||||||| 84080|EAP|0300|ALK POS W/ISOENZYMES|Blue Cross PPO Specialty|BCBSTX PPO|||||348.75||| 84080|EAP|0300|ALK POS W/ISOENZYMES|Managed Medicare|HEALTHSPRING MA|348.75||||||| 84080|EAP|0300|ALK POS W/ISOENZYMES|Humana Medicare Advantage|HUMANA MA|348.75||||||| 841|DRG||LYMPHOMA & NON-ACUTE LEUKEMIA W CC|Humana Medicare Advantage|HUMANA MA|43,327.90|12320.45|12320.45|12285.95|||| 841|DRG||LYMPHOMA & NON-ACUTE LEUKEMIA W CC|Medicare|MEDICARE ACUTE|44,589.20|12285.95|12320.45|12285.95|||| 84100|EAP|0300|PHOSPHORUS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|189.25||||189.25||| 84100|EAP|0300|PHOSPHORUS|United Medicare Advantage|UHC MEDICARE GOLD MA|189.25||||189.25||| 84100|EAP|0300|PHOSPHORUS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|189.25||||189.25||| 84100|EAP|0300|PHOSPHORUS|UTMB|UTMB CORRECTIONAL MANAGED CARE|189.25||||||| 84100|EAP|0300|PHOSPHORUS|Tricare|TRICARE EAST REGION|189.25||||||| 84100|EAP|0300|PHOSPHORUS|Medicare|MEDICARE ACUTE|189.25||||189.25||| 84100|EAP|0300|PHOSPHORUS|United Healthcare|UMR UNITED MEDICAL RESOURCES|189.25||||189.25||| 84100|EAP|0300|PHOSPHORUS|NON CONTRACTED|COMMERCIAL OTHER 1|189.25||||189.25||| 84100|EAP|0300|PHOSPHORUS|Medicare|MEDICARE PART B ONLY IP|189.25||||||| 84100|EAP|0300|PHOSPHORUS|United Healthcare|UNITED HEALTHCARE|189.25||||189.25||| 84100|EAP|0300|PHOSPHORUS|Medicaid|HENDERSON COUNTY INDIGENT|189.25||||||| 84100|EAP|0300|PHOSPHORUS|Medicaid|COUNTY INDIGENT HEALTH OTHER|189.25||||||| 84100|EAP|0300|PHOSPHORUS|Medicaid|MEDICAID|189.25||||189.25||| 84100|EAP|0300|PHOSPHORUS|United Healthcare|TML GROUP BENEFITS|189.25||||||| 84100|EAP|0300|PHOSPHORUS|Medicaid|MOLINA HEALTHCARE OF TEXAS|189.25||||||| 84100|EAP|0300|PHOSPHORUS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|189.25||||189.25||| 84100|EAP|0300|PHOSPHORUS|Aetna|BOON CHAPMAN|189.25||||||| 84100|EAP|0300|PHOSPHORUS|Aenta Medicare Advantage|AETNA MEDICARE MA|189.25||||189.25||| 84100|EAP|0300|PHOSPHORUS|Aetna|AETNA PPO|189.25||||189.25||| 84100|EAP|0300|PHOSPHORUS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||189.25||| 84100|EAP|0300|PHOSPHORUS|Blue Cross PPO Specialty|BCBSTX OTHER|||||189.25||| 84100|EAP|0300|PHOSPHORUS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|189.25||||||| 84100|EAP|0300|PHOSPHORUS|United Healthcare|UNITED HEALTHCARE OTHER|189.25||||||| 84100|EAP|0300|PHOSPHORUS|Blue Cross HMO Specialty|BCBSTX HMO|189.25||||189.25||| 84100|EAP|0300|PHOSPHORUS|Cigna|CIGNA OTHER|189.25||||||| 84100|EAP|0300|PHOSPHORUS|Cigna|CIGNA|189.25||||189.25||| 84100|EAP|0300|PHOSPHORUS|Blue Cross PPO Specialty|BCBSTX PPO|189.25||||189.25||| 84100|EAP|0300|PHOSPHORUS|Veterans Affairs|VETERANS ADMINISTRATION|189.25||||189.25||| 84100|EAP|0300|PHOSPHORUS|Managed Medicare|HEALTHSPRING MA|189.25||||189.25||| 84100|EAP|0300|PHOSPHORUS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|189.25||||189.25||| 84100|EAP|0300|PHOSPHORUS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|189.25||||189.25||| 84100|EAP|0300|PHOSPHORUS|Managed Medicaid|MEDICAID SUPERIOR|189.25||||189.25||| 84100|EAP|0300|PHOSPHORUS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|189.25||||189.25||| 84100|EAP|0300|PHOSPHORUS|Managed Medicaid|MEDICAID AMERIGROUP|189.25||||189.25||| 84100|EAP|0300|PHOSPHORUS|Managed Medicare|BCBS MEDICARE PPO MA|189.25||||||| 84100|EAP|0300|PHOSPHORUS|Managed Medicare|MA PART B ONLY IP|189.25||||||| 84100|EAP|0300|PHOSPHORUS|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|189.25||||189.25||| 84100|EAP|0300|PHOSPHORUS|Humana Medicare Advantage|HUMANA MA|189.25||||189.25||| 84112|EAP|0300|AMNISURE ROM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|398.25||||398.25||| 84112|EAP|0300|AMNISURE ROM|Managed Medicaid|MEDICAID SUPERIOR|398.25||||398.25||| 84112|EAP|0300|AMNISURE ROM|Managed Medicaid|MEDICAID AMERIGROUP|398.25||||398.25||| 84112|EAP|0300|AMNISURE ROM|Blue Cross HMO Specialty|BCBSTX HMO|398.25||||||| 84112|EAP|0300|AMNISURE ROM|Cigna|CIGNA|398.25||||398.25||| 84112|EAP|0300|AMNISURE ROM|Blue Cross PPO Specialty|BCBSTX PPO|398.25||||398.25||| 84112|EAP|0300|AMNISURE ROM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|398.25||||398.25||| 84112|EAP|0300|AMNISURE ROM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|398.25||||||| 84112|EAP|0300|AMNISURE ROM|Medicaid|MEDICAID HMO|398.25||||398.25||| 84112|EAP|0300|AMNISURE ROM|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||398.25||| 84112|EAP|0300|AMNISURE ROM|Medicaid|MEDICAID|398.25||||398.25||| 84112|EAP|0300|AMNISURE ROM|NON CONTRACTED|COMMERCIAL OTHER 1|398.25||||||| 84112|EAP|0300|AMNISURE ROM|Tricare|TRICARE EAST REGION|||||398.25||| 84112|EAP|0300|AMNISURE ROM|PHCS|HUMANA|398.25||||||| 84132|EAP|0300|POTASSIUM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|182.75||||182.75||| 84132|EAP|0300|POTASSIUM|United Medicare Advantage|UHC MEDICARE GOLD MA|182.75||||||| 84132|EAP|0300|POTASSIUM|Veterans Affairs|VETERANS ADMINISTRATION|||||182.75||| 84132|EAP|0300|POTASSIUM|Medicare|MEDICARE ACUTE|182.75||||182.75||| 84132|EAP|0300|POTASSIUM|NON CONTRACTED|COMMERCIAL OTHER 1|182.75||||182.75||| 84132|EAP|0300|POTASSIUM|Medicaid|MEDICAID|182.75||||||| 84132|EAP|0300|POTASSIUM|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||182.75||| 84132|EAP|0300|POTASSIUM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|182.75||||182.75||| 84132|EAP|0300|POTASSIUM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|182.75||||||| 84132|EAP|0300|POTASSIUM|Aenta Medicare Advantage|AETNA MEDICARE MA|182.75||||||| 84132|EAP|0300|POTASSIUM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|182.75||||||| 84132|EAP|0300|POTASSIUM|Blue Cross PPO Specialty|BCBSTX PPO|182.75||||182.75||| 84132|EAP|0300|POTASSIUM|Humana Medicare Advantage|HUMANA MA|182.75||||182.75||| 84132|EAP|0300|POTASSIUM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|182.75||||||| 84132|EAP|0300|POTASSIUM|Managed Medicaid|MEDICAID AMERIGROUP|182.75||||||| 84132|EAP|0300|POTASSIUM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|182.75||||182.75||| 84132|EAP|0300|POTASSIUM|Managed Medicaid|MEDICAID SUPERIOR|182.75||||182.75||| 84132|EAP|0300|POTASSIUM|Managed Medicare|HEALTHSPRING MA|||||182.75||| 84133|EAP|0300|POTASSIUM RANDOM URINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.71||||||| 84133|EAP|0300|POTASSIUM RANDOM URINE|Humana Medicare Advantage|HUMANA MA|1.71||||||| 84133|EAP|0300|FECAL POTASSIUM|Humana Medicare Advantage|HUMANA MA|1.71||||||| 84133|EAP|0300|POTASSIUM RANDOM URINE|Medicare|MEDICARE ACUTE|1.71||||1.71||| 84133|EAP|0300|POTASSIUM RANDOM URINE|Veterans Affairs|VETERANS ADMINISTRATION|1.71||||||| 84133|EAP|0300|POTASSIUM RANDOM URINE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.71||||||| 84133|EAP|0300|FECAL POTASSIUM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.71||||||| 84133|EAP|0300|POTASSIUM RANDOM URINE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1.71||| 84134|EAP|0300|PREALBUMIN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|336.25||||336.25||| 84134|EAP|0300|PREALBUMIN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|336.25||||||| 84134|EAP|0300|PREALBUMIN|United Medicare Advantage|UHC MEDICARE GOLD MA|336.25||||||| 84134|EAP|0300|PREALBUMIN|Medicaid|MEDICAID|336.25||||||| 84134|EAP|0300|PREALBUMIN|United Healthcare|UNITED HEALTHCARE|336.25||||||| 84134|EAP|0300|PREALBUMIN|Medicare|MEDICARE ACUTE|336.25||||336.25||| 84134|EAP|0300|PREALBUMIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|336.25||||||| 84134|EAP|0300|PREALBUMIN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|336.25||||||| 84134|EAP|0300|PREALBUMIN|Aenta Medicare Advantage|AETNA MEDICARE MA|336.25||||336.25||| 84134|EAP|0300|PREALBUMIN|Humana Medicare Advantage|HUMANA MA|336.25||||336.25||| 84134|EAP|0300|PREALBUMIN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|336.25||||||| 84134|EAP|0300|PREALBUMIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|336.25||||||| 84134|EAP|0300|PREALBUMIN|Managed Medicare|BCBS MEDICARE PPO MA|336.25||||||| 84144|EAP|0300|PROGESTERONE|Managed Medicaid|MEDICAID SUPERIOR|831.50||||||| 84144|EAP|0300|PROGESTERONE|Humana Medicare Advantage|HUMANA MA|831.50||||||| 84144|EAP|0300|PROGESTERONE|Blue Cross PPO Specialty|BCBSTX PPO|||||831.50||| 84144|EAP|0300|PROGESTERONE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||831.50||| 84144|EAP|0300|PROGESTERONE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||831.50||| 84146|EAP|0300|PROLACTIN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|772.50||||||| 84146|EAP|0300|PROLACTIN|Medicare|MEDICARE ACUTE|772.50||||772.50||| 84146|EAP|0300|PROLACTIN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||772.50||| 84146|EAP|0300|PROLACTIN|Blue Cross PPO Specialty|BCBSTX PPO|||||772.50||| 84146|EAP|0300|PROLACTIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|772.50||||||| 84146|EAP|0300|PROLACTIN|Managed Medicaid|MEDICAID SUPERIOR|||||772.50||| 84153|EAP|0300|PSA DIAGNOSTIC|Humana Medicare Advantage|HUMANA MA|732.75||||732.75||| 84153|EAP|0300|PSA DIAGNOSTIC|Managed Medicare|HEALTHSPRING MA|||||732.75||| 84153|EAP|0300|PSA DIAGNOSTIC|Blue Cross HMO Specialty|BCBSTX HMO|||||732.75||| 84153|EAP|0300|PSA DIAGNOSTIC|Blue Cross PPO Specialty|BCBSTX PPO|||||732.75||| 84153|EAP|0300|PSA DIAGNOSTIC|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||732.75||| 84153|EAP|0300|FREE PSA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||732.75||| 84153|EAP|0300|PSA DIAGNOSTIC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||732.75||| 84153|EAP|0300|PSA DIAGNOSTIC|Aetna|AETNA PPO|732.75||||732.75||| 84153|EAP|0300|PSA DIAGNOSTIC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||732.75||| 84153|EAP|0300|PSA DIAGNOSTIC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||732.75||| 84153|EAP|0300|PSA DIAGNOSTIC|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||732.75||| 84153|EAP|0300|PSA DIAGNOSTIC|Aenta Medicare Advantage|AETNA MEDICARE MA|||||732.75||| 84153|EAP|0300|PSA DIAGNOSTIC|United Healthcare|UNITED HEALTHCARE|732.75||||||| 84153|EAP|0300|PSA DIAGNOSTIC|Tricare|TRICARE EAST REGION|||||732.75||| 84153|EAP|0300|PSA DIAGNOSTIC|Medicare|MEDICARE ACUTE|732.75||||732.75||| 84153|EAP|0300|PSA DIAGNOSTIC|Veterans Affairs|VETERANS ADMINISTRATION|732.75||||||| 84153|EAP|0300|PSA DIAGNOSTIC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|732.75||||732.75||| 84153|EAP|0300|PSA DIAGNOSTIC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||732.75||| 84153|EAP|0300|PSA DIAGNOSTIC|United Medicare Advantage|UHC MEDICARE GOLD MA|||||732.75||| 84154|EAP|0300|FREE PSA|Medicare|MEDICARE ACUTE|732.75||||||| 84154|EAP|0300|FREE PSA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||732.75||| 84154|EAP|0300|FREE PSA|Aetna|AETNA PPO|732.75||||||| 84154|EAP|0300|FREE PSA|Humana Medicare Advantage|HUMANA MA|732.75||||||| 84155|EAP|0300|PROTEIN TOTAL|Managed Medicaid|MEDICAID SUPERIOR|1.46||||153.25||| 84155|EAP|0300||Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.46||||153.25||| 84155|EAP|0300||Managed Medicaid|MEDICAID SUPERIOR|153.25||||153.25||| 84155|EAP|0300||Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||153.25||| 84155|EAP|0300||Managed Medicaid|MEDICAID AMERIGROUP|||||153.25||| 84155|EAP|0300|PROTEIN ELECTROPHORESIS|Managed Medicare|HEALTHSPRING MA|1.46||||||| 84155|EAP|0300|URINE PROTEIN 24 HR|Humana Medicare Advantage|HUMANA MA|1.46||||1.46||| 84155|EAP|0300|PROTEIN ELECTROPHORESIS|Humana Medicare Advantage|HUMANA MA|1.46||||1.46||| 84155|EAP|0300|URINE PROTEIN 24 HR|Blue Cross PPO Specialty|BCBSTX PPO|1.46||||1.46||| 84155|EAP|0300|PROTEIN ELECTROPHORESIS|Cigna|CIGNA|1.46||||1.46||| 84155|EAP|0300|PROTEIN ELECTROPHORESIS|Blue Cross HMO Specialty|BCBSTX HMO|||||1.46||| 84155|EAP|0300|URINE PROTEIN 24 HR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.46||| 84155|EAP|0300|PROTEIN ELECTROPHORESIS|Aenta Medicare Advantage|AETNA MEDICARE MA|1.46||||1.46||| 84155|EAP|0300|PROTEIN ELECTROPHORESIS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.46||||1.46||| 84155|EAP|0300|PROTEIN ELECTROPHORESIS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.46||||||| 84155|EAP|0300|PROTEIN ELECTROPHORESIS|Veterans Affairs|VETERANS ADMINISTRATION|1.46||||||| 84155|EAP|0300||Medicaid|MOLINA HEALTHCARE OF TEXAS|1.46||||153.25||| 84155|EAP|0300|PROTEIN ELECTROPHORESIS|Medicaid|MEDICAID|1.46||||153.25||| 84155|EAP|0300||Medicaid|MEDICAID HMO|||||153.25||| 84155|EAP|0300||Medicaid|MEDICAID|153.25||||153.25||| 84155|EAP|0300|URINE PROTEIN 24 HR|Tricare|TRICARE EAST REGION|||||1.46||| 84155|EAP|0300|PROTEIN ELECTROPHORESIS|Medicare|MEDICARE ACUTE|1.46||||1.46||| 84156|EAP|0300||United Healthcare|UNITED HEALTHCARE|||||1.46||| 84156|EAP|0300|URINE PROTEIN ELECTROPHOR|Medicare|MEDICARE ACUTE|1.46||||1.46||| 84156|EAP|0300||Medicaid|MEDICAID HMO|||||1.46||| 84156|EAP|0300||Medicaid|MEDICAID|1.46||||||| 84156|EAP|0300|URINE PROTEIN ELECTROPHOR|Blue Cross HMO Specialty|BCBSTX HMO|||||1.46||| 84156|EAP|0300||Managed Medicaid|MEDICAID SUPERIOR|1.46||||1.46||| 84156|EAP|0300||Managed Medicaid|MEDICAID AMERIGROUP|1.46||||1.46||| 84157|EAP|0300|TOTAL PROTEIN, BODY FLUID|Managed Medicaid|MEDICAID UNITED HEALTHCARE|153.25||||||| 84157|EAP|0300|TOTAL PROTEIN, BODY FLUID|Managed Medicaid|MEDICAID SUPERIOR|153.25||||153.25||| 84157|EAP|0300|TOTAL PROTEIN, BODY FLUID|Managed Medicaid|MEDICAID AMERIGROUP|153.25||||153.25||| 84157|EAP|0300|TOTAL PROTEIN, BODY FLUID|Managed Medicare|BCBS MEDICARE PPO MA|153.25||||153.25||| 84157|EAP|0300|TOTAL PROTEIN, BODY FLUID|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|153.25||||153.25||| 84157|EAP|0300|TOTAL PROTEIN, BODY FLUID|Blue Cross PPO Specialty|BCBSTX PPO|153.25||||153.25||| 84157|EAP|0300|PROTEIN TOTAL SP FL|Managed Medicaid|MEDICAID SUPERIOR|1.84||||1.84||| 84157|EAP|0300|TOTAL PROTEIN, BODY FLUID|Humana Medicare Advantage|HUMANA MA|153.25||||153.25||| 84157|EAP|0300|PROTEIN TOTAL SP FL|Blue Cross PPO Specialty|BCBSTX PPO|1.84||||1.84||| 84157|EAP|0300|TOTAL PROTEIN, BODY FLUID|Veterans Affairs|VETERANS ADMINISTRATION|||||153.25||| 84157|EAP|0300|TOTAL PROTEIN, BODY FLUID|United Medicare Advantage|AARP UHC WEST COMPLETE MA|153.25||||153.25||| 84157|EAP|0300|TOTAL PROTEIN, BODY FLUID|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|153.25||||||| 84157|EAP|0300|TOTAL PROTEIN, BODY FLUID|Medicaid|MEDICAID HMO|153.25||||||| 84157|EAP|0300|PROTEIN TOTAL SP FL|Medicaid|MEDICAID HMO|1.84||||||| 84157|EAP|0300|TOTAL PROTEIN, BODY FLUID|Medicaid|MOLINA HEALTHCARE OF TEXAS|153.25||||||| 84157|EAP|0300|TOTAL PROTEIN, BODY FLUID|Medicare|MEDICARE ACUTE|153.25||||153.25||| 84157|EAP|0300|PROTEIN TOTAL SP FL|Medicare|MEDICARE ACUTE|1.84||||1.84||| 84157|EAP|0300|TOTAL PROTEIN, BODY FLUID|Tricare|TRICARE EAST REGION|||||153.25||| 84157|EAP|0300|TOTAL PROTEIN, BODY FLUID|United Healthcare|UNITED HEALTHCARE|153.25||||153.25||| 84157|EAP|0300|TOTAL PROTEIN, BODY FLUID|United Healthcare|UMR UNITED MEDICAL RESOURCES|153.25||||||| 84165|EAP|0300|PROTEIN ELECTROPHORESIS|Medicare|MEDICARE ACUTE|4.28||||4.28||| 84165|EAP|0300|PROTEIN ELECTROPHORESIS|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.28||||||| 84165|EAP|0300|PROTEIN ELECTROPHORESIS|Medicaid|MEDICAID|4.28||||||| 84165|EAP|0300|PROTEIN ELECTROPHORESIS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.28||||||| 84165|EAP|0300|PROTEIN ELECTROPHORESIS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.28||||4.28||| 84165|EAP|0300|PROTEIN ELECTROPHORESIS|Veterans Affairs|VETERANS ADMINISTRATION|4.28||||||| 84165|EAP|0300|PROTEIN ELECTROPHORESIS|Blue Cross PPO Specialty|BCBSTX PPO|4.28||||||| 84165|EAP|0300|PROTEIN ELECTROPHORESIS|Cigna|CIGNA|4.28||||4.28||| 84165|EAP|0300|PROTEIN ELECTROPHORESIS|Blue Cross HMO Specialty|BCBSTX HMO|||||4.28||| 84165|EAP|0300|PROTEIN ELECTROPHORESIS|Aenta Medicare Advantage|AETNA MEDICARE MA|4.28||||4.28||| 84165|EAP|0300|PROTEIN ELECTROPHORESIS|Managed Medicare|HEALTHSPRING MA|4.28||||||| 84165|EAP|0300|PROTEIN ELECTROPHORESIS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.28||||||| 84165|EAP|0300|PROTEIN ELECTROPHORESIS|Humana Medicare Advantage|HUMANA MA|4.28||||4.28||| 84182|EAP|0300|LAMBERT EATON CRMP 5 IGG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||139.25||| 842|DRG||LYMPHOMA & NON-ACUTE LEUKEMIA W/O CC/MCC|Cigna|CIGNA|13,480.25|15.75|15.75|15.75|||| 84206|EAP|0300|PROINSULIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.93||| 84207|EAP|0300|VITAMIN B6-PERIDOXINE|United Healthcare|UNITED HEALTHCARE|1,119.50||||||| 84207|EAP|0300|VITAMIN B6-PERIDOXINE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,119.50||| 84238|EAP|0300|LAMBERT EATON MOD AB|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||316.25||| 84238|EAP|0300|LAMBERT EATON ACH RECEPT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||313.25||| 84244|EAP|0300|RENIN|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|876.75||||||| 84244|EAP|0300|RENIN|Medicare|MEDICARE ACUTE|876.75||||||| 84244|EAP|0300|RENIN|United Medicare Advantage|UHC MEDICARE GOLD MA|||||876.75||| 84270|EAP|0300|SEX HORMONE BINDING GLOBU|Blue Cross PPO Specialty|BCBSTX PPO|||||209.25||| 84295|EAP|0300|SODIUM|United Medicare Advantage|UHC AARP MCR HMO MA|||||191.50||| 84295|EAP|0300|SODIUM|United Medicare Advantage|UHC MEDICARE GOLD MA|191.50||||||| 84295|EAP|0300|SODIUM|NON CONTRACTED|COMMERCIAL OTHER 1|191.50||||||| 84295|EAP|0300|SODIUM|Medicare|MEDICARE ACUTE|191.50||||||| 84295|EAP|0300|SODIUM|Humana Medicare Advantage|HUMANA MA|191.50||||191.50||| 84295|EAP|0300|SODIUM|Managed Medicare|BCBS MEDICARE PPO MA|||||191.50||| 84295|EAP|0300|SODIUM|Managed Medicare|HEALTHSPRING MA|191.50||||||| 84295|EAP|0300|SODIUM|Blue Cross PPO Specialty|BCBSTX PPO|191.50||||||| 84300|EAP|0300|SODIUM, RANDOM URINE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|193.75||||||| 84300|EAP|0300|SODIUM, RANDOM URINE|Cigna|CIGNA|193.75||||||| 84300|EAP|0300|SODIUM, RANDOM URINE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|193.75||||||| 84300|EAP|0300|SODIUM, RANDOM URINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|193.75||||||| 84300|EAP|0300|SODIUM, RANDOM URINE|Managed Medicaid|MEDICAID SUPERIOR|193.75||||||| 84300|EAP|0300|SODIUM, RANDOM URINE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|193.75||||||| 84300|EAP|0300|SODIUM, RANDOM URINE|Humana Medicare Advantage|HUMANA MA|193.75||||193.75||| 84300|EAP|0300|SODIUM, RANDOM URINE|Medicaid|HENDERSON COUNTY INDIGENT|193.75||||||| 84300|EAP|0300|SODIUM, RANDOM URINE|Medicare|MEDICARE ACUTE|193.75||||||| 84300|EAP|0300|SODIUM, RANDOM URINE|Veterans Affairs|VETERANS ADMINISTRATION|193.75||||||| 84300|EAP|0300|SODIUM, RANDOM URINE|United Medicare Advantage|UHC MEDICARE GOLD MA|193.75||||||| 84300|EAP|0300|SODIUM, RANDOM URINE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|193.75||||193.75||| 84300|EAP|0300|SODIUM, RANDOM URINE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|193.75||||193.75||| 84311|EAP|0300|BETAHYDROXY BUTERATE|United Medicare Advantage|UHC AARP MCR HMO MA|||||278.25||| 84311|EAP|0300|BETAHYDROXY BUTERATE|Medicare|MEDICARE ACUTE|278.25||||||| 84311|EAP|0300|BETAHYDROXY BUTERATE|Tricare|TRICARE EAST REGION|278.25||||||| 84311|EAP|0300|BETAHYDROXY BUTERATE|Humana Medicare Advantage|HUMANA MA|278.25||||||| 84311|EAP|0300|BETAHYDROXY BUTERATE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||278.25||| 84311|EAP|0300|BETAHYDROXY BUTERATE|Blue Cross HMO Specialty|BCBSTX HMO|278.25||||||| 84311|EAP|0300|BETAHYDROXY BUTERATE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||278.25||| 844|DRG||OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC|Medicare|MEDICARE ACUTE|25,313.25|9586.86|9586.86|1112.99|||| 844|DRG||OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|55,079.25|1112.99|9586.86|1112.99|||| 84402|EAP|0300|TESTOSTERONE, FREE & WEAK|Blue Cross HMO Specialty|BCBSTX HMO|||||1,014.50||| 84402|EAP|0300|TESTOSTERONE, FREE & WEAK|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1,014.50||| 84403|EAP|0300|TESTOSTERONE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,028.75||| 84403|EAP|0300|TESTOSTERONE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1,028.75||| 84403|EAP|0300|TESTOSTERONE|Medicare|MEDICARE ACUTE|||||1,028.75||| 84403|EAP|0300|TESTOSTERONE|United Healthcare|UNITED HEALTHCARE|||||1,028.75||| 84403|EAP|0300|TESTOSTERONE|Humana Medicare Advantage|HUMANA MA|||||1,028.75||| 84403|EAP|0300|TESTOSTERONE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1,028.75||| 84403|EAP|0300|TESTOSTERONE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,028.75||| 84403|EAP|0300|TESTOSTERONE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1,028.75||| 84403|EAP|0300|TESTOSTERONE|Blue Cross PPO Specialty|BCBSTX PPO|||||1,028.75||| 84403|EAP|0300|TESTOSTERONE|Blue Cross HMO Specialty|BCBSTX HMO|||||1,028.75||| 84425|EAP|0300|THIAMINE (B1)|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.71||| 84425|EAP|0300|THIAMINE (B1)|Humana Medicare Advantage|HUMANA MA|2.71||||2.71||| 84425|EAP|0300|THIAMINE (B1)|United Healthcare|UNITED HEALTHCARE|2.71||||||| 84425|EAP|0300|THIAMINE (B1)|Medicare|MEDICARE ACUTE|||||2.71||| 84425|EAP|0300|THIAMINE (B1)|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.71||||||| 84436|EAP|0300|T-4|Veterans Affairs|VETERANS ADMINISTRATION|273.50||||273.50||| 84436|EAP|0300|T-4|United Medicare Advantage|UHC MEDICARE GOLD MA|273.50||||273.50||| 84436|EAP|0300|T-4|United Medicare Advantage|AARP UHC WEST COMPLETE MA|273.50||||273.50||| 84436|EAP|0300|T-4|Medicaid|MEDICAID HMO|||||273.50||| 84436|EAP|0300|T-4|Medicaid|MEDICAID|273.50||||273.50||| 84436|EAP|0300|T-4|Medicare|MEDICARE ACUTE|273.50||||273.50||| 84436|EAP|0300|T-4|NON CONTRACTED|COMMERCIAL OTHER 1|||||273.50||| 84436|EAP|0300|T-4|United Healthcare|UNITED HEALTHCARE|||||273.50||| 84436|EAP|0300|T-4|ChampVA|CHAMPVA CENTER|273.50||||||| 84436|EAP|0300|T-4|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|273.50||||273.50||| 84436|EAP|0300|T-4|Blue Cross PPO Specialty|BCBSTX PPO|||||273.50||| 84436|EAP|0300|T-4|Blue Cross HMO Specialty|BCBSTX HMO|273.50||||||| 84436|EAP|0300|T-4|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|273.50||||273.50||| 84436|EAP|0300|T-4|Aenta Medicare Advantage|AETNA MEDICARE MA|273.50||||273.50||| 84436|EAP|0300|T-4|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||273.50||| 84436|EAP|0300|T-4|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||273.50||| 84436|EAP|0300|T-4|Aetna|AETNA PPO|||||273.50||| 84436|EAP|0300|T-4|Humana Medicare Advantage|HUMANA MA|273.50||||273.50||| 84436|EAP|0300|T-4|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||273.50||| 84436|EAP|0300|T-4|Managed Medicaid|MEDICAID SUPERIOR|273.50||||273.50||| 84436|EAP|0300|T-4|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||273.50||| 84436|EAP|0300|T-4|Managed Medicaid|MEDICAID AMERIGROUP|||||273.50||| 84436|EAP|0300|T-4|Managed Medicare|HEALTHSPRING MA|273.50||||273.50||| 84439|EAP|0300|FREE T4|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||359.25||| 84439|EAP|0300|FREE T4|Managed Medicare|BCBS MEDICARE PPO MA|||||359.25||| 84439|EAP|0300|FREE T4|Managed Medicaid|MEDICAID UNITED HEALTHCARE|359.25||||359.25||| 84439|EAP|0300|FREE T4|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|359.25||||359.25||| 84439|EAP|0300|FREE T4|Managed Medicaid|MEDICAID AMERIGROUP|359.25||||359.25||| 84439|EAP|0300|FREE T4|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|359.25||||359.25||| 84439|EAP|0300|FREE T4|Humana Medicare Advantage|HUMANA MA|359.25||||359.25||| 84439|EAP|0300|FREE T4|Aetna|AETNA PPO|359.25||||359.25||| 84439|EAP|0300|FREE T4|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|359.25||||359.25||| 84439|EAP|0300|FREE T4|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|359.25||||359.25||| 84439|EAP|0300|FREE T4|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||359.25||| 84439|EAP|0300|FREE T4|Access Direct Platinum|HEALTHFIRST TPA UMR|||||359.25||| 84439|EAP|0300|FREE T4|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||359.25||| 84439|EAP|0300|FREE T4|Managed Medicare|HEALTHSPRING MA|359.25||||359.25||| 84439|EAP|0300|FREE T4|Aenta Medicare Advantage|AETNA MEDICARE MA|359.25||||359.25||| 84439|EAP|0300|FREE T4|Blue Cross PPO Specialty|BCBSTX PPO|359.25||||359.25||| 84439|EAP|0300|FREE T4|Cigna|CIGNA|||||359.25||| 84439|EAP|0300|FREE T4|Blue Cross HMO Specialty|BCBSTX HMO|359.25||||359.25||| 84439|EAP|0300|FREE T4|Managed Medicaid|MEDICAID SUPERIOR|359.25||||359.25||| 84439|EAP|0300|FREE T4|Cigna|CIGNA|359.25||||359.25||| 84439|EAP|0300|FREE T4|Tricare|TRICARE EAST REGION|359.25||||359.25||| 84439|EAP|0300|FREE T4|Medicare|MEDICARE PART B ONLY IP|359.25||||||| 84439|EAP|0300|FREE T4|Medicare|MEDICARE ACUTE|359.25||||359.25||| 84439|EAP|0300|FREE T4|NON CONTRACTED|COMMERCIAL OTHER 1|359.25||||359.25||| 84439|EAP|0300|FREE T4|United Healthcare|UMR UNITED MEDICAL RESOURCES|359.25||||||| 84439|EAP|0300|FREE T4|United Healthcare|UNITED HEALTHCARE|359.25||||359.25||| 84439|EAP|0300|FREE T4|Medicaid|MEDICAID|359.25||||359.25||| 84439|EAP|0300|FREE T4|Medicaid|MOLINA HEALTHCARE OF TEXAS|359.25||||359.25||| 84439|EAP|0300|FREE T4|United Medicare Advantage|UHC AARP MCR HMO MA|||||359.25||| 84439|EAP|0300|FREE T4|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|359.25||||359.25||| 84439|EAP|0300|FREE T4|United Medicare Advantage|UHC MEDICARE GOLD MA|359.25||||359.25||| 84439|EAP|0300|FREE T4|United Medicare Advantage|AARP UHC WEST COMPLETE MA|359.25||||359.25||| 84439|EAP|0300|FREE T4|Veterans Affairs|VETERANS ADMINISTRATION|359.25||||359.25||| 84442|EAP|0300|THYROGLOBULIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||589.25||| 84443|EAP|0300|TSH|United Medicare Advantage|AARP UHC WEST COMPLETE MA|669.50||||669.50||| 84443|EAP|0300|TSH|United Medicare Advantage|UHC MEDICARE GOLD MA|669.50||||669.50||| 84443|EAP|0300|TSH|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|669.50||||669.50||| 84443|EAP|0300|TSH|Medicaid|LAW ENFORCEMENT OTHER|||||669.50||| 84443|EAP|0300|TSH|Medicaid|HENDERSON COUNTY INDIGENT|669.50||||669.50||| 84443|EAP|0300|TSH|Medicaid|MOLINA HEALTHCARE OF TEXAS|669.50||||669.50||| 84443|EAP|0300|TSH|Medicaid|MEDICAID HMO|||||669.50||| 84443|EAP|0300|TSH|United Healthcare|UNITED HEALTHCARE OTHER|||||669.50||| 84443|EAP|0300|TSH|United Healthcare|TML GROUP BENEFITS|669.50||||669.50||| 84443|EAP|0300|TSH|Medicare|MEDICARE ACUTE|669.50||||669.50||| 84443|EAP|0300|TSH|Tricare|TRICARE EAST REGION|669.50||||669.50||| 84443|EAP|0300|TSH|United Healthcare|UMR UNITED MEDICAL RESOURCES|669.50||||||| 84443|EAP|0300|TSH|PHCS|HUMANA|||||669.50||| 84443|EAP|0300|TSH|NON CONTRACTED|COMMERCIAL OTHER 1|669.50||||669.50||| 84443|EAP|0300|TSH|United Healthcare|UNITED HEALTHCARE|669.50||||669.50||| 84443|EAP|0300|TSH|UTMB|UTMB CORRECTIONAL MANAGED CARE|669.50||||||| 84443|EAP|0300|TSH|Humana Medicare Advantage|HUMANA MA|669.50||||669.50||| 84443|EAP|0300|TSH|Managed Medicare|HEALTHSPRING MA|669.50||||669.50||| 84443|EAP|0300|TSH|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|669.50||||669.50||| 84443|EAP|0300|TSH|Managed Medicare|BCBS MEDICARE PPO MA|669.50||||669.50||| 84443|EAP|0300|TSH|Medicare|MEDICARE PART B ONLY IP|669.50||||||| 84443|EAP|0300|TSH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|669.50||||669.50||| 84443|EAP|0300|TSH|Managed Medicaid|MEDICAID SUPERIOR|669.50||||669.50||| 84443|EAP|0300|TSH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|669.50||||669.50||| 84443|EAP|0300|TSH|Managed Medicaid|MEDICAID AMERIGROUP|669.50||||669.50||| 84443|EAP|0300|TSH|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|669.50||||669.50||| 84443|EAP|0300|TSH|Managed Medicare|MA PART B ONLY IP|669.50||||||| 84443|EAP|0300|TSH|Blue Cross PPO Specialty|BCBSTX PPO|669.50||||669.50||| 84443|EAP|0300|TSH|Cigna|CIGNA|669.50||||669.50||| 84443|EAP|0300|TSH|Medicaid|COUNTY INDIGENT HEALTH OTHER|669.50||||||| 84443|EAP|0300|TSH|Blue Cross PPO Specialty|BCBSTX OTHER|||||669.50||| 84443|EAP|0300|TSH|ChampVA|CHAMPVA CENTER|669.50||||||| 84443|EAP|0300|TSH|Medicaid|MEDICAID|669.50||||669.50||| 84443|EAP|0300|TSH|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|669.50||||669.50||| 84443|EAP|0300|TSH|Blue Cross HMO Specialty|BCBSTX HMO|669.50||||669.50||| 84443|EAP|0300|TSH|United Medicare Advantage|UHC AARP MCR HMO MA|||||669.50||| 84443|EAP|0300|TSH|Cigna|CIGNA|||||669.50||| 84443|EAP|0300|TSH|Cigna|CIGNA OTHER|669.50||||669.50||| 84443|EAP|0300|TSH|Aetna|AETNA OTHER|||||669.50||| 84443|EAP|0300|TSH|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|669.50||||669.50||| 84443|EAP|0300|TSH|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||669.50||| 84443|EAP|0300|TSH|Access Direct Platinum|HEALTHFIRST TPA UMR|||||669.50||| 84443|EAP|0300|TSH|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||669.50||| 84443|EAP|0300|TSH|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||669.50||| 84443|EAP|0300|TSH|Aetna|AETNA PPO|669.50||||669.50||| 84443|EAP|0300|TSH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|669.50||||669.50||| 84443|EAP|0300|TSH|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||669.50||| 84443|EAP|0300|TSH|Aenta Medicare Advantage|AETNA MEDICARE MA|669.50||||669.50||| 84443|EAP|0300|TSH|Veterans Affairs|VETERANS ADMINISTRATION|669.50||||669.50||| 84446|EAP|0300|VITAMIN E|United Healthcare|UNITED HEALTHCARE|564.75||||||| 84450|EAP|0300|SGOT|Medicaid|HENDERSON COUNTY INDIGENT|205.75||||||| 84450|EAP|0300|SGOT|Blue Cross PPO Specialty|BCBSTX PPO|||||205.75||| 84450|EAP|0300|SGOT|Medicare|MEDICARE ACUTE|||||205.75||| 84450|EAP|0300|SGOT|Medicaid|MEDICAID HMO|||||205.75||| 84450|EAP|0300|SGOT|Managed Medicaid|MEDICAID SUPERIOR|205.75||||||| 84450|EAP|0300|SGOT|Aenta Medicare Advantage|AETNA MEDICARE MA|||||205.75||| 84460|EAP|0300|TRANSFERASE ALANINE AMINO|Cigna|CIGNA|||||0.70||| 84460|EAP|0301|SGPT|Medicaid|MEDICAID HMO|||||210.75||| 84460|EAP|0301|SGPT|Medicare|MEDICARE ACUTE|||||210.75||| 84460|EAP|0301|SGPT|Aenta Medicare Advantage|AETNA MEDICARE MA|||||210.75||| 84460|EAP|0300|TRANSFERASE ALANINE AMINO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.70||| 84460|EAP|0300|TRANSFERASE ALANINE AMINO|United Healthcare|UNITED HEALTHCARE|||||0.70||| 84460|EAP|0300|TRANSFERASE ALANINE AMINO|Medicare|MEDICARE ACUTE|||||0.70||| 84460|EAP|0301|SGPT|Medicaid|HENDERSON COUNTY INDIGENT|210.75||||||| 84460|EAP|0300|TRANSFERASE ALANINE AMINO|Managed Medicare|HEALTHSPRING MA|||||0.70||| 84460|EAP|0300|TRANSFERASE ALANINE AMINO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.70||| 84460|EAP|0300|TRANSFERASE ALANINE AMINO|Blue Cross PPO Specialty|BCBSTX PPO|||||0.70||| 84460|EAP|0300|TRANSFERASE ALANINE AMINO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.70||| 84460|EAP|0301|SGPT|Blue Cross PPO Specialty|BCBSTX PPO|||||210.75||| 84460|EAP|0301|SGPT|Managed Medicaid|MEDICAID SUPERIOR|210.75||||||| 84460|EAP|0300|TRANSFERASE ALANINE AMINO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.70||| 84466|EAP|0300|TRANSFERRIN|Veterans Affairs|VETERANS ADMINISTRATION|366.50||||||| 84466|EAP|0300|TRANSFERRIN|Medicare|MEDICARE ACUTE|366.50||||366.50||| 84466|EAP|0300|TRANSFERRIN|Blue Cross HMO Specialty|BCBSTX HMO|||||366.50||| 84466|EAP|0300|TRANSFERRIN|United Medicare Advantage|UHC MEDICARE GOLD MA|366.50||||366.50||| 84466|EAP|0300|TRANSFERRIN|United Healthcare|UNITED HEALTHCARE|366.50||||366.50||| 84466|EAP|0300|TRANSFERRIN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|366.50||||366.50||| 84466|EAP|0300|TRANSFERRIN|Managed Medicare|HEALTHSPRING MA|366.50||||366.50||| 84466|EAP|0300|TRANSFERRIN|Aenta Medicare Advantage|AETNA MEDICARE MA|366.50||||366.50||| 84466|EAP|0300|TRANSFERRIN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||366.50||| 84466|EAP|0300|TRANSFERRIN|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||366.50||| 84466|EAP|0300|TRANSFERRIN|Cigna|CIGNA|366.50||||||| 84466|EAP|0300|TRANSFERRIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|366.50||||366.50||| 84466|EAP|0300|TRANSFERRIN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|366.50||||366.50||| 84466|EAP|0300|TRANSFERRIN|Blue Cross PPO Specialty|BCBSTX PPO|366.50||||366.50||| 84466|EAP|0300|TRANSFERRIN|ChampVA|CHAMPVA CENTER|366.50||||||| 84466|EAP|0300|TRANSFERRIN|Humana Medicare Advantage|HUMANA MA|366.50||||366.50||| 84466|EAP|0300|TRANSFERRIN|Cigna|CIGNA OTHER|||||366.50||| 84466|EAP|0300|TRANSFERRIN|Medicaid|HENDERSON COUNTY INDIGENT|||||366.50||| 84466|EAP|0300|TRANSFERRIN|Medicaid|MOLINA HEALTHCARE OF TEXAS|366.50||||||| 84466|EAP|0300|TRANSFERRIN|Managed Medicaid|MEDICAID SUPERIOR|366.50||||||| 84466|EAP|0300|TRANSFERRIN|Medicaid|MEDICAID|366.50||||366.50||| 84466|EAP|0300|TRANSFERRIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|366.50||||||| 84466|EAP|0300|TRANSFERRIN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|366.50||||366.50||| 84478|EAP|0301|TRIGLYCERIDES|Medicare|MEDICARE ACUTE|229.25||||||| 84478|EAP|0301|TRIGLYCERIDES|Aenta Medicare Advantage|AETNA MEDICARE MA|||||229.25||| 84478|EAP|0301|TRIGLYCERIDES|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|229.25||||||| 84478|EAP|0301|TRIGLYCERIDES|Humana Medicare Advantage|HUMANA MA|229.25||||||| 84478|EAP|0301|TRIGLYCERIDES|Blue Cross PPO Specialty|BCBSTX PPO|||||229.25||| 84479|EAP|0300|T-3|Medicaid|MEDICAID|564.75||||564.75||| 84479|EAP|0300|T-3|Medicaid|MEDICAID HMO|||||564.75||| 84479|EAP|0300|T-3|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||564.75||| 84479|EAP|0300|T-3|Medicare|MEDICARE ACUTE|564.75||||564.75||| 84479|EAP|0300|T-3|Managed Medicaid|MEDICAID AMERIGROUP|||||564.75||| 84479|EAP|0300|T-3|ChampVA|CHAMPVA CENTER|564.75||||||| 84479|EAP|0300|T-3|Managed Medicare|HEALTHSPRING MA|||||564.75||| 84479|EAP|0300|T-3|Veterans Affairs|VETERANS ADMINISTRATION|564.75||||||| 84479|EAP|0300|T-3|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||564.75||| 84479|EAP|0300|T-3|Managed Medicaid|MEDICAID SUPERIOR|564.75||||||| 84479|EAP|0300|T-3|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|564.75||||||| 84479|EAP|0300|T-3|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||564.75||| 84479|EAP|0300|T-3|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|564.75||||564.75||| 84479|EAP|0300|T-3|Humana Medicare Advantage|HUMANA MA|564.75||||||| 84480|EAP|0300|T3 BY RIA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||564.75||| 84480|EAP|0300|TOTAL T3|Medicaid|HENDERSON COUNTY INDIGENT|564.75||||||| 84480|EAP|0300|TOTAL T3|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|564.75||||564.75||| 84480|EAP|0300|TOTAL T3|Managed Medicaid|MEDICAID SUPERIOR|||||564.75||| 84480|EAP|0300|TOTAL T3|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||564.75||| 84480|EAP|0300|TOTAL T3|Humana Medicare Advantage|HUMANA MA|564.75||||||| 84480|EAP|0300|TOTAL T3|Medicare|MEDICARE ACUTE|564.75||||564.75||| 84481|EAP|0300|FREE T3|Managed Medicare|HEALTHSPRING MA|675.25||||||| 84481|EAP|0300|FREE T3|Managed Medicaid|MEDICAID AMERIGROUP|||||675.25||| 84481|EAP|0300|FREE T3|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|675.25||||675.25||| 84481|EAP|0300|FREE T3|United Medicare Advantage|AARP UHC WEST COMPLETE MA|675.25||||||| 84481|EAP|0300|FREE T3|Humana Medicare Advantage|HUMANA MA|675.25||||675.25||| 84481|EAP|0300|FREE T3|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||675.25||| 84481|EAP|0300|FREE T3|Cigna|CIGNA|675.25||||||| 84481|EAP|0300|FREE T3|Medicaid|MEDICAID|675.25||||675.25||| 84481|EAP|0300|FREE T3|Medicare|MEDICARE ACUTE|675.25||||675.25||| 84481|EAP|0300|FREE T3|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|675.25||||675.25||| 84481|EAP|0300|FREE T3|NON CONTRACTED|COMMERCIAL OTHER 1|675.25||||||| 84481|EAP|0300|FREE T3|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||675.25||| 84481|EAP|0300|FREE T3|Managed Medicaid|MEDICAID SUPERIOR|675.25||||675.25||| 84481|EAP|0300|FREE T3|Aenta Medicare Advantage|AETNA MEDICARE MA|675.25||||||| 84481|EAP|0300|FREE T3|Blue Cross PPO Specialty|BCBSTX PPO|||||675.25||| 84484|EAP|0300|TROPONIN|Managed Medicare|HEALTHSPRING MA|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Medicaid|HENDERSON COUNTY INDIGENT|392.25||||392.25||| 84484|EAP|0300|TROPONIN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|392.25||||392.25||| 84484|EAP|0300|TROPONIN|United Medicare Advantage|UHC AARP WELLMED HMO MA|||||392.25||| 84484|EAP|0300|TROPONIN|Workers Compensation|WORKERS COMPENSATION OTHER|||||392.25||| 84484|EAP|0300|TROPONIN|Managed Medicaid|MEDICAID SUPERIOR|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Managed Medicare|BCBS MEDICARE PPO MA|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Humana Medicare Advantage|HUMANA MA|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Managed Medicare|HOSPICE OF EAST TEXAS|392.25||||||| 84484|EAP|0300|TROPONIN|Blue Cross PPO Specialty|BCBSTX OTHER|||||392.25||| 84484|EAP|0300|TROPONIN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||392.25||| 84484|EAP|0300|TROPONIN|Veterans Affairs|VETERANS ADMINISTRATION|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Managed Medicare|HOSPICE ETMC|||||392.25||| 84484|EAP|0300|TROPONIN|United Medicare Advantage|UHC MEDICARE GOLD MA|392.25||||392.25||| 84484|EAP|0300|TROPONIN|United Medicare Advantage|UHC AARP MCR HMO MA|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Workers Compensation|UT EMPLOYEE INJURY|392.25||||||| 84484|EAP|0300|TROPONIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|392.25||||392.25||| 84484|EAP|0300|TROPONIN|ChampVA|CHAMPVA CENTER|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Blue Cross HMO Specialty|BCBSTX HMO|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Managed Medicare|WELLCARE CHOICE MA|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Blue Cross PPO Specialty|BCBSTX PPO|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|392.25||||392.25||| 84484|EAP|0300|TROPONIN|MTC Medical|VAN ZANDT COUNTY INMATE|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Managed Medicaid|MEDICAID AMERIGROUP|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Cigna|CIGNA|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Aenta Medicare Advantage|AETNA MEDICARE MA|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||392.25||| 84484|EAP|0300|TROPONIN|Aetna|AETNA OTHER|||||392.25||| 84484|EAP|0300|TROPONIN|Cigna|CIGNA OTHER|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Medicaid|COUNTY INDIGENT HEALTH OTHER|392.25||||||| 84484|EAP|0300|TROPONIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Aetna|AETNA PPO|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Managed Medicare|MA PART B ONLY IP|392.25||||||| 84484|EAP|0300|TROPONIN|Managed Medicare|VAN ZANDT COUNTY INMATE|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Tricare|TRICARE EAST REGION|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|392.25||||392.25||| 84484|EAP|0300|TROPONIN|United Healthcare|TML GROUP BENEFITS|392.25||||392.25||| 84484|EAP|0300|TROPONIN|United Healthcare|GOLDEN RULE|||||392.25||| 84484|EAP|0300|TROPONIN|Tricare|TRICARE FOR LIFE|||||392.25||| 84484|EAP|0300|TROPONIN|United Healthcare|UNITED HEALTHCARE|392.25||||392.25||| 84484|EAP|0300|TROPONIN|PHCS|HUMANA|||||392.25||| 84484|EAP|0300|TROPONIN|UTMB|UTMB CORRECTIONAL MANAGED CARE|392.25||||||| 84484|EAP|0300|TROPONIN|NON CONTRACTED|COMMERCIAL OTHER 1|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Medicare|MEDICARE ACUTE|392.25||||392.25||| 84484|EAP|0300|TROPONIN|NON CONTRACTED|COMMERCIAL OTHER 2|||||392.25||| 84484|EAP|0300|TROPONIN|Medicaid|MEDICAID|392.25||||392.25||| 84484|EAP|0300|TROPONIN|United Healthcare|UNITED HEALTHCARE OTHER|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Medicaid Out of State|MEDICAID LOUISIANA|||||392.25||| 84484|EAP|0300|TROPONIN|Access Direct Platinum|HEALTHFIRST TPA UMR|||||392.25||| 84484|EAP|0300|TROPONIN|PHCS|MULTIPLAN PHCS OTHER|||||392.25||| 84484|EAP|0300|TROPONIN|Medicaid|MOLINA HEALTHCARE OF TEXAS|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Multiplan|NALC|||||392.25||| 84484|EAP|0300|TROPONIN|United Healthcare|UMR UNITED MEDICAL RESOURCES|392.25||||392.25||| 84484|EAP|0300|TROPONIN|Medicare|MEDICARE PART B ONLY IP|392.25||||||| 84484|EAP|0300|TROPONIN|Medicaid|MEDICAID HMO|||||392.25||| 84520|EAP|0300|BUN|United Medicare Advantage|UHC AARP MCR HMO MA|||||157.25||| 84520|EAP|0300|BUN|Blue Cross PPO Specialty|BCBSTX PPO|157.25||||157.25||| 84520|EAP|0300|BUN|Humana Medicare Advantage|HUMANA MA|157.25||||157.25||| 84520|EAP|0300|BUN|Managed Medicare|BCBS MEDICARE PPO MA|157.25||||||| 84520|EAP|0300|BUN|Aetna|AETNA PPO|||||157.25||| 84520|EAP|0300|BUN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|157.25||||157.25||| 84520|EAP|0300|BUN|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||157.25||| 84520|EAP|0300|BUN|Managed Medicaid|MEDICAID SUPERIOR|157.25||||157.25||| 84520|EAP|0300|BUN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|157.25||||157.25||| 84520|EAP|0300|BUN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|157.25||||157.25||| 84520|EAP|0300|BUN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||157.25||| 84520|EAP|0300|BUN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|157.25||||||| 84520|EAP|0300|BUN|Managed Medicaid|MEDICAID AMERIGROUP|157.25||||157.25||| 84520|EAP|0300|BUN|Medicaid|MEDICAID|157.25||||157.25||| 84520|EAP|0300|BUN|Veterans Affairs|VETERANS ADMINISTRATION|157.25||||||| 84520|EAP|0300|BUN|NON CONTRACTED|COMMERCIAL OTHER 1|||||157.25||| 84520|EAP|0300|BUN|Medicare|MEDICARE ACUTE|157.25||||157.25||| 84520|EAP|0300|BUN|Blue Cross HMO Specialty|BCBSTX HMO|||||157.25||| 84520|EAP|0300|BUN|Cigna|CIGNA OTHER|157.25||||||| 84520|EAP|0300|BUN|United Healthcare|UNITED HEALTHCARE|||||157.25||| 84520|EAP|0300|BUN|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||157.25||| 84550|EAP|0300|URIC ACID|Aetna|AETNA PPO|||||180.25||| 84550|EAP|0300|URIC ACID|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||180.25||| 84550|EAP|0300|URIC ACID|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||180.25||| 84550|EAP|0300|URIC ACID|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|180.25||||180.25||| 84550|EAP|0300|URIC ACID|United Medicare Advantage|UHC MEDICARE GOLD MA|180.25||||180.25||| 84550|EAP|0300|URIC ACID|United Medicare Advantage|AARP UHC WEST COMPLETE MA|180.25||||180.25||| 84550|EAP|0300|URIC ACID|Medicaid|MEDICAID|180.25||||180.25||| 84550|EAP|0300|URIC ACID|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||180.25||| 84550|EAP|0300|URIC ACID|United Healthcare|UNITED HEALTHCARE|180.25||||180.25||| 84550|EAP|0300|URIC ACID|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||180.25||| 84550|EAP|0300|URIC ACID|Medicaid|MEDICAID HMO|||||180.25||| 84550|EAP|0300|URIC ACID|Veterans Affairs|VETERANS ADMINISTRATION|180.25||||180.25||| 84550|EAP|0300|URIC ACID|Humana Medicare Advantage|HUMANA MA|180.25||||180.25||| 84550|EAP|0300|URIC ACID|NON CONTRACTED|COMMERCIAL OTHER 1|180.25||||180.25||| 84550|EAP|0300|URIC ACID|Managed Medicare|HEALTHSPRING MA|||||180.25||| 84550|EAP|0300|URIC ACID|Managed Medicaid|MEDICAID SUPERIOR|180.25||||180.25||| 84550|EAP|0300|URIC ACID|PHCS|HUMANA|180.25||||||| 84550|EAP|0300|URIC ACID|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||180.25||| 84550|EAP|0300|URIC ACID|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|180.25||||180.25||| 84550|EAP|0300|URIC ACID|United Medicare Advantage|UHC AARP MCR HMO MA|||||180.25||| 84550|EAP|0300|URIC ACID|Blue Cross HMO Specialty|BCBSTX HMO|180.25||||180.25||| 84550|EAP|0300|URIC ACID|Managed Medicaid|MEDICAID AMERIGROUP|180.25||||180.25||| 84550|EAP|0300|URIC ACID|Cigna|CIGNA|||||180.25||| 84550|EAP|0300|URIC ACID|Aenta Medicare Advantage|AETNA MEDICARE MA|180.25||||180.25||| 84550|EAP|0300|URIC ACID|Medicare|MEDICARE ACUTE|180.25||||180.25||| 84550|EAP|0300|URIC ACID|Blue Cross PPO Specialty|BCBSTX PPO|180.25||||180.25||| 84550|EAP|0300|URIC ACID|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||180.25||| 84550|EAP|0300|URIC ACID|ChampVA|CHAMPVA CENTER|||||180.25||| 84550|EAP|0300|URIC ACID|Managed Medicaid|MEDICAID UNITED HEALTHCARE|180.25||||180.25||| 84550|EAP|0300|URIC ACID|Tricare|TRICARE EAST REGION|||||180.25||| 84578|EAP|0300|UROBILINOGEL QUAL UA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|129.50||||||| 84588|EAP|0300|ADH (ANTI-DIURETIC HORMON|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,352.50||||||| 84590|EAP|0300|VITAMIN A|United Healthcare|UNITED HEALTHCARE|4.62||||4.62||| 84597|EAP|0300|VITAMIN K|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.46||||||| 84597|EAP|0300|VITAMIN K|United Healthcare|UNITED HEALTHCARE|2.46||||||| 84597|EAP|0300|VITAMIN K|Managed Medicare|OTHER INSTITUTIONS|||||33.19||| 84600|EAP|0300|METHANOL|Medicare|MEDICARE ACUTE|||||640.75||| 84681|EAP|0300|C PEPTIDE|Blue Cross PPO Specialty|BCBSTX PPO|829.25||||||| 84681|EAP|0300|C PEPTIDE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|829.25||||||| 84681|EAP|0300|C PEPTIDE|Blue Cross HMO Specialty|BCBSTX HMO|829.25||||||| 84681|EAP|0300|C PEPTIDE|Medicare|MEDICARE ACUTE|829.25||||||| 84681|EAP|0300|C PEPTIDE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||829.25||| 84702|EAP|0300|QUANT HCG|Managed Medicaid|MEDICAID SUPERIOR|348.50||||348.50||| 84702|EAP|0300|QUANT HCG|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||348.50||| 84702|EAP|0300|QUANT HCG|Medicaid|MEDICAID HMO|||||348.50||| 84702|EAP|0300|QUANT HCG|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||348.50||| 84702|EAP|0300|QUANT HCG|Texas Workforce Commission|DIS DETER SERV (DDS)|348.50||||||| 84702|EAP|0300|QUANT HCG|Medicare|MEDICARE ACUTE|||||348.50||| 84702|EAP|0300|QUANT HCG|Medicaid|MEDICAID|348.50||||348.50||| 84702|EAP|0300|QUANT HCG|Medicaid Out of State|MEDICAID LOUISIANA|||||348.50||| 84702|EAP|0300|QUANT HCG|United Healthcare|UNITED HEALTHCARE|||||348.50||| 84702|EAP|0300|QUANT HCG|Workers Compensation|TEXAS MUTUAL INSURANCE|||||348.50||| 84702|EAP|0300|QUANT HCG|MTC Medical|VAN ZANDT COUNTY INMATE|||||348.50||| 84702|EAP|0300|QUANT HCG|United Healthcare|UNITED HEALTHCARE OTHER|||||348.50||| 84702|EAP|0300|QUANT HCG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||348.50||| 84702|EAP|0300|QUANT HCG|Managed Medicaid|MEDICAID AMERIGROUP|348.50||||348.50||| 84702|EAP|0300|QUANT HCG|Tricare|TRICARE EAST REGION|||||348.50||| 84702|EAP|0300|QUANT HCG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||348.50||| 84702|EAP|0300|QUANT HCG|Managed Medicare|VAN ZANDT COUNTY INMATE|||||348.50||| 84702|EAP|0300|QUANT HCG|Aetna|AETNA PPO|||||348.50||| 84702|EAP|0300|QUANT HCG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||348.50||| 84702|EAP|0300|QUANT HCG|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||348.50||| 84702|EAP|0300|QUANT HCG|United Healthcare|UNITED HEALTHCARE|348.50||||348.50||| 84702|EAP|0300|QUANT HCG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|348.50||||348.50||| 84702|EAP|0300|QUANT HCG|Access Direct Platinum|HEALTHFIRST TPA UMR|||||348.50||| 84702|EAP|0300|QUANT HCG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||348.50||| 84702|EAP|0300|QUANT HCG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||348.50||| 84702|EAP|0300|QUANT HCG|Blue Cross PPO Specialty|BCBSTX PPO|348.50||||348.50||| 84702|EAP|0300|QUANT HCG|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||348.50||| 84702|EAP|0300|QUANT HCG|Cigna|CIGNA|||||348.50||| 84702|EAP|0300|QUANT HCG|Cigna|CIGNA|348.50||||348.50||| 84702|EAP|0300|QUANT HCG|Blue Cross PPO Specialty|BCBSTX OTHER|||||348.50||| 84702|EAP|0300|QUANT HCG|Managed Medicare|HEALTHSPRING MA|||||348.50||| 84702|EAP|0300|QUANT HCG|ChampVA|CHAMPVA CENTER|||||348.50||| 84702|EAP|0300|QUANT HCG|United Medicare Advantage|UHC MEDICARE GOLD MA|||||348.50||| 84702|EAP|0300|QUANT HCG|Aetna|AETNA OTHER|||||348.50||| 84702|EAP|0300|QUANT HCG|Blue Cross HMO Specialty|BCBSTX HMO|||||348.50||| 84702|EAP|0300|QUANT HCG|NON CONTRACTED|COMMERCIAL OTHER 1|||||348.50||| 84703|EAP|0300|SERUM HCG QUAL|Medicaid|MEDICAID HMO|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Medicaid|MEDICAID TEXAS CHILDRENS|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Medicaid|HENDERSON COUNTY INDIGENT|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|United Healthcare|UNITED HEALTHCARE OTHER|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Texas Workforce Commission|DIS DETER SERV (DDS)|299.50||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Medicaid|MEDICAID|299.50||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|United Healthcare|UNITED HEALTHCARE|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Medicare|MEDICARE ACUTE|299.50||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Cigna|CIGNA OTHER|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Cigna|CIGNA|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|299.50||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Blue Cross PPO Specialty|BCBSTX PPO|299.50||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Veterans Affairs|VETERANS ADMINISTRATION|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Managed Medicare|VAN ZANDT COUNTY INMATE|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|299.50||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Managed Medicaid|MEDICAID SUPERIOR|299.50||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|299.50||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Managed Medicaid|MEDICAID AMERIGROUP|299.50||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Aetna|AETNA PPO|299.50||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|299.50||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|United Medicare Advantage|UHC AARP MCR HMO MA|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Humana Medicare Advantage|HUMANA MA|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|MTC Medical|VAN ZANDT COUNTY INMATE|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Access Direct Platinum|HEALTHFIRST TPA UMR|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|299.50||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|United Healthcare|UNITED HEALTHCARE|299.50||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Blue Cross PPO Specialty|BCBSTX OTHER|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Managed Medicare|HEALTHSPRING MA|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|299.50||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|ChampVA|CHAMPVA CENTER|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|United Healthcare|GOLDEN RULE|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Tricare|TRICARE EAST REGION|299.50||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Blue Cross HMO Specialty|BCBSTX HMO|299.50||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Workers Compensation|WORKERS COMPENSATION OTHER|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|NON CONTRACTED|COMMERCIAL OTHER 1|299.50||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Aetna|AETNA OTHER|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Cigna|CIGNA|299.50||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|United Healthcare|TML GROUP BENEFITS|||||299.50||| 84703|EAP|0300|SERUM HCG QUAL|Managed Medicare|BCBS MEDICARE PPO MA|||||299.50||| 85007|EAP|0300|MANUAL DIFF (WBC)|Managed Medicaid|MEDICAID AMERIGROUP|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Medicaid|COUNTY INDIGENT HEALTH OTHER|137.25||||||| 85007|EAP|0300|MANUAL DIFF (WBC)|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Medicaid Out of State|MEDICAID LOUISIANA|||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Medicaid|MEDICAID TEXAS CHILDRENS|||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Medicaid|LAW ENFORCEMENT OTHER|||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Medicaid|HENDERSON COUNTY INDIGENT|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Medicaid|MOLINA HEALTHCARE OF TEXAS|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Medicaid|MEDICAID HMO|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|NON CONTRACTED|COMMERCIAL OTHER 1|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|United Medicare Advantage|UHC MEDICARE GOLD MA|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Medicaid|MEDICAID|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|United Healthcare|GEHA|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|United Healthcare|UMR UNITED MEDICAL RESOURCES|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|PHCS|MULTIPLAN PHCS OTHER|||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|United Healthcare|UNITED HEALTHCARE OTHER|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Tricare|TRICARE EAST REGION|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|NON CONTRACTED|COMMERCIAL OTHER 2|||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|United Healthcare|TML GROUP BENEFITS|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Medicare|MEDICARE PART B ONLY IP|137.25||||||| 85007|EAP|0300|MANUAL DIFF (WBC)|Managed Medicare|HOSPICE ETMC|||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Veterans Affairs|VETERANS ADMINISTRATION|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|United Healthcare|GOLDEN RULE|||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|United Healthcare|UNITED HEALTHCARE|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|MTC Medical|VAN ZANDT COUNTY INMATE|||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Humana Medicare Advantage|HUMANA MA|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|United Medicare Advantage|AARP UHC WEST COMPLETE MA|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Texas Workforce Commission|DIS DETER SERV (DDS)|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Tricare|TRICARE FOR LIFE|||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Workers Compensation|UT EMPLOYEE INJURY|137.25||||||| 85007|EAP|0300|MANUAL DIFF (WBC)|Medicare|MEDICARE ACUTE|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Managed Medicare|HEALTHSPRING MA|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Managed Medicare|OTHER INSTITUTIONS|||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|United Medicare Advantage|UHC AARP MCR HMO MA|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|PHCS|HUMANA|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Managed Medicaid|MEDICAID UNITED HEALTHCARE|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Managed Medicare|BCBS MEDICARE PPO MA|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Managed Medicare|WELLCARE CHOICE MA|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Managed Medicare|HOSPICE OF EAST TEXAS|137.25||||||| 85007|EAP|0300|MANUAL DIFF (WBC)|Managed Medicare|MA PART B ONLY IP|137.25||||||| 85007|EAP|0300|MANUAL DIFF (WBC)|Managed Medicare|VAN ZANDT COUNTY INMATE|||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Managed Medicaid|MEDICAID SUPERIOR|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|UTMB|UTMB CORRECTIONAL MANAGED CARE|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Aetna|BOON CHAPMAN|137.25||||||| 85007|EAP|0300|MANUAL DIFF (WBC)|Aetna|AETNA OTHER|||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Blue Cross PPO Specialty|BCBSTX PPO|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|ChampVA|CHAMPVA CENTER|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Workers Compensation|WORKERS COMPENSATION OTHER|||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Aetna|AETNA PPO|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Aenta Medicare Advantage|AETNA MEDICARE MA|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Access Direct Platinum|HEALTHFIRST TPA UMR|||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Blue Cross PPO Specialty|BCBSTX OTHER|||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Cigna|CIGNA|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Blue Cross HMO Specialty|BCBSTX HMO|137.25||||137.25||| 85007|EAP|0300|MANUAL DIFF (WBC)|Cigna|CIGNA OTHER|137.25||||137.25||| 85014|EAP|0300|HEMATOCRIT|Managed Medicaid|MEDICAID SUPERIOR|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|Blue Cross PPO Specialty|BCBSTX PPO|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|United Healthcare|UNITED HEALTHCARE OTHER|||||94.50||| 85014|EAP|0300|HEMATOCRIT|Veterans Affairs|VETERANS ADMINISTRATION|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|ChampVA|CHAMPVA CENTER|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|Aetna|AETNA PPO|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|Managed Medicare|BCBS MEDICARE PPO MA|94.50||||||| 85014|EAP|0300|HEMATOCRIT|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|94.50||||||| 85014|EAP|0300|HEMATOCRIT|Managed Medicare|HEALTHSPRING MA|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|United Medicare Advantage|UHC MEDICARE GOLD MA|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|94.50||||||| 85014|EAP|0300|HEMATOCRIT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|Cigna|CIGNA|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|Cigna|CIGNA OTHER|94.50||||||| 85014|EAP|0300|HEMATOCRIT|Blue Cross HMO Specialty|BCBSTX HMO|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|United Medicare Advantage|UHC AARP MCR HMO MA|||||94.50||| 85014|EAP|0300|HEMATOCRIT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|Aenta Medicare Advantage|AETNA MEDICARE MA|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|Humana Medicare Advantage|HUMANA MA|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|United Healthcare|UMR UNITED MEDICAL RESOURCES|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|Access Direct Platinum|HEALTHFIRST TPA UMR|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|United Healthcare|TML GROUP BENEFITS|94.50||||||| 85014|EAP|0300|HEMATOCRIT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|United Healthcare|GEHA|||||94.50||| 85014|EAP|0300|HEMATOCRIT|Managed Medicaid|MEDICAID AMERIGROUP|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|Medicaid|COUNTY INDIGENT HEALTH OTHER|94.50||||||| 85014|EAP|0300|HEMATOCRIT|Medicare|MEDICARE ACUTE|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|Texas Workforce Commission|DIS DETER SERV (DDS)|94.50||||||| 85014|EAP|0300|HEMATOCRIT|Medicaid|MEDICAID HMO|94.50||||||| 85014|EAP|0300|HEMATOCRIT|United Healthcare|UNITED HEALTHCARE|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|PHCS|HUMANA|94.50||||||| 85014|EAP|0300|HEMATOCRIT|UTMB|UTMB CORRECTIONAL MANAGED CARE|94.50||||||| 85014|EAP|0300|HEMATOCRIT|Tricare|TRICARE EAST REGION|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|NON CONTRACTED|COMMERCIAL OTHER 1|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|Medicaid|MEDICAID|94.50||||94.50||| 85014|EAP|0300|HEMATOCRIT|Medicaid|MOLINA HEALTHCARE OF TEXAS|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|United Healthcare|UNITED HEALTHCARE|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|PHCS|HUMANA|94.50||||||| 85018|EAP|0300|HEMOGLOBIN|Medicaid|MEDICAID HMO|94.50||||||| 85018|EAP|0300|HEMOGLOBIN|Medicaid|MOLINA HEALTHCARE OF TEXAS|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|Texas Workforce Commission|DIS DETER SERV (DDS)|94.50||||||| 85018|EAP|0300|HEMOGLOBIN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|Medicaid|MEDICAID|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|United Healthcare|GEHA|||||94.50||| 85018|EAP|0300|HEMOGLOBIN|Medicaid|COUNTY INDIGENT HEALTH OTHER|94.50||||||| 85018|EAP|0300|HEMOGLOBIN|NON CONTRACTED|COMMERCIAL OTHER 1|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|Veterans Affairs|VETERANS ADMINISTRATION|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|United Medicare Advantage|UHC MEDICARE GOLD MA|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|Managed Medicare|HEALTHSPRING MA|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|United Healthcare|TML GROUP BENEFITS|94.50||||||| 85018|EAP|0300|HEMOGLOBIN|Humana Medicare Advantage|HUMANA MA|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|Medicare|MEDICARE ACUTE|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|United Healthcare|UNITED HEALTHCARE OTHER|||||94.50||| 85018|EAP|0300|HEMOGLOBIN|UTMB|UTMB CORRECTIONAL MANAGED CARE|94.50||||||| 85018|EAP|0300|HEMOGLOBIN|Managed Medicaid|MEDICAID AMERIGROUP|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|94.50||||||| 85018|EAP|0300|HEMOGLOBIN|United Healthcare|UMR UNITED MEDICAL RESOURCES|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|Access Direct Platinum|HEALTHFIRST TPA UMR|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|Managed Medicare|BCBS MEDICARE PPO MA|94.50||||||| 85018|EAP|0300|HEMOGLOBIN|Managed Medicaid|MEDICAID SUPERIOR|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|Cigna|CIGNA|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|Blue Cross HMO Specialty|BCBSTX HMO|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|ChampVA|CHAMPVA CENTER|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|Aetna|AETNA PPO|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|Tricare|TRICARE EAST REGION|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|94.50||||||| 85018|EAP|0300|HEMOGLOBIN|United Medicare Advantage|UHC AARP MCR HMO MA|||||94.50||| 85018|EAP|0300|HEMOGLOBIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|Aenta Medicare Advantage|AETNA MEDICARE MA|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|Blue Cross PPO Specialty|BCBSTX PPO|94.50||||94.50||| 85018|EAP|0300|HEMOGLOBIN|Cigna|CIGNA OTHER|94.50||||||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Aenta Medicare Advantage|AETNA MEDICARE MA|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Blue Cross PPO Specialty|BCBSTX PPO|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Cigna|CIGNA|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|United Healthcare|TML GROUP BENEFITS|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Medicaid Out of State|MEDICAID LOUISIANA|||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|ChampVA|CHAMPVA CENTER|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Blue Cross HMO Specialty|BCBSTX HMO|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Aetna|BOON CHAPMAN|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Aetna|AETNA OTHER|||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Blue Cross PPO Specialty|BCBSTX OTHER|||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Access Direct Platinum|HEALTHFIRST TPA UMR|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|MTC Medical|VAN ZANDT COUNTY INMATE|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|United Medicare Advantage|AARP UHC WEST COMPLETE MA|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Managed Medicaid|MEDICAID SUPERIOR|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Managed Medicaid|MEDICAID UNITED HEALTHCARE|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Managed Medicare|MA PART B ONLY IP|309.75||||||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Managed Medicare|OTHER INSTITUTIONS|||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Managed Medicaid|MEDICAID AMERIGROUP|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Managed Medicare|VAN ZANDT COUNTY INMATE|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Managed Medicare|HOSPICE ETMC|||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Managed Medicare|WELLCARE CHOICE MA|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|United Medicare Advantage|UHC AARP WELLMED HMO MA|||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Managed Medicare|BCBS MEDICARE PPO MA|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Managed Medicare|HOSPICE OF EAST TEXAS|309.75||||||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|United Medicare Advantage|UHC AARP MCR HMO MA|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Veterans Affairs|VETERANS ADMINISTRATION|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|PHCS|MULTIPLAN PHCS OTHER|||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Workers Compensation|WORKERS COMPENSATION OTHER|||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|PHCS|HUMANA|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Workers Compensation|UT EMPLOYEE INJURY|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Humana Medicare Advantage|HUMANA MA|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|NON CONTRACTED|COMMERCIAL OTHER 1|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Managed Medicare|HEALTHSPRING MA|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|United Healthcare|GOLDEN RULE|||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Texas Workforce Commission|DIS DETER SERV (DDS)|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|UTMB|UTMB CORRECTIONAL MANAGED CARE|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Medicaid|MEDICAID TEXAS CHILDRENS|||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Medicare|MEDICARE ACUTE|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Medicare|MEDICARE PART B ONLY IP|309.75||||||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|United Healthcare|GEHA|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|United Healthcare|UNITED HEALTHCARE OTHER|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|United Healthcare|UMR UNITED MEDICAL RESOURCES|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Aetna|AETNA PPO|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Brinson Benefits|THE HEALTH PLAN SMITH CO|||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Cigna|CIGNA OTHER|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Medicaid|MEDICAID HMO|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Medicaid|COUNTY INDIGENT HEALTH OTHER|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Medicaid|LAW ENFORCEMENT OTHER|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Medicaid|HENDERSON COUNTY INDIGENT|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|PHCS|HUMANA INSURANCE|||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Tricare|TRICARE EAST REGION|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Multiplan|NALC|||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Medicaid|MOLINA HEALTHCARE OF TEXAS|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Medicaid|MEDICAID|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Tricare|TRICARE FOR LIFE|||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Workers Compensation|TEXAS MUTUAL INSURANCE|||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|United Healthcare|UNITED HEALTHCARE|309.75||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|NON CONTRACTED|COMMERCIAL OTHER 2|||||309.75||| 85025|EAP|0300|CBC WITH AUTOMATED DIFF|United Medicare Advantage|UHC MEDICARE GOLD MA|309.75||||309.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|ChampVA|CHAMPVA CENTER|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Medicaid|MOLINA HEALTHCARE OF TEXAS|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Medicaid|MEDICAID|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Medicaid|LAW ENFORCEMENT OTHER|||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Medicaid|HENDERSON COUNTY INDIGENT|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Medicaid|COUNTY INDIGENT HEALTH OTHER|245.75||||||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Medicaid|MEDICAID TEXAS CHILDRENS|||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Medicaid|MEDICAID HMO|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Medicaid Out of State|MEDICAID LOUISIANA|||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|United Healthcare|GEHA|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Tricare|TRICARE FOR LIFE|||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Tricare|TRICARE EAST REGION|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|United Healthcare|UMR UNITED MEDICAL RESOURCES|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|United Healthcare|GOLDEN RULE|||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Medicare|MEDICARE ACUTE|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|United Healthcare|UNITED HEALTHCARE OTHER|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|PHCS|MULTIPLAN PHCS OTHER|||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|NON CONTRACTED|COMMERCIAL OTHER 1|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|United Healthcare|UNITED HEALTHCARE|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|PHCS|HUMANA|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Veterans Affairs|VETERANS ADMINISTRATION|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Workers Compensation|WORKERS COMPENSATION OTHER|||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Workers Compensation|UT EMPLOYEE INJURY|245.75||||||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|NON CONTRACTED|COMMERCIAL OTHER 2|||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|United Medicare Advantage|AARP UHC WEST COMPLETE MA|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|United Medicare Advantage|UHC MEDICARE GOLD MA|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|United Medicare Advantage|UHC AARP MCR HMO MA|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|MTC Medical|VAN ZANDT COUNTY INMATE|||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Managed Medicare|HOSPICE OF EAST TEXAS|245.75||||||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Managed Medicare|WELLCARE CHOICE MA|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Managed Medicare|HOSPICE ETMC|||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Medicare|MEDICARE PART B ONLY IP|245.75||||||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|United Healthcare|TML GROUP BENEFITS|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Managed Medicare|OTHER INSTITUTIONS|||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Texas Workforce Commission|DIS DETER SERV (DDS)|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Humana Medicare Advantage|HUMANA MA|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Managed Medicare|VAN ZANDT COUNTY INMATE|||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|UTMB|UTMB CORRECTIONAL MANAGED CARE|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Managed Medicare|MA PART B ONLY IP|245.75||||||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Managed Medicare|HEALTHSPRING MA|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Managed Medicaid|MEDICAID UNITED HEALTHCARE|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Managed Medicare|BCBS MEDICARE PPO MA|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Managed Medicaid|MEDICAID AMERIGROUP|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Aenta Medicare Advantage|AETNA MEDICARE MA|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Blue Cross PPO Specialty|BCBSTX OTHER|||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Aetna|BOON CHAPMAN|245.75||||||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Aetna|AETNA OTHER|||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Access Direct Platinum|HEALTHFIRST TPA UMR|||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Managed Medicaid|MEDICAID SUPERIOR|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Aetna|AETNA PPO|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Blue Cross PPO Specialty|BCBSTX PPO|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Cigna|CIGNA|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Cigna|CIGNA OTHER|245.75||||245.75||| 85027|EAP|0300|CBC AUTOMATED NO DIFF|Blue Cross HMO Specialty|BCBSTX HMO|245.75||||245.75||| 85041|EAP|0300|RBC|Managed Medicare|HEALTHSPRING MA|||||119.75||| 85044|EAP|0300|RETICULOCYTES COUNT|United Medicare Advantage|UHC MEDICARE GOLD MA|1.71||||||| 85044|EAP|0300|RETICULOCYTES COUNT|NON CONTRACTED|COMMERCIAL OTHER 1|1.71||||||| 85044|EAP|0300|RETICULOCYTES COUNT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.71||| 85044|EAP|0300|RETICULOCYTES COUNT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.71||||1.71||| 85044|EAP|0300|RETICULOCYTES COUNT|Medicare|MEDICARE ACUTE|1.71||||1.71||| 85044|EAP|0300|RETICULOCYTES COUNT|Veterans Affairs|VETERANS ADMINISTRATION|1.71||||||| 85044|EAP|0300|RETICULOCYTES COUNT|Medicaid|MOLINA HEALTHCARE OF TEXAS|1.71||||||| 85044|EAP|0300|RETICULOCYTES COUNT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.71||||1.71||| 85044|EAP|0300|RETICULOCYTES COUNT|Cigna|CIGNA|1.71||||1.71||| 85044|EAP|0300|RETICULOCYTES COUNT|Cigna|CIGNA OTHER|||||1.71||| 85044|EAP|0300|RETICULOCYTES COUNT|Blue Cross HMO Specialty|BCBSTX HMO|1.71||||1.71||| 85044|EAP|0300|RETICULOCYTES COUNT|Medicaid|MEDICAID|||||1.71||| 85044|EAP|0300|RETICULOCYTES COUNT|Aetna|AETNA PPO|1.71||||||| 85044|EAP|0300|RETICULOCYTES COUNT|Aenta Medicare Advantage|AETNA MEDICARE MA|1.71||||1.71||| 85044|EAP|0300|RETICULOCYTES COUNT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.71||||1.71||| 85044|EAP|0300|RETICULOCYTES COUNT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.71||||||| 85044|EAP|0300|RETICULOCYTES COUNT|Managed Medicare|HEALTHSPRING MA|1.71||||||| 85044|EAP|0300|RETICULOCYTES COUNT|Blue Cross PPO Specialty|BCBSTX PPO|1.71||||1.71||| 85044|EAP|0300|RETICULOCYTES COUNT|Managed Medicaid|MEDICAID AMERIGROUP|1.71||||||| 85044|EAP|0300|RETICULOCYTES COUNT|Managed Medicaid|MEDICAID SUPERIOR|1.71||||||| 85044|EAP|0300|RETICULOCYTES COUNT|Humana Medicare Advantage|HUMANA MA|1.71||||1.71||| 85044|EAP|0300|RETICULOCYTES COUNT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.71||||1.71||| 85048|EAP|0300|WBC|Humana Medicare Advantage|HUMANA MA|||||101.50||| 85048|EAP|0300|T&B LYMPHOCYTES (WBC)|Managed Medicaid|MEDICAID SUPERIOR|101.50||||||| 85048|EAP|0300|WBC|Managed Medicaid|MEDICAID SUPERIOR|101.50||||||| 85048|EAP|0300|WBC|Cigna|CIGNA|101.50||||||| 85048|EAP|0300|T&B LYMPHOCYTES (WBC)|Medicare|MEDICARE ACUTE|101.50||||101.50||| 85048|EAP|0300|WBC|Aenta Medicare Advantage|AETNA MEDICARE MA|101.50||||||| 85049|EAP|0300|PLATELET COUNT|Managed Medicaid|MEDICAID SUPERIOR|177.75||||||| 85049|EAP|0300|PLATELET COUNT|Medicare|MEDICARE ACUTE|177.75||||177.75||| 85049|EAP|0300|PLATELET COUNT|Blue Cross PPO Specialty|BCBSTX PPO|177.75||||177.75||| 85049|EAP|0300|PLATELET COUNT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||177.75||| 85049|EAP|0300|PLATELET COUNT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||177.75||| 85049|EAP|0300|PLATELET COUNT|United Healthcare|UMR UNITED MEDICAL RESOURCES|177.75||||||| 85240|EAP|0300|FACTOR VIII|Medicare|MEDICARE ACUTE|||||255.75||| 85240|EAP|0300|VON WILLEBRAND PANEL|Blue Cross PPO Specialty|BCBSTX PPO|||||1.00||| 85240|EAP|0300|FACTOR VIII|Managed Medicaid|MEDICAID SUPERIOR|255.75||||||| 85240|EAP|0300|FACTOR VIII|Blue Cross PPO Specialty|BCBSTX PPO|||||255.75||| 85245|EAP|0300|VON WILLEBRAND PANEL|Blue Cross PPO Specialty|BCBSTX PPO|||||1.24||| 85246|EAP|0300|VON WILLEBRAND PANEL|Blue Cross PPO Specialty|BCBSTX PPO|||||1.24||| 85247|EAP|0300|VON WILLEBRAND PANEL|Blue Cross PPO Specialty|BCBSTX PPO|||||1.24||| 853|DRG||INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|223,472.70|34282.65|157963.79|17107.07|||| 853|DRG||INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC|Medicare|MEDICARE ACUTE|95,397.85|29728.785|157963.79|17107.07|||| 853|DRG||INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC|Tricare|TRICARE EAST REGION|54,850.30|17107.07|157963.79|17107.07|||| 853|DRG||INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC|Veterans Affairs|VETERANS ADMINISTRATION|81,621.70|33687.97|157963.79|17107.07|||| 853|DRG||INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC|Humana Medicare Advantage|HUMANA MA|146,796.68|33661.345|157963.79|17107.07|||| 853|DRG||INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC|NON CONTRACTED|COMMERCIAL OTHER 1|228,933.03|157963.79|157963.79|17107.07|||| 85301|EAP|0300|ANTITHROMBIN III|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|430.75||||||| 85301|EAP|0300|ANTITHROMBIN III|Aenta Medicare Advantage|AETNA MEDICARE MA|430.75||||||| 85301|EAP|0300|ANTITHROMBIN III|Aetna|AETNA PPO|||||430.75||| 85301|EAP|0300|ANTITHROMBIN III|Managed Medicare|BCBS MEDICARE PPO MA|||||430.75||| 85301|EAP|0300|ANTITHROMBIN III|Blue Cross HMO Specialty|BCBSTX HMO|||||430.75||| 85301|EAP|0300|ANTITHROMBIN III|Managed Medicare|HEALTHSPRING MA|430.75||||||| 85301|EAP|0300|ANTITHROMBIN III|Managed Medicaid|MEDICAID SUPERIOR|430.75||||||| 85301|EAP|0300|ANTITHROMBIN III|Managed Medicaid|MEDICAID AMERIGROUP|||||430.75||| 85301|EAP|0300|ANTITHROMBIN III|Medicare|MEDICARE ACUTE|430.75||||||| 85301|EAP|0300|ANTITHROMBIN III|United Medicare Advantage|UHC MEDICARE GOLD MA|||||430.75||| 85301|EAP|0300|ANTITHROMBIN III|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|430.75||||430.75||| 85302|EAP|0300|PROTEIN C ANTIGEN|Humana Medicare Advantage|HUMANA MA|||||478.75||| 85302|EAP|0300|PROTEIN C ANTIGEN|Managed Medicaid|MEDICAID SUPERIOR|478.75||||||| 85302|EAP|0300|PROTEIN C ANTIGEN|Medicare|MEDICARE ACUTE|478.75||||478.75||| 85303|EAP|0300|PROTEIN C ACTIVITY|Medicare|MEDICARE ACUTE|550.75||||550.75||| 85303|EAP|0300|PROTEIN C ACTIVITY|Managed Medicaid|MEDICAID SUPERIOR|550.75||||||| 85306|EAP|0300|PROTEIN S ACTIVITY|Medicare|MEDICARE ACUTE|549.75||||357.75||| 85306|EAP|0300|PROTEIN S ACTIVITY|Managed Medicaid|MEDICAID SUPERIOR|549.75||||||| 85307|EAP|0300|ACTITED PROTEIN RESISTANC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|549.75||||549.75||| 85307|EAP|0300|ACTITED PROTEIN RESISTANC|Blue Cross HMO Specialty|BCBSTX HMO|||||549.75||| 85307|EAP|0300|ACTITED PROTEIN RESISTANC|Managed Medicare|HEALTHSPRING MA|549.75||||||| 85307|EAP|0300|PROTEIN C RESISTANCE|Managed Medicare|BCBS MEDICARE PPO MA|||||3.78||| 85307|EAP|0300|ACTITED PROTEIN RESISTANC|Managed Medicaid|MEDICAID AMERIGROUP|||||549.75||| 85307|EAP|0300|ACTITED PROTEIN RESISTANC|Medicare|MEDICARE ACUTE|549.75||||||| 85307|EAP|0300|ACTITED PROTEIN RESISTANC|United Medicare Advantage|UHC MEDICARE GOLD MA|||||549.75||| 85370|EAP|0300|FIBRIN DEGRADATION PRODUC|Blue Cross PPO Specialty|BCBSTX PPO|185.50||||185.50||| 85370|EAP|0300|FIBRIN DEGRADATION PRODUC|Managed Medicaid|MEDICAID SUPERIOR|185.50||||185.50||| 85370|EAP|0300|FIBRIN DEGRADATION PRODUC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||185.50||| 85370|EAP|0300|FIBRIN DEGRADATION PRODUC|Managed Medicaid|MEDICAID AMERIGROUP|185.50||||185.50||| 85370|EAP|0300|FIBRIN DEGRADATION PRODUC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||185.50||| 85370|EAP|0300|FIBRIN DEGRADATION PRODUC|Humana Medicare Advantage|HUMANA MA|185.50||||185.50||| 85370|EAP|0300|FIBRIN DEGRADATION PRODUC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|185.50||||||| 85370|EAP|0300|FIBRIN DEGRADATION PRODUC|Medicare|MEDICARE ACUTE|185.50||||||| 85370|EAP|0300|FIBRIN DEGRADATION PRODUC|ChampVA|CHAMPVA CENTER|185.50||||||| 85378|EAP|0300|D-DIMER|Cigna|CIGNA OTHER|||||2.84||| 85378|EAP|0300|D-DIMER|ChampVA|CHAMPVA CENTER|||||2.84||| 85378|EAP|0300|D-DIMER|Blue Cross HMO Specialty|BCBSTX HMO|2.84||||2.84||| 85378|EAP|0300|D-DIMER|Aetna|AETNA OTHER|||||2.84||| 85378|EAP|0300|D-DIMER|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.84||||2.84||| 85378|EAP|0300|D-DIMER|Aenta Medicare Advantage|AETNA MEDICARE MA|2.84||||2.84||| 85378|EAP|0300|D-DIMER|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.84||||2.84||| 85378|EAP|0300|D-DIMER|Blue Cross PPO Specialty|BCBSTX PPO|2.84||||2.84||| 85378|EAP|0300|D-DIMER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.84||||2.84||| 85378|EAP|0300|D-DIMER|Managed Medicare|BCBS MEDICARE PPO MA|2.84||||2.84||| 85378|EAP|0300|D-DIMER|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||2.84||| 85378|EAP|0300|D-DIMER|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.84||| 85378|EAP|0300|D-DIMER|Managed Medicaid|MEDICAID AMERIGROUP|2.84||||2.84||| 85378|EAP|0300|D-DIMER|Managed Medicare|HEALTHSPRING MA|2.84||||2.84||| 85378|EAP|0300|D-DIMER|Workers Compensation|UT EMPLOYEE INJURY|2.84||||||| 85378|EAP|0300|D-DIMER|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|2.84||||2.84||| 85378|EAP|0300|D-DIMER|Humana Medicare Advantage|HUMANA MA|2.84||||2.84||| 85378|EAP|0300|D-DIMER|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.84||| 85378|EAP|0300|D-DIMER|Managed Medicaid|MEDICAID SUPERIOR|2.84||||2.84||| 85378|EAP|0300|D-DIMER|Veterans Affairs|VETERANS ADMINISTRATION|2.84||||2.84||| 85378|EAP|0300|D-DIMER|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.84||||2.84||| 85378|EAP|0300|D-DIMER|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.84||| 85378|EAP|0300|D-DIMER|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||2.84||| 85378|EAP|0300|D-DIMER|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.84||||2.84||| 85378|EAP|0300|D-DIMER|Medicaid|MEDICAID|2.84||||2.84||| 85378|EAP|0300|D-DIMER|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.84||| 85378|EAP|0300|D-DIMER|United Healthcare|GEHA|||||2.84||| 85378|EAP|0300|D-DIMER|United Medicare Advantage|UHC AARP MCR HMO MA|||||2.84||| 85378|EAP|0300|D-DIMER|Tricare|TRICARE EAST REGION|2.84||||2.84||| 85378|EAP|0300|D-DIMER|Medicare|MEDICARE ACUTE|2.84||||2.84||| 85378|EAP|0300|D-DIMER|Tricare|TRICARE FOR LIFE|||||2.84||| 85378|EAP|0300|D-DIMER|United Healthcare|TML GROUP BENEFITS|||||2.84||| 85378|EAP|0300|D-DIMER|United Healthcare|UNITED HEALTHCARE|2.84||||2.84||| 85378|EAP|0300|D-DIMER|NON CONTRACTED|COMMERCIAL OTHER 1|2.84||||2.84||| 85378|EAP|0300|D-DIMER|United Healthcare|UNITED HEALTHCARE OTHER|||||2.84||| 85378|EAP|0300|D-DIMER|United Healthcare|UNITED HEALTHCARE|||||2.84||| 85378|EAP|0300|D-DIMER|Aetna|AETNA PPO|2.84||||2.84||| 85378|EAP|0300|D-DIMER|Cigna|CIGNA|2.84||||2.84||| 85378|EAP|0300|D-DIMER|Multiplan|NALC|||||2.84||| 85378|EAP|0300|D-DIMER|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.84||| 85378|EAP|0300|D-DIMER|Medicare|MEDICARE PART B ONLY IP|2.84||||||| 85378|EAP|0300|D-DIMER|Medicaid|MOLINA HEALTHCARE OF TEXAS|2.84||||||| 85378|EAP|0300|D-DIMER|Medicaid|HENDERSON COUNTY INDIGENT|2.84||||||| 85378|EAP|0300|D-DIMER|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.84||||2.84||| 85378|EAP|0300|D-DIMER|United Medicare Advantage|UHC MEDICARE GOLD MA|2.84||||2.84||| 85384|EAP|0300|FIBRINOGEN|Tricare|TRICARE EAST REGION|||||338.25||| 85384|EAP|0300|FIBRINOGEN|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||338.25||| 85384|EAP|0300|FIBRINOGEN|Medicare|MEDICARE ACUTE|338.25||||338.25||| 85384|EAP|0300|FIBRINOGEN|Medicaid|MEDICAID|338.25||||||| 85384|EAP|0300|FIBRINOGEN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|338.25||||||| 85384|EAP|0300|FIBRINOGEN|Humana Medicare Advantage|HUMANA MA|338.25||||338.25||| 85384|EAP|0300|FIBRINOGEN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|338.25||||||| 85384|EAP|0300|FIBRINOGEN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||338.25||| 85384|EAP|0300|FIBRINOGEN|Managed Medicaid|MEDICAID AMERIGROUP|338.25||||338.25||| 85384|EAP|0300|FIBRINOGEN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|338.25||||||| 85384|EAP|0300|FIBRINOGEN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||338.25||| 85384|EAP|0300|FIBRINOGEN|Aetna|AETNA OTHER|||||338.25||| 85384|EAP|0300|FIBRINOGEN|Blue Cross PPO Specialty|BCBSTX PPO|338.25||||338.25||| 85384|EAP|0300|FIBRINOGEN|Managed Medicaid|MEDICAID SUPERIOR|338.25||||338.25||| 85384|EAP|0300|FIBRINOGEN|ChampVA|CHAMPVA CENTER|338.25||||||| 854|DRG||INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|102,730.35|11463.37|34889.57|6783.18|||| 854|DRG||INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC|Humana Medicare Advantage|HUMANA MA|73,441.82|23864.49|34889.57|6783.18|||| 854|DRG||INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC|Managed Medicare|HEALTHSPRING MA|64,808.75|15491.65|34889.57|6783.18|||| 854|DRG||INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC|Blue Cross PPO Specialty|BCBSTX PPO|60,482.75|11051.45|34889.57|6783.18|||| 854|DRG||INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|89,885.55|15752.42|34889.57|6783.18|||| 854|DRG||INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|42,399.80|6783.18|34889.57|6783.18|||| 854|DRG||INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC|Managed Medicaid|MEDICAID AMERIGROUP|64,841.05|15492.53|34889.57|6783.18|||| 854|DRG||INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|78,518.43|11366.66|34889.57|6783.18|||| 854|DRG||INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC|Medicare|MEDICARE ACUTE|93,003.89|15492.09|34889.57|6783.18|||| 854|DRG||INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1,144.35|15752.42|34889.57|6783.18|||| 854|DRG||INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC|NON CONTRACTED|COMMERCIAL OTHER 1|50,564.60|34889.57|34889.57|6783.18|||| 85460|EAP|0300|KLEIHAUER BETKE (FETAL CE|Managed Medicaid|MEDICAID SUPERIOR|||||308.25||| 85460|EAP|0300|KLEIHAUER BETKE (FETAL CE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||308.25||| 85460|EAP|0300|KLEIHAUER BETKE (FETAL CE|Blue Cross PPO Specialty|BCBSTX PPO|||||308.25||| 85460|EAP|0300|KLEIHAUER BETKE (FETAL CE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||308.25||| 85461|EAP|0300|HEMOGLOBIN FETAL|Managed Medicaid|MEDICAID SUPERIOR|||||96.27||| 85461|EAP|0300|HEMOGLOBIN FETAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||96.27||| 85461|EAP|0300|HEMOGLOBIN FETAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||96.27||| 85520|EAP|0300|HEPARIN LEVEL|Managed Medicaid|MEDICAID AMERIGROUP|||||421.25||| 85549|EAP|0300|LYSOZYME|Medicare|MEDICARE ACUTE|||||6.79||| 856|DRG||POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|297,384.12|20835.36|20835.36|20835.36|||| 85610|EAP|0300|PROTHROMBIN TIME|United Medicare Advantage|UHC AARP WELLMED HMO MA|||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Veterans Affairs|VETERANS ADMINISTRATION|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Medicaid|HENDERSON COUNTY INDIGENT|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Medicaid|MEDICAID|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Medicaid|LAW ENFORCEMENT OTHER|||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|United Medicare Advantage|UHC AARP MCR HMO MA|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Medicaid|MEDICAID HMO|||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Medicaid|COUNTY INDIGENT HEALTH OTHER|156.50||||||| 85610|EAP|0300|PROTHROMBIN TIME|United Medicare Advantage|UHC MEDICARE GOLD MA|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Medicaid|MOLINA HEALTHCARE OF TEXAS|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Medicaid|MEDICAID TEXAS CHILDRENS|||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Workers Compensation|WORKERS COMPENSATION OTHER|||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|United Healthcare|UNITED HEALTHCARE|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|United Healthcare|GOLDEN RULE|||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|United Healthcare|GEHA|||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|United Healthcare|TML GROUP BENEFITS|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Multiplan|NALC|||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|UTMB|UTMB CORRECTIONAL MANAGED CARE|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Tricare|TRICARE EAST REGION|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|NON CONTRACTED|COMMERCIAL OTHER 1|156.50||||156.50||| 85610|EAP|0300|LUPUS PROFILE|Medicare|MEDICARE ACUTE|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Tricare|TRICARE FOR LIFE|||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Texas Workforce Commission|DIS DETER SERV (DDS)|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|United Healthcare|UNITED HEALTHCARE OTHER|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Blue Cross PPO Specialty|BCBSTX PPO|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|United Healthcare|UMR UNITED MEDICAL RESOURCES|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Blue Cross PPO Specialty|BCBSTX OTHER|||||156.50||| 85610|EAP|0300|LUPUS PROFILE|Blue Cross PPO Specialty|BCBSTX PPO|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|PHCS|MULTIPLAN PHCS OTHER|||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Workers Compensation|UT EMPLOYEE INJURY|156.50||||||| 85610|EAP|0300|LUPUS PROFILE|Blue Cross HMO Specialty|BCBSTX HMO|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Cigna|CIGNA OTHER|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Medicare|MEDICARE ACUTE|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Medicare|MEDICARE PART B ONLY IP|156.50||||||| 85610|EAP|0300|PROTHROMBIN TIME|NON CONTRACTED|COMMERCIAL OTHER 2|||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|PHCS|HUMANA|156.50||||156.50||| 85610|EAP|0300|LUPUS PROFILE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Blue Cross HMO Specialty|BCBSTX HMO|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Cigna|CIGNA|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Aetna|AETNA PPO|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Access Direct Platinum|HEALTHFIRST TPA UMR|||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Aetna|AETNA OTHER|||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|United Medicare Advantage|AARP UHC WEST COMPLETE MA|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Medicaid Out of State|MEDICAID LOUISIANA|||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|156.50||||156.50||| 85610|EAP|0300|LUPUS PROFILE|Aetna|AETNA PPO|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|156.50||||156.50||| 85610|EAP|0300|LUPUS PROFILE|United Medicare Advantage|UHC MEDICARE GOLD MA|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Aenta Medicare Advantage|AETNA MEDICARE MA|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Managed Medicare|MA PART B ONLY IP|156.50||||||| 85610|EAP|0300|PROTHROMBIN TIME|Managed Medicare|OTHER INSTITUTIONS|||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Managed Medicare|HEALTHSPRING MA|156.50||||156.50||| 85610|EAP|0300|LUPUS PROFILE|Managed Medicare|BCBS MEDICARE PPO MA|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Managed Medicare|BCBS MEDICARE PPO MA|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|ChampVA|CHAMPVA CENTER|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Managed Medicare|VAN ZANDT COUNTY INMATE|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Managed Medicare|HOSPICE OF EAST TEXAS|156.50||||||| 85610|EAP|0300|PROTHROMBIN TIME|Managed Medicaid|MEDICAID SUPERIOR|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Managed Medicaid|MEDICAID UNITED HEALTHCARE|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Managed Medicaid|MEDICAID AMERIGROUP|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Humana Medicare Advantage|HUMANA MA|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Managed Medicare|WELLCARE CHOICE MA|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|MTC Medical|VAN ZANDT COUNTY INMATE|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|156.50||||156.50||| 85610|EAP|0300|PROTHROMBIN TIME|Managed Medicare|HOSPICE ETMC|||||156.50||| 85610|EAP|0300|LUPUS PROFILE|Managed Medicaid|MEDICAID AMERIGROUP|156.50||||156.50||| 85613|EAP|0300|LUPUS PROFILE|Managed Medicare|HEALTHSPRING MA|278.75||||||| 85613|EAP|0300|LUPUS PROFILE|Managed Medicare|BCBS MEDICARE PPO MA|||||278.75||| 85613|EAP|0300|LUPUS PROFILE|Managed Medicaid|MEDICAID SUPERIOR|278.75||||||| 85613|EAP|0300|LUPUS PROFILE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|278.75||||||| 85613|EAP|0300|LUPUS PROFILE|Managed Medicaid|MEDICAID AMERIGROUP|||||278.75||| 85613|EAP|0300|LUPUS PROFILE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|278.75||||278.75||| 85613|EAP|0300|LUPUS PROFILE|Aenta Medicare Advantage|AETNA MEDICARE MA|278.75||||||| 85613|EAP|0300|LUPUS PROFILE|Blue Cross HMO Specialty|BCBSTX HMO|||||278.75||| 85613|EAP|0300|LUPUS PROFILE|Aetna|AETNA PPO|||||278.75||| 85613|EAP|0300|LUPUS PROFILE|Blue Cross PPO Specialty|BCBSTX PPO|||||278.75||| 85613|EAP|0300|LUPUS PROFILE|Medicare|MEDICARE ACUTE|278.75||||278.75||| 85613|EAP|0300|LUPUS PROFILE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||278.75||| 85651|EAP|0300|SED RATE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|141.50||||141.50||| 85651|EAP|0300|SED RATE|Workers Compensation|WORKERS COMPENSATION OTHER|||||141.50||| 85651|EAP|0300|SED RATE|Veterans Affairs|VETERANS ADMINISTRATION|141.50||||141.50||| 85651|EAP|0300|SED RATE|United Medicare Advantage|UHC MEDICARE GOLD MA|141.50||||141.50||| 85651|EAP|0300|SED RATE|United Medicare Advantage|UHC AARP MCR HMO MA|||||141.50||| 85651|EAP|0300|SED RATE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||141.50||| 85651|EAP|0300|SED RATE|Medicaid|HENDERSON COUNTY INDIGENT|141.50||||||| 85651|EAP|0300|SED RATE|Blue Cross PPO Specialty|BCBSTX PPO|141.50||||141.50||| 85651|EAP|0300|SED RATE|Medicare|MEDICARE ACUTE|141.50||||141.50||| 85651|EAP|0300|SED RATE|Cigna|CIGNA|||||141.50||| 85651|EAP|0300|SED RATE|Blue Cross HMO Specialty|BCBSTX HMO|141.50||||141.50||| 85651|EAP|0300|SED RATE|Managed Medicare|HEALTHSPRING MA|141.50||||141.50||| 85651|EAP|0300|SED RATE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||141.50||| 85651|EAP|0300|SED RATE|Aenta Medicare Advantage|AETNA MEDICARE MA|141.50||||141.50||| 85651|EAP|0300|SED RATE|NON CONTRACTED|COMMERCIAL OTHER 1|||||141.50||| 85651|EAP|0300|SED RATE|Aetna|AETNA PPO|141.50||||141.50||| 85651|EAP|0300|SED RATE|Tricare|TRICARE EAST REGION|||||141.50||| 85651|EAP|0300|SED RATE|United Healthcare|UNITED HEALTHCARE|||||141.50||| 85651|EAP|0300|SED RATE|Managed Medicaid|MEDICAID AMERIGROUP|141.50||||141.50||| 85651|EAP|0300|SED RATE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||141.50||| 85651|EAP|0300|SED RATE|Medicaid|MEDICAID|||||141.50||| 85651|EAP|0300|SED RATE|Managed Medicare|BCBS MEDICARE PPO MA|141.50||||141.50||| 85651|EAP|0300|SED RATE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|141.50||||141.50||| 85651|EAP|0300|SED RATE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||141.50||| 85651|EAP|0300|SED RATE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|141.50||||141.50||| 85651|EAP|0300|SED RATE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|141.50||||141.50||| 85651|EAP|0300|SED RATE|Managed Medicaid|MEDICAID SUPERIOR|141.50||||141.50||| 85651|EAP|0300|SED RATE|ChampVA|CHAMPVA CENTER|141.50||||||| 85651|EAP|0300|SED RATE|Humana Medicare Advantage|HUMANA MA|141.50||||141.50||| 85651|EAP|0300|SED RATE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||141.50||| 85651|EAP|0300|SED RATE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||141.50||| 857|DRG||POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W CC|Aenta Medicare Advantage|AETNA MEDICARE MA|104,954.95|14672.06|14945.57|14672.06|||| 857|DRG||POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W CC|Medicare|MEDICARE ACUTE|72,819.55|14945.57|14945.57|14672.06|||| 857|DRG||POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W CC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|69,417.75|14945.57|14945.57|14672.06|||| 85730|EAP|0300|PTT|Workers Compensation|UT EMPLOYEE INJURY|239.25||||||| 85730|EAP|0300|PTT|Veterans Affairs|VETERANS ADMINISTRATION|239.25||||239.25||| 85730|EAP|0300|PTT|Workers Compensation|WORKERS COMPENSATION OTHER|||||239.25||| 85730|EAP|0300|PTT|United Medicare Advantage|UHC AARP MCR HMO MA|239.25||||239.25||| 85730|EAP|0300|LUPUS PROFILE|United Medicare Advantage|UHC MEDICARE GOLD MA|239.25||||239.25||| 85730|EAP|0300|PTT|United Medicare Advantage|UHC AARP WELLMED HMO MA|||||239.25||| 85730|EAP|0300|PTT|United Healthcare|UNITED HEALTHCARE OTHER|239.25||||239.25||| 85730|EAP|0300|PTT|United Healthcare|TML GROUP BENEFITS|239.25||||239.25||| 85730|EAP|0300|PTT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|239.25||||239.25||| 85730|EAP|0300|PTT|UTMB|UTMB CORRECTIONAL MANAGED CARE|239.25||||239.25||| 85730|EAP|0300|PTT|NON CONTRACTED|COMMERCIAL OTHER 2|||||239.25||| 85730|EAP|0300|PTT|NON CONTRACTED|COMMERCIAL OTHER 1|239.25||||239.25||| 85730|EAP|0300|PTT|Tricare|TRICARE FOR LIFE|||||239.25||| 85730|EAP|0300|PTT|Medicare|MEDICARE ACUTE|239.25||||239.25||| 85730|EAP|0300|PTT|United Healthcare|GOLDEN RULE|||||239.25||| 85730|EAP|0300|PTT|United Medicare Advantage|UHC MEDICARE GOLD MA|239.25||||239.25||| 85730|EAP|0300|PTT|Medicaid|MEDICAID HMO|||||239.25||| 85730|EAP|0300|PTT|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||239.25||| 85730|EAP|0300|PTT|PHCS|HUMANA|239.25||||239.25||| 85730|EAP|0300|PTT|Medicaid|MOLINA HEALTHCARE OF TEXAS|239.25||||239.25||| 85730|EAP|0300|PTT|Medicaid|LAW ENFORCEMENT OTHER|||||239.25||| 85730|EAP|0300|PTT|Medicaid|COUNTY INDIGENT HEALTH OTHER|239.25||||||| 85730|EAP|0300|PTT|Medicare|MEDICARE PART B ONLY IP|239.25||||||| 85730|EAP|0300|PTT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|239.25||||239.25||| 85730|EAP|0300|PTT|Managed Medicare|HEALTHSPRING MA|239.25||||239.25||| 85730|EAP|0300|PTT|Managed Medicare|HOSPICE ETMC|||||239.25||| 85730|EAP|0300|PTT|Medicaid|MEDICAID|239.25||||239.25||| 85730|EAP|0300|PTT|Texas Workforce Commission|DIS DETER SERV (DDS)|239.25||||239.25||| 85730|EAP|0300|LUPUS PROFILE|Managed Medicare|BCBS MEDICARE PPO MA|239.25||||239.25||| 85730|EAP|0300|PTT|United Healthcare|GEHA|||||239.25||| 85730|EAP|0300|PTT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|239.25||||239.25||| 85730|EAP|0300|PTT|Multiplan|NALC|||||239.25||| 85730|EAP|0300|PTT|United Healthcare|UMR UNITED MEDICAL RESOURCES|239.25||||239.25||| 85730|EAP|0300|PTT|Managed Medicare|HOSPICE OF EAST TEXAS|239.25||||||| 85730|EAP|0300|PTT|United Healthcare|UNITED HEALTHCARE|239.25||||239.25||| 85730|EAP|0300|PTT|Managed Medicare|WELLCARE CHOICE MA|239.25||||239.25||| 85730|EAP|0300|PTT|Managed Medicare|VAN ZANDT COUNTY INMATE|239.25||||239.25||| 85730|EAP|0300|PTT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|239.25||||239.25||| 85730|EAP|0300|PTT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|239.25||||239.25||| 85730|EAP|0300|PTT|Managed Medicare|MA PART B ONLY IP|239.25||||||| 85730|EAP|0300|PTT|PHCS|MULTIPLAN PHCS OTHER|||||239.25||| 85730|EAP|0300|PTT|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|239.25||||239.25||| 85730|EAP|0300|LUPUS PROFILE|Medicare|MEDICARE ACUTE|239.25||||239.25||| 85730|EAP|0300|PTT|Managed Medicare|BCBS MEDICARE PPO MA|239.25||||239.25||| 85730|EAP|0300|PTT|Tricare|TRICARE EAST REGION|239.25||||239.25||| 85730|EAP|0300|PTT|Managed Medicaid|MEDICAID SUPERIOR|239.25||||239.25||| 85730|EAP|0300|PTT|Managed Medicaid|MEDICAID AMERIGROUP|239.25||||239.25||| 85730|EAP|0300|PTT|Blue Cross PPO Specialty|BCBSTX OTHER|||||239.25||| 85730|EAP|0300|PTT|Blue Cross PPO Specialty|BCBSTX PPO|239.25||||239.25||| 85730|EAP|0300|PTT|MTC Medical|VAN ZANDT COUNTY INMATE|239.25||||239.25||| 85730|EAP|0300|PTT|Humana Medicare Advantage|HUMANA MA|239.25||||239.25||| 85730|EAP|0300|PTT|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|239.25||||239.25||| 85730|EAP|0300|PTT|Cigna|CIGNA OTHER|239.25||||239.25||| 85730|EAP|0300|PTT|ChampVA|CHAMPVA CENTER|239.25||||239.25||| 85730|EAP|0300|LUPUS PROFILE|Blue Cross HMO Specialty|BCBSTX HMO|239.25||||239.25||| 85730|EAP|0300|LUPUS PROFILE|Blue Cross PPO Specialty|BCBSTX PPO|239.25||||239.25||| 85730|EAP|0300|LUPUS PROFILE|Managed Medicaid|MEDICAID AMERIGROUP|239.25||||239.25||| 85730|EAP|0300|PTT|Aetna|AETNA OTHER|||||239.25||| 85730|EAP|0300|PTT|Medicaid Out of State|MEDICAID LOUISIANA|||||239.25||| 85730|EAP|0300|PTT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|239.25||||239.25||| 85730|EAP|0300|LUPUS PROFILE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|239.25||||239.25||| 85730|EAP|0300|PTT|Medicaid|HENDERSON COUNTY INDIGENT|239.25||||239.25||| 85730|EAP|0300|PTT|Blue Cross HMO Specialty|BCBSTX HMO|239.25||||239.25||| 85730|EAP|0300|LUPUS PROFILE|Aetna|AETNA PPO|239.25||||239.25||| 85730|EAP|0300|PTT|Access Direct Platinum|HEALTHFIRST TPA UMR|||||239.25||| 85730|EAP|0300|PTT|Aenta Medicare Advantage|AETNA MEDICARE MA|239.25||||239.25||| 85730|EAP|0300|PTT|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|239.25||||239.25||| 85730|EAP|0300|PTT|Cigna|CIGNA|239.25||||239.25||| 85730|EAP|0300|PTT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|239.25||||239.25||| 85730|EAP|0300|PTT|Aetna|AETNA PPO|239.25||||239.25||| 85730|EAP|0300|PTT|Medicaid|MEDICAID TEXAS CHILDRENS|||||239.25||| 85730|EAP|0300|PTT|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||239.25||| 85730|EAP|0300|PTT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|239.25||||239.25||| 86|DRG||TRAUMATIC STUPOR & COMA, COMA <1 HR W CC|Humana Medicare Advantage|HUMANA MA|44,054.25|9927.25|9927.25|9927.25|||| 86003|EAP|0300|ALLG SPEC IGE CRUDE XTRC|Cigna|CIGNA|||||37.03||| 86003|EAP|0300|FOOD ALLERGY IGE PANEL|Medicaid|HENDERSON COUNTY INDIGENT|||||49.25||| 86022|EAP|0300|HEPARIN INDUCED DEPENDENT|Humana Medicare Advantage|HUMANA MA|3.90||||||| 86022|EAP|0300|HEPARIN INDUCED DEPENDENT|Aenta Medicare Advantage|AETNA MEDICARE MA|3.90||||||| 86022|EAP|0300|HEPARIN INDUCED DEPENDENT|Medicare|MEDICARE ACUTE|3.90||||||| 86022|EAP|0300|HEPARIN INDUCED DEPENDENT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3.90||||||| 86022|EAP|0300|HEPARIN INDUCED DEPENDENT|Medicaid|HENDERSON COUNTY INDIGENT|3.90||||||| 86039|EAP|0300|ANA TITER|Medicaid|HENDERSON COUNTY INDIGENT|444.75||||||| 86039|EAP|0300|ANA TITER|Veterans Affairs|VETERANS ADMINISTRATION|444.75||||||| 86039|EAP|0300|ANA TITER|Tricare|TRICARE EAST REGION|||||444.75||| 86039|EAP|0300|ANA TITER|United Medicare Advantage|AARP UHC WEST COMPLETE MA|444.75||||||| 86039|EAP|0300|ANA TITER|Blue Cross PPO Specialty|BCBSTX PPO|444.75||||444.75||| 86039|EAP|0300|ANA TITER|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|444.75||||444.75||| 86039|EAP|0300|ANA TITER|Medicare|MEDICARE ACUTE|444.75||||444.75||| 86039|EAP|0300|ANA TITER|Cigna|CIGNA|||||444.75||| 86039|EAP|0300|ANA TITER|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||444.75||| 86039|EAP|0300|ANA TITER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||444.75||| 86039|EAP|0300|ANA TITER|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||444.75||| 86039|EAP|0300|ANA TITER|Managed Medicaid|MEDICAID SUPERIOR|444.75||||444.75||| 86039|EAP|0300|ANA TITER|Humana Medicare Advantage|HUMANA MA|444.75||||||| 86140|EAP|0300|C-REACTIVE PROT,QN|Humana Medicare Advantage|HUMANA MA|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|Managed Medicaid|MEDICAID AMERIGROUP|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|Managed Medicare|BCBS MEDICARE PPO MA|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|Managed Medicaid|MEDICAID SUPERIOR|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|Aetna|AETNA PPO|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|Aenta Medicare Advantage|AETNA MEDICARE MA|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|Cigna|CIGNA|||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|Cigna|CIGNA OTHER|2.06||||||| 86140|EAP|0300|C-REACTIVE PROT,QN|Cigna|CIGNA|2.06||||||| 86140|EAP|0300|C-REACTIVE PROT,QN|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|United Medicare Advantage|UHC AARP MCR HMO MA|||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|Medicare|MEDICARE ACUTE|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|Workers Compensation|UT EMPLOYEE INJURY|2.06||||||| 86140|EAP|0300|C-REACTIVE PROT,QN|Tricare|TRICARE EAST REGION|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|NON CONTRACTED|COMMERCIAL OTHER 1|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|United Healthcare|TML GROUP BENEFITS|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|UTMB|UTMB CORRECTIONAL MANAGED CARE|2.06||||||| 86140|EAP|0300|C-REACTIVE PROT,QN|Blue Cross PPO Specialty|BCBSTX PPO|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|Managed Medicare|HEALTHSPRING MA|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|2.06||||||| 86140|EAP|0300|C-REACTIVE PROT,QN|United Healthcare|UNITED HEALTHCARE OTHER|||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|United Healthcare|UMR UNITED MEDICAL RESOURCES|2.06||||||| 86140|EAP|0300|C-REACTIVE PROT,QN|United Healthcare|UNITED HEALTHCARE|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|Medicaid|MEDICAID|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|Medicaid|LAW ENFORCEMENT OTHER|||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|United Healthcare|UNITED HEALTHCARE|||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|Veterans Affairs|VETERANS ADMINISTRATION|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|Medicaid|HENDERSON COUNTY INDIGENT|2.06||||||| 86140|EAP|0300|C-REACTIVE PROT,QN|Medicaid|COUNTY INDIGENT HEALTH OTHER|2.06||||||| 86140|EAP|0300|C-REACTIVE PROT,QN|United Medicare Advantage|UHC MEDICARE GOLD MA|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|ChampVA|CHAMPVA CENTER|||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|Medicaid|MOLINA HEALTHCARE OF TEXAS|2.06||||2.06||| 86140|EAP|0300|C-REACTIVE PROT,QN|Blue Cross HMO Specialty|BCBSTX HMO|2.06||||2.06||| 86146|EAP|0300|BETA 2 GLYCOPROTEIN ANTIB|Medicare|MEDICARE ACUTE|||||0.45||| 86147|EAP|0300|ANTIPHOSPHATIDYLSERINE IG|Medicare|MEDICARE ACUTE|||||70.25||| 86147|EAP|0300|PHOSPHOLIPID ANTIBODY|Medicare|MEDICARE ACUTE|||||3.13||| 86147|EAP|0300|CARDIOLIPIN ANTIBODIES|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.13||| 86147|EAP|0300|CARDIOLIPIN ANTIBODIES|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.13||| 86147|EAP|0300|CARDIOLIPIN ANTIBODIES|Blue Cross HMO Specialty|BCBSTX HMO|||||3.13||| 86148|EAP|0300|ANTIPHOSPHATIDYLSERINE IG|Medicare|MEDICARE ACUTE|||||70.25||| 86160|EAP|0300|COMPLEMENT C4|Managed Medicaid|MEDICAID UNITED HEALTHCARE|478.50||||478.50||| 86160|EAP|0300|COMPLEMENT C3|Managed Medicaid|MEDICAID UNITED HEALTHCARE|478.50||||478.50||| 86160|EAP|0300|COMPLEMENT C3|Managed Medicaid|MEDICAID AMERIGROUP|||||478.50||| 86160|EAP|0300|COMPLEMENT C4|Aetna|AETNA PPO|478.50||||||| 86160|EAP|0300|COMPLEMENT C3|Aetna|AETNA PPO|478.50||||||| 86160|EAP|0300|COMPLEMENT C3|Aenta Medicare Advantage|AETNA MEDICARE MA|||||478.50||| 86160|EAP|0300|COMPLEMENT C4|Aenta Medicare Advantage|AETNA MEDICARE MA|||||478.50||| 86160|EAP|0300|COMPLEMENT C4|United Medicare Advantage|UHC MEDICARE GOLD MA|||||478.50||| 86160|EAP|0300|COMPLEMENT C3|Blue Cross PPO Specialty|BCBSTX PPO|478.50||||||| 86160|EAP|0300|COMPLEMENT C4|Blue Cross PPO Specialty|BCBSTX PPO|478.50||||||| 86160|EAP|0300|COMPLEMENT C4|Medicaid|MOLINA HEALTHCARE OF TEXAS|478.50||||||| 86160|EAP|0300|COMPLEMENT C3|Medicaid|MOLINA HEALTHCARE OF TEXAS|478.50||||||| 86160|EAP|0300|COMPLEMENT C3|Medicare|MEDICARE ACUTE|478.50||||478.50||| 86160|EAP|0300|COMPLEMENT C4|Medicare|MEDICARE ACUTE|478.50||||478.50||| 86162|EAP|0300|COMPLEMENT TOTAL (CHF50)|Medicare|MEDICARE ACUTE|748.50||||||| 86162|EAP|0300|COMPLEMENT TOTAL (CHF50)|United Medicare Advantage|UHC MEDICARE GOLD MA|||||748.50||| 862|DRG||POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W MCC|Blue Cross PPO Specialty|BCBSTX PPO|232.15|1309.94|13568.46|1309.94|||| 862|DRG||POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W MCC|Veterans Affairs|VETERANS ADMINISTRATION|102,555.61|13568.46|13568.46|1309.94|||| 86225|EAP|0300|DNA AB, DOUBLE STRANDED|Medicare|MEDICARE ACUTE|547.50||||||| 86225|EAP|0300|DNA AB, DOUBLE STRANDED|United Medicare Advantage|UHC MEDICARE GOLD MA|||||547.50||| 86225|EAP|0300|DNA AB, DOUBLE STRANDED|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||547.50||| 86225|EAP|0300|DNA AB, DOUBLE STRANDED|Managed Medicare|HEALTHSPRING MA|||||547.50||| 86225|EAP|0300|DNA AB, DOUBLE STRANDED|Aetna|AETNA PPO|547.50||||||| 86225|EAP|0300|DNA AB, DOUBLE STRANDED|Medicaid|MOLINA HEALTHCARE OF TEXAS|547.50||||||| 86235|EAP|0300|SJOGREN'S B ANTIBODY (SSB|Cigna|CIGNA|||||714.75||| 86235|EAP|0300|ANTI-CYCLIC CITRALLINATED|Aenta Medicare Advantage|AETNA MEDICARE MA|||||714.75||| 86235|EAP|0300|SJOGREN'S A ANTIBODY (SSA|Managed Medicare|HEALTHSPRING MA|||||714.75||| 86235|EAP|0300|SMITH AB|Managed Medicare|HEALTHSPRING MA|||||1.00||| 86235|EAP|0300|ANTI-CYCLIC CITRALLINATED|Managed Medicare|HEALTHSPRING MA|||||714.75||| 86235|EAP|0300|SJOGREN'S B ANTIBODY (SSB|Managed Medicare|HEALTHSPRING MA|||||714.75||| 86235|EAP|0300|SJOGREN'S A ANTIBODY (SSA|Cigna|CIGNA|||||714.75||| 86235|EAP|0300|SJOGREN'S A ANTIBODY (SSA|United Medicare Advantage|UHC MEDICARE GOLD MA|||||714.75||| 86235|EAP|0300|ANTI-CYCLIC CITRALLINATED|United Medicare Advantage|UHC MEDICARE GOLD MA|||||714.75||| 86235|EAP|0300|SJOGREN'S B ANTIBODY (SSB|United Medicare Advantage|UHC MEDICARE GOLD MA|||||714.75||| 86235|EAP|0300|ANTI-JO-1 ANTIBODY|United Medicare Advantage|UHC MEDICARE GOLD MA|||||714.75||| 86235|EAP|0300|SCLERODERMA ANTIBODY (SCL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||714.75||| 86235|EAP|0300|SJOGREN'S A ANTIBODY (SSA|Medicare|MEDICARE ACUTE|||||714.75||| 86235|EAP|0300|ANTI-CYCLIC CITRALLINATED|Medicare|MEDICARE ACUTE|||||714.75||| 86235|EAP|0300|SJOGREN'S B ANTIBODY (SSB|Medicare|MEDICARE ACUTE|||||714.75||| 86255|EAP|0300|ANTI-NEUTROPHILIC CYTOPLA|United Healthcare|UNITED HEALTHCARE|||||480.50||| 86255|EAP|0300|ANTI-NEUTROPHILIC CYTOPLA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||480.50||| 86255|EAP|0300|ANTI-NEUTROPHILIC CYTOPLA|Blue Cross HMO Specialty|BCBSTX HMO|||||480.50||| 86255|EAP|0300|ANTI-NEUTROPHILIC CYTOPLA|United Medicare Advantage|UHC MEDICARE GOLD MA|||||480.50||| 86255|EAP|0300|ANTI-NEUTROPHILIC CYTOPLA|Medicare|MEDICARE ACUTE|480.50||||||| 86256|EAP|0300|NEURONAL ANTIBODY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||480.50||| 86256|EAP|0300|SMOOTH MUSCLE ANTIBODY|United Medicare Advantage|UHC MEDICARE GOLD MA|||||480.50||| 863|DRG||POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|181.93|4968.52|8351.42|4968.52|||| 863|DRG||POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W/O MCC|Medicare|MEDICARE ACUTE|60,042.25|8351.42|8351.42|4968.52|||| 86300|EAP|0300|CA 27.29|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||829.25||| 86300|EAP|0300|CA 15-3|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||829.25||| 86300|EAP|0300|CA 27.29|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||829.25||| 86300|EAP|0300|CA 15-3|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||829.25||| 86301|EAP|0300|CA19 9|United Medicare Advantage|AARP UHC WEST COMPLETE MA|829.25||||829.25||| 86301|EAP|0300|CA19 9|United Medicare Advantage|UHC MEDICARE GOLD MA|829.25||||829.25||| 86301|EAP|0300|CA19 9|Medicare|MEDICARE ACUTE|829.25||||829.25||| 86301|EAP|0300|CA19 9|Medicaid|HENDERSON COUNTY INDIGENT|||||829.25||| 86301|EAP|0300|CA19 9|Humana Medicare Advantage|HUMANA MA|829.25||||||| 86301|EAP|0300|CA19 9|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|829.25||||||| 86301|EAP|0300|CA19 9|Managed Medicaid|MEDICAID AMERIGROUP|829.25||||||| 86301|EAP|0300|CA19 9|Managed Medicare|HEALTHSPRING MA|829.25||||||| 86304|EAP|0300|CANCER ANTIGEN 125(CA125)|United Healthcare|UNITED HEALTHCARE|||||829.25||| 86304|EAP|0300|CANCER ANTIGEN 125(CA125)|Medicare|MEDICARE ACUTE|829.25||||||| 86304|EAP|0300|CANCER ANTIGEN 125(CA125)|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|829.25||||||| 86308|EAP|0300|MONOSPOT|Cigna|CIGNA|||||2.06||| 86308|EAP|0300|MONOSPOT|Blue Cross HMO Specialty|BCBSTX HMO|||||2.06||| 86308|EAP|0300|MONOSPOT|Cigna|CIGNA OTHER|||||2.06||| 86308|EAP|0300|MONOSPOT|Aetna|AETNA PPO|||||2.06||| 86308|EAP|0300|MONOSPOT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.06||| 86308|EAP|0300|MONOSPOT|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||2.06||| 86308|EAP|0300|MONOSPOT|Veterans Affairs|VETERANS ADMINISTRATION|||||2.06||| 86308|EAP|0300|MONOSPOT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.06||| 86308|EAP|0300|MONOSPOT|Medicaid|MEDICAID HMO|||||2.06||| 86308|EAP|0300|MONOSPOT|Blue Cross PPO Specialty|BCBSTX PPO|||||2.06||| 86308|EAP|0300|MONOSPOT|Medicaid|MEDICAID|||||2.06||| 86308|EAP|0300|MONOSPOT|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.06||| 86308|EAP|0300|MONOSPOT|Tricare|TRICARE EAST REGION|||||2.06||| 86308|EAP|0300|MONOSPOT|United Healthcare|UNITED HEALTHCARE OTHER|||||2.06||| 86308|EAP|0300|MONOSPOT|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.06||| 86308|EAP|0300|MONOSPOT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.06||||||| 86308|EAP|0300|MONOSPOT|Managed Medicaid|MEDICAID AMERIGROUP|||||2.06||| 86308|EAP|0300|MONOSPOT|United Healthcare|UNITED HEALTHCARE|||||2.06||| 86308|EAP|0300|MONOSPOT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.06||| 86308|EAP|0300|MONOSPOT|Managed Medicaid|MEDICAID SUPERIOR|2.06||||2.06||| 86316|EAP|0300|IMMUNOASSAY TUMOR ANTIGEN|Blue Cross HMO Specialty|BCBSTX HMO|||||2.14||| 86317|EAP|0300|CHROMOGRANIN A|Medicare|MEDICARE ACUTE|5.63||||||| 86317|EAP|0300|CHROMOGRANIN A|Blue Cross HMO Specialty|BCBSTX HMO|||||5.63||| 86334|EAP|0300|IMMUNOELECTROPHORESIS, SE|Humana Medicare Advantage|HUMANA MA|890.25||||||| 86334|EAP|0300|IMMUNOELECTROPHORESIS, UR|Humana Medicare Advantage|HUMANA MA|890.25||||||| 86334|EAP|0300|IMMUNOELECTROPHORESIS, UR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||890.25||| 86334|EAP|0300|IMMUNOELECTROPHORESIS, SE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||890.25||| 86334|EAP|0300|IMMUNOELECTROPHORESIS, SE|Blue Cross HMO Specialty|BCBSTX HMO|||||890.25||| 86334|EAP|0300|IMMUNOELECTROPHORESIS, SE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|890.25||||||| 86334|EAP|0300|IMMUNOELECTROPHORESIS, UR|Veterans Affairs|VETERANS ADMINISTRATION|||||890.25||| 86334|EAP|0300|IMMUNOELECTROPHORESIS, SE|Veterans Affairs|VETERANS ADMINISTRATION|||||890.25||| 86334|EAP|0300|IMMUNOELECTROPHORESIS, UR|Medicaid|MEDICAID|||||890.25||| 86334|EAP|0300|IMMUNOELECTROPHORESIS, SE|Medicaid|MEDICAID|||||890.25||| 86334|EAP|0300|IMMUNOELECTROPHORESIS, SE|United Healthcare|UNITED HEALTHCARE|||||890.25||| 86334|EAP|0300|IMMUNOELECTROPHORESIS, SE|Medicare|MEDICARE ACUTE|890.25||||890.25||| 86352|EAP|0300|ADALIMUNAB AB HUMIRA|Medicare|MEDICARE ACUTE|||||7.40||| 86359|EAP|0300|T CELLS, TOTAL|Managed Medicaid|MEDICAID SUPERIOR|1,378.50||||||| 86359|EAP|0300|T CELLS, TOTAL|Medicare|MEDICARE ACUTE|||||1,378.50||| 86360|EAP|0300|T CELL SUPRESSOR PANEL (C|Medicare|MEDICARE ACUTE|||||1,415.25||| 86360|EAP|0300|T CELL SUPRESSOR PANEL (C|Medicare|MEDICARE ACUTE|||||8.56||| 86360|EAP|0300|T CELL SUPRESSOR PANEL (C|Managed Medicaid|MEDICAID SUPERIOR|1,415.25||||||| 86360|EAP|0300|T CELL SUPRESSOR PANEL (C|Managed Medicaid|MEDICAID SUPERIOR|8.56||||||| 86361|EAP|0300|T CELLS/INDUCER/HELPER|Medicare|MEDICARE ACUTE|||||1,066.75||| 86361|EAP|0300|T CELLS/INDUCER/HELPER|Managed Medicaid|MEDICAID SUPERIOR|1,066.75||||||| 864|DRG||FEVER AND INFLAMMATORY CONDITIONS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|54,143.25|7353.92|8514.5|7353.92|||| 864|DRG||FEVER AND INFLAMMATORY CONDITIONS|Medicare|MEDICARE ACUTE|43,338.95|7353.92|8514.5|7353.92|||| 864|DRG||FEVER AND INFLAMMATORY CONDITIONS|Aenta Medicare Advantage|AETNA MEDICARE MA|40,234.50|8514.5|8514.5|7353.92|||| 864|DRG||FEVER AND INFLAMMATORY CONDITIONS|Humana Medicare Advantage|HUMANA MA|31,223.75|7464.47|8514.5|7353.92|||| 86431|EAP|0300|RA QUANT|Managed Medicare|HEALTHSPRING MA|||||2.26||| 86431|EAP|0300|RA QUANT|Blue Cross PPO Specialty|BCBSTX PPO|2.26||||2.26||| 86431|EAP|0300|RA QUANT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.26||| 86431|EAP|0300|RA QUANT|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.26||| 86431|EAP|0300|RA QUANT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.26||| 86431|EAP|0300|RA QUANT|United Healthcare|UNITED HEALTHCARE|||||2.26||| 86431|EAP|0300|RA QUANT|Tricare|TRICARE EAST REGION|||||2.26||| 86431|EAP|0300|RA QUANT|Medicaid|HENDERSON COUNTY INDIGENT|||||2.26||| 86431|EAP|0300|RA QUANT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.26||| 86431|EAP|0300|RA QUANT|Medicare|MEDICARE ACUTE|2.26||||2.26||| 86431|EAP|0300|RA QUANT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.26||| 86480|EAP|0300|QUANTIFERON TB GOLD|Veterans Affairs|VETERANS ADMINISTRATION|||||421.25||| 86480|EAP|0300|QUANTIFERON TB GOLD|United Medicare Advantage|AARP UHC WEST COMPLETE MA|421.25||||||| 86480|EAP|0300|QUANTIFERON TB GOLD|Tricare|TRICARE EAST REGION|||||421.25||| 86480|EAP|0300|QUANTIFERON TB GOLD|Medicare|MEDICARE ACUTE|421.25||||421.25||| 86480|EAP|0300|QUANTIFERON TB GOLD|Aetna|AETNA PPO|||||421.25||| 86480|EAP|0300|QUANTIFERON TB GOLD|Blue Cross PPO Specialty|BCBSTX PPO|421.25||||421.25||| 86480|EAP|0300|QUANTIFERON TB GOLD|Humana Medicare Advantage|HUMANA MA|421.25||||||| 86592|EAP|0300|VDRL (RPR)|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|169.75||||||| 86592|EAP|0300|VDRL (RPR)|Managed Medicaid|MEDICAID SUPERIOR|169.75||||169.75||| 86592|EAP|0300|VDRL (RPR)|Managed Medicaid|MEDICAID AMERIGROUP|169.75||||169.75||| 86592|EAP|0300|VDRL (RPR)|Humana Medicare Advantage|HUMANA MA|169.75||||||| 86592|EAP|0300|VDRL SPINAL FLUID|Blue Cross PPO Specialty|BCBSTX PPO|169.75||||169.75||| 86592|EAP|0300|VDRL (RPR)|Blue Cross PPO Specialty|BCBSTX PPO|169.75||||169.75||| 86592|EAP|0300|VDRL (RPR)|Blue Cross HMO Specialty|BCBSTX HMO|169.75||||||| 86592|EAP|0300|VDRL (RPR)|ChampVA|CHAMPVA CENTER|169.75||||||| 86592|EAP|0300|VDRL (RPR)|Cigna|CIGNA|169.75||||||| 86592|EAP|0300|VDRL (RPR)|Cigna|CIGNA OTHER|169.75||||||| 86592|EAP|0300|VDRL (RPR)|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|169.75||||||| 86592|EAP|0300|VDRL (RPR)|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|169.75||||||| 86592|EAP|0300|VDRL (RPR)|Medicaid|MEDICAID|169.75||||169.75||| 86592|EAP|0300|VDRL SPINAL FLUID|Medicare|MEDICARE ACUTE|169.75||||169.75||| 86592|EAP|0300|VDRL (RPR)|Medicaid|MOLINA HEALTHCARE OF TEXAS|169.75||||||| 86592|EAP|0300|VDRL (RPR)|United Healthcare|UNITED HEALTHCARE|169.75||||||| 86592|EAP|0300|VDRL SPINAL FLUID|Medicaid|MEDICAID HMO|169.75||||169.75||| 86592|EAP|0300|VDRL (RPR)|Tricare|TRICARE EAST REGION|169.75||||||| 86592|EAP|0300|VDRL (RPR)|United Healthcare|UMR UNITED MEDICAL RESOURCES|169.75||||||| 86592|EAP|0300|VDRL (RPR)|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|169.75||||169.75||| 86592|EAP|0300|VDRL (RPR)|Medicare|MEDICARE ACUTE|169.75||||169.75||| 86592|EAP|0300|VDRL (RPR)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|169.75||||||| 86592|EAP|0300|VDRL (RPR)|NON CONTRACTED|COMMERCIAL OTHER 1|169.75||||||| 86592|EAP|0300|VDRL (RPR)|Medicaid|MEDICAID HMO|169.75||||169.75||| 86592|EAP|0300|VDRL (RPR)|PHCS|HUMANA|169.75||||||| 86592|EAP|0300|VDRL (RPR)|United Healthcare|GEHA|169.75||||||| 86592|EAP|0300|VDRL (RPR)|United Healthcare|TML GROUP BENEFITS|169.75||||||| 86592|EAP|0300|VDRL (RPR)|United Healthcare|UNITED HEALTHCARE|169.75||||169.75||| 86592|EAP|0300|VDRL (RPR)|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|169.75||||169.75||| 86592|EAP|0300|VDRL (RPR)|United Medicare Advantage|AARP UHC WEST COMPLETE MA|169.75||||169.75||| 86592|EAP|0300|VDRL (RPR)|Workers Compensation|UT EMPLOYEE INJURY|||||169.75||| 86592|EAP|0300|VDRL (RPR)|Workers Compensation|WORKERS COMPENSATION OTHER|||||169.75||| 86592|EAP|0300|VDRL (RPR)|Managed Medicaid|MEDICAID UNITED HEALTHCARE|169.75||||169.75||| 86592|EAP|0300|VDRL (RPR)|Aetna|AETNA PPO|169.75||||||| 866|DRG||VIRAL ILLNESS W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|33,469.75|4115.95|4115.95|2693.84|||| 866|DRG||VIRAL ILLNESS W/O MCC|Managed Medicaid|MEDICAID SUPERIOR|405.17|2693.84|4115.95|2693.84|||| 86609|EAP|0300|HYPERSENSITIVITY PNEUMONI|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.26||| 86611|EAP|0300|BARTONELLA HENSELAE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.26||| 86611|EAP|0300|BARTONELLA HENSELAE|Managed Medicaid|MEDICAID SUPERIOR|||||3.26||| 86611|EAP|0300|BARTONELLA HENSELAE|Managed Medicaid|MEDICAID AMERIGROUP|||||3.26||| 86611|EAP|0300|BARTONELLA HENSELAE|Cigna|CIGNA|||||3.26||| 86618|EAP|0300|LYME DISEASE IGG & IGM|Tricare|TRICARE EAST REGION|||||678.75||| 86618|EAP|0300|LYME DISEASE IGG & IGM|Medicare|MEDICARE ACUTE|||||678.75||| 86618|EAP|0300|LYME DISEASE IGG & IGM|Cigna|CIGNA|||||678.75||| 86618|EAP|0300|LYME DISEASE IGG & IGM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||678.75||| 86618|EAP|0300|LYME DISEASE IGG & IGM|Blue Cross PPO Specialty|BCBSTX PPO|||||678.75||| 86618|EAP|0300|LYME DISEASE IGG & IGM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|678.75||||||| 86644|EAP|0300|CMV IGG(CYTOMEGLOVIRUS)|Managed Medicaid|MEDICAID UNITED HEALTHCARE|573.50||||||| 86644|EAP|0300|CMV IGG(CYTOMEGLOVIRUS)|Managed Medicaid|MEDICAID SUPERIOR|||||573.50||| 86644|EAP|0300|CMV IGG(CYTOMEGLOVIRUS)|Managed Medicaid|MEDICAID AMERIGROUP|||||573.50||| 86644|EAP|0300|CMV IGG(CYTOMEGLOVIRUS)|United Medicare Advantage|AARP UHC WEST COMPLETE MA|573.50||||||| 86645|EAP|0300|CMV IGM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3.26||||||| 86645|EAP|0300|CMV IGM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.26||||||| 86663|EAP|0300|EPSTEIN-BAR VIRUS COMP(EA|Managed Medicaid|MEDICAID SUPERIOR|||||522.25||| 86663|EAP|0300|EPSTEIN-BAR VIRUS COMP(EA|Managed Medicaid|MEDICAID AMERIGROUP|||||522.25||| 86664|EAP|0300|EPSTEIN-BAR VIRUS COMP(EB|Managed Medicaid|MEDICAID AMERIGROUP|||||609.50||| 86664|EAP|0300|EPSTEIN-BAR VIRUS COMP(EB|Managed Medicaid|MEDICAID SUPERIOR|||||609.50||| 86665|EAP|0300|EPSTEIN-BAR VIRUS AB SCRE|Managed Medicaid|MEDICAID SUPERIOR|||||722.75||| 86665|EAP|0300|EPSTEIN-BAR VIRUS AB SCRE|Managed Medicaid|MEDICAID AMERIGROUP|||||722.75||| 86665|EAP|0300|EPSTEIN-BAR VIRUS COMP(VC|Managed Medicaid|MEDICAID AMERIGROUP|||||722.75||| 86665|EAP|0300|EPSTEIN-BAR VIRUS COMP(VC|Managed Medicaid|MEDICAID SUPERIOR|||||722.75||| 86698|EAP|0300|HISTOPLASMA ANTIBODY, CF|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3.26||||||| 86701|EAP|0300||Cigna|CIGNA|546.50||||||| 86701|EAP|0300||Blue Cross HMO Specialty|BCBSTX HMO|546.50||||||| 86701|EAP|0300|HIV-1 ANTIBODY|Blue Cross PPO Specialty|BCBSTX PPO|546.50||||184.80||| 86701|EAP|0300||Managed Medicaid|MEDICAID SUPERIOR|546.50||||546.50||| 86701|EAP|0300||Managed Medicaid|MEDICAID AMERIGROUP|546.50||||546.50||| 86701|EAP|0300||Medicaid|MEDICAID HMO|||||546.50||| 86701|EAP|0300||Medicaid|MEDICAID|546.50||||||| 86703|EAP|0300|HIV SCREEN|Workers Compensation|WORKERS COMPENSATION OTHER|||||546.50||| 86703|EAP|0300|HIV SCREEN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|546.50||||546.50||| 86703|EAP|0300|HIV SCREEN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|546.50||||||| 86703|EAP|0300|HIV SCREEN|PHCS|HUMANA|546.50||||||| 86703|EAP|0300|HIV SCREEN|NON CONTRACTED|COMMERCIAL OTHER 1|546.50||||||| 86703|EAP|0300|HIV SCREEN|United Healthcare|UMR UNITED MEDICAL RESOURCES|546.50||||||| 86703|EAP|0300|HIV SCREEN|Tricare|TRICARE EAST REGION|546.50||||||| 86703|EAP|0300|HIV SCREEN|Medicare|MEDICARE ACUTE|546.50||||546.50||| 86703|EAP|0300|HIV SCREEN|United Healthcare|UNITED HEALTHCARE|546.50||||546.50||| 86703|EAP|0300|HIV SCREEN|United Healthcare|UNITED HEALTHCARE|546.50||||||| 86703|EAP|0300|HIV SCREEN|Medicaid|MEDICAID|546.50||||546.50||| 86703|EAP|0300|HIV SCREEN|Medicaid|MEDICAID HMO|546.50||||||| 86703|EAP|0300|HIV SCREEN|Humana Medicare Advantage|HUMANA MA|546.50||||||| 86703|EAP|0300|HIV SCREEN|Managed Medicare|HEALTHSPRING MA|546.50||||546.50||| 86703|EAP|0300|HIV SCREEN|Managed Medicaid|MEDICAID AMERIGROUP|546.50||||546.50||| 86703|EAP|0300|HIV SCREEN|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|546.50||||546.50||| 86703|EAP|0300|HIV SCREEN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|546.50||||546.50||| 86703|EAP|0300|HIV SCREEN|United Healthcare|TML GROUP BENEFITS|546.50||||||| 86703|EAP|0300|HIV SCREEN|Aetna|AETNA PPO|546.50||||||| 86703|EAP|0300|HIV SCREEN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|546.50||||||| 86703|EAP|0300|HIV SCREEN|Aenta Medicare Advantage|AETNA MEDICARE MA|||||546.50||| 86703|EAP|0300|HIV SCREEN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|546.50||||546.50||| 86703|EAP|0300|HIV SCREEN|Blue Cross PPO Specialty|BCBSTX PPO|546.50||||546.50||| 86703|EAP|0300|HIV SCREEN|Workers Compensation|UT EMPLOYEE INJURY|||||546.50||| 86703|EAP|0300|HIV SCREEN|Cigna|CIGNA|546.50||||||| 86703|EAP|0300|HIV SCREEN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|546.50||||||| 86703|EAP|0300|HIV SCREEN|Blue Cross HMO Specialty|BCBSTX HMO|546.50||||||| 86703|EAP|0300|HIV SCREEN|ChampVA|CHAMPVA CENTER|546.50||||||| 86703|EAP|0300|HIV SCREEN|Managed Medicaid|MEDICAID SUPERIOR|546.50||||546.50||| 86703|EAP|0300|HIV SCREEN|Cigna|CIGNA OTHER|546.50||||||| 86703|EAP|0300|HIV SCREEN|Cigna|CIGNA|546.50||||546.50||| 86703|EAP|0300|HIV SCREEN|Medicaid|MOLINA HEALTHCARE OF TEXAS|546.50||||||| 86703|EAP|0300|HIV SCREEN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|546.50||||||| 86703|EAP|0300|HIV SCREEN|United Healthcare|GEHA|546.50||||||| 86704|EAP|0300|HEP B CORE ANTIBODY|Blue Cross HMO Specialty|BCBSTX HMO|||||480.50||| 86704|EAP|0300|HEP B CORE ANTIBODY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||480.50||| 86704|EAP|0300|HEP B CORE ANTIBODY|Aenta Medicare Advantage|AETNA MEDICARE MA|480.50||||480.50||| 86704|EAP|0300|HEP ABC PANEL 0315, HEP B|Blue Cross PPO Specialty|BCBSTX PPO|480.50||||480.50||| 86704|EAP|0300|HEP B CORE ANTIBODY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|480.50||||||| 86704|EAP|0300|HEP ABC PANEL 0315, HEP B|Managed Medicaid|MEDICAID SUPERIOR|480.50||||480.50||| 86704|EAP|0300|HEP ABC PANEL 0315, HEP B|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|480.50||||||| 86704|EAP|0300|HEP ABC PANEL 0315, HEP B|Managed Medicaid|MEDICAID AMERIGROUP|||||480.50||| 86704|EAP|0300|HEP ABC PANEL 0315, HEP B|Humana Medicare Advantage|HUMANA MA|||||480.50||| 86704|EAP|0300|HEP B CORE ANTIBODY|Medicare|MEDICARE ACUTE|480.50||||480.50||| 86704|EAP|0300|HEP ABC PANEL 0315, HEP B|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||480.50||| 86704|EAP|0300|HEP ABC PANEL 0315, HEP B|United Healthcare|TML GROUP BENEFITS|480.50||||||| 86704|EAP|0300|HEP ABC PANEL 0315, HEP B|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||480.50||| 86704|EAP|0300|HEP ABC PANEL 0315, HEP B|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|480.50||||480.50||| 86704|EAP|0300|HEP ABC PANEL 0315, HEP B|Veterans Affairs|VETERANS ADMINISTRATION|||||480.50||| 86705|EAP|0300|HEPATITIS C CORE IGM AB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||468.75||| 86705|EAP|0300|HEPATITIS C CORE IGM AB|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|468.75||||||| 86706|EAP|0300|HEP B SURF ANTIBODY|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.28||| 86706|EAP|0300|HEP B SURF ANTIBODY|Workers Compensation|UT EMPLOYEE INJURY|||||4.28||| 86706|EAP|0300|HEP PANEL I W/HCV, HEP BS|Veterans Affairs|VETERANS ADMINISTRATION|4.28||||||| 86706|EAP|0300|HEP PANEL I W/HCV, HEP BS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.28||||4.28||| 86706|EAP|0300|HEP B SURF ANTIBODY|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.28||||4.28||| 86706|EAP|0300|HEP B SURF ANTIBODY|Medicaid|HENDERSON COUNTY INDIGENT|4.28||||4.28||| 86706|EAP|0300|HEP PANEL I W/HCV, HEP BS|Medicaid|MEDICAID|4.28||||||| 86706|EAP|0300|HEP PANEL I W/HCV, HEP BS|United Healthcare|UNITED HEALTHCARE|||||4.28||| 86706|EAP|0300|HEP PANEL I W/HCV, HEP BS|Medicare|MEDICARE ACUTE|4.28||||4.28||| 86706|EAP|0300|HEP B SURF ANTIBODY|Medicare|MEDICARE ACUTE|4.28||||4.28||| 86706|EAP|0300|HEP PANEL I W/HCV, HEP BS|United Healthcare|TML GROUP BENEFITS|4.28||||||| 86706|EAP|0300|HEP B SURF ANTIBODY|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.28||| 86706|EAP|0300|HEP B SURF ANTIBODY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.28||||4.28||| 86706|EAP|0300|HEP B SURF ANTIBODY|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.28||| 86706|EAP|0300|HEP B SURF ANTIBODY|Blue Cross HMO Specialty|BCBSTX HMO|||||4.28||| 86706|EAP|0300|HEP PANEL I W/HCV, HEP BS|Workers Compensation|UT EMPLOYEE INJURY|||||4.28||| 86706|EAP|0300|HEP PANEL I W/HCV, HEP BS|Humana Medicare Advantage|HUMANA MA|4.28||||||| 86706|EAP|0300|HEP PANEL I W/HCV, HEP BS|Blue Cross HMO Specialty|BCBSTX HMO|||||4.28||| 86706|EAP|0300|HEP PANEL I W/HCV, HEP BS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.28||||||| 86706|EAP|0300|HEP B SURF ANTIBODY|Cigna|CIGNA|||||4.28||| 86706|EAP|0300|HEP PANEL I W/HCV, HEP BS|Managed Medicaid|MEDICAID SUPERIOR|4.28||||||| 86706|EAP|0300|HEP PANEL I W/HCV, HEP BS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.28||||||| 86706|EAP|0300|HEP PANEL I W/HCV, HEP BS|Managed Medicaid|MEDICAID AMERIGROUP|4.28||||||| 86706|EAP|0300|HEP B SURF ANTIBODY|Blue Cross PPO Specialty|BCBSTX PPO|||||4.28||| 86706|EAP|0300|HEP PANEL I W/HCV, HEP BS|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||4.28||| 86706|EAP|0300|HEP B SURF ANTIBODY|Managed Medicare|HEALTHSPRING MA|||||4.28||| 86706|EAP|0300|HEP B SURF ANTIBODY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.28||| 86707|EAP|0300|HEP PANEL I W/HCV, HEP BE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.61||||||| 86707|EAP|0300|HEP PANEL I W/HCV, HEP BE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.61||||||| 86707|EAP|0300|HEP PANEL I W/HCV, HEP BE|Managed Medicaid|MEDICAID AMERIGROUP|4.61||||||| 86707|EAP|0300|HEP PANEL I W/HCV, HEP BE|Humana Medicare Advantage|HUMANA MA|4.61||||||| 86707|EAP|0300|HEP PANEL I W/HCV, HEP BE|Blue Cross HMO Specialty|BCBSTX HMO|||||4.61||| 86707|EAP|0300|HEP PANEL I W/HCV, HEP BE|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||4.61||| 86707|EAP|0300|HEP PANEL I W/HCV, HEP BE|United Healthcare|TML GROUP BENEFITS|4.61||||||| 86707|EAP|0300|HEP PANEL I W/HCV, HEP BE|United Healthcare|UNITED HEALTHCARE|||||4.61||| 86707|EAP|0300|HEP PANEL I W/HCV, HEP BE|Medicaid|HENDERSON COUNTY INDIGENT|4.61||||||| 86707|EAP|0300|HEP PANEL I W/HCV, HEP BE|Medicaid|MEDICAID|4.61||||||| 86707|EAP|0300|HEP PANEL I W/HCV, HEP BE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.61||||||| 86707|EAP|0300|HEP PANEL I W/HCV, HEP BE|Managed Medicaid|MEDICAID SUPERIOR|4.61||||||| 86707|EAP|0300|HEP PANEL I W/HCV, HEP BE|Veterans Affairs|VETERANS ADMINISTRATION|4.61||||||| 86707|EAP|0300|HEP PANEL I W/HCV, HEP BE|Workers Compensation|UT EMPLOYEE INJURY|||||4.61||| 86707|EAP|0300|HEP PANEL I W/HCV, HEP BE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.61||||4.61||| 86707|EAP|0300|HEP PANEL I W/HCV, HEP BE|Medicare|MEDICARE ACUTE|4.61||||4.61||| 86708|EAP|0300|HEP A ANTIBODY|Blue Cross HMO Specialty|BCBSTX HMO|||||493.75||| 86708|EAP|0300|HEP A ANTIBODY|Humana Medicare Advantage|HUMANA MA|||||493.75||| 86708|EAP|0300|HEP A ANTIBODY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|493.75||||||| 86709|EAP|0300|HEP A IGM ANITBODY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|448.50||||||| 86709|EAP|0300|HEP PANEL I W/HCV, HEP A|Medicare|MEDICARE ACUTE|448.50||||448.50||| 86709|EAP|0300|HEP ABC PANEL 0315, HEP A|Veterans Affairs|VETERANS ADMINISTRATION|448.50||||448.50||| 86709|EAP|0300|HEP PANEL I W/HCV, HEP A|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|448.50||||448.50||| 86709|EAP|0300|HEP ABC PANEL 0315, HEP A|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|448.50||||448.50||| 86709|EAP|0300|HEP PANEL I W/HCV, HEP A|Medicaid|HENDERSON COUNTY INDIGENT|448.50||||||| 86709|EAP|0300|HEP PANEL I W/HCV, HEP A|Workers Compensation|UT EMPLOYEE INJURY|||||448.50||| 86709|EAP|0300|HEP PANEL I W/HCV, HEP A|Medicaid|MEDICAID|448.50||||||| 86709|EAP|0300|HEP ABC PANEL 0315, HEP A|United Healthcare|TML GROUP BENEFITS|448.50||||||| 86709|EAP|0300|HEP PANEL I W/HCV, HEP A|United Healthcare|TML GROUP BENEFITS|448.50||||||| 86709|EAP|0300|HEP PANEL I W/HCV, HEP A|United Healthcare|UNITED HEALTHCARE|||||448.50||| 86709|EAP|0300|HEP PANEL I W/HCV, HEP A|Managed Medicaid|MEDICAID UNITED HEALTHCARE|448.50||||||| 86709|EAP|0300|HEP PANEL I W/HCV, HEP A|Managed Medicaid|MEDICAID SUPERIOR|448.50||||448.50||| 86709|EAP|0300|HEP ABC PANEL 0315, HEP A|United Medicare Advantage|AARP UHC WEST COMPLETE MA|448.50||||448.50||| 86709|EAP|0300|HEP PANEL I W/HCV, HEP A|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|448.50||||||| 86709|EAP|0300|HEP ABC PANEL 0315, HEP A|Managed Medicaid|MEDICAID SUPERIOR|448.50||||448.50||| 86709|EAP|0300|HEP ABC PANEL 0315, HEP A|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|448.50||||||| 86709|EAP|0300|HEP ABC PANEL 0315, HEP A|Managed Medicaid|MEDICAID AMERIGROUP|448.50||||448.50||| 86709|EAP|0300|HEP ABC PANEL 0315, HEP A|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||448.50||| 86709|EAP|0300|HEP ABC PANEL 0315, HEP A|Humana Medicare Advantage|HUMANA MA|448.50||||448.50||| 86709|EAP|0300|HEP PANEL I W/HCV, HEP A|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||448.50||| 86709|EAP|0300|HEP ABC PANEL 0315, HEP A|Aenta Medicare Advantage|AETNA MEDICARE MA|448.50||||||| 86709|EAP|0300|HEP ABC PANEL 0315, HEP A|Blue Cross PPO Specialty|BCBSTX PPO|448.50||||448.50||| 86709|EAP|0300|HEP PANEL I W/HCV, HEP A|Blue Cross HMO Specialty|BCBSTX HMO|||||448.50||| 86709|EAP|0300|HEP A IGM ANITBODY|Blue Cross PPO Specialty|BCBSTX PPO|448.50||||448.50||| 86713|EAP|0300|LEGIONELLA URINE ANTIGEN|Blue Cross PPO Specialty|BCBSTX PPO|609.75||||||| 86713|EAP|0300|LEGIONELLA URINE ANTIGEN|Cigna|CIGNA|609.75||||||| 86713|EAP|0300|LEGIONELLA URINE ANTIGEN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|609.75||||||| 86713|EAP|0300|LEGIONELLA URINE ANTIGEN|Medicare|MEDICARE ACUTE|609.75||||||| 86713|EAP|0300|LEGIONELLA URINE ANTIGEN|Tricare|TRICARE EAST REGION|609.75||||||| 86713|EAP|0300|LEGIONELLA URINE ANTIGEN|Humana Medicare Advantage|HUMANA MA|609.75||||||| 86713|EAP|0300|LEGIONELLA URINE ANTIGEN|Aenta Medicare Advantage|AETNA MEDICARE MA|609.75||||||| 86713|EAP|0300|LEGIONELLA URINE ANTIGEN|United Medicare Advantage|UHC MEDICARE GOLD MA|609.75||||||| 86713|EAP|0300|LEGIONELLA URINE ANTIGEN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||609.75||| 86738|EAP|0300|MYCOPLASMA PNEUMONIAE AB|Humana Medicare Advantage|HUMANA MA|527.75||||527.75||| 86738|EAP|0300|MYCOPLASMA PNEUMONIAE AB|Cigna|CIGNA|||||527.75||| 86738|EAP|0300|MYCOPLASMA PNEUMONIAE AB|Medicare|MEDICARE ACUTE|527.75||||||| 86738|EAP|0300|MYCOPLASMA PNEUMONIAE AB|Blue Cross PPO Specialty|BCBSTX PPO|527.75||||||| 86762|EAP|0300|RUBELLA TITER|Managed Medicaid|MEDICAID AMERIGROUP|573.50||||573.50||| 86762|EAP|0300|RUBELLA TITER|Tricare|TRICARE EAST REGION|573.50||||||| 86762|EAP|0300|RUBELLA TITER|PHCS|HUMANA|573.50||||||| 86762|EAP|0300|RUBELLA TITER|United Healthcare|UNITED HEALTHCARE|573.50||||||| 86762|EAP|0300|RUBELLA TITER|Medicaid|MEDICAID|573.50||||573.50||| 86762|EAP|0300|RUBELLA TITER|Medicaid|MEDICAID HMO|573.50||||573.50||| 86762|EAP|0300|RUBELLA TITER|Medicaid|MOLINA HEALTHCARE OF TEXAS|573.50||||||| 86762|EAP|0300|RUBELLA TITER|Managed Medicaid|MEDICAID SUPERIOR|573.50||||573.50||| 86762|EAP|0300|RUBELLA TITER|Blue Cross PPO Specialty|BCBSTX PPO|573.50||||573.50||| 86762|EAP|0300|RUBELLA TITER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|573.50||||||| 86777|EAP|0300|TOXOPLASMA IGG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||573.50||| 86778|EAP|0300|TOXOPLASMA IGM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||508.50||| 86780|EAP|0300|FTA - ABS|Blue Cross PPO Specialty|BCBSTX PPO|||||348.75||| 86787|EAP|0300|VARICELLI ZOSTER (IGG)|Medicare|MEDICARE ACUTE|||||3.26||| 868|DRG||OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES W CC|Humana Medicare Advantage|HUMANA MA|78,516.35|8904.47|8904.47|8904.47|||| 86803|EAP|0300|HEP ABC PANEL 0315, HEP C|Veterans Affairs|VETERANS ADMINISTRATION|5.69||||5.69||| 86803|EAP|0300|HEP C ANTIBODY|Workers Compensation|UT EMPLOYEE INJURY|||||5.69||| 86803|EAP|0300|HEP PANEL I W/HCV, HEP C|Workers Compensation|UT EMPLOYEE INJURY|||||5.69||| 86803|EAP|0300|HEP PANEL I W/HCV, HEP C|Veterans Affairs|VETERANS ADMINISTRATION|5.69||||5.69||| 86803|EAP|0300|HEP ABC PANEL 0315, HEP C|United Medicare Advantage|AARP UHC WEST COMPLETE MA|5.69||||5.69||| 86803|EAP|0300|HEP C ANTIBODY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|5.69||||5.69||| 86803|EAP|0300|HEP C ANTIBODY|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|5.69||||5.69||| 86803|EAP|0300|HEP ABC PANEL 0315, HEP C|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|5.69||||5.69||| 86803|EAP|0300|HEP C ANTIBODY|Medicaid|HENDERSON COUNTY INDIGENT|5.69||||5.69||| 86803|EAP|0300|HEP PANEL I W/HCV, HEP C|Medicaid|MEDICAID|5.69||||||| 86803|EAP|0300|HEP ABC PANEL 0315, HEP C|Medicaid|MEDICAID|5.69||||||| 86803|EAP|0300|HEP C ANTIBODY|Medicare|MEDICARE ACUTE|5.69||||5.69||| 86803|EAP|0300|HEP ABC PANEL 0315, HEP C|United Healthcare|UNITED HEALTHCARE|||||5.69||| 86803|EAP|0300|HEP PANEL I W/HCV, HEP C|United Healthcare|TML GROUP BENEFITS|5.69||||||| 86803|EAP|0300|HEP PANEL I W/HCV, HEP C|Medicare|MEDICARE ACUTE|5.69||||5.69||| 86803|EAP|0300|HEP ABC PANEL 0315, HEP C|Medicare|MEDICARE ACUTE|5.69||||5.69||| 86803|EAP|0300|HEP ABC PANEL 0315, HEP C|United Healthcare|TML GROUP BENEFITS|5.69||||||| 86803|EAP|0300|HEP PANEL I W/HCV, HEP C|United Healthcare|UNITED HEALTHCARE|||||5.69||| 86803|EAP|0300|HEP ABC PANEL 0315, HEP C|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||5.69||| 86803|EAP|0300|HEP PANEL I W/HCV, HEP C|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||5.69||| 86803|EAP|0300|HEP C ANTIBODY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||5.69||| 86803|EAP|0300|HEP C ANTIBODY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||5.69||| 86803|EAP|0300|HEP C ANTIBODY|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||5.69||| 86803|EAP|0300|HEP C ANTIBODY|Aenta Medicare Advantage|AETNA MEDICARE MA|5.69||||5.69||| 86803|EAP|0300|HEP PANEL I W/HCV, HEP C|Medicaid|HENDERSON COUNTY INDIGENT|5.69||||5.69||| 86803|EAP|0300|HEP ABC PANEL 0315, HEP C|Blue Cross PPO Specialty|BCBSTX PPO|5.69||||5.69||| 86803|EAP|0300|HEP PANEL I W/HCV, HEP C|Blue Cross HMO Specialty|BCBSTX HMO|||||5.69||| 86803|EAP|0300|HEP PANEL I W/HCV, HEP C|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|5.69||||||| 86803|EAP|0300|HEP PANEL I W/HCV, HEP C|Managed Medicaid|MEDICAID AMERIGROUP|5.69||||5.69||| 86803|EAP|0300|HEP PANEL I W/HCV, HEP C|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|5.69||||5.69||| 86803|EAP|0300|HEP C ANTIBODY|Workers Compensation|WORKERS COMPENSATION OTHER|||||5.69||| 86803|EAP|0300|HEP ABC PANEL 0315, HEP C|Workers Compensation|UT EMPLOYEE INJURY|||||5.69||| 86803|EAP|0300|HEP C ANTIBODY|Managed Medicaid|MEDICAID SUPERIOR|5.69||||5.69||| 86803|EAP|0300|HEP C ANTIBODY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|5.69||||||| 86803|EAP|0300|HEP ABC PANEL 0315, HEP C|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.69||||||| 86803|EAP|0300|HEP ABC PANEL 0315, HEP C|Managed Medicaid|MEDICAID SUPERIOR|5.69||||5.69||| 86803|EAP|0300|HEP ABC PANEL 0315, HEP C|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|5.69||||||| 86803|EAP|0300|HEP ABC PANEL 0315, HEP C|Managed Medicaid|MEDICAID AMERIGROUP|5.69||||5.69||| 86803|EAP|0300|HEP C ANTIBODY|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||5.69||| 86803|EAP|0300|HEP PANEL I W/HCV, HEP C|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.69||||||| 86803|EAP|0300|HEP C ANTIBODY|Managed Medicare|HEALTHSPRING MA|||||5.69||| 86803|EAP|0300|HEP ABC PANEL 0315, HEP C|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||5.69||| 86803|EAP|0300|HEP C ANTIBODY|Blue Cross PPO Specialty|BCBSTX PPO|5.69||||5.69||| 86803|EAP|0300|HEP PANEL I W/HCV, HEP C|Humana Medicare Advantage|HUMANA MA|5.69||||5.69||| 86803|EAP|0300|HEP ABC PANEL 0315, HEP C|Blue Cross HMO Specialty|BCBSTX HMO|||||5.69||| 86803|EAP|0300|HEP ABC PANEL 0315, HEP C|Humana Medicare Advantage|HUMANA MA|5.69||||5.69||| 86803|EAP|0300|HEP PANEL I W/HCV, HEP C|Managed Medicaid|MEDICAID SUPERIOR|5.69||||5.69||| 86812|EAP|0300|HLA-B27|Blue Cross PPO Specialty|BCBSTX PPO|||||1,028.25||| 86812|EAP|0300|HLA-B27|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,028.25||| 86860|EAP|0300|RBC ANTIBODY ELUTION|Medicare|MEDICARE ACUTE|1.45||||1.45||| 86860|EAP|0300|RBC ANTIBODY ELUTION|Medicaid|MEDICAID|1.45||||||| 86860|EAP|0300|RBC ANTIBODY ELUTION|United Medicare Advantage|UHC MEDICARE GOLD MA|1.45||||||| 86860|EAP|0300|RBC ANTIBODY ELUTION|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.45||||||| 86860|EAP|0300|RBC ANTIBODY ELUTION|Blue Cross PPO Specialty|BCBSTX PPO|1.45||||||| 86860|EAP|0300|RBC ANTIBODY ELUTION|Humana Medicare Advantage|HUMANA MA|1.45||||||| 86860|EAP|0300|RBC ANTIBODY ELUTION|Managed Medicaid|MEDICAID SUPERIOR|1.45||||||| 86860|EAP|0300|RBC ANTIBODY ELUTION|Managed Medicaid|MEDICAID AMERIGROUP|1.45||||||| 86870|EAP|0300|SBB ABID WARM/COLD AUTO|Blue Cross PPO Specialty|BCBSTX PPO|2.96||||548.50||| 86870|EAP|0300|SBB ABID SINGLE|Blue Cross PPO Specialty|BCBSTX PPO|2.96||||2.96||| 86870|EAP|0300|SBB ABID SINGLE|Managed Medicaid|MEDICAID SUPERIOR|2.96||||||| 86870|EAP|0300|SBB ABID SINGLE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.96||||||| 86870|EAP|0300|SBB ABID SINGLE|Humana Medicare Advantage|HUMANA MA|2.96||||||| 86870|EAP|0300|SBB ABID SINGLE|United Medicare Advantage|UHC MEDICARE GOLD MA|2.96||||||| 86870|EAP|0300|SBB ABID SINGLE|Medicaid|MEDICAID|2.96||||||| 86870|EAP|0300|SBB ABID WARM/COLD AUTO|Medicare|MEDICARE ACUTE|2.96||||548.50||| 86870|EAP|0300|SBB ABID SINGLE|Medicare|MEDICARE ACUTE|2.96||||2.96||| 86880|EAP|0300|DIRECT COOMBS|Tricare|TRICARE EAST REGION|213.75||||||| 86880|EAP|0300|DIRECT COOMBS|United Healthcare|TML GROUP BENEFITS|213.75||||||| 86880|EAP|0300|DIRECT COOMBS|United Healthcare|UMR UNITED MEDICAL RESOURCES|213.75||||||| 86880|EAP|0300|DIRECT COOMBS|PHCS|HUMANA|213.75||||||| 86880|EAP|0300|SBB DIRECT COOMBS|Medicare|MEDICARE ACUTE|213.75||||213.75||| 86880|EAP|0300|DIRECT COOMBS|United Healthcare|UNITED HEALTHCARE|213.75||||||| 86880|EAP|0300|DIRECT COOMBS|Medicaid|MOLINA HEALTHCARE OF TEXAS|213.75||||||| 86880|EAP|0300|DIRECT COOMBS|Medicaid|MEDICAID|213.75||||||| 86880|EAP|0300|DIRECT COOMBS|United Medicare Advantage|UHC MEDICARE GOLD MA|213.75||||||| 86880|EAP|0300|DIRECT COOMBS|Medicaid|MEDICAID HMO|213.75||||||| 86880|EAP|0300|DIRECT COOMBS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|213.75||||||| 86880|EAP|0300|DIRECT COOMBS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|213.75||||||| 86880|EAP|0300|DIRECT COOMBS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|213.75||||213.75||| 86880|EAP|0300|DIRECT COOMBS|Aenta Medicare Advantage|AETNA MEDICARE MA|213.75||||||| 86880|EAP|0300|DIRECT COOMBS|NON CONTRACTED|COMMERCIAL OTHER 1|213.75||||||| 86880|EAP|0300|DIRECT COOMBS|Aetna|AETNA PPO|213.75||||||| 86880|EAP|0300|DIRECT COOMBS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|213.75||||||| 86880|EAP|0300|DIRECT COOMBS|Cigna|CIGNA OTHER|213.75||||||| 86880|EAP|0300|SBB DIRECT COOMBS|Blue Cross PPO Specialty|BCBSTX PPO|213.75||||||| 86880|EAP|0300|DIRECT COOMBS|Blue Cross PPO Specialty|BCBSTX PPO|213.75||||||| 86880|EAP|0300|DIRECT COOMBS|Cigna|CIGNA|213.75||||||| 86880|EAP|0300|DIRECT COOMBS|Blue Cross HMO Specialty|BCBSTX HMO|213.75||||||| 86880|EAP|0300|SBB DIRECT COOMBS|Humana Medicare Advantage|HUMANA MA|213.75||||213.75||| 86880|EAP|0300|DIRECT COOMBS|Humana Medicare Advantage|HUMANA MA|213.75||||213.75||| 86880|EAP|0300|DIRECT COOMBS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|213.75||||||| 86880|EAP|0300|DIRECT COOMBS|Managed Medicaid|MEDICAID SUPERIOR|213.75||||||| 86880|EAP|0300|DIRECT COOMBS|Managed Medicaid|MEDICAID AMERIGROUP|213.75||||||| 86880|EAP|0300|DIRECT COOMBS|Managed Medicare|HEALTHSPRING MA|213.75||||||| 86885|EAP|0300|COOMBS INDIRECT|Managed Medicaid|MEDICAID AMERIGROUP|227.75||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|227.75||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|Managed Medicaid|MEDICAID SUPERIOR|227.75||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|227.75||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|Managed Medicare|HOSPICE ETMC|||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|Managed Medicare|HEALTHSPRING MA|227.75||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|Managed Medicare|BCBS MEDICARE PPO MA|227.75||||||| 86885|EAP|0300|COOMBS INDIRECT|Humana Medicare Advantage|HUMANA MA|227.75||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|Blue Cross PPO Specialty|BCBSTX PPO|227.75||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|ChampVA|CHAMPVA CENTER|227.75||||||| 86885|EAP|0300|COOMBS INDIRECT|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|Cigna|CIGNA|227.75||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|227.75||||||| 86885|EAP|0300|COOMBS INDIRECT|Aetna|AETNA OTHER|||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|Aetna|AETNA PPO|227.75||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|Aenta Medicare Advantage|AETNA MEDICARE MA|227.75||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|227.75||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|Blue Cross HMO Specialty|BCBSTX HMO|227.75||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|Veterans Affairs|VETERANS ADMINISTRATION|227.75||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|United Medicare Advantage|UHC MEDICARE GOLD MA|227.75||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|227.75||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|Medicaid|MOLINA HEALTHCARE OF TEXAS|227.75||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|Medicaid|MEDICAID HMO|227.75||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|Medicaid|MEDICAID|227.75||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|United Healthcare|TML GROUP BENEFITS|227.75||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|UTMB|UTMB CORRECTIONAL MANAGED CARE|227.75||||||| 86885|EAP|0300|COOMBS INDIRECT|United Healthcare|UMR UNITED MEDICAL RESOURCES|227.75||||||| 86885|EAP|0300|COOMBS INDIRECT|United Healthcare|UNITED HEALTHCARE|||||227.75||| 86885|EAP|0300|SBB FETAL SCREEN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|227.75||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|Medicaid|HENDERSON COUNTY INDIGENT|227.75||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|United Healthcare|UNITED HEALTHCARE|227.75||||||| 86885|EAP|0300|COOMBS INDIRECT|Tricare|TRICARE EAST REGION|227.75||||||| 86885|EAP|0300|COOMBS INDIRECT|NON CONTRACTED|COMMERCIAL OTHER 1|227.75||||||| 86885|EAP|0300|SBB INDIRECT COOMBS|United Medicare Advantage|UHC MEDICARE GOLD MA|227.75||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|PHCS|HUMANA|227.75||||||| 86885|EAP|0300|SBB INDIRECT COOMBS|Medicare|MEDICARE ACUTE|227.75||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|United Medicare Advantage|UHC AARP MCR HMO MA|||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|Medicare|MEDICARE ACUTE|227.75||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|227.75||||227.75||| 86885|EAP|0300|COOMBS INDIRECT|United Healthcare|UNITED HEALTHCARE OTHER|||||227.75||| 86886|EAP|0300|SBB ANTIBODY TITER|Blue Cross PPO Specialty|BCBSTX PPO|||||2.06||| 86890|EAP|0383|FRESH FROZEN PLASMA|Medicare|MEDICARE ACUTE|551.25||||||| 86890|EAP|0383|FRESH FROZEN PLASMA|NON CONTRACTED|COMMERCIAL OTHER 1|551.25||||||| 86890|EAP|0383|FRESH FROZEN PLASMA|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|551.25||||551.25||| 86890|EAP|0383|FRESH FROZEN PLASMA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|551.25||||||| 86890|EAP|0383|FRESH FROZEN PLASMA|Veterans Affairs|VETERANS ADMINISTRATION|551.25||||||| 86890|EAP|0383|FRESH FROZEN PLASMA|Humana Medicare Advantage|HUMANA MA|551.25||||||| 86890|EAP|0383|FRESH FROZEN PLASMA|Managed Medicaid|MEDICAID SUPERIOR|551.25||||||| 86890|EAP|0383|FRESH FROZEN PLASMA|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|551.25||||||| 86890|EAP|0383|FRESH FROZEN PLASMA|Aetna|AETNA PPO|551.25||||||| 86890|EAP|0383|FRESH FROZEN PLASMA|Blue Cross PPO Specialty|BCBSTX PPO|551.25||||||| 86890|EAP|0384||Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2,156.25||| 86890|EAP|0383|FRESH FROZEN PLASMA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||551.25||| 86900|EAP|0300|ABO GROUP|Cigna|CIGNA|118.75||||||| 86900|EAP|0300|GROUP DONE BY SBB|Blue Cross PPO Specialty|BCBSTX PPO|118.75||||118.75||| 86900|EAP|0300|ABO GROUP|Cigna|CIGNA|118.75||||118.75||| 86900|EAP|0300|ABO GROUP|Blue Cross PPO Specialty|BCBSTX PPO|118.75||||118.75||| 86900|EAP|0300|ABO GROUP|Blue Cross HMO Specialty|BCBSTX HMO|118.75||||118.75||| 86900|EAP|0300|ABO GROUP|ChampVA|CHAMPVA CENTER|118.75||||||| 86900|EAP|0300|ABO GROUP|Cigna|CIGNA OTHER|118.75||||||| 86900|EAP|0300|ABO GROUP|Aetna|AETNA OTHER|||||118.75||| 86900|EAP|0300|ABO GROUP|Aenta Medicare Advantage|AETNA MEDICARE MA|118.75||||118.75||| 86900|EAP|0300|ABO GROUP|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|118.75||||||| 86900|EAP|0300|ABO GROUP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|118.75||||118.75||| 86900|EAP|0300|ABO GROUP|Managed Medicaid|MEDICAID SUPERIOR|118.75||||118.75||| 86900|EAP|0300|ABO GROUP|Managed Medicaid|MEDICAID AMERIGROUP|118.75||||118.75||| 86900|EAP|0300|ABO GROUP|Managed Medicare|HOSPICE ETMC|||||118.75||| 86900|EAP|0300|ABO GROUP|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||118.75||| 86900|EAP|0300|ABO GROUP|Managed Medicare|BCBS MEDICARE PPO MA|118.75||||||| 86900|EAP|0300|ABO GROUP|Humana Medicare Advantage|HUMANA MA|118.75||||118.75||| 86900|EAP|0300|ABO GROUP|Managed Medicare|HEALTHSPRING MA|118.75||||118.75||| 86900|EAP|0300|ABO GROUP|Veterans Affairs|VETERANS ADMINISTRATION|118.75||||118.75||| 86900|EAP|0300|ABO GROUP|United Medicare Advantage|UHC MEDICARE GOLD MA|118.75||||118.75||| 86900|EAP|0300|ABO GROUP|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|118.75||||118.75||| 86900|EAP|0300|GROUP DONE BY SBB|United Medicare Advantage|UHC MEDICARE GOLD MA|118.75||||118.75||| 86900|EAP|0300|ABO GROUP|United Medicare Advantage|AARP UHC WEST COMPLETE MA|118.75||||118.75||| 86900|EAP|0300|ABO GROUP|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|118.75||||118.75||| 86900|EAP|0300|ABO GROUP|Aetna|AETNA PPO|118.75||||118.75||| 86900|EAP|0300|ABO GROUP|United Medicare Advantage|UHC AARP MCR HMO MA|||||118.75||| 86900|EAP|0300|ABO GROUP|Medicaid|MOLINA HEALTHCARE OF TEXAS|118.75||||118.75||| 86900|EAP|0300|ABO GROUP|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||118.75||| 86900|EAP|0300|ABO GROUP|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|118.75||||||| 86900|EAP|0300|ABO GROUP|Medicaid|MEDICAID HMO|118.75||||118.75||| 86900|EAP|0300|ABO GROUP|Medicaid|HENDERSON COUNTY INDIGENT|118.75||||118.75||| 86900|EAP|0300|ABO GROUP|Medicaid|MEDICAID|118.75||||118.75||| 86900|EAP|0300|ABO GROUP|Tricare|TRICARE EAST REGION|118.75||||||| 86900|EAP|0300|ABO GROUP|United Healthcare|UMR UNITED MEDICAL RESOURCES|118.75||||||| 86900|EAP|0300|ABO GROUP|United Healthcare|TML GROUP BENEFITS|118.75||||118.75||| 86900|EAP|0300|ABO GROUP|UTMB|UTMB CORRECTIONAL MANAGED CARE|118.75||||||| 86900|EAP|0300|ABO GROUP|United Healthcare|UNITED HEALTHCARE|118.75||||118.75||| 86900|EAP|0300|GROUP DONE BY SBB|Medicare|MEDICARE ACUTE|118.75||||118.75||| 86900|EAP|0300|ABO GROUP|Medicare|MEDICARE ACUTE|118.75||||118.75||| 86900|EAP|0300|ABO GROUP|PHCS|HUMANA|118.75||||||| 86900|EAP|0300|ABO GROUP|NON CONTRACTED|COMMERCIAL OTHER 1|118.75||||118.75||| 86900|EAP|0300|ABO GROUP|United Healthcare|UNITED HEALTHCARE OTHER|||||118.75||| 86900|EAP|0300|ABO GROUP|Managed Medicaid|MEDICAID UNITED HEALTHCARE|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|United Healthcare|UNITED HEALTHCARE|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|United Healthcare|UMR UNITED MEDICAL RESOURCES|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|UTMB|UTMB CORRECTIONAL MANAGED CARE|118.75||||||| 86901|EAP|0300|RH FACTOR|NON CONTRACTED|COMMERCIAL OTHER 1|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|PHCS|HUMANA|118.75||||||| 86901|EAP|0300|RH FACTOR|Medicare|MEDICARE ACUTE|118.75||||118.75||| 86901|EAP|0300|RH DONE BY SBB|Medicare|MEDICARE ACUTE|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|Medicaid|MEDICAID|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|Medicaid|MEDICAID HMO|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|Medicaid|HENDERSON COUNTY INDIGENT|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|Medicaid|MOLINA HEALTHCARE OF TEXAS|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||118.75||| 86901|EAP|0300|RH FACTOR|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|United Medicare Advantage|UHC AARP MCR HMO MA|||||118.75||| 86901|EAP|0300|RH FACTOR|United Medicare Advantage|UHC MEDICARE GOLD MA|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|MTC Medical|VAN ZANDT COUNTY INMATE|||||118.75||| 86901|EAP|0300|RH FACTOR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|Humana Medicare Advantage|HUMANA MA|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|Managed Medicare|BCBS MEDICARE PPO MA|118.75||||||| 86901|EAP|0300|RH FACTOR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|Veterans Affairs|VETERANS ADMINISTRATION|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|Managed Medicaid|MEDICAID SUPERIOR|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|Managed Medicaid|MEDICAID AMERIGROUP|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|Managed Medicare|HOSPICE ETMC|||||118.75||| 86901|EAP|0300|RH FACTOR|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||118.75||| 86901|EAP|0300|RH FACTOR|United Healthcare|UNITED HEALTHCARE OTHER|||||118.75||| 86901|EAP|0300|RH FACTOR|Managed Medicare|HEALTHSPRING MA|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|Managed Medicare|VAN ZANDT COUNTY INMATE|||||118.75||| 86901|EAP|0300|RH FACTOR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|Aetna|AETNA PPO|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|United Healthcare|TML GROUP BENEFITS|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|Tricare|TRICARE EAST REGION|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|Aetna|AETNA OTHER|||||118.75||| 86901|EAP|0300|RH FACTOR|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|118.75||||||| 86901|EAP|0300|RH FACTOR|Aenta Medicare Advantage|AETNA MEDICARE MA|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|Cigna|CIGNA|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|Blue Cross PPO Specialty|BCBSTX PPO|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|ChampVA|CHAMPVA CENTER|118.75||||||| 86901|EAP|0300|RH FACTOR|Blue Cross HMO Specialty|BCBSTX HMO|118.75||||118.75||| 86901|EAP|0300|RH DONE BY SBB|Blue Cross PPO Specialty|BCBSTX PPO|118.75||||118.75||| 86901|EAP|0300|RH FACTOR|Blue Cross PPO Specialty|BCBSTX OTHER|||||118.75||| 86901|EAP|0300|RH FACTOR|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||118.75||| 86901|EAP|0300|RH FACTOR|Cigna|CIGNA OTHER|118.75||||||| 86902|EAP|0300|SBB ANTIGEN SCREEN PER UN|Blue Cross PPO Specialty|BCBSTX PPO|||||3.76||| 86902|EAP|0300|SBB ANTIGEN SCREEN PER UN|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3.76||| 86902|EAP|0300|SBB ANTIGEN SCREEN PER UN|United Medicare Advantage|UHC MEDICARE GOLD MA|3.76||||||| 86902|EAP|0300|SBB ANTIGEN SCREEN PER UN|Medicare|MEDICARE ACUTE|3.76||||3.76||| 86922|EAP|0300|CROSSMATCH|Medicaid|MEDICAID|205.75||||205.75||| 86922|EAP|0300|CROSSMATCH|Medicaid|MOLINA HEALTHCARE OF TEXAS|205.75||||||| 86922|EAP|0300|CROSSMATCH|Medicaid|HENDERSON COUNTY INDIGENT|205.75||||||| 86922|EAP|0300|CROSSMATCH|United Healthcare|TML GROUP BENEFITS|205.75||||||| 86922|EAP|0300|CROSSMATCH|Tricare|TRICARE EAST REGION|205.75||||||| 86922|EAP|0300|CROSSMATCH|UTMB|UTMB CORRECTIONAL MANAGED CARE|205.75||||||| 86922|EAP|0300|CROSSMATCH|Medicare|MEDICARE ACUTE|205.75||||205.75||| 86922|EAP|0300|CROSSMATCH|United Healthcare|UNITED HEALTHCARE|||||205.75||| 86922|EAP|0300|CROSSMATCH DONE BY SBB|Medicare|MEDICARE ACUTE|205.75||||128.25||| 86922|EAP|0300|CROSSMATCH|United Healthcare|UNITED HEALTHCARE|205.75||||||| 86922|EAP|0300|CROSSMATCH|Veterans Affairs|VETERANS ADMINISTRATION|205.75||||205.75||| 86922|EAP|0300|CROSSMATCH|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|205.75||||205.75||| 86922|EAP|0300|CROSSMATCH|United Medicare Advantage|UHC AARP MCR HMO MA|||||205.75||| 86922|EAP|0300|CROSSMATCH|United Medicare Advantage|AARP UHC WEST COMPLETE MA|205.75||||205.75||| 86922|EAP|0300|CROSSMATCH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|205.75||||205.75||| 86922|EAP|0300|CROSSMATCH-PROBLEM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|205.75||||205.75||| 86922|EAP|0300|CROSSMATCH|Managed Medicaid|MEDICAID SUPERIOR|205.75||||205.75||| 86922|EAP|0300|CROSSMATCH|Managed Medicare|HEALTHSPRING MA|205.75||||205.75||| 86922|EAP|0300|CROSSMATCH|Managed Medicare|BCBS MEDICARE PPO MA|205.75||||||| 86922|EAP|0300|CROSSMATCH-PROBLEM|Humana Medicare Advantage|HUMANA MA|205.75||||205.75||| 86922|EAP|0300|CROSSMATCH|Humana Medicare Advantage|HUMANA MA|205.75||||205.75||| 86922|EAP|0300|CROSSMATCH|Aenta Medicare Advantage|AETNA MEDICARE MA|205.75||||205.75||| 86922|EAP|0300|CROSSMATCH|Aetna|AETNA OTHER|||||205.75||| 86922|EAP|0300|CROSSMATCH|Aetna|AETNA PPO|205.75||||205.75||| 86922|EAP|0300|CROSSMATCH|United Healthcare|UMR UNITED MEDICAL RESOURCES|205.75||||||| 86922|EAP|0300|CROSSMATCH|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|205.75||||||| 86922|EAP|0300|CROSSMATCH|Managed Medicaid|MEDICAID AMERIGROUP|205.75||||205.75||| 86922|EAP|0300|CROSSMATCH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|205.75||||205.75||| 86922|EAP|0300|CROSSMATCH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|205.75||||205.75||| 86922|EAP|0300|CROSSMATCH|Medicaid|MEDICAID HMO|205.75||||||| 86922|EAP|0300|CROSSMATCH-PROBLEM|Aenta Medicare Advantage|AETNA MEDICARE MA|205.75||||205.75||| 86922|EAP|0300|CROSSMATCH|ChampVA|CHAMPVA CENTER|205.75||||||| 86922|EAP|0300|CROSSMATCH-PROBLEM|Blue Cross PPO Specialty|BCBSTX PPO|205.75||||205.75||| 86922|EAP|0300|CROSSMATCH|United Medicare Advantage|UHC MEDICARE GOLD MA|205.75||||205.75||| 86922|EAP|0300|CROSSMATCH|Blue Cross PPO Specialty|BCBSTX PPO|205.75||||205.75||| 86922|EAP|0300|CROSSMATCH|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||205.75||| 86922|EAP|0300|CROSSMATCH|Managed Medicare|HOSPICE ETMC|||||205.75||| 86922|EAP|0300|CROSSMATCH|NON CONTRACTED|COMMERCIAL OTHER 1|205.75||||||| 86922|EAP|0300|CROSSMATCH|Cigna|CIGNA|205.75||||205.75||| 86922|EAP|0300|CROSSMATCH|Blue Cross HMO Specialty|BCBSTX HMO|205.75||||205.75||| 86922|EAP|0300|CROSSMATCH|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||205.75||| 86945|EAP|0300|IRRADIATED|Blue Cross PPO Specialty|BCBSTX PPO|533.50||||533.50||| 86945|EAP|0300|IRRADIATED|Managed Medicare|HEALTHSPRING MA|533.50||||||| 86945|EAP|0300|IRRADIATED|United Medicare Advantage|UHC MEDICARE GOLD MA|533.50||||||| 86945|EAP|0300|IRRADIATED|United Medicare Advantage|AARP UHC WEST COMPLETE MA|533.50||||||| 86945|EAP|0300|IRRADIATED|Medicare|MEDICARE ACUTE|533.50||||533.50||| 86945|EAP|0300|IRRADIATED|Managed Medicaid|MEDICAID UNITED HEALTHCARE|533.50||||533.50||| 86945|EAP|0300|IRRADIATED|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||533.50||| 87|DRG||TRAUMATIC STUPOR & COMA, COMA <1 HR W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|179.02|7412.73|7412.73|7303.11|||| 87|DRG||TRAUMATIC STUPOR & COMA, COMA <1 HR W/O CC/MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|39,751.75|7303.11|7412.73|7303.11|||| 870|DRG||SEPTICEMIA OR SEVERE SEPSIS W MV >96 HOURS|Humana Medicare Advantage|HUMANA MA|298,585.90|42014.84|42014.84|26004.42|||| 870|DRG||SEPTICEMIA OR SEVERE SEPSIS W MV >96 HOURS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|349,806.26|26004.42|42014.84|26004.42|||| 870|DRG||SEPTICEMIA OR SEVERE SEPSIS W MV >96 HOURS|Medicare|MEDICARE ACUTE|272,186.72|41161.1|42014.84|26004.42|||| 870|DRG||SEPTICEMIA OR SEVERE SEPSIS W MV >96 HOURS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|163,483.55|41280.82|42014.84|26004.42|||| 87040|EAP|0300|CULTURE, BLOOD|Veterans Affairs|VETERANS ADMINISTRATION|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Workers Compensation|UT EMPLOYEE INJURY|4.11||||||| 87040|EAP|0300|CULTURE, BLOOD|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|United Medicare Advantage|UHC MEDICARE GOLD MA|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|United Healthcare|TML GROUP BENEFITS|4.11||||||| 87040|EAP|0300|CULTURE, BLOOD|NON CONTRACTED|COMMERCIAL OTHER 1|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Tricare|TRICARE EAST REGION|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|United Healthcare|UNITED HEALTHCARE|||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Medicare|MEDICARE PART B ONLY IP|4.11||||||| 87040|EAP|0300|CULTURE, BLOOD|Medicare|MEDICARE ACUTE|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|United Healthcare|UNITED HEALTHCARE OTHER|||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|United Healthcare|UNITED HEALTHCARE|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Medicaid|MEDICAID HMO|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Medicaid|COUNTY INDIGENT HEALTH OTHER|4.11||||||| 87040|EAP|0300|CULTURE, BLOOD|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Medicaid|MEDICAID TEXAS CHILDRENS|||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Aetna|AETNA PPO|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Aetna|BOON CHAPMAN|4.11||||||| 87040|EAP|0300|CULTURE, BLOOD|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|4.11||||||| 87040|EAP|0300|CULTURE, BLOOD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Blue Cross PPO Specialty|BCBSTX PPO|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Blue Cross PPO Specialty|BCBSTX OTHER|||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Medicaid|HENDERSON COUNTY INDIGENT|4.11||||||| 87040|EAP|0300|CULTURE, BLOOD|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Blue Cross HMO Specialty|BCBSTX HMO|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Cigna|CIGNA|||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Cigna|CIGNA|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Cigna|CIGNA OTHER|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|UTMB|UTMB CORRECTIONAL MANAGED CARE|4.11||||||| 87040|EAP|0300|CULTURE, BLOOD|Aenta Medicare Advantage|AETNA MEDICARE MA|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|ChampVA|CHAMPVA CENTER|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Managed Medicaid|MEDICAID SUPERIOR|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|United Medicare Advantage|UHC AARP MCR HMO MA|||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Aetna|AETNA OTHER|||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Managed Medicaid|MEDICAID AMERIGROUP|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Veterans Affairs|VETERANS ADMINISTRATION|||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Medicaid|MEDICAID|4.11||||4.11||| 87040|EAP|0300||Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.11||||343.25||| 87040|EAP|0300||Managed Medicaid|MEDICAID SUPERIOR|4.11||||343.25||| 87040|EAP|0300||Managed Medicaid|MEDICAID AMERIGROUP|4.11||||343.25||| 87040|EAP|0300|CULTURE, BLOOD|Managed Medicare|VAN ZANDT COUNTY INMATE|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Medicaid|LAW ENFORCEMENT OTHER|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Managed Medicare|MA PART B ONLY IP|4.11||||||| 87040|EAP|0300|CULTURE, BLOOD|Managed Medicare|HEALTHSPRING MA|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Managed Medicare|BCBS MEDICARE PPO MA|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|Humana Medicare Advantage|HUMANA MA|4.11||||4.11||| 87040|EAP|0300|CULTURE, BLOOD|MTC Medical|VAN ZANDT COUNTY INMATE|4.11||||4.11||| 87045|EAP|0300|CULTURE, STOOL|Humana Medicare Advantage|HUMANA MA|375.75||||375.75||| 87045|EAP|0300|CULTURE, STOOL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|375.75||||375.75||| 87045|EAP|0300|CULTURE, STOOL|Managed Medicaid|MEDICAID SUPERIOR|375.75||||375.75||| 87045|EAP|0300|CULTURE, STOOL|Managed Medicare|HEALTHSPRING MA|375.75||||375.75||| 87045|EAP|0300|CULTURE, STOOL|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||375.75||| 87045|EAP|0300|CULTURE, STOOL|Managed Medicare|BCBS MEDICARE PPO MA|375.75||||||| 87045|EAP|0300|CULTURE, STOOL|ChampVA|CHAMPVA CENTER|375.75||||||| 87045|EAP|0300|CULTURE, STOOL|Cigna|CIGNA|375.75||||||| 87045|EAP|0300|CULTURE, STOOL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||375.75||| 87045|EAP|0300|CULTURE, STOOL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|375.75||||375.75||| 87045|EAP|0300|CULTURE, STOOL|Aetna|AETNA PPO|375.75||||375.75||| 87045|EAP|0300|CULTURE, STOOL|Aetna|AETNA OTHER|||||375.75||| 87045|EAP|0300|CULTURE, STOOL|Aenta Medicare Advantage|AETNA MEDICARE MA|375.75||||||| 87045|EAP|0300|CULTURE, STOOL|Blue Cross PPO Specialty|BCBSTX PPO|375.75||||375.75||| 87045|EAP|0300|CULTURE, STOOL|Managed Medicaid|MEDICAID AMERIGROUP|375.75||||375.75||| 87045|EAP|0300|CULTURE, STOOL|Medicaid|HENDERSON COUNTY INDIGENT|375.75||||||| 87045|EAP|0300|CULTURE, STOOL|Medicaid|MEDICAID|||||375.75||| 87045|EAP|0300|CULTURE, STOOL|Medicare|MEDICARE ACUTE|375.75||||375.75||| 87045|EAP|0300|CULTURE, STOOL|NON CONTRACTED|COMMERCIAL OTHER 1|||||375.75||| 87045|EAP|0300|CULTURE, STOOL|Tricare|TRICARE EAST REGION|375.75||||||| 87045|EAP|0300|CULTURE, STOOL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|375.75||||375.75||| 87045|EAP|0300|CULTURE, STOOL|United Healthcare|TML GROUP BENEFITS|375.75||||||| 87045|EAP|0300|CULTURE, STOOL|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||375.75||| 87045|EAP|0300|CULTURE, STOOL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|375.75||||||| 87045|EAP|0300|CULTURE, STOOL|Medicaid|MEDICAID HMO|||||375.75||| 87045|EAP|0300|CULTURE, STOOL|United Medicare Advantage|UHC MEDICARE GOLD MA|375.75||||375.75||| 87045|EAP|0300|CULTURE, STOOL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||375.75||| 87045|EAP|0300|CULTURE, STOOL|Veterans Affairs|VETERANS ADMINISTRATION|375.75||||||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|375.75||||||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||375.75||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|Veterans Affairs|VETERANS ADMINISTRATION|375.75||||||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|375.75||||375.75||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|United Medicare Advantage|UHC MEDICARE GOLD MA|375.75||||375.75||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|United Healthcare|TML GROUP BENEFITS|375.75||||||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|Tricare|TRICARE EAST REGION|375.75||||||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|NON CONTRACTED|COMMERCIAL OTHER 1|||||375.75||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|Medicare|MEDICARE ACUTE|375.75||||375.75||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||375.75||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|Medicaid|MEDICAID|||||375.75||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|Medicaid|HENDERSON COUNTY INDIGENT|375.75||||||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|Medicaid|MEDICAID HMO|||||375.75||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|Aetna|AETNA OTHER|||||375.75||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||375.75||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|375.75||||375.75||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|Aetna|AETNA PPO|375.75||||375.75||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|Blue Cross PPO Specialty|BCBSTX PPO|375.75||||375.75||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|ChampVA|CHAMPVA CENTER|375.75||||||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|Cigna|CIGNA|375.75||||||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|Aenta Medicare Advantage|AETNA MEDICARE MA|375.75||||||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|375.75||||375.75||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|Managed Medicaid|MEDICAID SUPERIOR|375.75||||375.75||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|Managed Medicaid|MEDICAID AMERIGROUP|375.75||||375.75||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|Managed Medicare|BCBS MEDICARE PPO MA|375.75||||||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||375.75||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|Managed Medicare|HEALTHSPRING MA|375.75||||375.75||| 87046|EAP|0300|CULTURE, CAMPYLOBACTER SC|Humana Medicare Advantage|HUMANA MA|375.75||||375.75||| 87070|EAP|0300|CULTURE, BODY FLUID|Humana Medicare Advantage|HUMANA MA|343.25||||343.25||| 87070|EAP|0300|CULTURE, THROAT|Humana Medicare Advantage|HUMANA MA|343.25||||343.25||| 87070|EAP|0300|CULTURE, RESPIRATORY|Humana Medicare Advantage|HUMANA MA|343.25||||343.25||| 87070|EAP|0300|CULTURE, WOUND|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|343.25||||343.25||| 87070|EAP|0300|CULTURE, RESPIRATORY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|343.25||||343.25||| 87070|EAP|0300|CULTURE, THROAT|Managed Medicaid|MEDICAID AMERIGROUP|343.25||||343.25||| 87070|EAP|0300|CULTURE, RESPIRATORY|Managed Medicaid|MEDICAID SUPERIOR|343.25||||343.25||| 87070|EAP|0300|CULTURE, BETA STREP SCREE|Managed Medicaid|MEDICAID AMERIGROUP|343.25||||343.25||| 87070|EAP|0300|CULTURE, WOUND|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|343.25||||||| 87070|EAP|0300|CULTURE, RESPIRATORY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|343.25||||343.25||| 87070|EAP|0300|CULTURE, WOUND|Managed Medicare|BCBS MEDICARE PPO MA|343.25||||||| 87070|EAP|0300|CULTURE, WOUND|Managed Medicaid|MEDICAID SUPERIOR|343.25||||343.25||| 87070|EAP|0300|CULTURE, THROAT|Managed Medicaid|MEDICAID SUPERIOR|343.25||||343.25||| 87070|EAP|0300|CULTURE, RESPIRATORY|Managed Medicare|BCBS MEDICARE PPO MA|343.25||||||| 87070|EAP|0300|CULTURE, BODY FLUID|Managed Medicare|BCBS MEDICARE PPO MA|343.25||||||| 87070|EAP|0300|CULTURE, WOUND|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||343.25||| 87070|EAP|0300|CULTURE, WOUND|Blue Cross PPO Specialty|BCBSTX PPO|343.25||||343.25||| 87070|EAP|0300|CULTURE, VAGINAL|Blue Cross PPO Specialty|BCBSTX OTHER|||||343.25||| 87070|EAP|0300|CULTURE, THROAT|Blue Cross PPO Specialty|BCBSTX OTHER|||||343.25||| 87070|EAP|0300|CULTURE, BODY FLUID|Blue Cross PPO Specialty|BCBSTX PPO|343.25||||343.25||| 87070|EAP|0300|CULTURE, WOUND|Managed Medicaid|MEDICAID AMERIGROUP|343.25||||343.25||| 87070|EAP|0300|CULTURE, RESPIRATORY|ChampVA|CHAMPVA CENTER|343.25||||||| 87070|EAP|0300|CULTURE, THROAT|Blue Cross HMO Specialty|BCBSTX HMO|343.25||||343.25||| 87070|EAP|0300|CULTURE, RESPIRATORY|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||343.25||| 87070|EAP|0300|CULTURE, WOUND|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||343.25||| 87070|EAP|0300|CULTURE, THROAT|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||343.25||| 87070|EAP|0300|CULTURE, WOUND|Cigna|CIGNA OTHER|||||343.25||| 87070|EAP|0300|CULTURE, WOUND|Blue Cross HMO Specialty|BCBSTX HMO|343.25||||343.25||| 87070|EAP|0300|CULTURE, THROAT|Aetna|AETNA PPO|343.25||||343.25||| 87070|EAP|0300|CULTURE, RESPIRATORY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|343.25||||343.25||| 87070|EAP|0300|CULTURE, THROAT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|343.25||||343.25||| 87070|EAP|0300|CULTURE, RESPIRATORY|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|343.25||||||| 87070|EAP|0300|CULTURE, THROAT|Blue Cross PPO Specialty|BCBSTX PPO|343.25||||343.25||| 87070|EAP|0300|CULTURE, WOUND|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|343.25||||343.25||| 87070|EAP|0300|CULTURE, THROAT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|343.25||||343.25||| 87070|EAP|0300|CULTURE, WOUND|Aenta Medicare Advantage|AETNA MEDICARE MA|343.25||||343.25||| 87070|EAP|0300|CULTURE, RESPIRATORY|Aenta Medicare Advantage|AETNA MEDICARE MA|343.25||||343.25||| 87070|EAP|0300|CULTURE, WOUND|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|343.25||||343.25||| 87070|EAP|0300|CULTURE, THROAT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|343.25||||343.25||| 87070|EAP|0300|CULTURE, BODY FLUID|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|343.25||||||| 87070|EAP|0300|CULTURE, THROAT|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||343.25||| 87070|EAP|0300|CULTURE, THROAT|Medicaid|MEDICAID HMO|343.25||||343.25||| 87070|EAP|0300|CULTURE, WOUND|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||343.25||| 87070|EAP|0300|CULTURE, BETA STREP SCREE|Medicaid|MEDICAID|343.25||||343.25||| 87070|EAP|0300|CULTURE, BETA STREP SCREE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||343.25||| 87070|EAP|0300|CULTURE, WOUND|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|343.25||||||| 87070|EAP|0300|CULTURE, BODY FLUID|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|343.25||||343.25||| 87070|EAP|0300|CULTURE, RESPIRATORY|Medicaid|MOLINA HEALTHCARE OF TEXAS|343.25||||||| 87070|EAP|0300|CULTURE, WOUND|Medicaid|HENDERSON COUNTY INDIGENT|343.25||||||| 87070|EAP|0300|CULTURE, WOUND|Medicaid|MEDICAID HMO|343.25||||343.25||| 87070|EAP|0300|CULTURE, WOUND|Cigna|CIGNA|343.25||||343.25||| 87070|EAP|0300|CULTURE, THROAT|Medicaid|MEDICAID|343.25||||343.25||| 87070|EAP|0300|CULTURE, WOUND|Medicaid|MEDICAID|343.25||||343.25||| 87070|EAP|0300|CULTURE, WOUND|Humana Medicare Advantage|HUMANA MA|343.25||||343.25||| 87070|EAP|0300|CULTURE, RESPIRATORY|Blue Cross PPO Specialty|BCBSTX PPO|343.25||||343.25||| 87070|EAP|0300|CULTURE, WOUND|Tricare|TRICARE EAST REGION|343.25||||343.25||| 87070|EAP|0300|CULTURE, WOUND|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||343.25||| 87070|EAP|0300|CULTURE, THROAT|Tricare|TRICARE EAST REGION|343.25||||343.25||| 87070|EAP|0300|CULTURE, BETA STREP SCREE|Managed Medicaid|MEDICAID SUPERIOR|343.25||||343.25||| 87070|EAP|0300|CULTURE, WOUND|Managed Medicaid|MEDICAID UNITED HEALTHCARE|343.25||||343.25||| 87070|EAP|0300|CULTURE, THROAT|Cigna|CIGNA|343.25||||343.25||| 87070|EAP|0300|CULTURE, RESPIRATORY|Managed Medicare|HEALTHSPRING MA|343.25||||343.25||| 87070|EAP|0300|CULTURE, WOUND|Medicare|MEDICARE ACUTE|343.25||||343.25||| 87070|EAP|0300|CULTURE, THROAT|Medicare|MEDICARE ACUTE|343.25||||343.25||| 87070|EAP|0300|CULTURE, WOUND|Managed Medicare|HEALTHSPRING MA|343.25||||343.25||| 87070|EAP|0300|CULTURE, RESPIRATORY|Medicare|MEDICARE ACUTE|343.25||||343.25||| 87070|EAP|0300|CULTURE, BODY FLUID|Medicare|MEDICARE ACUTE|343.25||||343.25||| 87070|EAP|0300|CULTURE, BODY FLUID|Managed Medicare|HEALTHSPRING MA|343.25||||343.25||| 87070|EAP|0300|CULTURE, WOUND|NON CONTRACTED|COMMERCIAL OTHER 1|343.25||||343.25||| 87070|EAP|0300|CULTURE, THROAT|United Healthcare|UNITED HEALTHCARE|343.25||||343.25||| 87070|EAP|0300|CULTURE, WOUND|United Healthcare|UNITED HEALTHCARE|343.25||||343.25||| 87070|EAP|0300|CULTURE, THROAT|United Medicare Advantage|UHC MEDICARE GOLD MA|343.25||||343.25||| 87070|EAP|0300|CULTURE, RESPIRATORY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|343.25||||343.25||| 87070|EAP|0300|CULTURE, BODY FLUID|United Medicare Advantage|UHC MEDICARE GOLD MA|343.25||||343.25||| 87070|EAP|0300|CULTURE, WOUND|United Healthcare|TML GROUP BENEFITS|343.25||||343.25||| 87070|EAP|0300|CULTURE, BODY FLUID|United Healthcare|UNITED HEALTHCARE OTHER|||||343.25||| 87070|EAP|0300|CULTURE, THROAT|United Medicare Advantage|UHC AARP MCR HMO MA|||||343.25||| 87070|EAP|0300|CULTURE, BODY FLUID|United Medicare Advantage|AARP UHC WEST COMPLETE MA|343.25||||343.25||| 87070|EAP|0300|CULTURE, THROAT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||343.25||| 87070|EAP|0300|CULTURE, THROAT|United Healthcare|TML GROUP BENEFITS|343.25||||343.25||| 87070|EAP|0300|CULTURE, WOUND|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|343.25||||343.25||| 87070|EAP|0300|CULTURE, WOUND|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||343.25||| 87070|EAP|0300|CULTURE, BODY FLUID|Texas Workforce Commission|DIS DETER SERV (DDS)|||||343.25||| 87070|EAP|0300|CULTURE, WOUND|United Medicare Advantage|UHC MEDICARE GOLD MA|343.25||||343.25||| 87070|EAP|0300|CULTURE, WOUND|United Medicare Advantage|AARP UHC WEST COMPLETE MA|343.25||||343.25||| 87070|EAP|0300|CULTURE, RESPIRATORY|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|343.25||||343.25||| 87070|EAP|0300|CULTURE, BODY FLUID|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|343.25||||343.25||| 87070|EAP|0300|CULTURE, RESPIRATORY|United Healthcare|UNITED HEALTHCARE|343.25||||343.25||| 87070|EAP|0300|CULTURE, WOUND|Workers Compensation|WORKERS COMPENSATION OTHER|||||343.25||| 87070|EAP|0300|CULTURE, THROAT|Veterans Affairs|VETERANS ADMINISTRATION|343.25||||343.25||| 87070|EAP|0300|CULTURE, WOUND|United Healthcare|UNITED HEALTHCARE OTHER|||||343.25||| 87070|EAP|0300|CULTURE, THROAT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|343.25||||343.25||| 87070|EAP|0300|CULTURE, WOUND|Veterans Affairs|VETERANS ADMINISTRATION|343.25||||343.25||| 87075|EAP|0300|CULTURE, ANAEROBIC|United Medicare Advantage|UHC MEDICARE GOLD MA|3.77||||||| 87075|EAP|0300|CULTURE, ANAEROBIC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3.77||||3.77||| 87075|EAP|0300|CULTURE, ANAEROBIC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3.77||||3.77||| 87075|EAP|0300|CULTURE, ANAEROBIC|Tricare|TRICARE EAST REGION|4.47||||||| 87075|EAP|0300|CULTURE, ANAEROBIC|Medicaid|HENDERSON COUNTY INDIGENT|3.77||||||| 87075|EAP|0300|CULTURE, ANAEROBIC|Medicaid|MEDICAID HMO|3.77||||||| 87075|EAP|0300|CULTURE, ANAEROBIC|Aenta Medicare Advantage|AETNA MEDICARE MA|3.77||||||| 87075|EAP|0300|CULTURE, ANAEROBIC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.77||||3.77||| 87075|EAP|0300|CULTURE, ANAEROBIC|Medicaid|MEDICAID|3.77||||||| 87075|EAP|0300|CULTURE, ANAEROBIC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.77||| 87075|EAP|0300|CULTURE, ANAEROBIC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|3.77||||||| 87075|EAP|0300|CULTURE, ANAEROBIC|Blue Cross PPO Specialty|BCBSTX PPO|3.77||||3.77||| 87075|EAP|0300|CULTURE, ANAEROBIC|Blue Cross HMO Specialty|BCBSTX HMO|3.77||||||| 87075|EAP|0300|CULTURE, ANAEROBIC|Veterans Affairs|VETERANS ADMINISTRATION|3.77||||3.77||| 87075|EAP|0300|CULTURE, ANAEROBIC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.77||||||| 87075|EAP|0300|CULTURE, ANAEROBIC|Managed Medicaid|MEDICAID SUPERIOR|3.77||||||| 87075|EAP|0300|CULTURE, ANAEROBIC|NON CONTRACTED|COMMERCIAL OTHER 1|3.77||||||| 87075|EAP|0300|CULTURE, ANAEROBIC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|3.77||||3.77||| 87075|EAP|0300|CULTURE, ANAEROBIC|Managed Medicaid|MEDICAID AMERIGROUP|3.77||||||| 87075|EAP|0300|CULTURE, ANAEROBIC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|3.77||||||| 87075|EAP|0300|CULTURE, ANAEROBIC|Managed Medicare|HEALTHSPRING MA|3.77||||3.77||| 87075|EAP|0300|CULTURE, ANAEROBIC|Managed Medicare|BCBS MEDICARE PPO MA|3.77||||||| 87075|EAP|0300|CULTURE, ANAEROBIC|Humana Medicare Advantage|HUMANA MA|3.77||||3.77||| 87075|EAP|0300|CULTURE, ANAEROBIC|Medicare|MEDICARE ACUTE|3.77||||3.77||| 87076|EAP|0300|ANAEROBIC CULTURE ISOLATI|Humana Medicare Advantage|HUMANA MA|322.50||||322.50||| 87076|EAP|0300|ANAEROBIC CULTURE ISOLATI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|322.50||||322.50||| 87076|EAP|0300|ANAEROBIC CULTURE ISOLATI|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|322.50||||||| 87076|EAP|0300|ANAEROBIC CULTURE ISOLATI|Managed Medicare|HEALTHSPRING MA|||||322.50||| 87076|EAP|0300|ANAEROBIC CULTURE ISOLATI|Blue Cross HMO Specialty|BCBSTX HMO|322.50||||||| 87076|EAP|0300|ANAEROBIC CULTURE ISOLATI|Managed Medicaid|MEDICAID AMERIGROUP|322.50||||||| 87076|EAP|0300|ANAEROBIC CULTURE ISOLATI|Blue Cross PPO Specialty|BCBSTX PPO|322.50||||322.50||| 87076|EAP|0300|ANAEROBIC CULTURE ISOLATI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|322.50||||||| 87076|EAP|0300|ANAEROBIC CULTURE ISOLATI|Medicaid|MEDICAID|322.50||||322.50||| 87076|EAP|0300|ANAEROBIC CULTURE ISOLATI|NON CONTRACTED|COMMERCIAL OTHER 1|322.50||||||| 87076|EAP|0300|DRL ANAEROBIC ORGANISM ID|NON CONTRACTED|COMMERCIAL OTHER 1|322.50||||||| 87076|EAP|0300|DRL ANAEROBIC ORGANISM ID|Medicare|MEDICARE ACUTE|322.50||||322.50||| 87076|EAP|0300|ANAEROBIC CULTURE ISOLATI|Medicare|MEDICARE ACUTE|322.50||||322.50||| 87076|EAP|0300|ANAEROBIC CULTURE ISOLATI|United Healthcare|UNITED HEALTHCARE|||||322.50||| 87076|EAP|0300|DRL ANAEROBIC ORGANISM ID|United Medicare Advantage|AARP UHC WEST COMPLETE MA|322.50||||322.50||| 87076|EAP|0300|ANAEROBIC CULTURE ISOLATI|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|322.50||||322.50||| 87076|EAP|0300|ANAEROBIC CULTURE ISOLATI|United Medicare Advantage|UHC MEDICARE GOLD MA|322.50||||||| 87076|EAP|0300|ANAEROBIC CULTURE ISOLATI|United Medicare Advantage|AARP UHC WEST COMPLETE MA|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Veterans Affairs|VETERANS ADMINISTRATION|322.50||||322.50||| 87077|EAP|0300|DRL AEORBIC ORGANISM ID|United Healthcare|UNITED HEALTHCARE|||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|United Healthcare|UNITED HEALTHCARE OTHER|||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|United Healthcare|UNITED HEALTHCARE|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|United Healthcare|UNITED HEALTHCARE|||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|322.50||||322.50||| 87077|EAP|0300|DRL AEORBIC ORGANISM ID|United Medicare Advantage|AARP UHC WEST COMPLETE MA|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|United Medicare Advantage|AARP UHC WEST COMPLETE MA|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|United Medicare Advantage|UHC MEDICARE GOLD MA|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|United Medicare Advantage|UHC AARP MCR HMO MA|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Tricare|TRICARE EAST REGION|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|PHCS|MULTIPLAN PHCS OTHER|||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|United Healthcare|UMR UNITED MEDICAL RESOURCES|322.50||||322.50||| 87077|EAP|0300|DRL AEORBIC ORGANISM ID|Medicare|MEDICARE ACUTE|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Medicare|MEDICARE ACUTE|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Medicaid|MOLINA HEALTHCARE OF TEXAS|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Medicaid|MEDICAID HMO|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Medicaid|MEDICAID|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Aenta Medicare Advantage|AETNA MEDICARE MA|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|322.50||||322.50||| 87077|EAP|0300|DRL AEORBIC ORGANISM ID|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Aetna|BOON CHAPMAN|322.50||||||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Aetna|AETNA PPO|322.50||||322.50||| 87077|EAP|0300|DRL AEORBIC ORGANISM ID|Aenta Medicare Advantage|AETNA MEDICARE MA|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Medicaid|HENDERSON COUNTY INDIGENT|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Blue Cross PPO Specialty|BCBSTX OTHER|||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Medicare|MEDICARE PART B ONLY IP|322.50||||||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|PHCS|HUMANA|||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Cigna|CIGNA|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Cigna|CIGNA|322.50||||||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|NON CONTRACTED|COMMERCIAL OTHER 1|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|ChampVA|CHAMPVA CENTER|322.50||||||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Blue Cross PPO Specialty|BCBSTX PPO|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Aetna|AETNA OTHER|||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Blue Cross HMO Specialty|BCBSTX HMO|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Cigna|CIGNA OTHER|322.50||||322.50||| 87077|EAP|0300|DRL AEORBIC ORGANISM ID|Managed Medicaid|MEDICAID UNITED HEALTHCARE|322.50||||322.50||| 87077|EAP|0300|DRL AEORBIC ORGANISM ID|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|322.50||||322.50||| 87077|EAP|0300|DRL AEORBIC ORGANISM ID|Managed Medicaid|MEDICAID AMERIGROUP|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|United Healthcare|TML GROUP BENEFITS|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Managed Medicaid|MEDICAID AMERIGROUP|322.50||||322.50||| 87077|EAP|0300|DRL AEORBIC ORGANISM ID|Managed Medicare|HEALTHSPRING MA|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Managed Medicare|MA PART B ONLY IP|322.50||||||| 87077|EAP|0300|DRL AEORBIC ORGANISM ID|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Managed Medicare|HEALTHSPRING MA|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Managed Medicare|BCBS MEDICARE PPO MA|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Managed Medicare|VAN ZANDT COUNTY INMATE|||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|MTC Medical|VAN ZANDT COUNTY INMATE|||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Managed Medicaid|MEDICAID SUPERIOR|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Managed Medicaid|MEDICAID UNITED HEALTHCARE|322.50||||322.50||| 87077|EAP|0300|AEROBIC CULTURE ISOLATION|Humana Medicare Advantage|HUMANA MA|322.50||||322.50||| 87077|EAP|0300|DRL AEORBIC ORGANISM ID|Humana Medicare Advantage|HUMANA MA|322.50||||322.50||| 87088|EAP|0300|CULTURE, URINE|MTC Medical|VAN ZANDT COUNTY INMATE|||||322.75||| 87088|EAP|0300|CULTURE, URINE|Humana Medicare Advantage|HUMANA MA|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|Managed Medicaid|MEDICAID SUPERIOR|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|Managed Medicaid|MEDICAID AMERIGROUP|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||322.75||| 87088|EAP|0300|CULTURE, URINE|Managed Medicare|VAN ZANDT COUNTY INMATE|||||322.75||| 87088|EAP|0300|CULTURE, URINE|Managed Medicare|MA PART B ONLY IP|322.75||||||| 87088|EAP|0300|CULTURE, URINE|Managed Medicare|BCBS MEDICARE PPO MA|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|Blue Cross PPO Specialty|BCBSTX PPO|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|Blue Cross PPO Specialty|BCBSTX OTHER|||||322.75||| 87088|EAP|0300|CULTURE, URINE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||322.75||| 87088|EAP|0300|CULTURE, URINE|ChampVA|CHAMPVA CENTER|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|Blue Cross HMO Specialty|BCBSTX HMO|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|Cigna|CIGNA|||||322.75||| 87088|EAP|0300|CULTURE, URINE|Cigna|CIGNA|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|Aetna|BOON CHAPMAN|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|Aetna|AETNA PPO|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|Aenta Medicare Advantage|AETNA MEDICARE MA|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|Aetna|AETNA OTHER|||||322.75||| 87088|EAP|0300|CULTURE, URINE|Cigna|CIGNA OTHER|322.75||||||| 87088|EAP|0300|CULTURE, URINE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|Medicaid|COUNTY INDIGENT HEALTH OTHER|322.75||||||| 87088|EAP|0300|CULTURE, URINE|Medicaid|MEDICAID|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|Medicaid|MOLINA HEALTHCARE OF TEXAS|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|Medicaid|MEDICAID HMO|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|Medicaid|HENDERSON COUNTY INDIGENT|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||322.75||| 87088|EAP|0300|CULTURE, URINE|Medicaid|MEDICAID TEXAS CHILDRENS|||||322.75||| 87088|EAP|0300|CULTURE, URINE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|Managed Medicare|HEALTHSPRING MA|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|Tricare|TRICARE EAST REGION|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|NON CONTRACTED|COMMERCIAL OTHER 1|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|PHCS|HUMANA|||||322.75||| 87088|EAP|0300|CULTURE, URINE|PHCS|MULTIPLAN PHCS OTHER|||||322.75||| 87088|EAP|0300|CULTURE, URINE|Medicare|MEDICARE PART B ONLY IP|322.75||||||| 87088|EAP|0300|CULTURE, URINE|Medicare|MEDICARE ACUTE|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|United Medicare Advantage|UHC MEDICARE GOLD MA|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|United Healthcare|TML GROUP BENEFITS|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|United Healthcare|UNITED HEALTHCARE|||||322.75||| 87088|EAP|0300|CULTURE, URINE|United Healthcare|UNITED HEALTHCARE|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|United Healthcare|GOLDEN RULE|||||322.75||| 87088|EAP|0300|CULTURE, URINE|United Medicare Advantage|UHC AARP MCR HMO MA|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|United Healthcare|UNITED HEALTHCARE OTHER|||||322.75||| 87088|EAP|0300|CULTURE, URINE|Veterans Affairs|VETERANS ADMINISTRATION|322.75||||322.75||| 87088|EAP|0300|CULTURE, URINE|United Healthcare|GEHA|||||322.75||| 87088|EAP|0300|CULTURE, URINE|United Healthcare|UMR UNITED MEDICAL RESOURCES|322.75||||322.75||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|604.67|13637.55|37086.195|1552.26|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|583.58|13658.35|37086.195|1552.26|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|961.80|13665.71|37086.195|1552.26|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|NON CONTRACTED|COMMERCIAL OTHER 1|37,051.88|37051.875|37086.195|1552.26|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Tricare|TRICARE EAST REGION|53,106.55|9439.31|37086.195|1552.26|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|United Healthcare|UMR UNITED MEDICAL RESOURCES|92,322.05|18646.2|37086.195|1552.26|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Medicare|MEDICARE ACUTE|52,156.77|13664.83|37086.195|1552.26|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|163,534.90|13637.55|37086.195|1552.26|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|41,092.40|9234.81|37086.195|1552.26|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Aetna|AETNA PPO|64,497.73|37086.195|37086.195|1552.26|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Blue Cross HMO Specialty|BCBSTX HMO|211,987.12|10311.315|37086.195|1552.26|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Blue Cross PPO Specialty|BCBSTX PPO|14,520.30|1552.26|37086.195|1552.26|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Managed Medicare|BCBS MEDICARE PPO MA|70,727.66|11737.58|37086.195|1552.26|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Managed Medicare|HEALTHSPRING MA|55,266.75|13665.71|37086.195|1552.26|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Managed Medicare|HOSPICE ETMC|3,806.50|13664.83|37086.195|1552.26|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|46,168.75|10899.21|37086.195|1552.26|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|59,943.40|6783.18|37086.195|1552.26|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Humana Medicare Advantage|HUMANA MA|65,845.27|13670.05|37086.195|1552.26|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Managed Medicaid|MEDICAID SUPERIOR|35,850.65|6783.18|37086.195|1552.26|||| 87102|EAP|0300|CULTURE, FUNGUS|Humana Medicare Advantage|HUMANA MA|3.35||||||| 87102|EAP|0300|CULTURE, FUNGUS|Blue Cross PPO Specialty|BCBSTX PPO|3.35||||3.35||| 87102|EAP|0300|CULTURE, FUNGUS|Aenta Medicare Advantage|AETNA MEDICARE MA|3.35||||||| 87102|EAP|0300|CULTURE, FUNGUS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.35||||||| 87102|EAP|0300|CULTURE, FUNGUS|Medicare|MEDICARE ACUTE|3.35||||3.35||| 87102|EAP|0300|CULTURE, FUNGUS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3.35||||||| 87102|EAP|0300|CULTURE, FUNGUS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3.35||||||| 87110|EAP|0300|CULTURE CHLAMYDIA|Medicare|MEDICARE ACUTE|||||51.63||| 87118|EAP|0300|AFB CULTURE|Aenta Medicare Advantage|AETNA MEDICARE MA|222.25||||||| 87118|EAP|0300|AFB CULTURE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|222.25||||||| 87118|EAP|0300|AFB CULTURE|Humana Medicare Advantage|HUMANA MA|222.25||||||| 87118|EAP|0300|AFB CULTURE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|222.25||||222.25||| 87118|EAP|0300|AFB CULTURE|Medicare|MEDICARE ACUTE|222.25||||222.25||| 87147|EAP|0300|SEROTYPING-SHIGELLA/SALMO|Medicare|MEDICARE ACUTE|2.06||||||| 87147|EAP|0300|SEROTYPING-SHIGELLA/SALMO|Managed Medicaid|MEDICAID AMERIGROUP|2.06||||||| 87147|EAP|0300|SEROTYPING-SHIGELLA/SALMO|Humana Medicare Advantage|HUMANA MA|2.06||||||| 87147|EAP|0300|SEROTYPING-SHIGELLA/SALMO|Blue Cross PPO Specialty|BCBSTX PPO|2.06||||2.06||| 87147|EAP|0300|SEROTYPING-SHIGELLA/SALMO|Cigna|CIGNA|2.06||||||| 87184|EAP|0300|KIRBY BAUER SENSITIVITY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.75||| 87184|EAP|0300|KIRBY BAUER SENSITIVITY|Aetna|AETNA PPO|||||2.75||| 87184|EAP|0300|KIRBY BAUER SENSITIVITY|Blue Cross HMO Specialty|BCBSTX HMO|||||2.75||| 87184|EAP|0300|KIRBY BAUER SENSITIVITY|Managed Medicaid|MEDICAID SUPERIOR|||||2.75||| 87184|EAP|0300|KIRBY BAUER SENSITIVITY|Managed Medicaid|MEDICAID AMERIGROUP|||||2.75||| 87184|EAP|0300|KIRBY BAUER SENSITIVITY|United Medicare Advantage|UHC MEDICARE GOLD MA|2.75||||2.75||| 87184|EAP|0300|KIRBY BAUER SENSITIVITY|Medicaid|MEDICAID|||||2.75||| 87184|EAP|0300|KIRBY BAUER SENSITIVITY|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.75||| 87184|EAP|0300|KIRBY BAUER SENSITIVITY|Medicare|MEDICARE ACUTE|2.75||||2.75||| 87186|EAP|0300|MIC SENSITIVITY|Tricare|TRICARE EAST REGION|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|NON CONTRACTED|COMMERCIAL OTHER 1|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|PHCS|HUMANA|||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Medicare|MEDICARE ACUTE|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Medicare|MEDICARE PART B ONLY IP|344.25||||||| 87186|EAP|0300|MIC SENSITIVITY|Medicaid|MOLINA HEALTHCARE OF TEXAS|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Medicaid|MEDICAID|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Veterans Affairs|VETERANS ADMINISTRATION|344.25||||344.25||| 87186|EAP|0300|DRL SENSITIVITY|Workers Compensation|UT EMPLOYEE INJURY|344.25||||||| 87186|EAP|0300|MIC SENSITIVITY|United Healthcare|UNITED HEALTHCARE|||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|United Healthcare|TML GROUP BENEFITS|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|United Healthcare|UNITED HEALTHCARE|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|United Medicare Advantage|UHC MEDICARE GOLD MA|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|United Healthcare|UMR UNITED MEDICAL RESOURCES|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|United Medicare Advantage|UHC AARP MCR HMO MA|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|United Healthcare|UNITED HEALTHCARE OTHER|||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|MTC Medical|VAN ZANDT COUNTY INMATE|||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Humana Medicare Advantage|HUMANA MA|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Managed Medicaid|MEDICAID SUPERIOR|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Managed Medicaid|MEDICAID AMERIGROUP|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Managed Medicare|HEALTHSPRING MA|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Managed Medicare|VAN ZANDT COUNTY INMATE|||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Managed Medicare|MA PART B ONLY IP|344.25||||||| 87186|EAP|0300|MIC SENSITIVITY|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Managed Medicare|BCBS MEDICARE PPO MA|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Medicaid|MEDICAID HMO|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Medicaid|HENDERSON COUNTY INDIGENT|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Blue Cross PPO Specialty|BCBSTX PPO|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Cigna|CIGNA|344.25||||||| 87186|EAP|0300|MIC SENSITIVITY|Cigna|CIGNA|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Blue Cross PPO Specialty|BCBSTX OTHER|||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|PHCS|MULTIPLAN PHCS OTHER|||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|ChampVA|CHAMPVA CENTER|344.25||||||| 87186|EAP|0300|MIC SENSITIVITY|Blue Cross HMO Specialty|BCBSTX HMO|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Cigna|CIGNA OTHER|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Aetna|BOON CHAPMAN|344.25||||||| 87186|EAP|0300|MIC SENSITIVITY|Aetna|AETNA OTHER|||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Aetna|AETNA PPO|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|344.25||||344.25||| 87186|EAP|0300|MIC SENSITIVITY|Aenta Medicare Advantage|AETNA MEDICARE MA|344.25||||344.25||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Aetna|AETNA PPO|64,283.90|36963.24|36963.24|627.21|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|44,222.50|8514.5|36963.24|627.21|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|32,156.55|5342.6|36963.24|627.21|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|58,407.63|5282.4|36963.24|627.21|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Managed Medicare|MA PART B ONLY IP|530.87|627.21|36963.24|627.21|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|57,759.50|8542.66|36963.24|627.21|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Managed Medicare|HEALTHSPRING MA|39,599.18|8608.845|36963.24|627.21|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Managed Medicaid|MEDICAID SUPERIOR|65,377.55|4259.83|36963.24|627.21|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|71,046.50|10899.21|36963.24|627.21|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Humana Medicare Advantage|HUMANA MA|57,134.50|8675.03|36963.24|627.21|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|51,369.80|7993.49|36963.24|627.21|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|51,432.30|8675.03|36963.24|627.21|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|43,106.65|8541.78|36963.24|627.21|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Veterans Affairs|VETERANS ADMINISTRATION|225.79|8541.78|36963.24|627.21|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Medicaid|COUNTY INDIGENT HEALTH OTHER|82,868.50|4266.15|36963.24|627.21|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Medicare|MEDICARE ACUTE|43,162.69|8675.03|36963.24|627.21|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Tricare|TRICARE EAST REGION|45,801.93|5089.44|36963.24|627.21|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|United Healthcare|UMR UNITED MEDICAL RESOURCES|59,793.25|10383.65|36963.24|627.21|||| 87205|EAP|0300|GRAM STAIN SMEAR|Tricare|TRICARE EAST REGION|169.75||||||| 87205|EAP|0300|GRAM STAIN SMEAR|Medicare|MEDICARE ACUTE|169.75||||169.75||| 87205|EAP|0300|GRAM STAIN SMEAR|Medicaid|HENDERSON COUNTY INDIGENT|169.75||||||| 87205|EAP|0300|GRAM STAIN SMEAR|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||169.75||| 87205|EAP|0300|GRAM STAIN SMEAR|Medicaid|MOLINA HEALTHCARE OF TEXAS|169.75||||||| 87205|EAP|0300|GRAM STAIN SMEAR|Medicaid|MEDICAID HMO|169.75||||||| 87205|EAP|0300||Medicaid|MEDICAID|169.75||||169.75||| 87205|EAP|0300|GRAM STAIN SMEAR|Workers Compensation|UT EMPLOYEE INJURY|169.75||||||| 87205|EAP|0300|GRAM STAIN SMEAR|Veterans Affairs|VETERANS ADMINISTRATION|169.75||||169.75||| 87205|EAP|0300|GRAM STAIN SMEAR|United Healthcare|UNITED HEALTHCARE|||||169.75||| 87205|EAP|0300|GRAM STAIN SMEAR|United Healthcare|UMR UNITED MEDICAL RESOURCES|169.75||||169.75||| 87205|EAP|0300|GRAM STAIN SMEAR|United Medicare Advantage|UHC MEDICARE GOLD MA|169.75||||169.75||| 87205|EAP|0300|GRAM STAIN SMEAR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|169.75||||169.75||| 87205|EAP|0300|GRAM STAIN SMEAR|United Healthcare|UNITED HEALTHCARE OTHER|||||169.75||| 87205|EAP|0300|GRAM STAIN SMEAR|United Medicare Advantage|UHC AARP MCR HMO MA|||||169.75||| 87205|EAP|0300|GRAM STAIN SMEAR|Humana Medicare Advantage|HUMANA MA|169.75||||169.75||| 87205|EAP|0300|GRAM STAIN SMEAR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|169.75||||169.75||| 87205|EAP|0300|GRAM STAIN SMEAR|Managed Medicaid|MEDICAID SUPERIOR|169.75||||169.75||| 87205|EAP|0300|GRAM STAIN SMEAR|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|169.75||||169.75||| 87205|EAP|0300|GRAM STAIN SMEAR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|169.75||||169.75||| 87205|EAP|0300|GRAM STAIN SMEAR|Managed Medicaid|MEDICAID AMERIGROUP|169.75||||169.75||| 87205|EAP|0300||Managed Medicaid|MEDICAID UNITED HEALTHCARE|169.75||||115.50||| 87205|EAP|0300||Managed Medicaid|MEDICAID SUPERIOR|169.75||||169.75||| 87205|EAP|0300|GRAM STAIN SMEAR|Managed Medicare|MA PART B ONLY IP|169.75||||||| 87205|EAP|0300|GRAM STAIN SMEAR|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||169.75||| 87205|EAP|0300|GRAM STAIN SMEAR|Managed Medicare|HEALTHSPRING MA|169.75||||169.75||| 87205|EAP|0300|GRAM STAIN SMEAR|Managed Medicare|BCBS MEDICARE PPO MA|169.75||||||| 87205|EAP|0300|GRAM STAIN SMEAR|Medicaid|MEDICAID|169.75||||169.75||| 87205|EAP|0300|GRAM STAIN SMEAR|NON CONTRACTED|COMMERCIAL OTHER 1|169.75||||169.75||| 87205|EAP|0300|GRAM STAIN SMEAR|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|169.75||||||| 87205|EAP|0300|GRAM STAIN SMEAR|Blue Cross PPO Specialty|BCBSTX PPO|169.75||||169.75||| 87205|EAP|0300|GRAM STAIN SMEAR|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||169.75||| 87205|EAP|0300|GRAM STAIN SMEAR|ChampVA|CHAMPVA CENTER|169.75||||||| 87205|EAP|0300|GRAM STAIN SMEAR|Cigna|CIGNA|169.75||||||| 87205|EAP|0300|GRAM STAIN SMEAR|Blue Cross HMO Specialty|BCBSTX HMO|||||169.75||| 87205|EAP|0300|GRAM STAIN SMEAR|Cigna|CIGNA OTHER|169.75||||||| 87205|EAP|0300|GRAM STAIN SMEAR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||169.75||| 87205|EAP|0300|GRAM STAIN SMEAR|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|169.75||||||| 87205|EAP|0300|GRAM STAIN SMEAR|Aetna|AETNA PPO|169.75||||||| 87205|EAP|0300|GRAM STAIN SMEAR|Aenta Medicare Advantage|AETNA MEDICARE MA|169.75||||169.75||| 87205|EAP|0300|GRAM STAIN SMEAR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|169.75||||169.75||| 87206|EAP|0300|ACID FAST(AFB) SMEAR|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||213.75||| 87206|EAP|0300|ACID FAST(AFB) SMEAR|Medicare|MEDICARE ACUTE|213.75||||213.75||| 87210|EAP|0300|WET MOUNT SMEAR|Aetna|AETNA PPO|||||169.75||| 87210|EAP|0300|WET MOUNT SMEAR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||169.75||| 87210|EAP|0300|WET MOUNT SMEAR|Blue Cross PPO Specialty|BCBSTX PPO|169.75||||169.75||| 87210|EAP|0300|KOH FUNGUS PREP|Blue Cross PPO Specialty|BCBSTX PPO|169.75||||169.75||| 87210|EAP|0300|WET MOUNT SMEAR|Managed Medicaid|MEDICAID SUPERIOR|169.75||||169.75||| 87210|EAP|0300|WET MOUNT SMEAR|Blue Cross HMO Specialty|BCBSTX HMO|||||169.75||| 87210|EAP|0300|WET MOUNT SMEAR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||169.75||| 87210|EAP|0300|WET MOUNT SMEAR|Managed Medicaid|MEDICAID AMERIGROUP|169.75||||169.75||| 87210|EAP|0300|KOH FUNGUS PREP|Managed Medicaid|MEDICAID SUPERIOR|169.75||||169.75||| 87210|EAP|0300|KOH FUNGUS PREP|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||169.75||| 87210|EAP|0300|WET MOUNT SMEAR|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||169.75||| 87210|EAP|0300|WET MOUNT SMEAR|Medicaid|MEDICAID|||||169.75||| 87210|EAP|0300|WET MOUNT SMEAR|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||169.75||| 87210|EAP|0300|KOH FUNGUS PREP|Medicaid|MEDICAID|||||169.75||| 87210|EAP|0300|WET MOUNT SMEAR|Medicaid|MEDICAID HMO|||||169.75||| 87210|EAP|0300|WET MOUNT SMEAR|NON CONTRACTED|COMMERCIAL OTHER 1|||||169.75||| 87210|EAP|0300|WET MOUNT SMEAR|Medicare|MEDICARE ACUTE|||||169.75||| 87210|EAP|0300|WET MOUNT SMEAR|United Healthcare|UNITED HEALTHCARE|||||169.75||| 87210|EAP|0300|WET MOUNT SMEAR|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||169.75||| 87210|EAP|0300|WET MOUNT SMEAR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||169.75||| 87210|EAP|0300|WET MOUNT SMEAR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||169.75||| 87252|EAP|0300|CULTURE, HERPES VIRUS|Medicare|MEDICARE ACUTE|1,038.75||||1,038.75||| 87252|EAP|0300|CULTURE VIRAL NON-RESPIRA|Medicaid|MEDICAID HMO|||||933.25||| 87252|EAP|0300|CULTURE, HERPES VIRUS|Humana Medicare Advantage|HUMANA MA|1,038.75||||||| 87252|EAP|0300|CULTURE, HERPES VIRUS|Managed Medicaid|MEDICAID AMERIGROUP|||||1,038.75||| 87252|EAP|0300|CULTURE VIRAL NON-RESPIRA|Managed Medicaid|MEDICAID SUPERIOR|1,038.75||||933.25||| 87252|EAP|0300|CULTURE, HERPES VIRUS|Blue Cross PPO Specialty|BCBSTX PPO|1,038.75||||1,038.75||| 87252|EAP|0300|CULTURE VIRAL NON-RESPIRA|Blue Cross PPO Specialty|BCBSTX PPO|933.25||||933.25||| 87281|EAP|0300|PNEUMOCYSITS CARNII|Medicare|MEDICARE ACUTE|||||121.50||| 87324|EAP|0300|C DIFFICILE COMBO TEST|Aenta Medicare Advantage|AETNA MEDICARE MA|70.25||||||| 87324|EAP|0300|C DIFFICILE COMBO TEST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||70.25||| 87324|EAP|0300|C DIFFICILE COMBO TEST|Aetna|AETNA PPO|70.25||||70.25||| 87324|EAP|0300|C DIFFICILE COMBO TEST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|70.25||||70.25||| 87324|EAP|0300|C DIFFICILE COMBO TEST|Blue Cross PPO Specialty|BCBSTX PPO|70.25||||70.25||| 87324|EAP|0300|C DIFFICILE COMBO TEST|Cigna|CIGNA|70.25||||||| 87324|EAP|0300|C DIFFICILE COMBO TEST|Blue Cross HMO Specialty|BCBSTX HMO|||||70.25||| 87324|EAP|0300|C DIFFICILE COMBO TEST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|70.25||||70.25||| 87324|EAP|0300|C DIFFICILE COMBO TEST|Managed Medicaid|MEDICAID SUPERIOR|70.25||||70.25||| 87324|EAP|0300|C DIFFICILE COMBO TEST|Managed Medicaid|MEDICAID AMERIGROUP|70.25||||70.25||| 87324|EAP|0300|C DIFFICILE COMBO TEST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||70.25||| 87324|EAP|0300|C DIFFICILE COMBO TEST|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|70.25||||70.25||| 87324|EAP|0300|C DIFFICILE COMBO TEST|Managed Medicare|HEALTHSPRING MA|70.25||||70.25||| 87324|EAP|0300|C DIFFICILE COMBO TEST|Managed Medicare|BCBS MEDICARE PPO MA|70.25||||||| 87324|EAP|0300|C DIFFICILE COMBO TEST|Humana Medicare Advantage|HUMANA MA|70.25||||70.25||| 87324|EAP|0300|C DIFFICILE COMBO TEST|Veterans Affairs|VETERANS ADMINISTRATION|70.25||||||| 87324|EAP|0300|C DIFFICILE COMBO TEST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||70.25||| 87324|EAP|0300|C DIFFICILE COMBO TEST|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||70.25||| 87324|EAP|0300|C DIFFICILE COMBO TEST|United Healthcare|TML GROUP BENEFITS|70.25||||||| 87324|EAP|0300|C DIFFICILE COMBO TEST|United Medicare Advantage|UHC AARP MCR HMO MA|||||70.25||| 87324|EAP|0300|C DIFFICILE COMBO TEST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|70.25||||70.25||| 87324|EAP|0300|C DIFFICILE COMBO TEST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|70.25||||70.25||| 87324|EAP|0300|C DIFFICILE COMBO TEST|United Medicare Advantage|UHC MEDICARE GOLD MA|70.25||||70.25||| 87324|EAP|0300|C DIFFICILE COMBO TEST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|326.60||||70.25||| 87324|EAP|0300|C DIFFICILE COMBO TEST|Medicaid|MEDICAID|70.25||||||| 87324|EAP|0300|C DIFFICILE COMBO TEST|Medicaid|HENDERSON COUNTY INDIGENT|70.25||||70.25||| 87324|EAP|0300|C DIFFICILE COMBO TEST|Medicare|MEDICARE ACUTE|70.25||||70.25||| 87324|EAP|0300|C DIFF TOXIN/GDH ANTIGEN|Medicare|MEDICARE ACUTE|70.25||||326.60||| 87324|EAP|0300|C DIFFICILE COMBO TEST|NON CONTRACTED|COMMERCIAL OTHER 1|70.25||||70.25||| 87328|EAP|0300|CRYPTOSPORIDIUM AG|Medicare|MEDICARE ACUTE|429.50||||429.50||| 87328|EAP|0300|CRYPTOSPORIDIUM AG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|429.50||||||| 87328|EAP|0300|CRYPTOSPORIDIUM AG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|429.50||||429.50||| 87328|EAP|0300|CRYPTOSPORIDIUM AG|United Medicare Advantage|UHC MEDICARE GOLD MA|||||429.50||| 87328|EAP|0300|CRYPTOSPORIDIUM AG|NON CONTRACTED|COMMERCIAL OTHER 1|||||429.50||| 87328|EAP|0300|CRYPTOSPORIDIUM AG|Humana Medicare Advantage|HUMANA MA|429.50||||429.50||| 87328|EAP|0300|CRYPTOSPORIDIUM AG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||429.50||| 87328|EAP|0300|CRYPTOSPORIDIUM AG|Managed Medicaid|MEDICAID SUPERIOR|||||429.50||| 87328|EAP|0300|CRYPTOSPORIDIUM AG|Managed Medicaid|MEDICAID AMERIGROUP|429.50||||429.50||| 87328|EAP|0300|CRYPTOSPORIDIUM AG|Managed Medicare|HEALTHSPRING MA|429.50||||||| 87328|EAP|0300|CRYPTOSPORIDIUM AG|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|429.50||||429.50||| 87328|EAP|0300|CRYPTOSPORIDIUM AG|Blue Cross PPO Specialty|BCBSTX PPO|429.50||||429.50||| 87328|EAP|0300|CRYPTOSPORIDIUM AG|Cigna|CIGNA|429.50||||||| 87328|EAP|0300|CRYPTOSPORIDIUM AG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||429.50||| 87328|EAP|0300|CRYPTOSPORIDIUM AG|Aenta Medicare Advantage|AETNA MEDICARE MA|429.50||||||| 87328|EAP|0300|CRYPTOSPORIDIUM AG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|429.50||||429.50||| 87329|EAP|0300|GIARDIA ANTIGEN|Aenta Medicare Advantage|AETNA MEDICARE MA|478.25||||||| 87329|EAP|0300|GIARDIA ANTIGEN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|478.25||||478.25||| 87329|EAP|0300|GIARDIA ANTIGEN|Cigna|CIGNA|478.25||||||| 87329|EAP|0300|GIARDIA ANTIGEN|Blue Cross PPO Specialty|BCBSTX PPO|478.25||||478.25||| 87329|EAP|0300|GIARDIA ANTIGEN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||373.50||| 87329|EAP|0300|GIARDIA ANTIGEN|Managed Medicaid|MEDICAID SUPERIOR|||||478.25||| 87329|EAP|0300|GIARDIA ANTIGEN|Managed Medicaid|MEDICAID AMERIGROUP|478.25||||478.25||| 87329|EAP|0300|GIARDIA ANTIGEN|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|478.25||||478.25||| 87329|EAP|0300|GIARDIA ANTIGEN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||268.75||| 87329|EAP|0300|GIARDIA ANTIGEN|Managed Medicare|HEALTHSPRING MA|478.25||||||| 87329|EAP|0300|GIARDIA ANTIGEN|Humana Medicare Advantage|HUMANA MA|478.25||||268.75||| 87329|EAP|0300|GIARDIA ANTIGEN|United Medicare Advantage|UHC MEDICARE GOLD MA|||||268.75||| 87329|EAP|0300|GIARDIA ANTIGEN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|478.25||||268.75||| 87329|EAP|0300|GIARDIA ANTIGEN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|478.25||||||| 87329|EAP|0300|GIARDIA ANTIGEN|Medicare|MEDICARE ACUTE|478.25||||478.25||| 87329|EAP|0300|GIARDIA ANTIGEN|NON CONTRACTED|COMMERCIAL OTHER 1|478.25||||268.75||| 87338|EAP|0300|H PYLORI STOOL|Medicare|MEDICARE ACUTE|0.98||||||| 87338|EAP|0300|H PYLORI STOOL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.98||| 87338|EAP|0300|H PYLORI STOOL|Managed Medicaid|MEDICAID SUPERIOR|0.98||||0.98||| 87338|EAP|0300|H PYLORI STOOL|Managed Medicaid|MEDICAID AMERIGROUP|0.98||||||| 87338|EAP|0300|H PYLORI STOOL|Managed Medicare|HEALTHSPRING MA|0.98||||0.98||| 87338|EAP|0300|H PYLORI STOOL|Blue Cross PPO Specialty|BCBSTX PPO|||||0.98||| 87338|EAP|0300|H PYLORI STOOL|Cigna|CIGNA|||||0.98||| 87338|EAP|0300|H PYLORI STOOL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.98||| 87338|EAP|0300|H PYLORI STOOL|Aetna|AETNA PPO|0.98||||||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|212.75||||||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|212.75||||212.75||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Aetna|AETNA PPO|212.75||||||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|212.75||||212.75||| 87340|EAP|0300|HEP PANEL I W/HCV, HEP BS|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||411.50||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Aenta Medicare Advantage|AETNA MEDICARE MA|411.50||||212.75||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Cigna|CIGNA|212.75||||||| 87340|EAP|0300|HEP ABC PANEL 0315, HEP B|Blue Cross PPO Specialty|BCBSTX PPO|411.50||||411.50||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Cigna|CIGNA|212.75||||212.75||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|ChampVA|CHAMPVA CENTER|212.75||||||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Cigna|CIGNA OTHER|212.75||||||| 87340|EAP|0300|HEP ABC PANEL 0315, HEP B|Humana Medicare Advantage|HUMANA MA|411.50||||411.50||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Humana Medicare Advantage|HUMANA MA|212.75||||411.50||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|212.75||||212.75||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Managed Medicaid|MEDICAID SUPERIOR|411.50||||212.75||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Managed Medicaid|MEDICAID SUPERIOR|212.75||||212.75||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|212.75||||||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Managed Medicaid|MEDICAID AMERIGROUP|212.75||||212.75||| 87340|EAP|0300|HEP PANEL I W/HCV, HEP BS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|411.50||||||| 87340|EAP|0300|HEP ABC PANEL 0315, HEP B|Managed Medicaid|MEDICAID SUPERIOR|411.50||||411.50||| 87340|EAP|0300|HEP ABC PANEL 0315, HEP B|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|411.50||||||| 87340|EAP|0300|HEP ABC PANEL 0315, HEP B|Managed Medicaid|MEDICAID AMERIGROUP|411.50||||411.50||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|212.75||||212.75||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Managed Medicare|HEALTHSPRING MA|||||212.75||| 87340|EAP|0300|HEP ABC PANEL 0315, HEP B|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|212.75||||411.50||| 87340|EAP|0300|HEP ABC PANEL 0315, HEP B|Veterans Affairs|VETERANS ADMINISTRATION|411.50||||411.50||| 87340|EAP|0300|HEP PANEL I W/HCV, HEP BS|Workers Compensation|UT EMPLOYEE INJURY|||||411.50||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Workers Compensation|UT EMPLOYEE INJURY|||||212.75||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|411.50||||212.75||| 87340|EAP|0300|HEP PANEL I W/HCV, HEP BS|Blue Cross HMO Specialty|BCBSTX HMO|212.75||||411.50||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|United Healthcare|UNITED HEALTHCARE|212.75||||||| 87340|EAP|0300|HEP PANEL I W/HCV, HEP BS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|411.50||||411.50||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|United Healthcare|TML GROUP BENEFITS|212.75||||||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|United Healthcare|GEHA|212.75||||||| 87340|EAP|0300|HEP PANEL I W/HCV, HEP BS|United Healthcare|UNITED HEALTHCARE|212.75||||411.50||| 87340|EAP|0300|HEP PANEL I W/HCV, HEP BS|United Healthcare|TML GROUP BENEFITS|411.50||||||| 87340|EAP|0300|HEP ABC PANEL 0315, HEP B|United Healthcare|TML GROUP BENEFITS|411.50||||||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|212.75||||212.75||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Blue Cross PPO Specialty|BCBSTX PPO|212.75||||212.75||| 87340|EAP|0300|HEP ABC PANEL 0315, HEP B|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|411.50||||411.50||| 87340|EAP|0300|HEP ABC PANEL 0315, HEP B|United Medicare Advantage|AARP UHC WEST COMPLETE MA|411.50||||411.50||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|United Healthcare|UMR UNITED MEDICAL RESOURCES|212.75||||||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Medicaid|MEDICAID|212.75||||212.75||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Medicaid|MOLINA HEALTHCARE OF TEXAS|212.75||||||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Medicaid|HENDERSON COUNTY INDIGENT|411.50||||212.75||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Medicaid|MEDICAID HMO|212.75||||212.75||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Medicaid|MEDICAID|411.50||||212.75||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Medicare|MEDICARE ACUTE|411.50||||212.75||| 87340|EAP|0300|HEP PANEL I W/HCV, HEP BS|Medicare|MEDICARE ACUTE|411.50||||411.50||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|PHCS|HUMANA|212.75||||||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Tricare|TRICARE EAST REGION|212.75||||212.75||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|Medicare|MEDICARE ACUTE|212.75||||212.75||| 87340|EAP|0300|HEPATITIS B SURFACE ANTIG|NON CONTRACTED|COMMERCIAL OTHER 1|212.75||||||| 87350|EAP|0300|HEP BE ANTIGEN|Medicare|MEDICARE ACUTE|459.25||||459.25||| 87350|EAP|0300|HEP PANEL I W/HCV, HEP BE|Medicaid|HENDERSON COUNTY INDIGENT|459.25||||||| 87350|EAP|0300|HEP PANEL I W/HCV, HEP BE|Medicaid|MEDICAID|459.25||||||| 87350|EAP|0300|HEP PANEL I W/HCV, HEP BE|United Healthcare|UNITED HEALTHCARE|||||459.25||| 87350|EAP|0300|HEP PANEL I W/HCV, HEP BE|United Healthcare|TML GROUP BENEFITS|459.25||||||| 87350|EAP|0300|HEP PANEL I W/HCV, HEP BE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|459.25||||459.25||| 87350|EAP|0300|HEP PANEL I W/HCV, HEP BE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|459.25||||||| 87350|EAP|0300|HEP PANEL I W/HCV, HEP BE|Workers Compensation|UT EMPLOYEE INJURY|||||459.25||| 87350|EAP|0300|HEP PANEL I W/HCV, HEP BE|Medicare|MEDICARE ACUTE|459.25||||459.25||| 87350|EAP|0300|HEP PANEL I W/HCV, HEP BE|Veterans Affairs|VETERANS ADMINISTRATION|459.25||||||| 87350|EAP|0300|HEP PANEL I W/HCV, HEP BE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|459.25||||||| 87350|EAP|0300|HEP PANEL I W/HCV, HEP BE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|459.25||||||| 87350|EAP|0300|HEP PANEL I W/HCV, HEP BE|Managed Medicaid|MEDICAID SUPERIOR|459.25||||||| 87350|EAP|0300|HEP PANEL I W/HCV, HEP BE|Managed Medicaid|MEDICAID AMERIGROUP|459.25||||||| 87350|EAP|0300|HEP BE ANTIGEN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|459.25||||||| 87350|EAP|0300|HEP PANEL I W/HCV, HEP BE|Humana Medicare Advantage|HUMANA MA|459.25||||||| 87350|EAP|0300|HEP PANEL I W/HCV, HEP BE|Blue Cross HMO Specialty|BCBSTX HMO|||||459.25||| 87350|EAP|0300|HEP PANEL I W/HCV, HEP BE|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||459.25||| 87420|EAP|0300|RSV|Aetna|AETNA PPO|||||478.25||| 87420|EAP|0300|RSV|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||478.25||| 87420|EAP|0300|RSV|Blue Cross PPO Specialty|BCBSTX OTHER|||||478.25||| 87420|EAP|0300|RSV|Blue Cross HMO Specialty|BCBSTX HMO|||||478.25||| 87420|EAP|0300|RSV|Cigna|CIGNA|478.25||||478.25||| 87420|EAP|0300|RSV|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||478.25||| 87420|EAP|0300|RSV|Managed Medicaid|MEDICAID SUPERIOR|478.25||||478.25||| 87420|EAP|0300|RSV|Blue Cross PPO Specialty|BCBSTX PPO|478.25||||478.25||| 87420|EAP|0300|RSV|Managed Medicaid|MEDICAID AMERIGROUP|478.25||||478.25||| 87420|EAP|0300|RSV|United Healthcare|UNITED HEALTHCARE OTHER|||||478.25||| 87420|EAP|0300|RSV|United Healthcare|UNITED HEALTHCARE|||||478.25||| 87420|EAP|0300|RSV|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||478.25||| 87420|EAP|0300|RSV|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||478.25||| 87420|EAP|0300|RSV|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||478.25||| 87420|EAP|0300|RSV|Medicaid|MEDICAID PCCM|||||478.25||| 87420|EAP|0300|RSV|Medicaid|MEDICAID|478.25||||478.25||| 87420|EAP|0300|RSV|Medicaid|MEDICAID TEXAS CHILDRENS|||||478.25||| 87420|EAP|0300|RSV|Medicaid|MEDICAID HMO|478.25||||478.25||| 87420|EAP|0300|RSV|Medicare|MEDICARE ACUTE|478.25||||||| 87420|EAP|0300|RSV|Tricare|TRICARE FOR LIFE|||||478.25||| 87420|EAP|0300|RSV|NON CONTRACTED|COMMERCIAL OTHER 1|478.25||||478.25||| 87425|EAP|0300|ROTAVIRUS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|478.25||||||| 87425|EAP|0300|ROTAVIRUS|Managed Medicaid|MEDICAID SUPERIOR|||||478.25||| 87425|EAP|0300|ROTAVIRUS|Managed Medicaid|MEDICAID AMERIGROUP|||||478.25||| 87449|EAP|0300|C DIFFICILE COMBO TEST|Blue Cross PPO Specialty|BCBSTX PPO|70.25||||70.25||| 87449|EAP|0300|C DIFFICILE COMBO TEST|Cigna|CIGNA|70.25||||||| 87449|EAP|0300|C DIFFICILE COMBO TEST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||70.25||| 87449|EAP|0300|C DIFFICILE COMBO TEST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||70.25||| 87449|EAP|0300|C DIFFICILE COMBO TEST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|70.25||||70.25||| 87449|EAP|0300|C DIFFICILE COMBO TEST|Aenta Medicare Advantage|AETNA MEDICARE MA|70.25||||||| 87449|EAP|0300|C DIFFICILE COMBO TEST|Humana Medicare Advantage|HUMANA MA|70.25||||70.25||| 87449|EAP|0300|C DIFFICILE COMBO TEST|Managed Medicaid|MEDICAID AMERIGROUP|70.25||||70.25||| 87449|EAP|0300|C DIFFICILE COMBO TEST|Managed Medicaid|MEDICAID SUPERIOR|70.25||||70.25||| 87449|EAP|0300|C DIFFICILE COMBO TEST|Managed Medicare|BCBS MEDICARE PPO MA|70.25||||||| 87449|EAP|0300|C DIFFICILE COMBO TEST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|70.25||||70.25||| 87449|EAP|0300|C DIFFICILE COMBO TEST|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|70.25||||70.25||| 87449|EAP|0300|C DIFFICILE COMBO TEST|Aetna|AETNA PPO|70.25||||70.25||| 87449|EAP|0300|C DIFFICILE COMBO TEST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||70.25||| 87449|EAP|0300|C DIFFICILE COMBO TEST|Managed Medicare|HEALTHSPRING MA|70.25||||70.25||| 87449|EAP|0300|C DIFFICILE COMBO TEST|Blue Cross HMO Specialty|BCBSTX HMO|||||70.25||| 87449|EAP|0300|C DIFFICILE COMBO TEST|Medicare|MEDICARE ACUTE|70.25||||70.25||| 87449|EAP|0300|C DIFF TOXIN/GDH ANTIGEN|Medicare|MEDICARE ACUTE|70.25||||326.60||| 87449|EAP|0300|C DIFFICILE COMBO TEST|NON CONTRACTED|COMMERCIAL OTHER 1|70.25||||70.25||| 87449|EAP|0300|C DIFFICILE COMBO TEST|Medicaid|HENDERSON COUNTY INDIGENT|70.25||||70.25||| 87449|EAP|0300|C DIFFICILE COMBO TEST|Medicaid|MEDICAID|70.25||||||| 87449|EAP|0300|C DIFFICILE COMBO TEST|Veterans Affairs|VETERANS ADMINISTRATION|70.25||||||| 87449|EAP|0300|C DIFFICILE COMBO TEST|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||70.25||| 87449|EAP|0300|C DIFFICILE COMBO TEST|United Medicare Advantage|UHC MEDICARE GOLD MA|70.25||||70.25||| 87449|EAP|0300|C DIFFICILE COMBO TEST|United Medicare Advantage|UHC AARP MCR HMO MA|||||70.25||| 87449|EAP|0300|C DIFFICILE COMBO TEST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|326.60||||70.25||| 87449|EAP|0300|C DIFFICILE COMBO TEST|United Healthcare|TML GROUP BENEFITS|70.25||||||| 87449|EAP|0300|C DIFFICILE COMBO TEST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|70.25||||70.25||| 87449|EAP|0300|C DIFFICILE COMBO TEST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|70.25||||70.25||| 87491|EAP|0300|CHLAMYDIA/GC PROBE|United Healthcare|UNITED HEALTHCARE|||||1,367.75||| 87491|EAP|0300|CHLAMYDIA/GC PROBE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,367.75||| 87491|EAP|0300|CHLAMYDIA/GC PROBE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1,367.75||| 87491|EAP|0300|GC APTIMA URINE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1.00||| 87491|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|United Healthcare|UNITED HEALTHCARE OTHER|||||1,367.75||| 87491|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|United Healthcare|UNITED HEALTHCARE|1,367.75||||1,367.75||| 87491|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1,367.75||| 87491|EAP|0300|GC APTIMA URINE|United Healthcare|UNITED HEALTHCARE|1,367.75||||1.00||| 87491|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Veterans Affairs|VETERANS ADMINISTRATION|||||1,367.75||| 87491|EAP|0300|CHLAMYDIA/GC PROBE|Veterans Affairs|VETERANS ADMINISTRATION|||||1,367.75||| 87491|EAP|0300|GC APTIMA URINE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.00||| 87491|EAP|0300|CHLAMYDIA/GC PROBE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||1,367.75||| 87491|EAP|0300|CHLAMYDIA/GC PROBE|Medicaid|MEDICAID HMO|1.00||||1,367.75||| 87491|EAP|0300|CHLAMYDIA/GC PROBE|Medicaid|HENDERSON COUNTY INDIGENT|1,367.75||||||| 87491|EAP|0300|GC APTIMA URINE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||1.00||| 87491|EAP|0300|GC APTIMA URINE|Medicaid|MEDICAID|1,367.75||||1.00||| 87491|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Medicare|MEDICARE ACUTE|1.00||||1,367.75||| 87491|EAP|0300|CHLAMYDIA/GC PROBE|Medicare|MEDICARE ACUTE|1.00||||1,367.75||| 87491|EAP|0300|CHLAMYDIA/GC PROBE|Tricare|TRICARE EAST REGION|||||1,367.75||| 87491|EAP|0300|GC APTIMA URINE|Medicare|MEDICARE ACUTE|1.00||||1.00||| 87491|EAP|0300|CHLAMYDIA/GC PROBE|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,367.75||| 87491|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,367.75||| 87491|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Managed Medicaid|MEDICAID SUPERIOR|1,367.75||||1,367.75||| 87491|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,367.75||| 87491|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,367.75||| 87491|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Managed Medicaid|MEDICAID AMERIGROUP|1,367.75||||1,367.75||| 87491|EAP|0300|GC APTIMA URINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.00||| 87491|EAP|0300|GC APTIMA URINE|Managed Medicaid|MEDICAID SUPERIOR|1,367.75||||1.00||| 87491|EAP|0300|GC APTIMA URINE|Managed Medicaid|MEDICAID AMERIGROUP|1,367.75||||1.00||| 87491|EAP|0300|CHLAMYDIA/GC PROBE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,367.75||| 87491|EAP|0300|CHLAMYDIA/GC PROBE|Managed Medicaid|MEDICAID SUPERIOR|1.00||||1,367.75||| 87491|EAP|0300|CHLAMYDIA/GC PROBE|Medicaid|MEDICAID|1.00||||1,367.75||| 87491|EAP|0300|CHLAMYDIA/GC PROBE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,367.75||| 87491|EAP|0300|CHLAMYDIA/GC PROBE|Managed Medicaid|MEDICAID AMERIGROUP|1,367.75||||1,367.75||| 87491|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Medicaid|MEDICAID|1,367.75||||1,367.75||| 87491|EAP|0300|CHLAMYDIA ATRIMA URINE|Managed Medicaid|MEDICAID SUPERIOR|1,367.75||||1.00||| 87491|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Managed Medicare|VAN ZANDT COUNTY INMATE|||||1,367.75||| 87491|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||1,367.75||| 87491|EAP|0300|GC APTIMA URINE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||1.00||| 87491|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|MTC Medical|VAN ZANDT COUNTY INMATE|||||1,367.75||| 87491|EAP|0300|CHLAMYDIA ATRIMA URINE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.00||| 87491|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Medicaid|MEDICAID HMO|1.00||||1,367.75||| 87491|EAP|0300|CHLAMYDIA/GC PROBE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,367.75||| 87491|EAP|0300|CHLAMYDIA ATRIMA URINE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.00||| 87491|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Aetna|AETNA PPO|||||1,367.75||| 87491|EAP|0300|CHLAMYDIA/GC PROBE|Aetna|AETNA PPO|||||1,367.75||| 87491|EAP|0300|CHLAMYDIA/GC PROBE|United Healthcare|UNITED HEALTHCARE|1,367.75||||1,367.75||| 87491|EAP|0300|GC APTIMA URINE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.00||| 87491|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1,367.75||| 87491|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,367.75||| 87491|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Blue Cross PPO Specialty|BCBSTX PPO|1,367.75||||1,367.75||| 87491|EAP|0300|CHLAMYDIA/GC PROBE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1,367.75||| 87491|EAP|0300|GC APTIMA URINE|Blue Cross PPO Specialty|BCBSTX PPO|1,367.75||||1.00||| 87491|EAP|0300|CHLAMYDIA ATRIMA URINE|Blue Cross PPO Specialty|BCBSTX PPO|1,367.75||||1.00||| 87491|EAP|0300|CHLAMYDIA ATRIMA URINE|Cigna|CIGNA|||||1.00||| 87491|EAP|0300|CHLAMYDIA/GC PROBE|Blue Cross HMO Specialty|BCBSTX HMO|||||1,367.75||| 87491|EAP|0300|GC APTIMA URINE|Blue Cross HMO Specialty|BCBSTX HMO|||||1.00||| 87491|EAP|0300|GC APTIMA URINE|Cigna|CIGNA|||||1.00||| 87491|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1,367.75||| 87491|EAP|0300|CHLAMYDIA/GC PROBE|Blue Cross PPO Specialty|BCBSTX PPO|1,367.75||||1,367.75||| 87491|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Blue Cross HMO Specialty|BCBSTX HMO|||||1,367.75||| 87491|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Cigna|CIGNA|||||1,367.75||| 87493|EAP|0300|C DIFF BY PCR|Blue Cross PPO Specialty|BCBSTX PPO|||||3.68||| 87493|EAP|0300|C DIFF BY PCR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.68||||3.68||| 87493|EAP|0300|C DIFF BY PCR|Access Direct Platinum|HEALTHFIRST TPA UMR|||||3.68||| 87493|EAP|0300|C DIFF BY PCR|Humana Medicare Advantage|HUMANA MA|3.68||||||| 87493|EAP|0300|C DIFF BY PCR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.68||||||| 87493|EAP|0300|C DIFF BY PCR|Managed Medicaid|MEDICAID SUPERIOR|3.68||||||| 87493|EAP|0300|C DIFF BY PCR|Medicare|MEDICARE ACUTE|3.68||||3.68||| 87493|EAP|0300|C DIFF BY PCR|Medicaid|MEDICAID|3.68||||||| 87493|EAP|0300|C DIFF BY PCR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3.68||| 87493|EAP|0300|C DIFF BY PCR|United Medicare Advantage|UHC MEDICARE GOLD MA|3.68||||||| 87493|EAP|0300|C DIFF BY PCR|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3.68||||3.68||| 87493|EAP|0300|C DIFF BY PCR|United Medicare Advantage|UHC AARP MCR HMO MA|||||3.68||| 87496|EAP|0300|CMV BY RAPID PCR, QL|Blue Cross PPO Specialty|BCBSTX PPO|1,367.75||||||| 87517|EAP|0300|HBV DNA QUANTITATIVE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1,130.75||| 87517|EAP|0300|HBV DNA QUANTITATIVE|Medicare|MEDICARE ACUTE|||||1,130.75||| 87521|EAP|0300|HEP C RNA BY PCR QL|Managed Medicare|HEALTHSPRING MA|||||1,367.75||| 87521|EAP|0300|HEP C RNA BY PCR QL|Humana Medicare Advantage|HUMANA MA|||||1,367.75||| 87521|EAP|0300|HEP C RNA BY PCR QL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,367.75||| 87521|EAP|0300|HEP C RNA BY PCR QL|Medicare|MEDICARE ACUTE|||||1,367.75||| 87521|EAP|0300|HEP C RNA BY PCR QL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,367.75||| 87521|EAP|0300|HEP C RNA BY PCR QL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1,367.75||| 87521|EAP|0300|HEP C RNA BY PCR QL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1,367.75||| 87522|EAP|0300|HEP C VIRUS RNA BY PCR,QN|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,130.75||| 87522|EAP|0300|HEP C VIRUS RNA BY PCR,QN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1,130.75||||1,130.75||| 87522|EAP|0300|HEP C VIRUS RNA BY PCR,QN|Medicaid|HENDERSON COUNTY INDIGENT|||||1,130.75||| 87522|EAP|0300|HEP C VIRUS RNA BY PCR,QN|Workers Compensation|UT EMPLOYEE INJURY|||||1,130.75||| 87522|EAP|0300|HEP C VIRUS RNA BY PCR,QN|Medicare|MEDICARE ACUTE|1,130.75||||1,130.75||| 87522|EAP|0300|HEP C VIRUS RNA BY PCR,QN|Cigna|CIGNA|||||1,130.75||| 87522|EAP|0300|HEP C VIRUS RNA BY PCR,QN|Blue Cross PPO Specialty|BCBSTX PPO|||||1,130.75||| 87522|EAP|0300|HEP C VIRUS RNA BY PCR,QN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1,130.75||| 87522|EAP|0300|HEP C VIRUS RNA BY PCR,QN|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1,130.75||| 87522|EAP|0300|HEP C VIRUS RNA BY PCR,QN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,130.75||| 87522|EAP|0300|HEP C VIRUS RNA BY PCR,QN|Humana Medicare Advantage|HUMANA MA|1,130.75||||1,130.75||| 87522|EAP|0300|HEP C VIRUS RNA BY PCR,QN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1,130.75||||1,130.75||| 87522|EAP|0300|HEP C VIRUS RNA BY PCR,QN|Managed Medicaid|MEDICAID SUPERIOR|1,130.75||||||| 87522|EAP|0300|HEP C VIRUS RNA BY PCR,QN|Managed Medicare|HEALTHSPRING MA|||||1,130.75||| 87529|EAP|0300|HERPES SIMPLEX VIRUS BY P|Managed Medicaid|MEDICAID SUPERIOR|1,367.75||||||| 87529|EAP|0300|HERPES SIMPLEX VIRUS BY P|Managed Medicaid|MEDICAID AMERIGROUP|1,367.75||||1,367.75||| 87529|EAP|0300|HERPES SIMPLEX VIRUS BY P|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1,367.75||| 87529|EAP|0300|HERPES SIMPLEX VIRUS BY P|Blue Cross PPO Specialty|BCBSTX PPO|1,367.75||||1,367.75||| 87529|EAP|0300|HERPES SIMPLEX VIRUS BY P|Medicare|MEDICARE ACUTE|||||1,367.75||| 87536|EAP|0300|HIV RNA BY PCR|Medicare|MEDICARE ACUTE|15.67||||15.67||| 87556|EAP|0300|MYCOBACTERIUM PCR|Medicare|MEDICARE ACUTE|1,256.25||||||| 87591|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Blue Cross PPO Specialty|BCBSTX PPO|1,367.75||||1,367.75||| 87591|EAP|0300|CHLAMYDIA GC DNA PROBE|Blue Cross PPO Specialty|BCBSTX PPO|1,367.75||||1,367.75||| 87591|EAP|0300|CHLAMYDIA GC DNA PROBE|Blue Cross HMO Specialty|BCBSTX HMO|||||1,367.75||| 87591|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Blue Cross HMO Specialty|BCBSTX HMO|||||1,367.75||| 87591|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Cigna|CIGNA|||||1,367.75||| 87591|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Aetna|AETNA PPO|||||1,367.75||| 87591|EAP|0300|CHLAMYDIA GC DNA PROBE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,367.75||| 87591|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1,367.75||| 87591|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|MTC Medical|VAN ZANDT COUNTY INMATE|||||1,367.75||| 87591|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,367.75||| 87591|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Managed Medicaid|MEDICAID SUPERIOR|1,367.75||||1,367.75||| 87591|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,367.75||| 87591|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Managed Medicaid|MEDICAID AMERIGROUP|1,367.75||||1,367.75||| 87591|EAP|0300|CHLAMYDIA GC DNA PROBE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,367.75||| 87591|EAP|0300|CHLAMYDIA GC DNA PROBE|Managed Medicaid|MEDICAID SUPERIOR|1,367.75||||1,367.75||| 87591|EAP|0300|CHLAMYDIA GC DNA PROBE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,367.75||| 87591|EAP|0300|CHLAMYDIA GC DNA PROBE|Managed Medicaid|MEDICAID AMERIGROUP|1,367.75||||1,367.75||| 87591|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Managed Medicare|VAN ZANDT COUNTY INMATE|||||1,367.75||| 87591|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||1,367.75||| 87591|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|United Healthcare|UNITED HEALTHCARE|1,367.75||||1,367.75||| 87591|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1,367.75||| 87591|EAP|0300|CHLAMYDIA GC DNA PROBE|United Healthcare|UNITED HEALTHCARE|1,367.75||||1,367.75||| 87591|EAP|0300|CHLAMYDIA GC DNA PROBE|United Healthcare|UNITED HEALTHCARE|||||1,367.75||| 87591|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,367.75||| 87591|EAP|0300|CHLAMYDIA GC DNA PROBE|Aetna|AETNA PPO|||||1,367.75||| 87591|EAP|0300|CHLAMYDIA GC DNA PROBE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1,367.75||| 87591|EAP|0300|CHLAMYDIA GC DNA PROBE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,367.75||| 87591|EAP|0300|CHLAMYDIA GC DNA PROBE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1,367.75||| 87591|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|United Healthcare|UNITED HEALTHCARE OTHER|||||1,367.75||| 87591|EAP|0300|CHLAMYDIA GC DNA PROBE|Veterans Affairs|VETERANS ADMINISTRATION|||||1,367.75||| 87591|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Veterans Affairs|VETERANS ADMINISTRATION|||||1,367.75||| 87591|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Medicaid|MEDICAID|1,367.75||||1,367.75||| 87591|EAP|0300|CHLAMYDIA GC DNA PROBE|Medicaid|MEDICAID HMO|||||1,367.75||| 87591|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1,367.75||| 87591|EAP|0300|CHLAMYDIA GC DNA PROBE|Medicaid|MEDICAID|1,367.75||||1,367.75||| 87591|EAP|0300|CHLAMYDIA GC DNA PROBE|Medicaid|HENDERSON COUNTY INDIGENT|1,367.75||||||| 87591|EAP|0300|CHLAMYDIA GC DNA PROBE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||1,367.75||| 87591|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Medicaid|MEDICAID HMO|||||1,367.75||| 87591|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|Medicare|MEDICARE ACUTE|||||1,367.75||| 87591|EAP|0300|CHLAMYDIA GC DNA PROBE|Medicare|MEDICARE ACUTE|||||1,367.75||| 87591|EAP|0300|CHLAMYDIA GC DNA PROBE|Tricare|TRICARE EAST REGION|||||1,367.75||| 87591|EAP|0300|CHLAMYDIA GC DNA PROBE|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,367.75||| 87591|EAP|0300|GC/CHLAMYDIA AMPLIFIED UR|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,367.75||| 87651|EAP|0300|STREP A|Medicare|MEDICARE ACUTE|9.60||||9.60||| 87651|EAP|0300|STREP A|NON CONTRACTED|COMMERCIAL OTHER 1|9.60||||9.60||| 87651|EAP|0300|STREP A|Tricare|TRICARE EAST REGION|||||9.60||| 87651|EAP|0300|STREP A|PHCS|MULTIPLAN PHCS OTHER|||||9.60||| 87651|EAP|0300|STREP A|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||9.60||| 87651|EAP|0300|STREP A|Medicaid|MEDICAID TEXAS CHILDRENS|||||9.60||| 87651|EAP|0300|STREP A|Medicaid|MEDICAID|||||9.60||| 87651|EAP|0300|STREP A|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||9.60||| 87651|EAP|0300|STREP A|Medicaid|MEDICAID HMO|||||9.60||| 87651|EAP|0300|STREP A|Veterans Affairs|VETERANS ADMINISTRATION|||||9.60||| 87651|EAP|0300|STREP A|United Healthcare|UNITED HEALTHCARE OTHER|||||9.60||| 87651|EAP|0300|STREP A|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||9.60||| 87651|EAP|0300|STREP A|United Medicare Advantage|AARP UHC WEST COMPLETE MA|9.60||||9.60||| 87651|EAP|0300|STREP A|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|9.60||||9.60||| 87651|EAP|0300|STREP A|United Medicare Advantage|UHC MEDICARE GOLD MA|||||9.60||| 87651|EAP|0300|STREP A|Managed Medicare|BCBS MEDICARE PPO MA|9.60||||||| 87651|EAP|0300|STREP A|Managed Medicaid|MEDICAID UNITED HEALTHCARE|9.60||||9.60||| 87651|EAP|0300|STREP A|Managed Medicaid|MEDICAID SUPERIOR|9.60||||9.60||| 87651|EAP|0300|STREP A|United Healthcare|UNITED HEALTHCARE|||||9.60||| 87651|EAP|0300|STREP A|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|9.60||||9.60||| 87651|EAP|0300|STREP A|Managed Medicaid|MEDICAID AMERIGROUP|9.60||||9.60||| 87651|EAP|0300|STREP A|Managed Medicare|VAN ZANDT COUNTY INMATE|9.60||||||| 87651|EAP|0300|STREP A|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||9.60||| 87651|EAP|0300|STREP A|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||9.60||| 87651|EAP|0300|STREP A|Managed Medicare|HEALTHSPRING MA|9.60||||9.60||| 87651|EAP|0300|STREP A|Humana Medicare Advantage|HUMANA MA|9.60||||9.60||| 87651|EAP|0300|STREP A|MTC Medical|VAN ZANDT COUNTY INMATE|9.60||||||| 87651|EAP|0300|STREP A|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||9.60||| 87651|EAP|0300|STREP A|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||9.60||| 87651|EAP|0300|STREP A|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.60||||9.60||| 87651|EAP|0300|STREP A|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|9.60||||9.60||| 87651|EAP|0300|STREP A|Aetna|AETNA PPO|||||9.60||| 87651|EAP|0300|STREP A|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||9.60||| 87651|EAP|0300|STREP A|Aetna|AETNA OTHER|||||9.60||| 87651|EAP|0300|STREP A|Aenta Medicare Advantage|AETNA MEDICARE MA|9.60||||9.60||| 87651|EAP|0300|STREP A|Cigna|CIGNA|||||9.60||| 87651|EAP|0300|STREP A|Blue Cross PPO Specialty|BCBSTX PPO|9.60||||9.60||| 87651|EAP|0300|STREP A|Blue Cross PPO Specialty|BCBSTX OTHER|||||9.60||| 87651|EAP|0300|STREP A|ChampVA|CHAMPVA CENTER|||||9.60||| 87651|EAP|0300|STREP A|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||9.60||| 87651|EAP|0300|STREP A|Blue Cross HMO Specialty|BCBSTX HMO|9.60||||9.60||| 87798|EAP|0300|WEST NILE VIRUS BY PCR|Blue Cross PPO Specialty|BCBSTX PPO|1,367.75||||1,367.75||| 87799|EAP|0300|EBV BY PCR|Blue Cross PPO Specialty|BCBSTX PPO|2.65||||||| 87801|EAP|0300|BORDETELLA PERTUSSIS BY P|Medicare|MEDICARE ACUTE|||||444.25||| 87801|EAP|0300|BORDETELLA PERTUSSIS BY P|Managed Medicaid|MEDICAID SUPERIOR|444.25||||||| 87801|EAP|0300|BORDETELLA PERTUSSIS BY P|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||444.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Blue Cross PPO Specialty|BCBSTX PPO|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Blue Cross PPO Specialty|BCBSTX OTHER|||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Blue Cross PPO Specialty|BCBSTX PPO|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Cigna|CIGNA|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Blue Cross PPO Specialty|BCBSTX OTHER|||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|ChampVA|CHAMPVA CENTER|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Blue Cross HMO Specialty|BCBSTX HMO|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Cigna|CIGNA OTHER|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Cigna|CIGNA|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Aetna|AETNA PPO|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Aetna|AETNA OTHER|||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Aetna|AETNA PPO|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Aenta Medicare Advantage|AETNA MEDICARE MA|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Aenta Medicare Advantage|AETNA MEDICARE MA|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Humana Medicare Advantage|HUMANA MA|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|MTC Medical|VAN ZANDT COUNTY INMATE|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Humana Medicare Advantage|HUMANA MA|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|MTC Medical|VAN ZANDT COUNTY INMATE|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Managed Medicaid|MEDICAID SUPERIOR|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Managed Medicaid|MEDICAID AMERIGROUP|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Managed Medicaid|MEDICAID SUPERIOR|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Managed Medicaid|MEDICAID AMERIGROUP|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Managed Medicare|VAN ZANDT COUNTY INMATE|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Managed Medicare|VAN ZANDT COUNTY INMATE|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Managed Medicare|BCBS MEDICARE PPO MA|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Managed Medicare|HEALTHSPRING MA|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Managed Medicare|HEALTHSPRING MA|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Managed Medicare|BCBS MEDICARE PPO MA|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Managed Medicare|WELLCARE CHOICE MA|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Managed Medicare|WELLCARE CHOICE MA|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|United Healthcare|UNITED HEALTHCARE OTHER|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|United Healthcare|UNITED HEALTHCARE|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Managed Medicare|MA PART B ONLY IP|478.25||||||| 87804|EAP|0300|INFLUENZA B SCREEN|United Healthcare|UNITED HEALTHCARE|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|United Healthcare|UMR UNITED MEDICAL RESOURCES|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|United Healthcare|TML GROUP BENEFITS|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|United Medicare Advantage|UHC MEDICARE GOLD MA|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|United Healthcare|GOLDEN RULE|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|United Healthcare|GEHA|||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|United Healthcare|UNITED HEALTHCARE|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|United Healthcare|UNITED HEALTHCARE|||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Managed Medicare|MA PART B ONLY IP|478.25||||||| 87804|EAP|0300|INFLUENZA A SCREEN|United Healthcare|TML GROUP BENEFITS|||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|United Healthcare|GOLDEN RULE|||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|United Healthcare|GEHA|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|United Medicare Advantage|UHC MEDICARE GOLD MA|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|United Medicare Advantage|UHC AARP MCR HMO MA|||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|United Medicare Advantage|UHC AARP MCR HMO MA|||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|United Healthcare|UNITED HEALTHCARE OTHER|||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|United Healthcare|UMR UNITED MEDICAL RESOURCES|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Veterans Affairs|VETERANS ADMINISTRATION|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Veterans Affairs|VETERANS ADMINISTRATION|||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Veterans Affairs|VETERANS ADMINISTRATION|||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Veterans Affairs|VETERANS ADMINISTRATION|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Workers Compensation|WORKERS COMPENSATION OTHER|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Workers Compensation|WORKERS COMPENSATION OTHER|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Medicaid|MEDICAID TEXAS CHILDRENS|||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Aetna|AETNA OTHER|||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Medicaid|MEDICAID PCCM|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Medicaid|MEDICAID PCCM|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Medicaid|MEDICAID|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Medicaid|MEDICAID TEXAS CHILDRENS|||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Medicaid|MEDICAID HMO|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Medicaid|HENDERSON COUNTY INDIGENT|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Medicaid|MEDICAID|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Cigna|CIGNA OTHER|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Medicaid|MEDICAID HMO|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Medicaid|HENDERSON COUNTY INDIGENT|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|ChampVA|CHAMPVA CENTER|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Blue Cross HMO Specialty|BCBSTX HMO|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Medicare|MEDICARE ACUTE|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Medicare|MEDICARE ACUTE|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|NON CONTRACTED|COMMERCIAL OTHER 2|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Tricare|TRICARE FOR LIFE|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|Tricare|TRICARE EAST REGION|478.25||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Tricare|TRICARE FOR LIFE|||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|Tricare|TRICARE EAST REGION|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|UTMB|UTMB CORRECTIONAL MANAGED CARE|478.25||||||| 87804|EAP|0300|INFLUENZA A SCREEN|UTMB|UTMB CORRECTIONAL MANAGED CARE|478.25||||||| 87804|EAP|0300|INFLUENZA A SCREEN|NON CONTRACTED|COMMERCIAL OTHER 2|||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|PHCS|HUMANA INSURANCE|||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|NON CONTRACTED|COMMERCIAL OTHER 1|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|NON CONTRACTED|COMMERCIAL OTHER 1|478.25||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|PHCS|MULTIPLAN PHCS OTHER|||||478.25||| 87804|EAP|0300|INFLUENZA B SCREEN|PHCS|HUMANA INSURANCE|||||478.25||| 87804|EAP|0300|INFLUENZA A SCREEN|PHCS|MULTIPLAN PHCS OTHER|||||478.25||| 87880|EAP|0300|RAPID STREP SCREEN|Medicare|MEDICARE ACUTE|75.25||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Tricare|TRICARE FOR LIFE|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|NON CONTRACTED|COMMERCIAL OTHER 1|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Tricare|TRICARE EAST REGION|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Medicaid|MEDICAID|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Medicaid|MEDICAID HMO|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Medicaid|MEDICAID TEXAS CHILDRENS|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Veterans Affairs|VETERANS ADMINISTRATION|75.25||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Workers Compensation|WORKERS COMPENSATION OTHER|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|75.25||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|United Medicare Advantage|UHC MEDICARE GOLD MA|75.25||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|United Healthcare|UNITED HEALTHCARE|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|United Healthcare|UMR UNITED MEDICAL RESOURCES|75.25||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|United Healthcare|TML GROUP BENEFITS|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|75.25||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|United Healthcare|GOLDEN RULE|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|United Healthcare|GEHA|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|United Medicare Advantage|UHC AARP MCR HMO MA|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|United Healthcare|UNITED HEALTHCARE OTHER|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|75.25||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Managed Medicaid|MEDICAID SUPERIOR|75.25||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|75.25||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Managed Medicaid|MEDICAID AMERIGROUP|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Medicaid|MEDICAID PCCM|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Managed Medicare|HEALTHSPRING MA|75.25||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Humana Medicare Advantage|HUMANA MA|75.25||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|PHCS|HUMANA INSURANCE|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Aetna|AETNA PPO|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Aenta Medicare Advantage|AETNA MEDICARE MA|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|75.25||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Blue Cross PPO Specialty|BCBSTX PPO|75.25||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Blue Cross PPO Specialty|BCBSTX OTHER|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|ChampVA|CHAMPVA CENTER|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Cigna|CIGNA|75.25||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Blue Cross HMO Specialty|BCBSTX HMO|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Cigna|CIGNA|||||75.25||| 87880|EAP|0300|RAPID STREP SCREEN|Cigna|CIGNA OTHER|||||75.25||| 87902|EAP|0300|HEP C VIRUS GENOTYPE|Blue Cross PPO Specialty|BCBSTX PPO|||||1,958.50||| 87902|EAP|0300|HEP C VIRUS GENOTYPE|Cigna|CIGNA|||||1,958.50||| 87902|EAP|0300|NSSA HCV RESISTANCE FOCUS|Aetna|AETNA PPO|||||14.03||| 87902|EAP|0300|HEP C VIRUS GENOTYPE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1,958.50||| 87902|EAP|0300|HEP C VIRUS GENOTYPE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1,958.50||| 87902|EAP|0300|HEP C VIRUS GENOTYPE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,958.50||||||| 87902|EAP|0300|HEP C VIRUS GENOTYPE|Managed Medicare|HEALTHSPRING MA|||||1,958.50||| 87902|EAP|0300|HEP C VIRUS GENOTYPE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1,958.50||| 87902|EAP|0300|HEP C VIRUS GENOTYPE|Medicaid|HENDERSON COUNTY INDIGENT|||||1,958.50||| 87902|EAP|0300|HEP C VIRUS GENOTYPE|Medicare|MEDICARE ACUTE|1,958.50||||1,958.50||| 87902|EAP|0300|HCV GENO 1 NS5A|Medicare|MEDICARE ACUTE|1,958.50||||14.12||| 880|DRG||ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION|Medicare|MEDICARE ACUTE|28,409.75|7412.77|7412.77|7412.77|||| 881|DRG||DEPRESSIVE NEUROSES|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|43,265.75|7287.19|7287.19|7287.19|||| 88182|EAP|0300|FLOW CYTOMETRY UNITS 19|Humana Medicare Advantage|HUMANA MA|73.50||||||| 88182|EAP|0300|ACETYLCHOLRINE MODULATING|Humana Medicare Advantage|HUMANA MA|538.75||||||| 88182|EAP|0300|FLOW CYTOMETRY UNITS 19|Managed Medicaid|MEDICAID UNITED HEALTHCARE|73.50||||||| 88182|EAP|0300|FLOW CYTOMETRY UNITS 19|Cigna|CIGNA OTHER|73.50||||||| 88182|EAP|0300|FLOW CYTOMETRY UNITS 19|Cigna|CIGNA|73.50||||||| 88182|EAP|0300|ACETYLCHOLRINE MODULATING|Medicare|MEDICARE ACUTE|73.50||||538.75||| 88182|EAP|0300|FLOW CYTOMETRY UNITS 19|Veterans Affairs|VETERANS ADMINISTRATION|73.50||||||| 88182|EAP|0300|ACETYLCHOLRINE MODULATING|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||538.75||| 88184|EAP|0300|T CELLS/HELPER|Medicare|MEDICARE ACUTE|158.25||||1,066.75||| 88184|EAP|0300|T CELLS/HELPER|Managed Medicaid|MEDICAID SUPERIOR|1,066.75||||||| 88185|EAP|0300|T&B LYMPHO/FLOW CYTOMETRY|Managed Medicaid|MEDICAID SUPERIOR|874.75||||||| 88185|EAP|0300|T&B LYMPHO/FLOW CYTOMETRY|Medicare|MEDICARE ACUTE|||||874.75||| 882|DRG||NEUROSES EXCEPT DEPRESSIVE|Veterans Affairs|VETERANS ADMINISTRATION|46,302.25|6997.1|6997.1|6997.1|||| 88230|EAP|0300|CHROMOSOME ANALYSIS|Medicaid|MEDICAID|||||1,692.25||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|Access Direct Platinum|HEALTHFIRST TPA UMR|||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|Aenta Medicare Advantage|AETNA MEDICARE MA|8.06||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|Blue Cross PPO Specialty|BCBSTX PPO|8.06||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|Blue Cross HMO Specialty|BCBSTX HMO|||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|Cigna|CIGNA|||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|Humana Medicare Advantage|HUMANA MA|8.06||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|8.06||||||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|Managed Medicaid|MEDICAID SUPERIOR|8.06||||||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|8.06||||||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|Managed Medicaid|MEDICAID AMERIGROUP|8.06||||||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|Managed Medicare|BCBS MEDICARE PPO MA|||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|Managed Medicare|HEALTHSPRING MA|8.06||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|United Healthcare|GEHA|||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|8.06||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|United Medicare Advantage|UHC MEDICARE GOLD MA|8.06||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|8.06||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|United Healthcare|UNITED HEALTHCARE OTHER|||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|8.06||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|Aetna|AETNA PPO|8.06||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|United Healthcare|UNITED HEALTHCARE|8.06||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|United Healthcare|UNITED HEALTHCARE|||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|United Healthcare|UMR UNITED MEDICAL RESOURCES|8.06||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|United Healthcare|TML GROUP BENEFITS|||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|Veterans Affairs|VETERANS ADMINISTRATION|8.06||||||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|Multiplan|NALC|||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|Medicare|MEDICARE ACUTE|8.06||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|Tricare|TRICARE EAST REGION|||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|NON CONTRACTED|COMMERCIAL OTHER 1|8.06||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|PHCS|MULTIPLAN PHCS OTHER|||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|PHCS|MULTIPLAN PHCS|||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|Medicaid|HENDERSON COUNTY INDIGENT|||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|Medicaid|MEDICAID|8.06||||8.06||| 88305|EAP|0310|TISSUE EXAM BY PATHOLOGIS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||8.06||| 88341|EAP|0300|MMR BY IHC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||7.44||| 88342|EAP|0300|IMMUNOHISTOCHEMISTRY STAI|Medicare|MEDICARE ACUTE|||||7.96||| 88342|EAP|0300|IMMUNOHISTOCHEMISTRY STAI|Managed Medicare|HEALTHSPRING MA|||||7.96||| 88342|EAP|0300|IMMUNOHISTOCHEMISTRY STAI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||7.96||| 884|DRG||ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|14,056.25|4209.65|11012.52|663.22|||| 884|DRG||ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY|Managed Medicare|HEALTHSPRING MA|33,663.25|663.22|11012.52|663.22|||| 884|DRG||ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY|Veterans Affairs|VETERANS ADMINISTRATION|49,876.75|11012.52|11012.52|663.22|||| 884|DRG||ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY|Medicare|MEDICARE ACUTE|37,801.25|10022.84|11012.52|663.22|||| 885|DRG||PSYCHOSES|Medicare|MEDICARE ACUTE|27,115.25|9605.41|9605.41|975.52|||| 885|DRG||PSYCHOSES|United Medicare Advantage|AARP UHC WEST COMPLETE MA|573.08|975.52|9605.41|975.52|||| 89|DRG||CONCUSSION W CC|Medicare|MEDICARE ACUTE|27,019.30|8202.04|8202.04|8202.04|||| 89050|EAP|0300||Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||219.50||| 89050|EAP|0300||Managed Medicaid|MEDICAID SUPERIOR|||||219.50||| 89050|EAP|0300||Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||219.50||| 89051|EAP|0300|CELL COUNT WITH DIFF BODY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|219.50||||219.50||| 89051|EAP|0300|CELL COUNT WITH DIFF BODY|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|219.50||||219.50||| 89051|EAP|0300|CELL COUNT WITH DIFF BODY|United Medicare Advantage|UHC MEDICARE GOLD MA|||||219.50||| 89051|EAP|0300|CELL COUNT W/DIFF CSF|Medicare|MEDICARE ACUTE|219.50||||219.50||| 89051|EAP|0300|CELL COUNT WITH DIFF BODY|Medicaid|MEDICAID HMO|219.50||||||| 89051|EAP|0300|CELL COUNT WITH DIFF BODY|Medicaid|MEDICAID|219.50||||||| 89051|EAP|0300|CELL COUNT WITH DIFF BODY|Medicare|MEDICARE ACUTE|219.50||||219.50||| 89051|EAP|0300|CELL COUNT W/DIFF CSF|Medicaid|MEDICAID HMO|219.50||||||| 89051|EAP|0300|CELL COUNT WITH DIFF BODY|Blue Cross PPO Specialty|BCBSTX PPO|219.50||||219.50||| 89051|EAP|0300|CELL COUNT W/DIFF CSF|Blue Cross PPO Specialty|BCBSTX PPO|219.50||||219.50||| 89051|EAP|0300|CELL COUNT WITH DIFF BODY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|219.50||||219.50||| 89051|EAP|0300|CELL COUNT WITH DIFF BODY|Aenta Medicare Advantage|AETNA MEDICARE MA|||||219.50||| 89051|EAP|0300|CELL COUNT WITH DIFF BODY|Humana Medicare Advantage|HUMANA MA|219.50||||219.50||| 89051|EAP|0300|CELL COUNT WITH DIFF BODY|Managed Medicare|BCBS MEDICARE PPO MA|219.50||||||| 89051|EAP|0300|CELL COUNT WITH DIFF BODY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|219.50||||||| 89051|EAP|0300|CELL COUNT W/DIFF CSF|Managed Medicaid|MEDICAID SUPERIOR|219.50||||219.50||| 89051|EAP|0300|CELL COUNT W/DIFF CSF|Managed Medicaid|MEDICAID AMERIGROUP|||||219.50||| 89051|EAP|0300|CELL COUNT WITH DIFF BODY|Managed Medicare|HEALTHSPRING MA|||||219.50||| 89051|EAP|0300|CELL COUNT WITH DIFF BODY|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||219.50||| 89055|EAP|0300|FECAL LEUKOCYTES|Managed Medicaid|MEDICAID UNITED HEALTHCARE|169.75||||169.75||| 89055|EAP|0300|FECAL LEUKOCYTES|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|169.75||||||| 89055|EAP|0300|FECAL LEUKOCYTES|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|169.75||||||| 89055|EAP|0300|FECAL LEUKOCYTES|Humana Medicare Advantage|HUMANA MA|169.75||||169.75||| 89055|EAP|0300|FECAL LEUKOCYTES|Aetna|AETNA OTHER|||||169.75||| 89055|EAP|0300|FECAL LEUKOCYTES|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|169.75||||||| 89055|EAP|0300|FECAL LEUKOCYTES|Aetna|AETNA PPO|169.75||||169.75||| 89055|EAP|0300|FECAL LEUKOCYTES|Aenta Medicare Advantage|AETNA MEDICARE MA|169.75||||||| 89055|EAP|0300|FECAL LEUKOCYTES|Blue Cross PPO Specialty|BCBSTX PPO|||||169.75||| 89055|EAP|0300|FECAL LEUKOCYTES|Medicaid|HENDERSON COUNTY INDIGENT|||||61.25||| 89055|EAP|0300|FECAL LEUKOCYTES|Medicare|MEDICARE ACUTE|169.75||||169.75||| 89055|EAP|0300|FECAL LEUKOCYTES|Tricare|TRICARE EAST REGION|169.75||||||| 89055|EAP|0300|FECAL LEUKOCYTES|United Medicare Advantage|AARP UHC WEST COMPLETE MA|169.75||||61.25||| 89055|EAP|0300|FECAL LEUKOCYTES|United Medicare Advantage|UHC MEDICARE GOLD MA|169.75||||115.50||| 89060|EAP|0300|BODY FLUID CRYSTALS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.85||| 89060|EAP|0300|CRYSTALS - BODY FLUID|Medicare|MEDICARE ACUTE|2.85||||2.85||| 89060|EAP|0300|BODY FLUID CRYSTALS|Medicare|MEDICARE ACUTE|2.85||||2.85||| 89060|EAP|0300|BODY FLUID CRYSTALS|Blue Cross PPO Specialty|BCBSTX PPO|||||2.85||| 89060|EAP|0300|BODY FLUID CRYSTALS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.85||| 89060|EAP|0300|BODY FLUID CRYSTALS|Humana Medicare Advantage|HUMANA MA|||||2.85||| 89060|EAP|0300|BODY FLUID CRYSTALS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.85||| 89060|EAP|0300|BODY FLUID CRYSTALS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.85||| 89321|EAP|0300|SEMEN COUNT (POST VAS)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.86||| 89321|EAP|0300|SEMEN COUNT (POST VAS)|Blue Cross PPO Specialty|BCBSTX PPO|||||0.86||| 89321|EAP|0300|SEMEN COUNT (POST VAS)|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.86||| 89321|EAP|0300|SEMEN COUNT (POST VAS)|Blue Cross HMO Specialty|BCBSTX HMO|||||0.86||| 89321|EAP|0300|SEMEN COUNT (POST VAS)|Cigna|CIGNA|||||0.86||| 89321|EAP|0300|SEMEN COUNT (POST VAS)|Tricare|TRICARE EAST REGION|||||0.86||| 89321|EAP|0300|SEMEN COUNT (POST VAS)|United Healthcare|UNITED HEALTHCARE|||||0.86||| 894|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|30,429.52||||||| 894|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA|Veterans Affairs|VETERANS ADMINISTRATION|37,202.41|5780.12|5780.12|3306.23|||| 894|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|43,968.05|5699.93|5780.12|3306.23|||| 894|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|42,217.82|3306.23|5780.12|3306.23|||| 896|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W MCC|Medicare|MEDICARE ACUTE|75,849.04|12967.28|12967.28|12757.57|||| 896|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W MCC|Veterans Affairs|VETERANS ADMINISTRATION|142,654.95|12757.57|12967.28|12757.57|||| 897|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|22,513.08||||||| 897|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC|Aetna|AETNA PPO|63,323.10|36410.78|36410.78|2546.95|||| 897|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|37,166.30|7302.97|36410.78|2546.95|||| 897|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|64,412.91|7302.97|36410.78|2546.95|||| 897|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC|Tricare|TRICARE EAST REGION|86,279.18|2546.95|36410.78|2546.95|||| 897|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC|Medicare|MEDICARE ACUTE|81,868.60|7302.97|36410.78|2546.95|||| 90|DRG||CONCUSSION W/O CC/MCC|Medicare|MEDICARE ACUTE|35,177.65|7348.9|7348.9|7348.9|||| 90371|ERX|0636|HEP B IMMUNE GLOB 110 UNI|Managed Medicaid|MEDICAID SUPERIOR|456.40||||||| 90371|ERX|0636|HEP B IMMUNE GLOB 110 UNI|Managed Medicaid|MEDICAID AMERIGROUP|456.40||||||| 90371|ERX|0636|HEP B IMMUNE GLOB 110 UNI|Blue Cross PPO Specialty|BCBSTX PPO|456.40||||||| 90371|ERX|0636|HEP B IMMUNE GLOB 110 UNI|Medicaid|MEDICAID|456.40||||||| 90371|ERX|0636|HEP B IMMUNE GLOB 110 UNI|Medicaid|MEDICAID HMO|456.40||||||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Workers Compensation|WORKERS COMP PHYSICIAN|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Veterans Affairs|VETERANS ADMINISTRATION|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|United Medicare Advantage|UHC MEDICARE GOLD MA|3.28||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|United Medicare Advantage|UHC AARP MCR HMO MA|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|86.25||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Workers Compensation|UT EMPLOYEE INJURY|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|United Healthcare|UNITED HEALTHCARE OTHER|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|United Healthcare|TML GROUP BENEFITS|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|United Healthcare|GEHA|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Tricare|TRICARE EAST REGION|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|UTMB|UTMB CORRECTIONAL MANAGED CARE|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Multiplan|NALC|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|NON CONTRACTED|COMMERCIAL OTHER 2|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|PHCS|HUMANA INSURANCE|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Medicare|MEDICARE ACUTE|3.28||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Medicaid|MEDICAID TEXAS CHILDRENS|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Medicaid|HENDERSON COUNTY INDIGENT|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Managed Medicare|VAN ZANDT COUNTY INMATE|||||207.13||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|3.28||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Medicaid|MEDICAID HMO|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|PHCS|MULTIPLAN PHCS OTHER|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Managed Medicare|HEALTHSPRING MA|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Medicaid|MEDICAID|3.28||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||86.25||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|United Healthcare|UNITED HEALTHCARE|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Workers Compensation|WORKERS COMPENSATION OTHER|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Aetna|AETNA OTHER|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Aetna|AETNA PPO|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3.28||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Blue Cross HMO Specialty|BCBSTX HMO|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|ChampVA|CHAMPVA CENTER|3.28||||||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Blue Cross PPO Specialty|BCBSTX PPO|3.28||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Blue Cross PPO Specialty|BCBSTX OTHER|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Humana Medicare Advantage|HUMANA MA|3.28||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|MTC Medical|VAN ZANDT COUNTY INMATE|||||207.13||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Cigna|CIGNA OTHER|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Cigna|CIGNA|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.28||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Managed Medicaid|MEDICAID SUPERIOR|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.28||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Managed Medicaid|MEDICAID AMERIGROUP|||||3.28||| 90686|ERX|0636|INFLUENZA VACCINE|Managed Medicaid|MEDICAID SUPERIOR|100.35||||||| 90686|ERX|0636|INFLUENZA VACCINE|Humana Medicare Advantage|HUMANA MA|100.35||||0.45||| 90686|ERX|0636|INFLUENZA VACCINE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|100.35||||||| 90686|ERX|0636|INFLUENZA VACCINE|Managed Medicare|HEALTHSPRING MA|100.35||||||| 90686|ERX|0636|INFLUENZA VACCINE|Medicare|MEDICARE ACUTE|100.35||||0.45||| 90686|ERX|0636|INFLUENZA VACCINE|United Healthcare|TML GROUP BENEFITS|100.35||||||| 90686|ERX|0636|INFLUENZA VACCINE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|100.35||||0.45||| 90686|ERX|0636|INFLUENZA VACCINE|United Medicare Advantage|UHC MEDICARE GOLD MA|100.35||||0.45||| 90686|ERX|0636|INFLUENZA VACCINE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||100.35||| 90696|ERX|0636||Managed Medicaid|MEDICAID SUPERIOR|||||142.05||| 90696|ERX|0636||Managed Medicaid|MEDICAID AMERIGROUP|||||142.05||| 90700|ERX|0250||Workers Compensation|WORKERS COMPENSATION OTHER|||||238.05||| 90700|ERX|0250||Workers Compensation|UT EMPLOYEE INJURY|||||238.05||| 90700|ERX|0250||Veterans Affairs|VETERANS ADMINISTRATION|||||238.05||| 90700|ERX|0250||Workers Compensation|WORKERS COMP PHYSICIAN|||||238.05||| 90700|ERX|0250||United Medicare Advantage|AARP UHC WEST COMPLETE MA|238.05||||238.05||| 90700|ERX|0250||United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||238.05||| 90700|ERX|0250||Tricare|TRICARE EAST REGION|||||238.05||| 90700|ERX|0250||NON CONTRACTED|COMMERCIAL OTHER 2|||||238.05||| 90700|ERX|0250||NON CONTRACTED|COMMERCIAL OTHER 1|||||238.05||| 90700|ERX|0250||United Healthcare|UNITED HEALTHCARE|||||238.05||| 90700|ERX|0250||United Healthcare|UNITED HEALTHCARE OTHER|||||238.05||| 90700|ERX|0250||PHCS|HUMANA INSURANCE|||||238.05||| 90700|ERX|0250||Medicaid|MEDICAID|238.05||||238.05||| 90700|ERX|0250||Medicaid|MOLINA HEALTHCARE OF TEXAS|||||238.05||| 90700|ERX|0636|TET-DIPH-PERTUS(ACEL)(PED|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||142.05||| 90700|ERX|0250||Medicaid|MEDICAID HMO|238.05||||238.05||| 90700|ERX|0250||Medicare|MEDICARE ACUTE|238.05||||238.05||| 90700|ERX|0250||Aetna|AETNA PPO|||||238.05||| 90700|ERX|0250||Aenta Medicare Advantage|AETNA MEDICARE MA|||||238.05||| 90700|ERX|0250||Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||238.05||| 90700|ERX|0250||United Healthcare|UMR UNITED MEDICAL RESOURCES|||||238.05||| 90700|ERX|0250||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||238.05||| 90700|ERX|0250||Access Direct Platinum|HEALTHFIRST TPA UMR|||||238.05||| 90700|ERX|0250||United Medicare Advantage|UHC MEDICARE GOLD MA|238.05||||238.05||| 90700|ERX|0250||Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||238.05||| 90700|ERX|0250||Blue Cross HMO Specialty|BCBSTX HMO|||||238.05||| 90700|ERX|0250||Blue Cross PPO Specialty|BCBSTX OTHER|||||238.05||| 90700|ERX|0250||Blue Cross PPO Specialty|BCBSTX PPO|238.05||||238.05||| 90700|ERX|0250||Cigna|CIGNA|||||238.05||| 90700|ERX|0250||Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||238.05||| 90700|ERX|0250||Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||238.05||| 90700|ERX|0250||Managed Medicaid|MEDICAID AMERIGROUP|||||238.05||| 90700|ERX|0250||Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||238.05||| 90700|ERX|0250||Managed Medicaid|MEDICAID SUPERIOR|238.05||||238.05||| 90700|ERX|0250||Humana Medicare Advantage|HUMANA MA|238.05||||238.05||| 90700|ERX|0250||MTC Medical|VAN ZANDT COUNTY INMATE|||||238.05||| 90700|ERX|0636|TET-DIPH-PERTUS(ACEL)(PED|Managed Medicaid|MEDICAID AMERIGROUP|||||142.05||| 90700|ERX|0250||Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||238.05||| 90700|ERX|0250||Managed Medicare|BCBS MEDICARE PPO MA|238.05||||||| 90700|ERX|0250||Managed Medicare|HEALTHSPRING MA|||||238.05||| 90700|ERX|0250||Managed Medicare|VAN ZANDT COUNTY INMATE|||||238.05||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|Managed Medicare|HEALTHSPRING MA|||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|Managed Medicaid|MEDICAID AMERIGROUP|||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|Humana Medicare Advantage|HUMANA MA|195.84||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|Blue Cross PPO Specialty|BCBSTX PPO|||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|Blue Cross PPO Specialty|BCBSTX OTHER|||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|Cigna|CIGNA|||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|Aetna|AETNA PPO|||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|Aenta Medicare Advantage|AETNA MEDICARE MA|||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|Medicare|MEDICARE ACUTE|195.84||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|Managed Medicaid|MEDICAID SUPERIOR|||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|Medicaid|LAW ENFORCEMENT OTHER|195.84||||||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|Medicaid|MEDICAID TEXAS CHILDRENS|||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|Medicaid|MEDICAID|195.84||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|NON CONTRACTED|COMMERCIAL OTHER 1|||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|United Healthcare|GEHA|||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|United Healthcare|UNITED HEALTHCARE|||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|United Healthcare|UNITED HEALTHCARE OTHER|||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|Tricare|TRICARE EAST REGION|||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|United Medicare Advantage|UHC AARP MCR HMO MA|||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|United Medicare Advantage|UHC MEDICARE GOLD MA|195.84||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|Workers Compensation|WORKERS COMPENSATION OTHER|||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|Workers Compensation|UT EMPLOYEE INJURY|||||195.84||| 90714|ERX|0250|TETANUS-DIPTHE TOX(ADULT)|Veterans Affairs|VETERANS ADMINISTRATION|||||195.84||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Veterans Affairs|VETERANS ADMINISTRATION|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|238.05||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|United Medicare Advantage|UHC MEDICARE GOLD MA|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Workers Compensation|WORKERS COMPENSATION OTHER|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|United Healthcare|UNITED HEALTHCARE|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|United Healthcare|UNITED HEALTHCARE OTHER|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Multiplan|NALC|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Tricare|TRICARE EAST REGION|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Medicare|MEDICARE ACUTE|238.05||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|UTMB|UTMB CORRECTIONAL MANAGED CARE|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|NON CONTRACTED|COMMERCIAL OTHER 1|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|PHCS|MULTIPLAN PHCS OTHER|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Managed Medicare|HEALTHSPRING MA|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Medicaid|MEDICAID HMO|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Medicaid|MEDICAID|238.05||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|238.05||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Medicaid|HENDERSON COUNTY INDIGENT|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Managed Medicare|VAN ZANDT COUNTY INMATE|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Aenta Medicare Advantage|AETNA MEDICARE MA|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|United Healthcare|TML GROUP BENEFITS|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Aetna|AETNA OTHER|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Aetna|AETNA PPO|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Blue Cross PPO Specialty|BCBSTX PPO|238.05||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Blue Cross PPO Specialty|BCBSTX OTHER|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|ChampVA|CHAMPVA CENTER|238.05||||||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Blue Cross HMO Specialty|BCBSTX HMO|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Cigna|CIGNA|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|MTC Medical|VAN ZANDT COUNTY INMATE|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Humana Medicare Advantage|HUMANA MA|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Cigna|CIGNA OTHER|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|238.05||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Managed Medicaid|MEDICAID SUPERIOR|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||238.05||| 90715|ERX|0636|TET-DIPH-PERTUS(ACEL) VAC|Managed Medicaid|MEDICAID AMERIGROUP|||||238.05||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Managed Medicaid|MEDICAID SUPERIOR|395.25||||395.25||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|395.25||||395.25||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Managed Medicaid|MEDICAID AMERIGROUP|395.25||||395.25||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|MTC Medical|VAN ZANDT COUNTY INMATE|395.25||||||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Humana Medicare Advantage|HUMANA MA|395.25||||395.25||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|395.25||||||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Blue Cross PPO Specialty|BCBSTX PPO|395.25||||395.25||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|395.25||||395.25||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Blue Cross HMO Specialty|BCBSTX HMO|||||395.25||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Aenta Medicare Advantage|AETNA MEDICARE MA|395.25||||395.25||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|395.25||||||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Aetna|AETNA PPO|395.25||||||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Medicaid|COUNTY INDIGENT HEALTH OTHER|395.25||||||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Managed Medicare|VAN ZANDT COUNTY INMATE|395.25||||||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Managed Medicare|MA PART B ONLY IP|395.25||||||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Managed Medicare|HEALTHSPRING MA|395.25||||395.25||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Medicaid|MOLINA HEALTHCARE OF TEXAS|395.25||||||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Medicaid|MEDICAID|395.25||||395.25||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Managed Medicare|BCBS MEDICARE PPO MA|395.25||||395.25||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Managed Medicaid|MEDICAID UNITED HEALTHCARE|395.25||||395.25||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||395.25||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|NON CONTRACTED|COMMERCIAL OTHER 1|395.25||||||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Tricare|TRICARE EAST REGION|395.25||||||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Medicare|MEDICARE ACUTE|395.25||||395.25||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|United Healthcare|UNITED HEALTHCARE|395.25||||395.25||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Veterans Affairs|VETERANS ADMINISTRATION|395.25||||395.25||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|395.25||||395.25||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|United Medicare Advantage|UHC MEDICARE GOLD MA|395.25||||395.25||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|United Medicare Advantage|AARP UHC WEST COMPLETE MA|395.25||||395.25||| 908|DRG||OTHER O.R. PROCEDURES FOR INJURIES W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|46,242.30|10260.68|10260.68|9997.88|||| 908|DRG||OTHER O.R. PROCEDURES FOR INJURIES W CC|Blue Cross PPO Specialty|BCBSTX PPO|24,596.55|9997.88|10260.68|9997.88|||| 91|DRG||OTHER DISORDERS OF NERVOUS SYSTEM W MCC|Medicare|MEDICARE ACUTE|29,203.25|11798.99|11798.99|11798.99|||| 914|DRG||TRAUMATIC INJURY W/O MCC|Managed Medicare|BCBS MEDICARE PPO MA|61,830.55|7442.51|7442.51|7442.51|||| 914|DRG||TRAUMATIC INJURY W/O MCC|Medicare|MEDICARE ACUTE|55,930.25|7442.51|7442.51|7442.51|||| 916|DRG||ALLERGIC REACTIONS W/O MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|68,034.75|12696.57|12696.57|12696.57|||| 917|DRG||POISONING & TOXIC EFFECTS OF DRUGS W MCC|Blue Cross PPO Specialty|BCBSTX PPO|45,225.75|7393.55|11930.22|6850.48|||| 917|DRG||POISONING & TOXIC EFFECTS OF DRUGS W MCC|Managed Medicaid|MEDICAID AMERIGROUP|55,300.75|11930.22|11930.22|6850.48|||| 917|DRG||POISONING & TOXIC EFFECTS OF DRUGS W MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|74,958.50|7142.25|11930.22|6850.48|||| 917|DRG||POISONING & TOXIC EFFECTS OF DRUGS W MCC|Humana Medicare Advantage|HUMANA MA|53,796.05|11153.45|11930.22|6850.48|||| 917|DRG||POISONING & TOXIC EFFECTS OF DRUGS W MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|39,419.35|6850.48|11930.22|6850.48|||| 917|DRG||POISONING & TOXIC EFFECTS OF DRUGS W MCC|Medicare|MEDICARE ACUTE|61,759.30|11168.61|11930.22|6850.48|||| 917|DRG||POISONING & TOXIC EFFECTS OF DRUGS W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|51,051.63|11349.17|11930.22|6850.48|||| 917|DRG||POISONING & TOXIC EFFECTS OF DRUGS W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|578.09|11258.89|11930.22|6850.48|||| 918|DRG||POISONING & TOXIC EFFECTS OF DRUGS W/O MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|62,815.65|11349.17|11349.17|1084.76|||| 918|DRG||POISONING & TOXIC EFFECTS OF DRUGS W/O MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|66,240.15|6961.17|11349.17|1084.76|||| 918|DRG||POISONING & TOXIC EFFECTS OF DRUGS W/O MCC|Medicare|MEDICARE ACUTE|28,573.85|6960.29|11349.17|1084.76|||| 918|DRG||POISONING & TOXIC EFFECTS OF DRUGS W/O MCC|Medicaid|MEDICAID|69,194.55|2278.92|11349.17|1084.76|||| 918|DRG||POISONING & TOXIC EFFECTS OF DRUGS W/O MCC|Managed Medicaid|MEDICAID AMERIGROUP|22,617.75|1084.76|11349.17|1084.76|||| 918|DRG||POISONING & TOXIC EFFECTS OF DRUGS W/O MCC|Managed Medicaid|MEDICAID SUPERIOR|28,676.05|2771.15|11349.17|1084.76|||| 918|DRG||POISONING & TOXIC EFFECTS OF DRUGS W/O MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|33,055.73|5365.165|11349.17|1084.76|||| 918|DRG||POISONING & TOXIC EFFECTS OF DRUGS W/O MCC|Humana Medicare Advantage|HUMANA MA|82,103.75|6947.41|11349.17|1084.76|||| 918|DRG||POISONING & TOXIC EFFECTS OF DRUGS W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|29,378.58|3906.74|11349.17|1084.76|||| 92|DRG||OTHER DISORDERS OF NERVOUS SYSTEM W CC|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|28,278.50|8213.27|8213.27|1788.79|||| 92|DRG||OTHER DISORDERS OF NERVOUS SYSTEM W CC|Humana Medicare Advantage|HUMANA MA|69,481.50|6066.37|8213.27|1788.79|||| 92|DRG||OTHER DISORDERS OF NERVOUS SYSTEM W CC|Medicare|MEDICARE ACUTE|33,124.15|6181.96|8213.27|1788.79|||| 92|DRG||OTHER DISORDERS OF NERVOUS SYSTEM W CC|Medicare|MEDICARE PART B ONLY IP|44,724.50|1788.79|8213.27|1788.79|||| 920|DRG||COMPLICATIONS OF TREATMENT W CC|Medicare|MEDICARE ACUTE|64,841.47|8395.975|8395.975|5032.55|||| 920|DRG||COMPLICATIONS OF TREATMENT W CC|Blue Cross PPO Specialty|BCBSTX PPO|52,414.40|5032.55|8395.975|5032.55|||| 920|DRG||COMPLICATIONS OF TREATMENT W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|61,010.71|6296.73|8395.975|5032.55|||| 922|DRG||OTHER INJURY, POISONING & TOXIC EFFECT DIAG W MCC|Medicare|MEDICARE ACUTE|581.97|12037.93|12037.93|12037.93|||| 92587|EAP|0471|SCREENING OAE|Managed Medicaid|MEDICAID SUPERIOR|107.50||||||| 92587|EAP|0471|SCREENING OAE|Managed Medicaid|MEDICAID AMERIGROUP|107.50||||||| 92587|EAP|0471|SCREENING OAE|Cigna|CIGNA|107.50||||107.50||| 92587|EAP|0471|SCREENING OAE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|107.50||||||| 92587|EAP|0471|SCREENING OAE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|107.50||||||| 92587|EAP|0471|SCREENING OAE|Aetna|AETNA PPO|107.50||||||| 92587|EAP|0471|SCREENING OAE|Blue Cross PPO Specialty|BCBSTX PPO|107.50||||107.50||| 92587|EAP|0471|SCREENING OAE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|107.50||||||| 92587|EAP|0471|SCREENING OAE|Blue Cross HMO Specialty|BCBSTX HMO|107.50||||||| 92587|EAP|0471|SCREENING OAE|United Healthcare|UNITED HEALTHCARE|107.50||||||| 92587|EAP|0471|SCREENING OAE|United Healthcare|UMR UNITED MEDICAL RESOURCES|107.50||||||| 92587|EAP|0471|SCREENING OAE|United Healthcare|TML GROUP BENEFITS|107.50||||||| 92587|EAP|0471|SCREENING OAE|Tricare|TRICARE EAST REGION|107.50||||||| 92587|EAP|0471|SCREENING OAE|NON CONTRACTED|COMMERCIAL OTHER 1|107.50||||||| 92587|EAP|0471|SCREENING OAE|Medicaid|MEDICAID HMO|107.50||||||| 92587|EAP|0471|SCREENING OAE|Medicaid|MEDICAID|107.50||||107.50||| 92950|EAP|0450|CPR|Managed Medicare|BCBS MEDICARE PPO MA|||||900.75||| 92950|EAP|0480|RESUSITATION, PER|Medicaid|MEDICAID|612.50||||||| 92950|EAP|0450|CPR|Medicare|MEDICARE ACUTE|||||900.75||| 92950|EAP|0450|CPR|Veterans Affairs|VETERANS ADMINISTRATION|||||900.75||| 92950|EAP|0450|CPR|Managed Medicare|HEALTHSPRING MA|||||900.75||| 92950|EAP|0450|CPR|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||900.75||| 92950|EAP|0450|CPR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||900.75||| 92950|EAP|0450|CPR|United Healthcare|UNITED HEALTHCARE OTHER|||||900.75||| 92950|EAP|0450|CPR|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||900.75||| 92950|EAP|0450|CPR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||900.75||| 92950|EAP|0450|CPR|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||900.75||| 92950|EAP|0450|CPR|Blue Cross PPO Specialty|BCBSTX PPO|||||900.75||| 92950|EAP|0450|CPR|Humana Medicare Advantage|HUMANA MA|||||900.75||| 92950|EAP|0450|CPR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|900.75||||||| 92950|EAP|0450|CPR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||900.75||| 92950|EAP|0450|CPR|Managed Medicaid|MEDICAID AMERIGROUP|||||900.75||| 92950|EAP|0450|CPR|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||900.75||| 92950|EAP|0450|CPR|Managed Medicare|OTHER INSTITUTIONS|||||900.75||| 92960|EAP|0480|CARDIOVERSION (NON OR TIM|Managed Medicaid|MEDICAID SUPERIOR|2,402.25||||||| 92960|EAP|0480|CARDIOVERSION (NON OR TIM|Humana Medicare Advantage|HUMANA MA|||||2,402.25||| 92960|EAP|0450|CARDIOVERSION EXTERNAL|Humana Medicare Advantage|HUMANA MA|||||1,291.50||| 92960|EAP|0480|CARDIOVERSION (NON OR TIM|United Healthcare|UNITED HEALTHCARE|2,402.25||||||| 92960|EAP|0480|CARDIOVERSION (NON OR TIM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2,402.25||||||| 92960|EAP|0480|CARDIOVERSION (NON OR TIM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2,402.25||| 92960|EAP|0480|CARDIOVERSION (NON OR TIM|Veterans Affairs|VETERANS ADMINISTRATION|||||2,402.25||| 92960|EAP|0450|CARDIOVERSION EXTERNAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,291.50||| 92960|EAP|0450|CARDIOVERSION EXTERNAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1,291.50||| 92960|EAP|0480|CARDIOVERSION (NON OR TIM|Medicare|MEDICARE ACUTE|2,402.25||||2,402.25||| 92960|EAP|0450|CARDIOVERSION EXTERNAL|Medicare|MEDICARE ACUTE|||||1,291.50||| 92960|EAP|0480|CARDIOVERSION (NON OR TIM|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2,402.25||| 92977|EAP|0450|THROMBOLYSIS|Medicare|MEDICARE ACUTE|||||980.50||| 92977|EAP|0450|THROMBOLYSIS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||980.50||| 92977|EAP|0450|THROMBOLYSIS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||980.50||| 92977|EAP|0450|THROMBOLYSIS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||980.50||| 92977|EAP|0450|THROMBOLYSIS|Blue Cross PPO Specialty|BCBSTX PPO|||||980.50||| 92977|EAP|0450|THROMBOLYSIS|Humana Medicare Advantage|HUMANA MA|980.50||||980.50||| 93|DRG||OTHER DISORDERS OF NERVOUS SYSTEM W/O CC/MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|21,089.70|5399.74|6391.3|5399.74|||| 93|DRG||OTHER DISORDERS OF NERVOUS SYSTEM W/O CC/MCC|Medicare|MEDICARE ACUTE|219.83|6391.3|6391.3|5399.74|||| 93005|EAP|0730|EKG|United Healthcare|UNITED HEALTHCARE OTHER|||||4.11||| 93005|EAP|0730|EKG|United Healthcare|UNITED HEALTHCARE|4.11||||4.11||| 93005|EAP|0730|EKG|United Healthcare|TML GROUP BENEFITS|4.11||||4.11||| 93005|EAP|0730|EKG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.11||||4.11||| 93005|EAP|0730|EKG|Veterans Affairs|VETERANS ADMINISTRATION|4.11||||4.11||| 93005|EAP|0730|EKG EMERGENCY STAFF|Veterans Affairs|VETERANS ADMINISTRATION|4.11||||395.25||| 93005|EAP|0730|EKG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.11||||4.11||| 93005|EAP|0730|EKG|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.11||| 93005|EAP|0730|EKG EMERGENCY STAFF|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|395.25||||395.25||| 93005|EAP|0730|EKG|United Medicare Advantage|UHC MEDICARE GOLD MA|4.11||||4.11||| 93005|EAP|0730|EKG EMERGENCY STAFF|United Medicare Advantage|UHC MEDICARE GOLD MA|4.11||||395.25||| 93005|EAP|0730|EKG|United Medicare Advantage|UHC AARP MCR HMO MA|||||4.11||| 93005|EAP|0730|EKG|Multiplan|NALC|||||4.11||| 93005|EAP|0730|EKG|PHCS|HUMANA|||||4.11||| 93005|EAP|0730|EKG|Tricare|TRICARE FOR LIFE|||||4.11||| 93005|EAP|0730|EKG|Medicare|MEDICARE ACUTE|4.11||||4.11||| 93005|EAP|0730|EKG|NON CONTRACTED|COMMERCIAL OTHER 1|4.11||||4.11||| 93005|EAP|0730|EKG EMERGENCY STAFF|NON CONTRACTED|COMMERCIAL OTHER 1|4.11||||395.25||| 93005|EAP|0730|EKG EMERGENCY STAFF|Medicare|MEDICARE ACUTE|395.25||||395.25||| 93005|EAP|0730|EKG|Medicare|MEDICARE PART B ONLY IP|4.11||||||| 93005|EAP|0730|EKG|PHCS|MULTIPLAN PHCS OTHER|||||4.11||| 93005|EAP|0730|EKG|Texas Workforce Commission|DIS DETER SERV (DDS)|4.11||||4.11||| 93005|EAP|0730|EKG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.11||||4.11||| 93005|EAP|0730|EKG EMERGENCY STAFF|Managed Medicare|BCBS MEDICARE PPO MA|395.25||||4.11||| 93005|EAP|0730|EKG|Managed Medicare|HEALTHSPRING MA|4.11||||4.11||| 93005|EAP|0730|EKG|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|4.11||||4.11||| 93005|EAP|0730|EKG|Managed Medicare|MA PART B ONLY IP|4.11||||||| 93005|EAP|0730|EKG EMERGENCY STAFF|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.11||||395.25||| 93005|EAP|0730|EKG|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.11||||4.11||| 93005|EAP|0730|EKG|Medicaid|MEDICAID|4.11||||4.11||| 93005|EAP|0730|EKG EMERGENCY STAFF|Managed Medicare|HEALTHSPRING MA|4.11||||395.25||| 93005|EAP|0730|EKG|Managed Medicare|HOSPICE ETMC|||||4.11||| 93005|EAP|0730|EKG|Medicaid|MEDICAID HMO|||||4.11||| 93005|EAP|0730|EKG|Medicaid|HENDERSON COUNTY INDIGENT|4.11||||4.11||| 93005|EAP|0730|EKG|Medicaid|LAW ENFORCEMENT OTHER|4.11||||4.11||| 93005|EAP|0730|EKG|Medicaid|COUNTY INDIGENT HEALTH OTHER|4.11||||||| 93005|EAP|0730|EKG|Managed Medicare|BCBS MEDICARE PPO MA|4.11||||4.11||| 93005|EAP|0730|EKG|Managed Medicare|OTHER INSTITUTIONS|||||4.11||| 93005|EAP|0730|EKG|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||4.11||| 93005|EAP|0730|EKG|Managed Medicare|VAN ZANDT COUNTY INMATE|||||4.11||| 93005|EAP|0730|EKG|Aenta Medicare Advantage|AETNA MEDICARE MA|4.11||||4.11||| 93005|EAP|0730|EKG|Access Direct Platinum|HEALTHFIRST TPA UMR|4.11||||4.11||| 93005|EAP|0730|EKG|Tricare|TRICARE EAST REGION|4.11||||4.11||| 93005|EAP|0730|EKG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.11||||4.11||| 93005|EAP|0730|EKG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|4.11||||4.11||| 93005|EAP|0730|EKG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|4.11||||4.11||| 93005|EAP|0730|EKG|Aetna|AETNA PPO|4.11||||4.11||| 93005|EAP|0730|EKG EMERGENCY STAFF|United Medicare Advantage|AARP UHC WEST COMPLETE MA|395.25||||4.11||| 93005|EAP|0730|EKG|Aetna|AETNA OTHER|||||4.11||| 93005|EAP|0730|EKG EMERGENCY STAFF|Blue Cross HMO Specialty|BCBSTX HMO|4.11||||395.25||| 93005|EAP|0730|EKG|Blue Cross HMO Specialty|BCBSTX HMO|4.11||||4.11||| 93005|EAP|0730|EKG|ChampVA|CHAMPVA CENTER|4.11||||4.11||| 93005|EAP|0730|EKG|Workers Compensation|GALLAGHER BASSETT|||||4.11||| 93005|EAP|0730|EKG EMERGENCY STAFF|Blue Cross PPO Specialty|BCBSTX PPO|4.11||||395.25||| 93005|EAP|0730|EKG EMERGENCY STAFF|ChampVA|CHAMPVA CENTER|4.11||||395.25||| 93005|EAP|0730|EKG|Blue Cross PPO Specialty|BCBSTX PPO|4.11||||4.11||| 93005|EAP|0730|EKG|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.11||| 93005|EAP|0730|EKG|Blue Cross PPO Specialty|BCBSTX OTHER|||||4.11||| 93005|EAP|0730|EKG EMERGENCY STAFF|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.11||||395.25||| 93005|EAP|0730|EKG|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.11||||4.11||| 93005|EAP|0730|EKG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.11||||4.11||| 93005|EAP|0730|EKG EMERGENCY STAFF|Managed Medicaid|MEDICAID SUPERIOR|395.25||||4.11||| 93005|EAP|0730|EKG EMERGENCY STAFF|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.11||||395.25||| 93005|EAP|0730|EKG EMERGENCY STAFF|Managed Medicaid|MEDICAID AMERIGROUP|4.11||||395.25||| 93005|EAP|0730|EKG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.11||||4.11||| 93005|EAP|0730|EKG|Managed Medicaid|MEDICAID SUPERIOR|4.11||||4.11||| 93005|EAP|0730|EKG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.11||||4.11||| 93005|EAP|0730|EKG|Managed Medicaid|MEDICAID AMERIGROUP|4.11||||4.11||| 93005|EAP|0730|EKG EMERGENCY STAFF|Humana Medicare Advantage|HUMANA MA|4.11||||395.25||| 93005|EAP|0730|EKG|Cigna|CIGNA|4.11||||4.11||| 93005|EAP|0730|EKG|Humana Medicare Advantage|HUMANA MA|4.11||||4.11||| 93005|EAP|0730|EKG|Cigna|CIGNA OTHER|4.11||||4.11||| 93005|EAP|0730|EKG|MTC Medical|VAN ZANDT COUNTY INMATE|||||4.11||| 93017|EAP|0482|STRESS TEST EKG|Cigna|CIGNA OTHER|||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|Humana Medicare Advantage|HUMANA MA|1,408.25||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|Cigna|CIGNA|||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|Managed Medicaid|MEDICAID SUPERIOR|1,408.25||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1,408.25||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|Managed Medicaid|MEDICAID AMERIGROUP|1,408.25||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|Blue Cross PPO Specialty|BCBSTX PPO|1,408.25||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|Blue Cross HMO Specialty|BCBSTX HMO|1,408.25||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|Access Direct Platinum|HEALTHFIRST TPA UMR|||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1,408.25||||||| 93017|EAP|0482|STRESS TEST EKG|Aetna|AETNA PPO|1,408.25||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|Aetna|AETNA OTHER|||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|Managed Medicare|HEALTHSPRING MA|1,408.25||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,408.25||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|Medicaid|MEDICAID|1,408.25||||||| 93017|EAP|0482|STRESS TEST EKG|Medicaid|HENDERSON COUNTY INDIGENT|1,408.25||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|Managed Medicare|BCBS MEDICARE PPO MA|||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1,408.25||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1,408.25||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|Medicare|MEDICARE PART B ONLY IP|1,408.25||||||| 93017|EAP|0482|STRESS TEST EKG|Tricare|TRICARE EAST REGION|||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|Medicare|MEDICARE ACUTE|1,408.25||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|PHCS|HUMANA|||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,408.25||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|United Medicare Advantage|UHC MEDICARE GOLD MA|1,408.25||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|United Medicare Advantage|UHC AARP MCR HMO MA|||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1,408.25||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|Veterans Affairs|VETERANS ADMINISTRATION|1,408.25||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|Veterans Affairs|VETERANS ADMINISTRATION|1,408.25||||||| 93017|EAP|0482|STRESS TEST EKG|United Healthcare|UNITED HEALTHCARE|1,408.25||||1,408.25||| 93017|EAP|0482|STRESS TEST EKG|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1,408.25||| 93225|EAP|0731|HOLTER MONITOR 24 HOURS|United Healthcare|UNITED HEALTHCARE|||||2,080.50||| 93225|EAP|0731|HOLTER MONITOR 24 HOURS|United Healthcare|UNITED HEALTHCARE OTHER|||||2,080.50||| 93225|EAP|0731|HOLTER MONITOR 24 HOURS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2,080.50||| 93225|EAP|0731|HOLTER MONITOR 24 HOURS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2,080.50||| 93225|EAP|0731|HOLTER MONITOR 24 HOURS|Medicare|MEDICARE ACUTE|||||2,080.50||| 93225|EAP|0731|HOLTER MONITOR 24 HOURS|Managed Medicare|HEALTHSPRING MA|||||2,080.50||| 93225|EAP|0731|HOLTER MONITOR 24 HOURS|Managed Medicare|BCBS MEDICARE PPO MA|||||2,080.50||| 93225|EAP|0731|HOLTER MONITOR 24 HOURS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2,080.50||| 93225|EAP|0731|HOLTER MONITOR 24 HOURS|Blue Cross PPO Specialty|BCBSTX PPO|||||2,080.50||| 93225|EAP|0731|HOLTER MONITOR 24 HOURS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2,080.50||| 93225|EAP|0731|HOLTER MONITOR 24 HOURS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2,080.50||| 93225|EAP|0731|HOLTER MONITOR 24 HOURS|Managed Medicaid|MEDICAID SUPERIOR|||||2,080.50||| 93225|EAP|0731|HOLTER MONITOR 24 HOURS|Cigna|CIGNA|||||2,080.50||| 93225|EAP|0731|HOLTER MONITOR 24 HOURS|Humana Medicare Advantage|HUMANA MA|||||2,080.50||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Cigna|CIGNA OTHER|||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Cigna|CIGNA|39.97||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Cigna|CIGNA|||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|MTC Medical|VAN ZANDT COUNTY INMATE|39.97||||||| 93306|EAP|0480|ECHOCARDIO 2DM DOPLR MAPP|Managed Medicaid|MEDICAID UNITED HEALTHCARE|27.68||||27.68||| 93306|EAP|0480|ECHOCARDIO 2DM DOPLR MAPP|Managed Medicaid|MEDICAID SUPERIOR|27.68||||||| 93306|EAP|0480|ECHOCARDIO 2DM DOPLR MAPP|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||27.68||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Managed Medicaid|MEDICAID SUPERIOR|39.97||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|39.97||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Managed Medicaid|MEDICAID AMERIGROUP|39.97||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|ChampVA|CHAMPVA CENTER|||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Blue Cross PPO Specialty|BCBSTX PPO|39.97||||39.97||| 93306|EAP|0480|ECHOCARDIO 2DM DOPLR MAPP|Blue Cross HMO Specialty|BCBSTX HMO|||||27.68||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Blue Cross HMO Specialty|BCBSTX HMO|39.97||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Aenta Medicare Advantage|AETNA MEDICARE MA|39.97||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|39.97||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Access Direct Platinum|HEALTHFIRST TPA UMR|||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|39.97||||||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Aetna|AETNA PPO|39.97||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Medicaid|MOLINA HEALTHCARE OF TEXAS|39.97||||||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Aetna|AETNA OTHER|||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Medicaid|MEDICAID|39.97||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Medicaid|COUNTY INDIGENT HEALTH OTHER|39.97||||||| 93306|EAP|0480|ECHOCARDIO 2DM DOPLR MAPP|Managed Medicare|HEALTHSPRING MA|||||27.68||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Medicaid|MEDICAID HMO|||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Medicaid|HENDERSON COUNTY INDIGENT|39.97||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Managed Medicare|WELLCARE CHOICE MA|39.97||||||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Managed Medicare|VAN ZANDT COUNTY INMATE|39.97||||||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|39.97||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|39.97||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Managed Medicare|HEALTHSPRING MA|39.97||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Managed Medicare|BCBS MEDICARE PPO MA|39.97||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Texas Workforce Commission|DIS DETER SERV (DDS)|||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|39.97||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|39.97||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Medicare|MEDICARE ACUTE|39.97||||39.97||| 93306|EAP|0480|ECHOCARDIO 2DM DOPLR MAPP|Medicare|MEDICARE PART B ONLY IP|27.68||||||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Tricare|TRICARE EAST REGION|39.97||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|NON CONTRACTED|COMMERCIAL OTHER 1|39.97||||39.97||| 93306|EAP|0480|ECHOCARDIO 2DM DOPLR MAPP|Medicare|MEDICARE ACUTE|27.68||||||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Medicare|MEDICARE PART B ONLY IP|39.97||||||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|PHCS|HUMANA|||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Veterans Affairs|VETERANS ADMINISTRATION|39.97||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Humana Medicare Advantage|HUMANA MA|39.97||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|39.97||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|United Medicare Advantage|UHC MEDICARE GOLD MA|39.97||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|United Medicare Advantage|UHC AARP MCR HMO MA|||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Veterans Affairs|VETERANS ADMINISTRATION|39.97||||||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|39.97||||39.97||| 93306|EAP|0480|ECHOCARDIO 2DM DOPLR MAPP|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||27.68||| 93306|EAP|0480|ECHOCARDIO 2DM DOPLR MAPP|United Healthcare|TML GROUP BENEFITS|27.68||||||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|United Healthcare|UNITED HEALTHCARE|39.97||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|United Healthcare|UMR UNITED MEDICAL RESOURCES|39.97||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|United Healthcare|UNITED HEALTHCARE OTHER|||||39.97||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|United Healthcare|TML GROUP BENEFITS|39.97||||39.97||| 93308|EAP|0483|ECHO LTD OR F/U|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|868.50||||||| 93308|EAP|0483|ECHO LTD OR F/U|United Medicare Advantage|AARP UHC WEST COMPLETE MA|868.50||||||| 93308|EAP|0483|ECHO LTD OR F/U|Tricare|TRICARE EAST REGION|868.50||||868.50||| 93308|EAP|0483|ECHO LTD OR F/U|Medicare|MEDICARE ACUTE|868.50||||868.50||| 93308|EAP|0483|ECHO LTD OR F/U|Managed Medicare|HEALTHSPRING MA|868.50||||||| 93308|EAP|0483|ECHO LTD OR F/U|Blue Cross PPO Specialty|BCBSTX PPO|868.50||||||| 93308|EAP|0483|ECHO LTD OR F/U|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|868.50||||||| 93308|EAP|0483|ECHO LTD OR F/U|Blue Cross HMO Specialty|BCBSTX HMO|868.50||||||| 93308|EAP|0483|ECHO LTD OR F/U|Humana Medicare Advantage|HUMANA MA|868.50||||868.50||| 93312|EAP|0483|ECHO TRANSEOPHAGEAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3,533.75||||||| 93312|EAP|0483|ECHO TRANSEOPHAGEAL|Managed Medicaid|MEDICAID SUPERIOR|3,533.75||||||| 93312|EAP|0483|ECHO TRANSEOPHAGEAL|Humana Medicare Advantage|HUMANA MA|3,533.75||||3,533.75||| 93312|EAP|0483|ECHO TRANSEOPHAGEAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3,533.75||| 93312|EAP|0483|ECHO TRANSEOPHAGEAL|Blue Cross PPO Specialty|BCBSTX PPO|3,533.75||||3,533.75||| 93312|EAP|0483|ECHO TRANSEOPHAGEAL|Managed Medicare|HEALTHSPRING MA|3,533.75||||||| 93312|EAP|0483|ECHO TRANSEOPHAGEAL|Medicare|MEDICARE ACUTE|3,533.75||||3,533.75||| 93312|EAP|0483|ECHO TRANSEOPHAGEAL|Veterans Affairs|VETERANS ADMINISTRATION|3,533.75||||3,533.75||| 93312|EAP|0483|ECHO TRANSEOPHAGEAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3,533.75||||||| 93312|EAP|0483|ECHO TRANSEOPHAGEAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3,533.75||||3,533.75||| 93312|EAP|0483|ECHO TRANSEOPHAGEAL|United Medicare Advantage|UHC MEDICARE GOLD MA|3,533.75||||||| 93325|EAP|0483|DOPPLER COLOR FLOW VELOCI|United Healthcare|UNITED HEALTHCARE|1,292.75||||||| 93325|EAP|0483|DOPPLER COLOR FLOW VELOCI|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,292.75||||||| 93325|EAP|0483|DOPPLER COLOR FLOW VELOCI|Veterans Affairs|VETERANS ADMINISTRATION|||||1,292.75||| 93325|EAP|0483|DOPPLER COLOR FLOW VELOCI|United Medicare Advantage|UHC MEDICARE GOLD MA|1,292.75||||||| 93325|EAP|0483|DOPPLER COLOR FLOW VELOCI|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1,292.75||||||| 93325|EAP|0483|DOPPLER COLOR FLOW VELOCI|Medicare|MEDICARE ACUTE|1,292.75||||1,292.75||| 93325|EAP|0483|DOPPLER COLOR FLOW VELOCI|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||1,292.75||| 93325|EAP|0483|DOPPLER COLOR FLOW VELOCI|Blue Cross PPO Specialty|BCBSTX PPO|1,292.75||||1,292.75||| 93325|EAP|0483|DOPPLER COLOR FLOW VELOCI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,292.75||| 93325|EAP|0483|DOPPLER COLOR FLOW VELOCI|Humana Medicare Advantage|HUMANA MA|1,292.75||||1,292.75||| 93325|EAP|0483|DOPPLER COLOR FLOW VELOCI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1,292.75||||||| 93325|EAP|0483|DOPPLER COLOR FLOW VELOCI|Managed Medicaid|MEDICAID SUPERIOR|1,292.75||||||| 93351|EAP|0483|ECHO STRESS|Managed Medicaid|MEDICAID SUPERIOR|||||16.60||| 93351|EAP|0483|ECHO STRESS|Managed Medicaid|MEDICAID AMERIGROUP|||||16.60||| 93351|EAP|0483|ECHO STRESS|Cigna|CIGNA|||||16.60||| 93351|EAP|0483|ECHO STRESS W/CONTRAST|Humana Medicare Advantage|HUMANA MA|||||27.68||| 93351|EAP|0483|ECHO STRESS|Humana Medicare Advantage|HUMANA MA|||||16.60||| 93351|EAP|0483|ECHO STRESS|Aetna|AETNA PPO|||||16.60||| 93351|EAP|0483|ECHO STRESS|Blue Cross PPO Specialty|BCBSTX PPO|||||16.60||| 93351|EAP|0483|ECHO STRESS|Medicare|MEDICARE ACUTE|16.60||||16.60||| 93351|EAP|0483|ECHO STRESS W/CONTRAST|Texas Workforce Commission|DIS DETER SERV (DDS)|||||27.68||| 93351|EAP|0483|ECHO STRESS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||16.60||| 93880|EAP|0921|CAROTID ARTERY PROFILE|United Healthcare|UNITED HEALTHCARE OTHER|||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|United Healthcare|UNITED HEALTHCARE|||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|United Healthcare|UNITED HEALTHCARE|3,528.50||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3,528.50||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|United Medicare Advantage|UHC AARP MCR HMO MA|||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3,528.50||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|Veterans Affairs|VETERANS ADMINISTRATION|3,528.50||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|Managed Medicare|HEALTHSPRING MA|3,528.50||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|Managed Medicare|BCBS MEDICARE PPO MA|||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|Medicaid|HENDERSON COUNTY INDIGENT|3,528.50||||||| 93880|EAP|0921|CAROTID ARTERY PROFILE|Managed Medicare|MA PART B ONLY IP|3,528.50||||||| 93880|EAP|0921|CAROTID ARTERY PROFILE|Medicaid|MEDICAID|3,528.50||||||| 93880|EAP|0921|CAROTID ARTERY PROFILE|Multiplan|NALC|||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|Tricare|TRICARE EAST REGION|||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|Medicare|MEDICARE PART B ONLY IP|3,528.50||||||| 93880|EAP|0921|CAROTID ARTERY PROFILE|United Medicare Advantage|UHC MEDICARE GOLD MA|3,528.50||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|United Healthcare|GEHA|||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|Medicare|MEDICARE ACUTE|3,528.50||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|Blue Cross HMO Specialty|BCBSTX HMO|||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|Blue Cross PPO Specialty|BCBSTX PPO|3,528.50||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3,528.50||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|Aenta Medicare Advantage|AETNA MEDICARE MA|3,528.50||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|Aetna|AETNA PPO|||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|Cigna|CIGNA OTHER|||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|Humana Medicare Advantage|HUMANA MA|3,528.50||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|Cigna|CIGNA|||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|Managed Medicaid|MEDICAID SUPERIOR|||||3,528.50||| 93880|EAP|0921|CAROTID ARTERY PROFILE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3,528.50||| 93922|EAP|0921|ANKLE BRACHIAL INDEX|Humana Medicare Advantage|HUMANA MA|||||421.25||| 93922|EAP|0921|ANKLE BRACHIAL INDEX|Blue Cross HMO Specialty|BCBSTX HMO|||||421.25||| 93922|EAP|0921|ANKLE BRACHIAL INDEX|Medicare|MEDICARE ACUTE|421.25||||421.25||| 93922|EAP|0921|ANKLE BRACHIAL INDEX|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||421.25||| 93922|EAP|0921|ANKLE BRACHIAL INDEX|United Medicare Advantage|UHC MEDICARE GOLD MA|421.25||||421.25||| 93922|EAP|0921|ANKLE BRACHIAL INDEX|United Medicare Advantage|AARP UHC WEST COMPLETE MA|421.25||||421.25||| 93923|EAP|0921|LOWER ARTERIAL/SEGMENT PR|United Healthcare|TML GROUP BENEFITS|||||9.69||| 93923|EAP|0921|LOWER ARTERIAL/SEGMENT PR|Medicare|MEDICARE ACUTE|||||9.69||| 93923|EAP|0921|LOWER ARTERIAL/SEGMENT PR|Aenta Medicare Advantage|AETNA MEDICARE MA|||||9.69||| 93923|EAP|0921|LOWER ARTERIAL/SEGMENT PR|Humana Medicare Advantage|HUMANA MA|||||9.69||| 93925|EAP|0921|LOWER ARTERIAL/BILATERAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4,456.75||||4,456.75||| 93925|EAP|0921|LOWER ARTERIAL/BILATERAL|Managed Medicaid|MEDICAID SUPERIOR|||||4,456.75||| 93925|EAP|0921|LOWER ARTERIAL/BILATERAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4,456.75||||4,456.75||| 93925|EAP|0921|LOWER ARTERIAL/BILATERAL|Managed Medicaid|MEDICAID AMERIGROUP|||||4,456.75||| 93925|EAP|0921|LOWER ARTERIAL/BILATERAL|Blue Cross HMO Specialty|BCBSTX HMO|||||4,456.75||| 93925|EAP|0921|LOWER ARTERIAL/BILATERAL|Blue Cross PPO Specialty|BCBSTX PPO|||||4,456.75||| 93925|EAP|0921|LOWER ARTERIAL/BILATERAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4,456.75||| 93925|EAP|0921|LOWER ARTERIAL/BILATERAL|Humana Medicare Advantage|HUMANA MA|4,456.75||||4,456.75||| 93925|EAP|0921|LOWER ARTERIAL/BILATERAL|Aenta Medicare Advantage|AETNA MEDICARE MA|4,456.75||||4,456.75||| 93925|EAP|0921|LOWER ARTERIAL/BILATERAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4,456.75||| 93925|EAP|0921|LOWER ARTERIAL/BILATERAL|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||4,456.75||| 93925|EAP|0921|LOWER ARTERIAL/BILATERAL|Managed Medicare|HEALTHSPRING MA|4,456.75||||4,456.75||| 93925|EAP|0921|LOWER ARTERIAL/BILATERAL|Managed Medicare|BCBS MEDICARE PPO MA|4,456.75||||||| 93925|EAP|0921|LOWER ARTERIAL/BILATERAL|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||4,456.75||| 93925|EAP|0921|LOWER ARTERIAL/BILATERAL|Tricare|TRICARE EAST REGION|||||4,456.75||| 93925|EAP|0921|LOWER ARTERIAL/BILATERAL|Multiplan|NALC|||||4,456.75||| 93925|EAP|0921|LOWER ARTERIAL/BILATERAL|Medicare|MEDICARE ACUTE|4,456.75||||4,456.75||| 93925|EAP|0921|LOWER ARTERIAL/BILATERAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4,456.75||||4,456.75||| 93925|EAP|0921|LOWER ARTERIAL/BILATERAL|United Medicare Advantage|UHC MEDICARE GOLD MA|4,456.75||||4,456.75||| 93925|EAP|0921|LOWER ARTERIAL/BILATERAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4,456.75||| 93925|EAP|0921|LOWER ARTERIAL/BILATERAL|Veterans Affairs|VETERANS ADMINISTRATION|||||4,456.75||| 93925|EAP|0921|LOWER ARTERIAL/BILATERAL|United Healthcare|UNITED HEALTHCARE|||||4,456.75||| 93925|EAP|0921|LOWER ARTERIAL/BILATERAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4,456.75||| 93925|EAP|0921|LOWER ARTERIAL/BILATERAL|United Healthcare|TML GROUP BENEFITS|||||4,456.75||| 93926|EAP|0921|LOWER ARTERIAL/UNILATERAL|United Healthcare|UNITED HEALTHCARE|||||3,135.50||| 93926|EAP|0921|LOWER ARTERIAL/UNILATERAL|United Healthcare|GOLDEN RULE|||||3,135.50||| 93926|EAP|0921|LOWER ARTERIAL/UNILATERAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3,135.50||||3,135.50||| 93926|EAP|0921|LOWER ARTERIAL/UNILATERAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3,135.50||| 93926|EAP|0921|LOWER ARTERIAL/UNILATERAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3,135.50||||3,135.50||| 93926|EAP|0921|LOWER ARTERIAL/UNILATERAL|Medicare|MEDICARE ACUTE|3,135.50||||3,135.50||| 93926|EAP|0921|LOWER ARTERIAL/UNILATERAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|3,135.50||||||| 93926|EAP|0921|LOWER ARTERIAL/UNILATERAL|Managed Medicare|HEALTHSPRING MA|||||3,135.50||| 93926|EAP|0921|LOWER ARTERIAL/UNILATERAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3,135.50||| 93926|EAP|0921|LOWER ARTERIAL/UNILATERAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3,135.50||| 93926|EAP|0921|LOWER ARTERIAL/UNILATERAL|Aetna|AETNA PPO|||||3,135.50||| 93926|EAP|0921|LOWER ARTERIAL/UNILATERAL|Blue Cross HMO Specialty|BCBSTX HMO|||||3,135.50||| 93926|EAP|0921|LOWER ARTERIAL/UNILATERAL|Blue Cross PPO Specialty|BCBSTX PPO|||||3,135.50||| 93926|EAP|0921|LOWER ARTERIAL/UNILATERAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3,135.50||| 93926|EAP|0921|LOWER ARTERIAL/UNILATERAL|Cigna|CIGNA|||||3,135.50||| 93926|EAP|0921|LOWER ARTERIAL/UNILATERAL|Humana Medicare Advantage|HUMANA MA|3,135.50||||3,135.50||| 93926|EAP|0921|LOWER ARTERIAL/UNILATERAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3,135.50||| 93926|EAP|0921|LOWER ARTERIAL/UNILATERAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|3,135.50||||3,135.50||| 93930|EAP|0921|UPPER ARTERIAL|Humana Medicare Advantage|HUMANA MA|||||1,928.25||| 93930|EAP|0921|UPPER ARTERIAL|Medicare|MEDICARE ACUTE|||||1,928.25||| 93931|EAP|0921|UPPER ARTERIAL/UNILATERAL|United Healthcare|UNITED HEALTHCARE OTHER|||||1,928.25||| 93931|EAP|0921|UPPER ARTERIAL/UNILATERAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,928.25||| 93931|EAP|0921|UPPER ARTERIAL/UNILATERAL|Medicare|MEDICARE ACUTE|||||1,928.25||| 93931|EAP|0921|UPPER ARTERIAL/UNILATERAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,928.25||| 93931|EAP|0921|UPPER ARTERIAL/UNILATERAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1,928.25||| 93931|EAP|0921|UPPER ARTERIAL/UNILATERAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1,928.25||||1,928.25||| 93931|EAP|0921|UPPER ARTERIAL/UNILATERAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,928.25||| 93931|EAP|0921|UPPER ARTERIAL/UNILATERAL|Managed Medicaid|MEDICAID AMERIGROUP|||||1,928.25||| 93931|EAP|0921|UPPER ARTERIAL/UNILATERAL|Humana Medicare Advantage|HUMANA MA|||||1,928.25||| 93970|EAP|0921|VENOUS PROFILE|Humana Medicare Advantage|HUMANA MA|3,947.75||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|Cigna|CIGNA|||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|Cigna|CIGNA|3,947.75||||||| 93970|EAP|0921|VENOUS PROFILE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3,947.75||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|Managed Medicaid|MEDICAID AMERIGROUP|3,947.75||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|Aenta Medicare Advantage|AETNA MEDICARE MA|3,947.75||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|Aetna|AETNA PPO|||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|Blue Cross HMO Specialty|BCBSTX HMO|||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|3,947.75||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|ChampVA|CHAMPVA CENTER|||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|Blue Cross PPO Specialty|BCBSTX PPO|3,947.75||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|Managed Medicaid|MEDICAID SUPERIOR|||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|Managed Medicare|HEALTHSPRING MA|3,947.75||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|Medicaid|MEDICAID|3,947.75||||||| 93970|EAP|0921|VENOUS PROFILE|Medicaid|LAW ENFORCEMENT OTHER|||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|Cigna|CIGNA OTHER|||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|Tricare|TRICARE FOR LIFE|||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|Tricare|TRICARE EAST REGION|3,947.75||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|NON CONTRACTED|COMMERCIAL OTHER 1|3,947.75||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|Medicare|MEDICARE ACUTE|3,947.75||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3,947.75||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|United Medicare Advantage|UHC MEDICARE GOLD MA|3,947.75||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|Veterans Affairs|VETERANS ADMINISTRATION|3,947.75||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3,947.75||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|United Healthcare|UNITED HEALTHCARE OTHER|||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|United Healthcare|UNITED HEALTHCARE|||||3,947.75||| 93970|EAP|0921|VENOUS PROFILE|United Healthcare|UMR UNITED MEDICAL RESOURCES|3,947.75||||||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|United Healthcare|UNITED HEALTHCARE|||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|United Healthcare|GOLDEN RULE|||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Workers Compensation|WORKERS COMPENSATION OTHER|||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2,884.75||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|United Medicare Advantage|UHC AARP MCR HMO MA|||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Veterans Affairs|VETERANS ADMINISTRATION|2,884.75||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Tricare|TRICARE EAST REGION|||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|PHCS|HUMANA INSURANCE|||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Medicare|MEDICARE ACUTE|2,884.75||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Managed Medicare|OTHER INSTITUTIONS|||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2,884.75||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|2,884.75||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Managed Medicare|HEALTHSPRING MA|2,884.75||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|UTMB|UTMB CORRECTIONAL MANAGED CARE|||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Managed Medicare|BCBS MEDICARE PPO MA|2,884.75||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Medicaid|LAW ENFORCEMENT OTHER|2,884.75||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Medicaid|MEDICAID|2,884.75||||||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2,884.75||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2,884.75||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Blue Cross HMO Specialty|BCBSTX HMO|||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Blue Cross PPO Specialty|BCBSTX PPO|2,884.75||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Aenta Medicare Advantage|AETNA MEDICARE MA|2,884.75||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Aetna|AETNA OTHER|||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Aetna|AETNA PPO|2,884.75||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2,884.75||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Managed Medicaid|MEDICAID SUPERIOR|2,884.75||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2,884.75||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Managed Medicaid|MEDICAID AMERIGROUP|||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Humana Medicare Advantage|HUMANA MA|2,884.75||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Cigna|CIGNA|2,884.75||||2,884.75||| 93971|EAP|0921|VENOUS PROFILE UNILATERAL|Cigna|CIGNA|||||2,884.75||| 93978|EAP|0921|SONO ABD VASCULAR|Managed Medicare|HEALTHSPRING MA|||||2,092.50||| 93978|EAP|0921|SONO ABD VASCULAR|Medicare|MEDICARE ACUTE|||||2,092.50||| 940|DRG||O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W CC|Humana Medicare Advantage|HUMANA MA|44,719.30|16159.24|16159.24|16159.24|||| 94002|EAP|0410|VENTILATOR INITIAL DAY|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2,764.25||||2,764.25||| 94002|EAP|0410|VENTILATOR INITIAL DAY|United Medicare Advantage|UHC MEDICARE GOLD MA|2,764.25||||2,764.25||| 94002|EAP|0410|VENTILATOR INITIAL DAY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2,764.25||||||| 94002|EAP|0410|VENTILATOR INITIAL DAY|United Healthcare|UMR UNITED MEDICAL RESOURCES|2,764.25||||||| 94002|EAP|0410|VENTILATOR INITIAL DAY|Medicare|MEDICARE ACUTE|2,764.25||||2,764.25||| 94002|EAP|0410|VENTILATOR INITIAL DAY|NON CONTRACTED|COMMERCIAL OTHER 1|2,764.25||||||| 94002|EAP|0410|VENTILATOR INITIAL DAY|Medicaid|MEDICAID TEXAS CHILDRENS|||||2,764.25||| 94002|EAP|0410|VENTILATOR INITIAL DAY|UTMB|UTMB CORRECTIONAL MANAGED CARE|2,764.25||||||| 94002|EAP|0410|VENTILATOR INITIAL DAY|Medicaid|MEDICAID|2,764.25||||||| 94002|EAP|0410|VENTILATOR INITIAL DAY|Aenta Medicare Advantage|AETNA MEDICARE MA|2,764.25||||||| 94002|EAP|0410|VENTILATOR INITIAL DAY|Aetna|AETNA PPO|2,764.25||||||| 94002|EAP|0410|VENTILATOR INITIAL DAY|Blue Cross PPO Specialty|BCBSTX PPO|||||2,764.25||| 94002|EAP|0410|VENTILATOR INITIAL DAY|Veterans Affairs|VETERANS ADMINISTRATION|2,764.25||||2,764.25||| 94002|EAP|0410|VENTILATOR INITIAL DAY|Blue Cross HMO Specialty|BCBSTX HMO|2,764.25||||||| 94002|EAP|0410|VENTILATOR INITIAL DAY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2,764.25||||2,764.25||| 94002|EAP|0410|VENTILATOR INITIAL DAY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2,764.25||||2,764.25||| 94002|EAP|0410|VENTILATOR INITIAL DAY|Managed Medicaid|MEDICAID SUPERIOR|2,764.25||||2,764.25||| 94002|EAP|0410|VENTILATOR INITIAL DAY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2,764.25||||||| 94002|EAP|0410|VENTILATOR INITIAL DAY|Managed Medicaid|MEDICAID AMERIGROUP|2,764.25||||||| 94002|EAP|0410|VENTILATOR INITIAL DAY|Managed Medicare|BCBS MEDICARE PPO MA|2,764.25||||2,764.25||| 94002|EAP|0410|VENTILATOR INITIAL DAY|Managed Medicare|HOSPICE OF EAST TEXAS|2,764.25||||||| 94002|EAP|0410|VENTILATOR INITIAL DAY|Managed Medicare|HEALTHSPRING MA|2,764.25||||2,764.25||| 94002|EAP|0410|VENTILATOR INITIAL DAY|Humana Medicare Advantage|HUMANA MA|2,764.25||||2,764.25||| 94002|EAP|0410|VENTILATOR INITIAL DAY|Cigna|CIGNA OTHER|2,764.25||||||| 94003|EAP|0410|VENTILATOR SUBSEQUENT DAY|Humana Medicare Advantage|HUMANA MA|2,258.50||||||| 94003|EAP|0410|VENTILATOR SUBSEQUENT DAY|Managed Medicaid|MEDICAID SUPERIOR|||||2,258.50||| 94003|EAP|0410|VENTILATOR SUBSEQUENT DAY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2,258.50||||2,258.50||| 94003|EAP|0410|VENTILATOR SUBSEQUENT DAY|Aetna|AETNA PPO|2,258.50||||||| 94003|EAP|0410|VENTILATOR SUBSEQUENT DAY|Medicare|MEDICARE ACUTE|2,258.50||||||| 94003|EAP|0410|VENTILATOR SUBSEQUENT DAY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2,258.50||||||| 94003|EAP|0410|VENTILATOR SUBSEQUENT DAY|United Medicare Advantage|UHC MEDICARE GOLD MA|2,258.50||||||| 94010|EAP|0460|PULMONARY FUNCTION BASIC|United Medicare Advantage|UHC MEDICARE GOLD MA|||||609.25||| 94010|EAP|0460|PULMONARY FUNCTION BASIC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||609.25||| 94010|EAP|0460|PULMONARY FUNCTION BASIC|Veterans Affairs|VETERANS ADMINISTRATION|||||609.25||| 94010|EAP|0460|PULMONARY FUNCTION BASIC|Medicaid|MEDICAID|||||609.25||| 94010|EAP|0460|PULMONARY FUNCTION BASIC|Managed Medicare|HEALTHSPRING MA|||||609.25||| 94010|EAP|0460|PULMONARY FUNCTION BASIC|Tricare|TRICARE EAST REGION|||||609.25||| 94010|EAP|0460|PULMONARY FUNCTION BASIC|Medicare|MEDICARE ACUTE|609.25||||609.25||| 94010|EAP|0460|PULMONARY FUNCTION BASIC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||609.25||| 94010|EAP|0460|PULMONARY FUNCTION BASIC|Aenta Medicare Advantage|AETNA MEDICARE MA|||||609.25||| 94010|EAP|0460|PULMONARY FUNCTION BASIC|Blue Cross PPO Specialty|BCBSTX PPO|||||609.25||| 94010|EAP|0460|PULMONARY FUNCTION BASIC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||609.25||| 94010|EAP|0460|PULMONARY FUNCTION BASIC|Blue Cross PPO Specialty|BCBSTX OTHER|||||609.25||| 94010|EAP|0460|PULMONARY FUNCTION BASIC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||609.25||| 94010|EAP|0460|PULMONARY FUNCTION BASIC|Managed Medicaid|MEDICAID SUPERIOR|||||609.25||| 94010|EAP|0460|PULMONARY FUNCTION BASIC|Humana Medicare Advantage|HUMANA MA|||||609.25||| 94010|EAP|0460|PULMONARY FUNCTION BASIC|Cigna|CIGNA|||||609.25||| 94060|EAP|0460|PFT B/A BRONCHDILATOR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|9.31||||||| 94060|EAP|0460|PFT B/A BRONCHDILATOR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|9.31||||||| 94060|EAP|0460|PFT B/A BRONCHDILATOR|Managed Medicaid|MEDICAID AMERIGROUP|9.31||||||| 94060|EAP|0460|PFT B/A BRONCHDILATOR|Blue Cross PPO Specialty|BCBSTX PPO|||||9.31||| 94060|EAP|0460|PFT B/A BRONCHDILATOR|Blue Cross HMO Specialty|BCBSTX HMO|||||9.31||| 94060|EAP|0460|PFT B/A BRONCHDILATOR|Aenta Medicare Advantage|AETNA MEDICARE MA|9.31||||||| 94060|EAP|0460|PFT B/A BRONCHDILATOR|Medicare|MEDICARE ACUTE|9.31||||9.31||| 94060|EAP|0460|PFT B/A BRONCHDILATOR|Humana Medicare Advantage|HUMANA MA|9.31||||9.31||| 94060|EAP|0460|TEXAS REHAB PFT|Texas Workforce Commission|DIS DETER SERV (DDS)|||||858.25||| 94060|EAP|0460|PFT B/A BRONCHDILATOR|Medicaid|HENDERSON COUNTY INDIGENT|||||9.31||| 94060|EAP|0460|PFT B/A BRONCHDILATOR|Medicaid|MEDICAID|||||9.31||| 94060|EAP|0460|PFT B/A BRONCHDILATOR|Managed Medicare|HEALTHSPRING MA|9.31||||9.31||| 94060|EAP|0460|PFT B/A BRONCHDILATOR|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||9.31||| 94060|EAP|0460|PFT B/A BRONCHDILATOR|United Medicare Advantage|UHC MEDICARE GOLD MA|9.31||||9.31||| 94060|EAP|0460|PFT B/A BRONCHDILATOR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|9.31||||9.31||| 94060|EAP|0460|PFT B/A BRONCHDILATOR|Veterans Affairs|VETERANS ADMINISTRATION|9.31||||9.31||| 94640|EAP|0410|UP-DRAFT NEBULIZER|United Healthcare|UNITED HEALTHCARE OTHER|||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|United Healthcare|UNITED HEALTHCARE|141.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|United Healthcare|UMR UNITED MEDICAL RESOURCES|148.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|United Medicare Advantage|UHC MEDICARE GOLD MA|141.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|United Medicare Advantage|UHC AARP MCR HMO MA|||||141.75||| 94640|EAP|0410|METERED DOSE INHALER|Veterans Affairs|VETERANS ADMINISTRATION|148.75||||148.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|United Medicare Advantage|AARP UHC WEST COMPLETE MA|148.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|United Medicare Advantage|UHC MEDICARE GOLD MA|148.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|141.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|United Medicare Advantage|AARP UHC WEST COMPLETE MA|141.75||||141.75||| 94640|EAP|0410|METERED DOSE INHALER|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|148.75||||148.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Medicaid|MEDICAID TEXAS CHILDRENS|||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Medicaid|MEDICAID HMO|141.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Medicaid|MEDICAID|141.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Medicaid|COUNTY INDIGENT HEALTH OTHER|141.75||||||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Medicaid|HENDERSON COUNTY INDIGENT|141.75||||||| 94640|EAP|0410|METERED DOSE INHALER|Medicaid|HENDERSON COUNTY INDIGENT|148.75||||||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Medicaid|MOLINA HEALTHCARE OF TEXAS|141.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Tricare|TRICARE EAST REGION|141.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|UTMB|UTMB CORRECTIONAL MANAGED CARE|141.75||||||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Medicare|MEDICARE ACUTE|141.75||||141.75||| 94640|EAP|0410|METERED DOSE INHALER|NON CONTRACTED|COMMERCIAL OTHER 1|141.75||||148.75||| 94640|EAP|0410|METERED DOSE INHALER|UTMB|UTMB CORRECTIONAL MANAGED CARE|148.75||||||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Medicare|MEDICARE PART B ONLY IP|141.75||||||| 94640|EAP|0410|METERED DOSE INHALER|Medicare|MEDICARE ACUTE|148.75||||148.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Aenta Medicare Advantage|AETNA MEDICARE MA|148.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|141.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Aenta Medicare Advantage|AETNA MEDICARE MA|141.75||||141.75||| 94640|EAP|0410|METERED DOSE INHALER|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|148.75||||148.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|141.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Aetna|AETNA PPO|141.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Aetna|AETNA OTHER|||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|148.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|141.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Blue Cross PPO Specialty|BCBSTX PPO|141.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|NON CONTRACTED|COMMERCIAL OTHER 1|141.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|141.75||||||| 94640|EAP|0410|METERED DOSE INHALER|Blue Cross PPO Specialty|BCBSTX PPO|148.75||||148.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Tricare|TRICARE EAST REGION|148.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|ChampVA|CHAMPVA CENTER|141.75||||141.75||| 94640|EAP|0410|METERED DOSE INHALER|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|148.75||||||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Blue Cross HMO Specialty|BCBSTX HMO|148.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Blue Cross HMO Specialty|BCBSTX HMO|141.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Managed Medicare|VAN ZANDT COUNTY INMATE|141.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Managed Medicaid|MEDICAID UNITED HEALTHCARE|148.75||||141.75||| 94640|EAP|0410|METERED DOSE INHALER|Medicaid|COUNTY INDIGENT HEALTH OTHER|148.75||||||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Managed Medicaid|MEDICAID UNITED HEALTHCARE|141.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Managed Medicaid|MEDICAID SUPERIOR|141.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|148.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|141.75||||141.75||| 94640|EAP|0410|METERED DOSE INHALER|Workers Compensation|UT EMPLOYEE INJURY|148.75||||||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Managed Medicaid|MEDICAID AMERIGROUP|141.75||||141.75||| 94640|EAP|0410|METERED DOSE INHALER|Managed Medicaid|MEDICAID SUPERIOR|148.75||||148.75||| 94640|EAP|0410|METERED DOSE INHALER|Managed Medicaid|MEDICAID AMERIGROUP|148.75||||148.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|141.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Veterans Affairs|VETERANS ADMINISTRATION|141.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Managed Medicare|BCBS MEDICARE PPO MA|148.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|141.75||||141.75||| 94640|EAP|0410|METERED DOSE INHALER|United Healthcare|UNITED HEALTHCARE|148.75||||148.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Managed Medicare|HEALTHSPRING MA|141.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Managed Medicare|WELLCARE CHOICE MA|||||141.75||| 94640|EAP|0410|METERED DOSE INHALER|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|148.75||||148.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Managed Medicare|BCBS MEDICARE PPO MA|141.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Managed Medicare|MA PART B ONLY IP|141.75||||||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Managed Medicare|HOSPICE GENESIS|141.75||||||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Managed Medicare|HEALTHSPRING MA|148.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|MTC Medical|VAN ZANDT COUNTY INMATE|141.75||||141.75||| 94640|EAP|0410|METERED DOSE INHALER|Humana Medicare Advantage|HUMANA MA|148.75||||148.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Humana Medicare Advantage|HUMANA MA|141.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Cigna|CIGNA OTHER|||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Cigna|CIGNA|148.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Cigna|CIGNA|141.75||||141.75||| 94640|EAP|0410|UP-DRAFT NEBULIZER|Cigna|CIGNA|141.75||||||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|Humana Medicare Advantage|HUMANA MA|766.25||||766.25||| 94660|EAP|0410|BIPAP/CPAP ADDL DAY|Humana Medicare Advantage|HUMANA MA|766.25||||766.25||| 94660|EAP|0410|BIPAP/CPAP ADDL DAY|Cigna|CIGNA|766.25||||||| 94660|EAP|0410|BIPAP/CPAP ADDL DAY|Managed Medicare|BCBS MEDICARE PPO MA|766.25||||||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|766.25||||766.25||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|Managed Medicaid|MEDICAID SUPERIOR|766.25||||766.25||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|766.25||||766.25||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|Managed Medicaid|MEDICAID AMERIGROUP|766.25||||||| 94660|EAP|0410|BIPAP/CPAP ADDL DAY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|766.25||||766.25||| 94660|EAP|0410|BIPAP/CPAP ADDL DAY|Managed Medicaid|MEDICAID AMERIGROUP|766.25||||||| 94660|EAP|0410|BIPAP/CPAP ADDL DAY|Managed Medicare|HEALTHSPRING MA|766.25||||766.25||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|Managed Medicare|MA PART B ONLY IP|766.25||||||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|Managed Medicare|HEALTHSPRING MA|766.25||||766.25||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|Managed Medicare|BCBS MEDICARE PPO MA|766.25||||||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|766.25||||766.25||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|766.25||||||| 94660|EAP|0410|BIPAP/CPAP ADDL DAY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|766.25||||766.25||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|Blue Cross PPO Specialty|BCBSTX PPO|766.25||||766.25||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|Blue Cross HMO Specialty|BCBSTX HMO|766.25||||766.25||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|Aenta Medicare Advantage|AETNA MEDICARE MA|766.25||||766.25||| 94660|EAP|0410|BIPAP/CPAP ADDL DAY|Aetna|AETNA PPO|766.25||||||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|Aetna|AETNA PPO|766.25||||||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|NON CONTRACTED|COMMERCIAL OTHER 1|766.25||||||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|Tricare|TRICARE EAST REGION|766.25||||||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|UTMB|UTMB CORRECTIONAL MANAGED CARE|766.25||||||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|Cigna|CIGNA|766.25||||||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|Medicare|MEDICARE ACUTE|766.25||||766.25||| 94660|EAP|0410|BIPAP/CPAP ADDL DAY|Medicare|MEDICARE ACUTE|766.25||||766.25||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|Medicaid|MOLINA HEALTHCARE OF TEXAS|766.25||||||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|Medicaid|MEDICAID|766.25||||||| 94660|EAP|0410|BIPAP/CPAP ADDL DAY|Medicaid|MEDICAID|766.25||||||| 94660|EAP|0410|BIPAP/CPAP ADDL DAY|Medicaid|MOLINA HEALTHCARE OF TEXAS|766.25||||||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|766.25||||766.25||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|United Medicare Advantage|UHC MEDICARE GOLD MA|766.25||||766.25||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|Veterans Affairs|VETERANS ADMINISTRATION|766.25||||766.25||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|766.25||||766.25||| 94660|EAP|0410|BIPAP/CPAP ADDL DAY|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|766.25||||766.25||| 94660|EAP|0410|BIPAP/CPAP ADDL DAY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|766.25||||766.25||| 94660|EAP|0410|BIPAP/CPAP INITIAL DAY|United Healthcare|UNITED HEALTHCARE|||||766.25||| 94664|EAP|0410|ULTRASONIC VAPORIZER|United Healthcare|UNITED HEALTHCARE|||||134.25||| 94664|EAP|0410|ULTRASONIC VAPORIZER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|134.25||||||| 94664|EAP|0410|ULTRASONIC VAPORIZER|Managed Medicaid|MEDICAID AMERIGROUP|134.25||||134.25||| 94667|EAP|0410|ACAPELLA FLUTE VALUE|Managed Medicare|HEALTHSPRING MA|137.50||||||| 94667|EAP|0410|ACAPELLA FLUTE VALUE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|137.50||||||| 94667|EAP|0410|ACAPELLA FLUTE VALUE|Managed Medicaid|MEDICAID SUPERIOR|137.50||||||| 94667|EAP|0410|ACAPELLA FLUTE VALUE|Humana Medicare Advantage|HUMANA MA|137.50||||137.50||| 94667|EAP|0410|ACAPELLA FLUTE VALUE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|137.50||||||| 94667|EAP|0410|ACAPELLA FLUTE VALUE|Managed Medicaid|MEDICAID AMERIGROUP|137.50||||||| 94667|EAP|0410|ACAPELLA FLUTE VALUE|Aenta Medicare Advantage|AETNA MEDICARE MA|137.50||||||| 94667|EAP|0410|ACAPELLA FLUTE VALUE|Blue Cross PPO Specialty|BCBSTX PPO|137.50||||||| 94667|EAP|0410|ACAPELLA FLUTE VALUE|Medicaid|MOLINA HEALTHCARE OF TEXAS|137.50||||||| 94667|EAP|0410|ACAPELLA FLUTE VALUE|Medicaid|HENDERSON COUNTY INDIGENT|137.50||||||| 94667|EAP|0410|ACAPELLA FLUTE VALUE|Medicare|MEDICARE ACUTE|137.50||||137.50||| 94667|EAP|0410|ACAPELLA FLUTE VALUE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|137.50||||||| 94667|EAP|0410|ACAPELLA FLUTE VALUE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|137.50||||||| 94667|EAP|0410|ACAPELLA FLUTE VALUE|Veterans Affairs|VETERANS ADMINISTRATION|137.50||||||| 94667|EAP|0410|ACAPELLA FLUTE VALUE|United Medicare Advantage|UHC MEDICARE GOLD MA|137.50||||||| 94668|EAP|0410|PERCUSSION & POSTURAL DRA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|331.50||||||| 94668|EAP|0410|PERCUSSION & POSTURAL DRA|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|331.50||||||| 94668|EAP|0410|PERCUSSION & POSTURAL DRA|United Medicare Advantage|UHC MEDICARE GOLD MA|331.50||||||| 94668|EAP|0410|PERCUSSION & POSTURAL DRA|Medicare|MEDICARE ACUTE|331.50||||||| 94668|EAP|0410|PERCUSSION & POSTURAL DRA|Blue Cross PPO Specialty|BCBSTX PPO|331.50||||||| 94668|EAP|0410|PERCUSSION & POSTURAL DRA|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|331.50||||||| 94668|EAP|0410|PERCUSSION & POSTURAL DRA|Managed Medicaid|MEDICAID AMERIGROUP|331.50||||||| 94668|EAP|0410|PERCUSSION & POSTURAL DRA|Humana Medicare Advantage|HUMANA MA|331.50||||||| 94729|EAP|0460|DLCO (DIFFUSION CAPACITY)|Humana Medicare Advantage|HUMANA MA|||||434.25||| 94729|EAP|0460|DLCO (DIFFUSION CAPACITY)|Blue Cross PPO Specialty|BCBSTX PPO|||||434.25||| 94729|EAP|0460|DLCO (DIFFUSION CAPACITY)|Medicaid|MEDICAID|||||434.25||| 94729|EAP|0460|DLCO (DIFFUSION CAPACITY)|Medicare|MEDICARE ACUTE|434.25||||434.25||| 94729|EAP|0460|DLCO (DIFFUSION CAPACITY)|Texas Workforce Commission|DIS DETER SERV (DDS)|||||434.25||| 94729|EAP|0460|DLCO (DIFFUSION CAPACITY)|United Medicare Advantage|UHC MEDICARE GOLD MA|||||434.25||| 94729|EAP|0460|DLCO (DIFFUSION CAPACITY)|United Medicare Advantage|AARP UHC WEST COMPLETE MA|434.25||||434.25||| 94729|EAP|0460|DLCO (DIFFUSION CAPACITY)|Veterans Affairs|VETERANS ADMINISTRATION|||||434.25||| 94760|EAP|0460|PULSE OXIMETER PER DAY|United Healthcare|UMR UNITED MEDICAL RESOURCES|564.75||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|564.75||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|United Medicare Advantage|UHC MEDICARE GOLD MA|564.75||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|564.75||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Veterans Affairs|VETERANS ADMINISTRATION|564.75||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Tricare|TRICARE EAST REGION|564.75||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|NON CONTRACTED|COMMERCIAL OTHER 1|564.75||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Medicaid|HENDERSON COUNTY INDIGENT|564.75||||||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Medicaid|COUNTY INDIGENT HEALTH OTHER|564.75||||||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Medicaid|MOLINA HEALTHCARE OF TEXAS|564.75||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Medicaid|MEDICAID HMO|||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Medicaid|MEDICAID|564.75||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|564.75||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Managed Medicare|HEALTHSPRING MA|564.75||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Managed Medicare|BCBS MEDICARE PPO MA|564.75||||||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Medicare|MEDICARE ACUTE|564.75||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Aenta Medicare Advantage|AETNA MEDICARE MA|564.75||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Workers Compensation|WORKERS COMPENSATION OTHER|||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|564.75||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Aetna|AETNA PPO|564.75||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Aetna|AETNA OTHER|||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|ChampVA|CHAMPVA CENTER|564.75||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|United Healthcare|UNITED HEALTHCARE|564.75||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Blue Cross PPO Specialty|BCBSTX PPO|564.75||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Blue Cross PPO Specialty|BCBSTX OTHER|||||564.75||| 94760|EAP|0460|PULSE OXIMETER|Blue Cross PPO Specialty|BCBSTX PPO|564.75||||184.50||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|564.75||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Blue Cross HMO Specialty|BCBSTX HMO|564.75||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|564.75||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Managed Medicaid|MEDICAID SUPERIOR|564.75||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|564.75||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Managed Medicaid|MEDICAID AMERIGROUP|564.75||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Cigna|CIGNA|564.75||||||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Cigna|CIGNA|564.75||||564.75||| 94760|EAP|0460|PULSE OXIMETER PER DAY|Humana Medicare Advantage|HUMANA MA|564.75||||564.75||| 94799|EAP|0460|INCENTIVE SPIROMETRY|Cigna|CIGNA|214.25||||||| 94799|EAP|0460|INCENTIVE SPIROMETRY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|214.25||||214.25||| 94799|EAP|0460|INCENTIVE SPIROMETRY|Managed Medicaid|MEDICAID SUPERIOR|214.25||||||| 94799|EAP|0460|INCENTIVE SPIROMETRY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|214.25||||214.25||| 94799|EAP|0460|INCENTIVE SPIROMETRY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|214.25||||214.25||| 94799|EAP|0460|INCENTIVE SPIROMETRY|Blue Cross HMO Specialty|BCBSTX HMO|214.25||||||| 94799|EAP|0460|INCENTIVE SPIROMETRY|Aenta Medicare Advantage|AETNA MEDICARE MA|214.25||||||| 94799|EAP|0460|INCENTIVE SPIROMETRY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|214.25||||||| 94799|EAP|0460|INCENTIVE SPIROMETRY|Aetna|AETNA PPO|214.25||||214.25||| 94799|EAP|0460|INCENTIVE SPIROMETRY|Managed Medicare|HEALTHSPRING MA|||||214.25||| 94799|EAP|0460|INCENTIVE SPIROMETRY|Managed Medicare|OTHER INSTITUTIONS|||||214.25||| 94799|EAP|0460|INCENTIVE SPIROMETRY|Blue Cross PPO Specialty|BCBSTX PPO|214.25||||214.25||| 94799|EAP|0460|INCENTIVE SPIROMETRY|Medicaid|MOLINA HEALTHCARE OF TEXAS|214.25||||||| 94799|EAP|0460|INCENTIVE SPIROMETRY|Medicaid|HENDERSON COUNTY INDIGENT|214.25||||||| 94799|EAP|0460|INCENTIVE SPIROMETRY|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|214.25||||||| 94799|EAP|0460|INCENTIVE SPIROMETRY|Medicare|MEDICARE PART B ONLY IP|214.25||||||| 94799|EAP|0460|INCENTIVE SPIROMETRY|Humana Medicare Advantage|HUMANA MA|214.25||||214.25||| 94799|EAP|0460|INCENTIVE SPIROMETRY|Tricare|TRICARE EAST REGION|214.25||||||| 94799|EAP|0460|INCENTIVE SPIROMETRY|Medicare|MEDICARE ACUTE|214.25||||214.25||| 94799|EAP|0460|INCENTIVE SPIROMETRY|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|214.25||||214.25||| 94799|EAP|0460|INCENTIVE SPIROMETRY|United Medicare Advantage|UHC MEDICARE GOLD MA|214.25||||214.25||| 94799|EAP|0460|INCENTIVE SPIROMETRY|Veterans Affairs|VETERANS ADMINISTRATION|214.25||||||| 94799|EAP|0460|INCENTIVE SPIROMETRY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|214.25||||214.25||| 94799|EAP|0460|INCENTIVE SPIROMETRY|Veterans Affairs|VETERANS ADMINISTRATION|||||214.25||| 94799|EAP|0460|INCENTIVE SPIROMETRY|United Healthcare|UNITED HEALTHCARE OTHER|214.25||||||| 94799|EAP|0460|INCENTIVE SPIROMETRY|United Healthcare|UNITED HEALTHCARE|214.25||||214.25||| 94799|EAP|0460|INCENTIVE SPIROMETRY|United Healthcare|GEHA|||||214.25||| 94799|EAP|0460|INCENTIVE SPIROMETRY|United Healthcare|UMR UNITED MEDICAL RESOURCES|214.25||||||| 948|DRG||SIGNS & SYMPTOMS W/O MCC|Medicare|MEDICARE ACUTE|29,560.88|6933.04|6933.04|1250.95|||| 948|DRG||SIGNS & SYMPTOMS W/O MCC|Blue Cross HMO Specialty|BCBSTX HMO|24,289.90|3326.77|6933.04|1250.95|||| 948|DRG||SIGNS & SYMPTOMS W/O MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|24,382.75|1250.95|6933.04|1250.95|||| 948|DRG||SIGNS & SYMPTOMS W/O MCC|Humana Medicare Advantage|HUMANA MA|11,086.25|6912.26|6933.04|1250.95|||| 95|DRG||BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W CC|Medicare|MEDICARE ACUTE|83,734.22|17303.65|17303.65|17303.65|||| 9500034|ERX|0250|ACETAM-COD 120-12MG/5ML E|Managed Medicaid|MEDICAID SUPERIOR|||||4.50||| 9500034|ERX|0250|ACETAM-COD 120-12MG/5ML E|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9500034|ERX|0250|ACETAM-COD 120-12MG/5ML E|Managed Medicaid|MEDICAID AMERIGROUP|||||4.50||| 9500034|ERX|0250|ACETAM-COD 120-12MG/5ML E|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.50||| 9500034|ERX|0250|ACETAM-COD 120-12MG/5ML E|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9500034|ERX|0250|ACETAM-COD 120-12MG/5ML E|Blue Cross PPO Specialty|BCBSTX PPO|||||4.50||| 9500034|ERX|0250|ACETAM-COD 120-12MG/5ML E|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4.50||| 9500034|ERX|0250|ACETAM-COD 120-12MG/5ML E|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9500034|ERX|0250|ACETAM-COD 120-12MG/5ML E|Medicaid|MEDICAID|||||4.50||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||28.25||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|28.25||||28.25||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|Workers Compensation|WORKERS COMPENSATION OTHER|||||28.25||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|Workers Compensation|TEXAS MUTUAL INSURANCE|||||28.25||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|Veterans Affairs|VETERANS ADMINISTRATION|||||28.25||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|Medicare|MEDICARE ACUTE|28.25||||28.25||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|Medicaid|MEDICAID|28.25||||||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|Medicaid|MEDICAID HMO|28.25||||||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|Tricare|TRICARE EAST REGION|28.25||||28.25||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|NON CONTRACTED|COMMERCIAL OTHER 1|28.25||||28.25||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|United Healthcare|UMR UNITED MEDICAL RESOURCES|28.25||||||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|United Healthcare|UNITED HEALTHCARE|28.25||||28.25||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|United Healthcare|UNITED HEALTHCARE|28.25||||||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|United Healthcare|UNITED HEALTHCARE OTHER|||||28.25||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|PHCS|HUMANA|28.25||||||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|Texas Workforce Commission|DIS DETER SERV (DDS)|28.25||||||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|Medicaid|MOLINA HEALTHCARE OF TEXAS|28.25||||28.25||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|ChampVA|CHAMPVA CENTER|28.25||||||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|Blue Cross HMO Specialty|BCBSTX HMO|28.25||||28.25||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|Blue Cross PPO Specialty|BLUE SHIELD PHYSICIAN|||||28.25||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|Blue Cross PPO Specialty|BCBSTX PPO|28.25||||28.25||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|United Medicare Advantage|UHC MEDICARE GOLD MA|||||28.25||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|Cigna|CIGNA|28.25||||||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||28.25||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|Aetna|AETNA PPO|28.25||||||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|Aenta Medicare Advantage|AETNA MEDICARE MA|||||28.25||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|28.25||||||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|28.25||||28.25||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|28.25||||||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||28.25||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|Managed Medicaid|MEDICAID AMERIGROUP|28.25||||28.25||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|28.25||||28.25||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|Managed Medicaid|MEDICAID SUPERIOR|28.25||||28.25||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|28.25||||28.25||| 9500075|ERX|0250|NAPROXEN SODIUM 550MG TAB|Humana Medicare Advantage|HUMANA MA|||||28.25||| 9500117|ERX|0250|METOCLOPRAMIDE 5MG/5ML, 1|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9500117|ERX|0250|METOCLOPRAMIDE 5MG/5ML, 1|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9500117|ERX|0250|METOCLOPRAMIDE 5MG/5ML, 1|Medicare|MEDICARE ACUTE|4.50||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Veterans Affairs|VETERANS ADMINISTRATION|5.25||||5.25||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||5.25||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|5.25||||5.25||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Tricare|TRICARE EAST REGION|5.25||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|NON CONTRACTED|COMMERCIAL OTHER 1|5.25||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|United Healthcare|TML GROUP BENEFITS|5.25||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Multiplan|NALC|||||5.25||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|5.25||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Medicare|MEDICARE ACUTE|5.25||||5.25||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Medicaid|MEDICAID|5.25||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Medicaid|HENDERSON COUNTY INDIGENT|5.25||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Aetna|AETNA PPO|5.25||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|United Healthcare|UNITED HEALTHCARE|||||5.25||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.25||||5.25||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Aenta Medicare Advantage|AETNA MEDICARE MA|5.25||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|5.25||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Aetna|BOON CHAPMAN|||||5.25||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Blue Cross HMO Specialty|BCBSTX HMO|5.25||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Blue Cross PPO Specialty|BCBSTX PPO|5.25||||5.25||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Cigna|CIGNA|5.25||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Cigna|CIGNA OTHER|5.25||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||5.25||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Managed Medicare|HEALTHSPRING MA|5.25||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Managed Medicare|BCBS MEDICARE PPO MA|5.25||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.25||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Managed Medicaid|MEDICAID AMERIGROUP|5.25||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Humana Medicare Advantage|HUMANA MA|5.25||||5.25||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Managed Medicaid|MEDICAID SUPERIOR|5.25||||5.25||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|5.25||||5.25||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|Managed Medicaid|MEDICAID AMERIGROUP|2.75||||2.75||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.75||||||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|Managed Medicaid|MEDICAID SUPERIOR|2.75||||||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|Humana Medicare Advantage|HUMANA MA|2.75||||||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|Managed Medicare|HEALTHSPRING MA|2.75||||||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.75||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.75||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|Blue Cross PPO Specialty|BCBSTX PPO|2.75||||2.75||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|Blue Cross HMO Specialty|BCBSTX HMO|2.75||||2.75||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|ChampVA|CHAMPVA CENTER|||||2.75||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|Cigna|CIGNA|||||2.75||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2.75||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|Aenta Medicare Advantage|AETNA MEDICARE MA|2.75||||||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.75||||2.75||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|Medicare|MEDICARE ACUTE|2.75||||2.75||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|Medicaid|MEDICAID|||||2.75||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.75||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.75||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.75||||2.75||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.75||| 9500158|ERX|0250|RANITIDINE 150MG/10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.56||| 9500158|ERX|0250|RANITIDINE 150MG/10ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.56||| 9500158|ERX|0250|RANITIDINE 150MG/10ML|Medicare|MEDICARE PART B ONLY IP|0.56||||||| 9500158|ERX|0250|RANITIDINE 150MG/10ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|0.56||||||| 9500158|ERX|0250|RANITIDINE 150MG/10ML|Medicare|MEDICARE ACUTE|0.56||||0.56||| 9500158|ERX|0250|RANITIDINE 150MG/10ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.56||||||| 9500158|ERX|0250|RANITIDINE 150MG/10ML|Blue Cross PPO Specialty|BCBSTX PPO|||||0.56||| 9500158|ERX|0250|RANITIDINE 150MG/10ML|Managed Medicaid|MEDICAID AMERIGROUP|||||0.56||| 9500158|ERX|0250|RANITIDINE 150MG/10ML|Humana Medicare Advantage|HUMANA MA|||||0.56||| 9500174|ERX|0250|GLYCERIN SUPP|Managed Medicare|HEALTHSPRING MA|5.25||||||| 9500174|ERX|0250|GLYCERIN SUPP|Managed Medicaid|MEDICAID SUPERIOR|5.25||||||| 9500174|ERX|0250|GLYCERIN SUPP|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.25||||||| 9500174|ERX|0250|GLYCERIN SUPP|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|5.25||||||| 9500174|ERX|0250|GLYCERIN SUPP|Humana Medicare Advantage|HUMANA MA|5.25||||||| 9500174|ERX|0250|GLYCERIN SUPP|Tricare|TRICARE EAST REGION|||||5.25||| 9500174|ERX|0250|GLYCERIN SUPP|Medicare|MEDICARE ACUTE|5.25||||5.25||| 9500174|ERX|0250|GLYCERIN SUPP|Medicaid|MOLINA HEALTHCARE OF TEXAS|5.25||||||| 9500174|ERX|0250|GLYCERIN SUPP|United Medicare Advantage|AARP UHC WEST COMPLETE MA|5.25||||||| 9500174|ERX|0250|GLYCERIN SUPP|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|5.25||||||| 9500232|ERX|0250|NICOTINE POLACRILEX 2MG G|Veterans Affairs|VETERANS ADMINISTRATION|8.25||||||| 9500232|ERX|0250|NICOTINE POLACRILEX 2MG G|Medicaid|MEDICAID HMO|||||8.25||| 9500232|ERX|0250|NICOTINE POLACRILEX 2MG G|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||8.25||| 9500281|ERX|0250|HYDROCORTISONE 20MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9500281|ERX|0250|HYDROCORTISONE 20MG TABLE|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9500281|ERX|0250|HYDROCORTISONE 20MG TABLE|Medicare|MEDICARE ACUTE|4.50||||||| 9500281|ERX|0250|HYDROCORTISONE 20MG TABLE|Medicaid|MEDICAID|||||4.50||| 9500281|ERX|0250|HYDROCORTISONE 20MG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.50||| 9500281|ERX|0250|HYDROCORTISONE 20MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9500299|ERX|0250|LITHIUM 450MG TABLET|Medicare|MEDICARE ACUTE|||||8.50||| 9500299|ERX|0250|LITHIUM 450MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|8.50||||||| 9500307|ERX|0250|PROPYLTHIOURACIL 50MG TAB|Medicare|MEDICARE ACUTE|2.75||||||| 9500349|ERX|0250|FLUMAZENIL 0.5MG/5ML|Blue Cross PPO Specialty|BCBSTX PPO|246.25||||246.25||| 9500349|ERX|0250|FLUMAZENIL 0.5MG/5ML|Blue Cross HMO Specialty|BCBSTX HMO|246.25||||246.25||| 9500349|ERX|0250|FLUMAZENIL 0.5MG/5ML|Cigna|CIGNA|||||246.25||| 9500349|ERX|0250|FLUMAZENIL 0.5MG/5ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||246.25||| 9500349|ERX|0250|FLUMAZENIL 0.5MG/5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|246.25||||||| 9500349|ERX|0250|FLUMAZENIL 0.5MG/5ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||246.25||| 9500349|ERX|0250|FLUMAZENIL 0.5MG/5ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||246.25||| 9500349|ERX|0250|FLUMAZENIL 0.5MG/5ML|Managed Medicare|BCBS MEDICARE PPO MA|||||246.25||| 9500349|ERX|0250|FLUMAZENIL 0.5MG/5ML|Managed Medicare|HEALTHSPRING MA|||||246.25||| 9500349|ERX|0250|FLUMAZENIL 0.5MG/5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|246.25||||||| 9500349|ERX|0250|FLUMAZENIL 0.5MG/5ML|Managed Medicaid|MEDICAID AMERIGROUP|246.25||||||| 9500349|ERX|0250|FLUMAZENIL 0.5MG/5ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|246.25||||||| 9500349|ERX|0250|FLUMAZENIL 0.5MG/5ML|Managed Medicaid|MEDICAID SUPERIOR|||||246.25||| 9500349|ERX|0250|FLUMAZENIL 0.5MG/5ML|Humana Medicare Advantage|HUMANA MA|246.25||||246.25||| 9500349|ERX|0250|FLUMAZENIL 0.5MG/5ML|Veterans Affairs|VETERANS ADMINISTRATION|||||246.25||| 9500349|ERX|0250|FLUMAZENIL 0.5MG/5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|246.25||||246.25||| 9500349|ERX|0250|FLUMAZENIL 0.5MG/5ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|246.25||||||| 9500349|ERX|0250|FLUMAZENIL 0.5MG/5ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|246.25||||||| 9500349|ERX|0250|FLUMAZENIL 0.5MG/5ML|United Healthcare|TML GROUP BENEFITS|||||246.25||| 9500349|ERX|0250|FLUMAZENIL 0.5MG/5ML|Medicare|MEDICARE ACUTE|246.25||||246.25||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Medicaid|MEDICAID|||||26.50||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||26.50||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|26.50||||26.50||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Veterans Affairs|VETERANS ADMINISTRATION|||||26.50||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Managed Medicaid|MEDICAID SUPERIOR|26.50||||26.50||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|26.50||||26.50||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||26.50||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Medicare|MEDICARE ACUTE|26.50||||26.50||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Managed Medicaid|MEDICAID AMERIGROUP|26.50||||26.50||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Humana Medicare Advantage|HUMANA MA|26.50||||26.50||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|MTC Medical|VAN ZANDT COUNTY INMATE|||||26.50||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Managed Medicare|VAN ZANDT COUNTY INMATE|||||26.50||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Managed Medicare|HEALTHSPRING MA|26.50||||||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||26.50||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|26.50||||||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Aenta Medicare Advantage|AETNA MEDICARE MA|26.50||||26.50||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|26.50||||26.50||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Blue Cross PPO Specialty|BCBSTX PPO|||||26.50||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Cigna|CIGNA|26.50||||26.50||| 9500380|ERX|0250|MESALAMINE 400MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|20.50||||||| 9500380|ERX|0250|MESALAMINE 400MG TABLET|Managed Medicare|HEALTHSPRING MA|20.50||||||| 9500380|ERX|0250|MESALAMINE 400MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|20.50||||20.50||| 9500380|ERX|0250|MESALAMINE 400MG TABLET|Medicare|MEDICARE ACUTE|20.50||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Medicaid|MEDICAID|4.50||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.50||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9500406|ERX|0250|TRIAMCINOLONE ACET 0.1% ,|Blue Cross PPO Specialty|BCBSTX PPO|0.41||||||| 9500406|ERX|0250|TRIAMCINOLONE ACET 0.1% ,|Aetna|AETNA PPO|0.41||||||| 9500406|ERX|0250|TRIAMCINOLONE ACET 0.1% ,|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.41||||||| 9500406|ERX|0250|TRIAMCINOLONE ACET 0.1% ,|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||0.41||| 9500406|ERX|0250|TRIAMCINOLONE ACET 0.1% ,|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.41||||||| 9500406|ERX|0250|TRIAMCINOLONE ACET 0.1% ,|Humana Medicare Advantage|HUMANA MA|0.41||||||| 9500406|ERX|0250|TRIAMCINOLONE ACET 0.1% ,|Medicare|MEDICARE ACUTE|0.41||||0.41||| 9500406|ERX|0250|TRIAMCINOLONE ACET 0.1% ,|Medicaid|COUNTY INDIGENT HEALTH OTHER|0.41||||||| 9500406|ERX|0250|TRIAMCINOLONE ACET 0.1% ,|United Healthcare|UNITED HEALTHCARE|0.41||||||| 9500422|ERX|0250|NYSTATIN OINT, 15 GM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|34.50||||||| 9500422|ERX|0250|NYSTATIN OINT, 15 GM|Medicare|MEDICARE ACUTE|34.50||||||| 9500422|ERX|0250|NYSTATIN OINT, 15 GM|Humana Medicare Advantage|HUMANA MA|34.50||||||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||33.25||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|Medicare|MEDICARE ACUTE|33.25||||33.25||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|Veterans Affairs|VETERANS ADMINISTRATION|||||33.25||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||33.25||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|United Medicare Advantage|UHC MEDICARE GOLD MA|||||33.25||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||33.25||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||33.25||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|Aetna|AETNA PPO|||||33.25||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|Managed Medicaid|MEDICAID AMERIGROUP|33.25||||33.25||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|Blue Cross PPO Specialty|BCBSTX PPO|||||33.25||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|Tricare|TRICARE EAST REGION|||||33.25||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|NON CONTRACTED|COMMERCIAL OTHER 1|||||33.25||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|United Healthcare|UNITED HEALTHCARE|||||33.25||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|Cigna|CIGNA|||||33.25||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|33.25||||||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||33.25||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||33.25||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|Humana Medicare Advantage|HUMANA MA|33.25||||33.25||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|Managed Medicaid|MEDICAID SUPERIOR|||||33.25||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Medicaid|MEDICAID HMO|||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Medicaid|MEDICAID TEXAS CHILDRENS|||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Tricare|TRICARE EAST REGION|4.50||||||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Aetna|AETNA PPO|||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|MTC Medical|VAN ZANDT COUNTY INMATE|||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Medicaid|MEDICAID|||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Veterans Affairs|VETERANS ADMINISTRATION|||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Cigna|CIGNA|||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|ChampVA|CHAMPVA CENTER|||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|United Healthcare|UNITED HEALTHCARE OTHER|||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Managed Medicaid|MEDICAID AMERIGROUP|||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Blue Cross PPO Specialty|BCBSTX OTHER|||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Managed Medicare|VAN ZANDT COUNTY INMATE|||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|United Healthcare|TML GROUP BENEFITS|||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Medicaid|MEDICAID|||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Veterans Affairs|VETERANS ADMINISTRATION|||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Medicaid|MEDICAID TEXAS CHILDRENS|||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|United Healthcare|GEHA|||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Aetna|AETNA PPO|4.50||||||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Texas Workforce Commission|DIS DETER SERV (DDS)|||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Cigna|CIGNA|||||4.50||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9500489|ERX|0250|HYDROCORTISONE 1% CREAM,|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9500489|ERX|0250|HYDROCORTISONE 1% CREAM,|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9500505|ERX|0250|HYDROCORTISONE 1% OINT, 3|United Medicare Advantage|AARP UHC WEST COMPLETE MA|42.50||||||| 9500539|ERX|0250|NEOMYC-BACITR-POLYMYX ,3.|Managed Medicaid|MEDICAID SUPERIOR|||||133.75||| 9500539|ERX|0250|NEOMYC-BACITR-POLYMYX ,3.|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||133.75||| 9500539|ERX|0250|NEOMYC-BACITR-POLYMYX ,3.|Medicare|MEDICARE ACUTE|||||133.75||| 9500539|ERX|0250|NEOMYC-BACITR-POLYMYX ,3.|Blue Cross PPO Specialty|BCBSTX PPO|||||133.75||| 9500539|ERX|0250|NEOMYC-BACITR-POLYMYX ,3.|Cigna|CIGNA|||||133.75||| 9500547|ERX|0250|NEOMYC-BACIT-POLY-HC 3.|Blue Cross PPO Specialty|BCBSTX PPO|||||155.25||| 9500554|ERX|0250|VITAMINS A AND D OINT, 60|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|24.50||||||| 9500596|ERX|0250|PETROLATUM, WHITE, 30 GM|Medicare|MEDICARE ACUTE|15.25||||||| 9500604|ERX|0250|BETAMETH DIPR 0.05% CRM,1|Medicare|MEDICARE ACUTE|||||279.50||| 9500612|ERX|0250|ZINC OXIDE 20% OINT, 30 G|Aenta Medicare Advantage|AETNA MEDICARE MA|0.14||||||| 9500653|ERX|0250|NYSTATIN-TRIAMCINOLONE 1|Medicare|MEDICARE PART B ONLY IP|38.50||||||| 9500653|ERX|0250|NYSTATIN-TRIAMCINOLONE 1|Medicare|MEDICARE ACUTE|38.50||||||| 9500653|ERX|0250|NYSTATIN-TRIAMCINOLONE 1|Blue Cross PPO Specialty|BCBSTX PPO|||||38.50||| 9500653|ERX|0250|NYSTATIN-TRIAMCINOLONE 1|Humana Medicare Advantage|HUMANA MA|||||38.50||| 9500661|ERX|0250|NYSTATIN-TRIAMCINOLONE ,1|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||50.50||| 9500679|ERX|0250|MICONAZOLE 2% CREAM, 30 G|Managed Medicaid|MEDICAID AMERIGROUP|36.50||||||| 9500679|ERX|0250|MICONAZOLE 2% CREAM, 30 G|Blue Cross PPO Specialty|BCBSTX PPO|36.50||||||| 9500679|ERX|0250|MICONAZOLE 2% CREAM, 30 G|Medicare|MEDICARE ACUTE|36.50||||||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|Humana Medicare Advantage|HUMANA MA|24.25||||24.25||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|Managed Medicaid|MEDICAID AMERIGROUP|||||24.25||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|Managed Medicaid|MEDICAID SUPERIOR|||||24.25||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|Blue Cross PPO Specialty|BCBSTX PPO|||||24.25||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|PHCS|MULTIPLAN PHCS OTHER|||||24.25||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||24.25||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|Aenta Medicare Advantage|AETNA MEDICARE MA|24.25||||24.25||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|24.25||||24.25||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|24.25||||||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|Medicare|MEDICARE ACUTE|24.25||||24.25||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|Aetna|AETNA PPO|24.25||||||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|United Healthcare|UNITED HEALTHCARE|||||24.25||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|Veterans Affairs|VETERANS ADMINISTRATION|||||24.25||| 9500695|ERX|0250|LIDOCAINE 5% OINT, 35 GM|Blue Cross PPO Specialty|BCBSTX PPO|1,000.50||||1,000.50||| 9500695|ERX|0250|LIDOCAINE 5% OINT, 35 GM|United Healthcare|UNITED HEALTHCARE|||||1,000.50||| 9500695|ERX|0250|LIDOCAINE 5% OINT, 35 GM|Managed Medicaid|MEDICAID SUPERIOR|1,000.50||||||| 9500695|ERX|0250|LIDOCAINE 5% OINT, 35 GM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1,000.50||| 9500695|ERX|0250|LIDOCAINE 5% OINT, 35 GM|Workers Compensation|WORKERS COMPENSATION OTHER|||||1,000.50||| 9500695|ERX|0250|LIDOCAINE 5% OINT, 35 GM|United Medicare Advantage|UHC MEDICARE GOLD MA|1,000.50||||||| 9500695|ERX|0250|LIDOCAINE 5% OINT, 35 GM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,000.50||||||| 9500695|ERX|0250|LIDOCAINE 5% OINT, 35 GM|Medicare|MEDICARE ACUTE|||||1,000.50||| 9500695|ERX|0250|LIDOCAINE 5% OINT, 35 GM|Managed Medicare|HEALTHSPRING MA|1,000.50||||||| 9500695|ERX|0250|LIDOCAINE 5% OINT, 35 GM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,000.50||||1,000.50||| 9500695|ERX|0250|LIDOCAINE 5% OINT, 35 GM|Tricare|TRICARE EAST REGION|1,000.50||||||| 9500695|ERX|0250|LIDOCAINE 5% OINT, 35 GM|Humana Medicare Advantage|HUMANA MA|1,000.50||||||| 9500695|ERX|0250|LIDOCAINE 5% OINT, 35 GM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,000.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|PHCS|HUMANA|||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Medicaid|MEDICAID|4.50||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Aetna|AETNA OTHER|||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|4.50||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|United Medicare Advantage|UHC AARP MCR HMO MA|||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Cigna|CIGNA|||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Tricare|TRICARE FOR LIFE|||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Aetna|AETNA PPO|4.50||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Medicaid|COUNTY INDIGENT HEALTH OTHER|4.50||||||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|United Healthcare|TML GROUP BENEFITS|||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Medicaid|HENDERSON COUNTY INDIGENT|||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Tricare|TRICARE EAST REGION|4.50||||4.50||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|14.50||||14.50||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||14.50||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|14.50||||14.50||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|14.50||||14.50||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Medicaid|MOLINA HEALTHCARE OF TEXAS|14.50||||||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Medicare|MEDICARE ACUTE|14.50||||14.50||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Medicaid|MEDICAID HMO|||||14.50||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Tricare|TRICARE EAST REGION|14.50||||||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Workers Compensation|WORKERS COMPENSATION OTHER|||||14.50||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|14.50||||14.50||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|14.50||||14.50||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Medicaid|HENDERSON COUNTY INDIGENT|14.50||||||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|14.50||||||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|14.50||||14.50||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Medicaid|MEDICAID|14.50||||||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|14.50||||||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|||||14.50||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Humana Medicare Advantage|HUMANA MA|14.50||||14.50||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||4.50||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||4.50||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Aetna|AETNA PPO|4.50||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Cigna|CIGNA OTHER|4.50||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UMR|||||4.50||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Medicaid|MEDICAID|4.50||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Medicaid|LAW ENFORCEMENT OTHER|4.50||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||4.50||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|United Healthcare|TML GROUP BENEFITS|4.50||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|||||4.50||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.50||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Blue Cross PPO Specialty|BCBSTX OTHER|||||14.50||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|14.50||||14.50||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|14.50||||14.50||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Medicare|MEDICARE ACUTE|14.50||||14.50||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|14.50||||||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Medicaid|MEDICAID|14.50||||||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|14.50||||14.50||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|14.50||||14.50||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Cigna|CIGNA OTHER|14.50||||||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|ChampVA|CHAMPVA CENTER|14.50||||||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|14.50||||14.50||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Aetna|AETNA PPO|14.50||||||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|14.50||||14.50||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|14.50||||14.50||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Humana Medicare Advantage|HUMANA MA|14.50||||14.50||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|14.50||||14.50||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Managed Medicare|HEALTHSPRING MA|14.50||||14.50||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|14.50||||14.50||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|14.50||||||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||14.50||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|14.50||||14.50||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|14.50||||14.50||| 9500927|ERX|0250|MINOCYCLINE 50MG CAPSULE|United Healthcare|UNITED HEALTHCARE OTHER|0.48||||||| 9500927|ERX|0250|MINOCYCLINE 50MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.48||| 9500927|ERX|0250|MINOCYCLINE 50MG CAPSULE|Medicare|MEDICARE ACUTE|0.48||||||| 9500968|ERX|0250|TAMOXIFEN 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9500968|ERX|0250|TAMOXIFEN 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9500968|ERX|0250|TAMOXIFEN 10MG TABLET|Medicare|MEDICARE ACUTE|4.50||||||| 9501016|ERX|0250|BUPROPION SR 150MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|35.25||||||| 9501016|ERX|0250|BUPROPION SR 150MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|35.25||||||| 9501016|ERX|0250|BUPROPION SR 150MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|35.25||||35.25||| 9501016|ERX|0250|BUPROPION SR 150MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|35.25||||||| 9501016|ERX|0250|BUPROPION SR 150MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|35.25||||||| 9501016|ERX|0250|BUPROPION SR 150MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|35.25||||35.25||| 9501016|ERX|0250|BUPROPION SR 150MG TABLET|Medicaid|MEDICAID|35.25||||||| 9501016|ERX|0250|BUPROPION SR 150MG TABLET|Humana Medicare Advantage|HUMANA MA|35.25||||||| 9501016|ERX|0250|BUPROPION SR 150MG TABLET|Cigna|CIGNA|35.25||||||| 9501016|ERX|0250|BUPROPION SR 150MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|35.25||||||| 9501016|ERX|0250|BUPROPION SR 150MG TABLET|Medicare|MEDICARE ACUTE|35.25||||||| 9501016|ERX|0250|BUPROPION SR 150MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|35.25||||35.25||| 9501016|ERX|0250|BUPROPION SR 150MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|35.25||||||| 9501032|ERX|0250|BUPROPION 100MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|28.75||||||| 9501032|ERX|0250|BUPROPION 100MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|28.75||||||| 9501032|ERX|0250|BUPROPION 100MG TABLET|Medicare|MEDICARE ACUTE|28.75||||||| 9501032|ERX|0250|BUPROPION 100MG TABLET|Tricare|TRICARE EAST REGION|||||28.75||| 9501032|ERX|0250|BUPROPION 100MG TABLET|Humana Medicare Advantage|HUMANA MA|28.75||||28.75||| 9501032|ERX|0250|BUPROPION 100MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|28.75||||28.75||| 9501032|ERX|0250|BUPROPION 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|28.75||||||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||4.50||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||4.50||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Managed Medicare|VAN ZANDT COUNTY INMATE|4.50||||||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|MTC Medical|VAN ZANDT COUNTY INMATE|4.50||||||| 9501073|ERX|0250|DIGOXIN 250MCG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9501073|ERX|0250|DIGOXIN 250MCG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||4.50||| 9501073|ERX|0250|DIGOXIN 250MCG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9501073|ERX|0250|DIGOXIN 250MCG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.50||| 9501073|ERX|0250|DIGOXIN 250MCG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9501073|ERX|0250|DIGOXIN 250MCG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9501073|ERX|0250|DIGOXIN 250MCG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9501073|ERX|0250|DIGOXIN 250MCG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9501073|ERX|0250|DIGOXIN 250MCG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9501073|ERX|0250|DIGOXIN 250MCG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9501115|ERX|0250|CLOBETASOL 0.05% CREAM, 1|Medicare|MEDICARE ACUTE|||||2.27||| 9501206|ERX|0250|SUMATRIPTAN 6MG/0.5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.12||| 9501206|ERX|0250|SUMATRIPTAN 6MG/0.5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.12||| 9501206|ERX|0250|SUMATRIPTAN 6MG/0.5ML|Managed Medicaid|MEDICAID AMERIGROUP|||||3.12||| 9501206|ERX|0250|SUMATRIPTAN 6MG/0.5ML|Medicare|MEDICARE ACUTE|3.12||||||| 9501206|ERX|0250|SUMATRIPTAN 6MG/0.5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.12||||||| 9501206|ERX|0250|SUMATRIPTAN 6MG/0.5ML|Humana Medicare Advantage|HUMANA MA|||||3.12||| 9501206|ERX|0250|SUMATRIPTAN 6MG/0.5ML|Blue Cross PPO Specialty|BCBSTX PPO|||||3.12||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|NON CONTRACTED|COMMERCIAL OTHER 1|497.50||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Medicare|MEDICARE ACUTE|497.50||||497.50||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Managed Medicare|BCBS MEDICARE PPO MA|497.50||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|United Healthcare|UNITED HEALTHCARE|||||497.50||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Medicaid|MEDICAID|497.50||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Managed Medicare|HEALTHSPRING MA|497.50||||497.50||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|United Medicare Advantage|AARP UHC WEST COMPLETE MA|497.50||||497.50||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|United Medicare Advantage|UHC MEDICARE GOLD MA|497.50||||497.50||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|497.50||||497.50||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Blue Cross HMO Specialty|BCBSTX HMO|497.50||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|497.50||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Medicaid|COUNTY INDIGENT HEALTH OTHER|497.50||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Veterans Affairs|VETERANS ADMINISTRATION|497.50||||497.50||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|497.50||||497.50||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Cigna|CIGNA|497.50||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Managed Medicaid|MEDICAID UNITED HEALTHCARE|497.50||||497.50||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Managed Medicaid|MEDICAID AMERIGROUP|497.50||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Managed Medicaid|MEDICAID SUPERIOR|497.50||||497.50||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Humana Medicare Advantage|HUMANA MA|497.50||||497.50||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Blue Cross PPO Specialty|BCBSTX PPO|497.50||||497.50||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|497.50||||497.50||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Aenta Medicare Advantage|AETNA MEDICARE MA|497.50||||497.50||| 9501222|ERX|0250|LAMIVUDINE 150MG TABLET|Workers Compensation|UT EMPLOYEE INJURY|||||63.75||| 9501255|ERX|0250|LAMOTRIGINE 25MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.46||||||| 9501255|ERX|0250|LAMOTRIGINE 25MG TABLET|Blue Cross PPO Specialty|BCBSTX OTHER|||||0.46||| 9501255|ERX|0250|LAMOTRIGINE 25MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|0.46||||||| 9501255|ERX|0250|LAMOTRIGINE 25MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||0.46||| 9501255|ERX|0250|LAMOTRIGINE 25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.46||||0.46||| 9501255|ERX|0250|LAMOTRIGINE 25MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.46||||0.46||| 9501255|ERX|0250|LAMOTRIGINE 25MG TABLET|Medicare|MEDICARE ACUTE|0.46||||||| 9501263|ERX|0250|DEMECLOCYCLINE 150MG TABL|Medicare|MEDICARE ACUTE|111.75||||||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Workers Compensation|WORKERS COMP PHYSICIAN|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Aetna|AETNA PPO|8.80||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|8.80||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|ChampVA|CHAMPVA CENTER|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Cigna|CIGNA|8.80||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Cigna|CIGNA|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Blue Cross PPO Specialty|BCBSTX OTHER|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Aetna|AETNA OTHER|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|8.80||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Managed Medicare|BCBS MEDICARE PPO MA|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Managed Medicare|HEALTHSPRING MA|8.80||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|8.80||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|MTC Medical|VAN ZANDT COUNTY INMATE|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Humana Medicare Advantage|HUMANA MA|8.80||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Managed Medicare|VAN ZANDT COUNTY INMATE|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Managed Medicaid|MEDICAID SUPERIOR|8.80||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|8.80||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Veterans Affairs|VETERANS ADMINISTRATION|8.80||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Managed Medicaid|MEDICAID AMERIGROUP|8.80||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Workers Compensation|TEXAS MUTUAL INSURANCE|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Workers Compensation|WORKERS COMPENSATION OTHER|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|United Medicare Advantage|UHC AARP MCR HMO MA|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|8.80||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|8.80||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|United Healthcare|UNITED HEALTHCARE|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|PHCS|HUMANA|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|NON CONTRACTED|COMMERCIAL OTHER 2|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Texas Workforce Commission|DIS DETER SERV (DDS)|8.80||||||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Cigna|CIGNA OTHER|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|United Healthcare|UNITED HEALTHCARE OTHER|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Tricare|TRICARE FOR LIFE|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Medicaid|MEDICAID HMO|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Tricare|TRICARE EAST REGION|8.80||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|NON CONTRACTED|COMMERCIAL OTHER 1|8.80||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Medicaid|MEDICAID|8.80||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Medicare|MEDICARE ACUTE|8.80||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|8.80||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|8.80||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Medicaid|HENDERSON COUNTY INDIGENT|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|PHCS|MULTIPLAN PHCS OTHER|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Medicaid|MEDICAID TEXAS CHILDRENS|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Medicaid|LAW ENFORCEMENT OTHER|||||8.80||| 9501305|ERX|0250|LAMOTRIGINE 100MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||50.25||| 9501305|ERX|0250|LAMOTRIGINE 100MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|50.25||||||| 9501305|ERX|0250|LAMOTRIGINE 100MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|50.25||||50.25||| 9501305|ERX|0250|LAMOTRIGINE 100MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|50.25||||||| 9501305|ERX|0250|LAMOTRIGINE 100MG TABLET|Humana Medicare Advantage|HUMANA MA|50.25||||||| 9501305|ERX|0250|LAMOTRIGINE 100MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||50.25||| 9501305|ERX|0250|LAMOTRIGINE 100MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||50.25||| 9501305|ERX|0250|LAMOTRIGINE 100MG TABLET|Medicare|MEDICARE ACUTE|50.25||||50.25||| 9501305|ERX|0250|LAMOTRIGINE 100MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|50.25||||50.25||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|107.25||||107.25||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Aetna|AETNA PPO|||||107.25||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Veterans Affairs|VETERANS ADMINISTRATION|107.25||||107.25||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|107.25||||||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Blue Cross HMO Specialty|BCBSTX HMO|107.25||||107.25||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Blue Cross PPO Specialty|BCBSTX PPO|107.25||||107.25||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Cigna|CIGNA|107.25||||||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Aenta Medicare Advantage|AETNA MEDICARE MA|107.25||||||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Blue Cross PPO Specialty|BCBSTX OTHER|||||107.25||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Managed Medicaid|MEDICAID AMERIGROUP|107.25||||107.25||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Managed Medicare|BCBS MEDICARE PPO MA|107.25||||||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Managed Medicare|HEALTHSPRING MA|107.25||||107.25||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Managed Medicaid|MEDICAID UNITED HEALTHCARE|107.25||||107.25||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Humana Medicare Advantage|HUMANA MA|107.25||||107.25||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Workers Compensation|UT EMPLOYEE INJURY|107.25||||||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|United Healthcare|UNITED HEALTHCARE|107.25||||||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|United Medicare Advantage|AARP UHC WEST COMPLETE MA|107.25||||||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Medicaid|MEDICAID|||||107.25||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|United Healthcare|UNITED HEALTHCARE|||||107.25||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|107.25||||107.25||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Tricare|TRICARE EAST REGION|107.25||||107.25||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|NON CONTRACTED|COMMERCIAL OTHER 1|||||107.25||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Medicare|MEDICARE ACUTE|107.25||||107.25||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||107.25||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|United Healthcare|UNITED HEALTHCARE OTHER|||||107.25||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|107.25||||107.25||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||107.25||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Managed Medicaid|MEDICAID SUPERIOR|107.25||||107.25||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|United Medicare Advantage|UHC MEDICARE GOLD MA|107.25||||107.25||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|UTMB|UTMB CORRECTIONAL MANAGED CARE|107.25||||||| 9501412|ERX|0250|DUTASTERIDE 0.5MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|14.50||||||| 9501412|ERX|0250|DUTASTERIDE 0.5MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|14.50||||||| 9501412|ERX|0250|DUTASTERIDE 0.5MG CAPSULE|Medicare|MEDICARE ACUTE|14.50||||||| 9501412|ERX|0250|DUTASTERIDE 0.5MG CAPSULE|Humana Medicare Advantage|HUMANA MA|14.50||||||| 9501438|ERX|0250|PHYTONADIONE 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|2.65||||||| 9501438|ERX|0250|PHYTONADIONE 5MG TABLET|Managed Medicare|HEALTHSPRING MA|2.65||||||| 9501438|ERX|0250|PHYTONADIONE 5MG TABLET|Aetna|AETNA PPO|2.65||||||| 9501438|ERX|0250|PHYTONADIONE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|2.65||||||| 9501438|ERX|0250|PHYTONADIONE 5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.65||||||| 9501438|ERX|0250|PHYTONADIONE 5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.65||||||| 9501438|ERX|0250|PHYTONADIONE 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|2.65||||||| 9501438|ERX|0250|PHYTONADIONE 5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.65||||||| 9501438|ERX|0250|PHYTONADIONE 5MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|2.65||||||| 9501438|ERX|0250|PHYTONADIONE 5MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|2.65||||||| 9501438|ERX|0250|PHYTONADIONE 5MG TABLET|Medicare|MEDICARE ACUTE|2.65||||||| 9501438|ERX|0250|PHYTONADIONE 5MG TABLET|Medicaid|MEDICAID|2.65||||||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Tricare|TRICARE EAST REGION|4.50||||4.50||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Medicaid|MEDICAID HMO|||||4.50||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||4.50||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Aetna|AETNA PPO|4.50||||||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9501487|ERX|0250|SUMATRIPTAN 50MG TABLET|Aetna|AETNA PPO|2.43||||2.43||| 9501487|ERX|0250|SUMATRIPTAN 50MG TABLET|Cigna|CIGNA|2.43||||||| 9501487|ERX|0250|SUMATRIPTAN 50MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.43||||||| 9501487|ERX|0250|SUMATRIPTAN 50MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||2.43||| 9501487|ERX|0250|SUMATRIPTAN 50MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||2.43||| 9501487|ERX|0250|SUMATRIPTAN 50MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|2.43||||||| 9501487|ERX|0250|SUMATRIPTAN 50MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.43||||||| 9501487|ERX|0250|SUMATRIPTAN 50MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.43||||||| 9501487|ERX|0250|SUMATRIPTAN 50MG TABLET|Humana Medicare Advantage|HUMANA MA|2.43||||||| 9501487|ERX|0250|SUMATRIPTAN 50MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.43||| 9501487|ERX|0250|SUMATRIPTAN 50MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||2.43||| 9501487|ERX|0250|SUMATRIPTAN 50MG TABLET|Medicaid|MEDICAID|2.43||||||| 9501487|ERX|0250|SUMATRIPTAN 50MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.43||||||| 9501487|ERX|0250|SUMATRIPTAN 50MG TABLET|Managed Medicare|HEALTHSPRING MA|||||2.43||| 9501487|ERX|0250|SUMATRIPTAN 50MG TABLET|Medicaid|COUNTY INDIGENT HEALTH OTHER|2.43||||||| 9501487|ERX|0250|SUMATRIPTAN 50MG TABLET|Medicare|MEDICARE ACUTE|2.43||||2.43||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|United Healthcare|UNITED HEALTHCARE|0.18||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.18||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Managed Medicare|HEALTHSPRING MA|0.18||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Medicare|MEDICARE ACUTE|0.18||||0.18||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Medicaid|MEDICAID|0.18||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.18||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||0.18||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Cigna|CIGNA|0.18||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.18||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.18||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Humana Medicare Advantage|HUMANA MA|0.18||||0.18||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.18||| 9501545|ERX|0250|BUPROPION SR 100MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9501545|ERX|0250|BUPROPION SR 100MG TABLET|Medicaid|MEDICAID|4.50||||||| 9501545|ERX|0250|BUPROPION SR 100MG TABLET|Tricare|TRICARE EAST REGION|4.50||||||| 9501545|ERX|0250|BUPROPION SR 100MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.50||| 9501545|ERX|0250|BUPROPION SR 100MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9501545|ERX|0250|BUPROPION SR 100MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9501545|ERX|0250|BUPROPION SR 100MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9501552|ERX|0250|ACYCLOVIR SUSP 200MG 5ML|Managed Medicaid|MEDICAID SUPERIOR|139.25||||||| 9501560|ERX|0250|ACYCLOVIR 200MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|||||27.75||| 9501560|ERX|0250|ACYCLOVIR 200MG CAPSULE|Humana Medicare Advantage|HUMANA MA|||||27.75||| 9501560|ERX|0250|ACYCLOVIR 200MG CAPSULE|Medicare|MEDICARE ACUTE|27.75||||27.75||| 9501560|ERX|0250|ACYCLOVIR 200MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|27.75||||||| 9501560|ERX|0250|ACYCLOVIR 200MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|27.75||||||| 9501560|ERX|0250|ACYCLOVIR 200MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|27.75||||||| 9501578|ERX|0250|METHYL SALIC/MENTHOL CRM,|Humana Medicare Advantage|HUMANA MA|58.75||||||| 9501578|ERX|0250|METHYL SALIC/MENTHOL CRM,|United Healthcare|UNITED HEALTHCARE|||||58.75||| 9501578|ERX|0250|METHYL SALIC/MENTHOL CRM,|Medicare|MEDICARE ACUTE|58.75||||||| 9501578|ERX|0250|METHYL SALIC/MENTHOL CRM,|United Healthcare|UMR UNITED MEDICAL RESOURCES|58.75||||||| 9501586|ERX|0250|POTASSIUM CITRATE 10 MEQ|Veterans Affairs|VETERANS ADMINISTRATION|||||8.75||| 9501586|ERX|0250|POTASSIUM CITRATE 10 MEQ|Managed Medicare|HEALTHSPRING MA|||||8.75||| 9501586|ERX|0250|POTASSIUM CITRATE 10 MEQ|Managed Medicare|BCBS MEDICARE PPO MA|8.75||||||| 9501586|ERX|0250|POTASSIUM CITRATE 10 MEQ|Managed Medicaid|MEDICAID SUPERIOR|||||8.75||| 9501586|ERX|0250|POTASSIUM CITRATE 10 MEQ|Medicare|MEDICARE ACUTE|8.75||||||| 9501602|ERX|0250|FINASTERIDE 5MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9501602|ERX|0250|FINASTERIDE 5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9501602|ERX|0250|FINASTERIDE 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9501602|ERX|0250|FINASTERIDE 5MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9501602|ERX|0250|FINASTERIDE 5MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||||| 9501602|ERX|0250|FINASTERIDE 5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9501602|ERX|0250|FINASTERIDE 5MG TABLET|Managed Medicare|HEALTHSPRING MA|||||4.50||| 9501602|ERX|0250|FINASTERIDE 5MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9501602|ERX|0250|FINASTERIDE 5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.50||| 9501602|ERX|0250|FINASTERIDE 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.50||| 9501602|ERX|0250|FINASTERIDE 5MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|4.50||||||| 9501602|ERX|0250|FINASTERIDE 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||4.50||| 9501602|ERX|0250|FINASTERIDE 5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 9501602|ERX|0250|FINASTERIDE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9501610|ERX|0250|CALCIUM CITRATE W/VIT D T|Veterans Affairs|VETERANS ADMINISTRATION|2.25||||||| 9501610|ERX|0250|CALCIUM CITRATE W/VIT D T|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.25||||||| 9501610|ERX|0250|CALCIUM CITRATE W/VIT D T|Medicare|MEDICARE ACUTE|2.25||||2.25||| 9501610|ERX|0250|CALCIUM CITRATE W/VIT D T|United Healthcare|UNITED HEALTHCARE|2.25||||||| 9501610|ERX|0250|CALCIUM CITRATE W/VIT D T|Humana Medicare Advantage|HUMANA MA|2.25||||2.25||| 9501610|ERX|0250|CALCIUM CITRATE W/VIT D T|Aenta Medicare Advantage|AETNA MEDICARE MA|2.25||||||| 9501651|ERX|0250|CYANOCOBALAMIN 500MCG TAB|Blue Cross HMO Specialty|BCBSTX HMO|2.25||||||| 9501651|ERX|0250|CYANOCOBALAMIN 500MCG TAB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.25||||2.25||| 9501651|ERX|0250|CYANOCOBALAMIN 500MCG TAB|Aenta Medicare Advantage|AETNA MEDICARE MA|2.25||||2.25||| 9501651|ERX|0250|CYANOCOBALAMIN 500MCG TAB|Managed Medicare|HEALTHSPRING MA|2.25||||2.25||| 9501651|ERX|0250|CYANOCOBALAMIN 500MCG TAB|Aetna|AETNA PPO|2.25||||||| 9501651|ERX|0250|CYANOCOBALAMIN 500MCG TAB|Humana Medicare Advantage|HUMANA MA|2.25||||2.25||| 9501651|ERX|0250|CYANOCOBALAMIN 500MCG TAB|Blue Cross PPO Specialty|BCBSTX PPO|2.25||||||| 9501651|ERX|0250|CYANOCOBALAMIN 500MCG TAB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.25||||||| 9501651|ERX|0250|CYANOCOBALAMIN 500MCG TAB|Managed Medicaid|MEDICAID SUPERIOR|2.25||||||| 9501651|ERX|0250|CYANOCOBALAMIN 500MCG TAB|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.25||||||| 9501651|ERX|0250|CYANOCOBALAMIN 500MCG TAB|Medicare|MEDICARE ACUTE|2.25||||2.25||| 9501651|ERX|0250|CYANOCOBALAMIN 500MCG TAB|Medicare|MEDICARE PART B ONLY IP|2.25||||||| 9501651|ERX|0250|CYANOCOBALAMIN 500MCG TAB|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.25||||2.25||| 9501651|ERX|0250|CYANOCOBALAMIN 500MCG TAB|Veterans Affairs|VETERANS ADMINISTRATION|2.25||||||| 9501651|ERX|0250|CYANOCOBALAMIN 500MCG TAB|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.25||||2.25||| 9501651|ERX|0250|CYANOCOBALAMIN 500MCG TAB|United Medicare Advantage|UHC MEDICARE GOLD MA|2.25||||2.25||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.50||| 9501669|ERX|0250|THIAMINE 100MG TABLET|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9501669|ERX|0250|THIAMINE 100MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|United Healthcare|GOLDEN RULE|||||4.50||| 9501669|ERX|0250|THIAMINE 100MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Tricare|TRICARE EAST REGION|4.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9501669|ERX|0250|THIAMINE 100MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.50||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|4.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||4.50||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Aetna|AETNA PPO|4.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.50||| 9501669|ERX|0250|THIAMINE 100MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Cigna|CIGNA|4.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Medicaid|MEDICAID HMO|||||4.50||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Medicaid|MEDICAID|4.50||||4.50||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Aetna|AETNA PPO|4.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Cigna|CIGNA|4.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Medicaid|MEDICAID HMO|4.50||||||| 9501701|ERX|0250|VITAMIN E 400 UNIT CAPSUL|Managed Medicare|HEALTHSPRING MA|||||4.50||| 9501701|ERX|0250|VITAMIN E 400 UNIT CAPSUL|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9501727|ERX|0250|PYRIDOXINE 50MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.25||| 9501727|ERX|0250|PYRIDOXINE 50MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||2.25||| 9501727|ERX|0250|PYRIDOXINE 50MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|2.25||||2.25||| 9501727|ERX|0250|PYRIDOXINE 50MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||2.25||| 9501727|ERX|0250|PYRIDOXINE 50MG TABLET|United Healthcare|UNITED HEALTHCARE|||||2.25||| 9501727|ERX|0250|PYRIDOXINE 50MG TABLET|Medicare|MEDICARE ACUTE|2.25||||||| 9501750|ERX|0250|PREDNISONE 5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9501750|ERX|0250|PREDNISONE 5MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9501750|ERX|0250|PREDNISONE 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9501750|ERX|0250|PREDNISONE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9501750|ERX|0250|PREDNISONE 5MG TABLET|Medicaid|MEDICAID|4.50||||||| 9501750|ERX|0250|PREDNISONE 5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9501750|ERX|0250|PREDNISONE 5MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Aetna|AETNA PPO|4.50||||4.50||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||4.50||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Tricare|TRICARE EAST REGION|4.50||||||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UMR|||||4.50||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|PHCS|HUMANA|||||4.50||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Medicaid|MEDICAID|4.50||||||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9501776|ERX|0250|ISOSORBIDE DINITRATE 10MG|Medicare|MEDICARE ACUTE|0.03||||0.03||| 9501776|ERX|0250|ISOSORBIDE DINITRATE 10MG|Managed Medicare|HEALTHSPRING MA|||||0.03||| 9501776|ERX|0250|ISOSORBIDE DINITRATE 10MG|Humana Medicare Advantage|HUMANA MA|0.03||||||| 9501776|ERX|0250|ISOSORBIDE DINITRATE 10MG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.03||||0.03||| 9501776|ERX|0250|ISOSORBIDE DINITRATE 10MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.03||||||| 9501776|ERX|0250|ISOSORBIDE DINITRATE 10MG|Managed Medicare|MA PART B ONLY IP|0.03||||||| 9501776|ERX|0250|ISOSORBIDE DINITRATE 10MG|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.03||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|7.50||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|7.50||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|7.50||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|7.50||||7.50||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Aetna|AETNA PPO|7.50||||7.50||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.50||||7.50||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Humana Medicare Advantage|HUMANA MA|7.50||||7.50||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|7.50||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|7.50||||7.50||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Managed Medicare|VAN ZANDT COUNTY INMATE|||||7.50||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|7.50||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|7.50||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||7.50||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Medicaid|MEDICAID|7.50||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Medicare|MEDICARE PART B ONLY IP|7.50||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|MTC Medical|VAN ZANDT COUNTY INMATE|||||7.50||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Managed Medicare|HEALTHSPRING MA|7.50||||7.50||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|7.50||||7.50||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|7.50||||7.50||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|7.50||||7.50||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|7.50||||7.50||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|7.50||||7.50||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Medicare|MEDICARE ACUTE|7.50||||7.50||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|7.50||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|United Healthcare|UNITED HEALTHCARE|7.50||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Tricare|TRICARE EAST REGION|||||4.50||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Medicaid|MEDICAID|4.50||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Multiplan|NALC|||||4.50||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Managed Medicare|MA PART B ONLY IP|4.50||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Aetna|AETNA PPO|||||4.50||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Cigna|CIGNA|4.50||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|ChampVA|CHAMPVA CENTER|4.50||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||4.50||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9501818|ERX|0250|HYDRALAZINE 50MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|7.50||||7.50||| 9501818|ERX|0250|HYDRALAZINE 50MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|7.50||||||| 9501818|ERX|0250|HYDRALAZINE 50MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|7.50||||7.50||| 9501818|ERX|0250|HYDRALAZINE 50MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|7.50||||||| 9501818|ERX|0250|HYDRALAZINE 50MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.50||||7.50||| 9501818|ERX|0250|HYDRALAZINE 50MG TABLET|Aetna|AETNA PPO|7.50||||||| 9501818|ERX|0250|HYDRALAZINE 50MG TABLET|Humana Medicare Advantage|HUMANA MA|7.50||||7.50||| 9501818|ERX|0250|HYDRALAZINE 50MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|7.50||||||| 9501818|ERX|0250|HYDRALAZINE 50MG TABLET|Medicare|MEDICARE ACUTE|7.50||||7.50||| 9501818|ERX|0250|HYDRALAZINE 50MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|7.50||||||| 9501818|ERX|0250|HYDRALAZINE 50MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|7.50||||||| 9501818|ERX|0250|HYDRALAZINE 50MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|7.50||||||| 9501818|ERX|0250|HYDRALAZINE 50MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|7.50||||7.50||| 9501818|ERX|0250|HYDRALAZINE 50MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|7.50||||7.50||| 9501818|ERX|0250|HYDRALAZINE 50MG TABLET|Managed Medicare|HEALTHSPRING MA|7.50||||||| 9501818|ERX|0250|HYDRALAZINE 50MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|7.50||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Medicaid|MEDICAID|4.50||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Tricare|TRICARE EAST REGION|4.50||||4.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Medicaid|LAW ENFORCEMENT OTHER|4.50||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||4.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||4.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Multiplan|NALC|||||4.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Texas Workforce Commission|DIS DETER SERV (DDS)|4.50||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||4.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||4.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Managed Medicare|WELLCARE CHOICE MA|||||4.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Aetna|AETNA PPO|4.50||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|4.50||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9501867|ERX|0250|ISOSORBIDE DINITRATE 20MG|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9501867|ERX|0250|ISOSORBIDE DINITRATE 20MG|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||||| 9501867|ERX|0250|ISOSORBIDE DINITRATE 20MG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9501867|ERX|0250|ISOSORBIDE DINITRATE 20MG|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9501875|ERX|0250|HYDRALAZINE 10MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|7.50||||||| 9501875|ERX|0250|HYDRALAZINE 10MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|7.50||||||| 9501875|ERX|0250|HYDRALAZINE 10MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|7.50||||||| 9501875|ERX|0250|HYDRALAZINE 10MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|7.50||||||| 9501875|ERX|0250|HYDRALAZINE 10MG TABLET|Managed Medicare|HEALTHSPRING MA|7.50||||||| 9501875|ERX|0250|HYDRALAZINE 10MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|7.50||||7.50||| 9501875|ERX|0250|HYDRALAZINE 10MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|7.50||||||| 9501875|ERX|0250|HYDRALAZINE 10MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|7.50||||7.50||| 9501875|ERX|0250|HYDRALAZINE 10MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|7.50||||||| 9501875|ERX|0250|HYDRALAZINE 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|7.50||||||| 9501875|ERX|0250|HYDRALAZINE 10MG TABLET|Medicare|MEDICARE ACUTE|7.50||||7.50||| 9501875|ERX|0250|HYDRALAZINE 10MG TABLET|Humana Medicare Advantage|HUMANA MA|7.50||||7.50||| 9501891|ERX|0250|SITAGLIPTIN 25MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.60||||||| 9501891|ERX|0250|SITAGLIPTIN 25MG TABLET|Humana Medicare Advantage|HUMANA MA|0.60||||||| 9501891|ERX|0250|SITAGLIPTIN 25MG TABLET|Medicare|MEDICARE ACUTE|0.60||||0.60||| 9501891|ERX|0250|SITAGLIPTIN 25MG TABLET|Aetna|AETNA PPO|0.60||||||| 9501891|ERX|0250|SITAGLIPTIN 25MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.60||||||| 9501891|ERX|0250|SITAGLIPTIN 25MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.60||||||| 9501891|ERX|0250|SITAGLIPTIN 25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.60||||0.60||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Aetna|AETNA PPO|4.50||||||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|United Healthcare|UNITED HEALTHCARE OTHER|||||4.50||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Medicaid|MEDICAID|4.50||||4.50||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Cigna|CIGNA|||||4.50||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Aetna|AETNA OTHER|||||4.50||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.50||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9501917|ERX|0250|CYPROHEPTADINE 4MG TABLET|Humana Medicare Advantage|HUMANA MA|2.75||||||| 9501917|ERX|0250|CYPROHEPTADINE 4MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.75||| 9501917|ERX|0250|CYPROHEPTADINE 4MG TABLET|Medicare|MEDICARE ACUTE|2.75||||2.75||| 9501925|ERX|0250|CARBAMAZEPINE 200MG TABLE|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9501925|ERX|0250|CARBAMAZEPINE 200MG TABLE|Veterans Affairs|VETERANS ADMINISTRATION|||||4.50||| 9501925|ERX|0250|CARBAMAZEPINE 200MG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.50||| 9501925|ERX|0250|CARBAMAZEPINE 200MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.50||| 9501925|ERX|0250|CARBAMAZEPINE 200MG TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9501925|ERX|0250|CARBAMAZEPINE 200MG TABLE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9501925|ERX|0250|CARBAMAZEPINE 200MG TABLE|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9501925|ERX|0250|CARBAMAZEPINE 200MG TABLE|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9501925|ERX|0250|CARBAMAZEPINE 200MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9501925|ERX|0250|CARBAMAZEPINE 200MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||4.50||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|Aetna|AETNA PPO|||||4.50||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9501958|ERX|0250|PREDNISONE 10MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.25||||||| 9501958|ERX|0250|PREDNISONE 10MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.25||||2.25||| 9501958|ERX|0250|PREDNISONE 10MG TABLET|Medicare|MEDICARE ACUTE|2.25||||2.25||| 9501958|ERX|0250|PREDNISONE 10MG TABLET|Tricare|TRICARE EAST REGION|2.25||||||| 9501958|ERX|0250|PREDNISONE 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|2.25||||||| 9501958|ERX|0250|PREDNISONE 10MG TABLET|United Healthcare|UNITED HEALTHCARE|2.25||||||| 9501958|ERX|0250|PREDNISONE 10MG TABLET|Cigna|CIGNA|2.25||||||| 9501958|ERX|0250|PREDNISONE 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|2.25||||||| 9501958|ERX|0250|PREDNISONE 10MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.25||||||| 9501958|ERX|0250|PREDNISONE 10MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|2.25||||||| 9501958|ERX|0250|PREDNISONE 10MG TABLET|Managed Medicare|HEALTHSPRING MA|2.25||||||| 9501958|ERX|0250|PREDNISONE 10MG TABLET|ChampVA|CHAMPVA CENTER|2.25||||||| 9501958|ERX|0250|PREDNISONE 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.25||||||| 9501958|ERX|0250|PREDNISONE 10MG TABLET|Humana Medicare Advantage|HUMANA MA|2.25||||||| 9501958|ERX|0250|PREDNISONE 10MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|2.25||||||| 9501966|ERX|0250|HYDROXYZINE HCL 10MG/5ML,|Medicaid|MEDICAID|16.50||||||| 9501974|ERX|0250|MONTELUKAST CHEWABLE 5MG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|38.50||||||| 9501974|ERX|0250|MONTELUKAST CHEWABLE 5MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|38.50||||||| 9501982|ERX|0250|THEOPHYLLINE SR 300MG TAB|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.50||| 9501982|ERX|0250|THEOPHYLLINE SR 300MG TAB|Medicare|MEDICARE ACUTE|4.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Aetna|AETNA PPO|||||4.50||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Cigna|CIGNA OTHER|||||4.50||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|4.50||||4.50||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Cigna|CIGNA|4.50||||4.50||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Tricare|TRICARE EAST REGION|4.50||||4.50||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||4.50||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Medicaid|LAW ENFORCEMENT OTHER|4.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Medicaid|MEDICAID|4.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||4.50||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.27||||0.27||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|Veterans Affairs|VETERANS ADMINISTRATION|||||0.27||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.27||||0.27||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|United Healthcare|UNITED HEALTHCARE|||||0.27||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.27||||0.27||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|Medicaid|MEDICAID|0.27||||0.27||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.27||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|Tricare|TRICARE EAST REGION|||||0.27||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.27||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|Managed Medicare|HEALTHSPRING MA|0.27||||0.27||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|Managed Medicaid|MEDICAID SUPERIOR|||||0.27||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|Managed Medicaid|MEDICAID AMERIGROUP|||||0.27||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|Blue Cross PPO Specialty|BCBSTX PPO|0.27||||0.27||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|United Healthcare|UNITED HEALTHCARE|0.27||||0.27||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|Medicare|MEDICARE ACUTE|0.27||||0.27||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.27||||0.27||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|Humana Medicare Advantage|HUMANA MA|0.27||||0.27||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.27||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||0.27||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|Blue Cross HMO Specialty|BCBSTX HMO|||||0.27||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|ChampVA|CHAMPVA CENTER|||||0.27||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.27||||0.27||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.27||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.27||||0.27||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|Aetna|AETNA PPO|||||0.27||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|0.27||||0.27||| 9502022|ERX|0250|ACETAMINOPHEN 120MG SUPP|Blue Cross HMO Specialty|BCBSTX HMO|||||9.25||| 9502022|ERX|0250|ACETAMINOPHEN 120MG SUPP|Cigna|CIGNA|||||9.25||| 9502022|ERX|0250|ACETAMINOPHEN 120MG SUPP|Managed Medicaid|MEDICAID SUPERIOR|||||9.25||| 9502022|ERX|0250|ACETAMINOPHEN 120MG SUPP|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||9.25||| 9502022|ERX|0250|ACETAMINOPHEN 120MG SUPP|Medicaid|MEDICAID HMO|||||9.25||| 9502022|ERX|0250|ACETAMINOPHEN 120MG SUPP|Medicaid|MEDICAID|||||9.25||| 9502022|ERX|0250|ACETAMINOPHEN 120MG SUPP|Aetna|AETNA OTHER|||||9.25||| 9502022|ERX|0250|ACETAMINOPHEN 120MG SUPP|Tricare|TRICARE FOR LIFE|||||9.25||| 9502022|ERX|0250|ACETAMINOPHEN 120MG SUPP|Blue Cross PPO Specialty|BCBSTX PPO|||||9.25||| 9502022|ERX|0250|ACETAMINOPHEN 120MG SUPP|Managed Medicaid|MEDICAID AMERIGROUP|||||9.25||| 9502022|ERX|0250|ACETAMINOPHEN 120MG SUPP|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||9.25||| 9502048|ERX|0250|TETRAHYDROZOLIN 0.05%, 15|United Medicare Advantage|AARP UHC WEST COMPLETE MA|27.50||||||| 9502048|ERX|0250|TETRAHYDROZOLIN 0.05%, 15|Cigna|CIGNA|27.50||||||| 9502048|ERX|0250|TETRAHYDROZOLIN 0.05%, 15|Medicare|MEDICARE ACUTE|27.50||||27.50||| 9502063|ERX|0250|BISMUTH SUBSAL 262MG/15ML|Managed Medicare|HEALTHSPRING MA|||||5.50||| 9502063|ERX|0250|BISMUTH SUBSAL 262MG/15ML|Blue Cross PPO Specialty|BCBSTX PPO|||||5.50||| 9502063|ERX|0250|BISMUTH SUBSAL 262MG/15ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|5.50||||||| 9502063|ERX|0250|BISMUTH SUBSAL 262MG/15ML|Medicare|MEDICARE ACUTE|5.50||||5.50||| 9502071|ERX|0250|SITAGLIPTIN 100MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||22.25||| 9502071|ERX|0250|SITAGLIPTIN 100MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|22.25||||22.25||| 9502071|ERX|0250|SITAGLIPTIN 100MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|22.25||||22.25||| 9502071|ERX|0250|SITAGLIPTIN 100MG TABLET|Medicare|MEDICARE ACUTE|22.25||||22.25||| 9502071|ERX|0250|SITAGLIPTIN 100MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||22.25||| 9502071|ERX|0250|SITAGLIPTIN 100MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||22.25||| 9502071|ERX|0250|SITAGLIPTIN 100MG TABLET|Humana Medicare Advantage|HUMANA MA|22.25||||22.25||| 9502071|ERX|0250|SITAGLIPTIN 100MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|22.25||||||| 9502071|ERX|0250|SITAGLIPTIN 100MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|22.25||||||| 9502071|ERX|0250|SITAGLIPTIN 100MG TABLET|Medicare|MEDICARE PART B ONLY IP|22.25||||||| 9502071|ERX|0250|SITAGLIPTIN 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||22.25||| 9502071|ERX|0250|SITAGLIPTIN 100MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|22.25||||||| 9502089|ERX|0250|PROPRANOLOL 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.75||||||| 9502089|ERX|0250|PROPRANOLOL 10MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.75||||||| 9502089|ERX|0250|PROPRANOLOL 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.75||||||| 9502089|ERX|0250|PROPRANOLOL 10MG TABLET|Tricare|TRICARE EAST REGION|||||4.75||| 9502089|ERX|0250|PROPRANOLOL 10MG TABLET|Humana Medicare Advantage|HUMANA MA|4.75||||4.75||| 9502089|ERX|0250|PROPRANOLOL 10MG TABLET|Medicare|MEDICARE ACUTE|4.75||||||| 9502089|ERX|0250|PROPRANOLOL 10MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.75||||||| 9502089|ERX|0250|PROPRANOLOL 10MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|||||4.75||| 9502089|ERX|0250|PROPRANOLOL 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.75||| 9502089|ERX|0250|PROPRANOLOL 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.75||||||| 9502089|ERX|0250|PROPRANOLOL 10MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.75||||||| 9502097|ERX|0250|PROPRANOLOL 20MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9502097|ERX|0250|PROPRANOLOL 20MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9502097|ERX|0250|PROPRANOLOL 20MG TABLET|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||4.50||| 9502097|ERX|0250|PROPRANOLOL 20MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9502097|ERX|0250|PROPRANOLOL 20MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9502097|ERX|0250|PROPRANOLOL 20MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9502097|ERX|0250|PROPRANOLOL 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9502097|ERX|0250|PROPRANOLOL 20MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9502097|ERX|0250|PROPRANOLOL 20MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9502097|ERX|0250|PROPRANOLOL 20MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9502097|ERX|0250|PROPRANOLOL 20MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9502105|ERX|0250|PROPRANOLOL 40MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|||||7.50||| 9502105|ERX|0250|PROPRANOLOL 40MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||7.50||| 9502105|ERX|0250|PROPRANOLOL 40MG TABLET|Humana Medicare Advantage|HUMANA MA|7.50||||||| 9502105|ERX|0250|PROPRANOLOL 40MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|7.50||||||| 9502105|ERX|0250|PROPRANOLOL 40MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||7.50||| 9502105|ERX|0250|PROPRANOLOL 40MG TABLET|Medicare|MEDICARE ACUTE|7.50||||7.50||| 9502105|ERX|0250|PROPRANOLOL 40MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|7.50||||||| 9502105|ERX|0250|PROPRANOLOL 40MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|7.50||||||| 9502139|ERX|0250|NITROFURANTOIN MACRO 50MG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9502139|ERX|0250|NITROFURANTOIN MACRO 50MG|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.50||| 9502139|ERX|0250|NITROFURANTOIN MACRO 50MG|Medicare|MEDICARE ACUTE|4.50||||||| 9502139|ERX|0250|NITROFURANTOIN MACRO 50MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Tricare|TRICARE EAST REGION|4.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|United Medicare Advantage|UHC AARP MCR HMO MA|4.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9502204|ERX|0250|TROLAMINE SALIC 10% CRM,8|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|28.50||||||| 9502204|ERX|0250|TROLAMINE SALIC 10% CRM,8|Veterans Affairs|VETERANS ADMINISTRATION|28.50||||||| 9502204|ERX|0250|TROLAMINE SALIC 10% CRM,8|Medicare|MEDICARE PART B ONLY IP|28.50||||||| 9502204|ERX|0250|TROLAMINE SALIC 10% CRM,8|United Medicare Advantage|AARP UHC WEST COMPLETE MA|28.50||||||| 9502204|ERX|0250|TROLAMINE SALIC 10% CRM,8|Medicare|MEDICARE ACUTE|28.50||||||| 9502204|ERX|0250|TROLAMINE SALIC 10% CRM,8|Managed Medicaid|MEDICAID UNITED HEALTHCARE|28.50||||||| 9502212|ERX|0250|CARBAMIDE PEROXIDE DROP,|Cigna|CIGNA|||||54.50||| 9502212|ERX|0250|CARBAMIDE PEROXIDE DROP,|Blue Cross PPO Specialty|BCBSTX PPO|54.50||||||| 9502212|ERX|0250|CARBAMIDE PEROXIDE DROP,|Medicare|MEDICARE ACUTE|54.50||||54.50||| 9502253|ERX|0250|ACETAMINOPHEN 325MG SUPP|United Healthcare|UNITED HEALTHCARE|||||6.50||| 9502253|ERX|0250|ACETAMINOPHEN 325MG SUPP|Humana Medicare Advantage|HUMANA MA|6.50||||||| 9502261|ERX|0250|EYE WASH, 120ML|Blue Cross PPO Specialty|BCBSTX PPO|||||42.75||| 9502261|ERX|0250|EYE WASH, 120ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||42.75||| 9502261|ERX|0250|EYE WASH, 120ML|Managed Medicaid|MEDICAID AMERIGROUP|||||42.75||| 9502261|ERX|0250|EYE WASH, 120ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||42.75||| 9502261|ERX|0250|EYE WASH, 120ML|Managed Medicaid|MEDICAID SUPERIOR|||||42.75||| 9502261|ERX|0250|EYE WASH, 120ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||42.75||| 9502261|ERX|0250|EYE WASH, 120ML|Humana Medicare Advantage|HUMANA MA|||||42.75||| 9502261|ERX|0250|EYE WASH, 120ML|Medicaid|HENDERSON COUNTY INDIGENT|||||42.75||| 9502261|ERX|0250|EYE WASH, 120ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||42.75||| 9502261|ERX|0250|EYE WASH, 120ML|Medicare|MEDICARE ACUTE|||||42.75||| 9502261|ERX|0250|EYE WASH, 120ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||42.75||| 9502261|ERX|0250|EYE WASH, 120ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||42.75||| 9502261|ERX|0250|EYE WASH, 120ML|Veterans Affairs|VETERANS ADMINISTRATION|||||42.75||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.09||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|United Healthcare|UNITED HEALTHCARE|||||0.09||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Medicaid|MEDICAID HMO|||||0.09||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.09||||0.09||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Medicaid|MEDICAID|0.09||||0.09||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||0.09||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.09||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|0.09||||0.09||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Medicare|MEDICARE ACUTE|0.09||||0.09||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.09||||0.09||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.09||||0.09||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Cigna|CIGNA|||||0.09||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Humana Medicare Advantage|HUMANA MA|0.09||||0.09||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.09||||0.09||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.09||||0.09||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Tricare|TRICARE EAST REGION|0.09||||||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.09||||0.09||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||0.09||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Managed Medicare|HEALTHSPRING MA|0.09||||0.09||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Aetna|AETNA PPO|0.09||||0.09||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Managed Medicare|MA PART B ONLY IP|4.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9502287|ERX|0250|BISACODYL 5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Medicaid|MEDICAID HMO|4.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Medicaid|MEDICAID|4.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Tricare|TRICARE EAST REGION|4.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|4.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|United Healthcare|TML GROUP BENEFITS|4.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Cigna|CIGNA|4.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UMR|4.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.50||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Aetna|AETNA PPO|4.50||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Tricare|TRICARE EAST REGION|4.50||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Medicaid|MEDICAID HMO|4.50||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Medicaid|MEDICAID|4.50||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Access Direct Platinum|HEALTHFIRST TPA UMR|4.50||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|4.50||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Aetna|AETNA PPO|4.50||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|ChampVA|CHAMPVA CENTER|4.50||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Cigna|CIGNA|4.50||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9502378|ERX|0250|HYDROXYZINE PAMOATE 25MG|Blue Cross PPO Specialty|BCBSTX OTHER|||||4.50||| 9502378|ERX|0250|HYDROXYZINE PAMOATE 25MG|Cigna|CIGNA|4.50||||||| 9502378|ERX|0250|HYDROXYZINE PAMOATE 25MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9502378|ERX|0250|HYDROXYZINE PAMOATE 25MG|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9502378|ERX|0250|HYDROXYZINE PAMOATE 25MG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.50||| 9502378|ERX|0250|HYDROXYZINE PAMOATE 25MG|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9502378|ERX|0250|HYDROXYZINE PAMOATE 25MG|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9502378|ERX|0250|HYDROXYZINE PAMOATE 25MG|Medicaid|MEDICAID|4.50||||||| 9502378|ERX|0250|HYDROXYZINE PAMOATE 25MG|Medicare|MEDICARE ACUTE|4.50||||||| 9502402|ERX|0250|CHOLESTYRAMINE-ASPART 4G|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.32||||||| 9502402|ERX|0250|CHOLESTYRAMINE-ASPART 4G|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.32||||||| 9502402|ERX|0250|CHOLESTYRAMINE-ASPART 4G|Humana Medicare Advantage|HUMANA MA|0.32||||||| 9502402|ERX|0250|CHOLESTYRAMINE-ASPART 4G|United Medicare Advantage|UHC MEDICARE GOLD MA|0.32||||||| 9502402|ERX|0250|CHOLESTYRAMINE-ASPART 4G|Medicare|MEDICARE ACUTE|0.32||||0.32||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Aetna|AETNA OTHER|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Aetna|AETNA PPO|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Aenta Medicare Advantage|AETNA MEDICARE MA|19.50||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|19.50||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Aetna|BOON CHAPMAN|19.50||||||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Blue Cross PPO Specialty|BCBSTX OTHER|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Cigna|CIGNA|19.50||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|ChampVA|CHAMPVA CENTER|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Blue Cross HMO Specialty|BCBSTX HMO|19.50||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Managed Medicare|VAN ZANDT COUNTY INMATE|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Managed Medicaid|MEDICAID AMERIGROUP|19.50||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Managed Medicare|HEALTHSPRING MA|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Managed Medicaid|MEDICAID SUPERIOR|19.50||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Humana Medicare Advantage|HUMANA MA|19.50||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|MTC Medical|VAN ZANDT COUNTY INMATE|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Veterans Affairs|VETERANS ADMINISTRATION|19.50||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|19.50||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|19.50||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|19.50||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Tricare|TRICARE EAST REGION|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|NON CONTRACTED|COMMERCIAL OTHER 2|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|NON CONTRACTED|COMMERCIAL OTHER 1|19.50||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|PHCS|HUMANA|19.50||||||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|UTMB|UTMB CORRECTIONAL MANAGED CARE|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Cigna|CIGNA OTHER|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Cigna|CIGNA|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Blue Cross PPO Specialty|BCBSTX PPO|19.50||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|United Healthcare|UNITED HEALTHCARE|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|19.50||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|United Healthcare|TML GROUP BENEFITS|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|United Healthcare|UNITED HEALTHCARE|19.50||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|United Healthcare|UNITED HEALTHCARE OTHER|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Workers Compensation|WORKERS COMP PHYSICIAN|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|PHCS|HUMANA INSURANCE|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|United Healthcare|GEHA|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Multiplan|NALC|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Medicaid|MEDICAID|19.50||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Medicaid|MEDICAID HMO|19.50||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|19.50||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Medicaid|MEDICAID PCCM|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Medicaid|MEDICAID BCBSTX|||||19.50||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Medicare|MEDICARE ACUTE|19.50||||19.50||| 9502444|ERX|0250|LIDOCAINE 2%MDV 20ML|Managed Medicaid|MEDICAID AMERIGROUP|39.75||||39.75||| 9502444|ERX|0250|LIDOCAINE 2%MDV 20ML|Medicare|MEDICARE ACUTE|39.75||||39.75||| 9502444|ERX|0250|LIDOCAINE 2%MDV 20ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||39.75||| 9502444|ERX|0250|LIDOCAINE 2%MDV 20ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||39.75||| 9502444|ERX|0250|LIDOCAINE 2%MDV 20ML|Managed Medicaid|MEDICAID SUPERIOR|||||39.75||| 9502444|ERX|0250|LIDOCAINE 2%MDV 20ML|Humana Medicare Advantage|HUMANA MA|||||39.75||| 9502444|ERX|0250|LIDOCAINE 2%MDV 20ML|Blue Cross PPO Specialty|BCBSTX PPO|||||39.75||| 9502444|ERX|0250|LIDOCAINE 2%MDV 20ML|Blue Cross PPO Specialty|BCBSTX OTHER|||||39.75||| 9502444|ERX|0250|LIDOCAINE 2%MDV 20ML|Cigna|CIGNA|||||39.75||| 9502444|ERX|0250|LIDOCAINE 2%MDV 20ML|Blue Cross HMO Specialty|BCBSTX HMO|||||39.75||| 9502444|ERX|0250|LIDOCAINE 2%MDV 20ML|Aetna|AETNA PPO|||||39.75||| 9502444|ERX|0250|LIDOCAINE 2%MDV 20ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|39.75||||||| 9502451|ERX|0250|LIDOCAINE-EPI 2% SDV 20ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|31.64||||||| 9502451|ERX|0250|LIDOCAINE-EPI 2% SDV 20ML|Blue Cross PPO Specialty|BCBSTX PPO|25.57||||||| 9502451|ERX|0250|LIDOCAINE-EPI 2% SDV 20ML|Blue Cross HMO Specialty|BCBSTX HMO|19.50||||||| 9502451|ERX|0250|LIDOCAINE-EPI 2% SDV 20ML|Cigna|CIGNA|31.64||||||| 9502451|ERX|0250|LIDOCAINE-EPI 2% SDV 20ML|Humana Medicare Advantage|HUMANA MA|||||25.57||| 9502451|ERX|0250|LIDOCAINE-EPI 2% SDV 20ML|Managed Medicaid|MEDICAID AMERIGROUP|19.50||||19.50||| 9502451|ERX|0250|LIDOCAINE-EPI 2% SDV 20ML|Managed Medicaid|MEDICAID SUPERIOR|19.50||||||| 9502451|ERX|0250|LIDOCAINE-EPI 2% SDV 20ML|Veterans Affairs|VETERANS ADMINISTRATION|||||19.50||| 9502451|ERX|0250|LIDOCAINE-EPI 2% SDV 20ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||19.50||| 9502451|ERX|0250|LIDOCAINE-EPI 2% SDV 20ML|United Healthcare|UNITED HEALTHCARE|||||31.64||| 9502451|ERX|0250|LIDOCAINE-EPI 2% SDV 20ML|Medicare|MEDICARE ACUTE|||||19.50||| 9502451|ERX|0250|LIDOCAINE-EPI 2% SDV 20ML|Medicaid|MEDICAID|25.57||||||| 9502451|ERX|0250|LIDOCAINE-EPI 2% SDV 20ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|19.50||||||| 9502451|ERX|0250|LIDOCAINE-EPI 2% SDV 20ML|United Healthcare|UNITED HEALTHCARE|19.50||||||| 9502451|ERX|0250|LIDOCAINE-EPI 2% SDV 20ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||19.50||| 9502451|ERX|0250|LIDOCAINE-EPI 2% SDV 20ML|United Medicare Advantage|UHC MEDICARE GOLD MA|31.64||||||| 9502451|ERX|0250|LIDOCAINE-EPI 2% SDV 20ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||31.64||| 9502451|ERX|0250|LIDOCAINE-EPI 2% SDV 20ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|19.50||||||| 9502469|ERX|0250|OLANZAPINE 5MG TABLET|Tricare|TRICARE EAST REGION|||||4.50||| 9502469|ERX|0250|OLANZAPINE 5MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9502469|ERX|0250|OLANZAPINE 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9502469|ERX|0250|OLANZAPINE 5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9502469|ERX|0250|OLANZAPINE 5MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9502469|ERX|0250|OLANZAPINE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9502469|ERX|0250|OLANZAPINE 5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9502469|ERX|0250|OLANZAPINE 5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9502477|ERX|0250|LIDOCAINE 0.5%PF 50ML|Managed Medicare|BCBS MEDICARE PPO MA|||||64.50||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|22.25||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|NON CONTRACTED|COMMERCIAL OTHER 1|22.25||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|22.25||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|United Healthcare|UNITED HEALTHCARE|22.25||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|United Healthcare|UNITED HEALTHCARE|||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|United Healthcare|UNITED HEALTHCARE OTHER|||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|United Healthcare|TML GROUP BENEFITS|22.25||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Texas Workforce Commission|DIS DETER SERV (DDS)|22.25||||||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Multiplan|NALC|||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Medicare|MEDICARE ACUTE|22.25||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Medicaid|HENDERSON COUNTY INDIGENT|22.25||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Medicaid|LAW ENFORCEMENT OTHER|22.25||||||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Medicaid|MEDICAID|22.25||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Cigna|CIGNA|||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Veterans Affairs|VETERANS ADMINISTRATION|22.25||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Blue Cross PPO Specialty|BCBSTX PPO|22.25||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Blue Cross HMO Specialty|BCBSTX HMO|22.25||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Tricare|TRICARE EAST REGION|||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Aetna|AETNA PPO|22.25||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|22.25||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|22.25||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Aenta Medicare Advantage|AETNA MEDICARE MA|22.25||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|22.25||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|22.25||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Managed Medicaid|MEDICAID AMERIGROUP|22.25||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Humana Medicare Advantage|HUMANA MA|22.25||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Managed Medicare|OTHER INSTITUTIONS|||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Managed Medicare|BCBS MEDICARE PPO MA|22.25||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Managed Medicare|HEALTHSPRING MA|22.25||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|22.25||||22.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Managed Medicaid|MEDICAID SUPERIOR|22.25||||22.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Managed Medicare|HEALTHSPRING MA|214.25||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Managed Medicare|BCBS MEDICARE PPO MA|214.25||||||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Humana Medicare Advantage|HUMANA MA|214.25||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Managed Medicaid|MEDICAID SUPERIOR|214.25||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Managed Medicaid|MEDICAID UNITED HEALTHCARE|214.25||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Managed Medicaid|MEDICAID AMERIGROUP|214.25||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Access Direct Platinum|HEALTHFIRST TPA UMR|214.25||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|214.25||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Aetna|AETNA OTHER|||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|214.25||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|ChampVA|CHAMPVA CENTER|||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Blue Cross PPO Specialty|BCBSTX PPO|214.25||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Blue Cross HMO Specialty|BCBSTX HMO|214.25||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Cigna|CIGNA OTHER|214.25||||||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Cigna|CIGNA|||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Medicaid|HENDERSON COUNTY INDIGENT|214.25||||||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Medicare|MEDICARE ACUTE|214.25||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Aenta Medicare Advantage|AETNA MEDICARE MA|214.25||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Aetna|AETNA PPO|214.25||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|NON CONTRACTED|COMMERCIAL OTHER 1|214.25||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Medicaid|MEDICAID|214.25||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|United Healthcare|UMR UNITED MEDICAL RESOURCES|214.25||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|United Healthcare|UNITED HEALTHCARE OTHER|214.25||||||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|United Healthcare|UNITED HEALTHCARE|||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|United Healthcare|UNITED HEALTHCARE|214.25||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Tricare|TRICARE EAST REGION|214.25||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|PHCS|MULTIPLAN PHCS OTHER|||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Texas Workforce Commission|DIS DETER SERV (DDS)|214.25||||||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|United Medicare Advantage|UHC AARP MCR HMO MA|||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|214.25||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|United Medicare Advantage|AARP UHC WEST COMPLETE MA|214.25||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|United Medicare Advantage|UHC MEDICARE GOLD MA|214.25||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Veterans Affairs|VETERANS ADMINISTRATION|214.25||||||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Veterans Affairs|VETERANS ADMINISTRATION|214.25||||214.25||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Medicaid|MEDICAID HMO|214.25||||214.25||| 9502535|ERX|0250|LIDOCAINE 2% JELLY, 30ML|Veterans Affairs|VETERANS ADMINISTRATION|||||146.75||| 9502535|ERX|0250|LIDOCAINE 2% JELLY, 30ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||146.75||| 9502535|ERX|0250|LIDOCAINE 2% JELLY, 30ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||146.75||| 9502535|ERX|0250|LIDOCAINE 2% JELLY, 30ML|Medicare|MEDICARE ACUTE|146.75||||146.75||| 9502535|ERX|0250|LIDOCAINE 2% JELLY, 30ML|Blue Cross PPO Specialty|BCBSTX PPO|||||146.75||| 9502535|ERX|0250|LIDOCAINE 2% JELLY, 30ML|Cigna|CIGNA|||||146.75||| 9502535|ERX|0250|LIDOCAINE 2% JELLY, 30ML|Aenta Medicare Advantage|AETNA MEDICARE MA|146.75||||146.75||| 9502535|ERX|0250|LIDOCAINE 2% JELLY, 30ML|Humana Medicare Advantage|HUMANA MA|146.75||||146.75||| 9502535|ERX|0250|LIDOCAINE 2% JELLY, 30ML|Managed Medicaid|MEDICAID AMERIGROUP|||||146.75||| 9502535|ERX|0250|LIDOCAINE 2% JELLY, 30ML|Managed Medicare|HEALTHSPRING MA|||||146.75||| 9502535|ERX|0250|LIDOCAINE 2% JELLY, 30ML|Managed Medicaid|MEDICAID SUPERIOR|||||146.75||| 9502535|ERX|0250|LIDOCAINE 2% JELLY, 30ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|146.75||||146.75||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Managed Medicare|HEALTHSPRING MA|94.75||||||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Managed Medicare|BCBS MEDICARE PPO MA|94.75||||94.75||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|94.75||||94.75||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|94.75||||||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Humana Medicare Advantage|HUMANA MA|94.75||||94.75||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Aetna|AETNA PPO|||||94.75||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||94.75||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Aenta Medicare Advantage|AETNA MEDICARE MA|94.75||||94.75||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||94.75||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Managed Medicaid|MEDICAID SUPERIOR|94.75||||||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Cigna|CIGNA|||||94.75||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Blue Cross PPO Specialty|BCBSTX PPO|94.75||||94.75||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Blue Cross HMO Specialty|BCBSTX HMO|94.75||||94.75||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Tricare|TRICARE EAST REGION|||||94.75||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||94.75||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|United Healthcare|UNITED HEALTHCARE|||||94.75||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|United Healthcare|UNITED HEALTHCARE OTHER|||||94.75||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Medicaid|MEDICAID|||||94.75||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|94.75||||94.75||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|94.75||||94.75||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Medicare|MEDICARE ACUTE|94.75||||94.75||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||94.75||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Veterans Affairs|VETERANS ADMINISTRATION|94.75||||94.75||| 9502592|ERX|0250|ROPIVACAINE 0.2%, 100ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|2.35||||||| 9502592|ERX|0250|ROPIVACAINE 0.2%, 100ML|Medicaid|MEDICAID|2.35||||||| 9502592|ERX|0250|ROPIVACAINE 0.2%, 100ML|Medicaid|MEDICAID HMO|2.35||||||| 9502592|ERX|0250|ROPIVACAINE 0.2%, 100ML|Tricare|TRICARE EAST REGION|2.35||||||| 9502592|ERX|0250|ROPIVACAINE 0.2%, 100ML|United Healthcare|UNITED HEALTHCARE|2.35||||||| 9502592|ERX|0250|ROPIVACAINE 0.2%, 100ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|2.35||||||| 9502592|ERX|0250|ROPIVACAINE 0.2%, 100ML|PHCS|HUMANA|2.35||||||| 9502592|ERX|0250|ROPIVACAINE 0.2%, 100ML|United Healthcare|GEHA|2.35||||||| 9502592|ERX|0250|ROPIVACAINE 0.2%, 100ML|United Healthcare|TML GROUP BENEFITS|2.35||||||| 9502592|ERX|0250|ROPIVACAINE 0.2%, 100ML|Blue Cross PPO Specialty|BCBSTX PPO|2.35||||||| 9502592|ERX|0250|ROPIVACAINE 0.2%, 100ML|Cigna|CIGNA|2.35||||||| 9502592|ERX|0250|ROPIVACAINE 0.2%, 100ML|Blue Cross HMO Specialty|BCBSTX HMO|2.35||||||| 9502592|ERX|0250|ROPIVACAINE 0.2%, 100ML|Aetna|AETNA PPO|2.35||||||| 9502592|ERX|0250|ROPIVACAINE 0.2%, 100ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.35||||||| 9502592|ERX|0250|ROPIVACAINE 0.2%, 100ML|Medicare|MEDICARE ACUTE|2.35||||||| 9502592|ERX|0250|ROPIVACAINE 0.2%, 100ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.35||||||| 9502592|ERX|0250|ROPIVACAINE 0.2%, 100ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.35||||||| 9502592|ERX|0250|ROPIVACAINE 0.2%, 100ML|Managed Medicaid|MEDICAID AMERIGROUP|2.35||||||| 9502592|ERX|0250|ROPIVACAINE 0.2%, 100ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.35||||||| 9502592|ERX|0250|ROPIVACAINE 0.2%, 100ML|Managed Medicaid|MEDICAID SUPERIOR|2.35||||||| 9502592|ERX|0250|ROPIVACAINE 0.2%, 100ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|2.35||||||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|Managed Medicare|HEALTHSPRING MA|70.75||||70.75||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|70.75||||70.75||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|Managed Medicaid|MEDICAID SUPERIOR|70.75||||70.75||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|Aetna|AETNA PPO|70.75||||70.75||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|70.75||||70.75||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|70.75||||70.75||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|Access Direct Platinum|HEALTHFIRST TPA UMR|||||70.75||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|70.75||||70.75||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|Humana Medicare Advantage|HUMANA MA|70.75||||70.75||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|Blue Cross PPO Specialty|BCBSTX PPO|70.75||||70.75||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|ChampVA|CHAMPVA CENTER|70.75||||||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|70.75||||70.75||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|Blue Cross HMO Specialty|BCBSTX HMO|70.75||||70.75||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|Managed Medicaid|MEDICAID AMERIGROUP|70.75||||70.75||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|Cigna|CIGNA|70.75||||70.75||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||70.75||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|70.75||||70.75||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|United Medicare Advantage|UHC MEDICARE GOLD MA|70.75||||70.75||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|NON CONTRACTED|COMMERCIAL OTHER 1|70.75||||||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|Texas Workforce Commission|DIS DETER SERV (DDS)|||||70.75||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|Medicaid|MEDICAID HMO|70.75||||||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|Medicaid|HENDERSON COUNTY INDIGENT|||||70.75||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|Medicare|MEDICARE ACUTE|70.75||||70.75||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|United Healthcare|UNITED HEALTHCARE|70.75||||70.75||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|Aetna|AETNA OTHER|||||70.75||| 9502600|ERX|0250|ROPIVACAINE 0.5%, 30ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|70.75||||70.75||| 9502642|ERX|0250|BUPIVACAINE W/DEX 0.75%PF|Medicaid|MEDICAID|56.25||||||| 9502642|ERX|0250|BUPIVACAINE W/DEX 0.75%PF|Medicare|MEDICARE ACUTE|||||56.25||| 9502642|ERX|0250|BUPIVACAINE W/DEX 0.75%PF|Managed Medicaid|MEDICAID AMERIGROUP|56.25||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|14.50||||14.50||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Blue Cross PPO Specialty|BCBSTX PPO|14.50||||14.50||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Cigna|CIGNA|14.50||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Blue Cross HMO Specialty|BCBSTX HMO|14.50||||14.50||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|14.50||||14.50||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Aenta Medicare Advantage|AETNA MEDICARE MA|14.50||||14.50||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Managed Medicare|BCBS MEDICARE PPO MA|||||14.50||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Managed Medicare|HEALTHSPRING MA|14.50||||14.50||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|14.50||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Managed Medicare|MA PART B ONLY IP|14.50||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|14.50||||14.50||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Managed Medicaid|MEDICAID SUPERIOR|14.50||||14.50||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|14.50||||14.50||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Humana Medicare Advantage|HUMANA MA|14.50||||14.50||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|14.50||||14.50||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|14.50||||14.50||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|United Medicare Advantage|UHC MEDICARE GOLD MA|14.50||||14.50||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Veterans Affairs|VETERANS ADMINISTRATION|14.50||||14.50||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|United Healthcare|UMR UNITED MEDICAL RESOURCES|14.50||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|United Healthcare|UNITED HEALTHCARE|14.50||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Medicaid|HENDERSON COUNTY INDIGENT|14.50||||14.50||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Medicaid|MEDICAID|14.50||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|NON CONTRACTED|COMMERCIAL OTHER 1|14.50||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Medicaid|MOLINA HEALTHCARE OF TEXAS|14.50||||14.50||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Medicare|MEDICARE ACUTE|14.50||||14.50||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|4.50||||||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Managed Medicare|MA PART B ONLY IP|4.50||||||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Cigna|CIGNA|||||4.50||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Aetna|AETNA PPO|4.50||||4.50||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9502683|ERX|0250|METOPROLOL SUCCINATE 100M|Blue Cross PPO Specialty|BCBSTX PPO|19.50||||19.50||| 9502683|ERX|0250|METOPROLOL SUCCINATE 100M|Blue Cross HMO Specialty|BCBSTX HMO|||||19.50||| 9502683|ERX|0250|METOPROLOL SUCCINATE 100M|Aetna|AETNA PPO|19.50||||||| 9502683|ERX|0250|METOPROLOL SUCCINATE 100M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|19.50||||||| 9502683|ERX|0250|METOPROLOL SUCCINATE 100M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|19.50||||||| 9502683|ERX|0250|METOPROLOL SUCCINATE 100M|Managed Medicaid|MEDICAID SUPERIOR|19.50||||19.50||| 9502683|ERX|0250|METOPROLOL SUCCINATE 100M|Cigna|CIGNA|19.50||||||| 9502683|ERX|0250|METOPROLOL SUCCINATE 100M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|19.50||||19.50||| 9502683|ERX|0250|METOPROLOL SUCCINATE 100M|Humana Medicare Advantage|HUMANA MA|19.50||||19.50||| 9502683|ERX|0250|METOPROLOL SUCCINATE 100M|Managed Medicare|HEALTHSPRING MA|19.50||||19.50||| 9502683|ERX|0250|METOPROLOL SUCCINATE 100M|Veterans Affairs|VETERANS ADMINISTRATION|19.50||||||| 9502683|ERX|0250|METOPROLOL SUCCINATE 100M|Workers Compensation|WORKERS COMPENSATION OTHER|||||19.50||| 9502683|ERX|0250|METOPROLOL SUCCINATE 100M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||19.50||| 9502683|ERX|0250|METOPROLOL SUCCINATE 100M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|19.50||||19.50||| 9502683|ERX|0250|METOPROLOL SUCCINATE 100M|Medicare|MEDICARE ACUTE|19.50||||19.50||| 9502683|ERX|0250|METOPROLOL SUCCINATE 100M|Medicare|MEDICARE PART B ONLY IP|19.50||||||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.37||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|Medicare|MEDICARE ACUTE|0.37||||0.37||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.37||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|Tricare|TRICARE EAST REGION|||||0.37||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.37||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|Workers Compensation|UT EMPLOYEE INJURY|||||0.37||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|Managed Medicaid|MEDICAID AMERIGROUP|||||0.37||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|Managed Medicaid|MEDICAID SUPERIOR|||||0.37||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.37||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|Humana Medicare Advantage|HUMANA MA|||||0.37||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||0.37||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.37||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|Blue Cross PPO Specialty|BCBSTX PPO|0.37||||0.37||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|United Healthcare|UNITED HEALTHCARE OTHER|||||0.37||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.37||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|Blue Cross HMO Specialty|BCBSTX HMO|||||0.37||| 9502733|ERX|0250|BUDESONIDE NEB 0.25MG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|65.75||||||| 9502733|ERX|0250|BUDESONIDE NEB 0.25MG/2ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||65.75||| 9502733|ERX|0250|BUDESONIDE NEB 0.25MG/2ML|Managed Medicare|BCBS MEDICARE PPO MA|65.75||||||| 9502733|ERX|0250|BUDESONIDE NEB 0.25MG/2ML|Managed Medicaid|MEDICAID SUPERIOR|65.75||||65.75||| 9502733|ERX|0250|BUDESONIDE NEB 0.25MG/2ML|Managed Medicaid|MEDICAID AMERIGROUP|||||65.75||| 9502733|ERX|0250|BUDESONIDE NEB 0.25MG/2ML|Managed Medicare|HEALTHSPRING MA|65.75||||||| 9502733|ERX|0250|BUDESONIDE NEB 0.25MG/2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|65.75||||65.75||| 9502733|ERX|0250|BUDESONIDE NEB 0.25MG/2ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|65.75||||||| 9502733|ERX|0250|BUDESONIDE NEB 0.25MG/2ML|Humana Medicare Advantage|HUMANA MA|65.75||||65.75||| 9502733|ERX|0250|BUDESONIDE NEB 0.25MG/2ML|Veterans Affairs|VETERANS ADMINISTRATION|65.75||||||| 9502733|ERX|0250|BUDESONIDE NEB 0.25MG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|65.75||||||| 9502733|ERX|0250|BUDESONIDE NEB 0.25MG/2ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|65.75||||65.75||| 9502733|ERX|0250|BUDESONIDE NEB 0.25MG/2ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|65.75||||65.75||| 9502733|ERX|0250|BUDESONIDE NEB 0.25MG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|65.75||||||| 9502733|ERX|0250|BUDESONIDE NEB 0.25MG/2ML|Aenta Medicare Advantage|AETNA MEDICARE MA|65.75||||||| 9502733|ERX|0250|BUDESONIDE NEB 0.25MG/2ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|65.75||||||| 9502733|ERX|0250|BUDESONIDE NEB 0.25MG/2ML|Medicare|MEDICARE ACUTE|65.75||||65.75||| 9502733|ERX|0250|BUDESONIDE NEB 0.25MG/2ML|United Healthcare|UNITED HEALTHCARE|65.75||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Tricare|TRICARE EAST REGION|22.25||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|United Healthcare|UNITED HEALTHCARE|22.25||||22.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Medicaid|MEDICAID HMO|||||22.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Medicaid|COUNTY INDIGENT HEALTH OTHER|22.25||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Medicaid|MEDICAID|22.25||||22.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Medicare|MEDICARE ACUTE|22.25||||22.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|22.25||||22.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|22.25||||22.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|United Healthcare|UNITED HEALTHCARE|22.25||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|22.25||||22.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Veterans Affairs|VETERANS ADMINISTRATION|22.25||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Veterans Affairs|VETERANS ADMINISTRATION|22.25||||22.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Humana Medicare Advantage|HUMANA MA|22.25||||22.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Managed Medicaid|MEDICAID SUPERIOR|22.25||||22.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|22.25||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|22.25||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|22.25||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Managed Medicare|BCBS MEDICARE PPO MA|22.25||||22.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Aetna|AETNA PPO|22.25||||22.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|22.25||||22.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Aenta Medicare Advantage|AETNA MEDICARE MA|22.25||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|22.25||||22.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Managed Medicare|HEALTHSPRING MA|22.25||||22.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|22.25||||22.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Blue Cross HMO Specialty|BCBSTX HMO|22.25||||22.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Managed Medicaid|MEDICAID AMERIGROUP|22.25||||22.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|ChampVA|CHAMPVA CENTER|22.25||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Cigna|CIGNA|22.25||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|22.25||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||22.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||22.25||| 9502808|ERX|0250|DEXTROSE GEL 15 G|Managed Medicaid|MEDICAID AMERIGROUP|25.25||||||| 9502808|ERX|0250|DEXTROSE GEL 15 G|Managed Medicaid|MEDICAID SUPERIOR|25.25||||||| 9502824|ERX|0250|PYRIDOSTIGMINE 60MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.75||| 9502824|ERX|0250|PYRIDOSTIGMINE 60MG TABLE|Medicare|MEDICARE ACUTE|2.75||||2.75||| 9502824|ERX|0250|PYRIDOSTIGMINE 60MG TABLE|Managed Medicaid|MEDICAID AMERIGROUP|2.75||||||| 9502824|ERX|0250|PYRIDOSTIGMINE 60MG TABLE|Humana Medicare Advantage|HUMANA MA|2.75||||||| 9502907|ERX|0250|CHLORDIAZ-CLIDIN 5-2.5MG|Medicare|MEDICARE ACUTE|30.25||||||| 9502949|ERX|0250|PIPERACILLIN-TAZOBACTAM 2|Blue Cross PPO Specialty|BCBSTX PPO|||||59.50||| 9502949|ERX|0250|PIPERACILLIN-TAZOBACTAM 2|Managed Medicaid|MEDICAID SUPERIOR|59.50||||||| 9502949|ERX|0250|PIPERACILLIN-TAZOBACTAM 2|Managed Medicaid|MEDICAID AMERIGROUP|||||59.50||| 9502964|ERX|0250|PIPERACILLIN-TAZOBACTAM 3|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||138.25||| 9502964|ERX|0250|PIPERACILLIN-TAZOBACTAM 3|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|138.25||||||| 9502964|ERX|0250|PIPERACILLIN-TAZOBACTAM 3|United Healthcare|UNITED HEALTHCARE|||||138.25||| 9502964|ERX|0250|PIPERACILLIN-TAZOBACTAM 3|Medicare|MEDICARE ACUTE|138.25||||||| 9502964|ERX|0250|PIPERACILLIN-TAZOBACTAM 3|Blue Cross HMO Specialty|BCBSTX HMO|138.25||||||| 9502972|ERX|0250|PIPERACILLIN-TAZOBACTAM 4|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||104.50||| 9502972|ERX|0250|PIPERACILLIN-TAZOBACTAM 4|United Healthcare|UMR UNITED MEDICAL RESOURCES|104.50||||||| 9503046|ERX|0250|SODIUM CHLORIDE 1 G TABLE|Veterans Affairs|VETERANS ADMINISTRATION|2.25||||||| 9503046|ERX|0250|SODIUM CHLORIDE 1 G TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|2.25||||||| 9503046|ERX|0250|SODIUM CHLORIDE 1 G TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.25||||||| 9503046|ERX|0250|SODIUM CHLORIDE 1 G TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.25||||2.25||| 9503046|ERX|0250|SODIUM CHLORIDE 1 G TABLE|Medicaid|HENDERSON COUNTY INDIGENT|2.25||||||| 9503046|ERX|0250|SODIUM CHLORIDE 1 G TABLE|Medicare|MEDICARE ACUTE|2.25||||2.25||| 9503046|ERX|0250|SODIUM CHLORIDE 1 G TABLE|Blue Cross PPO Specialty|BCBSTX PPO|2.25||||||| 9503046|ERX|0250|SODIUM CHLORIDE 1 G TABLE|Managed Medicare|BCBS MEDICARE PPO MA|||||2.25||| 9503046|ERX|0250|SODIUM CHLORIDE 1 G TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.25||||||| 9503046|ERX|0250|SODIUM CHLORIDE 1 G TABLE|Managed Medicaid|MEDICAID SUPERIOR|2.25||||||| 9503046|ERX|0250|SODIUM CHLORIDE 1 G TABLE|Humana Medicare Advantage|HUMANA MA|2.25||||||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|23.50||||23.50||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|23.50||||23.50||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|23.50||||||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|23.50||||23.50||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Humana Medicare Advantage|HUMANA MA|23.50||||23.50||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|23.50||||23.50||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Managed Medicare|HEALTHSPRING MA|23.50||||23.50||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|23.50||||23.50||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|23.50||||23.50||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|23.50||||||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Aetna|AETNA PPO|||||23.50||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|23.50||||23.50||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Cigna|CIGNA|23.50||||||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Tricare|TRICARE EAST REGION|23.50||||||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|23.50||||||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|23.50||||23.50||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|United Healthcare|UNITED HEALTHCARE|23.50||||23.50||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|23.50||||||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Texas Workforce Commission|DIS DETER SERV (DDS)|23.50||||||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||23.50||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Medicaid|MEDICAID|||||23.50||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Medicare|MEDICARE PART B ONLY IP|23.50||||||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|23.50||||23.50||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|||||23.50||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|23.50||||23.50||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|23.50||||23.50||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|23.50||||23.50||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Medicare|MEDICARE ACUTE|23.50||||23.50||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|||||23.50||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|23.50||||23.50||| 9503061|ERX|0250|NIFEDIPINE 10MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9503061|ERX|0250|NIFEDIPINE 10MG CAPSULE|Medicare|MEDICARE ACUTE|4.50||||||| 9503061|ERX|0250|NIFEDIPINE 10MG CAPSULE|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||||| 9503061|ERX|0250|NIFEDIPINE 10MG CAPSULE|Cigna|CIGNA|4.50||||||| 9503061|ERX|0250|NIFEDIPINE 10MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|||||4.50||| 9503061|ERX|0250|NIFEDIPINE 10MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9503061|ERX|0250|NIFEDIPINE 10MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9503061|ERX|0250|NIFEDIPINE 10MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9503061|ERX|0250|NIFEDIPINE 10MG CAPSULE|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9503079|ERX|0250|ISOSORBIDE MONONITRATE 20|Medicare|MEDICARE ACUTE|0.11||||||| 9503079|ERX|0250|ISOSORBIDE MONONITRATE 20|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.11||||||| 9503079|ERX|0250|ISOSORBIDE MONONITRATE 20|Humana Medicare Advantage|HUMANA MA|0.11||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Veterans Affairs|VETERANS ADMINISTRATION|5.25||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|5.25||||5.25||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|United Medicare Advantage|UHC AARP MCR HMO MA|5.25||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|United Medicare Advantage|UHC MEDICARE GOLD MA|5.25||||5.25||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Tricare|TRICARE EAST REGION|5.25||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|United Healthcare|TML GROUP BENEFITS|5.25||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|United Healthcare|UNITED HEALTHCARE|||||5.25||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||5.25||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Medicaid|MOLINA HEALTHCARE OF TEXAS|5.25||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Medicaid|MEDICAID|5.25||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Medicaid|HENDERSON COUNTY INDIGENT|5.25||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Medicare|MEDICARE ACUTE|5.25||||5.25||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Aetna|AETNA PPO|5.25||||5.25||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Aenta Medicare Advantage|AETNA MEDICARE MA|5.25||||5.25||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||5.25||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.25||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|NON CONTRACTED|COMMERCIAL OTHER 1|||||5.25||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|5.25||||5.25||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Blue Cross PPO Specialty|BCBSTX PPO|5.25||||5.25||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Blue Cross HMO Specialty|BCBSTX HMO|5.25||||5.25||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|ChampVA|CHAMPVA CENTER|||||5.25||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Cigna|CIGNA OTHER|||||5.25||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Cigna|CIGNA|||||5.25||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Managed Medicare|BCBS MEDICARE PPO MA|||||5.25||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|5.25||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Managed Medicare|HEALTHSPRING MA|5.25||||5.25||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|5.25||||5.25||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Managed Medicaid|MEDICAID SUPERIOR|5.25||||5.25||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Managed Medicaid|MEDICAID AMERIGROUP|5.25||||5.25||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Humana Medicare Advantage|HUMANA MA|5.25||||5.25||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Managed Medicaid|MEDICAID AMERIGROUP|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Humana Medicare Advantage|HUMANA MA|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|MTC Medical|VAN ZANDT COUNTY INMATE|5.25||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Managed Medicare|VAN ZANDT COUNTY INMATE|5.25||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Managed Medicare|HEALTHSPRING MA|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|ChampVA|CHAMPVA CENTER|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Blue Cross PPO Specialty|BCBSTX PPO|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Blue Cross PPO Specialty|BCBSTX OTHER|||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Cigna|CIGNA|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Cigna|CIGNA|||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Cigna|CIGNA OTHER|5.25||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Aetna|AETNA PPO|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Aenta Medicare Advantage|AETNA MEDICARE MA|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Blue Cross HMO Specialty|BCBSTX HMO|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Medicaid|MOLINA HEALTHCARE OF TEXAS|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Medicaid|MEDICAID|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Medicaid|HENDERSON COUNTY INDIGENT|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Medicare|MEDICARE ACUTE|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Tricare|TRICARE EAST REGION|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Managed Medicare|BCBS MEDICARE PPO MA|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|PHCS|HUMANA|||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Tricare|TRICARE FOR LIFE|||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|NON CONTRACTED|COMMERCIAL OTHER 1|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|United Healthcare|TML GROUP BENEFITS|||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Managed Medicaid|MEDICAID SUPERIOR|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|United Healthcare|UNITED HEALTHCARE|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|United Healthcare|UMR UNITED MEDICAL RESOURCES|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|United Healthcare|GOLDEN RULE|||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Texas Workforce Commission|DIS DETER SERV (DDS)|5.25||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|United Medicare Advantage|AARP UHC WEST COMPLETE MA|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|United Medicare Advantage|UHC MEDICARE GOLD MA|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Workers Compensation|WORKERS COMPENSATION OTHER|||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Veterans Affairs|VETERANS ADMINISTRATION|5.25||||5.25||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|United Medicare Advantage|UHC AARP MCR HMO MA|||||5.25||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Veterans Affairs|VETERANS ADMINISTRATION|22.25||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|United Medicare Advantage|UHC MEDICARE GOLD MA|22.25||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|22.25||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|22.25||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|United Healthcare|UNITED HEALTHCARE|||||22.25||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|United Healthcare|UMR UNITED MEDICAL RESOURCES|22.25||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Medicare|MEDICARE ACUTE|22.25||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|22.25||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Aenta Medicare Advantage|AETNA MEDICARE MA|22.25||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Blue Cross PPO Specialty|BCBSTX PPO|22.25||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Managed Medicare|HEALTHSPRING MA|22.25||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|22.25||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Humana Medicare Advantage|HUMANA MA|22.25||||22.25||| 9503202|ERX|0250|NA CHL 0.65% NASAL SPRAY,|Managed Medicaid|MEDICAID SUPERIOR|36.50||||||| 9503202|ERX|0250|NA CHL 0.65% NASAL SPRAY,|Humana Medicare Advantage|HUMANA MA|36.50||||36.50||| 9503202|ERX|0250|NA CHL 0.65% NASAL SPRAY,|Blue Cross PPO Specialty|BCBSTX PPO|36.50||||||| 9503202|ERX|0250|NA CHL 0.65% NASAL SPRAY,|Cigna|CIGNA|36.50||||||| 9503202|ERX|0250|NA CHL 0.65% NASAL SPRAY,|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|36.50||||||| 9503202|ERX|0250|NA CHL 0.65% NASAL SPRAY,|Medicare|MEDICARE ACUTE|36.50||||36.50||| 9503202|ERX|0250|NA CHL 0.65% NASAL SPRAY,|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|36.50||||36.50||| 9503202|ERX|0250|NA CHL 0.65% NASAL SPRAY,|Veterans Affairs|VETERANS ADMINISTRATION|36.50||||||| 9503202|ERX|0250|NA CHL 0.65% NASAL SPRAY,|United Medicare Advantage|UHC MEDICARE GOLD MA|36.50||||||| 9503202|ERX|0250|NA CHL 0.65% NASAL SPRAY,|NON CONTRACTED|COMMERCIAL OTHER 1|36.50||||||| 9503251|ERX|0250|SODIUM CHLORIDE 3% 500ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||48.25||| 9503251|ERX|0250|SODIUM CHLORIDE 3% 500ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|48.25||||||| 9503251|ERX|0250|SODIUM CHLORIDE 3% 500ML|Medicare|MEDICARE ACUTE|48.25||||||| 9503251|ERX|0250|SODIUM CHLORIDE 3% 500ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|48.25||||48.25||| 9503251|ERX|0250|SODIUM CHLORIDE 3% 500ML|Humana Medicare Advantage|HUMANA MA|48.25||||||| 9503343|ERX|0250|LANSOPRAZOLE SOLUTAB 30MG|Managed Medicare|BCBS MEDICARE PPO MA|78.25||||||| 9503343|ERX|0250|LANSOPRAZOLE SOLUTAB 30MG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||78.25||| 9503343|ERX|0250|LANSOPRAZOLE SOLUTAB 30MG|Medicare|MEDICARE ACUTE|78.25||||78.25||| 9503343|ERX|0250|LANSOPRAZOLE SOLUTAB 30MG|Humana Medicare Advantage|HUMANA MA|78.25||||78.25||| 9503434|ERX|0250|ANASTROZOLE 1MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.05||||1.05||| 9503434|ERX|0250|ANASTROZOLE 1MG TABLET|United Healthcare|UNITED HEALTHCARE|1.05||||||| 9503434|ERX|0250|ANASTROZOLE 1MG TABLET|Medicare|MEDICARE ACUTE|1.05||||1.05||| 9503434|ERX|0250|ANASTROZOLE 1MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.05||||||| 9503434|ERX|0250|ANASTROZOLE 1MG TABLET|Humana Medicare Advantage|HUMANA MA|1.05||||||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|||||4.50||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|Managed Medicare|OTHER INSTITUTIONS|||||4.50||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.50||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|Medicaid|MEDICAID|4.50||||||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9503475|ERX|0250|DORZOLAMIDE 2% EYE DROP,|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|476.75||||||| 9503475|ERX|0250|DORZOLAMIDE 2% EYE DROP,|Medicare|MEDICARE ACUTE|476.75||||476.75||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Managed Medicare|OTHER INSTITUTIONS|||||4.50||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Medicaid|MEDICAID HMO|4.50||||||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Medicaid|MEDICAID|4.50||||||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9503525|ERX|0250|MEROPENEM 500MG VIAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||3.65||| 9503525|ERX|0250|MEROPENEM 500MG VIAL|Medicaid|MEDICAID|3.65||||||| 9503525|ERX|0250|MEROPENEM 500MG VIAL|Medicare|MEDICARE ACUTE|||||3.65||| 9503525|ERX|0250|MEROPENEM 500MG VIAL|Managed Medicaid|MEDICAID SUPERIOR|3.65||||||| 9503558|ERX|0250|BICALUTAMIDE 50MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|173.50||||||| 9503558|ERX|0250|BICALUTAMIDE 50MG TABLET|Humana Medicare Advantage|HUMANA MA|173.50||||||| 9503558|ERX|0250|BICALUTAMIDE 50MG TABLET|Medicare|MEDICARE ACUTE|173.50||||173.50||| 9503558|ERX|0250|BICALUTAMIDE 50MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|173.50||||||| 9503558|ERX|0250|BICALUTAMIDE 50MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|173.50||||||| 9503574|ERX|0250|ROSUVASTATIN 10MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.36||||0.36||| 9503574|ERX|0250|ROSUVASTATIN 10MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.36||||0.36||| 9503574|ERX|0250|ROSUVASTATIN 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.36||||0.36||| 9503574|ERX|0250|ROSUVASTATIN 10MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|0.36||||0.36||| 9503574|ERX|0250|ROSUVASTATIN 10MG TABLET|Medicare|MEDICARE ACUTE|0.36||||0.36||| 9503574|ERX|0250|ROSUVASTATIN 10MG TABLET|Managed Medicare|HEALTHSPRING MA|0.36||||||| 9503574|ERX|0250|ROSUVASTATIN 10MG TABLET|Managed Medicare|MA PART B ONLY IP|0.36||||||| 9503574|ERX|0250|ROSUVASTATIN 10MG TABLET|United Healthcare|UNITED HEALTHCARE|||||0.36||| 9503574|ERX|0250|ROSUVASTATIN 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.36||||||| 9503574|ERX|0250|ROSUVASTATIN 10MG TABLET|Humana Medicare Advantage|HUMANA MA|0.36||||0.36||| 9503574|ERX|0250|ROSUVASTATIN 10MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.36||| 9503574|ERX|0250|ROSUVASTATIN 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.36||||0.36||| 9503574|ERX|0250|ROSUVASTATIN 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.36||||0.36||| 9503574|ERX|0250|ROSUVASTATIN 10MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.36||||0.36||| 9503582|ERX|0250|ROSUVASTATIN 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.36||||0.36||| 9503582|ERX|0250|ROSUVASTATIN 20MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.36||||0.36||| 9503582|ERX|0250|ROSUVASTATIN 20MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|0.36||||0.36||| 9503582|ERX|0250|ROSUVASTATIN 20MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.36||||||| 9503582|ERX|0250|ROSUVASTATIN 20MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|0.36||||||| 9503582|ERX|0250|ROSUVASTATIN 20MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.36||||0.36||| 9503582|ERX|0250|ROSUVASTATIN 20MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.36||| 9503582|ERX|0250|ROSUVASTATIN 20MG TABLET|Humana Medicare Advantage|HUMANA MA|0.36||||0.36||| 9503582|ERX|0250|ROSUVASTATIN 20MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.36||| 9503582|ERX|0250|ROSUVASTATIN 20MG TABLET|Managed Medicare|HEALTHSPRING MA|0.36||||||| 9503582|ERX|0250|ROSUVASTATIN 20MG TABLET|Medicare|MEDICARE ACUTE|0.36||||0.36||| 9503582|ERX|0250|ROSUVASTATIN 20MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|0.36||||0.36||| 9503582|ERX|0250|ROSUVASTATIN 20MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.36||||||| 9503582|ERX|0250|ROSUVASTATIN 20MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|0.36||||||| 9503582|ERX|0250|ROSUVASTATIN 20MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.36||||0.36||| 9503582|ERX|0250|ROSUVASTATIN 20MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.36||||0.36||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|41.75||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|United Medicare Advantage|UHC AARP MCR HMO MA|||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|United Medicare Advantage|UHC MEDICARE GOLD MA|||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Veterans Affairs|VETERANS ADMINISTRATION|41.75||||||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Veterans Affairs|VETERANS ADMINISTRATION|||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Tricare|TRICARE EAST REGION|||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|United Healthcare|UNITED HEALTHCARE|41.75||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|NON CONTRACTED|COMMERCIAL OTHER 1|||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|United Healthcare|GEHA|||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|United Healthcare|UNITED HEALTHCARE|||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|PHCS|MULTIPLAN PHCS OTHER|||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Texas Workforce Commission|DIS DETER SERV (DDS)|||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Medicaid|MEDICAID HMO|||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Medicaid|MEDICAID|||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|United Healthcare|TML GROUP BENEFITS|41.75||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Medicaid|HENDERSON COUNTY INDIGENT|41.75||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Medicare|MEDICARE ACUTE|41.75||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Managed Medicare|HEALTHSPRING MA|41.75||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Workers Compensation|WORKERS COMPENSATION OTHER|||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|United Medicare Advantage|AARP UHC WEST COMPLETE MA|41.75||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Humana Medicare Advantage|HUMANA MA|41.75||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Aetna|AETNA PPO|||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Managed Medicaid|MEDICAID SUPERIOR|||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Aenta Medicare Advantage|AETNA MEDICARE MA|41.75||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Managed Medicare|BCBS MEDICARE PPO MA|||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Managed Medicaid|MEDICAID AMERIGROUP|41.75||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|41.75||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Blue Cross PPO Specialty|BCBSTX PPO|41.75||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Blue Cross HMO Specialty|BCBSTX HMO|41.75||||41.75||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Cigna|CIGNA|||||41.75||| 9503657|ERX|0258|VANCOMYCIN 1000MG/200ML D|Medicare|MEDICARE ACUTE|349.50||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Blue Cross PPO Specialty|BCBSTX PPO|0.05||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Aenta Medicare Advantage|AETNA MEDICARE MA|0.05||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Aetna|AETNA PPO|0.05||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.05||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Humana Medicare Advantage|HUMANA MA|0.05||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.05||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|ChampVA|CHAMPVA CENTER|||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.05||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Managed Medicaid|MEDICAID AMERIGROUP|0.05||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Managed Medicaid|MEDICAID SUPERIOR|0.05||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.05||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Managed Medicare|BCBS MEDICARE PPO MA|0.05||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Managed Medicare|VAN ZANDT COUNTY INMATE|||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Blue Cross HMO Specialty|BCBSTX HMO|0.05||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|MTC Medical|VAN ZANDT COUNTY INMATE|||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|0.05||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Managed Medicare|OTHER INSTITUTIONS|||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Managed Medicare|HEALTHSPRING MA|0.05||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Veterans Affairs|VETERANS ADMINISTRATION|0.05||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.05||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|United Medicare Advantage|UHC AARP MCR HMO MA|0.05||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.05||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|United Medicare Advantage|UHC MEDICARE GOLD MA|0.05||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Medicaid|LAW ENFORCEMENT OTHER|0.05||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Medicaid|HENDERSON COUNTY INDIGENT|||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Medicaid|MEDICAID|0.05||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Tricare|TRICARE EAST REGION|0.05||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|NON CONTRACTED|COMMERCIAL OTHER 1|0.05||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Medicare|MEDICARE PART B ONLY IP|0.05||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Medicare|MEDICARE ACUTE|0.05||||0.05||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.05||| 9503681|ERX|0250|CLORAZEPATE 7.5MG TABLET|Medicare|MEDICARE ACUTE|19.50||||||| 9503780|ERX|0250|TIMOLOL/DORZOLAM DROP,10M|Managed Medicare|BCBS MEDICARE PPO MA|935.50||||||| 9503780|ERX|0250|TIMOLOL/DORZOLAM DROP,10M|Managed Medicare|HEALTHSPRING MA|935.50||||935.50||| 9503780|ERX|0250|TIMOLOL/DORZOLAM DROP,10M|Humana Medicare Advantage|HUMANA MA|935.50||||935.50||| 9503780|ERX|0250|TIMOLOL/DORZOLAM DROP,10M|Aenta Medicare Advantage|AETNA MEDICARE MA|935.50||||||| 9503780|ERX|0250|TIMOLOL/DORZOLAM DROP,10M|United Medicare Advantage|UHC MEDICARE GOLD MA|935.50||||935.50||| 9503780|ERX|0250|TIMOLOL/DORZOLAM DROP,10M|Veterans Affairs|VETERANS ADMINISTRATION|935.50||||||| 9503780|ERX|0250|TIMOLOL/DORZOLAM DROP,10M|Medicare|MEDICARE ACUTE|935.50||||935.50||| 9503848|ERX|0250|GUANFACINE 1MG TABLET|Medicaid|MEDICAID|4.50||||||| 9503848|ERX|0250|GUANFACINE 1MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9503848|ERX|0250|GUANFACINE 1MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.50||| 9503863|ERX|0250|LEVOTHYROXINE 25MCG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|0.05||||||| 9503863|ERX|0250|LEVOTHYROXINE 25MCG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.05||||0.05||| 9503863|ERX|0250|LEVOTHYROXINE 25MCG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.05||||0.05||| 9503863|ERX|0250|LEVOTHYROXINE 25MCG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.05||||0.05||| 9503863|ERX|0250|LEVOTHYROXINE 25MCG TABLE|Managed Medicaid|MEDICAID SUPERIOR|0.05||||||| 9503863|ERX|0250|LEVOTHYROXINE 25MCG TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.05||||0.05||| 9503863|ERX|0250|LEVOTHYROXINE 25MCG TABLE|Humana Medicare Advantage|HUMANA MA|0.05||||0.05||| 9503863|ERX|0250|LEVOTHYROXINE 25MCG TABLE|Tricare|TRICARE EAST REGION|0.05||||||| 9503863|ERX|0250|LEVOTHYROXINE 25MCG TABLE|Medicare|MEDICARE ACUTE|0.05||||0.05||| 9503863|ERX|0250|LEVOTHYROXINE 25MCG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|0.05||||0.05||| 9503863|ERX|0250|LEVOTHYROXINE 25MCG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.05||||0.05||| 9503863|ERX|0250|LEVOTHYROXINE 25MCG TABLE|Cigna|CIGNA|0.05||||||| 9503863|ERX|0250|LEVOTHYROXINE 25MCG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.05||||||| 9503863|ERX|0250|LEVOTHYROXINE 25MCG TABLE|Managed Medicare|HEALTHSPRING MA|0.05||||0.05||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Medicaid|MEDICAID|4.50||||||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Tricare|TRICARE EAST REGION|||||4.50||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|ChampVA|CHAMPVA CENTER|4.50||||||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Cigna|CIGNA|4.50||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Cigna|CIGNA OTHER|4.50||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Aetna|BOON CHAPMAN|4.50||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Managed Medicare|HEALTHSPRING MA|||||4.50||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|United Healthcare|TML GROUP BENEFITS|4.50||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Tricare|TRICARE EAST REGION|4.50||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Medicaid|MEDICAID|4.50||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Workers Compensation|UT EMPLOYEE INJURY|4.50||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Medicaid|MEDICAID|4.50||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|United Healthcare|TML GROUP BENEFITS|4.50||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Workers Compensation|UT EMPLOYEE INJURY|4.50||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9503905|ERX|0250|LEVOTHYROXINE 112MCG TABL|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9503905|ERX|0250|LEVOTHYROXINE 112MCG TABL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9503905|ERX|0250|LEVOTHYROXINE 112MCG TABL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9503905|ERX|0250|LEVOTHYROXINE 112MCG TABL|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9503905|ERX|0250|LEVOTHYROXINE 112MCG TABL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9503905|ERX|0250|LEVOTHYROXINE 112MCG TABL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9503905|ERX|0250|LEVOTHYROXINE 112MCG TABL|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9503905|ERX|0250|LEVOTHYROXINE 112MCG TABL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.50||| 9503905|ERX|0250|LEVOTHYROXINE 112MCG TABL|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9503913|ERX|0250|LEVOTHYROXINE 125MCG TABL|Medicaid|HENDERSON COUNTY INDIGENT|6.25||||||| 9503913|ERX|0250|LEVOTHYROXINE 125MCG TABL|Medicare|MEDICARE ACUTE|6.25||||6.25||| 9503913|ERX|0250|LEVOTHYROXINE 125MCG TABL|Veterans Affairs|VETERANS ADMINISTRATION|6.25||||||| 9503913|ERX|0250|LEVOTHYROXINE 125MCG TABL|United Medicare Advantage|UHC MEDICARE GOLD MA|6.25||||6.25||| 9503913|ERX|0250|LEVOTHYROXINE 125MCG TABL|Managed Medicare|MA PART B ONLY IP|6.25||||||| 9503913|ERX|0250|LEVOTHYROXINE 125MCG TABL|Managed Medicare|HEALTHSPRING MA|6.25||||||| 9503913|ERX|0250|LEVOTHYROXINE 125MCG TABL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||6.25||| 9503913|ERX|0250|LEVOTHYROXINE 125MCG TABL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||6.25||| 9503913|ERX|0250|LEVOTHYROXINE 125MCG TABL|Blue Cross PPO Specialty|BCBSTX PPO|||||6.25||| 9503913|ERX|0250|LEVOTHYROXINE 125MCG TABL|ChampVA|CHAMPVA CENTER|6.25||||||| 9503913|ERX|0250|LEVOTHYROXINE 125MCG TABL|Cigna|CIGNA OTHER|6.25||||||| 9503913|ERX|0250|LEVOTHYROXINE 125MCG TABL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|6.25||||||| 9503913|ERX|0250|LEVOTHYROXINE 125MCG TABL|Humana Medicare Advantage|HUMANA MA|6.25||||||| 9503913|ERX|0250|LEVOTHYROXINE 125MCG TABL|Managed Medicaid|MEDICAID SUPERIOR|6.25||||6.25||| 9503913|ERX|0250|LEVOTHYROXINE 125MCG TABL|Managed Medicare|BCBS MEDICARE PPO MA|6.25||||||| 9503913|ERX|0250|LEVOTHYROXINE 125MCG TABL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|6.25||||6.25||| 9503913|ERX|0250|LEVOTHYROXINE 125MCG TABL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|6.25||||6.25||| 9503921|ERX|0250|LEVOTHYROXINE 150MCG TABL|Blue Cross PPO Specialty|BCBSTX PPO|6.50||||||| 9503921|ERX|0250|LEVOTHYROXINE 150MCG TABL|Blue Cross HMO Specialty|BCBSTX HMO|6.50||||6.50||| 9503921|ERX|0250|LEVOTHYROXINE 150MCG TABL|Humana Medicare Advantage|HUMANA MA|6.50||||6.50||| 9503921|ERX|0250|LEVOTHYROXINE 150MCG TABL|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||6.50||| 9503921|ERX|0250|LEVOTHYROXINE 150MCG TABL|Managed Medicare|BCBS MEDICARE PPO MA|6.50||||||| 9503921|ERX|0250|LEVOTHYROXINE 150MCG TABL|Managed Medicare|HEALTHSPRING MA|6.50||||||| 9503921|ERX|0250|LEVOTHYROXINE 150MCG TABL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|6.50||||6.50||| 9503921|ERX|0250|LEVOTHYROXINE 150MCG TABL|United Medicare Advantage|UHC MEDICARE GOLD MA|6.50||||||| 9503921|ERX|0250|LEVOTHYROXINE 150MCG TABL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|6.50||||6.50||| 9503921|ERX|0250|LEVOTHYROXINE 150MCG TABL|Veterans Affairs|VETERANS ADMINISTRATION|6.50||||||| 9503921|ERX|0250|LEVOTHYROXINE 150MCG TABL|Tricare|TRICARE EAST REGION|6.50||||6.50||| 9503921|ERX|0250|LEVOTHYROXINE 150MCG TABL|Medicare|MEDICARE ACUTE|6.50||||6.50||| 9503954|ERX|0250|NITROGLYCERIN 0.1MG PATCH|Medicare|MEDICARE ACUTE|19.25||||19.25||| 9503954|ERX|0250|NITROGLYCERIN 0.1MG PATCH|United Medicare Advantage|UHC MEDICARE GOLD MA|19.25||||||| 9503962|ERX|0250|NITROGLYCERIN 0.2MG PATCH|Medicare|MEDICARE ACUTE|2.75||||||| 9503970|ERX|0250|NITROGLYCERIN 0.4MG PATCH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.22||| 9503970|ERX|0250|NITROGLYCERIN 0.4MG PATCH|Humana Medicare Advantage|HUMANA MA|0.22||||||| 9503970|ERX|0250|NITROGLYCERIN 0.4MG PATCH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.22||||||| 9503970|ERX|0250|NITROGLYCERIN 0.4MG PATCH|Medicare|MEDICARE ACUTE|0.22||||0.22||| 9504051|ERX|0250|MORPHINE ER 15MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.13||| 9504051|ERX|0250|MORPHINE ER 15MG TABLET|Tricare|TRICARE EAST REGION|0.13||||||| 9504051|ERX|0250|MORPHINE ER 15MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|0.13||||||| 9504051|ERX|0250|MORPHINE ER 15MG TABLET|Medicare|MEDICARE ACUTE|0.13||||0.13||| 9504051|ERX|0250|MORPHINE ER 15MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||||| 9504051|ERX|0250|MORPHINE ER 15MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.13||||||| 9504051|ERX|0250|MORPHINE ER 15MG TABLET|Humana Medicare Advantage|HUMANA MA|0.13||||0.13||| 9504051|ERX|0250|MORPHINE ER 15MG TABLET|Managed Medicare|HEALTHSPRING MA|0.13||||||| 9504051|ERX|0250|MORPHINE ER 15MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.13||||0.13||| 9504069|ERX|0250|MORPHINE ER 30MG TABLET|Humana Medicare Advantage|HUMANA MA|||||4.50||| 9504069|ERX|0250|MORPHINE ER 30MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9504069|ERX|0250|MORPHINE ER 30MG TABLET|Medicare|MEDICARE ACUTE|4.50||||||| 9504069|ERX|0250|MORPHINE ER 30MG TABLET|Tricare|TRICARE EAST REGION|4.50||||||| 9504069|ERX|0250|MORPHINE ER 30MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9504069|ERX|0250|MORPHINE ER 30MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9504101|ERX|0250|TEMAZEPAM 7.5MG CAPSULE|Cigna|CIGNA|70.75||||||| 9504101|ERX|0250|TEMAZEPAM 7.5MG CAPSULE|Medicare|MEDICARE ACUTE|70.75||||70.75||| 9504101|ERX|0250|TEMAZEPAM 7.5MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|70.75||||||| 9504101|ERX|0250|TEMAZEPAM 7.5MG CAPSULE|Humana Medicare Advantage|HUMANA MA|70.75||||||| 9504127|ERX|0250|ERTAPENEM 1 G VIAL|Humana Medicare Advantage|HUMANA MA|504.25||||504.25||| 9504127|ERX|0250|ERTAPENEM 1 G VIAL|Managed Medicaid|MEDICAID SUPERIOR|||||504.25||| 9504127|ERX|0250|ERTAPENEM 1 G VIAL|Managed Medicaid|MEDICAID AMERIGROUP|||||504.25||| 9504127|ERX|0250|ERTAPENEM 1 G VIAL|Managed Medicare|BCBS MEDICARE PPO MA|504.25||||||| 9504127|ERX|0250|ERTAPENEM 1 G VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|504.25||||504.25||| 9504127|ERX|0250|ERTAPENEM 1 G VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|504.25||||||| 9504127|ERX|0250|ERTAPENEM 1 G VIAL|Blue Cross PPO Specialty|BCBSTX PPO|504.25||||||| 9504127|ERX|0250|ERTAPENEM 1 G VIAL|Blue Cross HMO Specialty|BCBSTX HMO|||||504.25||| 9504127|ERX|0250|ERTAPENEM 1 G VIAL|Veterans Affairs|VETERANS ADMINISTRATION|||||504.25||| 9504127|ERX|0250|ERTAPENEM 1 G VIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|504.25||||||| 9504127|ERX|0250|ERTAPENEM 1 G VIAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|504.25||||||| 9504127|ERX|0250|ERTAPENEM 1 G VIAL|United Healthcare|UNITED HEALTHCARE|||||504.25||| 9504127|ERX|0250|ERTAPENEM 1 G VIAL|United Healthcare|UNITED HEALTHCARE OTHER|504.25||||||| 9504127|ERX|0250|ERTAPENEM 1 G VIAL|Medicaid|MEDICAID HMO|||||504.25||| 9504127|ERX|0250|ERTAPENEM 1 G VIAL|Medicare|MEDICARE ACUTE|504.25||||504.25||| 9504176|ERX|0250|VERAPAMIL 5MG/2ML|Medicare|MEDICARE ACUTE|11.75||||||| 9504176|ERX|0250|VERAPAMIL 5MG/2ML|Managed Medicaid|MEDICAID SUPERIOR|11.75||||||| 9504218|ERX|0250|GENTAMICIN 40MG/ML, 2ML|Blue Cross PPO Specialty|BCBSTX PPO|||||54.50||| 9504218|ERX|0250|GENTAMICIN 40MG/ML, 2ML|Managed Medicaid|MEDICAID SUPERIOR|||||54.50||| 9504218|ERX|0250|GENTAMICIN 40MG/ML, 2ML|Managed Medicaid|MEDICAID AMERIGROUP|||||54.50||| 9504218|ERX|0250|GENTAMICIN 40MG/ML, 2ML|Humana Medicare Advantage|HUMANA MA|||||54.50||| 9504218|ERX|0250|GENTAMICIN 40MG/ML, 2ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|54.50||||||| 9504218|ERX|0250|GENTAMICIN 40MG/ML, 2ML|United Healthcare|UNITED HEALTHCARE|||||54.50||| 9504218|ERX|0250|GENTAMICIN 40MG/ML, 2ML|Medicare|MEDICARE ACUTE|54.50||||||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|Medicaid|MEDICAID|35.25||||||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|Medicare|MEDICARE ACUTE|35.25||||35.25||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|35.25||||||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|35.25||||35.25||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|35.25||||35.25||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|Managed Medicare|HEALTHSPRING MA|35.25||||35.25||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|Veterans Affairs|VETERANS ADMINISTRATION|35.25||||35.25||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||35.25||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|Humana Medicare Advantage|HUMANA MA|35.25||||35.25||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|35.25||||35.25||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||35.25||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|||||35.25||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|35.25||||||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|35.25||||35.25||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|35.25||||35.25||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||35.25||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|35.25||||||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|35.25||||||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|Aetna|AETNA PPO|35.25||||||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Cigna|CIGNA|||||50.50||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Blue Cross PPO Specialty|BCBSTX PPO|50.50||||50.50||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||50.50||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Aetna|AETNA OTHER|||||50.50||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||50.50||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||50.50||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Managed Medicaid|MEDICAID SUPERIOR|||||50.50||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|50.50||||50.50||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Managed Medicaid|MEDICAID AMERIGROUP|||||50.50||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Aetna|AETNA PPO|||||50.50||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||50.50||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Humana Medicare Advantage|HUMANA MA|50.50||||50.50||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Managed Medicare|WELLCARE CHOICE MA|||||50.50||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||50.50||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|50.50||||50.50||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|50.50||||50.50||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Veterans Affairs|VETERANS ADMINISTRATION|50.50||||||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||50.50||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|United Healthcare|GOLDEN RULE|||||50.50||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|United Healthcare|UNITED HEALTHCARE|||||50.50||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Medicaid|HENDERSON COUNTY INDIGENT|50.50||||||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||50.50||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Medicaid|MEDICAID HMO|||||50.50||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Medicare|MEDICARE ACUTE|50.50||||50.50||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Managed Medicare|BCBS MEDICARE PPO MA|50.50||||||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||50.50||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Medicaid|MEDICAID|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Medicaid|HENDERSON COUNTY INDIGENT|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Medicare|MEDICARE ACUTE|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Tricare|TRICARE FOR LIFE|||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|NON CONTRACTED|COMMERCIAL OTHER 1|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|United Healthcare|TML GROUP BENEFITS|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|United Healthcare|UNITED HEALTHCARE|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|PHCS|HUMANA|||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Texas Workforce Commission|DIS DETER SERV (DDS)|0.16||||||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Veterans Affairs|VETERANS ADMINISTRATION|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Workers Compensation|WORKERS COMP PHYSICIAN|||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Managed Medicare|HEALTHSPRING MA|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Managed Medicare|BCBS MEDICARE PPO MA|||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Managed Medicare|OTHER INSTITUTIONS|||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Humana Medicare Advantage|HUMANA MA|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Aetna|AETNA OTHER|||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|United Healthcare|UNITED HEALTHCARE OTHER|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Tricare|TRICARE EAST REGION|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Aetna|AETNA PPO|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Aetna|BOON CHAPMAN|0.16||||||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UMR|||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|ChampVA|CHAMPVA CENTER|||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Blue Cross PPO Specialty|BCBSTX OTHER|||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Blue Cross HMO Specialty|BCBSTX HMO|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Cigna|CIGNA|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Cigna|CIGNA OTHER|0.16||||0.16||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Medicaid|LAW ENFORCEMENT OTHER|0.16||||||| 9504275|ERX|0250|PHENYTOIN 100MG/2ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.63||| 9504291|ERX|0250|PHENYTOIN 250MG/5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||27.50||| 9504317|ERX|0250|ISOPROTERENOL 0.2MG/ML,5M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||5,607.75||| 9504317|ERX|0250|ISOPROTERENOL 0.2MG/ML,5M|Medicare|MEDICARE ACUTE|||||5,607.75||| 9504325|ERX|0250|NOREPINEPHRINE 4MG/4ML|Blue Cross PPO Specialty|BCBSTX PPO|||||54.50||| 9504325|ERX|0250|NOREPINEPHRINE 4MG/4ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||54.50||| 9504325|ERX|0250|NOREPINEPHRINE 4MG/4ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||54.50||| 9504325|ERX|0250|NOREPINEPHRINE 4MG/4ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||54.50||| 9504325|ERX|0250|NOREPINEPHRINE 4MG/4ML|Managed Medicare|BCBS MEDICARE PPO MA|||||54.50||| 9504325|ERX|0250|NOREPINEPHRINE 4MG/4ML|Managed Medicare|HEALTHSPRING MA|||||54.50||| 9504325|ERX|0250|NOREPINEPHRINE 4MG/4ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|54.50||||54.50||| 9504325|ERX|0250|NOREPINEPHRINE 4MG/4ML|Managed Medicaid|MEDICAID AMERIGROUP|54.50||||54.50||| 9504325|ERX|0250|NOREPINEPHRINE 4MG/4ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|54.50||||54.50||| 9504325|ERX|0250|NOREPINEPHRINE 4MG/4ML|Humana Medicare Advantage|HUMANA MA|54.50||||54.50||| 9504325|ERX|0250|NOREPINEPHRINE 4MG/4ML|Medicare|MEDICARE ACUTE|54.50||||54.50||| 9504325|ERX|0250|NOREPINEPHRINE 4MG/4ML|Veterans Affairs|VETERANS ADMINISTRATION|||||54.50||| 9504325|ERX|0250|NOREPINEPHRINE 4MG/4ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|54.50||||54.50||| 9504325|ERX|0250|NOREPINEPHRINE 4MG/4ML|United Medicare Advantage|UHC MEDICARE GOLD MA|54.50||||54.50||| 9504325|ERX|0250|NOREPINEPHRINE 4MG/4ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|54.50||||54.50||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|30.75||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Tricare|TRICARE EAST REGION|||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|NON CONTRACTED|COMMERCIAL OTHER 1|30.75||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|PHCS|MULTIPLAN PHCS OTHER|||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|United Healthcare|UNITED HEALTHCARE|||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|United Healthcare|TML GROUP BENEFITS|30.75||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|United Healthcare|UNITED HEALTHCARE OTHER|30.75||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|United Healthcare|GEHA|||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Texas Workforce Commission|DIS DETER SERV (DDS)|||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Medicaid|HENDERSON COUNTY INDIGENT|30.75||||||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Medicaid|MEDICAID|30.75||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Medicaid|LAW ENFORCEMENT OTHER|30.75||||||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Medicaid|MEDICAID HMO|||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Medicare|MEDICARE ACUTE|30.75||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Managed Medicaid|MEDICAID SUPERIOR|30.75||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Managed Medicaid|MEDICAID AMERIGROUP|30.75||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|30.75||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Humana Medicare Advantage|HUMANA MA|30.75||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Managed Medicare|HEALTHSPRING MA|30.75||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Veterans Affairs|VETERANS ADMINISTRATION|30.75||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|30.75||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Managed Medicare|BCBS MEDICARE PPO MA|30.75||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Aetna|AETNA PPO|30.75||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Aenta Medicare Advantage|AETNA MEDICARE MA|30.75||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Aetna|AETNA OTHER|||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|30.75||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|30.75||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Cigna|CIGNA|||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Blue Cross PPO Specialty|BCBSTX PPO|30.75||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||30.75||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Blue Cross HMO Specialty|BCBSTX HMO|30.75||||30.75||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Blue Cross PPO Specialty|BCBSTX PPO|2.75||||2.75||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Blue Cross HMO Specialty|BCBSTX HMO|2.75||||||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.75||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.75||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Humana Medicare Advantage|HUMANA MA|2.75||||2.75||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Managed Medicaid|MEDICAID SUPERIOR|||||2.75||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.75||||||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Managed Medicaid|MEDICAID AMERIGROUP|||||2.75||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Medicaid|MEDICAID|2.75||||2.75||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Medicare|MEDICARE ACUTE|2.75||||2.75||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|United Healthcare|UNITED HEALTHCARE|||||2.75||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.75||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.75||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Veterans Affairs|VETERANS ADMINISTRATION|||||2.75||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.75||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|United Medicare Advantage|UHC MEDICARE GOLD MA|2.75||||||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.75||||2.75||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Tricare|TRICARE EAST REGION|||||2.75||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|United Healthcare|UNITED HEALTHCARE OTHER|||||2.75||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.75||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|United Healthcare|UNITED HEALTHCARE|||||2.75||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.75||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|United Healthcare|TML GROUP BENEFITS|||||2.75||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Medicaid|MEDICAID|2.75||||2.75||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.75||||2.75||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Medicare|MEDICARE ACUTE|2.75||||2.75||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Managed Medicare|HEALTHSPRING MA|||||2.75||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Humana Medicare Advantage|HUMANA MA|2.75||||2.75||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Managed Medicaid|MEDICAID SUPERIOR|2.75||||2.75||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Managed Medicaid|MEDICAID AMERIGROUP|||||2.75||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.75||||2.75||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.75||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.75||||2.75||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.75||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.75||||2.75||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Blue Cross PPO Specialty|BCBSTX PPO|2.75||||2.75||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Blue Cross HMO Specialty|BCBSTX HMO|||||2.75||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Cigna|CIGNA|||||2.75||| 9504424|ERX|0250|BUPIVACAINE 0.75%PF 30ML|Blue Cross HMO Specialty|BCBSTX HMO|||||41.75||| 9504424|ERX|0250|BUPIVACAINE 0.75%PF 30ML|ChampVA|CHAMPVA CENTER|||||41.75||| 9504424|ERX|0250|BUPIVACAINE 0.75%PF 30ML|Cigna|CIGNA|||||41.75||| 9504424|ERX|0250|BUPIVACAINE 0.75%PF 30ML|Blue Cross PPO Specialty|BCBSTX PPO|||||41.75||| 9504424|ERX|0250|BUPIVACAINE 0.75%PF 30ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||41.75||| 9504424|ERX|0250|BUPIVACAINE 0.75%PF 30ML|Aetna|AETNA PPO|||||41.75||| 9504424|ERX|0250|BUPIVACAINE 0.75%PF 30ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||41.75||| 9504424|ERX|0250|BUPIVACAINE 0.75%PF 30ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||41.75||| 9504424|ERX|0250|BUPIVACAINE 0.75%PF 30ML|Humana Medicare Advantage|HUMANA MA|||||41.75||| 9504424|ERX|0250|BUPIVACAINE 0.75%PF 30ML|Managed Medicare|HEALTHSPRING MA|||||41.75||| 9504424|ERX|0250|BUPIVACAINE 0.75%PF 30ML|Medicare|MEDICARE ACUTE|||||41.75||| 9504424|ERX|0250|BUPIVACAINE 0.75%PF 30ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||41.75||| 9504424|ERX|0250|BUPIVACAINE 0.75%PF 30ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||41.75||| 9504424|ERX|0250|BUPIVACAINE 0.75%PF 30ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||41.75||| 9504481|ERX|0250|DEXMEDETOMIDINE 200MCG/2M|Medicare|MEDICARE ACUTE|||||674.75||| 9504481|ERX|0250|DEXMEDETOMIDINE 200MCG/2M|Humana Medicare Advantage|HUMANA MA|674.75||||||| 9504499|ERX|0250|BUPIVACAINE-EPI 0.25%PF 1|Managed Medicaid|MEDICAID SUPERIOR|||||0.35||| 9504499|ERX|0250|BUPIVACAINE-EPI 0.25%PF 1|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.35||| 9504499|ERX|0250|BUPIVACAINE-EPI 0.25%PF 1|Medicare|MEDICARE ACUTE|0.35||||||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|NON CONTRACTED|COMMERCIAL OTHER 1|80.50||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|United Healthcare|UNITED HEALTHCARE|80.50||||||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|United Healthcare|UNITED HEALTHCARE|||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Texas Workforce Commission|DIS DETER SERV (DDS)|||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Medicaid|MEDICAID|80.50||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Medicare|MEDICARE ACUTE|80.50||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|80.50||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|United Medicare Advantage|UHC MEDICARE GOLD MA|||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Veterans Affairs|VETERANS ADMINISTRATION|||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Workers Compensation|WORKERS COMPENSATION OTHER|||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|United Medicare Advantage|AARP UHC WEST COMPLETE MA|80.50||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Medicaid|HENDERSON COUNTY INDIGENT|||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Aetna|AETNA PPO|80.50||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Aenta Medicare Advantage|AETNA MEDICARE MA|80.50||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Aetna|AETNA OTHER|||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|80.50||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|80.50||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Access Direct Platinum|HEALTHFIRST TPA UMR|||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Blue Cross PPO Specialty|BCBSTX PPO|80.50||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Tricare|TRICARE EAST REGION|80.50||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Blue Cross HMO Specialty|BCBSTX HMO|80.50||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Cigna|CIGNA|||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Cigna|CIGNA|80.50||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|ChampVA|CHAMPVA CENTER|||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Managed Medicare|HEALTHSPRING MA|||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Managed Medicaid|MEDICAID AMERIGROUP|80.50||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Managed Medicaid|MEDICAID SUPERIOR|80.50||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Managed Medicaid|MEDICAID UNITED HEALTHCARE|80.50||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|80.50||||80.50||| 9504507|ERX|0250|BUPIVACAINE-EPI 0.25%PF 3|Humana Medicare Advantage|HUMANA MA|80.50||||80.50||| 9504523|ERX|0250|BUPIVACAINE-EPI 0.5%PF 30|Managed Medicaid|MEDICAID AMERIGROUP|||||62.50||| 9504523|ERX|0250|BUPIVACAINE-EPI 0.5%PF 30|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||62.50||| 9504523|ERX|0250|BUPIVACAINE-EPI 0.5%PF 30|Humana Medicare Advantage|HUMANA MA|||||62.50||| 9504523|ERX|0250|BUPIVACAINE-EPI 0.5%PF 30|Blue Cross PPO Specialty|BCBSTX PPO|||||62.50||| 9504523|ERX|0250|BUPIVACAINE-EPI 0.5%PF 30|Blue Cross HMO Specialty|BCBSTX HMO|||||62.50||| 9504523|ERX|0250|BUPIVACAINE-EPI 0.5%PF 30|Cigna|CIGNA|||||62.50||| 9504523|ERX|0250|BUPIVACAINE-EPI 0.5%PF 30|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||62.50||| 9504523|ERX|0250|BUPIVACAINE-EPI 0.5%PF 30|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||62.50||| 9504523|ERX|0250|BUPIVACAINE-EPI 0.5%PF 30|Aenta Medicare Advantage|AETNA MEDICARE MA|||||62.50||| 9504523|ERX|0250|BUPIVACAINE-EPI 0.5%PF 30|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||62.50||| 9504523|ERX|0250|BUPIVACAINE-EPI 0.5%PF 30|Veterans Affairs|VETERANS ADMINISTRATION|||||62.50||| 9504523|ERX|0250|BUPIVACAINE-EPI 0.5%PF 30|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||62.50||| 9504523|ERX|0250|BUPIVACAINE-EPI 0.5%PF 30|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||62.50||| 9504523|ERX|0250|BUPIVACAINE-EPI 0.5%PF 30|Medicare|MEDICARE ACUTE|||||62.50||| 9504523|ERX|0250|BUPIVACAINE-EPI 0.5%PF 30|United Healthcare|UNITED HEALTHCARE|||||62.50||| 9504549|ERX|0250|MEASLES,MUMPS&RUBELLA VAC|United Healthcare|UNITED HEALTHCARE|3.15||||||| 9504549|ERX|0250|MEASLES,MUMPS&RUBELLA VAC|Medicaid|MEDICAID HMO|3.15||||||| 9504549|ERX|0250|MEASLES,MUMPS&RUBELLA VAC|Medicaid|MEDICAID|3.15||||||| 9504549|ERX|0250|MEASLES,MUMPS&RUBELLA VAC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.15||||||| 9504549|ERX|0250|MEASLES,MUMPS&RUBELLA VAC|Blue Cross PPO Specialty|BCBSTX PPO|3.15||||||| 9504549|ERX|0250|MEASLES,MUMPS&RUBELLA VAC|Cigna|CIGNA|3.15||||||| 9504549|ERX|0250|MEASLES,MUMPS&RUBELLA VAC|Managed Medicaid|MEDICAID AMERIGROUP|3.15||||||| 9504549|ERX|0250|MEASLES,MUMPS&RUBELLA VAC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.15||||||| 9504549|ERX|0250|MEASLES,MUMPS&RUBELLA VAC|Managed Medicaid|MEDICAID SUPERIOR|3.15||||||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Managed Medicare|BCBS MEDICARE PPO MA|0.66||||||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Managed Medicaid|MEDICAID AMERIGROUP|0.66||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.66||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.66||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Humana Medicare Advantage|HUMANA MA|0.66||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Blue Cross PPO Specialty|BCBSTX PPO|0.66||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Blue Cross HMO Specialty|BCBSTX HMO|0.66||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Cigna|CIGNA|||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Aetna|AETNA OTHER|||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.66||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.66||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Blue Cross PPO Specialty|BCBSTX OTHER|||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Managed Medicaid|MEDICAID SUPERIOR|0.66||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.66||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.66||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.66||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Veterans Affairs|VETERANS ADMINISTRATION|0.66||||||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Managed Medicare|HEALTHSPRING MA|0.66||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Medicaid|MEDICAID|0.66||||||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Medicaid|HENDERSON COUNTY INDIGENT|||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Medicaid|MEDICAID BCBSTX|||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Medicaid|MEDICAID HMO|||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Medicare|MEDICARE ACUTE|0.66||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|United Healthcare|TML GROUP BENEFITS|||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|United Healthcare|UNITED HEALTHCARE|||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|United Healthcare|UNITED HEALTHCARE|0.66||||0.66||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Texas Workforce Commission|DIS DETER SERV (DDS)|||||0.66||| 9504648|ERX|0250|LABETALOL 100MG/20ML|NON CONTRACTED|COMMERCIAL OTHER 1|0.21||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|United Healthcare|UNITED HEALTHCARE|0.21||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|0.21||||||| 9504648|ERX|0250|LABETALOL 100MG/20ML|United Healthcare|GEHA|0.21||||||| 9504648|ERX|0250|LABETALOL 100MG/20ML|United Healthcare|UNITED HEALTHCARE OTHER|||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Texas Workforce Commission|DIS DETER SERV (DDS)|0.21||||||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Medicaid|HENDERSON COUNTY INDIGENT|0.21||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Medicaid|MEDICAID|0.21||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Medicare|MEDICARE ACUTE|0.21||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Medicare|MEDICARE PART B ONLY IP|0.21||||||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Veterans Affairs|VETERANS ADMINISTRATION|0.21||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.21||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.21||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.21||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Aetna|AETNA PPO|0.21||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Access Direct Platinum|HEALTHFIRST TPA UMR|||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.21||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|0.21||||||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Blue Cross PPO Specialty|BCBSTX PPO|0.21||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Blue Cross HMO Specialty|BCBSTX HMO|0.21||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Cigna|CIGNA|0.21||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Managed Medicaid|MEDICAID AMERIGROUP|0.21||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Tricare|TRICARE EAST REGION|||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Managed Medicaid|MEDICAID SUPERIOR|0.21||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.21||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.21||||||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Humana Medicare Advantage|HUMANA MA|0.21||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|MTC Medical|VAN ZANDT COUNTY INMATE|||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|0.21||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Managed Medicare|VAN ZANDT COUNTY INMATE|||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Managed Medicare|WELLCARE CHOICE MA|||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.21||||||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Managed Medicare|BCBS MEDICARE PPO MA|||||0.21||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Managed Medicare|OTHER INSTITUTIONS|||||0.21||| 9504663|ERX|0250|DOBUTAMINE 250MG/20ML|Managed Medicare|HEALTHSPRING MA|||||0.45||| 9504663|ERX|0250|DOBUTAMINE 250MG/20ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.45||| 9504663|ERX|0250|DOBUTAMINE 250MG/20ML|Managed Medicaid|MEDICAID SUPERIOR|||||0.45||| 9504663|ERX|0250|DOBUTAMINE 250MG/20ML|Blue Cross PPO Specialty|BCBSTX PPO|||||0.45||| 9504663|ERX|0250|DOBUTAMINE 250MG/20ML|Aetna|AETNA PPO|||||0.45||| 9504663|ERX|0250|DOBUTAMINE 250MG/20ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.45||| 9504663|ERX|0250|DOBUTAMINE 250MG/20ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.45||| 9504663|ERX|0250|DOBUTAMINE 250MG/20ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.45||| 9504663|ERX|0250|DOBUTAMINE 250MG/20ML|Medicare|MEDICARE ACUTE|0.45||||0.45||| 9504671|ERX|0250|DOBUTAMINE 250MG/250ML D5|Medicare|MEDICARE ACUTE|548.50||||548.50||| 9504671|ERX|0250|DOBUTAMINE 250MG/250ML D5|United Medicare Advantage|UHC MEDICARE GOLD MA|548.50||||||| 9504671|ERX|0250|DOBUTAMINE 250MG/250ML D5|Managed Medicaid|MEDICAID UNITED HEALTHCARE|548.50||||||| 9504671|ERX|0250|DOBUTAMINE 250MG/250ML D5|Humana Medicare Advantage|HUMANA MA|||||548.50||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Aenta Medicare Advantage|AETNA MEDICARE MA|63.75||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|63.75||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Aetna|AETNA PPO|63.75||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|63.75||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Access Direct Platinum|HEALTHFIRST TPA UMR|||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Blue Cross PPO Specialty|BCBSTX PPO|63.75||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Cigna|CIGNA|63.75||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|ChampVA|CHAMPVA CENTER|63.75||||||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Managed Medicare|BCBS MEDICARE PPO MA|63.75||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Managed Medicare|HEALTHSPRING MA|63.75||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Managed Medicaid|MEDICAID SUPERIOR|63.75||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|63.75||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|63.75||||||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Blue Cross HMO Specialty|BCBSTX HMO|63.75||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|63.75||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Managed Medicaid|MEDICAID AMERIGROUP|63.75||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Humana Medicare Advantage|HUMANA MA|63.75||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Veterans Affairs|VETERANS ADMINISTRATION|63.75||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|United Medicare Advantage|UHC MEDICARE GOLD MA|63.75||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|63.75||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|63.75||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Aetna|AETNA OTHER|||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Tricare|TRICARE EAST REGION|63.75||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|NON CONTRACTED|COMMERCIAL OTHER 1|63.75||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|United Healthcare|UNITED HEALTHCARE|63.75||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|United Healthcare|GEHA|||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|United Healthcare|TML GROUP BENEFITS|63.75||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|United Healthcare|UNITED HEALTHCARE|||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|United Healthcare|UNITED HEALTHCARE OTHER|||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Medicaid|HENDERSON COUNTY INDIGENT|63.75||||||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Medicaid|MEDICAID HMO|63.75||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Medicaid|MEDICAID|63.75||||63.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Medicare|MEDICARE ACUTE|63.75||||63.75||| 9504739|ERX|0250|ACETYLCYSTEINE 20%, 30ML|Humana Medicare Advantage|HUMANA MA|104.50||||||| 9504762|ERX|0250|WATER ,BACTERIOSTATIC 30M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||12.25||| 9504762|ERX|0250|WATER ,BACTERIOSTATIC 30M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||12.25||| 9504762|ERX|0250|WATER ,BACTERIOSTATIC 30M|Humana Medicare Advantage|HUMANA MA|12.25||||||| 9504770|ERX|0250|MANNITOL 25% 12.5 G/50ML|Managed Medicare|HEALTHSPRING MA|14.25||||||| 9504770|ERX|0250|MANNITOL 25% 12.5 G/50ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|14.25||||||| 9504770|ERX|0250|MANNITOL 25% 12.5 G/50ML|Humana Medicare Advantage|HUMANA MA|14.25||||||| 9504770|ERX|0250|MANNITOL 25% 12.5 G/50ML|Blue Cross HMO Specialty|BCBSTX HMO|14.25||||||| 9504770|ERX|0250|MANNITOL 25% 12.5 G/50ML|Medicaid|MEDICAID|14.25||||||| 9504770|ERX|0250|MANNITOL 25% 12.5 G/50ML|Medicare|MEDICARE ACUTE|14.25||||14.25||| 9504770|ERX|0250|MANNITOL 25% 12.5 G/50ML|United Medicare Advantage|UHC MEDICARE GOLD MA|14.25||||||| 9504796|ERX|0250|RALOXIFENE 60MG TABLET|Medicare|MEDICARE ACUTE|11.75||||11.75||| 9504796|ERX|0250|RALOXIFENE 60MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|11.75||||||| 9504796|ERX|0250|RALOXIFENE 60MG TABLET|Humana Medicare Advantage|HUMANA MA|11.75||||11.75||| 9504804|ERX|0250|FONDAPARINUX 2.5MG/0.5ML|Medicare|MEDICARE ACUTE|4.14||||||| 9504820|ERX|0258|AA 3.5%/ELECTROLYTE-M 100|Humana Medicare Advantage|HUMANA MA|610.25||||||| 9504820|ERX|0258|AA 3.5%/ELECTROLYTE-M 100|Medicare|MEDICARE ACUTE|610.25||||||| 9504838|ERX|0250|LIDOCAINE 1%MDV 50ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|19.75||||19.75||| 9504838|ERX|0250|LIDOCAINE 1%MDV 50ML|Medicaid|MEDICAID|19.75||||19.75||| 9504838|ERX|0250|LIDOCAINE 1%MDV 50ML|Medicare|MEDICARE ACUTE|19.75||||19.75||| 9504838|ERX|0250|LIDOCAINE 1%MDV 50ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||19.75||| 9504838|ERX|0250|LIDOCAINE 1%MDV 50ML|Blue Cross PPO Specialty|BCBSTX PPO|19.75||||19.75||| 9504838|ERX|0250|LIDOCAINE 1%MDV 50ML|Blue Cross HMO Specialty|BCBSTX HMO|||||19.75||| 9504838|ERX|0250|LIDOCAINE 1%MDV 50ML|Cigna|CIGNA|||||19.75||| 9504838|ERX|0250|LIDOCAINE 1%MDV 50ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|19.75||||||| 9504838|ERX|0250|LIDOCAINE 1%MDV 50ML|Managed Medicaid|MEDICAID SUPERIOR|||||19.75||| 9504838|ERX|0250|LIDOCAINE 1%MDV 50ML|Humana Medicare Advantage|HUMANA MA|||||19.75||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|Managed Medicare|HEALTHSPRING MA|52.50||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|Managed Medicaid|MEDICAID SUPERIOR|52.50||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|Managed Medicaid|MEDICAID AMERIGROUP|52.50||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|52.50||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|Humana Medicare Advantage|HUMANA MA|52.50||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|Blue Cross PPO Specialty|BCBSTX PPO|52.50||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|Cigna|CIGNA OTHER|52.50||||||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|Cigna|CIGNA|||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|Aetna|AETNA PPO|||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|Aenta Medicare Advantage|AETNA MEDICARE MA|52.50||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|52.50||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|52.50||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|Blue Cross HMO Specialty|BCBSTX HMO|52.50||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|52.50||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|NON CONTRACTED|COMMERCIAL OTHER 1|52.50||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|United Healthcare|GEHA|||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|United Healthcare|TML GROUP BENEFITS|||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|52.50||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|United Healthcare|UNITED HEALTHCARE|||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|United Healthcare|UNITED HEALTHCARE OTHER|52.50||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|Tricare|TRICARE EAST REGION|||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|United Healthcare|UNITED HEALTHCARE|52.50||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|Texas Workforce Commission|DIS DETER SERV (DDS)|||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|Medicaid|MEDICAID|||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|Medicaid|HENDERSON COUNTY INDIGENT|52.50||||||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|Medicare|MEDICARE ACUTE|52.50||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|Veterans Affairs|VETERANS ADMINISTRATION|||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|52.50||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|52.50||||52.50||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|United Medicare Advantage|UHC MEDICARE GOLD MA|52.50||||52.50||| 9504861|ERX|0250|FONDAPARINUX 7.5MG/0.6ML|Medicare|MEDICARE ACUTE|938.75||||||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Aetna|AETNA PPO|88.50||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|88.50||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Aetna|AETNA OTHER|||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|88.50||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|88.50||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Cigna|CIGNA OTHER|88.50||||||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Cigna|CIGNA|88.50||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|ChampVA|CHAMPVA CENTER|88.50||||||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Blue Cross HMO Specialty|BCBSTX HMO|88.50||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|88.50||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|88.50||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Managed Medicaid|MEDICAID AMERIGROUP|88.50||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Humana Medicare Advantage|HUMANA MA|88.50||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Managed Medicaid|MEDICAID SUPERIOR|88.50||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|88.50||||||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|88.50||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Managed Medicare|HEALTHSPRING MA|88.50||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Managed Medicare|BCBS MEDICARE PPO MA|88.50||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|88.50||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|88.50||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|88.50||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Veterans Affairs|VETERANS ADMINISTRATION|||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|88.50||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Workers Compensation|WORKERS COMPENSATION OTHER|||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Tricare|TRICARE EAST REGION|||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|United Healthcare|TML GROUP BENEFITS|88.50||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|United Healthcare|UNITED HEALTHCARE|88.50||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|PHCS|MULTIPLAN PHCS OTHER|||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|United Healthcare|GEHA|||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Texas Workforce Commission|DIS DETER SERV (DDS)|||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Medicaid|HENDERSON COUNTY INDIGENT|||||88.50||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Medicaid|MEDICAID|88.50||||||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Medicare|MEDICARE ACUTE|88.50||||88.50||| 9504911|ERX|0250||Medicaid|MEDICAID TEXAS CHILDRENS|||||2.75||| 9504911|ERX|0250||Medicaid|HENDERSON COUNTY INDIGENT|2.75||||||| 9504911|ERX|0250||Medicare|MEDICARE ACUTE|2.75||||2.75||| 9504911|ERX|0250||Workers Compensation|WORKERS COMPENSATION OTHER|||||2.75||| 9504911|ERX|0250||United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.75||||||| 9504911|ERX|0250||United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.75||| 9504911|ERX|0250||United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.75||| 9504911|ERX|0250||Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.75||| 9504911|ERX|0250||Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.75||||2.75||| 9504911|ERX|0250||Humana Medicare Advantage|HUMANA MA|2.75||||2.75||| 9504911|ERX|0250||Blue Cross PPO Specialty|BCBSTX PPO|||||2.75||| 9504911|ERX|0250||Cigna|CIGNA|||||2.75||| 9504911|ERX|0250||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.75||| 9504911|ERX|0250||Aenta Medicare Advantage|AETNA MEDICARE MA|2.75||||||| 9504929|ERX|0250|WATER FOR INJ.,STERILE 20|Blue Cross PPO Specialty|BCBSTX PPO|||||12.25||| 9504937|ERX|0250|WATER FOR INJ.,STERILE 50|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9504937|ERX|0250|WATER FOR INJ.,STERILE 50|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.50||| 9504937|ERX|0250|WATER FOR INJ.,STERILE 50|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9504937|ERX|0250|WATER FOR INJ.,STERILE 50|Medicaid|MEDICAID TEXAS CHILDRENS|||||4.50||| 9504937|ERX|0250|WATER FOR INJ.,STERILE 50|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9504937|ERX|0250|WATER FOR INJ.,STERILE 50|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9504937|ERX|0250|WATER FOR INJ.,STERILE 50|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9504937|ERX|0250|WATER FOR INJ.,STERILE 50|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Cigna|CIGNA|||||0.13||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Blue Cross PPO Specialty|BCBSTX PPO|||||0.13||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.13||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.13||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Access Direct Platinum|HEALTHFIRST TPA UMR|||||0.13||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.13||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.13||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.13||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Humana Medicare Advantage|HUMANA MA|||||0.13||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.13||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Managed Medicaid|MEDICAID SUPERIOR|0.13||||0.13||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.13||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Blue Cross HMO Specialty|BCBSTX HMO|||||0.13||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Managed Medicare|HEALTHSPRING MA|0.13||||0.13||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Managed Medicare|BCBS MEDICARE PPO MA|||||0.13||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Tricare|TRICARE EAST REGION|||||0.13||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.13||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|United Healthcare|UNITED HEALTHCARE OTHER|0.13||||||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|United Healthcare|TML GROUP BENEFITS|||||0.13||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.13||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|United Healthcare|UNITED HEALTHCARE|||||0.13||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Medicaid|HENDERSON COUNTY INDIGENT|0.13||||||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Medicare|MEDICARE ACUTE|0.13||||0.13||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.13||||0.13||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.13||||0.13||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.13||| 9504978|ERX|0250|NA BICARB 8.4% 10 MEQ/10M|Medicare|MEDICARE ACUTE|56.25||||||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||0.57||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Managed Medicare|BCBS MEDICARE PPO MA|||||0.57||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.57||||0.57||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Managed Medicaid|MEDICAID SUPERIOR|||||0.57||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.57||||0.57||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Humana Medicare Advantage|HUMANA MA|0.57||||0.57||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Aetna|AETNA PPO|||||0.57||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Aenta Medicare Advantage|AETNA MEDICARE MA|0.57||||0.57||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Managed Medicaid|MEDICAID AMERIGROUP|0.57||||0.57||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Managed Medicare|HEALTHSPRING MA|0.57||||0.57||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.57||||0.57||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Blue Cross HMO Specialty|BCBSTX HMO|0.57||||0.57||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Blue Cross PPO Specialty|BCBSTX PPO|0.57||||0.57||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Veterans Affairs|VETERANS ADMINISTRATION|0.57||||0.57||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.57||||0.57||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|United Medicare Advantage|UHC AARP MCR HMO MA|||||0.57||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|United Medicare Advantage|UHC MEDICARE GOLD MA|0.57||||0.57||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.57||||0.57||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Tricare|TRICARE EAST REGION|||||0.57||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.57||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|United Healthcare|UNITED HEALTHCARE|0.57||||||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Medicaid|MEDICAID|0.57||||||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.57||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Medicare|MEDICARE ACUTE|0.57||||0.57||| 9504994|ERX|0250|LIDOCAINE ABBOJECT 100MG/|Medicare|MEDICARE ACUTE|32.25||||32.25||| 9504994|ERX|0250|LIDOCAINE ABBOJECT 100MG/|Tricare|TRICARE EAST REGION|||||32.25||| 9504994|ERX|0250|LIDOCAINE ABBOJECT 100MG/|PHCS|HUMANA|||||32.25||| 9504994|ERX|0250|LIDOCAINE ABBOJECT 100MG/|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||32.25||| 9504994|ERX|0250|LIDOCAINE ABBOJECT 100MG/|Veterans Affairs|VETERANS ADMINISTRATION|||||32.25||| 9504994|ERX|0250|LIDOCAINE ABBOJECT 100MG/|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||32.25||| 9504994|ERX|0250|LIDOCAINE ABBOJECT 100MG/|Blue Cross PPO Specialty|BCBSTX PPO|||||32.25||| 9504994|ERX|0250|LIDOCAINE ABBOJECT 100MG/|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||32.25||| 9504994|ERX|0250|LIDOCAINE ABBOJECT 100MG/|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||32.25||| 9504994|ERX|0250|LIDOCAINE ABBOJECT 100MG/|Humana Medicare Advantage|HUMANA MA|||||32.25||| 9504994|ERX|0250|LIDOCAINE ABBOJECT 100MG/|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||32.25||| 9504994|ERX|0250|LIDOCAINE ABBOJECT 100MG/|Managed Medicaid|MEDICAID SUPERIOR|||||32.25||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||75.75||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|Managed Medicare|HEALTHSPRING MA|||||75.75||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|Managed Medicaid|MEDICAID AMERIGROUP|75.75||||75.75||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||75.75||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|Managed Medicaid|MEDICAID SUPERIOR|||||75.75||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|Managed Medicare|BCBS MEDICARE PPO MA|||||75.75||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||75.75||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|Humana Medicare Advantage|HUMANA MA|75.75||||75.75||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|Aetna|AETNA PPO|||||75.75||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||75.75||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||75.75||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|Blue Cross HMO Specialty|BCBSTX HMO|||||75.75||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|Blue Cross PPO Specialty|BCBSTX PPO|||||75.75||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|Veterans Affairs|VETERANS ADMINISTRATION|||||75.75||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|75.75||||75.75||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|75.75||||75.75||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|United Medicare Advantage|UHC MEDICARE GOLD MA|||||75.75||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|Medicaid|MEDICAID|75.75||||||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|Medicaid|MEDICAID TEXAS CHILDRENS|||||75.75||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|Medicare|MEDICARE ACUTE|75.75||||75.75||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1,312.50||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|United Healthcare|UNITED HEALTHCARE OTHER|||||1,312.50||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Medicaid|MEDICAID TEXAS CHILDRENS|||||1,312.50||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Medicare|MEDICARE ACUTE|1,312.50||||1,312.50||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1,312.50||||1,312.50||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,312.50||||1,312.50||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,312.50||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Veterans Affairs|VETERANS ADMINISTRATION|||||1,312.50||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1,312.50||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Blue Cross PPO Specialty|BCBSTX PPO|||||1,312.50||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Blue Cross HMO Specialty|BCBSTX HMO|||||1,312.50||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Cigna|CIGNA|||||1,312.50||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Aetna|AETNA PPO|||||1,312.50||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Aenta Medicare Advantage|AETNA MEDICARE MA|1,312.50||||||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,312.50||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,312.50||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,312.50||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Managed Medicaid|MEDICAID AMERIGROUP|1,312.50||||1,312.50||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Humana Medicare Advantage|HUMANA MA|1,312.50||||1,312.50||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Managed Medicare|HEALTHSPRING MA|||||1,312.50||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Managed Medicare|BCBS MEDICARE PPO MA|||||1,312.50||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1,312.50||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Managed Medicare|OTHER INSTITUTIONS|||||1,312.50||| 9505025|ERX|0250|CA CHLORIDE 1000MG/10ML|Managed Medicare|HEALTHSPRING MA|||||6.50||| 9505025|ERX|0250|CA CHLORIDE 1000MG/10ML|Managed Medicaid|MEDICAID SUPERIOR|6.50||||||| 9505025|ERX|0250|CA CHLORIDE 1000MG/10ML|Humana Medicare Advantage|HUMANA MA|6.50||||||| 9505025|ERX|0250|CA CHLORIDE 1000MG/10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||6.50||| 9505025|ERX|0250|CA CHLORIDE 1000MG/10ML|Blue Cross PPO Specialty|BCBSTX PPO|||||6.50||| 9505025|ERX|0250|CA CHLORIDE 1000MG/10ML|Medicare|MEDICARE ACUTE|6.50||||6.50||| 9505033|ERX|0250|CEFTAZIDIME 1 G VIAL|Managed Medicaid|MEDICAID SUPERIOR|1.93||||||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.18||||0.18||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.18||||0.18||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.18||||0.18||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|NON CONTRACTED|COMMERCIAL OTHER 1|0.18||||||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.18||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|United Healthcare|UNITED HEALTHCARE|||||0.18||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Medicaid|MEDICAID|0.18||||||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Medicare|MEDICARE ACUTE|0.18||||0.18||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Medicare|MEDICARE PART B ONLY IP|0.18||||||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Blue Cross HMO Specialty|BCBSTX HMO|0.18||||0.18||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|0.18||||0.18||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Cigna|CIGNA|||||0.18||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Tricare|TRICARE EAST REGION|0.18||||0.18||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.18||||||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Aetna|AETNA PPO|0.18||||||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Veterans Affairs|VETERANS ADMINISTRATION|0.18||||||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Aetna|AETNA OTHER|||||0.18||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.18||||||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.18||||0.18||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Managed Medicare|BCBS MEDICARE PPO MA|0.18||||||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Managed Medicare|VAN ZANDT COUNTY INMATE|0.18||||||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Managed Medicare|HEALTHSPRING MA|0.18||||0.18||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.18||||0.18||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Managed Medicaid|MEDICAID AMERIGROUP|0.18||||||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Managed Medicaid|MEDICAID SUPERIOR|0.18||||||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.18||||0.18||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|MTC Medical|VAN ZANDT COUNTY INMATE|0.18||||||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Humana Medicare Advantage|HUMANA MA|0.18||||0.18||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Managed Medicaid|MEDICAID SUPERIOR|24.25||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Managed Medicaid|MEDICAID AMERIGROUP|24.25||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|24.25||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Managed Medicare|HEALTHSPRING MA|24.25||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Managed Medicare|HOSPICE ETMC|||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|24.25||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Managed Medicare|BCBS MEDICARE PPO MA|24.25||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|24.25||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Aetna|AETNA PPO|24.25||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Aenta Medicare Advantage|AETNA MEDICARE MA|24.25||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|24.25||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Blue Cross PPO Specialty|BCBSTX PPO|24.25||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Blue Cross HMO Specialty|BCBSTX HMO|24.25||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Cigna|CIGNA|||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Cigna|CIGNA|24.25||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Medicaid|MEDICAID HMO|24.25||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|24.25||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Medicaid|HENDERSON COUNTY INDIGENT|24.25||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Medicaid|MEDICAID|24.25||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Humana Medicare Advantage|HUMANA MA|24.25||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|24.25||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Medicare|MEDICARE PART B ONLY IP|24.25||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Medicare|MEDICARE ACUTE|24.25||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Tricare|TRICARE EAST REGION|24.25||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|NON CONTRACTED|COMMERCIAL OTHER 1|24.25||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|United Healthcare|UNITED HEALTHCARE|||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|24.25||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|United Healthcare|UNITED HEALTHCARE|24.25||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|24.25||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|24.25||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|United Medicare Advantage|UHC MEDICARE GOLD MA|24.25||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||24.25||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Veterans Affairs|VETERANS ADMINISTRATION|24.25||||24.25||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|Veterans Affairs|VETERANS ADMINISTRATION|12.25||||12.25||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|12.25||||12.25||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|12.25||||12.25||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|12.25||||12.25||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|Tricare|TRICARE EAST REGION|||||12.25||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|12.25||||||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|Medicaid|MEDICAID|12.25||||||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|Medicare|MEDICARE ACUTE|12.25||||12.25||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|Medicare|MEDICARE PART B ONLY IP|12.25||||||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|Blue Cross HMO Specialty|BCBSTX HMO|12.25||||||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|Blue Cross PPO Specialty|BCBSTX PPO|12.25||||12.25||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|Aetna|AETNA PPO|12.25||||||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|Aenta Medicare Advantage|AETNA MEDICARE MA|12.25||||||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|12.25||||12.25||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|Managed Medicare|HEALTHSPRING MA|12.25||||12.25||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|Managed Medicare|BCBS MEDICARE PPO MA|12.25||||||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||12.25||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|12.25||||12.25||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|Managed Medicaid|MEDICAID SUPERIOR|12.25||||12.25||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|Managed Medicaid|MEDICAID AMERIGROUP|12.25||||12.25||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||12.25||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|Humana Medicare Advantage|HUMANA MA|12.25||||12.25||| 9505124|ERX|0250|NA CHLORIDE 0.9%,500ML IR|Medicare|MEDICARE ACUTE|1.32||||||| 9505140|ERX|0250|WATER FOR IRRIGATION 500M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|135.50||||||| 9505140|ERX|0250|WATER FOR IRRIGATION 500M|Humana Medicare Advantage|HUMANA MA|135.50||||135.50||| 9505140|ERX|0250|WATER FOR IRRIGATION 500M|Aenta Medicare Advantage|AETNA MEDICARE MA|135.50||||||| 9505140|ERX|0250|WATER FOR IRRIGATION 500M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|135.50||||||| 9505140|ERX|0250|WATER FOR IRRIGATION 500M|Blue Cross PPO Specialty|BCBSTX PPO|135.50||||135.50||| 9505140|ERX|0250|WATER FOR IRRIGATION 500M|United Medicare Advantage|UHC MEDICARE GOLD MA|135.50||||||| 9505140|ERX|0250|WATER FOR IRRIGATION 500M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|135.50||||||| 9505140|ERX|0250|WATER FOR IRRIGATION 500M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|135.50||||||| 9505140|ERX|0250|WATER FOR IRRIGATION 500M|Veterans Affairs|VETERANS ADMINISTRATION|135.50||||||| 9505140|ERX|0250|WATER FOR IRRIGATION 500M|Medicaid|HENDERSON COUNTY INDIGENT|||||135.50||| 9505140|ERX|0250|WATER FOR IRRIGATION 500M|Medicare|MEDICARE ACUTE|135.50||||135.50||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Tricare|TRICARE EAST REGION|246.25||||246.25||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|NON CONTRACTED|COMMERCIAL OTHER 1|246.25||||246.25||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|246.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|United Healthcare|GEHA|||||246.25||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|United Healthcare|UNITED HEALTHCARE|246.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|United Healthcare|UNITED HEALTHCARE|246.25||||246.25||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|United Healthcare|TML GROUP BENEFITS|||||246.25||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Texas Workforce Commission|DIS DETER SERV (DDS)|||||246.25||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Medicaid|MEDICAID|246.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Medicaid|MEDICAID TEXAS CHILDRENS|||||246.25||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Medicaid|COUNTY INDIGENT HEALTH OTHER|246.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Medicaid|MOLINA HEALTHCARE OF TEXAS|246.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Medicare|MEDICARE ACUTE|246.25||||246.25||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Medicaid|HENDERSON COUNTY INDIGENT|246.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Veterans Affairs|VETERANS ADMINISTRATION|||||246.25||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|246.25||||246.25||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|246.25||||246.25||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|246.25||||246.25||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Blue Cross HMO Specialty|BCBSTX HMO|246.25||||246.25||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|ChampVA|CHAMPVA CENTER|246.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Cigna|CIGNA|246.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Cigna|CIGNA OTHER|246.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|PHCS|MULTIPLAN PHCS OTHER|||||246.25||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|246.25||||246.25||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|246.25||||246.25||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|246.25||||246.25||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Aetna|AETNA PPO|246.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|246.25||||246.25||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|246.25||||246.25||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Managed Medicare|BCBS MEDICARE PPO MA|246.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|246.25||||246.25||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Managed Medicare|HEALTHSPRING MA|246.25||||246.25||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Humana Medicare Advantage|HUMANA MA|246.25||||246.25||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|246.25||||246.25||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Managed Medicaid|MEDICAID SUPERIOR|246.25||||246.25||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|246.25||||246.25||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Managed Medicaid|MEDICAID AMERIGROUP|246.25||||||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Managed Medicaid|MEDICAID AMERIGROUP|0.37||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Managed Medicaid|MEDICAID SUPERIOR|0.37||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.37||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Managed Medicare|BCBS MEDICARE PPO MA|0.37||||||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Managed Medicare|HOSPICE OF EAST TEXAS|0.37||||||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Managed Medicare|HEALTHSPRING MA|0.37||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.37||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Aetna|AETNA PPO|0.37||||||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Aenta Medicare Advantage|AETNA MEDICARE MA|0.37||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.37||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Cigna|CIGNA|||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Aetna|AETNA OTHER|||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Blue Cross HMO Specialty|BCBSTX HMO|0.37||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Cigna|CIGNA OTHER|0.37||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Blue Cross PPO Specialty|BCBSTX PPO|0.37||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|United Medicare Advantage|UHC MEDICARE GOLD MA|0.37||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.37||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.37||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Veterans Affairs|VETERANS ADMINISTRATION|0.37||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.37||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Veterans Affairs|VETERANS ADMINISTRATION|0.37||||||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Medicaid|HENDERSON COUNTY INDIGENT|0.37||||||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Medicaid|MEDICAID HMO|0.37||||||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Medicaid|LAW ENFORCEMENT OTHER|0.37||||||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Humana Medicare Advantage|HUMANA MA|0.37||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Medicaid|MEDICAID|0.37||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Medicare|MEDICARE ACUTE|0.37||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Tricare|TRICARE EAST REGION|||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|NON CONTRACTED|COMMERCIAL OTHER 1|0.37||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|United Healthcare|UMR UNITED MEDICAL RESOURCES|0.37||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|United Healthcare|TML GROUP BENEFITS|0.37||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|United Healthcare|UNITED HEALTHCARE|||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|PHCS|MULTIPLAN PHCS OTHER|||||0.37||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Texas Workforce Commission|DIS DETER SERV (DDS)|0.37||||0.37||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||22.25||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Medicare|MEDICARE ACUTE|22.25||||22.25||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Veterans Affairs|VETERANS ADMINISTRATION|||||22.25||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|United Medicare Advantage|UHC MEDICARE GOLD MA|||||22.25||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|22.25||||22.25||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|United Medicare Advantage|UHC AARP MCR HMO MA|22.25||||||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|22.25||||22.25||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Blue Cross HMO Specialty|BCBSTX HMO|||||22.25||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Medicaid|MEDICAID|22.25||||||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Blue Cross PPO Specialty|BCBSTX PPO|22.25||||22.25||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||22.25||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Aetna|AETNA PPO|22.25||||||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Aenta Medicare Advantage|AETNA MEDICARE MA|22.25||||||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|22.25||||22.25||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||22.25||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Managed Medicare|HEALTHSPRING MA|||||22.25||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Managed Medicare|BCBS MEDICARE PPO MA|||||22.25||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Humana Medicare Advantage|HUMANA MA|22.25||||22.25||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Managed Medicaid|MEDICAID AMERIGROUP|||||22.25||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|22.25||||22.25||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|22.25||||22.25||| 9505223|ERX|0250|K CHLORIDE 2 MEQ/ML,20ML|Humana Medicare Advantage|HUMANA MA|12.25||||||| 9505223|ERX|0250|K CHLORIDE 2 MEQ/ML,20ML|Managed Medicaid|MEDICAID SUPERIOR|12.25||||12.25||| 9505223|ERX|0250|K CHLORIDE 2 MEQ/ML,20ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|12.25||||12.25||| 9505223|ERX|0250|K CHLORIDE 2 MEQ/ML,20ML|Managed Medicaid|MEDICAID AMERIGROUP|12.25||||12.25||| 9505223|ERX|0250|K CHLORIDE 2 MEQ/ML,20ML|Managed Medicare|HEALTHSPRING MA|12.25||||||| 9505223|ERX|0250|K CHLORIDE 2 MEQ/ML,20ML|Managed Medicare|BCBS MEDICARE PPO MA|12.25||||||| 9505223|ERX|0250|K CHLORIDE 2 MEQ/ML,20ML|Aetna|BOON CHAPMAN|12.25||||||| 9505223|ERX|0250|K CHLORIDE 2 MEQ/ML,20ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|12.25||||||| 9505223|ERX|0250|K CHLORIDE 2 MEQ/ML,20ML|Aetna|AETNA PPO|12.25||||||| 9505223|ERX|0250|K CHLORIDE 2 MEQ/ML,20ML|Blue Cross PPO Specialty|BCBSTX PPO|12.25||||||| 9505223|ERX|0250|K CHLORIDE 2 MEQ/ML,20ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|12.25||||||| 9505223|ERX|0250|K CHLORIDE 2 MEQ/ML,20ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|12.25||||12.25||| 9505223|ERX|0250|K CHLORIDE 2 MEQ/ML,20ML|Veterans Affairs|VETERANS ADMINISTRATION|12.25||||||| 9505223|ERX|0250|K CHLORIDE 2 MEQ/ML,20ML|Medicaid|MEDICAID|12.25||||||| 9505223|ERX|0250|K CHLORIDE 2 MEQ/ML,20ML|Medicare|MEDICARE ACUTE|12.25||||||| 9505223|ERX|0250|K CHLORIDE 2 MEQ/ML,20ML|NON CONTRACTED|COMMERCIAL OTHER 1|12.25||||||| 9505223|ERX|0250|K CHLORIDE 2 MEQ/ML,20ML|UTMB|UTMB CORRECTIONAL MANAGED CARE|12.25||||||| 9505223|ERX|0250|K CHLORIDE 2 MEQ/ML,20ML|United Healthcare|UNITED HEALTHCARE|12.25||||||| 9505223|ERX|0250|K CHLORIDE 2 MEQ/ML,20ML|United Healthcare|UNITED HEALTHCARE|||||12.25||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|4.50||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Managed Medicare|VAN ZANDT COUNTY INMATE|4.50||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.50||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|MTC Medical|VAN ZANDT COUNTY INMATE|4.50||||||| 9505249|ERX|0250|MAG SULF 20 GM/500ML WATE|Managed Medicaid|MEDICAID SUPERIOR|0.91||||0.91||| 9505249|ERX|0250|MAG SULF 20 GM/500ML WATE|Managed Medicaid|MEDICAID AMERIGROUP|0.91||||0.91||| 9505249|ERX|0250|MAG SULF 20 GM/500ML WATE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.91||||||| 9505249|ERX|0250|MAG SULF 20 GM/500ML WATE|Blue Cross PPO Specialty|BCBSTX PPO|0.91||||||| 9505249|ERX|0250|MAG SULF 20 GM/500ML WATE|Medicaid|MEDICAID|0.91||||||| 9505249|ERX|0250|MAG SULF 20 GM/500ML WATE|United Healthcare|UNITED HEALTHCARE|0.91||||0.91||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|110.25||||110.25||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|110.25||||110.25||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|United Medicare Advantage|UHC MEDICARE GOLD MA|110.25||||110.25||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Veterans Affairs|VETERANS ADMINISTRATION|110.25||||110.25||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|United Healthcare|UNITED HEALTHCARE|110.25||||||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|United Healthcare|GOLDEN RULE|||||110.25||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|United Healthcare|UNITED HEALTHCARE|110.25||||110.25||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||110.25||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Medicaid|MEDICAID HMO|||||110.25||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Medicare|MEDICARE ACUTE|110.25||||110.25||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Medicaid|MEDICAID|110.25||||110.25||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Blue Cross HMO Specialty|BCBSTX HMO|110.25||||||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Cigna|CIGNA|110.25||||110.25||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Blue Cross PPO Specialty|BCBSTX PPO|||||110.25||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Aetna|AETNA PPO|110.25||||110.25||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Aetna|BOON CHAPMAN|110.25||||||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||110.25||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|110.25||||110.25||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|110.25||||110.25||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Managed Medicare|HEALTHSPRING MA|110.25||||110.25||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||110.25||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Humana Medicare Advantage|HUMANA MA|110.25||||110.25||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Managed Medicaid|MEDICAID AMERIGROUP|110.25||||||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|110.25||||110.25||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|110.25||||110.25||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Managed Medicaid|MEDICAID SUPERIOR|110.25||||110.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Humana Medicare Advantage|HUMANA MA|15.25||||15.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|15.25||||15.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Managed Medicaid|MEDICAID SUPERIOR|15.25||||15.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|15.25||||15.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|15.25||||15.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|15.25||||||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Managed Medicare|HEALTHSPRING MA|15.25||||15.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Managed Medicare|BCBS MEDICARE PPO MA|15.25||||||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Aetna|AETNA PPO|15.25||||15.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|15.25||||15.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Cigna|CIGNA|||||15.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||15.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Blue Cross PPO Specialty|BCBSTX PPO|15.25||||15.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Aenta Medicare Advantage|AETNA MEDICARE MA|15.25||||15.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Blue Cross HMO Specialty|BCBSTX HMO|||||15.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|ChampVA|CHAMPVA CENTER|||||15.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Cigna|CIGNA OTHER|15.25||||||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Cigna|CIGNA|15.25||||15.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Medicaid|MEDICAID|15.25||||||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||15.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Medicaid|HENDERSON COUNTY INDIGENT|15.25||||15.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Medicare|MEDICARE ACUTE|15.25||||15.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Managed Medicaid|MEDICAID AMERIGROUP|15.25||||15.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Medicare|MEDICARE PART B ONLY IP|15.25||||||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Tricare|TRICARE EAST REGION|15.25||||||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|NON CONTRACTED|COMMERCIAL OTHER 1|15.25||||||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|UTMB|UTMB CORRECTIONAL MANAGED CARE|15.25||||||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|United Healthcare|UNITED HEALTHCARE|||||15.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|United Healthcare|TML GROUP BENEFITS|15.25||||||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|United Healthcare|UNITED HEALTHCARE|15.25||||||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Texas Workforce Commission|DIS DETER SERV (DDS)|15.25||||||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Veterans Affairs|VETERANS ADMINISTRATION|15.25||||15.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||15.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|15.25||||15.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|United Medicare Advantage|UHC MEDICARE GOLD MA|15.25||||15.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|15.25||||15.25||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|United Healthcare|TML GROUP BENEFITS|4.50||||||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Medicaid|MEDICAID|4.50||||||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Medicaid|COUNTY INDIGENT HEALTH OTHER|4.50||||||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|4.50||||||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||4.50||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||4.50||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Managed Medicare|MA PART B ONLY IP|4.50||||||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Managed Medicare|VAN ZANDT COUNTY INMATE|4.50||||||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||4.50||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|MTC Medical|VAN ZANDT COUNTY INMATE|4.50||||||| 9505314|ERX|0250|DEX 5%-NS KCL 20 MEQ 1000|Humana Medicare Advantage|HUMANA MA|16.50||||||| 9505314|ERX|0250|DEX 5%-NS KCL 20 MEQ 1000|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|16.50||||||| 9505314|ERX|0250|DEX 5%-NS KCL 20 MEQ 1000|Managed Medicaid|MEDICAID UNITED HEALTHCARE|16.50||||||| 9505314|ERX|0250|DEX 5%-NS KCL 20 MEQ 1000|Managed Medicaid|MEDICAID SUPERIOR|16.50||||16.50||| 9505314|ERX|0250|DEX 5%-NS KCL 20 MEQ 1000|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|16.50||||||| 9505314|ERX|0250|DEX 5%-NS KCL 20 MEQ 1000|Cigna|CIGNA OTHER|16.50||||||| 9505314|ERX|0250|DEX 5%-NS KCL 20 MEQ 1000|Blue Cross PPO Specialty|BCBSTX PPO|16.50||||||| 9505314|ERX|0250|DEX 5%-NS KCL 20 MEQ 1000|Medicaid|MOLINA HEALTHCARE OF TEXAS|16.50||||||| 9505314|ERX|0250|DEX 5%-NS KCL 20 MEQ 1000|Medicaid|MEDICAID|16.50||||||| 9505314|ERX|0250|DEX 5%-NS KCL 20 MEQ 1000|Medicare|MEDICARE ACUTE|16.50||||||| 9505314|ERX|0250|DEX 5%-NS KCL 20 MEQ 1000|United Healthcare|UNITED HEALTHCARE|16.50||||||| 9505314|ERX|0250|DEX 5%-NS KCL 20 MEQ 1000|United Healthcare|TML GROUP BENEFITS|16.50||||||| 9505314|ERX|0250|DEX 5%-NS KCL 20 MEQ 1000|United Medicare Advantage|AARP UHC WEST COMPLETE MA|16.50||||||| 9505314|ERX|0250|DEX 5%-NS KCL 20 MEQ 1000|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||16.50||| 9505322|ERX|0250|DEX 5%-LR KCL 20 MEQ 1000|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.31||||||| 9505322|ERX|0250|DEX 5%-LR KCL 20 MEQ 1000|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.31||||||| 9505322|ERX|0250|DEX 5%-LR KCL 20 MEQ 1000|Medicaid|MEDICAID HMO|||||2.31||| 9505322|ERX|0250|DEX 5%-LR KCL 20 MEQ 1000|Medicaid|MEDICAID|2.31||||||| 9505322|ERX|0250|DEX 5%-LR KCL 20 MEQ 1000|Medicare|MEDICARE ACUTE|2.31||||||| 9505322|ERX|0250|DEX 5%-LR KCL 20 MEQ 1000|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2.31||| 9505322|ERX|0250|DEX 5%-LR KCL 20 MEQ 1000|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.31||||2.31||| 9505322|ERX|0250|DEX 5%-LR KCL 20 MEQ 1000|Managed Medicare|HEALTHSPRING MA|2.31||||||| 9505322|ERX|0250|DEX 5%-LR KCL 20 MEQ 1000|Humana Medicare Advantage|HUMANA MA|2.31||||2.31||| 9505322|ERX|0250|DEX 5%-LR KCL 20 MEQ 1000|Managed Medicaid|MEDICAID SUPERIOR|2.31||||||| 9505322|ERX|0250|DEX 5%-LR KCL 20 MEQ 1000|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.31||||||| 9505322|ERX|0250|DEX 5%-LR KCL 20 MEQ 1000|Managed Medicaid|MEDICAID AMERIGROUP|||||2.31||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Humana Medicare Advantage|HUMANA MA|23.50||||23.50||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|23.50||||||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||23.50||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|23.50||||23.50||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|23.50||||||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||23.50||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Managed Medicare|HEALTHSPRING MA|23.50||||23.50||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|23.50||||23.50||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|23.50||||23.50||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|23.50||||||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|23.50||||||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Tricare|TRICARE EAST REGION|23.50||||||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|United Healthcare|UNITED HEALTHCARE|23.50||||||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|23.50||||||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Medicare|MEDICARE ACUTE|23.50||||23.50||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|23.50||||||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|23.50||||23.50||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|23.50||||23.50||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|23.50||||23.50||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|United Medicare Advantage|UHC MEDICARE GOLD MA|0.18||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.18||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.18||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Veterans Affairs|VETERANS ADMINISTRATION|||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Medicare|MEDICARE ACUTE|0.18||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Tricare|TRICARE EAST REGION|||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|United Healthcare|TML GROUP BENEFITS|0.18||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|United Healthcare|UNITED HEALTHCARE|||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|United Healthcare|UNITED HEALTHCARE|0.18||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|United Healthcare|GEHA|||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Texas Workforce Commission|DIS DETER SERV (DDS)|||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Blue Cross HMO Specialty|BCBSTX HMO|0.18||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Blue Cross PPO Specialty|BCBSTX PPO|0.18||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Medicaid|HENDERSON COUNTY INDIGENT|||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Cigna|CIGNA OTHER|0.18||||||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Cigna|CIGNA|0.18||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.18||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Aetna|AETNA OTHER|||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Aetna|AETNA PPO|0.18||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.18||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Aenta Medicare Advantage|AETNA MEDICARE MA|0.18||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.18||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Managed Medicare|HEALTHSPRING MA|0.18||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Managed Medicare|BCBS MEDICARE PPO MA|||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Humana Medicare Advantage|HUMANA MA|0.18||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.18||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.18||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Managed Medicaid|MEDICAID SUPERIOR|0.18||||0.18||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Managed Medicaid|MEDICAID AMERIGROUP|0.18||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Humana Medicare Advantage|HUMANA MA|0.18||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Managed Medicaid|MEDICAID SUPERIOR|0.18||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Managed Medicaid|MEDICAID AMERIGROUP|||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Managed Medicare|HEALTHSPRING MA|0.18||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Aetna|AETNA OTHER|||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Aetna|AETNA PPO|0.18||||||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.18||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Access Direct Platinum|HEALTHFIRST TPA UMR|||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Cigna|CIGNA|||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Blue Cross PPO Specialty|BCBSTX PPO|0.18||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Managed Medicare|WELLCARE CHOICE MA|||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|ChampVA|CHAMPVA CENTER|||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Blue Cross HMO Specialty|BCBSTX HMO|0.18||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Tricare|TRICARE EAST REGION|||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|United Healthcare|UNITED HEALTHCARE|||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|United Healthcare|UNITED HEALTHCARE|0.18||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Medicaid|MEDICAID HMO|||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Medicare|MEDICARE ACUTE|0.18||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Veterans Affairs|VETERANS ADMINISTRATION|||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.18||||0.18||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.18||||||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.18||||0.18||| 9505421|ERX|0250|HETASTARCH IN NS 500ML|Medicare|MEDICARE ACUTE|48.25||||||| 9505439|ERX|0250|K PHOSPHATE 3 MMOL/ML,15M|Aetna|BOON CHAPMAN|12.25||||||| 9505439|ERX|0250|K PHOSPHATE 3 MMOL/ML,15M|Managed Medicare|HEALTHSPRING MA|12.25||||||| 9505439|ERX|0250|K PHOSPHATE 3 MMOL/ML,15M|Managed Medicare|BCBS MEDICARE PPO MA|12.25||||||| 9505439|ERX|0250|K PHOSPHATE 3 MMOL/ML,15M|Blue Cross PPO Specialty|BCBSTX PPO|12.25||||||| 9505439|ERX|0250|K PHOSPHATE 3 MMOL/ML,15M|Humana Medicare Advantage|HUMANA MA|12.25||||12.25||| 9505439|ERX|0250|K PHOSPHATE 3 MMOL/ML,15M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|12.25||||||| 9505439|ERX|0250|K PHOSPHATE 3 MMOL/ML,15M|Managed Medicaid|MEDICAID AMERIGROUP|||||12.25||| 9505439|ERX|0250|K PHOSPHATE 3 MMOL/ML,15M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|12.25||||||| 9505439|ERX|0250|K PHOSPHATE 3 MMOL/ML,15M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|12.25||||||| 9505439|ERX|0250|K PHOSPHATE 3 MMOL/ML,15M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|12.25||||||| 9505439|ERX|0250|K PHOSPHATE 3 MMOL/ML,15M|United Medicare Advantage|UHC MEDICARE GOLD MA|12.25||||||| 9505439|ERX|0250|K PHOSPHATE 3 MMOL/ML,15M|United Healthcare|UNITED HEALTHCARE|12.25||||||| 9505439|ERX|0250|K PHOSPHATE 3 MMOL/ML,15M|Medicaid|HENDERSON COUNTY INDIGENT|12.25||||||| 9505439|ERX|0250|K PHOSPHATE 3 MMOL/ML,15M|Medicare|MEDICARE ACUTE|12.25||||||| 9505447|ERX|0250|NA PHOSPHATE 3 MMOL/ML,15|Medicare|MEDICARE ACUTE|12.25||||||| 9505447|ERX|0250|NA PHOSPHATE 3 MMOL/ML,15|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|12.25||||||| 9505447|ERX|0250|NA PHOSPHATE 3 MMOL/ML,15|Humana Medicare Advantage|HUMANA MA|12.25||||||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|Aetna|AETNA PPO|9.25||||||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||9.25||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.25||||9.25||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|9.25||||9.25||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|9.25||||||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|Managed Medicare|VAN ZANDT COUNTY INMATE|9.25||||||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|Managed Medicare|HEALTHSPRING MA|9.25||||||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|MTC Medical|VAN ZANDT COUNTY INMATE|9.25||||||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|Humana Medicare Advantage|HUMANA MA|9.25||||9.25||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|9.25||||||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|9.25||||9.25||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|9.25||||9.25||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|9.25||||9.25||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|9.25||||9.25||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|9.25||||9.25||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|9.25||||9.25||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|9.25||||9.25||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|9.25||||9.25||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|Tricare|TRICARE EAST REGION|9.25||||||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|9.25||||||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|9.25||||||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|Medicaid|MEDICAID|9.25||||||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|9.25||||||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|Medicare|MEDICARE ACUTE|9.25||||9.25||| 9505504|ERX|0250|HEPARIN 1000 UNITS/500ML|Medicare|MEDICARE ACUTE|135.50||||||| 9505504|ERX|0250|HEPARIN 1000 UNITS/500ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|135.50||||||| 9505504|ERX|0250|HEPARIN 1000 UNITS/500ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|135.50||||||| 9505504|ERX|0250|HEPARIN 1000 UNITS/500ML|Humana Medicare Advantage|HUMANA MA|135.50||||||| 9505504|ERX|0250|HEPARIN 1000 UNITS/500ML|Aenta Medicare Advantage|AETNA MEDICARE MA|135.50||||||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|Blue Cross PPO Specialty|BCBSTX PPO|156.25||||156.25||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|Blue Cross HMO Specialty|BCBSTX HMO|||||156.25||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|Aetna|AETNA PPO|156.25||||156.25||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|Aenta Medicare Advantage|AETNA MEDICARE MA|156.25||||156.25||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||156.25||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|156.25||||||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|Managed Medicare|HEALTHSPRING MA|||||156.25||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|Humana Medicare Advantage|HUMANA MA|156.25||||156.25||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|156.25||||156.25||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|156.25||||156.25||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|Managed Medicaid|MEDICAID SUPERIOR|156.25||||156.25||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|Veterans Affairs|VETERANS ADMINISTRATION|||||156.25||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|156.25||||156.25||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|United Medicare Advantage|UHC MEDICARE GOLD MA|||||156.25||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|156.25||||156.25||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|Tricare|TRICARE EAST REGION|||||156.25||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|NON CONTRACTED|COMMERCIAL OTHER 1|156.25||||||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|United Healthcare|UNITED HEALTHCARE|||||156.25||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|United Healthcare|UNITED HEALTHCARE OTHER|||||156.25||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||156.25||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|Medicaid|MEDICAID|||||156.25||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|Medicare|MEDICARE ACUTE|156.25||||156.25||| 9505561|ERX|0258|DOPAMINE 800MG/500ML D5W|Medicare|MEDICARE ACUTE|210.75||||210.75||| 9505561|ERX|0258|DOPAMINE 800MG/500ML D5W|United Medicare Advantage|UHC MEDICARE GOLD MA|||||210.75||| 9505561|ERX|0258|DOPAMINE 800MG/500ML D5W|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|210.75||||||| 9505561|ERX|0258|DOPAMINE 800MG/500ML D5W|Humana Medicare Advantage|HUMANA MA|210.75||||210.75||| 9505561|ERX|0258|DOPAMINE 800MG/500ML D5W|Managed Medicaid|MEDICAID UNITED HEALTHCARE|210.75||||||| 9505561|ERX|0258|DOPAMINE 800MG/500ML D5W|Managed Medicare|HEALTHSPRING MA|||||210.75||| 9505561|ERX|0258|DOPAMINE 800MG/500ML D5W|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||210.75||| 9505561|ERX|0258|DOPAMINE 800MG/500ML D5W|Blue Cross PPO Specialty|BCBSTX PPO|||||210.75||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Aenta Medicare Advantage|AETNA MEDICARE MA|141.50||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Aetna|AETNA PPO|141.50||||141.50||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||141.50||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Blue Cross HMO Specialty|BCBSTX HMO|141.50||||141.50||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Blue Cross PPO Specialty|BCBSTX PPO|141.50||||141.50||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Cigna|CIGNA OTHER|141.50||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Cigna|CIGNA|||||141.50||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Managed Medicare|HEALTHSPRING MA|141.50||||141.50||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|141.50||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Humana Medicare Advantage|HUMANA MA|141.50||||141.50||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|141.50||||141.50||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Managed Medicaid|MEDICAID SUPERIOR|141.50||||141.50||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|141.50||||141.50||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Managed Medicaid|MEDICAID AMERIGROUP|141.50||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Veterans Affairs|VETERANS ADMINISTRATION|141.50||||141.50||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Blue Cross PPO Specialty|BCBSTX OTHER|||||141.50||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|United Medicare Advantage|UHC MEDICARE GOLD MA|141.50||||141.50||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|141.50||||141.50||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|141.50||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Medicaid|HENDERSON COUNTY INDIGENT|141.50||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|141.50||||141.50||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|141.50||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Medicaid|MEDICAID|141.50||||141.50||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||141.50||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Medicare|MEDICARE ACUTE|141.50||||141.50||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Tricare|TRICARE EAST REGION|141.50||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|141.50||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|NON CONTRACTED|COMMERCIAL OTHER 1|141.50||||141.50||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|United Healthcare|UNITED HEALTHCARE|||||141.50||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|United Healthcare|UNITED HEALTHCARE OTHER|||||141.50||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|United Healthcare|TML GROUP BENEFITS|141.50||||||| 9505603|ERX|0250|GENTAMICIN 80MG/100ML NS|United Healthcare|UMR UNITED MEDICAL RESOURCES|99.50||||||| 9505603|ERX|0250|GENTAMICIN 80MG/100ML NS|Medicaid|HENDERSON COUNTY INDIGENT|||||99.50||| 9505603|ERX|0250|GENTAMICIN 80MG/100ML NS|Medicare|MEDICARE ACUTE|99.50||||99.50||| 9505603|ERX|0250|GENTAMICIN 80MG/100ML NS|Humana Medicare Advantage|HUMANA MA|||||99.50||| 9505603|ERX|0250|GENTAMICIN 80MG/100ML NS|Managed Medicaid|MEDICAID SUPERIOR|99.50||||||| 9505603|ERX|0250|GENTAMICIN 80MG/100ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|99.50||||||| 9505603|ERX|0250|GENTAMICIN 80MG/100ML NS|Managed Medicaid|MEDICAID AMERIGROUP|99.50||||||| 9505603|ERX|0250|GENTAMICIN 80MG/100ML NS|Cigna|CIGNA|99.50||||||| 9505603|ERX|0250|GENTAMICIN 80MG/100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||99.50||| 9505611|ERX|0258|DEX 5%-1/4NS KCL 20 MEQ 1|Managed Medicare|BCBS MEDICARE PPO MA|64.50||||||| 9505611|ERX|0258|DEX 5%-1/4NS KCL 20 MEQ 1|Medicaid|MEDICAID|||||64.50||| 9505611|ERX|0258|DEX 5%-1/4NS KCL 20 MEQ 1|Medicare|MEDICARE ACUTE|64.50||||||| 9505637|ERX|0250|DEX 5%-1/2NS KCL 30 MEQ 1|Medicare|MEDICARE ACUTE|1.73||||||| 9505728|ERX|0250|DEXTROSE 5%-WATER 50ML|Aetna|AETNA PPO|||||204.25||| 9505728|ERX|0250|DEXTROSE 5%-WATER 50ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|204.25||||204.25||| 9505728|ERX|0250|DEXTROSE 5%-WATER 50ML|Blue Cross PPO Specialty|BCBSTX PPO|204.25||||204.25||| 9505728|ERX|0250|DEXTROSE 5%-WATER 50ML|Humana Medicare Advantage|HUMANA MA|204.25||||204.25||| 9505728|ERX|0250|DEXTROSE 5%-WATER 50ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|204.25||||204.25||| 9505728|ERX|0250|DEXTROSE 5%-WATER 50ML|Managed Medicaid|MEDICAID SUPERIOR|204.25||||204.25||| 9505728|ERX|0250|DEXTROSE 5%-WATER 50ML|Cigna|CIGNA|||||204.25||| 9505728|ERX|0250|DEXTROSE 5%-WATER 50ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||204.25||| 9505728|ERX|0250|DEXTROSE 5%-WATER 50ML|Managed Medicaid|MEDICAID AMERIGROUP|204.25||||||| 9505728|ERX|0250|DEXTROSE 5%-WATER 50ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|204.25||||204.25||| 9505728|ERX|0250|DEXTROSE 5%-WATER 50ML|Managed Medicare|HEALTHSPRING MA|||||204.25||| 9505728|ERX|0250|DEXTROSE 5%-WATER 50ML|Managed Medicare|BCBS MEDICARE PPO MA|204.25||||||| 9505728|ERX|0250|DEXTROSE 5%-WATER 50ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||204.25||| 9505728|ERX|0250|DEXTROSE 5%-WATER 50ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||204.25||| 9505728|ERX|0250|DEXTROSE 5%-WATER 50ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|204.25||||204.25||| 9505728|ERX|0250|DEXTROSE 5%-WATER 50ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|204.25||||204.25||| 9505728|ERX|0250|DEXTROSE 5%-WATER 50ML|Veterans Affairs|VETERANS ADMINISTRATION|204.25||||204.25||| 9505728|ERX|0250|DEXTROSE 5%-WATER 50ML|Tricare|TRICARE EAST REGION|204.25||||||| 9505728|ERX|0250|DEXTROSE 5%-WATER 50ML|Medicaid|MEDICAID|204.25||||||| 9505728|ERX|0250|DEXTROSE 5%-WATER 50ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|204.25||||||| 9505728|ERX|0250|DEXTROSE 5%-WATER 50ML|Medicare|MEDICARE ACUTE|204.25||||204.25||| 9505736|ERX|0250|DEXTROSE 5%-WATER 100ML|Medicare|MEDICARE ACUTE|51.50||||51.50||| 9505736|ERX|0250|DEXTROSE 5%-WATER 100ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|51.50||||||| 9505736|ERX|0250|DEXTROSE 5%-WATER 100ML|United Medicare Advantage|UHC MEDICARE GOLD MA|51.50||||||| 9505736|ERX|0250|DEXTROSE 5%-WATER 100ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|51.50||||||| 9505751|ERX|0250|DEXTROSE 5%-1/4 NS 1000ML|Managed Medicare|BCBS MEDICARE PPO MA|168.25||||||| 9505751|ERX|0250|DEXTROSE 5%-1/4 NS 1000ML|Humana Medicare Advantage|HUMANA MA|168.25||||||| 9505751|ERX|0250|DEXTROSE 5%-1/4 NS 1000ML|Managed Medicaid|MEDICAID AMERIGROUP|||||168.25||| 9505751|ERX|0250|DEXTROSE 5%-1/4 NS 1000ML|Medicare|MEDICARE ACUTE|168.25||||||| 9505785|ERX|0250|DEXTROSE 10%-WATER 500ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||127.75||| 9505785|ERX|0250|DEXTROSE 10%-WATER 500ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||127.75||| 9505785|ERX|0250|DEXTROSE 10%-WATER 500ML|Medicaid|MEDICAID HMO|127.75||||||| 9505785|ERX|0250|DEXTROSE 10%-WATER 500ML|Medicaid|MEDICAID|127.75||||||| 9505785|ERX|0250|DEXTROSE 10%-WATER 500ML|Medicare|MEDICARE ACUTE|127.75||||127.75||| 9505785|ERX|0250|DEXTROSE 10%-WATER 500ML|Blue Cross PPO Specialty|BCBSTX PPO|127.75||||||| 9505785|ERX|0250|DEXTROSE 10%-WATER 500ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|127.75||||||| 9505785|ERX|0250|DEXTROSE 10%-WATER 500ML|Humana Medicare Advantage|HUMANA MA|127.75||||127.75||| 9505785|ERX|0250|DEXTROSE 10%-WATER 500ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|127.75||||||| 9505785|ERX|0250|DEXTROSE 10%-WATER 500ML|Managed Medicaid|MEDICAID AMERIGROUP|127.75||||||| 9505785|ERX|0250|DEXTROSE 10%-WATER 500ML|Managed Medicaid|MEDICAID SUPERIOR|127.75||||||| 9505785|ERX|0250|DEXTROSE 10%-WATER 500ML|Managed Medicare|HEALTHSPRING MA|127.75||||||| 9505793|ERX|0250|DEXTROSE 10%-WATER 1000ML|Managed Medicare|HEALTHSPRING MA|1.91||||||| 9505793|ERX|0250|DEXTROSE 10%-WATER 1000ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|1.91||||||| 9505793|ERX|0250|DEXTROSE 10%-WATER 1000ML|Humana Medicare Advantage|HUMANA MA|1.91||||1.91||| 9505793|ERX|0250|DEXTROSE 10%-WATER 1000ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.91||| 9505793|ERX|0250|DEXTROSE 10%-WATER 1000ML|Managed Medicaid|MEDICAID SUPERIOR|1.91||||||| 9505793|ERX|0250|DEXTROSE 10%-WATER 1000ML|Managed Medicaid|MEDICAID AMERIGROUP|1.91||||||| 9505793|ERX|0250|DEXTROSE 10%-WATER 1000ML|Blue Cross PPO Specialty|BCBSTX PPO|1.91||||1.91||| 9505793|ERX|0250|DEXTROSE 10%-WATER 1000ML|Brinson Benefits|THE HEALTH PLAN SMITH CO|||||1.91||| 9505793|ERX|0250|DEXTROSE 10%-WATER 1000ML|Blue Cross HMO Specialty|BCBSTX HMO|1.91||||||| 9505793|ERX|0250|DEXTROSE 10%-WATER 1000ML|Tricare|TRICARE EAST REGION|1.91||||||| 9505793|ERX|0250|DEXTROSE 10%-WATER 1000ML|United Healthcare|UNITED HEALTHCARE|1.91||||||| 9505793|ERX|0250|DEXTROSE 10%-WATER 1000ML|Medicaid|MEDICAID HMO|1.91||||||| 9505793|ERX|0250|DEXTROSE 10%-WATER 1000ML|Medicare|MEDICARE ACUTE|1.91||||1.91||| 9505793|ERX|0250|DEXTROSE 10%-WATER 1000ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.91||||1.91||| 9505793|ERX|0250|DEXTROSE 10%-WATER 1000ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.91||| 9505793|ERX|0250|DEXTROSE 10%-WATER 1000ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.91||||||| 9505801|ERX|0250|LIDOCAINE 0.4% IN D5W 500|United Medicare Advantage|UHC MEDICARE GOLD MA|1.48||||||| 9505801|ERX|0250|LIDOCAINE 0.4% IN D5W 500|Humana Medicare Advantage|HUMANA MA|1.48||||1.48||| 9505819|ERX|0250|ROPINIROLE 0.25MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|26.75||||||| 9505819|ERX|0250|ROPINIROLE 0.25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|26.75||||||| 9505819|ERX|0250|ROPINIROLE 0.25MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|26.75||||||| 9505819|ERX|0250|ROPINIROLE 0.25MG TABLET|Cigna|CIGNA|26.75||||||| 9505819|ERX|0250|ROPINIROLE 0.25MG TABLET|Managed Medicare|HEALTHSPRING MA|26.75||||||| 9505819|ERX|0250|ROPINIROLE 0.25MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||26.75||| 9505819|ERX|0250|ROPINIROLE 0.25MG TABLET|Humana Medicare Advantage|HUMANA MA|26.75||||26.75||| 9505819|ERX|0250|ROPINIROLE 0.25MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|26.75||||||| 9505819|ERX|0250|ROPINIROLE 0.25MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|26.75||||||| 9505819|ERX|0250|ROPINIROLE 0.25MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|26.75||||||| 9505819|ERX|0250|ROPINIROLE 0.25MG TABLET|Medicare|MEDICARE ACUTE|26.75||||26.75||| 9505819|ERX|0250|ROPINIROLE 0.25MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|26.75||||||| 9505819|ERX|0250|ROPINIROLE 0.25MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|26.75||||||| 9505819|ERX|0250|ROPINIROLE 0.25MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|26.75||||26.75||| 9505819|ERX|0250|ROPINIROLE 0.25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|26.75||||26.75||| 9505819|ERX|0250|ROPINIROLE 0.25MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|26.75||||||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|United Medicare Advantage|AARP UHC WEST COMPLETE MA|18.25||||18.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|United Medicare Advantage|UHC MEDICARE GOLD MA|18.25||||18.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Veterans Affairs|VETERANS ADMINISTRATION|||||18.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Workers Compensation|WORKERS COMPENSATION OTHER|||||18.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|United Healthcare|UNITED HEALTHCARE|18.25||||18.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|United Healthcare|UNITED HEALTHCARE|18.25||||||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Medicare|MEDICARE ACUTE|18.25||||18.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Humana Medicare Advantage|HUMANA MA|18.25||||18.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|United Healthcare|GEHA|||||18.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Managed Medicaid|MEDICAID UNITED HEALTHCARE|18.25||||18.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Managed Medicaid|MEDICAID AMERIGROUP|18.25||||18.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Managed Medicaid|MEDICAID SUPERIOR|18.25||||18.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|18.25||||18.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|18.25||||18.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|18.25||||||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Managed Medicare|HEALTHSPRING MA|18.25||||18.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Managed Medicare|BCBS MEDICARE PPO MA|18.25||||||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Blue Cross PPO Specialty|BCBSTX PPO|18.25||||18.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Blue Cross HMO Specialty|BCBSTX HMO|||||18.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|ChampVA|CHAMPVA CENTER|18.25||||||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Aetna|AETNA PPO|18.25||||18.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|18.25||||18.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Aenta Medicare Advantage|AETNA MEDICARE MA|18.25||||18.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|18.25||||18.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|18.25||||18.25||| 9505918|ERX|0250|SODIUM CHLORIDE 0.9% 150M|Blue Cross PPO Specialty|BCBSTX PPO|108.75||||||| 9505918|ERX|0250|SODIUM CHLORIDE 0.9% 150M|Humana Medicare Advantage|HUMANA MA|108.75||||108.75||| 9505918|ERX|0250|SODIUM CHLORIDE 0.9% 150M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|108.75||||108.75||| 9505918|ERX|0250|SODIUM CHLORIDE 0.9% 150M|Managed Medicaid|MEDICAID SUPERIOR|||||108.75||| 9505918|ERX|0250|SODIUM CHLORIDE 0.9% 150M|Medicaid|HENDERSON COUNTY INDIGENT|||||108.75||| 9505918|ERX|0250|SODIUM CHLORIDE 0.9% 150M|Medicare|MEDICARE ACUTE|108.75||||108.75||| 9505918|ERX|0250|SODIUM CHLORIDE 0.9% 150M|United Healthcare|TML GROUP BENEFITS|||||108.75||| 9505918|ERX|0250|SODIUM CHLORIDE 0.9% 150M|United Healthcare|UNITED HEALTHCARE|||||108.75||| 9505918|ERX|0250|SODIUM CHLORIDE 0.9% 150M|United Medicare Advantage|UHC MEDICARE GOLD MA|||||108.75||| 9505918|ERX|0250|SODIUM CHLORIDE 0.9% 150M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||108.75||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|Tricare|TRICARE EAST REGION|4.50||||||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|Medicaid|MEDICAID|4.50||||||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|Cigna|CIGNA|4.50||||||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|4.50||||||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|ChampVA|CHAMPVA CENTER|4.50||||||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Blue Cross PPO Specialty|BCBSTX PPO|210.75||||210.75||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Aenta Medicare Advantage|AETNA MEDICARE MA|210.75||||||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|210.75||||210.75||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Humana Medicare Advantage|HUMANA MA|210.75||||210.75||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Managed Medicaid|MEDICAID UNITED HEALTHCARE|210.75||||||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|210.75||||210.75||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Managed Medicaid|MEDICAID SUPERIOR|210.75||||||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Managed Medicare|HEALTHSPRING MA|210.75||||||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Managed Medicare|OTHER INSTITUTIONS|||||210.75||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Medicaid|HENDERSON COUNTY INDIGENT|210.75||||210.75||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Medicare|MEDICARE ACUTE|210.75||||210.75||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|NON CONTRACTED|COMMERCIAL OTHER 1|210.75||||||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Aetna|AETNA PPO|210.75||||210.75||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|UTMB|UTMB CORRECTIONAL MANAGED CARE|210.75||||||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|United Healthcare|UNITED HEALTHCARE|210.75||||210.75||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Multiplan|NALC|||||210.75||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Veterans Affairs|VETERANS ADMINISTRATION|210.75||||210.75||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|United Medicare Advantage|AARP UHC WEST COMPLETE MA|210.75||||210.75||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|210.75||||210.75||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|United Medicare Advantage|UHC MEDICARE GOLD MA|||||210.75||| 9505967|ERX|0250|WATER FOR INJECTION 1000M|Medicare|MEDICARE ACUTE|135.50||||135.50||| 9505967|ERX|0250|WATER FOR INJECTION 1000M|Humana Medicare Advantage|HUMANA MA|||||135.50||| 9505967|ERX|0250|WATER FOR INJECTION 1000M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|135.50||||||| 9505975|ERX|0250|DEX 5%-1/2NS KCL 10 MEQ 1|Cigna|CIGNA|1.56||||||| 9505975|ERX|0250|DEX 5%-1/2NS KCL 10 MEQ 1|Managed Medicaid|MEDICAID SUPERIOR|1.56||||||| 9505975|ERX|0250|DEX 5%-1/2NS KCL 10 MEQ 1|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.56||||||| 9505975|ERX|0250|DEX 5%-1/2NS KCL 10 MEQ 1|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.56||||||| 9505975|ERX|0250|DEX 5%-1/2NS KCL 10 MEQ 1|Medicare|MEDICARE ACUTE|1.56||||||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|Medicaid|HENDERSON COUNTY INDIGENT|157.50||||||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|Medicare|MEDICARE ACUTE|157.50||||157.50||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|Veterans Affairs|VETERANS ADMINISTRATION|157.50||||||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|157.50||||157.50||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|157.50||||157.50||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||157.50||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|Managed Medicare|HEALTHSPRING MA|157.50||||157.50||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|United Healthcare|UNITED HEALTHCARE|||||157.50||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|Managed Medicare|HOSPICE OF EAST TEXAS|157.50||||||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|Humana Medicare Advantage|HUMANA MA|157.50||||157.50||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|157.50||||157.50||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||157.50||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|Managed Medicaid|MEDICAID AMERIGROUP|157.50||||||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||157.50||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|Aenta Medicare Advantage|AETNA MEDICARE MA|157.50||||157.50||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|Aetna|AETNA PPO|157.50||||||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|Cigna|CIGNA|||||157.50||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|Blue Cross PPO Specialty|BCBSTX PPO|||||157.50||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|Cigna|CIGNA OTHER|157.50||||||| 9505991|ERX|0250|K ACETATE 2 MEQ/ML,20ML|Managed Medicaid|MEDICAID AMERIGROUP|||||12.25||| 9505991|ERX|0250|K ACETATE 2 MEQ/ML,20ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|12.25||||||| 9505991|ERX|0250|K ACETATE 2 MEQ/ML,20ML|Medicare|MEDICARE ACUTE|12.25||||||| 9506007|ERX|0250|PHYTONADIONE (PF) 1MG/0.5|Tricare|TRICARE EAST REGION|0.92||||||| 9506007|ERX|0250|PHYTONADIONE (PF) 1MG/0.5|United Healthcare|UNITED HEALTHCARE|0.92||||||| 9506007|ERX|0250|PHYTONADIONE (PF) 1MG/0.5|United Healthcare|UMR UNITED MEDICAL RESOURCES|0.92||||||| 9506007|ERX|0250|PHYTONADIONE (PF) 1MG/0.5|PHCS|HUMANA|0.92||||||| 9506007|ERX|0250|PHYTONADIONE (PF) 1MG/0.5|NON CONTRACTED|COMMERCIAL OTHER 1|0.92||||||| 9506007|ERX|0250|PHYTONADIONE (PF) 1MG/0.5|United Healthcare|TML GROUP BENEFITS|0.92||||||| 9506007|ERX|0250|PHYTONADIONE (PF) 1MG/0.5|Medicaid|MEDICAID|0.92||||||| 9506007|ERX|0250|PHYTONADIONE (PF) 1MG/0.5|Medicaid|MEDICAID HMO|0.92||||||| 9506007|ERX|0250|PHYTONADIONE (PF) 1MG/0.5|Blue Cross PPO Specialty|BCBSTX PPO|0.92||||||| 9506007|ERX|0250|PHYTONADIONE (PF) 1MG/0.5|Blue Cross HMO Specialty|BCBSTX HMO|0.92||||||| 9506007|ERX|0250|PHYTONADIONE (PF) 1MG/0.5|Cigna|CIGNA|0.92||||||| 9506007|ERX|0250|PHYTONADIONE (PF) 1MG/0.5|Cigna|CIGNA OTHER|0.92||||||| 9506007|ERX|0250|PHYTONADIONE (PF) 1MG/0.5|Aetna|AETNA PPO|0.92||||||| 9506007|ERX|0250|PHYTONADIONE (PF) 1MG/0.5|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.92||||||| 9506007|ERX|0250|PHYTONADIONE (PF) 1MG/0.5|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.92||||||| 9506007|ERX|0250|PHYTONADIONE (PF) 1MG/0.5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.92||||||| 9506007|ERX|0250|PHYTONADIONE (PF) 1MG/0.5|Managed Medicaid|MEDICAID SUPERIOR|0.92||||||| 9506007|ERX|0250|PHYTONADIONE (PF) 1MG/0.5|Managed Medicaid|MEDICAID AMERIGROUP|0.92||||||| 9506015|ERX|0250|PHYTONADIONE 10MG/1ML|Managed Medicare|HEALTHSPRING MA|84.25||||||| 9506015|ERX|0250|PHYTONADIONE 10MG/1ML|Managed Medicare|BCBS MEDICARE PPO MA|84.25||||||| 9506015|ERX|0250|PHYTONADIONE 10MG/1ML|Humana Medicare Advantage|HUMANA MA|84.25||||84.25||| 9506015|ERX|0250|PHYTONADIONE 10MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||84.25||| 9506015|ERX|0250|PHYTONADIONE 10MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|84.25||||84.25||| 9506015|ERX|0250|PHYTONADIONE 10MG/1ML|Cigna|CIGNA|84.25||||||| 9506015|ERX|0250|PHYTONADIONE 10MG/1ML|Cigna|CIGNA OTHER|||||84.25||| 9506015|ERX|0250|PHYTONADIONE 10MG/1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|84.25||||84.25||| 9506015|ERX|0250|PHYTONADIONE 10MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|84.25||||84.25||| 9506015|ERX|0250|PHYTONADIONE 10MG/1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|84.25||||||| 9506015|ERX|0250|PHYTONADIONE 10MG/1ML|Veterans Affairs|VETERANS ADMINISTRATION|84.25||||||| 9506015|ERX|0250|PHYTONADIONE 10MG/1ML|Medicare|MEDICARE ACUTE|84.25||||84.25||| 9506015|ERX|0250|PHYTONADIONE 10MG/1ML|United Healthcare|UNITED HEALTHCARE|84.25||||||| 9506049|ERX|0258|FAT EMULSION 20% 250ML|Medicare|MEDICARE ACUTE|95.54||||||| 9506049|ERX|0258|FAT EMULSION 20% 250ML|United Healthcare|UNITED HEALTHCARE|95.54||||||| 9506049|ERX|0258|FAT EMULSION 20% 250ML|Aetna|BOON CHAPMAN|95.54||||||| 9506049|ERX|0258|FAT EMULSION 20% 250ML|Humana Medicare Advantage|HUMANA MA|95.54||||||| 9506049|ERX|0258|FAT EMULSION 20% 250ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|95.54||||||| 9506049|ERX|0258|FAT EMULSION 20% 250ML|Managed Medicare|OTHER INSTITUTIONS|||||13.28||| 9506049|ERX|0258|FAT EMULSION 20% 250ML|Managed Medicare|BCBS MEDICARE PPO MA|95.54||||||| 9506056|ERX|0258|FAT EMULSION 20% 500ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|110.04||||||| 9506056|ERX|0258|FAT EMULSION 20% 500ML|Humana Medicare Advantage|HUMANA MA|110.04||||||| 9506056|ERX|0258|FAT EMULSION 20% 500ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|110.04||||||| 9506056|ERX|0258|FAT EMULSION 20% 500ML|Medicare|MEDICARE ACUTE|110.04||||||| 9506056|ERX|0258|FAT EMULSION 20% 500ML|United Healthcare|UNITED HEALTHCARE|110.04||||||| 9506064|ERX|0250|ESTRADIOL 1MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9506064|ERX|0250|ESTRADIOL 1MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||||| 9506064|ERX|0250|ESTRADIOL 1MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9506064|ERX|0250|ESTRADIOL 1MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.50||| 9506064|ERX|0250|ESTRADIOL 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.50||| 9506064|ERX|0250|ESTRADIOL 1MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9506064|ERX|0250|ESTRADIOL 1MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9506064|ERX|0250|ESTRADIOL 1MG TABLET|Aetna|AETNA PPO|||||4.50||| 9506064|ERX|0250|ESTRADIOL 1MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9506064|ERX|0250|ESTRADIOL 1MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9506064|ERX|0250|ESTRADIOL 1MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9506064|ERX|0250|ESTRADIOL 1MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9506064|ERX|0250|ESTRADIOL 1MG TABLET|Managed Medicare|HEALTHSPRING MA|||||4.50||| 9506072|ERX|0250|PHENAZOPYRIDINE 100MG TAB|Humana Medicare Advantage|HUMANA MA|14.50||||||| 9506072|ERX|0250|PHENAZOPYRIDINE 100MG TAB|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||14.50||| 9506072|ERX|0250|PHENAZOPYRIDINE 100MG TAB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||14.50||| 9506072|ERX|0250|PHENAZOPYRIDINE 100MG TAB|Managed Medicaid|MEDICAID SUPERIOR|14.50||||14.50||| 9506072|ERX|0250|PHENAZOPYRIDINE 100MG TAB|Managed Medicaid|MEDICAID AMERIGROUP|||||14.50||| 9506072|ERX|0250|PHENAZOPYRIDINE 100MG TAB|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|14.50||||14.50||| 9506072|ERX|0250|PHENAZOPYRIDINE 100MG TAB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|14.50||||14.50||| 9506072|ERX|0250|PHENAZOPYRIDINE 100MG TAB|Blue Cross PPO Specialty|BCBSTX PPO|14.50||||14.50||| 9506072|ERX|0250|PHENAZOPYRIDINE 100MG TAB|Cigna|CIGNA|||||14.50||| 9506072|ERX|0250|PHENAZOPYRIDINE 100MG TAB|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|14.50||||||| 9506072|ERX|0250|PHENAZOPYRIDINE 100MG TAB|United Medicare Advantage|AARP UHC WEST COMPLETE MA|14.50||||14.50||| 9506072|ERX|0250|PHENAZOPYRIDINE 100MG TAB|NON CONTRACTED|COMMERCIAL OTHER 1|||||14.50||| 9506072|ERX|0250|PHENAZOPYRIDINE 100MG TAB|United Healthcare|UNITED HEALTHCARE|||||14.50||| 9506072|ERX|0250|PHENAZOPYRIDINE 100MG TAB|Medicaid|MEDICAID|||||14.50||| 9506072|ERX|0250|PHENAZOPYRIDINE 100MG TAB|Medicaid|MEDICAID HMO|||||14.50||| 9506072|ERX|0250|PHENAZOPYRIDINE 100MG TAB|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||14.50||| 9506072|ERX|0250|PHENAZOPYRIDINE 100MG TAB|Medicare|MEDICARE ACUTE|14.50||||14.50||| 9506080|ERX|0250|ESTRADIOL 2MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|23.50||||||| 9506106|ERX|0250|ESTRADIOL 0.01% VAG CRM,4|Medicare|MEDICARE ACUTE|954.75||||||| 9506106|ERX|0250|ESTRADIOL 0.01% VAG CRM,4|United Medicare Advantage|AARP UHC WEST COMPLETE MA|954.75||||||| 9506114|ERX|0250|NA HYPOCHLOR 0.25% SOLN,4|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||83.50||| 9506114|ERX|0250|NA HYPOCHLOR 0.25% SOLN,4|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|83.50||||||| 9506122|ERX|0250|NA HYPOCHLOR 0.5% SOLN,47|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|83.50||||||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Managed Medicare|BCBS MEDICARE PPO MA|||||4.50||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Cigna|CIGNA|4.50||||||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.50||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.50||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.50||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Texas Workforce Commission|DIS DETER SERV (DDS)|4.50||||||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Veterans Affairs|VETERANS ADMINISTRATION|||||4.50||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9506205|ERX|0250|VENLAFAXINE XL 150MG CAPS|United Medicare Advantage|UHC MEDICARE GOLD MA|0.46||||||| 9506205|ERX|0250|VENLAFAXINE XL 150MG CAPS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.46||||0.46||| 9506205|ERX|0250|VENLAFAXINE XL 150MG CAPS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.46||||0.46||| 9506205|ERX|0250|VENLAFAXINE XL 150MG CAPS|Veterans Affairs|VETERANS ADMINISTRATION|0.46||||||| 9506205|ERX|0250|VENLAFAXINE XL 150MG CAPS|Medicaid|MEDICAID|0.46||||||| 9506205|ERX|0250|VENLAFAXINE XL 150MG CAPS|Medicare|MEDICARE ACUTE|0.46||||0.46||| 9506205|ERX|0250|VENLAFAXINE XL 150MG CAPS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.46||| 9506205|ERX|0250|VENLAFAXINE XL 150MG CAPS|Blue Cross PPO Specialty|BCBSTX PPO|||||0.46||| 9506205|ERX|0250|VENLAFAXINE XL 150MG CAPS|Blue Cross HMO Specialty|BCBSTX HMO|||||0.46||| 9506205|ERX|0250|VENLAFAXINE XL 150MG CAPS|Humana Medicare Advantage|HUMANA MA|0.46||||0.46||| 9506205|ERX|0250|VENLAFAXINE XL 150MG CAPS|Managed Medicaid|MEDICAID SUPERIOR|0.46||||0.46||| 9506205|ERX|0250|VENLAFAXINE XL 150MG CAPS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.46||||0.46||| 9506205|ERX|0250|VENLAFAXINE XL 150MG CAPS|Managed Medicaid|MEDICAID AMERIGROUP|0.46||||||| 9506205|ERX|0250|VENLAFAXINE XL 150MG CAPS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.46||||||| 9506205|ERX|0250|VENLAFAXINE XL 150MG CAPS|Managed Medicare|BCBS MEDICARE PPO MA|||||0.46||| 9506205|ERX|0250|VENLAFAXINE XL 150MG CAPS|Managed Medicare|HEALTHSPRING MA|||||0.46||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|4.50||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Blue Cross PPO Specialty|BCBSTX OTHER|||||4.50||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Cigna|CIGNA|4.50||||4.50||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Aetna|AETNA PPO|4.50||||4.50||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Tricare|TRICARE EAST REGION|4.50||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||4.50||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||4.50||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|United Healthcare|UNITED HEALTHCARE OTHER|||||4.50||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Medicaid|MEDICAID PCCM|||||4.50||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Medicaid|MEDICAID|||||4.50||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|||||4.50||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Workers Compensation|UT EMPLOYEE INJURY|4.50||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9506254|ERX|0250|LEVOTHYROXINE 88MCG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.50||| 9506254|ERX|0250|LEVOTHYROXINE 88MCG TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9506254|ERX|0250|LEVOTHYROXINE 88MCG TABLE|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9506254|ERX|0250|LEVOTHYROXINE 88MCG TABLE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9506254|ERX|0250|LEVOTHYROXINE 88MCG TABLE|Tricare|TRICARE EAST REGION|||||4.50||| 9506254|ERX|0250|LEVOTHYROXINE 88MCG TABLE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9506254|ERX|0250|LEVOTHYROXINE 88MCG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9506254|ERX|0250|LEVOTHYROXINE 88MCG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9506254|ERX|0250|LEVOTHYROXINE 88MCG TABLE|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9506254|ERX|0250|LEVOTHYROXINE 88MCG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9506254|ERX|0250|LEVOTHYROXINE 88MCG TABLE|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9506254|ERX|0250|LEVOTHYROXINE 88MCG TABLE|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9506254|ERX|0250|LEVOTHYROXINE 88MCG TABLE|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9506270|ERX|0250|VENLAFAXINE XL 37.5MG CAP|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||||| 9506270|ERX|0250|VENLAFAXINE XL 37.5MG CAP|Managed Medicare|HEALTHSPRING MA|||||4.50||| 9506270|ERX|0250|VENLAFAXINE XL 37.5MG CAP|Humana Medicare Advantage|HUMANA MA|||||4.50||| 9506270|ERX|0250|VENLAFAXINE XL 37.5MG CAP|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9506270|ERX|0250|VENLAFAXINE XL 37.5MG CAP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.50||| 9506270|ERX|0250|VENLAFAXINE XL 37.5MG CAP|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9506270|ERX|0250|VENLAFAXINE XL 37.5MG CAP|Medicaid|MEDICAID|4.50||||||| 9506270|ERX|0250|VENLAFAXINE XL 37.5MG CAP|Medicare|MEDICARE ACUTE|4.50||||||| 9506270|ERX|0250|VENLAFAXINE XL 37.5MG CAP|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9506270|ERX|0250|VENLAFAXINE XL 37.5MG CAP|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.50||| 9506296|ERX|0250|NEBIVOLOL 5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||7.50||| 9506296|ERX|0250|NEBIVOLOL 5MG TABLET|Medicare|MEDICARE ACUTE|7.50||||7.50||| 9506296|ERX|0250|NEBIVOLOL 5MG TABLET|United Healthcare|UNITED HEALTHCARE|||||7.50||| 9506296|ERX|0250|NEBIVOLOL 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.50||||7.50||| 9506296|ERX|0250|NEBIVOLOL 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|7.50||||||| 9506296|ERX|0250|NEBIVOLOL 5MG TABLET|Humana Medicare Advantage|HUMANA MA|7.50||||||| 9506304|ERX|0250|NEBIVOLOL 10MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|15.75||||||| 9506304|ERX|0250|NEBIVOLOL 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||15.75||| 9506304|ERX|0250|NEBIVOLOL 10MG TABLET|United Healthcare|UNITED HEALTHCARE|||||15.75||| 9506304|ERX|0250|NEBIVOLOL 10MG TABLET|Medicare|MEDICARE ACUTE|15.75||||15.75||| 9506304|ERX|0250|NEBIVOLOL 10MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|15.75||||15.75||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|0.31||||||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.31||||0.31||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.31||||0.31||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.31||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Medicaid|MEDICAID|0.31||||||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Medicare|MEDICARE PART B ONLY IP|0.31||||||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Medicare|MEDICARE ACUTE|0.31||||0.31||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Tricare|TRICARE EAST REGION|||||0.31||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.31||||||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.31||||0.31||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.31||||0.31||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Aetna|AETNA PPO|0.31||||||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|0.31||||||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.31||||0.31||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.31||||0.31||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.31||||0.31||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Cigna|CIGNA|0.31||||||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Managed Medicare|HEALTHSPRING MA|||||0.31||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Humana Medicare Advantage|HUMANA MA|0.31||||0.31||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.31||||0.31||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.31||||||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|0.31||||||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|0.31||||0.31||| 9506346|ERX|0250|MEMANTINE HCL 5MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9506346|ERX|0250|MEMANTINE HCL 5MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9506346|ERX|0250|MEMANTINE HCL 5MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9506346|ERX|0250|MEMANTINE HCL 5MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9506346|ERX|0250|MEMANTINE HCL 5MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9506346|ERX|0250|MEMANTINE HCL 5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9506346|ERX|0250|MEMANTINE HCL 5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9506353|ERX|0250|MEMANTINE 10MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|27.50||||27.50||| 9506353|ERX|0250|MEMANTINE 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|27.50||||||| 9506353|ERX|0250|MEMANTINE 10MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|27.50||||27.50||| 9506353|ERX|0250|MEMANTINE 10MG TABLET|Medicare|MEDICARE ACUTE|27.50||||27.50||| 9506353|ERX|0250|MEMANTINE 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||27.50||| 9506353|ERX|0250|MEMANTINE 10MG TABLET|ChampVA|CHAMPVA CENTER|27.50||||||| 9506353|ERX|0250|MEMANTINE 10MG TABLET|Aetna|AETNA PPO|27.50||||27.50||| 9506353|ERX|0250|MEMANTINE 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||27.50||| 9506353|ERX|0250|MEMANTINE 10MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|27.50||||||| 9506353|ERX|0250|MEMANTINE 10MG TABLET|Humana Medicare Advantage|HUMANA MA|27.50||||27.50||| 9506353|ERX|0250|MEMANTINE 10MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|27.50||||||| 9506353|ERX|0250|MEMANTINE 10MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|27.50||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Managed Medicare|MA PART B ONLY IP|4.50||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|4.50||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Aetna|BOON CHAPMAN|4.50||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Aetna|AETNA PPO|4.50||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Cigna|CIGNA|4.50||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|4.50||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|ChampVA|CHAMPVA CENTER|4.50||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Cigna|CIGNA OTHER|4.50||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Cigna|CIGNA|||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Tricare|TRICARE EAST REGION|4.50||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|United Healthcare|TML GROUP BENEFITS|4.50||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Medicaid|LAW ENFORCEMENT OTHER|4.50||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Medicaid|COUNTY INDIGENT HEALTH OTHER|4.50||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Medicaid|MEDICAID|4.50||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9506395|ERX|0250|DINOPROSTONE 10MG VAG INS|Medicaid|MEDICAID|2,439.75||||||| 9506395|ERX|0250|DINOPROSTONE 10MG VAG INS|Medicaid|MOLINA HEALTHCARE OF TEXAS|2,439.75||||||| 9506395|ERX|0250|DINOPROSTONE 10MG VAG INS|Blue Cross PPO Specialty|BCBSTX PPO|2,439.75||||||| 9506395|ERX|0250|DINOPROSTONE 10MG VAG INS|Managed Medicaid|MEDICAID SUPERIOR|2,439.75||||||| 9506395|ERX|0250|DINOPROSTONE 10MG VAG INS|Managed Medicaid|MEDICAID AMERIGROUP|2,439.75||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Managed Medicare|BCBS MEDICARE PPO MA|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Managed Medicare|VAN ZANDT COUNTY INMATE|||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Managed Medicare|HEALTHSPRING MA|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|MTC Medical|VAN ZANDT COUNTY INMATE|||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Humana Medicare Advantage|HUMANA MA|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Managed Medicaid|MEDICAID SUPERIOR|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Managed Medicaid|MEDICAID AMERIGROUP|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Aetna|BOON CHAPMAN|151.25||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|ChampVA|CHAMPVA CENTER|||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Blue Cross HMO Specialty|BCBSTX HMO|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Cigna|CIGNA OTHER|151.25||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Cigna|CIGNA|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Cigna|CIGNA|||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|United Medicare Advantage|UHC AARP MCR HMO MA|||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Aetna|AETNA PPO|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|United Medicare Advantage|UHC AARP WELLMED HMO MA|||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Veterans Affairs|VETERANS ADMINISTRATION|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Tricare|TRICARE EAST REGION|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|NON CONTRACTED|COMMERCIAL OTHER 1|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|UTMB|UTMB CORRECTIONAL MANAGED CARE|151.25||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|United Healthcare|TML GROUP BENEFITS|151.25||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|United Healthcare|UNITED HEALTHCARE|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|United Healthcare|UNITED HEALTHCARE OTHER|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Medicaid|HENDERSON COUNTY INDIGENT|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Medicaid|MEDICAID|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Medicaid|MOLINA HEALTHCARE OF TEXAS|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Medicare|MEDICARE ACUTE|151.25||||151.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Medicare|MEDICARE PART B ONLY IP|151.25||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Medicaid|HENDERSON COUNTY INDIGENT|28.50||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Medicare|MEDICARE ACUTE|28.50||||28.50||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Tricare|TRICARE EAST REGION|||||28.50||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|United Healthcare|UNITED HEALTHCARE|28.50||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Medicaid|MEDICAID|28.50||||28.50||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|28.50||||28.50||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|United Medicare Advantage|UHC MEDICARE GOLD MA|28.50||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|28.50||||28.50||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Blue Cross PPO Specialty|BCBSTX PPO|28.50||||28.50||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Aetna|AETNA PPO|28.50||||28.50||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|28.50||||28.50||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Aenta Medicare Advantage|AETNA MEDICARE MA|28.50||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Humana Medicare Advantage|HUMANA MA|28.50||||28.50||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|28.50||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Managed Medicaid|MEDICAID SUPERIOR|28.50||||28.50||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|28.50||||28.50||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Managed Medicaid|MEDICAID AMERIGROUP|||||28.50||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Managed Medicare|HEALTHSPRING MA|28.50||||28.50||| 9506650|ERX|0250|PHENYTOIN 100MG/4ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.25||||||| 9506650|ERX|0250|PHENYTOIN 100MG/4ML|Medicare|MEDICARE ACUTE|5.25||||||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.13||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|Tricare|TRICARE EAST REGION|0.13||||||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.13||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|Medicaid|MEDICAID HMO|||||0.13||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.13||||0.13||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.13||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|Medicaid|MEDICAID|0.13||||||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|Medicare|MEDICARE ACUTE|0.13||||0.13||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.13||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.13||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.13||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|Blue Cross PPO Specialty|BCBSTX PPO|||||0.13||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|ChampVA|CHAMPVA CENTER|||||0.13||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|Managed Medicare|HEALTHSPRING MA|||||0.13||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|Humana Medicare Advantage|HUMANA MA|0.13||||0.13||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.13||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|Managed Medicaid|MEDICAID SUPERIOR|0.13||||0.13||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|Managed Medicaid|MEDICAID AMERIGROUP|0.13||||0.13||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Humana Medicare Advantage|HUMANA MA|22.25||||22.25||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Managed Medicaid|MEDICAID SUPERIOR|||||22.25||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Managed Medicaid|MEDICAID UNITED HEALTHCARE|22.25||||22.25||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|22.25||||22.25||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Managed Medicaid|MEDICAID AMERIGROUP|||||22.25||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Managed Medicare|HEALTHSPRING MA|22.25||||22.25||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Managed Medicare|BCBS MEDICARE PPO MA|22.25||||||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Cigna|CIGNA|22.25||||||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Blue Cross PPO Specialty|BCBSTX PPO|22.25||||22.25||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Blue Cross HMO Specialty|BCBSTX HMO|||||22.25||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Aetna|AETNA PPO|22.25||||22.25||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Aenta Medicare Advantage|AETNA MEDICARE MA|22.25||||22.25||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|22.25||||22.25||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||22.25||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Medicaid|MEDICAID|22.25||||||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Medicare|MEDICARE ACUTE|22.25||||22.25||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|United Healthcare|UNITED HEALTHCARE|22.25||||22.25||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|United Healthcare|UNITED HEALTHCARE|||||22.25||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Veterans Affairs|VETERANS ADMINISTRATION|22.25||||22.25||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|United Medicare Advantage|AARP UHC WEST COMPLETE MA|22.25||||22.25||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|22.25||||22.25||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|United Medicare Advantage|UHC MEDICARE GOLD MA|22.25||||22.25||| 9506700|ERX|0250|ALBUTEROL 0.5% SOLN 0.5M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|24.25||||||| 9506726|ERX|0250|METHYLNALTREXONE 12MG/0.6|Aetna|AETNA PPO|||||343.50||| 9506726|ERX|0250|METHYLNALTREXONE 12MG/0.6|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||343.50||| 9506726|ERX|0250|METHYLNALTREXONE 12MG/0.6|Blue Cross PPO Specialty|BCBSTX PPO|||||343.50||| 9506726|ERX|0250|METHYLNALTREXONE 12MG/0.6|Humana Medicare Advantage|HUMANA MA|||||343.50||| 9506726|ERX|0250|METHYLNALTREXONE 12MG/0.6|Managed Medicaid|MEDICAID AMERIGROUP|343.50||||||| 9506726|ERX|0250|METHYLNALTREXONE 12MG/0.6|United Healthcare|UNITED HEALTHCARE|||||343.50||| 9506726|ERX|0250|METHYLNALTREXONE 12MG/0.6|Medicare|MEDICARE ACUTE|343.50||||343.50||| 9506726|ERX|0250|METHYLNALTREXONE 12MG/0.6|United Medicare Advantage|UHC MEDICARE GOLD MA|||||343.50||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|59.50||||||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|Medicaid|HENDERSON COUNTY INDIGENT|59.50||||||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|Medicare|MEDICARE PART B ONLY IP|59.50||||||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|Medicare|MEDICARE ACUTE|59.50||||||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|United Healthcare|UNITED HEALTHCARE|59.50||||||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|Humana Medicare Advantage|HUMANA MA|59.50||||||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|59.50||||||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|Blue Cross PPO Specialty|BCBSTX PPO|59.50||||||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|Cigna|CIGNA OTHER|59.50||||||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||59.50||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|ChampVA|CHAMPVA CENTER|||||4.50||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Managed Medicare|MA PART B ONLY IP|4.50||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||4.50||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||4.50||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9506825|ERX|0250|PHENYLEPHRINE 50MG/5ML|Medicare|MEDICARE ACUTE|156.75||||156.75||| 9506825|ERX|0250|PHENYLEPHRINE 50MG/5ML|Humana Medicare Advantage|HUMANA MA|156.75||||||| 9506825|ERX|0250|PHENYLEPHRINE 50MG/5ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|156.75||||||| 9506825|ERX|0250|PHENYLEPHRINE 50MG/5ML|Aetna|AETNA OTHER|||||156.75||| 9506841|ERX|0250|VASOPRESSIN 20 UNIT/1ML|Humana Medicare Advantage|HUMANA MA|||||4.86||| 9506841|ERX|0250|VASOPRESSIN 20 UNIT/1ML|Managed Medicaid|MEDICAID AMERIGROUP|4.86||||||| 9506841|ERX|0250|VASOPRESSIN 20 UNIT/1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.86||| 9506841|ERX|0250|VASOPRESSIN 20 UNIT/1ML|Medicare|MEDICARE ACUTE|4.86||||4.86||| 9506866|ERX|0250|SODIUM ACETATE 2 MEQ/ML,|Medicare|MEDICARE ACUTE|27.25||||||| 9506866|ERX|0250|SODIUM ACETATE 2 MEQ/ML,|Managed Medicaid|MEDICAID UNITED HEALTHCARE|27.25||||||| 9506882|ERX|0250|MAGNESIUM SULFATE 40 MEQ/|Humana Medicare Advantage|HUMANA MA|14.50||||14.50||| 9506882|ERX|0250|MAGNESIUM SULFATE 40 MEQ/|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|14.50||||||| 9506882|ERX|0250|MAGNESIUM SULFATE 40 MEQ/|United Medicare Advantage|UHC MEDICARE GOLD MA|||||14.50||| 9506882|ERX|0250|MAGNESIUM SULFATE 40 MEQ/|Medicare|MEDICARE ACUTE|14.50||||14.50||| 9506908|ERX|0250|NA CHLORIDE 23.4% 4MEQ/ML|United Healthcare|UNITED HEALTHCARE|0.16||||||| 9506908|ERX|0250|NA CHLORIDE 23.4% 4MEQ/ML|Medicare|MEDICARE ACUTE|0.16||||||| 9506908|ERX|0250|NA CHLORIDE 23.4% 4MEQ/ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.16||||||| 9506908|ERX|0250|NA CHLORIDE 23.4% 4MEQ/ML|Aetna|BOON CHAPMAN|0.16||||||| 9506908|ERX|0250|NA CHLORIDE 23.4% 4MEQ/ML|Managed Medicare|BCBS MEDICARE PPO MA|0.16||||||| 9506908|ERX|0250|NA CHLORIDE 23.4% 4MEQ/ML|Humana Medicare Advantage|HUMANA MA|0.16||||||| 9506908|ERX|0250|NA CHLORIDE 23.4% 4MEQ/ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.16||||||| 9506924|ERX|0250|HYDROXYZINE HCL 25MG/1ML|Humana Medicare Advantage|HUMANA MA|||||14.50||| 9506924|ERX|0250|HYDROXYZINE HCL 25MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|||||14.50||| 9506924|ERX|0250|HYDROXYZINE HCL 25MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||14.50||| 9506924|ERX|0250|HYDROXYZINE HCL 25MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|||||14.50||| 9506924|ERX|0250|HYDROXYZINE HCL 25MG/1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||14.50||| 9506924|ERX|0250|HYDROXYZINE HCL 25MG/1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||14.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Medicaid|HENDERSON COUNTY INDIGENT|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Medicaid|MEDICAID|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Medicare|MEDICARE ACUTE|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Tricare|TRICARE EAST REGION|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|NON CONTRACTED|COMMERCIAL OTHER 1|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|UTMB|UTMB CORRECTIONAL MANAGED CARE|64.50||||||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|United Healthcare|UNITED HEALTHCARE OTHER|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|United Healthcare|TML GROUP BENEFITS|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|United Healthcare|GEHA|||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|PHCS|MULTIPLAN PHCS OTHER|||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Veterans Affairs|VETERANS ADMINISTRATION|64.50||||||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Veterans Affairs|VETERANS ADMINISTRATION|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Workers Compensation|UT EMPLOYEE INJURY|||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|United Medicare Advantage|UHC MEDICARE GOLD MA|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Aetna|AETNA OTHER|||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Access Direct Platinum|HEALTHFIRST TPA UMR|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Texas Workforce Commission|DIS DETER SERV (DDS)|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Aenta Medicare Advantage|AETNA MEDICARE MA|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|United Healthcare|UNITED HEALTHCARE|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Aetna|AETNA PPO|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Cigna|CIGNA OTHER|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Blue Cross PPO Specialty|BCBSTX OTHER|||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Blue Cross PPO Specialty|BCBSTX PPO|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Medicaid|MEDICAID HMO|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|ChampVA|CHAMPVA CENTER|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Blue Cross HMO Specialty|BCBSTX HMO|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Cigna|CIGNA|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Cigna|CIGNA|||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Managed Medicare|HEALTHSPRING MA|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Managed Medicare|BCBS MEDICARE PPO MA|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Managed Medicare|OTHER INSTITUTIONS|||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Humana Medicare Advantage|HUMANA MA|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Managed Medicaid|MEDICAID AMERIGROUP|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Managed Medicaid|MEDICAID SUPERIOR|64.50||||64.50||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|64.50||||64.50||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Humana Medicare Advantage|HUMANA MA|35.25||||35.25||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Managed Medicaid|MEDICAID SUPERIOR|35.25||||35.25||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|35.25||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Managed Medicaid|MEDICAID UNITED HEALTHCARE|35.25||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Managed Medicare|HEALTHSPRING MA|||||35.25||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Blue Cross PPO Specialty|BCBSTX PPO|35.25||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Blue Cross HMO Specialty|BCBSTX HMO|35.25||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Aenta Medicare Advantage|AETNA MEDICARE MA|35.25||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|35.25||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|United Medicare Advantage|UHC MEDICARE GOLD MA|35.25||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|United Medicare Advantage|AARP UHC WEST COMPLETE MA|35.25||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Veterans Affairs|VETERANS ADMINISTRATION|35.25||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Medicaid|HENDERSON COUNTY INDIGENT|35.25||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Medicare|MEDICARE ACUTE|35.25||||35.25||| 9507005|ERX|0250|TRACE ELEMENTS 10ML|United Healthcare|UNITED HEALTHCARE|58.25||||||| 9507005|ERX|0250|TRACE ELEMENTS 10ML|Medicare|MEDICARE ACUTE|58.25||||||| 9507005|ERX|0250|TRACE ELEMENTS 10ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|58.25||||||| 9507005|ERX|0250|TRACE ELEMENTS 10ML|Aetna|BOON CHAPMAN|58.25||||||| 9507005|ERX|0250|TRACE ELEMENTS 10ML|Managed Medicare|BCBS MEDICARE PPO MA|58.25||||||| 9507005|ERX|0250|TRACE ELEMENTS 10ML|Humana Medicare Advantage|HUMANA MA|58.25||||||| 9507005|ERX|0250|TRACE ELEMENTS 10ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|58.25||||||| 9507013|ERX|0250|AMINOCAPROIC ACID 250MG/M|Managed Medicaid|MEDICAID SUPERIOR|||||30.75||| 9507013|ERX|0250|AMINOCAPROIC ACID 250MG/M|Blue Cross PPO Specialty|BCBSTX PPO|||||30.75||| 9507013|ERX|0250|AMINOCAPROIC ACID 250MG/M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||30.75||| 9507013|ERX|0250|AMINOCAPROIC ACID 250MG/M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||30.75||| 9507039|ERX|0250|PRIMIDONE 50MG TABLET|Medicare|MEDICARE ACUTE|4.75||||4.75||| 9507039|ERX|0250|PRIMIDONE 50MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||4.75||| 9507039|ERX|0250|PRIMIDONE 50MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.75||||4.75||| 9507039|ERX|0250|PRIMIDONE 50MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.75||| 9507039|ERX|0250|PRIMIDONE 50MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.75||| 9507039|ERX|0250|PRIMIDONE 50MG TABLET|Humana Medicare Advantage|HUMANA MA|4.75||||||| 9507039|ERX|0250|PRIMIDONE 50MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.75||||||| 9507047|ERX|0250|BUTAL-ASPIRIN-CAF 50-325-|Managed Medicare|HEALTHSPRING MA|12.75||||||| 9507047|ERX|0250|BUTAL-ASPIRIN-CAF 50-325-|Medicare|MEDICARE ACUTE|12.75||||||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|Tricare|TRICARE EAST REGION|4.50||||||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|United Healthcare|TML GROUP BENEFITS|4.50||||||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|Medicaid|MEDICAID|4.50||||||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|Cigna|CIGNA|4.50||||||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9507146|ERX|0250|DIPHENHYDRAMINE CREAM, 30|Blue Cross PPO Specialty|BCBSTX PPO|||||4.50||| 9507146|ERX|0250|DIPHENHYDRAMINE CREAM, 30|Medicare|MEDICARE ACUTE|4.50||||||| 9507146|ERX|0250|DIPHENHYDRAMINE CREAM, 30|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9507195|ERX|0250|LIDOCAINE 2% URO-JET 10ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||83.50||| 9507195|ERX|0250|LIDOCAINE 2% URO-JET 10ML|Tricare|TRICARE EAST REGION|||||83.50||| 9507195|ERX|0250|LIDOCAINE 2% URO-JET 10ML|United Healthcare|TML GROUP BENEFITS|||||83.50||| 9507195|ERX|0250|LIDOCAINE 2% URO-JET 10ML|Medicare|MEDICARE ACUTE|||||83.50||| 9507195|ERX|0250|LIDOCAINE 2% URO-JET 10ML|Aetna|AETNA PPO|||||83.50||| 9507195|ERX|0250|LIDOCAINE 2% URO-JET 10ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||83.50||| 9507195|ERX|0250|LIDOCAINE 2% URO-JET 10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||83.50||| 9507195|ERX|0250|LIDOCAINE 2% URO-JET 10ML|Blue Cross PPO Specialty|BCBSTX PPO|||||83.50||| 9507260|ERX|0250|HYALURONIDASE 150 UNIT/1M|Aetna|AETNA PPO|||||285.50||| 9507260|ERX|0250|HYALURONIDASE 150 UNIT/1M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||285.50||| 9507260|ERX|0250|HYALURONIDASE 150 UNIT/1M|Medicare|MEDICARE ACUTE|||||285.50||| 9507260|ERX|0250|HYALURONIDASE 150 UNIT/1M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||285.50||| 9507260|ERX|0250|HYALURONIDASE 150 UNIT/1M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||285.50||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Medicaid|MEDICAID|4.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9507310|ERX|0250|P-EPHED SUL/LORATADINE T|Blue Cross HMO Specialty|BCBSTX HMO|9.25||||||| 9507310|ERX|0250|P-EPHED SUL/LORATADINE T|Blue Cross PPO Specialty|BCBSTX PPO|||||9.25||| 9507310|ERX|0250|P-EPHED SUL/LORATADINE T|Managed Medicare|BCBS MEDICARE PPO MA|9.25||||||| 9507310|ERX|0250|P-EPHED SUL/LORATADINE T|Medicare|MEDICARE ACUTE|9.25||||||| 9507328|ERX|0250|PHENYLEPH-SHK LV-MO-PET,W|United Healthcare|UNITED HEALTHCARE|30.75||||||| 9507328|ERX|0250|PHENYLEPH-SHK LV-MO-PET,W|Medicaid|MEDICAID|30.75||||||| 9507328|ERX|0250|PHENYLEPH-SHK LV-MO-PET,W|Medicare|MEDICARE ACUTE|30.75||||||| 9507328|ERX|0250|PHENYLEPH-SHK LV-MO-PET,W|Humana Medicare Advantage|HUMANA MA|30.75||||||| 9507328|ERX|0250|PHENYLEPH-SHK LV-MO-PET,W|Managed Medicaid|MEDICAID UNITED HEALTHCARE|30.75||||||| 9507328|ERX|0250|PHENYLEPH-SHK LV-MO-PET,W|Aetna|AETNA PPO|||||30.75||| 9507369|ERX|0250|CHARCOAL-SORBITOL 50 G, 2|Medicare|MEDICARE ACUTE|2.09||||||| 9507393|ERX|0250|CHARCOAL AQ 50 G, 240ML|Blue Cross PPO Specialty|BCBSTX PPO|||||2.09||| 9507393|ERX|0250|CHARCOAL AQ 50 G, 240ML|ChampVA|CHAMPVA CENTER|||||2.09||| 9507393|ERX|0250|CHARCOAL AQ 50 G, 240ML|Cigna|CIGNA|||||2.09||| 9507393|ERX|0250|CHARCOAL AQ 50 G, 240ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.09||| 9507393|ERX|0250|CHARCOAL AQ 50 G, 240ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.09||| 9507393|ERX|0250|CHARCOAL AQ 50 G, 240ML|Managed Medicaid|MEDICAID SUPERIOR|||||2.09||| 9507393|ERX|0250|CHARCOAL AQ 50 G, 240ML|Managed Medicaid|MEDICAID AMERIGROUP|||||2.09||| 9507393|ERX|0250|CHARCOAL AQ 50 G, 240ML|Medicaid|MEDICAID|||||2.09||| 9507401|ERX|0250|HYDROCORT 100MG ENEMA,60M|Medicare|MEDICARE ACUTE|115.25||||||| 9507427|ERX|0250|ASPIRIN 300MG SUPP|Managed Medicare|HEALTHSPRING MA|||||0.11||| 9507427|ERX|0250|ASPIRIN 300MG SUPP|Humana Medicare Advantage|HUMANA MA|0.11||||0.11||| 9507427|ERX|0250|ASPIRIN 300MG SUPP|Blue Cross PPO Specialty|BCBSTX PPO|||||0.11||| 9507427|ERX|0250|ASPIRIN 300MG SUPP|Blue Cross HMO Specialty|BCBSTX HMO|0.11||||||| 9507427|ERX|0250|ASPIRIN 300MG SUPP|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.11||||0.11||| 9507427|ERX|0250|ASPIRIN 300MG SUPP|United Medicare Advantage|UHC MEDICARE GOLD MA|0.11||||||| 9507427|ERX|0250|ASPIRIN 300MG SUPP|Medicaid|MEDICAID|0.11||||||| 9507427|ERX|0250|ASPIRIN 300MG SUPP|Medicare|MEDICARE ACUTE|0.11||||0.11||| 9507450|ERX|0250|PROMETHAZINE 25MG SUPP|Medicaid|MEDICAID|||||41.75||| 9507450|ERX|0250|PROMETHAZINE 25MG SUPP|Medicare|MEDICARE ACUTE|41.75||||||| 9507450|ERX|0250|PROMETHAZINE 25MG SUPP|Managed Medicaid|MEDICAID SUPERIOR|||||41.75||| 9507468|ERX|0250|PROMETHAZINE 12.5MG SUPP|Medicare|MEDICARE ACUTE|28.75||||||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Aetna|AETNA OTHER|||||4.50||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Aetna|AETNA PPO|4.50||||||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.50||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Cigna|CIGNA|||||4.50||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Managed Medicare|BCBS MEDICARE PPO MA|||||4.50||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.50||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|||||4.50||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.50||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|||||4.50||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.50||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.50||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4.50||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Medicaid|MEDICAID HMO|||||4.50||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Medicaid|MEDICAID|||||4.50||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9507559|ERX|0250|PROBENECID 500MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2.75||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Medicare|MEDICARE ACUTE|2.75||||2.75||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.75||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|United Healthcare|UNITED HEALTHCARE|||||2.75||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Veterans Affairs|VETERANS ADMINISTRATION|2.75||||2.75||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.75||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.75||||||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.75||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.75||||2.75||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2.75||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|United Healthcare|UNITED HEALTHCARE OTHER|||||2.75||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|2.75||||2.75||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.75||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|2.75||||2.75||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Cigna|CIGNA|||||2.75||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Medicaid|HENDERSON COUNTY INDIGENT|||||2.75||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.75||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.75||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.75||||2.75||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Managed Medicare|HEALTHSPRING MA|2.75||||2.75||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.75||||2.75||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Humana Medicare Advantage|HUMANA MA|2.75||||2.75||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Managed Medicaid|MEDICAID SUPERIOR|||||2.75||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.75||||2.75||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.75||||2.75||| 9507609|ERX|0250|MINOXIDIL 2.5MG TABLET|Humana Medicare Advantage|HUMANA MA|8.75||||||| 9507609|ERX|0250|MINOXIDIL 2.5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|8.75||||||| 9507609|ERX|0250|MINOXIDIL 2.5MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|8.75||||8.75||| 9507609|ERX|0250|MINOXIDIL 2.5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|8.75||||||| 9507609|ERX|0250|MINOXIDIL 2.5MG TABLET|Medicare|MEDICARE ACUTE|8.75||||||| 9507633|ERX|0250|ASPIRIN-DIPYRIDAMOLE 25-2|Medicare|MEDICARE ACUTE|4.50||||||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Aenta Medicare Advantage|AETNA MEDICARE MA|1,450.75||||||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,450.75||||||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Cigna|CIGNA|1,450.75||||||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Blue Cross HMO Specialty|BCBSTX HMO|1,450.75||||||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Managed Medicare|HEALTHSPRING MA|1,450.75||||1,450.75||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1,450.75||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|1,450.75||||1,450.75||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Humana Medicare Advantage|HUMANA MA|1,450.75||||1,450.75||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1,450.75||||1,450.75||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Managed Medicaid|MEDICAID AMERIGROUP|1,450.75||||1,450.75||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1,450.75||||1,450.75||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Managed Medicaid|MEDICAID SUPERIOR|1,450.75||||1,450.75||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1,450.75||||1,450.75||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|United Medicare Advantage|UHC MEDICARE GOLD MA|1,450.75||||1,450.75||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Blue Cross PPO Specialty|BCBSTX PPO|1,450.75||||1,450.75||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|United Medicare Advantage|UHC AARP MCR HMO MA|||||1,450.75||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,450.75||||1,450.75||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Veterans Affairs|VETERANS ADMINISTRATION|1,450.75||||1,450.75||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Tricare|TRICARE EAST REGION|1,450.75||||||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,450.75||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|United Healthcare|TML GROUP BENEFITS|||||1,450.75||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|United Healthcare|UNITED HEALTHCARE|||||1,450.75||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|United Healthcare|UMR UNITED MEDICAL RESOURCES|1,450.75||||||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Medicaid|HENDERSON COUNTY INDIGENT|1,450.75||||||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Medicare|MEDICARE ACUTE|1,450.75||||1,450.75||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.50||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|Cigna|CIGNA|4.50||||||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|Aetna|AETNA PPO|4.50||||||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.50||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.50||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9507674|ERX|0250|CLONIDINE 0.1MG PATCH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.50||| 9507674|ERX|0250|CLONIDINE 0.1MG PATCH|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9507674|ERX|0250|CLONIDINE 0.1MG PATCH|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9507674|ERX|0250|CLONIDINE 0.1MG PATCH|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9507674|ERX|0250|CLONIDINE 0.1MG PATCH|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9507674|ERX|0250|CLONIDINE 0.1MG PATCH|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9507682|ERX|0250|CLONIDINE 0.2MG PATCH|NON CONTRACTED|COMMERCIAL OTHER 1|||||157.50||| 9507682|ERX|0250|CLONIDINE 0.2MG PATCH|Medicare|MEDICARE ACUTE|157.50||||157.50||| 9507682|ERX|0250|CLONIDINE 0.2MG PATCH|United Medicare Advantage|AARP UHC WEST COMPLETE MA|157.50||||||| 9507682|ERX|0250|CLONIDINE 0.2MG PATCH|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|157.50||||||| 9507682|ERX|0250|CLONIDINE 0.2MG PATCH|Humana Medicare Advantage|HUMANA MA|157.50||||||| 9507682|ERX|0250|CLONIDINE 0.2MG PATCH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|157.50||||||| 9507690|ERX|0250|CLONIDINE 0.3MG PATCH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.35||||||| 9507690|ERX|0250|CLONIDINE 0.3MG PATCH|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.35||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Tricare|TRICARE EAST REGION|4.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|United Healthcare|UNITED HEALTHCARE OTHER|||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|United Healthcare|TML GROUP BENEFITS|||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Cigna|CIGNA|||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|ChampVA|CHAMPVA CENTER|4.50||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Cigna|CIGNA|4.50||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Aetna|AETNA PPO|||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Medicaid|MEDICAID|4.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Managed Medicare|OTHER INSTITUTIONS|||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Medicaid|MEDICAID HMO|||||4.50||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Medicaid|HENDERSON COUNTY INDIGENT|||||4.50||| 9507724|ERX|0250|METHYLPREDNISOLONE 4MG TA|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9507724|ERX|0250|METHYLPREDNISOLONE 4MG TA|Medicare|MEDICARE ACUTE|4.50||||||| 9507724|ERX|0250|METHYLPREDNISOLONE 4MG TA|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9507757|ERX|0250|IPRATROP 0.03% NASAL, 30M|Medicare|MEDICARE ACUTE|7.63||||7.63||| 9507799|ERX|0250|PRAMIPEXOLE 0.25MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|23.50||||||| 9507799|ERX|0250|PRAMIPEXOLE 0.25MG TABLET|Medicare|MEDICARE ACUTE|23.50||||23.50||| 9507799|ERX|0250|PRAMIPEXOLE 0.25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||23.50||| 9507799|ERX|0250|PRAMIPEXOLE 0.25MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|23.50||||||| 9507799|ERX|0250|PRAMIPEXOLE 0.25MG TABLET|Managed Medicare|HEALTHSPRING MA|23.50||||23.50||| 9507799|ERX|0250|PRAMIPEXOLE 0.25MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|23.50||||||| 9507799|ERX|0250|PRAMIPEXOLE 0.25MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|23.50||||||| 9507799|ERX|0250|PRAMIPEXOLE 0.25MG TABLET|Humana Medicare Advantage|HUMANA MA|23.50||||||| 9507799|ERX|0250|PRAMIPEXOLE 0.25MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||23.50||| 9507856|ERX|0250|DICYCLOMINE 10MG/5ML, 30M|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||27.50||| 9507922|ERX|0250|COLCHICINE 0.6MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9507922|ERX|0250|COLCHICINE 0.6MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9507922|ERX|0250|COLCHICINE 0.6MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9507922|ERX|0250|COLCHICINE 0.6MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.50||| 9507922|ERX|0250|COLCHICINE 0.6MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.50||| 9507922|ERX|0250|COLCHICINE 0.6MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9507922|ERX|0250|COLCHICINE 0.6MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9507922|ERX|0250|COLCHICINE 0.6MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|||||4.50||| 9507922|ERX|0250|COLCHICINE 0.6MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9507922|ERX|0250|COLCHICINE 0.6MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||4.50||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Cigna|CIGNA|4.50||||4.50||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Medicaid|MEDICAID TEXAS CHILDRENS|||||4.50||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Medicaid|MEDICAID|4.50||||||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Tricare|TRICARE EAST REGION|||||4.50||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Managed Medicare|HEALTHSPRING MA|||||4.50||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Aetna|AETNA OTHER|||||4.50||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Aetna|AETNA PPO|||||4.50||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||4.50||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.50||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||4.50||| 9508011|ERX|0250|MEDROXYPROGESTERONE 2.5MG|ChampVA|CHAMPVA CENTER|||||13.25||| 9508011|ERX|0250|MEDROXYPROGESTERONE 2.5MG|Humana Medicare Advantage|HUMANA MA|13.25||||||| 9508011|ERX|0250|MEDROXYPROGESTERONE 2.5MG|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||13.25||| 9508011|ERX|0250|MEDROXYPROGESTERONE 2.5MG|Blue Cross PPO Specialty|BCBSTX PPO|13.25||||||| 9508011|ERX|0250|MEDROXYPROGESTERONE 2.5MG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|13.25||||||| 9508037|ERX|0250|SULFASALAZINE 500MG TABLE|Humana Medicare Advantage|HUMANA MA|0.05||||||| 9508037|ERX|0250|SULFASALAZINE 500MG TABLE|Medicare|MEDICARE ACUTE|0.05||||0.05||| 9508037|ERX|0250|SULFASALAZINE 500MG TABLE|Managed Medicare|HEALTHSPRING MA|0.05||||||| 9508037|ERX|0250|SULFASALAZINE 500MG TABLE|Cigna|CIGNA|0.05||||||| 9508052|ERX|0250|TRIHEXYPHENIDYL 2MG TABLE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.03||| 9508052|ERX|0250|TRIHEXYPHENIDYL 2MG TABLE|Medicare|MEDICARE ACUTE|0.03||||||| 9508052|ERX|0250|TRIHEXYPHENIDYL 2MG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.03||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Managed Medicare|HEALTHSPRING MA|22.25||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Aetna|AETNA PPO|22.25||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Medicaid|MEDICAID PCCM|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Aenta Medicare Advantage|AETNA MEDICARE MA|22.25||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Blue Cross HMO Specialty|BCBSTX HMO|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|ChampVA|CHAMPVA CENTER|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Blue Cross PPO Specialty|BCBSTX OTHER|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|22.25||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Cigna|CIGNA|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Managed Medicaid|MEDICAID SUPERIOR|22.25||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Humana Medicare Advantage|HUMANA MA|22.25||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|United Medicare Advantage|UHC MEDICARE GOLD MA|22.25||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Cigna|CIGNA|22.25||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|PHCS|HUMANA INSURANCE|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Medicaid|MEDICAID HMO|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Tricare|TRICARE EAST REGION|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|PHCS|MULTIPLAN PHCS OTHER|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|United Healthcare|UNITED HEALTHCARE OTHER|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Medicaid Out of State|MEDICAID LOUISIANA|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|United Healthcare|UNITED HEALTHCARE|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Blue Cross PPO Specialty|BCBSTX PPO|22.25||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|22.25||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Managed Medicaid|MEDICAID AMERIGROUP|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Medicaid|MEDICAID|22.25||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Aetna|AETNA OTHER|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|22.25||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Workers Compensation|TEXAS MUTUAL INSURANCE|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Veterans Affairs|VETERANS ADMINISTRATION|22.25||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Medicare|MEDICARE ACUTE|22.25||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|22.25||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Workers Compensation|UT EMPLOYEE INJURY|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Veterans Affairs|VETERANS ADMINISTRATION|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|22.25||||22.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||22.25||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Blue Cross HMO Specialty|BCBSTX HMO|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Managed Medicaid|MEDICAID AMERIGROUP|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Blue Cross PPO Specialty|BCBSTX PPO|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Managed Medicaid|MEDICAID SUPERIOR|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Cigna|CIGNA|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Blue Cross PPO Specialty|BCBSTX OTHER|||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Cigna|CIGNA|||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Managed Medicare|BCBS MEDICARE PPO MA|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|ChampVA|CHAMPVA CENTER|||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Aetna|AETNA PPO|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Aetna|AETNA OTHER|||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Humana Medicare Advantage|HUMANA MA|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|United Healthcare|UNITED HEALTHCARE OTHER|||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Workers Compensation|TEXAS MUTUAL INSURANCE|||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Veterans Affairs|VETERANS ADMINISTRATION|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Medicaid|MEDICAID|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Medicaid|MEDICAID HMO|||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Medicare|MEDICARE PART B ONLY IP|0.18||||||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Medicaid|HENDERSON COUNTY INDIGENT|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Tricare|TRICARE EAST REGION|||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|NON CONTRACTED|COMMERCIAL OTHER 1|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|United Healthcare|UNITED HEALTHCARE|||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Medicare|MEDICARE ACUTE|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Medicaid|LAW ENFORCEMENT OTHER|0.18||||||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Managed Medicare|WELLCARE CHOICE MA|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Texas Workforce Commission|DIS DETER SERV (DDS)|0.18||||||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|United Healthcare|UNITED HEALTHCARE|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Managed Medicare|HEALTHSPRING MA|0.18||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|United Healthcare|TML GROUP BENEFITS|0.18||||||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Tricare|TRICARE FOR LIFE|||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|PHCS|HUMANA|||||0.18||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|PHCS|MULTIPLAN PHCS|||||0.18||| 9508136|ERX|0250|HEPARIN 1000 UNIT/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|12.25||||||| 9508136|ERX|0250|HEPARIN 1000 UNIT/1ML|Managed Medicare|BCBS MEDICARE PPO MA|12.25||||||| 9508136|ERX|0250|HEPARIN 1000 UNIT/1ML|Aetna|BOON CHAPMAN|12.25||||||| 9508136|ERX|0250|HEPARIN 1000 UNIT/1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|12.25||||||| 9508136|ERX|0250|HEPARIN 1000 UNIT/1ML|Humana Medicare Advantage|HUMANA MA|12.25||||||| 9508136|ERX|0250|HEPARIN 1000 UNIT/1ML|Medicare|MEDICARE ACUTE|12.25||||||| 9508136|ERX|0250|HEPARIN 1000 UNIT/1ML|United Healthcare|UNITED HEALTHCARE|12.25||||||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|NON CONTRACTED|COMMERCIAL OTHER 1|51.50||||51.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Medicare|MEDICARE ACUTE|51.50||||51.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||51.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Veterans Affairs|VETERANS ADMINISTRATION|51.50||||51.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|51.50||||51.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|51.50||||51.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Medicaid|MEDICAID|||||51.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Medicaid|HENDERSON COUNTY INDIGENT|51.50||||||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Managed Medicare|BCBS MEDICARE PPO MA|51.50||||||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|United Healthcare|UNITED HEALTHCARE OTHER|||||51.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|United Healthcare|UNITED HEALTHCARE|||||51.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|51.50||||51.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Managed Medicaid|MEDICAID SUPERIOR|51.50||||51.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|51.50||||51.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|51.50||||||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Humana Medicare Advantage|HUMANA MA|51.50||||51.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|51.50||||51.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Cigna|CIGNA OTHER|51.50||||||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||51.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||51.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Blue Cross HMO Specialty|BCBSTX HMO|51.50||||51.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|51.50||||51.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Managed Medicaid|MEDICAID AMERIGROUP|51.50||||51.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Aetna|AETNA PPO|||||51.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Managed Medicare|HEALTHSPRING MA|51.50||||51.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Blue Cross PPO Specialty|BCBSTX PPO|51.50||||51.50||| 9508169|ERX|0250|PHENOBARBITAL 130MG/1ML|Medicare|MEDICARE ACUTE|19.50||||||| 9508169|ERX|0250|PHENOBARBITAL 130MG/1ML|Humana Medicare Advantage|HUMANA MA|19.50||||||| 9508169|ERX|0250|PHENOBARBITAL 130MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||19.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Medicaid|HENDERSON COUNTY INDIGENT|||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Tricare|TRICARE EAST REGION|||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|NON CONTRACTED|COMMERCIAL OTHER 1|35.50||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|United Medicare Advantage|UHC MEDICARE GOLD MA|||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|35.50||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Veterans Affairs|VETERANS ADMINISTRATION|35.50||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|United Healthcare|UNITED HEALTHCARE|||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Workers Compensation|WORKERS COMPENSATION OTHER|||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Aetna|AETNA PPO|||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Medicare|MEDICARE ACUTE|35.50||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Managed Medicare|VAN ZANDT COUNTY INMATE|||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Blue Cross PPO Specialty|BCBSTX PPO|||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Texas Workforce Commission|DIS DETER SERV (DDS)|35.50||||||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Medicaid|MEDICAID HMO|||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|United Healthcare|UNITED HEALTHCARE OTHER|||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Cigna|CIGNA|||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Medicaid|MEDICAID|35.50||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Cigna|CIGNA OTHER|35.50||||||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Blue Cross HMO Specialty|BCBSTX HMO|||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Managed Medicare|BCBS MEDICARE PPO MA|||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Managed Medicaid|MEDICAID AMERIGROUP|||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|MTC Medical|VAN ZANDT COUNTY INMATE|||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Managed Medicare|HEALTHSPRING MA|||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Humana Medicare Advantage|HUMANA MA|||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||35.50||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Managed Medicaid|MEDICAID SUPERIOR|35.50||||35.50||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Cigna|CIGNA|||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Medicaid|HENDERSON COUNTY INDIGENT|||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.18||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UMR|0.18||||||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Medicaid|MEDICAID|0.18||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.18||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Tricare|TRICARE EAST REGION|0.18||||||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Medicaid|LAW ENFORCEMENT OTHER|0.18||||||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Medicaid|MEDICAID HMO|||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Aetna|BOON CHAPMAN|||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.18||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Aetna|AETNA OTHER|||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|United Healthcare|UNITED HEALTHCARE OTHER|0.18||||||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|United Healthcare|TML GROUP BENEFITS|0.18||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.18||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|United Healthcare|UNITED HEALTHCARE|0.18||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Veterans Affairs|VETERANS ADMINISTRATION|||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Texas Workforce Commission|DIS DETER SERV (DDS)|0.18||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Medicare|MEDICARE ACUTE|0.18||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|United Healthcare|UNITED HEALTHCARE|||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Aetna|AETNA PPO|||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.18||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.18||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Blue Cross PPO Specialty|BCBSTX OTHER|||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Humana Medicare Advantage|HUMANA MA|0.18||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|0.18||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Cigna|CIGNA OTHER|0.18||||||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.18||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Managed Medicare|HEALTHSPRING MA|0.18||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|0.18||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|0.18||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Blue Cross HMO Specialty|BCBSTX HMO|0.18||||0.18||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.18||| 9508219|ERX|0250|GENTAMICIN 40MG/ML, 20ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|119.25||||||| 9508219|ERX|0250|GENTAMICIN 40MG/ML, 20ML|Blue Cross PPO Specialty|BCBSTX PPO|119.25||||||| 9508219|ERX|0250|GENTAMICIN 40MG/ML, 20ML|Medicare|MEDICARE ACUTE|119.25||||119.25||| 9508219|ERX|0250|GENTAMICIN 40MG/ML, 20ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|119.25||||||| 9508219|ERX|0250|GENTAMICIN 40MG/ML, 20ML|Medicaid|MEDICAID HMO|119.25||||||| 9508219|ERX|0250|GENTAMICIN 40MG/ML, 20ML|Managed Medicaid|MEDICAID AMERIGROUP|119.25||||||| 9508219|ERX|0250|GENTAMICIN 40MG/ML, 20ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|119.25||||||| 9508219|ERX|0250|GENTAMICIN 40MG/ML, 20ML|Medicaid|HENDERSON COUNTY INDIGENT|||||119.25||| 9508219|ERX|0250|GENTAMICIN 40MG/ML, 20ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|119.25||||||| 9508219|ERX|0250|GENTAMICIN 40MG/ML, 20ML|Managed Medicaid|MEDICAID SUPERIOR|119.25||||||| 9508219|ERX|0250|GENTAMICIN 40MG/ML, 20ML|Cigna|CIGNA|119.25||||||| 9508219|ERX|0250|GENTAMICIN 40MG/ML, 20ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|119.25||||||| 9508219|ERX|0250|GENTAMICIN 40MG/ML, 20ML|United Medicare Advantage|UHC MEDICARE GOLD MA|119.25||||||| 9508235|ERX|0250|ESMOLOL 100MG/10ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||104.50||| 9508235|ERX|0250|ESMOLOL 100MG/10ML|Humana Medicare Advantage|HUMANA MA|104.50||||||| 9508235|ERX|0250|ESMOLOL 100MG/10ML|Medicare|MEDICARE ACUTE|||||104.50||| 9508235|ERX|0250|ESMOLOL 100MG/10ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||104.50||| 9508235|ERX|0250|ESMOLOL 100MG/10ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||104.50||| 9508235|ERX|0250|ESMOLOL 100MG/10ML|Blue Cross PPO Specialty|BCBSTX PPO|||||104.50||| 9508243|ERX|0250|ALPRAZOLAM 1MG TABLET|Humana Medicare Advantage|HUMANA MA|||||23.50||| 9508243|ERX|0250|ALPRAZOLAM 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|23.50||||||| 9508243|ERX|0250|ALPRAZOLAM 1MG TABLET|Medicare|MEDICARE ACUTE|23.50||||23.50||| 9508243|ERX|0250|ALPRAZOLAM 1MG TABLET|Medicaid|MEDICAID|23.50||||||| 9508243|ERX|0250|ALPRAZOLAM 1MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|23.50||||||| 9508243|ERX|0250|ALPRAZOLAM 1MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||23.50||| 9508243|ERX|0250|ALPRAZOLAM 1MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|23.50||||||| 9508243|ERX|0250|ALPRAZOLAM 1MG TABLET|Aetna|AETNA PPO|23.50||||||| 9508243|ERX|0250|ALPRAZOLAM 1MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|23.50||||||| 9508243|ERX|0250|ALPRAZOLAM 1MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||23.50||| 9508243|ERX|0250|ALPRAZOLAM 1MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|23.50||||||| 9508243|ERX|0250|ALPRAZOLAM 1MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|23.50||||23.50||| 9508243|ERX|0250|ALPRAZOLAM 1MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||23.50||| 9508243|ERX|0250|ALPRAZOLAM 1MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|23.50||||23.50||| 9508243|ERX|0250|ALPRAZOLAM 1MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|23.50||||||| 9508243|ERX|0250|ALPRAZOLAM 1MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|23.50||||||| 9508243|ERX|0250|ALPRAZOLAM 1MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|23.50||||23.50||| 9508243|ERX|0250|ALPRAZOLAM 1MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|23.50||||23.50||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|Aetna|AETNA PPO|4.50||||||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|Blue Cross PPO Specialty|BCBSTX PPO|||||4.50||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|United Medicare Advantage|UHC AARP MCR HMO MA|4.50||||||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9508367|ERX|0250|GLYCERIN, PEDIATRIC SUPP|Aetna|AETNA PPO|||||5.25||| 9508367|ERX|0250|GLYCERIN, PEDIATRIC SUPP|Cigna|CIGNA|||||5.25||| 9508367|ERX|0250|GLYCERIN, PEDIATRIC SUPP|Managed Medicaid|MEDICAID SUPERIOR|||||5.25||| 9508367|ERX|0250|GLYCERIN, PEDIATRIC SUPP|Blue Cross PPO Specialty|BCBSTX PPO|||||5.25||| 9508367|ERX|0250|GLYCERIN, PEDIATRIC SUPP|Managed Medicaid|MEDICAID AMERIGROUP|||||5.25||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Medicaid|MOLINA HEALTHCARE OF TEXAS|0.18||||0.18||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.18||||0.18||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Veterans Affairs|VETERANS ADMINISTRATION|0.18||||0.18||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Tricare|TRICARE EAST REGION|0.18||||||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.18||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|NON CONTRACTED|COMMERCIAL OTHER 1|0.18||||||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|PHCS|HUMANA|||||0.18||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Medicare|MEDICARE ACUTE|0.18||||0.18||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|0.18||||||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Managed Medicare|HEALTHSPRING MA|0.18||||0.18||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|United Healthcare|UNITED HEALTHCARE|||||0.18||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Medicaid|MEDICAID|0.18||||0.18||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Medicare|MEDICARE PART B ONLY IP|0.18||||||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|United Medicare Advantage|UHC MEDICARE GOLD MA|0.18||||0.18||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|United Healthcare|UNITED HEALTHCARE|0.18||||||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Managed Medicare|BCBS MEDICARE PPO MA|0.18||||||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.18||||0.18||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Humana Medicare Advantage|HUMANA MA|0.18||||0.18||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.18||||0.18||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Blue Cross HMO Specialty|BCBSTX HMO|0.18||||0.18||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|ChampVA|CHAMPVA CENTER|0.18||||||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Blue Cross PPO Specialty|BCBSTX PPO|0.18||||0.18||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Cigna|CIGNA|0.18||||0.18||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Aetna|AETNA PPO|0.18||||||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.18||||0.18||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Aenta Medicare Advantage|AETNA MEDICARE MA|0.18||||||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Managed Medicaid|MEDICAID SUPERIOR|0.18||||0.18||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.18||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.18||||0.18||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Managed Medicaid|MEDICAID AMERIGROUP|0.18||||0.18||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|11.75||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|United Medicare Advantage|UHC MEDICARE GOLD MA|11.75||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Medicare|MEDICARE ACUTE|11.75||||11.75||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|11.75||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||11.75||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Cigna|CIGNA|11.75||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Humana Medicare Advantage|HUMANA MA|11.75||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Managed Medicaid|MEDICAID UNITED HEALTHCARE|11.75||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Medicaid|MEDICAID HMO|11.75||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|11.75||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Managed Medicaid|MEDICAID SUPERIOR|11.75||||11.75||| 9508383|ERX|0250|BISACODYL 10MG SUPP|United Healthcare|UNITED HEALTHCARE|11.75||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Medicaid|MEDICAID|11.75||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|United Medicare Advantage|AARP UHC WEST COMPLETE MA|11.75||||11.75||| 9508383|ERX|0250|BISACODYL 10MG SUPP|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|11.75||||11.75||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Blue Cross PPO Specialty|BCBSTX PPO|11.75||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|United Healthcare|UMR UNITED MEDICAL RESOURCES|11.75||||||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Medicaid|MEDICAID|9.25||||9.25||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|9.25||||9.25||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Veterans Affairs|VETERANS ADMINISTRATION|||||9.25||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Managed Medicare|HOSPICE GENESIS|9.25||||||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Managed Medicare|HEALTHSPRING MA|9.25||||||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Medicaid|MOLINA HEALTHCARE OF TEXAS|9.25||||||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Managed Medicare|HOSPICE ETMC|9.25||||||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|United Medicare Advantage|UHC MEDICARE GOLD MA|9.25||||||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Managed Medicaid|MEDICAID UNITED HEALTHCARE|9.25||||9.25||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|9.25||||9.25||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|United Medicare Advantage|AARP UHC WEST COMPLETE MA|9.25||||9.25||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Tricare|TRICARE FOR LIFE|||||9.25||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|NON CONTRACTED|COMMERCIAL OTHER 1|9.25||||||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Managed Medicaid|MEDICAID SUPERIOR|9.25||||||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Aenta Medicare Advantage|AETNA MEDICARE MA|||||9.25||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Medicare|MEDICARE ACUTE|9.25||||9.25||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Humana Medicare Advantage|HUMANA MA|9.25||||9.25||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Blue Cross PPO Specialty|BCBSTX PPO|9.25||||9.25||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Aetna|AETNA PPO|9.25||||||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Aetna|AETNA OTHER|||||9.25||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.25||||||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Blue Cross HMO Specialty|BCBSTX HMO|9.25||||||| 9508417|ERX|0250|HYDROCORTISONE 25MG SUPP|Medicare|MEDICARE ACUTE|0.18||||||| 9508417|ERX|0250|HYDROCORTISONE 25MG SUPP|Humana Medicare Advantage|HUMANA MA|0.18||||||| 9508417|ERX|0250|HYDROCORTISONE 25MG SUPP|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.18||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|United Medicare Advantage|UHC AARP MCR HMO MA|||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|NON CONTRACTED|COMMERCIAL OTHER 2|||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|United Healthcare|UNITED HEALTHCARE OTHER|||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Medicaid|MEDICAID|||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Aetna|AETNA OTHER|||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Medicaid|MEDICAID HMO|||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|United Healthcare|TML GROUP BENEFITS|||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Medicaid|MEDICAID PCCM|||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Aetna|AETNA PPO|||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Tricare|TRICARE EAST REGION|||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Cigna|CIGNA|||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Managed Medicare|BCBS MEDICARE PPO MA|||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.50||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9508433|ERX|0250|FLUOXETINE 10MG CAPSULE|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9508433|ERX|0250|FLUOXETINE 10MG CAPSULE|Cigna|CIGNA|4.50||||||| 9508433|ERX|0250|FLUOXETINE 10MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||||| 9508433|ERX|0250|FLUOXETINE 10MG CAPSULE|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9508433|ERX|0250|FLUOXETINE 10MG CAPSULE|Medicare|MEDICARE ACUTE|4.50||||||| 9508433|ERX|0250|FLUOXETINE 10MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9508433|ERX|0250|FLUOXETINE 10MG CAPSULE|Aetna|BOON CHAPMAN|4.50||||||| 9508433|ERX|0250|FLUOXETINE 10MG CAPSULE|Cigna|CIGNA OTHER|4.50||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Cigna|CIGNA|0.55||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.55||||0.55||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|0.55||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Medicaid|MEDICAID|0.55||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.55||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Tricare|TRICARE EAST REGION|0.55||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.55||||0.55||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.55||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|0.55||||0.55||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.55||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.55||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|0.55||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Managed Medicare|BCBS MEDICARE PPO MA|0.55||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|0.55||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Humana Medicare Advantage|HUMANA MA|0.55||||0.55||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Managed Medicare|HEALTHSPRING MA|0.55||||0.55||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|0.55||||0.55||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|0.55||||0.55||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Medicare|MEDICARE ACUTE|0.55||||0.55||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.55||||0.55||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.55||||0.55||| 9508516|ERX|0250|PENICILLIN VK 250MG TABLE|Medicaid|MEDICAID HMO|||||0.05||| 9508516|ERX|0250|PENICILLIN VK 250MG TABLE|Managed Medicaid|MEDICAID SUPERIOR|||||0.05||| 9508516|ERX|0250|PENICILLIN VK 250MG TABLE|Veterans Affairs|VETERANS ADMINISTRATION|0.05||||||| 9508516|ERX|0250|PENICILLIN VK 250MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|0.05||||||| 9508516|ERX|0250|PENICILLIN VK 250MG TABLE|Humana Medicare Advantage|HUMANA MA|||||0.05||| 9508516|ERX|0250|PENICILLIN VK 250MG TABLE|Managed Medicaid|MEDICAID AMERIGROUP|||||0.05||| 9508532|ERX|0250|HALOPERIDOL 1MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9508532|ERX|0250|HALOPERIDOL 1MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|ChampVA|CHAMPVA CENTER|||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Blue Cross PPO Specialty|BCBSTX OTHER|||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|59.50||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Humana Medicare Advantage|HUMANA MA|59.50||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Blue Cross PPO Specialty|BCBSTX PPO|59.50||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Cigna|CIGNA|59.50||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Medicaid|MEDICAID HMO|||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Aetna|AETNA OTHER|||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Managed Medicare|WELLCARE CHOICE MA|59.50||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Managed Medicare|BCBS MEDICARE PPO MA|59.50||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Aetna|AETNA PPO|59.50||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Managed Medicaid|MEDICAID SUPERIOR|59.50||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|NON CONTRACTED|COMMERCIAL OTHER 1|59.50||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|59.50||||||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Managed Medicare|HEALTHSPRING MA|59.50||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Tricare|TRICARE FOR LIFE|||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Tricare|TRICARE EAST REGION|59.50||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|59.50||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|NON CONTRACTED|COMMERCIAL OTHER 2|||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Managed Medicaid|MEDICAID UNITED HEALTHCARE|59.50||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|PHCS|MULTIPLAN PHCS OTHER|||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|59.50||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|United Healthcare|UNITED HEALTHCARE OTHER|||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Managed Medicare|HOSPICE ETMC|||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|United Healthcare|UNITED HEALTHCARE|||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Veterans Affairs|VETERANS ADMINISTRATION|59.50||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Blue Cross HMO Specialty|BCBSTX HMO|59.50||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Medicaid|MEDICAID|59.50||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Medicare|MEDICARE ACUTE|59.50||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Managed Medicare|OTHER INSTITUTIONS|||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Aenta Medicare Advantage|AETNA MEDICARE MA|59.50||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Managed Medicaid|MEDICAID AMERIGROUP|59.50||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Medicaid|MOLINA HEALTHCARE OF TEXAS|59.50||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Workers Compensation|WORKERS COMPENSATION OTHER|||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|United Medicare Advantage|UHC AARP MCR HMO MA|||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|United Medicare Advantage|UHC MEDICARE GOLD MA|59.50||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|59.50||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|United Medicare Advantage|AARP UHC WEST COMPLETE MA|59.50||||59.50||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|United Healthcare|UNITED HEALTHCARE|59.50||||59.50||| 9508565|ERX|0250|HALOPERIDOL 5MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9508565|ERX|0250|HALOPERIDOL 5MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||4.50||| 9508565|ERX|0250|HALOPERIDOL 5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9508565|ERX|0250|HALOPERIDOL 5MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9508565|ERX|0250|HALOPERIDOL 5MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9508565|ERX|0250|HALOPERIDOL 5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.50||| 9508581|ERX|0250|IMIPRAMINE 25MG TABLET|Medicare|MEDICARE ACUTE|4.50||||||| 9508581|ERX|0250|IMIPRAMINE 25MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|United Healthcare|UNITED HEALTHCARE|||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Workers Compensation|WORKERS COMP PHYSICIAN|||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.18||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|NON CONTRACTED|COMMERCIAL OTHER 1|0.18||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Medicare|MEDICARE ACUTE|0.18||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Medicaid|HENDERSON COUNTY INDIGENT|||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Medicaid|MEDICAID HMO|||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|0.18||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Aetna|AETNA PPO|||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Medicaid|MEDICAID|||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Medicare|MEDICARE PART B ONLY IP|0.18||||||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.18||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|United Medicare Advantage|UHC AARP MCR HMO MA|||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Humana Medicare Advantage|HUMANA MA|||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Cigna|CIGNA|||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.18||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.18||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|||||0.18||| 9508698|ERX|0250|AMPICILLIN 125MG VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.57||||||| 9508698|ERX|0250|AMPICILLIN 125MG VIAL|Medicaid|MEDICAID HMO|0.57||||||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|United Healthcare|UNITED HEALTHCARE|||||3.22||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3.22||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|Blue Cross PPO Specialty|BCBSTX PPO|||||3.22||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.22||||||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3.22||||3.22||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|Cigna|CIGNA|||||3.22||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|Humana Medicare Advantage|HUMANA MA|3.22||||||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|Medicare|MEDICARE ACUTE|3.22||||3.22||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||4.50||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|4.50||||||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Tricare|TRICARE EAST REGION|||||4.50||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.50||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9508870|ERX|0250|PENTOXIFYLLINE 400MG TABL|Aetna|AETNA PPO|4.50||||||| 9508870|ERX|0250|PENTOXIFYLLINE 400MG TABL|Medicare|MEDICARE ACUTE|4.50||||||| 9508870|ERX|0250|PENTOXIFYLLINE 400MG TABL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9508920|ERX|0250|CAFFEINE 200MG TABLET|Humana Medicare Advantage|HUMANA MA|||||2.50||| 9508920|ERX|0250|CAFFEINE 200MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||2.50||| 9509068|ERX|0250|PROPARACAINE 0.5% DROP,15|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||295.25||| 9509068|ERX|0250|PROPARACAINE 0.5% DROP,15|United Medicare Advantage|UHC MEDICARE GOLD MA|||||295.25||| 9509068|ERX|0250|PROPARACAINE 0.5% DROP,15|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||295.25||| 9509068|ERX|0250|PROPARACAINE 0.5% DROP,15|Medicare|MEDICARE ACUTE|||||295.25||| 9509068|ERX|0250|PROPARACAINE 0.5% DROP,15|Blue Cross PPO Specialty|BCBSTX PPO|||||295.25||| 9509068|ERX|0250|PROPARACAINE 0.5% DROP,15|Aetna|AETNA PPO|||||295.25||| 9509068|ERX|0250|PROPARACAINE 0.5% DROP,15|ChampVA|CHAMPVA CENTER|||||295.25||| 9509068|ERX|0250|PROPARACAINE 0.5% DROP,15|Cigna|CIGNA|||||295.25||| 9509068|ERX|0250|PROPARACAINE 0.5% DROP,15|Aenta Medicare Advantage|AETNA MEDICARE MA|||||295.25||| 9509068|ERX|0250|PROPARACAINE 0.5% DROP,15|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||295.25||| 9509068|ERX|0250|PROPARACAINE 0.5% DROP,15|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||295.25||| 9509068|ERX|0250|PROPARACAINE 0.5% DROP,15|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||295.25||| 9509068|ERX|0250|PROPARACAINE 0.5% DROP,15|Blue Cross HMO Specialty|BCBSTX HMO|||||295.25||| 9509068|ERX|0250|PROPARACAINE 0.5% DROP,15|Humana Medicare Advantage|HUMANA MA|||||295.25||| 9509134|ERX|0250|ATROPINE 1% EYE DROP, 5ML|Managed Medicare|HOSPICE ETMC|227.75||||||| 9509134|ERX|0250|ATROPINE 1% EYE DROP, 5ML|Managed Medicare|HOSPICE OF EAST TEXAS|227.75||||||| 9509134|ERX|0250|ATROPINE 1% EYE DROP, 5ML|Managed Medicare|HOSPICE CARING HEARTS|227.75||||||| 9509134|ERX|0250|ATROPINE 1% EYE DROP, 5ML|Managed Medicare|HOSPICE GENESIS|227.75||||||| 9509134|ERX|0250|ATROPINE 1% EYE DROP, 5ML|Managed Medicare|HEALTHSPRING MA|||||227.75||| 9509134|ERX|0250|ATROPINE 1% EYE DROP, 5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|227.75||||||| 9509134|ERX|0250|ATROPINE 1% EYE DROP, 5ML|Medicaid|MEDICAID|227.75||||||| 9509134|ERX|0250|ATROPINE 1% EYE DROP, 5ML|Medicare|MEDICARE ACUTE|227.75||||227.75||| 9509134|ERX|0250|ATROPINE 1% EYE DROP, 5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|227.75||||||| 9509134|ERX|0250|ATROPINE 1% EYE DROP, 5ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|227.75||||||| 9509134|ERX|0250|ATROPINE 1% EYE DROP, 5ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|227.75||||||| 9509209|ERX|0250|LUBRICANT EYE DROP, 15ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.90||||||| 9509209|ERX|0250|LUBRICANT EYE DROP, 15ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.90||||||| 9509209|ERX|0250|LUBRICANT EYE DROP, 15ML|Medicare|MEDICARE ACUTE|0.90||||0.90||| 9509209|ERX|0250|LUBRICANT EYE DROP, 15ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.90||||||| 9509209|ERX|0250|LUBRICANT EYE DROP, 15ML|Managed Medicare|HEALTHSPRING MA|0.90||||||| 9509209|ERX|0250|LUBRICANT EYE DROP, 15ML|Managed Medicare|BCBS MEDICARE PPO MA|0.90||||||| 9509209|ERX|0250|LUBRICANT EYE DROP, 15ML|Humana Medicare Advantage|HUMANA MA|0.90||||||| 9509225|ERX|0250|BISMUTH SUBSALIC 262MG TA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.25||||||| 9509225|ERX|0250|BISMUTH SUBSALIC 262MG TA|Managed Medicare|HEALTHSPRING MA|2.25||||||| 9509290|ERX|0250|MIDAZOLAM 50MG/10ML|Medicare|MEDICARE ACUTE|||||94.50||| 9509290|ERX|0250|MIDAZOLAM 50MG/10ML|Veterans Affairs|VETERANS ADMINISTRATION|||||94.50||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|ChampVA|CHAMPVA CENTER|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Cigna|CIGNA OTHER|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Blue Cross HMO Specialty|BCBSTX HMO|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Cigna|CIGNA|||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Aetna|AETNA PPO|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Access Direct Platinum|HEALTHFIRST TPA UMR|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Managed Medicaid|MEDICAID SUPERIOR|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Humana Medicare Advantage|HUMANA MA|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|22.25||||||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Managed Medicare|OTHER INSTITUTIONS|||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Managed Medicare|BCBS MEDICARE PPO MA|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Veterans Affairs|VETERANS ADMINISTRATION|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|United Healthcare|UNITED HEALTHCARE OTHER|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|United Healthcare|UNITED HEALTHCARE|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Aenta Medicare Advantage|AETNA MEDICARE MA|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Managed Medicaid|MEDICAID AMERIGROUP|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Cigna|CIGNA|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Aetna|AETNA OTHER|||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Veterans Affairs|VETERANS ADMINISTRATION|22.25||||||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|PHCS|MULTIPLAN PHCS OTHER|||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Multiplan|NALC|||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Tricare|TRICARE EAST REGION|17.63||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Texas Workforce Commission|DIS DETER SERV (DDS)|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Medicaid|HENDERSON COUNTY INDIGENT|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Medicaid|LAW ENFORCEMENT OTHER|22.25||||||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|NON CONTRACTED|COMMERCIAL OTHER 1|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Medicaid|MEDICAID HMO|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Managed Medicare|HEALTHSPRING MA|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Medicaid|MEDICAID|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Medicare|MEDICARE ACUTE|22.25||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|United Healthcare|GEHA|||||22.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|United Healthcare|TML GROUP BENEFITS|22.25||||22.25||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Medicare|MEDICARE PART B ONLY IP|26.75||||||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Medicaid|HENDERSON COUNTY INDIGENT|||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Medicaid|MEDICAID|26.75||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Medicare|MEDICARE ACUTE|26.75||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Tricare|TRICARE EAST REGION|26.75||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|NON CONTRACTED|COMMERCIAL OTHER 1|26.75||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|UTMB|UTMB CORRECTIONAL MANAGED CARE|26.75||||||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|United Healthcare|GOLDEN RULE|||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|United Healthcare|TML GROUP BENEFITS|||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|26.75||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|PHCS|MULTIPLAN PHCS|||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|PHCS|MULTIPLAN PHCS OTHER|||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|United Healthcare|UNITED HEALTHCARE|26.75||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|PHCS|HUMANA|||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Veterans Affairs|VETERANS ADMINISTRATION|26.75||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|26.75||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Multiplan|NALC|||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|United Healthcare|GEHA|||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|26.75||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|26.75||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Managed Medicare|HEALTHSPRING MA|26.75||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|United Healthcare|UNITED HEALTHCARE|||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|United Healthcare|UNITED HEALTHCARE OTHER|||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Humana Medicare Advantage|HUMANA MA|26.75||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|26.75||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Managed Medicaid|MEDICAID AMERIGROUP|26.75||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|26.75||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Aetna|AETNA PPO|26.75||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Aenta Medicare Advantage|AETNA MEDICARE MA|26.75||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Aetna|AETNA OTHER|||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Managed Medicare|BCBS MEDICARE PPO MA|||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|26.75||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Access Direct Platinum|HEALTHFIRST TPA UMR|||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Blue Cross PPO Specialty|BCBSTX PPO|26.75||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Managed Medicaid|MEDICAID SUPERIOR|26.75||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Blue Cross HMO Specialty|BCBSTX HMO|26.75||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Cigna|CIGNA|26.75||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Cigna|CIGNA OTHER|26.75||||26.75||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Cigna|CIGNA|||||26.75||| 9509324|ERX|0258|ESMOLOL 2500MG/250ML SALI|Aetna|AETNA PPO|1,568.38||||||| 9509324|ERX|0258|ESMOLOL 2500MG/250ML SALI|Medicare|MEDICARE ACUTE|1,568.38||||||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|14.50||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|14.50||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|14.50||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Veterans Affairs|VETERANS ADMINISTRATION|14.50||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|14.50||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Medicaid|MEDICAID HMO|14.50||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Medicaid|HENDERSON COUNTY INDIGENT|14.50||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Medicaid|MEDICAID|14.50||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|14.50||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|PHCS|MULTIPLAN PHCS OTHER|||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|United Healthcare|UNITED HEALTHCARE|14.50||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Tricare|TRICARE EAST REGION|14.50||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Texas Workforce Commission|DIS DETER SERV (DDS)|14.50||||||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Medicare|MEDICARE ACUTE|14.50||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Humana Medicare Advantage|HUMANA MA|14.50||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|14.50||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Cigna|CIGNA|14.50||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|United Healthcare|UNITED HEALTHCARE OTHER|14.50||||||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|14.50||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Cigna|CIGNA|14.50||||||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Managed Medicare|HEALTHSPRING MA|14.50||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|NON CONTRACTED|COMMERCIAL OTHER 1|14.50||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|14.50||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|14.50||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|ChampVA|CHAMPVA CENTER|||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Cigna|CIGNA OTHER|||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|14.50||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|14.50||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Blue Cross HMO Specialty|BCBSTX HMO|14.50||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Aetna|AETNA PPO|14.50||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|14.50||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||14.50||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|14.50||||14.50||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UMR|15.75||||||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|15.75||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|15.75||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|15.75||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|15.75||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Aetna|AETNA PPO|15.75||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Cigna|CIGNA|15.75||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|15.75||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Cigna|CIGNA OTHER|15.75||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Blue Cross HMO Specialty|BCBSTX HMO|15.75||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Humana Medicare Advantage|HUMANA MA|15.75||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|15.75||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|United Healthcare|UNITED HEALTHCARE|15.75||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|United Healthcare|TML GROUP BENEFITS|||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Texas Workforce Commission|DIS DETER SERV (DDS)|15.75||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|NON CONTRACTED|COMMERCIAL OTHER 1|15.75||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Tricare|TRICARE EAST REGION|15.75||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Medicaid|MEDICAID HMO|15.75||||||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|15.75||||||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|15.75||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|15.75||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Medicaid|HENDERSON COUNTY INDIGENT|15.75||||||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Medicaid|MEDICAID|15.75||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|15.75||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Medicaid|LAW ENFORCEMENT OTHER|15.75||||||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Medicare|MEDICARE ACUTE|15.75||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Veterans Affairs|VETERANS ADMINISTRATION|15.75||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|15.75||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|15.75||||15.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Managed Medicare|HEALTHSPRING MA|15.75||||15.75||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|42.50||||42.50||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|United Healthcare|UNITED HEALTHCARE|42.50||||||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|ChampVA|CHAMPVA CENTER|42.50||||||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|Medicaid|MEDICAID|42.50||||42.50||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|Veterans Affairs|VETERANS ADMINISTRATION|42.50||||||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|Medicare|MEDICARE ACUTE|42.50||||42.50||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|NON CONTRACTED|COMMERCIAL OTHER 1|42.50||||42.50||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|United Healthcare|UNITED HEALTHCARE|42.50||||42.50||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|42.50||||42.50||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|42.50||||42.50||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|42.50||||42.50||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|42.50||||42.50||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|42.50||||42.50||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|Managed Medicare|BCBS MEDICARE PPO MA|42.50||||42.50||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|Managed Medicare|HEALTHSPRING MA|42.50||||42.50||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|Blue Cross HMO Specialty|BCBSTX HMO|42.50||||42.50||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|Cigna|CIGNA|42.50||||42.50||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|Humana Medicare Advantage|HUMANA MA|42.50||||42.50||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|42.50||||||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|42.50||||42.50||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|42.50||||42.50||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|42.50||||||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|42.50||||||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|175.50||||||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Cigna|CIGNA|||||175.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|175.50||||175.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Blue Cross HMO Specialty|BCBSTX HMO|||||175.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Managed Medicare|HEALTHSPRING MA|175.50||||175.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Humana Medicare Advantage|HUMANA MA|175.50||||175.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Managed Medicaid|MEDICAID AMERIGROUP|||||175.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||175.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Managed Medicaid|MEDICAID SUPERIOR|175.50||||||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Aenta Medicare Advantage|AETNA MEDICARE MA|175.50||||175.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|175.50||||175.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|United Healthcare|UNITED HEALTHCARE|175.50||||||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Medicare|MEDICARE ACUTE|175.50||||175.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|NON CONTRACTED|COMMERCIAL OTHER 1|175.50||||||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|175.50||||||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Blue Cross PPO Specialty|BCBSTX PPO|175.50||||175.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Veterans Affairs|VETERANS ADMINISTRATION|175.50||||175.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|175.50||||175.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|175.50||||175.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|175.50||||175.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||175.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Medicaid|MEDICAID|175.50||||||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Medicaid|HENDERSON COUNTY INDIGENT|175.50||||||| 9509456|ERX|0250|METHYLPREDNIS DEPO 80MG/M|Medicare|MEDICARE ACUTE|||||83.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Humana Medicare Advantage|HUMANA MA|64.50||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Managed Medicaid|MEDICAID SUPERIOR|64.50||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|64.50||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Cigna|CIGNA OTHER|||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Managed Medicaid|MEDICAID AMERIGROUP|64.50||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Blue Cross PPO Specialty|BCBSTX PPO|64.50||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|64.50||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Blue Cross HMO Specialty|BCBSTX HMO|64.50||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Aetna|AETNA PPO|||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Access Direct Platinum|HEALTHFIRST TPA UMR|||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|64.50||||||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|64.50||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|64.50||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Veterans Affairs|VETERANS ADMINISTRATION|64.50||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|64.50||||||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Workers Compensation|WORKERS COMP PHYSICIAN|||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Cigna|CIGNA|||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Tricare|TRICARE EAST REGION|||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|64.50||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Workers Compensation|WORKERS COMPENSATION OTHER|||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|United Healthcare|UNITED HEALTHCARE|||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Blue Cross PPO Specialty|BCBSTX OTHER|||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|United Healthcare|TML GROUP BENEFITS|||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Medicaid|MEDICAID|64.50||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Medicare|MEDICARE ACUTE|64.50||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|United Healthcare|GEHA|||||64.50||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|64.50||||64.50||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|Medicaid|MEDICAID|4.50||||||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|Aetna|AETNA PPO|4.50||||4.50||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|Cigna|CIGNA|4.50||||||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|||||4.50||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9509571|ERX|0250|BENZOCAINE DENTAL GEL|Workers Compensation|UT EMPLOYEE INJURY|0.41||||||| 9509571|ERX|0250|BENZOCAINE DENTAL GEL|Medicare|MEDICARE ACUTE|||||0.41||| 9509571|ERX|0250|BENZOCAINE DENTAL GEL|Medicaid|MEDICAID HMO|||||0.41||| 9509597|ERX|0250|DROPERIDOL 2.5MG 1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.63||| 9509597|ERX|0250|DROPERIDOL 2.5MG 1ML|Medicare|MEDICARE ACUTE|||||0.63||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Veterans Affairs|VETERANS ADMINISTRATION|27.50||||||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|United Healthcare|UNITED HEALTHCARE OTHER|||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|PHCS|HUMANA|||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Veterans Affairs|VETERANS ADMINISTRATION|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|NON CONTRACTED|COMMERCIAL OTHER 1|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|NON CONTRACTED|COMMERCIAL OTHER 2|||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|PHCS|MULTIPLAN PHCS|||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|United Healthcare|GEHA|||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|United Healthcare|TML GROUP BENEFITS|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|United Healthcare|UNITED HEALTHCARE|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Texas Workforce Commission|DIS DETER SERV (DDS)|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Medicaid|LAW ENFORCEMENT OTHER|27.50||||||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Medicaid|MEDICAID HMO|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Medicaid|MEDICAID|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|United Healthcare|GOLDEN RULE|||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Medicaid|HENDERSON COUNTY INDIGENT|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Medicaid|MEDICAID BCBSTX|||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Medicare|MEDICARE PART B ONLY IP|27.50||||||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Humana Medicare Advantage|HUMANA MA|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Multiplan|NALC|||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Managed Medicaid|MEDICAID AMERIGROUP|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Medicare|MEDICARE ACUTE|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Managed Medicaid|MEDICAID SUPERIOR|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Tricare|TRICARE EAST REGION|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|PHCS|MULTIPLAN PHCS OTHER|||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Managed Medicare|WELLCARE CHOICE MA|||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Managed Medicare|HOSPICE OF EAST TEXAS|27.50||||||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Managed Medicare|BCBS MEDICARE PPO MA|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Managed Medicare|OTHER INSTITUTIONS|||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Cigna|CIGNA|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|UTMB|UTMB CORRECTIONAL MANAGED CARE|27.50||||||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Managed Medicare|HEALTHSPRING MA|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Cigna|CIGNA OTHER|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Blue Cross PPO Specialty|BCBSTX OTHER|||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|ChampVA|CHAMPVA CENTER|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Blue Cross HMO Specialty|BCBSTX HMO|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Access Direct Platinum|HEALTHFIRST TPA UMR|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Aenta Medicare Advantage|AETNA MEDICARE MA|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Cigna|CIGNA|||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|27.50||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Aetna|AETNA OTHER|||||27.50||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Aetna|AETNA PPO|27.50||||27.50||| 9509613|ERX|0250|FENTANYL 250MCG/5ML|Managed Medicare|HOSPICE OF EAST TEXAS|0.16||||||| 9509613|ERX|0250|FENTANYL 250MCG/5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.16||| 9509613|ERX|0250|FENTANYL 250MCG/5ML|Humana Medicare Advantage|HUMANA MA|0.16||||0.16||| 9509613|ERX|0250|FENTANYL 250MCG/5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.16||||||| 9509613|ERX|0250|FENTANYL 250MCG/5ML|Medicare|MEDICARE ACUTE|0.16||||0.16||| 9509712|ERX|0250|UREA 10% CREAM, 142 GM|Humana Medicare Advantage|HUMANA MA|||||98.25||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||78.25||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Medicare|MEDICARE ACUTE|78.25||||||| 9509779|ERX|0250|PREDNISOLONE 1% EYE DROP,|Humana Medicare Advantage|HUMANA MA|269.50||||||| 9509779|ERX|0250|PREDNISOLONE 1% EYE DROP,|Medicare|MEDICARE ACUTE|269.50||||269.50||| 9509779|ERX|0250|PREDNISOLONE 1% EYE DROP,|Veterans Affairs|VETERANS ADMINISTRATION|269.50||||||| 9509779|ERX|0250|PREDNISOLONE 1% EYE DROP,|United Medicare Advantage|UHC MEDICARE GOLD MA|269.50||||269.50||| 9509779|ERX|0250|PREDNISOLONE 1% EYE DROP,|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||269.50||| 9509811|ERX|0250|OFLOXACIN 0.3% EYE DROP,|United Medicare Advantage|UHC MEDICARE GOLD MA|||||5.20||| 9509811|ERX|0250|OFLOXACIN 0.3% EYE DROP,|United Healthcare|TML GROUP BENEFITS|||||5.20||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Blue Cross PPO Specialty|BCBSTX OTHER|||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Aetna|AETNA OTHER|||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Aetna|AETNA PPO|4.50||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Cigna|CIGNA|4.50||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UMR|||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|4.50||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|4.50||||||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Managed Medicare|WELLCARE CHOICE MA|4.50||||||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|MTC Medical|VAN ZANDT COUNTY INMATE|||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Medicaid|MEDICAID|4.50||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Medicaid|COUNTY INDIGENT HEALTH OTHER|4.50||||||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Tricare|TRICARE EAST REGION|4.50||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|4.50||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Medicaid|MEDICAID HMO|||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Managed Medicare|VAN ZANDT COUNTY INMATE|||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|United Healthcare|GEHA|||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Tricare|TRICARE FOR LIFE|||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|United Healthcare|GOLDEN RULE|||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|United Healthcare|TML GROUP BENEFITS|||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|PHCS|MULTIPLAN PHCS OTHER|||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|ChampVA|CHAMPVA CENTER|4.50||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|PHCS|HUMANA|||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Multiplan|NALC|||||4.50||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|||||4.50||| 9509993|ERX|0250|COLESTIPOL 1 G TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.12||| 9509993|ERX|0250|COLESTIPOL 1 G TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.12||||||| 9509993|ERX|0250|COLESTIPOL 1 G TABLET|Medicare|MEDICARE ACUTE|0.12||||0.12||| 9509993|ERX|0250|COLESTIPOL 1 G TABLET|Humana Medicare Advantage|HUMANA MA|0.12||||0.12||| 9509993|ERX|0250|COLESTIPOL 1 G TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.12||| 951|DRG||OTHER FACTORS INFLUENCING HEALTH STATUS|Managed Medicare|HOSPICE ETMC|4,559.75|5736.84|5778.16|5730.39|||| 951|DRG||OTHER FACTORS INFLUENCING HEALTH STATUS|Managed Medicare|HOSPICE CARING HEARTS|56.92|5778.16|5778.16|5730.39|||| 951|DRG||OTHER FACTORS INFLUENCING HEALTH STATUS|Managed Medicare|HOSPICE GENESIS|7,279.63|5736.84|5778.16|5730.39|||| 951|DRG||OTHER FACTORS INFLUENCING HEALTH STATUS|Managed Medicare|HOSPICE OF EAST TEXAS|3,608.75|5737.72|5778.16|5730.39|||| 951|DRG||OTHER FACTORS INFLUENCING HEALTH STATUS|Medicare|MEDICARE ACUTE|22,173.25|5730.39|5778.16|5730.39|||| 9510041|ERX|0250|SIMETHICONE 40MG/0.6ML, 3|Medicare|MEDICARE ACUTE|85.50||||||| 9510041|ERX|0250|SIMETHICONE 40MG/0.6ML, 3|Humana Medicare Advantage|HUMANA MA|85.50||||||| 9510066|ERX|0250|COENZYME Q10 30MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|8.50||||||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.50||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|Cigna|CIGNA|4.50||||||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.50||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.50||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9510140|ERX|0250|FLAVOXATE 100MG TABLET|Humana Medicare Advantage|HUMANA MA|||||21.75||| 9510140|ERX|0250|FLAVOXATE 100MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|21.75||||||| 9510157|ERX|0250|NA CITRATE-CITRIC ACID 30|Medicare|MEDICARE ACUTE|19.50||||||| 9510157|ERX|0250|NA CITRATE-CITRIC ACID 30|United Medicare Advantage|AARP UHC WEST COMPLETE MA|19.50||||||| 9510157|ERX|0250|NA CITRATE-CITRIC ACID 30|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|19.50||||19.50||| 9510157|ERX|0250|NA CITRATE-CITRIC ACID 30|Humana Medicare Advantage|HUMANA MA|19.50||||||| 9510157|ERX|0250|NA CITRATE-CITRIC ACID 30|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|19.50||||||| 9510157|ERX|0250|NA CITRATE-CITRIC ACID 30|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|19.50||||||| 9510157|ERX|0250|NA CITRATE-CITRIC ACID 30|Managed Medicaid|MEDICAID SUPERIOR|19.50||||||| 9510157|ERX|0250|NA CITRATE-CITRIC ACID 30|Managed Medicaid|MEDICAID AMERIGROUP|19.50||||||| 9510165|ERX|0250|CLOTRIMAZOLE 10MG TROCHE|Humana Medicare Advantage|HUMANA MA|23.50||||||| 9510165|ERX|0250|CLOTRIMAZOLE 10MG TROCHE|Medicare|MEDICARE ACUTE|23.50||||||| 9510181|ERX|0250|METHYLPREDNISOLONE 1000MG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.96||||||| 9510181|ERX|0250|METHYLPREDNISOLONE 1000MG|Cigna|CIGNA|||||2.96||| 9510181|ERX|0250|METHYLPREDNISOLONE 1000MG|Humana Medicare Advantage|HUMANA MA|2.96||||2.96||| 9510181|ERX|0250|METHYLPREDNISOLONE 1000MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.96||| 9510215|ERX|0250|GENTAMICIN EYE OINT, 3.5G|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.24||| 9510215|ERX|0250|GENTAMICIN EYE OINT, 3.5G|Aetna|AETNA PPO|||||1.24||| 9510215|ERX|0250|GENTAMICIN EYE OINT, 3.5G|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.24||| 9510215|ERX|0250|GENTAMICIN EYE OINT, 3.5G|Medicare|MEDICARE ACUTE|||||1.24||| 9510215|ERX|0250|GENTAMICIN EYE OINT, 3.5G|Veterans Affairs|VETERANS ADMINISTRATION|||||1.24||| 9510215|ERX|0250|GENTAMICIN EYE OINT, 3.5G|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1.24||| 9510231|ERX|0250|ASPIRIN-ACETAM-CAFFEINE|Medicare|MEDICARE ACUTE|2.25||||||| 9510231|ERX|0250|ASPIRIN-ACETAM-CAFFEINE|Managed Medicare|HEALTHSPRING MA|||||2.25||| 9510231|ERX|0250|ASPIRIN-ACETAM-CAFFEINE|Managed Medicaid|MEDICAID SUPERIOR|2.25||||||| 9510231|ERX|0250|ASPIRIN-ACETAM-CAFFEINE|Aetna|AETNA PPO|2.25||||||| 9510256|ERX|0250|MEDROXYPROGEST DEPO 150MG|Cigna|CIGNA|324.50||||||| 9510256|ERX|0250|MEDROXYPROGEST DEPO 150MG|Medicaid|MEDICAID|324.50||||||| 9510256|ERX|0250|MEDROXYPROGEST DEPO 150MG|Managed Medicaid|MEDICAID AMERIGROUP|324.50||||324.50||| 9510256|ERX|0250|MEDROXYPROGEST DEPO 150MG|Blue Cross PPO Specialty|BCBSTX PPO|324.50||||||| 9510256|ERX|0250|MEDROXYPROGEST DEPO 150MG|United Healthcare|UNITED HEALTHCARE|||||324.50||| 9510256|ERX|0250|MEDROXYPROGEST DEPO 150MG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||324.50||| 9510272|ERX|0250|NA CHLORIDE 5% DROP,15ML|Humana Medicare Advantage|HUMANA MA|173.25||||||| 9510298|ERX|0250|TIMOLOL 0.5% EYE DROP, 5M|Medicare|MEDICARE ACUTE|161.75||||161.75||| 9510298|ERX|0250|TIMOLOL 0.5% EYE DROP, 5M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|161.75||||161.75||| 9510298|ERX|0250|TIMOLOL 0.5% EYE DROP, 5M|Blue Cross PPO Specialty|BCBSTX PPO|161.75||||||| 9510298|ERX|0250|TIMOLOL 0.5% EYE DROP, 5M|Managed Medicare|HEALTHSPRING MA|161.75||||161.75||| 9510298|ERX|0250|TIMOLOL 0.5% EYE DROP, 5M|Humana Medicare Advantage|HUMANA MA|161.75||||161.75||| 9510306|ERX|0250|TIMOLOL 0.25% EYE DROP, 5|Medicare|MEDICARE ACUTE|142.75||||||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Humana Medicare Advantage|HUMANA MA|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Managed Medicaid|MEDICAID SUPERIOR|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Managed Medicaid|MEDICAID AMERIGROUP|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Cigna|CIGNA OTHER|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Blue Cross PPO Specialty|BCBSTX PPO|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Veterans Affairs|VETERANS ADMINISTRATION|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Cigna|CIGNA|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Workers Compensation|TEXAS MUTUAL INSURANCE|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Workers Compensation|WORKERS COMP PHYSICIAN|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|United Medicare Advantage|UHC AARP MCR HMO MA|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Blue Cross HMO Specialty|BCBSTX HMO|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Tricare|TRICARE EAST REGION|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Medicaid|HENDERSON COUNTY INDIGENT|||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Medicare|MEDICARE ACUTE|2.75||||2.75||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Aetna|AETNA PPO|||||2.75||| 9510397|ERX|0250|CLINDAMYCIN 75MG/5ML, 100|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||403.50||| 9510397|ERX|0250|CLINDAMYCIN 75MG/5ML, 100|Blue Cross PPO Specialty|BCBSTX PPO|403.50||||||| 9510397|ERX|0250|CLINDAMYCIN 75MG/5ML, 100|Managed Medicaid|MEDICAID AMERIGROUP|||||403.50||| 9510397|ERX|0250|CLINDAMYCIN 75MG/5ML, 100|Managed Medicaid|MEDICAID SUPERIOR|||||403.50||| 9510447|ERX|0250|PHENYLEPHRINE 2.5% DROP,2|Humana Medicare Advantage|HUMANA MA|||||42.75||| 9510447|ERX|0250|PHENYLEPHRINE 2.5% DROP,2|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||42.75||| 9510447|ERX|0250|PHENYLEPHRINE 2.5% DROP,2|Aetna|AETNA PPO|||||42.75||| 9510447|ERX|0250|PHENYLEPHRINE 2.5% DROP,2|Managed Medicare|HEALTHSPRING MA|||||42.75||| 9510447|ERX|0250|PHENYLEPHRINE 2.5% DROP,2|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||42.75||| 9510447|ERX|0250|PHENYLEPHRINE 2.5% DROP,2|Aenta Medicare Advantage|AETNA MEDICARE MA|||||42.75||| 9510447|ERX|0250|PHENYLEPHRINE 2.5% DROP,2|Blue Cross PPO Specialty|BCBSTX PPO|||||42.75||| 9510447|ERX|0250|PHENYLEPHRINE 2.5% DROP,2|ChampVA|CHAMPVA CENTER|||||42.75||| 9510447|ERX|0250|PHENYLEPHRINE 2.5% DROP,2|Blue Cross HMO Specialty|BCBSTX HMO|||||42.75||| 9510447|ERX|0250|PHENYLEPHRINE 2.5% DROP,2|Cigna|CIGNA|||||42.75||| 9510447|ERX|0250|PHENYLEPHRINE 2.5% DROP,2|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||42.75||| 9510447|ERX|0250|PHENYLEPHRINE 2.5% DROP,2|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||42.75||| 9510447|ERX|0250|PHENYLEPHRINE 2.5% DROP,2|United Medicare Advantage|UHC MEDICARE GOLD MA|||||42.75||| 9510447|ERX|0250|PHENYLEPHRINE 2.5% DROP,2|Medicare|MEDICARE ACUTE|||||42.75||| 9510454|ERX|0250|ATROPINE 1% EYE OINT, 3.5|Medicare|MEDICARE ACUTE|27.75||||||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Cigna|CIGNA|||||305.50||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Aetna|AETNA PPO|||||305.50||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||305.50||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||305.50||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Managed Medicaid|MEDICAID AMERIGROUP|||||305.50||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Humana Medicare Advantage|HUMANA MA|||||305.50||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||305.50||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Managed Medicaid|MEDICAID SUPERIOR|||||305.50||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||305.50||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||305.50||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Managed Medicare|HEALTHSPRING MA|||||305.50||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Veterans Affairs|VETERANS ADMINISTRATION|||||305.50||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||305.50||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||305.50||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|United Healthcare|UNITED HEALTHCARE OTHER|||||305.50||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Blue Cross PPO Specialty|BCBSTX PPO|||||305.50||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Medicaid|MEDICAID HMO|||||305.50||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||305.50||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Medicare|MEDICARE ACUTE|||||305.50||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|United Healthcare|UNITED HEALTHCARE|||||305.50||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||305.50||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||305.50||| 9510512|ERX|0250|NAPROXEN SODIUM 220MG TAB|Medicare|MEDICARE ACUTE|2.25||||||| 9510512|ERX|0250|NAPROXEN SODIUM 220MG TAB|United Healthcare|UNITED HEALTHCARE|||||2.25||| 9510512|ERX|0250|NAPROXEN SODIUM 220MG TAB|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.25||||||| 9510512|ERX|0250|NAPROXEN SODIUM 220MG TAB|Workers Compensation|TEXAS MUTUAL INSURANCE|||||2.25||| 9510512|ERX|0250|NAPROXEN SODIUM 220MG TAB|Aetna|AETNA PPO|2.25||||||| 9510512|ERX|0250|NAPROXEN SODIUM 220MG TAB|Blue Cross PPO Specialty|BCBSTX PPO|||||2.25||| 9510512|ERX|0250|NAPROXEN SODIUM 220MG TAB|Humana Medicare Advantage|HUMANA MA|2.25||||2.25||| 9510512|ERX|0250|NAPROXEN SODIUM 220MG TAB|Managed Medicare|HEALTHSPRING MA|2.25||||2.25||| 9510520|ERX|0250|THROMBIN (RECOMB) 5,000 U|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||590.50||| 9510520|ERX|0250|THROMBIN (RECOMB) 5,000 U|Medicare|MEDICARE ACUTE|||||590.50||| 9510546|ERX|0250|FLECAINIDE 100MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||40.75||| 9510546|ERX|0250|FLECAINIDE 100MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|40.75||||||| 9510546|ERX|0250|FLECAINIDE 100MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|40.75||||||| 9510546|ERX|0250|FLECAINIDE 100MG TABLET|United Healthcare|UNITED HEALTHCARE|40.75||||||| 9510546|ERX|0250|FLECAINIDE 100MG TABLET|Medicare|MEDICARE ACUTE|40.75||||40.75||| 9510546|ERX|0250|FLECAINIDE 100MG TABLET|Humana Medicare Advantage|HUMANA MA|40.75||||||| 9510546|ERX|0250|FLECAINIDE 100MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|40.75||||||| 9510579|ERX|0250|VITAMIN B COMP W-C TABLE|Blue Cross PPO Specialty|BCBSTX PPO|2.25||||||| 9510579|ERX|0250|VITAMIN B COMP W-C TABLE|Cigna|CIGNA|2.25||||||| 9510579|ERX|0250|VITAMIN B COMP W-C TABLE|Managed Medicaid|MEDICAID AMERIGROUP|2.25||||||| 9510579|ERX|0250|VITAMIN B COMP W-C TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.25||| 9510579|ERX|0250|VITAMIN B COMP W-C TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.25||| 9510579|ERX|0250|VITAMIN B COMP W-C TABLE|Medicare|MEDICARE ACUTE|2.25||||2.25||| 9510579|ERX|0250|VITAMIN B COMP W-C TABLE|Managed Medicaid|MEDICAID SUPERIOR|2.25||||||| 9510579|ERX|0250|VITAMIN B COMP W-C TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|2.25||||||| 9510579|ERX|0250|VITAMIN B COMP W-C TABLE|Humana Medicare Advantage|HUMANA MA|||||2.25||| 9510579|ERX|0250|VITAMIN B COMP W-C TABLE|Managed Medicare|BCBS MEDICARE PPO MA|2.25||||2.25||| 9510587|ERX|0250|PSYLLIUM SEED (SUGAR FREE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.05||||0.05||| 9510587|ERX|0250|PSYLLIUM SEED (SUGAR FREE|Medicare|MEDICARE ACUTE|0.05||||0.05||| 9510587|ERX|0250|PSYLLIUM SEED (SUGAR FREE|Humana Medicare Advantage|HUMANA MA|0.05||||||| 9510587|ERX|0250|PSYLLIUM SEED (SUGAR FREE|Blue Cross PPO Specialty|BCBSTX PPO|0.05||||||| 9510637|ERX|0250|TOBRAMYCIN 1.2 G VIAL|Medicare|MEDICARE ACUTE|2,573.75||||||| 9510678|ERX|0250|AMMONIA AROMATIC AMPULE|Aetna|AETNA PPO|||||0.09||| 9510678|ERX|0250|AMMONIA AROMATIC AMPULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.09||| 9510678|ERX|0250|AMMONIA AROMATIC AMPULE|Blue Cross PPO Specialty|BCBSTX PPO|||||0.09||| 9510678|ERX|0250|AMMONIA AROMATIC AMPULE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||0.09||| 9510678|ERX|0250|AMMONIA AROMATIC AMPULE|Managed Medicaid|MEDICAID AMERIGROUP|||||0.09||| 9510678|ERX|0250|AMMONIA AROMATIC AMPULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.09||||||| 9510678|ERX|0250|AMMONIA AROMATIC AMPULE|Medicare|MEDICARE ACUTE|||||0.09||| 9510710|ERX|0250|CARBOPROST 250MCG/ML|Medicaid|MEDICAID HMO|836.75||||||| 9510710|ERX|0250|CARBOPROST 250MCG/ML|Managed Medicaid|MEDICAID SUPERIOR|836.75||||||| 9510710|ERX|0250|CARBOPROST 250MCG/ML|Blue Cross PPO Specialty|BCBSTX PPO|836.75||||||| 9510728|ERX|0250|TUBERCULIN,PPD 5 UNIT/ 0.|Managed Medicaid|MEDICAID SUPERIOR|||||32.50||| 9510728|ERX|0250|TUBERCULIN,PPD 5 UNIT/ 0.|United Medicare Advantage|AARP UHC WEST COMPLETE MA|32.50||||||| 9510728|ERX|0250|TUBERCULIN,PPD 5 UNIT/ 0.|Medicare|MEDICARE ACUTE|32.50||||||| 9510736|ERX|0250|METHOHEXITAL 500MG/VIAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||458.75||| 9510736|ERX|0250|METHOHEXITAL 500MG/VIAL|United Healthcare|UNITED HEALTHCARE|||||458.75||| 9510736|ERX|0250|METHOHEXITAL 500MG/VIAL|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||458.75||| 9510736|ERX|0250|METHOHEXITAL 500MG/VIAL|Medicaid|HENDERSON COUNTY INDIGENT|458.75||||||| 9510736|ERX|0250|METHOHEXITAL 500MG/VIAL|Workers Compensation|WORKERS COMPENSATION OTHER|||||458.75||| 9510736|ERX|0250|METHOHEXITAL 500MG/VIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||458.75||| 9510736|ERX|0250|METHOHEXITAL 500MG/VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||458.75||| 9510736|ERX|0250|METHOHEXITAL 500MG/VIAL|Medicare|MEDICARE ACUTE|||||458.75||| 9510736|ERX|0250|METHOHEXITAL 500MG/VIAL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||458.75||| 9510736|ERX|0250|METHOHEXITAL 500MG/VIAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||458.75||| 9510736|ERX|0250|METHOHEXITAL 500MG/VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||458.75||| 9510736|ERX|0250|METHOHEXITAL 500MG/VIAL|Blue Cross PPO Specialty|BCBSTX PPO|||||458.75||| 9510736|ERX|0250|METHOHEXITAL 500MG/VIAL|Humana Medicare Advantage|HUMANA MA|||||458.75||| 9510736|ERX|0250|METHOHEXITAL 500MG/VIAL|Managed Medicaid|MEDICAID SUPERIOR|||||458.75||| 9510777|ERX|0250|CALCITRIOL 0.25MCG CAPSUL|Managed Medicare|HEALTHSPRING MA|16.50||||||| 9510777|ERX|0250|CALCITRIOL 0.25MCG CAPSUL|Humana Medicare Advantage|HUMANA MA|16.50||||||| 9510777|ERX|0250|CALCITRIOL 0.25MCG CAPSUL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|16.50||||||| 9510777|ERX|0250|CALCITRIOL 0.25MCG CAPSUL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||16.50||| 9510777|ERX|0250|CALCITRIOL 0.25MCG CAPSUL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|16.50||||16.50||| 9510777|ERX|0250|CALCITRIOL 0.25MCG CAPSUL|United Medicare Advantage|UHC MEDICARE GOLD MA|16.50||||||| 9510777|ERX|0250|CALCITRIOL 0.25MCG CAPSUL|Medicare|MEDICARE ACUTE|16.50||||16.50||| 9510801|ERX|0250|CLINDAMYCIN 300MG/2ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||64.50||| 9510801|ERX|0250|CLINDAMYCIN 300MG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|64.50||||||| 9510801|ERX|0250|CLINDAMYCIN 300MG/2ML|Managed Medicaid|MEDICAID SUPERIOR|64.50||||64.50||| 9510801|ERX|0250|CLINDAMYCIN 300MG/2ML|Managed Medicaid|MEDICAID AMERIGROUP|64.50||||64.50||| 9510835|ERX|0250|CALCIUM ACETATE 667MG CAP|Humana Medicare Advantage|HUMANA MA|0.09||||||| 9510835|ERX|0250|CALCIUM ACETATE 667MG CAP|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.09||| 9510835|ERX|0250|CALCIUM ACETATE 667MG CAP|United Medicare Advantage|UHC AARP MCR HMO MA|0.09||||||| 9510835|ERX|0250|CALCIUM ACETATE 667MG CAP|Medicare|MEDICARE ACUTE|0.09||||||| 9510850|ERX|0250|HYDROCORTISONE 100MG/2ML|United Healthcare|UNITED HEALTHCARE|30.75||||||| 9510850|ERX|0250|HYDROCORTISONE 100MG/2ML|Medicare|MEDICARE ACUTE|30.75||||30.75||| 9510850|ERX|0250|HYDROCORTISONE 100MG/2ML|Medicaid|MEDICAID|||||30.75||| 9510850|ERX|0250|HYDROCORTISONE 100MG/2ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||30.75||| 9510850|ERX|0250|HYDROCORTISONE 100MG/2ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|30.75||||30.75||| 9510850|ERX|0250|HYDROCORTISONE 100MG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|30.75||||||| 9510850|ERX|0250|HYDROCORTISONE 100MG/2ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||30.75||| 9510850|ERX|0250|HYDROCORTISONE 100MG/2ML|Aetna|AETNA OTHER|||||30.75||| 9510850|ERX|0250|HYDROCORTISONE 100MG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|30.75||||30.75||| 9510850|ERX|0250|HYDROCORTISONE 100MG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|30.75||||30.75||| 9510850|ERX|0250|HYDROCORTISONE 100MG/2ML|Managed Medicare|HEALTHSPRING MA|30.75||||30.75||| 9510850|ERX|0250|HYDROCORTISONE 100MG/2ML|Humana Medicare Advantage|HUMANA MA|30.75||||30.75||| 9510850|ERX|0250|HYDROCORTISONE 100MG/2ML|Managed Medicaid|MEDICAID SUPERIOR|30.75||||||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Managed Medicaid|MEDICAID SUPERIOR|9.25||||9.25||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Managed Medicaid|MEDICAID AMERIGROUP|9.25||||9.25||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Managed Medicare|MA PART B ONLY IP|9.25||||||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Humana Medicare Advantage|HUMANA MA|9.25||||9.25||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||9.25||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Cigna|CIGNA|9.25||||9.25||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||9.25||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Blue Cross PPO Specialty|BCBSTX PPO|9.25||||9.25||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Blue Cross HMO Specialty|BCBSTX HMO|||||9.25||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Aetna|AETNA PPO|9.25||||||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.25||||9.25||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Aenta Medicare Advantage|AETNA MEDICARE MA|9.25||||||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|9.25||||||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Veterans Affairs|VETERANS ADMINISTRATION|9.25||||9.25||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|9.25||||9.25||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|United Medicare Advantage|UHC MEDICARE GOLD MA|9.25||||9.25||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Managed Medicare|HEALTHSPRING MA|9.25||||9.25||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||9.25||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||9.25||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|9.25||||9.25||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|9.25||||9.25||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Medicaid|COUNTY INDIGENT HEALTH OTHER|9.25||||||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||9.25||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Medicaid|MEDICAID HMO|||||9.25||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Medicaid|MEDICAID|9.25||||9.25||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Medicaid|HENDERSON COUNTY INDIGENT|9.25||||||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Medicare|MEDICARE ACUTE|9.25||||9.25||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Tricare|TRICARE EAST REGION|9.25||||||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|9.25||||9.25||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|NON CONTRACTED|COMMERCIAL OTHER 1|9.25||||9.25||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|United Healthcare|UNITED HEALTHCARE|9.25||||9.25||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|9.25||||||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|United Healthcare|UNITED HEALTHCARE OTHER|||||9.25||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Tricare|TRICARE EAST REGION|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|United Healthcare|UNITED HEALTHCARE OTHER|||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|United Healthcare|UNITED HEALTHCARE|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Texas Workforce Commission|DIS DETER SERV (DDS)|||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Medicaid|COUNTY INDIGENT HEALTH OTHER|0.07||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Medicaid|HENDERSON COUNTY INDIGENT|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Medicaid|MEDICAID HMO|||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Medicaid|MEDICAID|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|NON CONTRACTED|COMMERCIAL OTHER 1|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Medicare|MEDICARE ACUTE|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|United Medicare Advantage|UHC MEDICARE GOLD MA|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Veterans Affairs|VETERANS ADMINISTRATION|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Medicaid|MOLINA HEALTHCARE OF TEXAS|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Aetna|AETNA PPO|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Aenta Medicare Advantage|AETNA MEDICARE MA|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|UTMB|UTMB CORRECTIONAL MANAGED CARE|0.07||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Blue Cross PPO Specialty|BCBSTX PPO|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Cigna|CIGNA|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Cigna|CIGNA|0.07||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Blue Cross HMO Specialty|BCBSTX HMO|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Managed Medicare|BCBS MEDICARE PPO MA|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Managed Medicare|HEALTHSPRING MA|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Humana Medicare Advantage|HUMANA MA|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Managed Medicaid|MEDICAID AMERIGROUP|0.07||||0.07||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Managed Medicaid|MEDICAID SUPERIOR|0.07||||0.07||| 9510983|ERX|0250|FLUPHENAZINE 2.5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||12.25||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||54.50||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Managed Medicaid|MEDICAID AMERIGROUP|||||54.50||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Managed Medicaid|MEDICAID SUPERIOR|||||54.50||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Blue Cross PPO Specialty|BCBSTX PPO|54.50||||54.50||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|ChampVA|CHAMPVA CENTER|54.50||||||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Cigna|CIGNA|||||54.50||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Blue Cross HMO Specialty|BCBSTX HMO|||||54.50||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Cigna|CIGNA OTHER|||||54.50||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Aenta Medicare Advantage|AETNA MEDICARE MA|||||54.50||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||54.50||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||54.50||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||54.50||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||54.50||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Medicare|MEDICARE ACUTE|54.50||||54.50||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Tricare|TRICARE EAST REGION|||||54.50||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||54.50||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|United Healthcare|UNITED HEALTHCARE OTHER|||||54.50||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Medicaid|MEDICAID HMO|||||54.50||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|United Healthcare|UNITED HEALTHCARE|||||54.50||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Workers Compensation|WORKERS COMPENSATION OTHER|||||54.50||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Workers Compensation|UT EMPLOYEE INJURY|||||54.50||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|United Medicare Advantage|UHC MEDICARE GOLD MA|||||54.50||| 9511023|ERX|0250|HYDROCORTISONE 250MG/2ML|Managed Medicaid|MEDICAID AMERIGROUP|32.25||||||| 9511072|ERX|0250|HYDROCORTISONE 500MG/4ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|144.50||||||| 9511080|ERX|0250|HYDROXYZINE HCL 10MG TABL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||8.75||| 9511080|ERX|0250|HYDROXYZINE HCL 10MG TABL|Tricare|TRICARE EAST REGION|8.75||||||| 9511080|ERX|0250|HYDROXYZINE HCL 10MG TABL|Medicare|MEDICARE ACUTE|8.75||||||| 9511080|ERX|0250|HYDROXYZINE HCL 10MG TABL|Veterans Affairs|VETERANS ADMINISTRATION|8.75||||||| 9511098|ERX|0250|ERGOCALCIFEROL 50000 UNIT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|20.25||||||| 9511098|ERX|0250|ERGOCALCIFEROL 50000 UNIT|Medicare|MEDICARE ACUTE|20.25||||||| 9511098|ERX|0250|ERGOCALCIFEROL 50000 UNIT|United Healthcare|UNITED HEALTHCARE|20.25||||||| 9511098|ERX|0250|ERGOCALCIFEROL 50000 UNIT|Managed Medicare|HEALTHSPRING MA|20.25||||||| 9511098|ERX|0250|ERGOCALCIFEROL 50000 UNIT|Humana Medicare Advantage|HUMANA MA|20.25||||20.25||| 9511098|ERX|0250|ERGOCALCIFEROL 50000 UNIT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|20.25||||||| 9511239|ERX|0250|GLYCERIN-WITCH HAZEL PADS|Blue Cross PPO Specialty|BCBSTX PPO|30.75||||30.75||| 9511239|ERX|0250|GLYCERIN-WITCH HAZEL PADS|Cigna|CIGNA|30.75||||||| 9511239|ERX|0250|GLYCERIN-WITCH HAZEL PADS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|30.75||||||| 9511239|ERX|0250|GLYCERIN-WITCH HAZEL PADS|Aetna|AETNA PPO|30.75||||30.75||| 9511239|ERX|0250|GLYCERIN-WITCH HAZEL PADS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|30.75||||||| 9511239|ERX|0250|GLYCERIN-WITCH HAZEL PADS|Managed Medicaid|MEDICAID SUPERIOR|30.75||||30.75||| 9511239|ERX|0250|GLYCERIN-WITCH HAZEL PADS|Managed Medicaid|MEDICAID AMERIGROUP|30.75||||||| 9511239|ERX|0250|GLYCERIN-WITCH HAZEL PADS|NON CONTRACTED|COMMERCIAL OTHER 1|30.75||||||| 9511239|ERX|0250|GLYCERIN-WITCH HAZEL PADS|Blue Cross HMO Specialty|BCBSTX HMO|30.75||||||| 9511239|ERX|0250|GLYCERIN-WITCH HAZEL PADS|PHCS|HUMANA|30.75||||||| 9511239|ERX|0250|GLYCERIN-WITCH HAZEL PADS|United Healthcare|UMR UNITED MEDICAL RESOURCES|30.75||||||| 9511239|ERX|0250|GLYCERIN-WITCH HAZEL PADS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|30.75||||||| 9511239|ERX|0250|GLYCERIN-WITCH HAZEL PADS|United Healthcare|UNITED HEALTHCARE|30.75||||||| 9511239|ERX|0250|GLYCERIN-WITCH HAZEL PADS|Medicaid|MEDICAID HMO|30.75||||||| 9511239|ERX|0250|GLYCERIN-WITCH HAZEL PADS|Medicaid|MOLINA HEALTHCARE OF TEXAS|30.75||||||| 9511239|ERX|0250|GLYCERIN-WITCH HAZEL PADS|Medicaid|MEDICAID|30.75||||30.75||| 9511239|ERX|0250|GLYCERIN-WITCH HAZEL PADS|Medicare|MEDICARE ACUTE|30.75||||||| 9511239|ERX|0250|GLYCERIN-WITCH HAZEL PADS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|30.75||||||| 9511254|ERX|0250|AMANTADINE 50MG/5ML, 30ML|Medicare|MEDICARE ACUTE|||||38.25||| 9511262|ERX|0250|SOTALOL 80MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9511262|ERX|0250|SOTALOL 80MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9511262|ERX|0250|SOTALOL 80MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9511262|ERX|0250|SOTALOL 80MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9511262|ERX|0250|SOTALOL 80MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||||| 9511262|ERX|0250|SOTALOL 80MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9511262|ERX|0250|SOTALOL 80MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9511262|ERX|0250|SOTALOL 80MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9511262|ERX|0250|SOTALOL 80MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9511262|ERX|0250|SOTALOL 80MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9511262|ERX|0250|SOTALOL 80MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||||| 9511262|ERX|0250|SOTALOL 80MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||||| 9511262|ERX|0250|SOTALOL 80MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9511270|ERX|0250|METHYLPREDNISOL DEPO 40MG|United Healthcare|UNITED HEALTHCARE|||||97.75||| 9511270|ERX|0250|METHYLPREDNISOL DEPO 40MG|Blue Cross PPO Specialty|BCBSTX PPO|||||97.75||| 9511270|ERX|0250|METHYLPREDNISOL DEPO 40MG|Medicare|MEDICARE ACUTE|||||97.75||| 9511288|ERX|0250|ESTRADIOL 0.05MG PATCH|Medicare|MEDICARE ACUTE|||||1.13||| 9511296|ERX|0250|ESTRADIOL 0.1MG PATCH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.13||||||| 9511296|ERX|0250|ESTRADIOL 0.1MG PATCH|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.13||| 9511296|ERX|0250|ESTRADIOL 0.1MG PATCH|Blue Cross PPO Specialty|BCBSTX PPO|1.13||||||| 9511296|ERX|0250|ESTRADIOL 0.1MG PATCH|Tricare|TRICARE EAST REGION|||||1.13||| 9511296|ERX|0250|ESTRADIOL 0.1MG PATCH|United Healthcare|UNITED HEALTHCARE|||||1.13||| 9511361|ERX|0250|FENTANYL 25MCG PATCH|United Medicare Advantage|UHC MEDICARE GOLD MA|11.75||||11.75||| 9511361|ERX|0250|FENTANYL 25MCG PATCH|United Medicare Advantage|AARP UHC WEST COMPLETE MA|11.75||||||| 9511361|ERX|0250|FENTANYL 25MCG PATCH|Medicare|MEDICARE ACUTE|11.75||||11.75||| 9511361|ERX|0250|FENTANYL 25MCG PATCH|Humana Medicare Advantage|HUMANA MA|11.75||||||| 9511361|ERX|0250|FENTANYL 25MCG PATCH|Managed Medicare|HEALTHSPRING MA|11.75||||||| 9511361|ERX|0250|FENTANYL 25MCG PATCH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|11.75||||||| 9511379|ERX|0250|FENTANYL 50MCG PATCH|Aetna|BOON CHAPMAN|18.50||||||| 9511379|ERX|0250|FENTANYL 50MCG PATCH|Managed Medicare|HOSPICE ETMC|18.50||||||| 9511379|ERX|0250|FENTANYL 50MCG PATCH|Managed Medicare|HOSPICE GENESIS|18.50||||||| 9511379|ERX|0250|FENTANYL 50MCG PATCH|Humana Medicare Advantage|HUMANA MA|18.50||||18.50||| 9511379|ERX|0250|FENTANYL 50MCG PATCH|Medicare|MEDICARE ACUTE|18.50||||18.50||| 9511379|ERX|0250|FENTANYL 50MCG PATCH|United Medicare Advantage|AARP UHC WEST COMPLETE MA|18.50||||||| 9511387|ERX|0250|FENTANYL 75MCG PATCH|United Medicare Advantage|UHC MEDICARE GOLD MA|42.50||||||| 9511387|ERX|0250|FENTANYL 75MCG PATCH|NON CONTRACTED|COMMERCIAL OTHER 1|42.50||||||| 9511387|ERX|0250|FENTANYL 75MCG PATCH|Medicare|MEDICARE ACUTE|42.50||||42.50||| 9511387|ERX|0250|FENTANYL 75MCG PATCH|Humana Medicare Advantage|HUMANA MA|42.50||||||| 9511387|ERX|0250|FENTANYL 75MCG PATCH|Managed Medicaid|MEDICAID SUPERIOR|||||42.50||| 9511387|ERX|0250|FENTANYL 75MCG PATCH|Managed Medicare|HOSPICE ETMC|42.50||||||| 9511387|ERX|0250|FENTANYL 75MCG PATCH|Blue Cross PPO Specialty|BCBSTX PPO|||||42.50||| 9511395|ERX|0250|FENTANYL 100MCG PATCH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|32.50||||||| 9511395|ERX|0250|FENTANYL 100MCG PATCH|Medicare|MEDICARE ACUTE|32.50||||32.50||| 9511445|ERX|0250|RISPERIDONE 1MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9511445|ERX|0250|RISPERIDONE 1MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9511445|ERX|0250|RISPERIDONE 1MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9511445|ERX|0250|RISPERIDONE 1MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9511445|ERX|0250|RISPERIDONE 1MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9511445|ERX|0250|RISPERIDONE 1MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9511445|ERX|0250|RISPERIDONE 1MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9511445|ERX|0250|RISPERIDONE 1MG TABLET|Cigna|CIGNA|4.50||||||| 9511445|ERX|0250|RISPERIDONE 1MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.50||| 9511445|ERX|0250|RISPERIDONE 1MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|167.75||||167.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Blue Cross PPO Specialty|BCBSTX PPO|167.75||||167.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Blue Cross HMO Specialty|BCBSTX HMO|||||167.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Humana Medicare Advantage|HUMANA MA|167.75||||167.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Managed Medicaid|MEDICAID AMERIGROUP|167.75||||167.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Managed Medicaid|MEDICAID SUPERIOR|167.75||||167.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Aenta Medicare Advantage|AETNA MEDICARE MA|167.75||||167.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Managed Medicare|BCBS MEDICARE PPO MA|167.75||||||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Managed Medicare|HEALTHSPRING MA|167.75||||167.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||167.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Tricare|TRICARE EAST REGION|||||167.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|NON CONTRACTED|COMMERCIAL OTHER 1|167.75||||167.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|UTMB|UTMB CORRECTIONAL MANAGED CARE|||||167.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||167.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||167.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|United Healthcare|UNITED HEALTHCARE OTHER|||||167.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Medicare|MEDICARE ACUTE|167.75||||167.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Cigna|CIGNA|167.75||||167.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Medicaid|MEDICAID|167.75||||||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Medicaid|HENDERSON COUNTY INDIGENT|||||167.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Medicaid|MEDICAID HMO|167.75||||||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|167.75||||167.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|United Medicare Advantage|UHC MEDICARE GOLD MA|||||167.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|United Medicare Advantage|AARP UHC WEST COMPLETE MA|167.75||||167.75||| 9511460|ERX|0250|RISPERIDONE 0.25MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9511460|ERX|0250|RISPERIDONE 0.25MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9511460|ERX|0250|RISPERIDONE 0.25MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9511460|ERX|0250|RISPERIDONE 0.25MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9511460|ERX|0250|RISPERIDONE 0.25MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9511460|ERX|0250|RISPERIDONE 0.25MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9511551|ERX|0250|CLINDAMYCIN 300MG/50ML D5|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|122.50||||||| 9511551|ERX|0250|CLINDAMYCIN 300MG/50ML D5|Medicare|MEDICARE ACUTE|122.50||||122.50||| 9511551|ERX|0250|CLINDAMYCIN 300MG/50ML D5|United Medicare Advantage|UHC MEDICARE GOLD MA|122.50||||||| 9511643|ERX|0250|LEVETIRACETAM 100MG/ML, 3|Medicare|MEDICARE ACUTE|2.05||||2.05||| 9511643|ERX|0250|LEVETIRACETAM 100MG/ML, 3|Humana Medicare Advantage|HUMANA MA|2.05||||||| 9511643|ERX|0250|LEVETIRACETAM 100MG/ML, 3|United Medicare Advantage|UHC AARP MCR HMO MA|2.05||||||| 9511643|ERX|0250|LEVETIRACETAM 100MG/ML, 3|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.05||||||| 9511643|ERX|0250|LEVETIRACETAM 100MG/ML, 3|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.05||||||| 9511650|ERX|0250|LEVETIRACETAM 500MG/5ML|Medicare|MEDICARE ACUTE|356.75||||||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|ChampVA|CHAMPVA CENTER|||||190.75||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|Cigna|CIGNA|||||190.75||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|Aetna|AETNA PPO|190.75||||||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|190.75||||||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|Managed Medicare|HEALTHSPRING MA|190.75||||||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|Humana Medicare Advantage|HUMANA MA|190.75||||190.75||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|Managed Medicaid|MEDICAID AMERIGROUP|190.75||||190.75||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||190.75||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|Blue Cross HMO Specialty|BCBSTX HMO|190.75||||||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|Managed Medicaid|MEDICAID UNITED HEALTHCARE|190.75||||||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|Managed Medicaid|MEDICAID SUPERIOR|190.75||||190.75||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||190.75||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|Blue Cross PPO Specialty|BCBSTX PPO|190.75||||190.75||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|Workers Compensation|WORKERS COMPENSATION OTHER|||||190.75||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|United Medicare Advantage|UHC MEDICARE GOLD MA|||||190.75||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||190.75||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||190.75||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|Tricare|TRICARE EAST REGION|||||190.75||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|NON CONTRACTED|COMMERCIAL OTHER 1|190.75||||||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|Medicaid|MEDICAID HMO|190.75||||||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|United Healthcare|UMR UNITED MEDICAL RESOURCES|190.75||||||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|United Healthcare|UNITED HEALTHCARE|||||190.75||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|Medicare|MEDICARE ACUTE|190.75||||190.75||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.13||||0.13||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.13||||0.13||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|United Medicare Advantage|UHC AARP MCR HMO MA|0.13||||||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.13||||0.13||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Managed Medicaid|MEDICAID SUPERIOR|0.13||||||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Veterans Affairs|VETERANS ADMINISTRATION|0.13||||||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.13||||0.13||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Humana Medicare Advantage|HUMANA MA|0.13||||0.13||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|MTC Medical|VAN ZANDT COUNTY INMATE|0.13||||||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Managed Medicaid|MEDICAID AMERIGROUP|0.13||||||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.13||||||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Medicare|MEDICARE ACUTE|0.13||||0.13||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Managed Medicare|HEALTHSPRING MA|0.13||||||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Managed Medicare|VAN ZANDT COUNTY INMATE|0.13||||||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Managed Medicare|MA PART B ONLY IP|0.13||||||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||0.13||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Aetna|AETNA PPO|0.13||||||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|0.13||||||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.13||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|0.13||||||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|||||0.13||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Blue Cross PPO Specialty|BCBSTX OTHER|||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|ChampVA|CHAMPVA CENTER|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Cigna|CIGNA OTHER|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Cigna|CIGNA|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Aetna|AETNA PPO|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Aetna|AETNA OTHER|||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Managed Medicare|VAN ZANDT COUNTY INMATE|||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Managed Medicare|OTHER INSTITUTIONS|||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|MTC Medical|VAN ZANDT COUNTY INMATE|||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Managed Medicare|MA PART B ONLY IP|4.50||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Workers Compensation|UT EMPLOYEE INJURY|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|United Medicare Advantage|UHC AARP MCR HMO MA|||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Tricare|TRICARE EAST REGION|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|PHCS|HUMANA|||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|United Healthcare|GEHA|||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|United Healthcare|TML GROUP BENEFITS|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|United Healthcare|UNITED HEALTHCARE OTHER|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Multiplan|NALC|||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Medicaid|COUNTY INDIGENT HEALTH OTHER|4.50||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Medicaid|MEDICAID PCCM|||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Medicaid|MEDICAID HMO|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Medicaid|LAW ENFORCEMENT OTHER|||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Medicaid|MEDICAID TEXAS CHILDRENS|||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Medicaid|MEDICAID|4.50||||4.50||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Tricare|TRICARE EAST REGION|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Medicaid|MEDICAID|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Medicare|MEDICARE ACUTE|156.75||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|NON CONTRACTED|COMMERCIAL OTHER 1|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|PHCS|MULTIPLAN PHCS OTHER|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|United Healthcare|UNITED HEALTHCARE|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|United Healthcare|UNITED HEALTHCARE OTHER|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Texas Workforce Commission|DIS DETER SERV (DDS)|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|156.75||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Workers Compensation|UT EMPLOYEE INJURY|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Veterans Affairs|VETERANS ADMINISTRATION|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|United Medicare Advantage|UHC MEDICARE GOLD MA|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Humana Medicare Advantage|HUMANA MA|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Managed Medicaid|MEDICAID SUPERIOR|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|156.75||||||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Managed Medicare|HEALTHSPRING MA|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Managed Medicare|BCBS MEDICARE PPO MA|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Aetna|AETNA PPO|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Aetna|AETNA OTHER|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Aenta Medicare Advantage|AETNA MEDICARE MA|156.75||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Managed Medicaid|MEDICAID AMERIGROUP|156.75||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Cigna|CIGNA|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Blue Cross PPO Specialty|BLUE SHIELD PHYSICIAN|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Cigna|CIGNA OTHER|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Blue Cross PPO Specialty|BCBSTX PPO|||||156.75||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Blue Cross HMO Specialty|BCBSTX HMO|156.75||||156.75||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Cigna|CIGNA|||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Blue Cross PPO Specialty|BCBSTX OTHER|||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Cigna|CIGNA OTHER|||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Cigna|CIGNA|4.50||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Aetna|AETNA OTHER|||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Managed Medicare|VAN ZANDT COUNTY INMATE|||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|MTC Medical|VAN ZANDT COUNTY INMATE|||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|4.50||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Workers Compensation|UT EMPLOYEE INJURY|4.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|United Medicare Advantage|UHC AARP MCR HMO MA|||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Aetna|AETNA PPO|4.50||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Tricare|TRICARE EAST REGION|4.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Medicaid|MEDICAID|4.50||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Medicaid|MEDICAID TEXAS CHILDRENS|||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Medicaid|MEDICAID HMO|4.50||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|United Healthcare|UNITED HEALTHCARE OTHER|||||4.50||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|United Healthcare|TML GROUP BENEFITS|||||4.50||| 9511866|ERX|0250|NEOMYCIN SULFATE 500MG TA|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9511866|ERX|0250|NEOMYCIN SULFATE 500MG TA|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9511866|ERX|0250|NEOMYCIN SULFATE 500MG TA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9511866|ERX|0250|NEOMYCIN SULFATE 500MG TA|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9511866|ERX|0250|NEOMYCIN SULFATE 500MG TA|Texas Workforce Commission|DIS DETER SERV (DDS)|4.50||||||| 9511866|ERX|0250|NEOMYCIN SULFATE 500MG TA|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9511866|ERX|0250|NEOMYCIN SULFATE 500MG TA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|41.75||||41.75||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|41.75||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Managed Medicare|HEALTHSPRING MA|41.75||||41.75||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Humana Medicare Advantage|HUMANA MA|41.75||||41.75||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||41.75||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||41.75||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|41.75||||41.75||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Medicare|MEDICARE ACUTE|41.75||||41.75||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|41.75||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|41.75||||41.75||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|41.75||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Tricare|TRICARE EAST REGION|4.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Medicaid|LAW ENFORCEMENT OTHER|4.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Managed Medicare|OTHER INSTITUTIONS|||||4.50||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Aetna|AETNA PPO|4.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|4.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Cigna|CIGNA|4.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Cigna|CIGNA|4.50||||4.50||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Managed Medicare|MA PART B ONLY IP|4.50||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Aetna|AETNA PPO|4.50||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Tricare|TRICARE EAST REGION|4.50||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|PHCS|HUMANA|4.50||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Medicaid|MEDICAID|4.50||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9511940|ERX|0250|CARISOPRODOL 350MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9511940|ERX|0250|CARISOPRODOL 350MG TABLET|Medicare|MEDICARE ACUTE|4.50||||||| 9511940|ERX|0250|CARISOPRODOL 350MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9511940|ERX|0250|CARISOPRODOL 350MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9511940|ERX|0250|CARISOPRODOL 350MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.50||| 9511940|ERX|0250|CARISOPRODOL 350MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9511940|ERX|0250|CARISOPRODOL 350MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9511940|ERX|0250|CARISOPRODOL 350MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9511940|ERX|0250|CARISOPRODOL 350MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|4.50||||||| 9511940|ERX|0250|CARISOPRODOL 350MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9511957|ERX|0250|CHLORTHALIDONE 25MG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.03||| 9511957|ERX|0250|CHLORTHALIDONE 25MG TABLE|Medicare|MEDICARE ACUTE|0.03||||0.03||| 9511957|ERX|0250|CHLORTHALIDONE 25MG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.03||||||| 9511957|ERX|0250|CHLORTHALIDONE 25MG TABLE|Veterans Affairs|VETERANS ADMINISTRATION|0.03||||||| 9511957|ERX|0250|CHLORTHALIDONE 25MG TABLE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|0.03||||||| 9511957|ERX|0250|CHLORTHALIDONE 25MG TABLE|Humana Medicare Advantage|HUMANA MA|0.03||||||| 9511957|ERX|0250|CHLORTHALIDONE 25MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.03||| 9511999|ERX|0250|DIPHENOX-ATROP 2.5-0.025M|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9511999|ERX|0250|DIPHENOX-ATROP 2.5-0.025M|Medicaid|MEDICAID|4.50||||||| 9511999|ERX|0250|DIPHENOX-ATROP 2.5-0.025M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9511999|ERX|0250|DIPHENOX-ATROP 2.5-0.025M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9511999|ERX|0250|DIPHENOX-ATROP 2.5-0.025M|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.50||| 9511999|ERX|0250|DIPHENOX-ATROP 2.5-0.025M|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9511999|ERX|0250|DIPHENOX-ATROP 2.5-0.025M|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9511999|ERX|0250|DIPHENOX-ATROP 2.5-0.025M|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9511999|ERX|0250|DIPHENOX-ATROP 2.5-0.025M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Aetna|AETNA PPO|2.25||||||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.25||||2.25||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Access Direct Platinum|HEALTHFIRST TPA UMR|2.25||||||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.25||||||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.25||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Blue Cross PPO Specialty|BCBSTX PPO|2.25||||2.25||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|ChampVA|CHAMPVA CENTER|||||2.25||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Cigna|CIGNA|2.25||||2.25||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Blue Cross HMO Specialty|BCBSTX HMO|2.25||||2.25||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Managed Medicare|HEALTHSPRING MA|2.25||||2.25||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Managed Medicaid|MEDICAID SUPERIOR|2.25||||||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.25||||||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Cigna|CIGNA|2.25||||||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.25||||||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Humana Medicare Advantage|HUMANA MA|2.25||||2.25||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Managed Medicaid|MEDICAID AMERIGROUP|2.25||||2.25||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Managed Medicare|BCBS MEDICARE PPO MA|||||2.25||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.25||||2.25||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.25||||2.25||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|United Medicare Advantage|UHC MEDICARE GOLD MA|2.25||||2.25||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|2.25||||||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Tricare|TRICARE EAST REGION|2.25||||2.25||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|NON CONTRACTED|COMMERCIAL OTHER 1|2.25||||2.25||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|PHCS|HUMANA|2.25||||||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Aenta Medicare Advantage|AETNA MEDICARE MA|2.25||||2.25||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|United Healthcare|UNITED HEALTHCARE|2.25||||2.25||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|United Healthcare|UMR UNITED MEDICAL RESOURCES|2.25||||||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Texas Workforce Commission|DIS DETER SERV (DDS)|2.25||||||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Medicaid|MOLINA HEALTHCARE OF TEXAS|2.25||||||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Medicaid|MEDICAID HMO|2.25||||||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Medicare|MEDICARE ACUTE|2.25||||2.25||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Medicaid|MEDICAID|2.25||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Medicaid|MEDICAID|4.50||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||4.50||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|ChampVA|CHAMPVA CENTER|||||4.50||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.50||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Aetna|AETNA PPO|4.50||||4.50||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Cigna|CIGNA|4.50||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|4.50||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Tricare|TRICARE EAST REGION|4.50||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|United Healthcare|TML GROUP BENEFITS|4.50||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Medicaid|MEDICAID|4.50||||4.50||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||4.50||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512088|ERX|0250|MIRTAZAPINE 30MG TABLET|Medicare|MEDICARE ACUTE|26.75||||26.75||| 9512088|ERX|0250|MIRTAZAPINE 30MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|26.75||||26.75||| 9512088|ERX|0250|MIRTAZAPINE 30MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||26.75||| 9512088|ERX|0250|MIRTAZAPINE 30MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|26.75||||26.75||| 9512088|ERX|0250|MIRTAZAPINE 30MG TABLET|Humana Medicare Advantage|HUMANA MA|26.75||||26.75||| 9512088|ERX|0250|MIRTAZAPINE 30MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|26.75||||||| 9512088|ERX|0250|MIRTAZAPINE 30MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|26.75||||||| 9512088|ERX|0250|MIRTAZAPINE 30MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|26.75||||||| 9512088|ERX|0250|MIRTAZAPINE 30MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|26.75||||||| 9512088|ERX|0250|MIRTAZAPINE 30MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|26.75||||||| 9512088|ERX|0250|MIRTAZAPINE 30MG TABLET|Managed Medicare|HEALTHSPRING MA|26.75||||26.75||| 9512088|ERX|0250|MIRTAZAPINE 30MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|26.75||||||| 9512088|ERX|0250|MIRTAZAPINE 30MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||26.75||| 9512088|ERX|0250|MIRTAZAPINE 30MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|26.75||||||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|0.05||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Cigna|CIGNA|||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.05||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Cigna|CIGNA OTHER|||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.05||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.05||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|PHCS|HUMANA INSURANCE|||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|United Healthcare|UNITED HEALTHCARE|||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|United Healthcare|TML GROUP BENEFITS|0.05||||||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Aetna|AETNA PPO|||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|United Healthcare|GOLDEN RULE|||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Medicaid|MEDICAID HMO|||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|0.05||||||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Medicaid|MEDICAID|||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Medicare|MEDICARE ACUTE|0.05||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Managed Medicare|HEALTHSPRING MA|0.05||||0.05||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Humana Medicare Advantage|HUMANA MA|0.05||||0.05||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Medicaid|MEDICAID|4.50||||||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|MTC Medical|VAN ZANDT COUNTY INMATE|4.50||||||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Tricare|TRICARE EAST REGION|||||4.50||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Aetna|AETNA PPO|4.50||||4.50||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Managed Medicare|VAN ZANDT COUNTY INMATE|4.50||||||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|Aetna|AETNA PPO|4.50||||||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||4.50||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||4.50||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|Medicaid|MEDICAID|4.50||||||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.50||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||4.50||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.50||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.50||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||4.50||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||4.50||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|Cigna|CIGNA|||||4.50||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|Aetna|AETNA OTHER|||||4.50||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|Cigna|CIGNA|4.50||||4.50||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|Cigna|CIGNA|||||4.50||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.50||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|Managed Medicaid|MEDICAID SUPERIOR|||||4.50||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||4.50||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|United Healthcare|UNITED HEALTHCARE OTHER|||||4.50||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|Medicaid|MEDICAID|4.50||||4.50||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||4.50||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|Medicaid|HENDERSON COUNTY INDIGENT|||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Medicaid|MEDICAID HMO|4.50||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Medicaid|MEDICAID|4.50||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Medicaid|LAW ENFORCEMENT OTHER|||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Tricare|TRICARE EAST REGION|||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|United Healthcare|GOLDEN RULE|||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|United Healthcare|UNITED HEALTHCARE OTHER|||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|United Medicare Advantage|UHC AARP MCR HMO MA|4.50||||||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Veterans Affairs|VETERANS ADMINISTRATION|||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Cigna|CIGNA OTHER|||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Cigna|CIGNA|4.50||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Cigna|CIGNA|||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Aetna|AETNA PPO|||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Aetna|AETNA OTHER|||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9512195|ERX|0250|AMITRIPTYLINE 10MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9512195|ERX|0250|AMITRIPTYLINE 10MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512195|ERX|0250|AMITRIPTYLINE 10MG TABLET|Cigna|CIGNA|4.50||||||| 9512195|ERX|0250|AMITRIPTYLINE 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9512195|ERX|0250|AMITRIPTYLINE 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9512203|ERX|0250|LORATADINE 10MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9512203|ERX|0250|LORATADINE 10MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512203|ERX|0250|LORATADINE 10MG TABLET|Medicaid|MEDICAID|4.50||||4.50||| 9512203|ERX|0250|LORATADINE 10MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9512203|ERX|0250|LORATADINE 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9512203|ERX|0250|LORATADINE 10MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9512203|ERX|0250|LORATADINE 10MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9512203|ERX|0250|LORATADINE 10MG TABLET|Managed Medicare|MA PART B ONLY IP|4.50||||||| 9512203|ERX|0250|LORATADINE 10MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9512203|ERX|0250|LORATADINE 10MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9512203|ERX|0250|LORATADINE 10MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9512203|ERX|0250|LORATADINE 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9512203|ERX|0250|LORATADINE 10MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||4.50||| 9512203|ERX|0250|LORATADINE 10MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9512203|ERX|0250|LORATADINE 10MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9512203|ERX|0250|LORATADINE 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9512203|ERX|0250|LORATADINE 10MG TABLET|Cigna|CIGNA|4.50||||||| 9512203|ERX|0250|LORATADINE 10MG TABLET|Aetna|AETNA PPO|4.50||||||| 9512203|ERX|0250|LORATADINE 10MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9512203|ERX|0250|LORATADINE 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9512211|ERX|0250|AMITRIPTYLINE 50MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.50||| 9512211|ERX|0250|AMITRIPTYLINE 50MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9512211|ERX|0250|AMITRIPTYLINE 50MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9512211|ERX|0250|AMITRIPTYLINE 50MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9512211|ERX|0250|AMITRIPTYLINE 50MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9512211|ERX|0250|AMITRIPTYLINE 50MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9512211|ERX|0250|AMITRIPTYLINE 50MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9512211|ERX|0250|AMITRIPTYLINE 50MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.50||| 9512211|ERX|0250|AMITRIPTYLINE 50MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9512211|ERX|0250|AMITRIPTYLINE 50MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512211|ERX|0250|AMITRIPTYLINE 50MG TABLET|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9512229|ERX|0250|CHLORDIAZEPOXIDE 25MG CAP|Tricare|TRICARE EAST REGION|4.50||||||| 9512229|ERX|0250|CHLORDIAZEPOXIDE 25MG CAP|Medicaid|MEDICAID|4.50||||||| 9512229|ERX|0250|CHLORDIAZEPOXIDE 25MG CAP|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512229|ERX|0250|CHLORDIAZEPOXIDE 25MG CAP|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9512229|ERX|0250|CHLORDIAZEPOXIDE 25MG CAP|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9512229|ERX|0250|CHLORDIAZEPOXIDE 25MG CAP|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9512229|ERX|0250|CHLORDIAZEPOXIDE 25MG CAP|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9512229|ERX|0250|CHLORDIAZEPOXIDE 25MG CAP|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|4.50||||||| 9512229|ERX|0250|CHLORDIAZEPOXIDE 25MG CAP|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||||| 9512229|ERX|0250|CHLORDIAZEPOXIDE 25MG CAP|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9512229|ERX|0250|CHLORDIAZEPOXIDE 25MG CAP|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9512229|ERX|0250|CHLORDIAZEPOXIDE 25MG CAP|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 9512229|ERX|0250|CHLORDIAZEPOXIDE 25MG CAP|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9512229|ERX|0250|CHLORDIAZEPOXIDE 25MG CAP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9512229|ERX|0250|CHLORDIAZEPOXIDE 25MG CAP|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Blue Cross PPO Specialty|BCBSTX OTHER|||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|4.50||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|MTC Medical|VAN ZANDT COUNTY INMATE|||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Managed Medicare|MA PART B ONLY IP|4.50||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Managed Medicare|VAN ZANDT COUNTY INMATE|||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|United Medicare Advantage|UHC AARP MCR HMO MA|||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Cigna|CIGNA|4.50||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Veterans Affairs|VETERANS ADMINISTRATION|||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Workers Compensation|TEXAS MUTUAL INSURANCE|||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|ChampVA|CHAMPVA CENTER|||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Medicaid|LAW ENFORCEMENT OTHER|4.50||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Medicaid|MEDICAID|4.50||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Medicaid|MEDICAID HMO|||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Tricare|TRICARE EAST REGION|4.50||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|United Healthcare|UNITED HEALTHCARE OTHER|||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Aetna|AETNA PPO|4.50||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 9512260|ERX|0250|INDOMETHACIN 25MG CAPSULE|Tricare|TRICARE EAST REGION|6.75||||||| 9512260|ERX|0250|INDOMETHACIN 25MG CAPSULE|United Healthcare|UMR UNITED MEDICAL RESOURCES|6.75||||||| 9512260|ERX|0250|INDOMETHACIN 25MG CAPSULE|Medicare|MEDICARE ACUTE|6.75||||6.75||| 9512260|ERX|0250|INDOMETHACIN 25MG CAPSULE|United Medicare Advantage|UHC AARP MCR HMO MA|||||6.75||| 9512260|ERX|0250|INDOMETHACIN 25MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||6.75||| 9512260|ERX|0250|INDOMETHACIN 25MG CAPSULE|Humana Medicare Advantage|HUMANA MA|6.75||||||| 9512260|ERX|0250|INDOMETHACIN 25MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|6.75||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.50||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512344|ERX|0250|ALLOPURINOL 300MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||||| 9512344|ERX|0250|ALLOPURINOL 300MG TABLET|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9512344|ERX|0250|ALLOPURINOL 300MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512344|ERX|0250|ALLOPURINOL 300MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9512344|ERX|0250|ALLOPURINOL 300MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9512344|ERX|0250|ALLOPURINOL 300MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9512344|ERX|0250|ALLOPURINOL 300MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9512344|ERX|0250|ALLOPURINOL 300MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9512344|ERX|0250|ALLOPURINOL 300MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9512344|ERX|0250|ALLOPURINOL 300MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9512344|ERX|0250|ALLOPURINOL 300MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9512344|ERX|0250|ALLOPURINOL 300MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9512344|ERX|0250|ALLOPURINOL 300MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9512344|ERX|0250|ALLOPURINOL 300MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9512344|ERX|0250|ALLOPURINOL 300MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9512351|ERX|0250|BENZTROPINE 1MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||||| 9512351|ERX|0250|BENZTROPINE 1MG TABLET|Managed Medicare|HEALTHSPRING MA|||||4.50||| 9512351|ERX|0250|BENZTROPINE 1MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||||| 9512351|ERX|0250|BENZTROPINE 1MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9512351|ERX|0250|BENZTROPINE 1MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9512351|ERX|0250|BENZTROPINE 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9512351|ERX|0250|BENZTROPINE 1MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9512351|ERX|0250|BENZTROPINE 1MG TABLET|Medicare|MEDICARE ACUTE|4.50||||||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Tricare|TRICARE EAST REGION|4.50||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|United Healthcare|TML GROUP BENEFITS|4.50||||||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Medicaid|MEDICAID|4.50||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Medicaid|MEDICAID TEXAS CHILDRENS|||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Medicaid|MEDICAID HMO|4.50||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Workers Compensation|UT EMPLOYEE INJURY|||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Medicaid|MEDICAID BCBSTX|||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|MTC Medical|VAN ZANDT COUNTY INMATE|||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Managed Medicare|VAN ZANDT COUNTY INMATE|||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Cigna|CIGNA OTHER|||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Cigna|CIGNA|4.50||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Aetna|AETNA PPO|4.50||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Aetna|AETNA OTHER|||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UMR|||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Aetna|BOON CHAPMAN|||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Aetna|AETNA PPO|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Aetna|AETNA OTHER|||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Cigna|CIGNA|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Cigna|CIGNA OTHER|||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Cigna|CIGNA|||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Managed Medicare|VAN ZANDT COUNTY INMATE|||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|MTC Medical|VAN ZANDT COUNTY INMATE|||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Managed Medicare|WELLCARE CHOICE MA|||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Workers Compensation|WORKERS COMP PHYSICIAN|||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Workers Compensation|TEXAS MUTUAL INSURANCE|||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Workers Compensation|UT EMPLOYEE INJURY|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Medicaid|MEDICAID HMO|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Medicaid Out of State|MEDICAID LOUISIANA|||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Medicaid|MEDICAID|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Tricare|TRICARE FOR LIFE|||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|Tricare|TRICARE EAST REGION|||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|UTMB|UTMB CORRECTIONAL MANAGED CARE|||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|United Healthcare|GEHA|||||4.50||| 9512385|ERX|0250|IBUPROFEN 600MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||4.50||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|United Healthcare|UNITED HEALTHCARE OTHER|||||4.50||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Medicaid|MEDICAID HMO|||||4.50||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.50||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Medicaid|MEDICAID|||||4.50||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|MTC Medical|VAN ZANDT COUNTY INMATE|||||4.50||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Managed Medicare|VAN ZANDT COUNTY INMATE|||||4.50||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Cigna|CIGNA|||||4.50||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.50||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Aetna|AETNA OTHER|||||4.50||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.50||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9512419|ERX|0250|DIAZEPAM 2MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9512419|ERX|0250|DIAZEPAM 2MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 9512419|ERX|0250|DIAZEPAM 2MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9512419|ERX|0250|DIAZEPAM 2MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.50||| 9512419|ERX|0250|DIAZEPAM 2MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||4.50||| 9512419|ERX|0250|DIAZEPAM 2MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.50||| 9512419|ERX|0250|DIAZEPAM 2MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||4.50||| 9512419|ERX|0250|DIAZEPAM 2MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9512419|ERX|0250|DIAZEPAM 2MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Workers Compensation|UT EMPLOYEE INJURY|4.50||||||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Workers Compensation|TEXAS MUTUAL INSURANCE|||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Managed Medicare|HEALTHSPRING MA|||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Medicaid|MEDICAID|||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Aetna|AETNA PPO|4.50||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Aetna|AETNA OTHER|||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Blue Cross PPO Specialty|BCBSTX OTHER|||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Cigna|CIGNA|||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Cigna|CIGNA|4.50||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Cigna|CIGNA|||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Aetna|AETNA PPO|4.50||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Managed Medicare|WELLCARE CHOICE MA|||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Managed Medicare|VAN ZANDT COUNTY INMATE|||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|4.50||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|MTC Medical|VAN ZANDT COUNTY INMATE|||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Aetna|AETNA OTHER|||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Medicaid|MEDICAID|4.50||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Tricare|TRICARE EAST REGION|||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|United Healthcare|GOLDEN RULE|||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9512484|ERX|0250|CHLORDIAZEPOXIDE 5MG CAPS|Medicare|MEDICARE ACUTE|4.50||||||| 9512484|ERX|0250|CHLORDIAZEPOXIDE 5MG CAPS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9512484|ERX|0250|CHLORDIAZEPOXIDE 5MG CAPS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9512484|ERX|0250|CHLORDIAZEPOXIDE 5MG CAPS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9512484|ERX|0250|CHLORDIAZEPOXIDE 5MG CAPS|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9512500|ERX|0250|TOLTERODINE 2MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.24||||||| 9512500|ERX|0250|TOLTERODINE 2MG TABLET|Medicare|MEDICARE ACUTE|||||0.24||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Tricare|TRICARE EAST REGION|4.50||||||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|PHCS|HUMANA INSURANCE|||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|4.50||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Managed Medicare|HOSPICE ETMC|4.50||||||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Managed Medicare|HOSPICE CARING HEARTS|4.50||||||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Medicaid|MEDICAID|||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Managed Medicare|VAN ZANDT COUNTY INMATE|||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|MTC Medical|VAN ZANDT COUNTY INMATE|||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Cigna|CIGNA|||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Cigna|CIGNA OTHER|4.50||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UMR|||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Aetna|AETNA OTHER|||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Aetna|AETNA PPO|4.50||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.50||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Aetna|AETNA PPO|4.50||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Cigna|CIGNA|4.50||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Workers Compensation|UT EMPLOYEE INJURY|4.50||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||4.50||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Cigna|CIGNA|4.50||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Aetna|AETNA PPO|4.50||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9512567|ERX|0250|CILOSTAZOL 100MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9512567|ERX|0250|CILOSTAZOL 100MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9512567|ERX|0250|CILOSTAZOL 100MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9512567|ERX|0250|CILOSTAZOL 100MG TABLET|Managed Medicare|HEALTHSPRING MA|||||4.50||| 9512567|ERX|0250|CILOSTAZOL 100MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||4.50||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.50||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||4.50||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|||||4.50||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||4.50||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Cigna|CIGNA|4.50||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|ChampVA|CHAMPVA CENTER|4.50||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Aetna|AETNA PPO|||||4.50||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Medicaid|MEDICAID TEXAS CHILDRENS|||||4.50||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Medicaid|MEDICAID|4.50||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Tricare|TRICARE EAST REGION|4.50||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Multiplan|NALC|||||4.50||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9512617|ERX|0250|LINEZOLID 600MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3.16||||||| 9512617|ERX|0250|LINEZOLID 600MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|3.16||||||| 9512617|ERX|0250|LINEZOLID 600MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3.16||||3.16||| 9512617|ERX|0250|LINEZOLID 600MG TABLET|Medicare|MEDICARE ACUTE|3.16||||||| 9512617|ERX|0250|LINEZOLID 600MG TABLET|Medicaid|MEDICAID|3.16||||||| 9512617|ERX|0250|LINEZOLID 600MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.16||| 9512617|ERX|0250|LINEZOLID 600MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.16||| 9512617|ERX|0250|LINEZOLID 600MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|3.16||||||| 9512633|ERX|0250|MEGESTROL 40MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9512633|ERX|0250|MEGESTROL 40MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9512633|ERX|0250|MEGESTROL 40MG TABLET|Medicare|MEDICARE ACUTE|||||4.50||| 9512633|ERX|0250|MEGESTROL 40MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.50||| 9512633|ERX|0250|MEGESTROL 40MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9512641|ERX|0250|DOXEPIN 10MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|5.50||||||| 9512641|ERX|0250|DOXEPIN 10MG CAPSULE|Medicare|MEDICARE ACUTE|5.50||||||| 9512641|ERX|0250|DOXEPIN 10MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|5.50||||||| 9512641|ERX|0250|DOXEPIN 10MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|||||5.50||| 9512658|ERX|0250|DOXEPIN 25MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||||| 9512658|ERX|0250|DOXEPIN 25MG CAPSULE|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9512658|ERX|0250|DOXEPIN 25MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9512658|ERX|0250|DOXEPIN 25MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9512658|ERX|0250|DOXEPIN 25MG CAPSULE|Medicare|MEDICARE ACUTE|4.50||||||| 9512658|ERX|0250|DOXEPIN 25MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9512658|ERX|0250|DOXEPIN 25MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9512690|ERX|0250|AMANTADINE 100MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9512690|ERX|0250|AMANTADINE 100MG CAPSULE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512690|ERX|0250|AMANTADINE 100MG CAPSULE|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9512765|ERX|0250|CHLORPROMAZINE 10MG TABLE|Medicare|MEDICARE ACUTE|6.25||||||| 9512773|ERX|0250|CHLORPROMAZINE 25MG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9512773|ERX|0250|CHLORPROMAZINE 25MG TABLE|Medicare|MEDICARE ACUTE|||||4.50||| 9512781|ERX|0250|FUROSEMIDE 80MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9512781|ERX|0250|FUROSEMIDE 80MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9512781|ERX|0250|FUROSEMIDE 80MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9512781|ERX|0250|FUROSEMIDE 80MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||4.50||| 9512781|ERX|0250|FUROSEMIDE 80MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9512781|ERX|0250|FUROSEMIDE 80MG TABLET|Medicaid|MEDICAID|4.50||||||| 9512781|ERX|0250|FUROSEMIDE 80MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9512781|ERX|0250|FUROSEMIDE 80MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9512781|ERX|0250|FUROSEMIDE 80MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9512781|ERX|0250|FUROSEMIDE 80MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9512799|ERX|0250|PROCHLORPERAZINE 5MG TABL|United Medicare Advantage|UHC MEDICARE GOLD MA|8.75||||8.75||| 9512799|ERX|0250|PROCHLORPERAZINE 5MG TABL|Medicaid|MEDICAID|8.75||||||| 9512799|ERX|0250|PROCHLORPERAZINE 5MG TABL|Managed Medicare|HEALTHSPRING MA|||||8.75||| 9512799|ERX|0250|PROCHLORPERAZINE 5MG TABL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||8.75||| 9512799|ERX|0250|PROCHLORPERAZINE 5MG TABL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||8.75||| 9512799|ERX|0250|PROCHLORPERAZINE 5MG TABL|Managed Medicaid|MEDICAID SUPERIOR|||||8.75||| 9512799|ERX|0250|PROCHLORPERAZINE 5MG TABL|Blue Cross PPO Specialty|BCBSTX PPO|||||8.75||| 9512799|ERX|0250|PROCHLORPERAZINE 5MG TABL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||8.75||| 9513003|ERX|0250|AMOXICILLIN 250MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.05||| 9513003|ERX|0250|AMOXICILLIN 250MG CAPSULE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.05||| 9513003|ERX|0250|AMOXICILLIN 250MG CAPSULE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.05||| 9513003|ERX|0250|AMOXICILLIN 250MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|||||0.05||| 9513003|ERX|0250|AMOXICILLIN 250MG CAPSULE|Cigna|CIGNA|||||0.05||| 9513003|ERX|0250|AMOXICILLIN 250MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|||||0.05||| 9513003|ERX|0250|AMOXICILLIN 250MG CAPSULE|Humana Medicare Advantage|HUMANA MA|||||0.05||| 9513003|ERX|0250|AMOXICILLIN 250MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.05||||0.05||| 9513003|ERX|0250|AMOXICILLIN 250MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|0.05||||0.05||| 9513003|ERX|0250|AMOXICILLIN 250MG CAPSULE|Aetna|AETNA PPO|||||0.05||| 9513003|ERX|0250|AMOXICILLIN 250MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.05||| 9513003|ERX|0250|AMOXICILLIN 250MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|||||0.05||| 9513003|ERX|0250|AMOXICILLIN 250MG CAPSULE|Managed Medicare|HEALTHSPRING MA|0.05||||0.05||| 9513003|ERX|0250|AMOXICILLIN 250MG CAPSULE|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.05||| 9513003|ERX|0250|AMOXICILLIN 250MG CAPSULE|United Healthcare|UNITED HEALTHCARE|||||0.05||| 9513003|ERX|0250|AMOXICILLIN 250MG CAPSULE|Medicare|MEDICARE ACUTE|0.05||||0.05||| 9513003|ERX|0250|AMOXICILLIN 250MG CAPSULE|Medicaid|MEDICAID HMO|||||0.05||| 9513003|ERX|0250|AMOXICILLIN 250MG CAPSULE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.05||| 9513003|ERX|0250|AMOXICILLIN 250MG CAPSULE|Medicaid|MEDICAID|||||0.05||| 9513003|ERX|0250|AMOXICILLIN 250MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|||||0.05||| 9513003|ERX|0250|AMOXICILLIN 250MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.05||| 9513003|ERX|0250|AMOXICILLIN 250MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.05||||0.05||| 9513045|ERX|0250|TOLTERODINE XL 2MG CAPSUL|Medicare|MEDICARE ACUTE|42.50||||||| 9513045|ERX|0250|TOLTERODINE XL 2MG CAPSUL|Managed Medicare|BCBS MEDICARE PPO MA|42.50||||||| 9513045|ERX|0250|TOLTERODINE XL 2MG CAPSUL|Humana Medicare Advantage|HUMANA MA|42.50||||||| 9513045|ERX|0250|TOLTERODINE XL 2MG CAPSUL|Blue Cross PPO Specialty|BCBSTX PPO|||||42.50||| 9513045|ERX|0250|TOLTERODINE XL 2MG CAPSUL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|42.50||||||| 9513045|ERX|0250|TOLTERODINE XL 2MG CAPSUL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|42.50||||||| 9513052|ERX|0250|PRAZOSIN 1MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.25||||||| 9513052|ERX|0250|PRAZOSIN 1MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|5.25||||||| 9513052|ERX|0250|PRAZOSIN 1MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.25||||5.25||| 9513052|ERX|0250|PRAZOSIN 1MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|5.25||||||| 9513052|ERX|0250|PRAZOSIN 1MG CAPSULE|Medicare|MEDICARE ACUTE|5.25||||5.25||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Workers Compensation|UT EMPLOYEE INJURY|4.50||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.50||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|United Healthcare|UNITED HEALTHCARE OTHER|||||4.50||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|United Healthcare|GEHA|4.50||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Medicaid|MEDICAID|4.50||||4.50||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.50||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||4.50||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Managed Medicare|BCBS MEDICARE PPO MA|||||4.50||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|United Medicare Advantage|UHC AARP MCR HMO MA|||||4.50||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Cigna|CIGNA|||||4.50||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Aetna|AETNA PPO|4.50||||4.50||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9513136|ERX|0250|VERAPAMIL 80MG TABLET|Medicare|MEDICARE ACUTE|4.50||||||| 9513151|ERX|0250|ATENOLOL 50MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9513151|ERX|0250|ATENOLOL 50MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9513151|ERX|0250|ATENOLOL 50MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9513151|ERX|0250|ATENOLOL 50MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9513151|ERX|0250|ATENOLOL 50MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9513151|ERX|0250|ATENOLOL 50MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9513151|ERX|0250|ATENOLOL 50MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9513151|ERX|0250|ATENOLOL 50MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||||| 9513151|ERX|0250|ATENOLOL 50MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.50||| 9513151|ERX|0250|ATENOLOL 50MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9513151|ERX|0250|ATENOLOL 50MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||||| 9513151|ERX|0250|ATENOLOL 50MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Medicaid|MEDICAID|||||4.50||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Medicaid|MEDICAID HMO|4.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Tricare|TRICARE EAST REGION|4.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|United Healthcare|UNITED HEALTHCARE OTHER|||||4.50||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Cigna|CIGNA|4.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Cigna|CIGNA|4.50||||4.50||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Aetna|BOON CHAPMAN|||||4.50||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Aetna|AETNA PPO|4.50||||4.50||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Cigna|CIGNA|4.50||||4.50||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Managed Medicare|OTHER INSTITUTIONS|||||4.50||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Tricare|TRICARE EAST REGION|4.50||||||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||4.50||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||4.50||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|United Healthcare|GEHA|4.50||||||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Texas Workforce Commission|DIS DETER SERV (DDS)|4.50||||||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|||||4.50||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Medicaid|MEDICAID|4.50||||||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Medicaid|MEDICAID HMO|4.50||||||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Medicaid|MEDICAID TEXAS CHILDRENS|||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Medicaid|MEDICAID|||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Workers Compensation|UT EMPLOYEE INJURY|||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Medicaid|MEDICAID HMO|||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Humana Medicare Advantage|HUMANA MA|||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Blue Cross PPO Specialty|BCBSTX OTHER|||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Cigna|CIGNA|4.50||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UMR|||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Aetna|AETNA PPO|||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Aetna|AETNA OTHER|||||4.50||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.50||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.75||||||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|2.75||||||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.75||||2.75||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|2.75||||2.75||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Managed Medicare|HEALTHSPRING MA|2.75||||||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Humana Medicare Advantage|HUMANA MA|2.75||||2.75||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.75||||||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|2.75||||||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|2.75||||2.75||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.75||||||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.75||||2.75||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|||||2.75||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|2.75||||||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|2.75||||||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Medicaid|MEDICAID|2.75||||||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Medicare|MEDICARE ACUTE|2.75||||2.75||| 9513201|ERX|0250|DILTIAZEM 60MG TABLET|Medicare|MEDICARE ACUTE|0.10||||0.10||| 9513201|ERX|0250|DILTIAZEM 60MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|0.10||||||| 9513201|ERX|0250|DILTIAZEM 60MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.10||||||| 9513201|ERX|0250|DILTIAZEM 60MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.10||||||| 9513201|ERX|0250|DILTIAZEM 60MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.10||||||| 9513201|ERX|0250|DILTIAZEM 60MG TABLET|Humana Medicare Advantage|HUMANA MA|0.10||||0.10||| 9513201|ERX|0250|DILTIAZEM 60MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|0.10||||||| 9513201|ERX|0250|DILTIAZEM 60MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|0.10||||||| 9513201|ERX|0250|DILTIAZEM 60MG TABLET|Managed Medicare|HEALTHSPRING MA|0.10||||||| 9513201|ERX|0250|DILTIAZEM 60MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.10||||||| 9513235|ERX|0250|CARBIDOPA-LEVODOPA 10-100|ChampVA|CHAMPVA CENTER|4.50||||||| 9513235|ERX|0250|CARBIDOPA-LEVODOPA 10-100|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9513235|ERX|0250|CARBIDOPA-LEVODOPA 10-100|Medicare|MEDICARE ACUTE|4.50||||||| 9513243|ERX|0250|CARBIDOPA-LEVODOPA 25-100|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9513243|ERX|0250|CARBIDOPA-LEVODOPA 25-100|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9513243|ERX|0250|CARBIDOPA-LEVODOPA 25-100|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9513243|ERX|0250|CARBIDOPA-LEVODOPA 25-100|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9513243|ERX|0250|CARBIDOPA-LEVODOPA 25-100|Managed Medicare|BCBS MEDICARE PPO MA|||||4.50||| 9513243|ERX|0250|CARBIDOPA-LEVODOPA 25-100|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9513243|ERX|0250|CARBIDOPA-LEVODOPA 25-100|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9513243|ERX|0250|CARBIDOPA-LEVODOPA 25-100|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9513250|ERX|0250|ATENOLOL 25MG TABLET|Cigna|CIGNA|||||4.50||| 9513250|ERX|0250|ATENOLOL 25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9513250|ERX|0250|ATENOLOL 25MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9513250|ERX|0250|ATENOLOL 25MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9513250|ERX|0250|ATENOLOL 25MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.50||| 9513250|ERX|0250|ATENOLOL 25MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9513250|ERX|0250|ATENOLOL 25MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9513250|ERX|0250|ATENOLOL 25MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||4.50||| 9513250|ERX|0250|ATENOLOL 25MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9513268|ERX|0250|CARBIDOPA-LEVODOPA 25-250|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9513268|ERX|0250|CARBIDOPA-LEVODOPA 25-250|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9513268|ERX|0250|CARBIDOPA-LEVODOPA 25-250|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.50||| 9513268|ERX|0250|CARBIDOPA-LEVODOPA 25-250|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9513268|ERX|0250|CARBIDOPA-LEVODOPA 25-250|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Aetna|AETNA PPO|4.50||||4.50||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Cigna|CIGNA|4.50||||4.50||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Tricare|TRICARE EAST REGION|4.50||||4.50||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||4.50||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Medicaid|MEDICAID|4.50||||4.50||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|MTC Medical|VAN ZANDT COUNTY INMATE|4.50||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Managed Medicare|VAN ZANDT COUNTY INMATE|4.50||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|4.50||||4.50||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|4.50||||4.50||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|4.50||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Aetna|AETNA PPO|4.50||||4.50||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9513326|ERX|0250|NORTRIPTYLINE 10MG CAPSUL|Blue Cross PPO Specialty|BCBSTX PPO|7.50||||||| 9513326|ERX|0250|NORTRIPTYLINE 10MG CAPSUL|Medicare|MEDICARE ACUTE|7.50||||7.50||| 9513326|ERX|0250|NORTRIPTYLINE 10MG CAPSUL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||7.50||| 9513326|ERX|0250|NORTRIPTYLINE 10MG CAPSUL|United Medicare Advantage|UHC MEDICARE GOLD MA|7.50||||||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|Medicaid|COUNTY INDIGENT HEALTH OTHER|4.50||||||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.50||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|4.50||||||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9513391|ERX|0250|CAPTOPRIL 12.5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||10.50||| 9513391|ERX|0250|CAPTOPRIL 12.5MG TABLET|Medicare|MEDICARE ACUTE|||||10.50||| 9513417|ERX|0250|INDAPAMIDE 2.5MG TABLET|Medicare|MEDICARE ACUTE|4.50||||||| 9513433|ERX|0250|SUCRALFATE 1 G TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9513433|ERX|0250|SUCRALFATE 1 G TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9513433|ERX|0250|SUCRALFATE 1 G TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9513433|ERX|0250|SUCRALFATE 1 G TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9513433|ERX|0250|SUCRALFATE 1 G TABLET|Cigna|CIGNA OTHER|||||4.50||| 9513433|ERX|0250|SUCRALFATE 1 G TABLET|Aetna|AETNA PPO|4.50||||||| 9513433|ERX|0250|SUCRALFATE 1 G TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.50||| 9513433|ERX|0250|SUCRALFATE 1 G TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9513433|ERX|0250|SUCRALFATE 1 G TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9513433|ERX|0250|SUCRALFATE 1 G TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||4.50||| 9513433|ERX|0250|SUCRALFATE 1 G TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9513441|ERX|0250|GLYBURIDE 2.5MG TABLET|Tricare|TRICARE EAST REGION|||||4.50||| 9513441|ERX|0250|GLYBURIDE 2.5MG TABLET|Medicare|MEDICARE ACUTE|4.50||||||| 9513441|ERX|0250|GLYBURIDE 2.5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9513441|ERX|0250|GLYBURIDE 2.5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||4.50||| 9513441|ERX|0250|GLYBURIDE 2.5MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9513441|ERX|0250|GLYBURIDE 2.5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.50||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|Managed Medicare|VAN ZANDT COUNTY INMATE|4.50||||||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|MTC Medical|VAN ZANDT COUNTY INMATE|4.50||||||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|Aetna|AETNA PPO|4.50||||4.50||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.50||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9513490|ERX|0250|VERAPAMIL SR 180MG TABLET|Medicare|MEDICARE ACUTE|4.50||||||| 9513490|ERX|0250|VERAPAMIL SR 180MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.50||| 9513490|ERX|0250|VERAPAMIL SR 180MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9513490|ERX|0250|VERAPAMIL SR 180MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||4.50||| 9513490|ERX|0250|VERAPAMIL SR 180MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9513490|ERX|0250|VERAPAMIL SR 180MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9513508|ERX|0250|CARBIDOPA-LEVO SR 50-200M|Humana Medicare Advantage|HUMANA MA|23.50||||||| 9513508|ERX|0250|CARBIDOPA-LEVO SR 50-200M|Managed Medicaid|MEDICAID SUPERIOR|23.50||||||| 9513508|ERX|0250|CARBIDOPA-LEVO SR 50-200M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|23.50||||||| 9513508|ERX|0250|CARBIDOPA-LEVO SR 50-200M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||23.50||| 9513508|ERX|0250|CARBIDOPA-LEVO SR 50-200M|Medicare|MEDICARE ACUTE|23.50||||23.50||| 9513516|ERX|0250|DILTIAZEM SR 60MG CAPSULE|Medicare|MEDICARE ACUTE|||||11.50||| 9513516|ERX|0250|DILTIAZEM SR 60MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|11.50||||||| 9513516|ERX|0250|DILTIAZEM SR 60MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|11.50||||||| 9513516|ERX|0250|DILTIAZEM SR 60MG CAPSULE|Humana Medicare Advantage|HUMANA MA|11.50||||||| 9513516|ERX|0250|DILTIAZEM SR 60MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||11.50||| 9513540|ERX|0250|DILTIAZEM SR 120MG CAPSUL|Blue Cross PPO Specialty|BCBSTX PPO|14.50||||||| 9513540|ERX|0250|DILTIAZEM SR 120MG CAPSUL|Humana Medicare Advantage|HUMANA MA|14.50||||||| 9513540|ERX|0250|DILTIAZEM SR 120MG CAPSUL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||14.50||| 9513540|ERX|0250|DILTIAZEM SR 120MG CAPSUL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|14.50||||||| 9513540|ERX|0250|DILTIAZEM SR 120MG CAPSUL|Veterans Affairs|VETERANS ADMINISTRATION|14.50||||||| 9513540|ERX|0250|DILTIAZEM SR 120MG CAPSUL|Medicare|MEDICARE ACUTE|14.50||||||| 9513557|ERX|0250|LABETALOL 100MG TABLET|Medicaid|MEDICAID|4.50||||||| 9513557|ERX|0250|LABETALOL 100MG TABLET|Medicare|MEDICARE ACUTE|4.50||||||| 9513557|ERX|0250|LABETALOL 100MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9513557|ERX|0250|LABETALOL 100MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9513557|ERX|0250|LABETALOL 100MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9513557|ERX|0250|LABETALOL 100MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9513557|ERX|0250|LABETALOL 100MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9513557|ERX|0250|LABETALOL 100MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9513557|ERX|0250|LABETALOL 100MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9513557|ERX|0250|LABETALOL 100MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9513557|ERX|0250|LABETALOL 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9513565|ERX|0250|LABETALOL 200MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|9.25||||||| 9513565|ERX|0250|LABETALOL 200MG TABLET|Humana Medicare Advantage|HUMANA MA|9.25||||||| 9513565|ERX|0250|LABETALOL 200MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|9.25||||||| 9513565|ERX|0250|LABETALOL 200MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|9.25||||9.25||| 9513565|ERX|0250|LABETALOL 200MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|9.25||||9.25||| 9513565|ERX|0250|LABETALOL 200MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||9.25||| 9513565|ERX|0250|LABETALOL 200MG TABLET|United Healthcare|UNITED HEALTHCARE|9.25||||||| 9513565|ERX|0250|LABETALOL 200MG TABLET|Medicare|MEDICARE ACUTE|9.25||||||| 9513565|ERX|0250|LABETALOL 200MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|9.25||||||| 9513573|ERX|0250|TRIAMTERENE/HCTZ 37.5-25M|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9513573|ERX|0250|TRIAMTERENE/HCTZ 37.5-25M|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||||| 9513573|ERX|0250|TRIAMTERENE/HCTZ 37.5-25M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9513573|ERX|0250|TRIAMTERENE/HCTZ 37.5-25M|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9513573|ERX|0250|TRIAMTERENE/HCTZ 37.5-25M|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9513573|ERX|0250|TRIAMTERENE/HCTZ 37.5-25M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9513573|ERX|0250|TRIAMTERENE/HCTZ 37.5-25M|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.50||| 9513599|ERX|0250|ENALAPRIL 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|14.50||||||| 9513599|ERX|0250|ENALAPRIL 5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|14.50||||14.50||| 9513599|ERX|0250|ENALAPRIL 5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||14.50||| 9513599|ERX|0250|ENALAPRIL 5MG TABLET|Humana Medicare Advantage|HUMANA MA|||||14.50||| 9513599|ERX|0250|ENALAPRIL 5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|14.50||||14.50||| 9513599|ERX|0250|ENALAPRIL 5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|14.50||||14.50||| 9513599|ERX|0250|ENALAPRIL 5MG TABLET|United Healthcare|UNITED HEALTHCARE|||||14.50||| 9513599|ERX|0250|ENALAPRIL 5MG TABLET|Medicare|MEDICARE ACUTE|14.50||||14.50||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|20.75||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Medicaid|COUNTY INDIGENT HEALTH OTHER|20.75||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Medicare|MEDICARE ACUTE|20.75||||20.75||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Medicaid|MEDICAID|20.75||||20.75||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Medicaid|MEDICAID HMO|||||20.75||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Tricare|TRICARE EAST REGION|20.75||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|United Healthcare|GEHA|||||20.75||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|United Healthcare|UNITED HEALTHCARE|20.75||||20.75||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|20.75||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|20.75||||20.75||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|20.75||||20.75||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|20.75||||20.75||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|||||20.75||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Managed Medicare|HEALTHSPRING MA|20.75||||20.75||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|20.75||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|20.75||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|20.75||||20.75||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|20.75||||20.75||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Humana Medicare Advantage|HUMANA MA|20.75||||20.75||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|20.75||||20.75||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|20.75||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|20.75||||20.75||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|20.75||||20.75||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|20.75||||20.75||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|20.75||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|20.75||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Aetna|AETNA PPO|20.75||||20.75||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Aetna|AETNA OTHER|||||20.75||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|20.75||||20.75||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|20.75||||20.75||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||20.75||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|20.75||||20.75||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Cigna|CIGNA|20.75||||20.75||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|ChampVA|CHAMPVA CENTER|||||20.75||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|20.75||||20.75||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Cigna|CIGNA|4.50||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|4.50||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Aetna|AETNA PPO|4.50||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|4.50||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Managed Medicare|HEALTHSPRING MA|||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|United Medicare Advantage|UHC AARP MCR HMO MA|||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Aetna|AETNA OTHER|||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Tricare|TRICARE EAST REGION|4.50||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|PHCS|MULTIPLAN PHCS OTHER|||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|United Healthcare|UNITED HEALTHCARE OTHER|||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Medicaid|MEDICAID TEXAS CHILDRENS|||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Medicaid|MEDICAID HMO|4.50||||4.50||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Medicaid|MEDICAID|4.50||||4.50||| 9513664|ERX|0250|SPIRONOLACTONE 100MG TABL|Medicare|MEDICARE PART B ONLY IP|17.50||||||| 9513664|ERX|0250|SPIRONOLACTONE 100MG TABL|Medicare|MEDICARE ACUTE|17.50||||17.50||| 9513664|ERX|0250|SPIRONOLACTONE 100MG TABL|Medicaid|MEDICAID|17.50||||||| 9513664|ERX|0250|SPIRONOLACTONE 100MG TABL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|17.50||||||| 9513664|ERX|0250|SPIRONOLACTONE 100MG TABL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|17.50||||||| 9513664|ERX|0250|SPIRONOLACTONE 100MG TABL|Managed Medicare|HEALTHSPRING MA|17.50||||||| 9513664|ERX|0250|SPIRONOLACTONE 100MG TABL|Humana Medicare Advantage|HUMANA MA|17.50||||||| 9513664|ERX|0250|SPIRONOLACTONE 100MG TABL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|17.50||||||| 9513664|ERX|0250|SPIRONOLACTONE 100MG TABL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|17.50||||17.50||| 9513664|ERX|0250|SPIRONOLACTONE 100MG TABL|Managed Medicaid|MEDICAID AMERIGROUP|17.50||||||| 9513664|ERX|0250|SPIRONOLACTONE 100MG TABL|Aetna|AETNA PPO|17.50||||||| 9513664|ERX|0250|SPIRONOLACTONE 100MG TABL|Blue Cross PPO Specialty|BCBSTX PPO|17.50||||||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Cigna|CIGNA|4.50||||4.50||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|4.50||||||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Aetna|AETNA PPO|4.50||||4.50||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|MTC Medical|VAN ZANDT COUNTY INMATE|4.50||||||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Managed Medicare|VAN ZANDT COUNTY INMATE|4.50||||||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Managed Medicare|OTHER INSTITUTIONS|||||4.50||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|4.50||||||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Tricare|TRICARE EAST REGION|4.50||||||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4.50||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||4.50||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Medicaid|COUNTY INDIGENT HEALTH OTHER|4.50||||||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Medicaid|MEDICAID|4.50||||||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Medicaid|MEDICAID|14.50||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|14.50||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Medicare|MEDICARE PART B ONLY IP|14.50||||||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Medicare|MEDICARE ACUTE|14.50||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|14.50||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Medicaid|LAW ENFORCEMENT OTHER|14.50||||||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Tricare|TRICARE EAST REGION|14.50||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|14.50||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|United Healthcare|TML GROUP BENEFITS|||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Texas Workforce Commission|DIS DETER SERV (DDS)|14.50||||||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|14.50||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|14.50||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|14.50||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|14.50||||||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Managed Medicare|MA PART B ONLY IP|14.50||||||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|14.50||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|United Healthcare|UNITED HEALTHCARE|||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Managed Medicare|WELLCARE CHOICE MA|||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Managed Medicare|HEALTHSPRING MA|14.50||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Managed Medicare|VAN ZANDT COUNTY INMATE|14.50||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|14.50||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|MTC Medical|VAN ZANDT COUNTY INMATE|14.50||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Humana Medicare Advantage|HUMANA MA|14.50||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Medicaid|COUNTY INDIGENT HEALTH OTHER|14.50||||||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|14.50||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|14.50||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|14.50||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|14.50||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Aetna|AETNA PPO|14.50||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|14.50||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|14.50||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|14.50||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Cigna|CIGNA OTHER|14.50||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Cigna|CIGNA|||||14.50||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|14.50||||14.50||| 9513748|ERX|0250|CHLORHEXIDINE 0.12% ORAL|Blue Cross PPO Specialty|BCBSTX PPO|156.75||||||| 9513748|ERX|0250|CHLORHEXIDINE 0.12% ORAL|Aenta Medicare Advantage|AETNA MEDICARE MA|156.75||||156.75||| 9513748|ERX|0250|CHLORHEXIDINE 0.12% ORAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|156.75||||||| 9513748|ERX|0250|CHLORHEXIDINE 0.12% ORAL|Managed Medicaid|MEDICAID AMERIGROUP|156.75||||||| 9513748|ERX|0250|CHLORHEXIDINE 0.12% ORAL|Humana Medicare Advantage|HUMANA MA|156.75||||156.75||| 9513748|ERX|0250|CHLORHEXIDINE 0.12% ORAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|156.75||||||| 9513748|ERX|0250|CHLORHEXIDINE 0.12% ORAL|Managed Medicaid|MEDICAID SUPERIOR|||||156.75||| 9513748|ERX|0250|CHLORHEXIDINE 0.12% ORAL|Managed Medicare|HEALTHSPRING MA|156.75||||||| 9513748|ERX|0250|CHLORHEXIDINE 0.12% ORAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|156.75||||||| 9513748|ERX|0250|CHLORHEXIDINE 0.12% ORAL|United Medicare Advantage|UHC MEDICARE GOLD MA|156.75||||156.75||| 9513748|ERX|0250|CHLORHEXIDINE 0.12% ORAL|Medicare|MEDICARE ACUTE|||||156.75||| 9513789|ERX|0250|BISOPROLOL 5MG TABLET|Medicare|MEDICARE ACUTE|11.75||||||| 9513896|ERX|0250|BETHANECHOL 25MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9513896|ERX|0250|BETHANECHOL 25MG TABLET|Medicare|MEDICARE ACUTE|4.50||||||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|Managed Medicare|HEALTHSPRING MA|433.25||||433.25||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||433.25||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|433.25||||433.25||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|Managed Medicaid|MEDICAID SUPERIOR|433.25||||433.25||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|433.25||||||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|433.25||||||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|433.25||||||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|Aetna|AETNA PPO|433.25||||||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|Managed Medicaid|MEDICAID AMERIGROUP|433.25||||433.25||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||433.25||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|433.25||||433.25||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|ChampVA|CHAMPVA CENTER|433.25||||||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|Blue Cross PPO Specialty|BCBSTX PPO|433.25||||||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|Cigna|CIGNA|433.25||||||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|Blue Cross HMO Specialty|BCBSTX HMO|433.25||||||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|United Healthcare|UNITED HEALTHCARE|433.25||||433.25||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|United Healthcare|GEHA|||||433.25||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|Humana Medicare Advantage|HUMANA MA|433.25||||433.25||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|United Healthcare|UNITED HEALTHCARE|433.25||||||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|Medicare|MEDICARE ACUTE|433.25||||433.25||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|Medicaid|MEDICAID HMO|433.25||||||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|Medicaid|MEDICAID|433.25||||||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|Veterans Affairs|VETERANS ADMINISTRATION|433.25||||||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|433.25||||433.25||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|433.25||||433.25||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||433.25||| 9513938|ERX|0250|AZTREONAM 1000MG VIAL|Medicare|MEDICARE ACUTE|3.46||||3.46||| 9513938|ERX|0250|AZTREONAM 1000MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|||||3.46||| 9513938|ERX|0250|AZTREONAM 1000MG VIAL|Cigna|CIGNA|||||3.46||| 9513938|ERX|0250|AZTREONAM 1000MG VIAL|Blue Cross HMO Specialty|BCBSTX HMO|||||3.46||| 9513938|ERX|0250|AZTREONAM 1000MG VIAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.46||| 9513938|ERX|0250|AZTREONAM 1000MG VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.46||| 9513938|ERX|0250|AZTREONAM 1000MG VIAL|Managed Medicare|OTHER INSTITUTIONS|||||3.46||| 9513946|ERX|0250|AZTREONAM 2000MG VIAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||622.50||| 9513946|ERX|0250|AZTREONAM 2000MG VIAL|Medicare|MEDICARE ACUTE|||||622.50||| 9513953|ERX|0250|CEFEPIME 1 G VIAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|214.75||||214.75||| 9513953|ERX|0250|CEFEPIME 1 G VIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|214.75||||||| 9513953|ERX|0250|CEFEPIME 1 G VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||214.75||| 9513953|ERX|0250|CEFEPIME 1 G VIAL|Veterans Affairs|VETERANS ADMINISTRATION|214.75||||214.75||| 9513953|ERX|0250|CEFEPIME 1 G VIAL|United Healthcare|UNITED HEALTHCARE|214.75||||||| 9513953|ERX|0250|CEFEPIME 1 G VIAL|Medicaid|MEDICAID HMO|||||214.75||| 9513953|ERX|0250|CEFEPIME 1 G VIAL|Medicare|MEDICARE ACUTE|214.75||||214.75||| 9513953|ERX|0250|CEFEPIME 1 G VIAL|Humana Medicare Advantage|HUMANA MA|214.75||||214.75||| 9513953|ERX|0250|CEFEPIME 1 G VIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||214.75||| 9513953|ERX|0250|CEFEPIME 1 G VIAL|Managed Medicaid|MEDICAID SUPERIOR|214.75||||214.75||| 9513953|ERX|0250|CEFEPIME 1 G VIAL|Managed Medicaid|MEDICAID AMERIGROUP|214.75||||214.75||| 9513953|ERX|0250|CEFEPIME 1 G VIAL|Blue Cross PPO Specialty|BCBSTX PPO|214.75||||214.75||| 9513953|ERX|0250|CEFEPIME 1 G VIAL|Blue Cross HMO Specialty|BCBSTX HMO|||||214.75||| 9513961|ERX|0250|CEFEPIME 2 G VIAL|Humana Medicare Advantage|HUMANA MA|||||1.35||| 9513961|ERX|0250|CEFEPIME 2 G VIAL|Medicare|MEDICARE ACUTE|1.35||||||| 9513961|ERX|0250|CEFEPIME 2 G VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.35||| 9513979|ERX|0250|CLOTRIMAZOLE 1% SOLUTION,|Medicare|MEDICARE ACUTE|147.75||||||| 9513979|ERX|0250|CLOTRIMAZOLE 1% SOLUTION,|Blue Cross PPO Specialty|BCBSTX PPO|147.75||||||| 9514001|ERX|0250|NYSTATIN CREAM, 15 GM|Humana Medicare Advantage|HUMANA MA|48.25||||48.25||| 9514001|ERX|0250|NYSTATIN CREAM, 15 GM|Managed Medicaid|MEDICAID SUPERIOR|48.25||||||| 9514001|ERX|0250|NYSTATIN CREAM, 15 GM|Blue Cross PPO Specialty|BCBSTX PPO|48.25||||||| 9514001|ERX|0250|NYSTATIN CREAM, 15 GM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|48.25||||||| 9514001|ERX|0250|NYSTATIN CREAM, 15 GM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|48.25||||||| 9514001|ERX|0250|NYSTATIN CREAM, 15 GM|Medicare|MEDICARE ACUTE|48.25||||48.25||| 9514019|ERX|0250|CLOTRIMAZOLE 1% CREAM, 15|Medicare|MEDICARE ACUTE|64.50||||64.50||| 9514019|ERX|0250|CLOTRIMAZOLE 1% CREAM, 15|United Medicare Advantage|UHC MEDICARE GOLD MA|||||64.50||| 9514019|ERX|0250|CLOTRIMAZOLE 1% CREAM, 15|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|64.50||||||| 9514019|ERX|0250|CLOTRIMAZOLE 1% CREAM, 15|Blue Cross HMO Specialty|BCBSTX HMO|64.50||||||| 9514019|ERX|0250|CLOTRIMAZOLE 1% CREAM, 15|Humana Medicare Advantage|HUMANA MA|64.50||||||| 9514043|ERX|0250|ACETAZOLAMIDE 250MG TABLE|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9514043|ERX|0250|ACETAZOLAMIDE 250MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9514043|ERX|0250|ACETAZOLAMIDE 250MG TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9514043|ERX|0250|ACETAZOLAMIDE 250MG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9514043|ERX|0250|ACETAZOLAMIDE 250MG TABLE|Medicare|MEDICARE ACUTE|4.50||||||| 9514076|ERX|0250|PRENATAL VIT-FE FUMARATE-|Tricare|TRICARE EAST REGION|5.50||||||| 9514076|ERX|0250|PRENATAL VIT-FE FUMARATE-|United Healthcare|UMR UNITED MEDICAL RESOURCES|5.50||||||| 9514076|ERX|0250|PRENATAL VIT-FE FUMARATE-|Medicaid|MEDICAID|5.50||||||| 9514076|ERX|0250|PRENATAL VIT-FE FUMARATE-|Medicaid|MOLINA HEALTHCARE OF TEXAS|5.50||||||| 9514076|ERX|0250|PRENATAL VIT-FE FUMARATE-|Medicare|MEDICARE ACUTE|5.50||||||| 9514076|ERX|0250|PRENATAL VIT-FE FUMARATE-|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|5.50||||||| 9514076|ERX|0250|PRENATAL VIT-FE FUMARATE-|Blue Cross PPO Specialty|BCBSTX PPO|5.50||||||| 9514076|ERX|0250|PRENATAL VIT-FE FUMARATE-|Cigna|CIGNA|5.50||||||| 9514076|ERX|0250|PRENATAL VIT-FE FUMARATE-|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|5.50||||||| 9514076|ERX|0250|PRENATAL VIT-FE FUMARATE-|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.50||||||| 9514076|ERX|0250|PRENATAL VIT-FE FUMARATE-|Managed Medicaid|MEDICAID SUPERIOR|5.50||||5.50||| 9514076|ERX|0250|PRENATAL VIT-FE FUMARATE-|Managed Medicaid|MEDICAID AMERIGROUP|5.50||||||| 9514084|ERX|0250|PEG 3350, 4L|Managed Medicaid|MEDICAID SUPERIOR|170.25||||170.25||| 9514084|ERX|0250|PEG 3350, 4L|Managed Medicaid|MEDICAID AMERIGROUP|170.25||||||| 9514084|ERX|0250|PEG 3350, 4L|Aenta Medicare Advantage|AETNA MEDICARE MA|170.25||||||| 9514084|ERX|0250|PEG 3350, 4L|Humana Medicare Advantage|HUMANA MA|170.25||||170.25||| 9514084|ERX|0250|PEG 3350, 4L|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|170.25||||||| 9514084|ERX|0250|PEG 3350, 4L|Blue Cross PPO Specialty|BCBSTX PPO|170.25||||170.25||| 9514084|ERX|0250|PEG 3350, 4L|Cigna|CIGNA|170.25||||170.25||| 9514084|ERX|0250|PEG 3350, 4L|Blue Cross HMO Specialty|BCBSTX HMO|||||170.25||| 9514084|ERX|0250|PEG 3350, 4L|United Medicare Advantage|AARP UHC WEST COMPLETE MA|170.25||||||| 9514084|ERX|0250|PEG 3350, 4L|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||170.25||| 9514084|ERX|0250|PEG 3350, 4L|Medicaid|MEDICAID|170.25||||||| 9514084|ERX|0250|PEG 3350, 4L|Medicare|MEDICARE ACUTE|170.25||||170.25||| 9514084|ERX|0250|PEG 3350, 4L|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||170.25||| 9514084|ERX|0250|PEG 3350, 4L|NON CONTRACTED|COMMERCIAL OTHER 1|170.25||||||| 9514084|ERX|0250|PEG 3350, 4L|Texas Workforce Commission|DIS DETER SERV (DDS)|170.25||||||| 9514100|ERX|0250|LATANOPROST EYE DROP, 2.5|Medicare|MEDICARE ACUTE|558.25||||558.25||| 9514100|ERX|0250|LATANOPROST EYE DROP, 2.5|Veterans Affairs|VETERANS ADMINISTRATION|558.25||||558.25||| 9514100|ERX|0250|LATANOPROST EYE DROP, 2.5|United Medicare Advantage|UHC MEDICARE GOLD MA|558.25||||558.25||| 9514100|ERX|0250|LATANOPROST EYE DROP, 2.5|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|558.25||||558.25||| 9514100|ERX|0250|LATANOPROST EYE DROP, 2.5|United Medicare Advantage|AARP UHC WEST COMPLETE MA|558.25||||||| 9514100|ERX|0250|LATANOPROST EYE DROP, 2.5|Blue Cross PPO Specialty|BCBSTX PPO|558.25||||||| 9514100|ERX|0250|LATANOPROST EYE DROP, 2.5|Aenta Medicare Advantage|AETNA MEDICARE MA|||||558.25||| 9514100|ERX|0250|LATANOPROST EYE DROP, 2.5|Managed Medicare|HEALTHSPRING MA|558.25||||558.25||| 9514100|ERX|0250|LATANOPROST EYE DROP, 2.5|Humana Medicare Advantage|HUMANA MA|558.25||||558.25||| 9514100|ERX|0250|LATANOPROST EYE DROP, 2.5|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|558.25||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Managed Medicaid|MEDICAID AMERIGROUP|5.75||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Humana Medicare Advantage|HUMANA MA|5.75||||5.75||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Managed Medicaid|MEDICAID SUPERIOR|5.75||||5.75||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|5.75||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Managed Medicare|OTHER INSTITUTIONS|||||5.75||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Managed Medicare|BCBS MEDICARE PPO MA|5.75||||5.75||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Managed Medicare|HEALTHSPRING MA|5.75||||5.75||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Managed Medicare|MA PART B ONLY IP|5.75||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Aetna|AETNA PPO|5.75||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.75||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.75||||5.75||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Aenta Medicare Advantage|AETNA MEDICARE MA|5.75||||5.75||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Blue Cross PPO Specialty|BCBSTX PPO|5.75||||5.75||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Cigna|CIGNA|5.75||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|United Medicare Advantage|UHC MEDICARE GOLD MA|5.75||||5.75||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|United Medicare Advantage|AARP UHC WEST COMPLETE MA|5.75||||5.75||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|5.75||||5.75||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Veterans Affairs|VETERANS ADMINISTRATION|5.75||||5.75||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|United Healthcare|UNITED HEALTHCARE|5.75||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|United Healthcare|UNITED HEALTHCARE|||||5.75||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Medicaid|MEDICAID HMO|5.75||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Medicare|MEDICARE ACUTE|5.75||||5.75||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Medicare|MEDICARE PART B ONLY IP|5.75||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Medicaid|MOLINA HEALTHCARE OF TEXAS|5.75||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Medicaid|MOLINA HEALTHCARE OF TEXAS|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Medicare|MEDICARE ACUTE|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Medicaid|MEDICAID TEXAS CHILDRENS|||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Medicaid|MEDICAID|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Tricare|TRICARE EAST REGION|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|NON CONTRACTED|COMMERCIAL OTHER 1|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|PHCS|HUMANA|||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|United Healthcare|GEHA|||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|United Healthcare|TML GROUP BENEFITS|||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|United Healthcare|UNITED HEALTHCARE|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Veterans Affairs|VETERANS ADMINISTRATION|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Workers Compensation|UT EMPLOYEE INJURY|||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Workers Compensation|WORKERS COMPENSATION OTHER|||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|United Medicare Advantage|UHC MEDICARE GOLD MA|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|United Medicare Advantage|UHC AARP MCR HMO MA|||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|ChampVA|CHAMPVA CENTER|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Blue Cross PPO Specialty|BCBSTX OTHER|||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Blue Cross PPO Specialty|BCBSTX PPO|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|United Healthcare|UMR UNITED MEDICAL RESOURCES|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Cigna|CIGNA|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Cigna|CIGNA OTHER|||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|United Healthcare|UNITED HEALTHCARE OTHER|||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Blue Cross HMO Specialty|BCBSTX HMO|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Cigna|CIGNA|||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Aetna|AETNA PPO|||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Medicaid|MEDICAID HMO|9.50||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Aetna|AETNA OTHER|||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Aenta Medicare Advantage|AETNA MEDICARE MA|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Managed Medicare|MA PART B ONLY IP|9.50||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Managed Medicare|VAN ZANDT COUNTY INMATE|||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Managed Medicare|HEALTHSPRING MA|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Humana Medicare Advantage|HUMANA MA|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Managed Medicaid|MEDICAID SUPERIOR|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Managed Medicaid|MEDICAID AMERIGROUP|9.50||||9.50||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|MTC Medical|VAN ZANDT COUNTY INMATE|||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Managed Medicaid|MEDICAID SUPERIOR|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Managed Medicaid|MEDICAID AMERIGROUP|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Managed Medicare|HEALTHSPRING MA|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Managed Medicare|BCBS MEDICARE PPO MA|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Access Direct Platinum|HEALTHFIRST TPA UMR|9.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Aetna|AETNA PPO|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Aetna|AETNA OTHER|||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Cigna|CIGNA|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|ChampVA|CHAMPVA CENTER|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Blue Cross PPO Specialty|BCBSTX PPO|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Blue Cross HMO Specialty|BCBSTX HMO|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Aenta Medicare Advantage|AETNA MEDICARE MA|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|United Medicare Advantage|UHC MEDICARE GOLD MA|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|United Medicare Advantage|UHC AARP MCR HMO MA|||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Workers Compensation|WORKERS COMPENSATION OTHER|||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Veterans Affairs|VETERANS ADMINISTRATION|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Veterans Affairs|VETERANS ADMINISTRATION|9.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Workers Compensation|BROOKSHIRES WORKERS COMP|||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Tricare|TRICARE EAST REGION|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|NON CONTRACTED|COMMERCIAL OTHER 1|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|United Healthcare|UNITED HEALTHCARE OTHER|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|PHCS|MULTIPLAN PHCS OTHER|||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|PHCS|HUMANA|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|United Healthcare|UMR UNITED MEDICAL RESOURCES|9.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Humana Medicare Advantage|HUMANA MA|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|United Healthcare|UNITED HEALTHCARE|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|United Healthcare|TML GROUP BENEFITS|9.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Texas Workforce Commission|DIS DETER SERV (DDS)|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Medicaid|MEDICAID|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Medicaid|MOLINA HEALTHCARE OF TEXAS|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Medicaid|HENDERSON COUNTY INDIGENT|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Medicare|MEDICARE ACUTE|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Medicaid|MEDICAID HMO|9.50||||9.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Medicaid|LAW ENFORCEMENT OTHER|9.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Medicare|MEDICARE ACUTE|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Medicaid|LAW ENFORCEMENT OTHER|9.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Medicaid|MOLINA HEALTHCARE OF TEXAS|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Medicaid|MEDICAID|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Medicaid|HENDERSON COUNTY INDIGENT|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Tricare|TRICARE EAST REGION|||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|NON CONTRACTED|COMMERCIAL OTHER 1|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|PHCS|HUMANA|||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|United Healthcare|TML GROUP BENEFITS|9.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|United Healthcare|UMR UNITED MEDICAL RESOURCES|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|United Healthcare|UNITED HEALTHCARE|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Workers Compensation|WORKERS COMP PHYSICIAN|||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Workers Compensation|TEXAS MUTUAL INSURANCE|||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Workers Compensation|WORKERS COMPENSATION OTHER|||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|United Medicare Advantage|UHC MEDICARE GOLD MA|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|United Medicare Advantage|AARP UHC WEST COMPLETE MA|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Cigna|CIGNA|||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Cigna|CIGNA OTHER|9.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Blue Cross PPO Specialty|BCBSTX OTHER|||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Veterans Affairs|VETERANS ADMINISTRATION|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Blue Cross PPO Specialty|BCBSTX PPO|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Cigna|CIGNA|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|United Healthcare|UNITED HEALTHCARE OTHER|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Blue Cross HMO Specialty|BCBSTX HMO|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|United Healthcare|GEHA|9.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Aetna|AETNA PPO|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Aetna|AETNA OTHER|||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Access Direct Platinum|HEALTHFIRST TPA UMR|9.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Aenta Medicare Advantage|AETNA MEDICARE MA|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Managed Medicare|HEALTHSPRING MA|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Managed Medicare|VAN ZANDT COUNTY INMATE|||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|9.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Managed Medicare|OTHER INSTITUTIONS|||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Managed Medicare|BCBS MEDICARE PPO MA|||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Medicaid|MEDICAID HMO|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Managed Medicare|MA PART B ONLY IP|9.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Humana Medicare Advantage|HUMANA MA|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Managed Medicaid|MEDICAID UNITED HEALTHCARE|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Managed Medicaid|MEDICAID SUPERIOR|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|9.50||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|MTC Medical|VAN ZANDT COUNTY INMATE|||||9.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Managed Medicaid|MEDICAID AMERIGROUP|9.50||||9.50||| 9514233|ERX|0250|OXYBUTYNIN 3.9MG PATCH|Managed Medicare|BCBS MEDICARE PPO MA|139.50||||||| 9514233|ERX|0250|OXYBUTYNIN 3.9MG PATCH|United Medicare Advantage|UHC MEDICARE GOLD MA|139.50||||||| 9514233|ERX|0250|OXYBUTYNIN 3.9MG PATCH|Medicare|MEDICARE ACUTE|139.50||||||| 9514241|ERX|0250|FERRICGLUC CPLX/SUC 62.5M|Medicare|MEDICARE ACUTE|409.25||||||| 9514241|ERX|0250|FERRICGLUC CPLX/SUC 62.5M|Veterans Affairs|VETERANS ADMINISTRATION|409.25||||||| 9514241|ERX|0250|FERRICGLUC CPLX/SUC 62.5M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|409.25||||409.25||| 9514241|ERX|0250|FERRICGLUC CPLX/SUC 62.5M|United Medicare Advantage|UHC MEDICARE GOLD MA|409.25||||||| 9514241|ERX|0250|FERRICGLUC CPLX/SUC 62.5M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|409.25||||||| 9514241|ERX|0250|FERRICGLUC CPLX/SUC 62.5M|Aenta Medicare Advantage|AETNA MEDICARE MA|409.25||||||| 9514241|ERX|0250|FERRICGLUC CPLX/SUC 62.5M|Managed Medicaid|MEDICAID SUPERIOR|409.25||||||| 9514241|ERX|0250|FERRICGLUC CPLX/SUC 62.5M|Humana Medicare Advantage|HUMANA MA|409.25||||||| 9514258|ERX|0250|URSODIOL 300MG CAPSULE|Humana Medicare Advantage|HUMANA MA|0.46||||0.46||| 9514258|ERX|0250|URSODIOL 300MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|0.46||||||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|19.75||||||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|United Medicare Advantage|UHC MEDICARE GOLD MA|||||19.75||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Workers Compensation|WORKERS COMPENSATION OTHER|||||19.75||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|United Healthcare|UNITED HEALTHCARE|19.75||||||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Medicaid|COUNTY INDIGENT HEALTH OTHER|19.75||||||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Medicaid|HENDERSON COUNTY INDIGENT|19.75||||||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Medicaid|MEDICAID HMO|||||19.75||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Medicare|MEDICARE ACUTE|19.75||||19.75||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Medicaid|MEDICAID|19.75||||19.75||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Blue Cross PPO Specialty|BCBSTX PPO|19.75||||19.75||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Tricare|TRICARE EAST REGION|19.75||||19.75||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|United Medicare Advantage|AARP UHC WEST COMPLETE MA|19.75||||||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Cigna|CIGNA|19.75||||19.75||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Blue Cross HMO Specialty|BCBSTX HMO|19.75||||||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Aetna|AETNA PPO|||||19.75||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|19.75||||19.75||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Managed Medicare|HEALTHSPRING MA|19.75||||19.75||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Humana Medicare Advantage|HUMANA MA|||||19.75||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Managed Medicaid|MEDICAID UNITED HEALTHCARE|19.75||||19.75||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Managed Medicaid|MEDICAID SUPERIOR|19.75||||19.75||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|19.75||||19.75||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Managed Medicaid|MEDICAID AMERIGROUP|||||19.75||| 9514332|ERX|0250|METOLAZONE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|23.50||||||| 9514332|ERX|0250|METOLAZONE 5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|23.50||||||| 9514332|ERX|0250|METOLAZONE 5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|23.50||||||| 9514332|ERX|0250|METOLAZONE 5MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|23.50||||||| 9514332|ERX|0250|METOLAZONE 5MG TABLET|Managed Medicare|HEALTHSPRING MA|23.50||||||| 9514332|ERX|0250|METOLAZONE 5MG TABLET|Aetna|AETNA PPO|23.50||||||| 9514332|ERX|0250|METOLAZONE 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|23.50||||||| 9514332|ERX|0250|METOLAZONE 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|23.50||||||| 9514332|ERX|0250|METOLAZONE 5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|23.50||||||| 9514332|ERX|0250|METOLAZONE 5MG TABLET|Medicare|MEDICARE ACUTE|23.50||||||| 9514332|ERX|0250|METOLAZONE 5MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|23.50||||||| 9514332|ERX|0250|METOLAZONE 5MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||23.50||| 9514332|ERX|0250|METOLAZONE 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|23.50||||||| 9514332|ERX|0250|METOLAZONE 5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|23.50||||23.50||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|4.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Tricare|TRICARE EAST REGION|4.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Medicaid|MEDICAID|4.50||||4.50||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||4.50||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||4.50||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Medicaid|LAW ENFORCEMENT OTHER|4.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Medicaid|COUNTY INDIGENT HEALTH OTHER|4.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|4.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||4.50||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Cigna|CIGNA|4.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Aetna|AETNA PPO|4.50||||4.50||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||4.50||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|4.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Managed Medicare|WELLCARE CHOICE MA|4.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||4.50||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Managed Medicare|MA PART B ONLY IP|4.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|4.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9514381|ERX|0250|MINOXIDIL 10MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|15.25||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|0.06||||0.06||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.06||||0.06||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.06||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Managed Medicare|HEALTHSPRING MA|0.06||||0.06||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.06||||0.06||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|ChampVA|CHAMPVA CENTER|0.06||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.06||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||0.06||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Medicare|MEDICARE ACUTE|0.06||||0.06||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.06||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.06||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.06||||||| 9514480|ERX|0250|MESALAMINE 250MG CAPSULE|Medicare|MEDICARE ACUTE|4.50||||||| 9514480|ERX|0250|MESALAMINE 250MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9514571|ERX|0250|PERMETHRIN 1% RINSE, 59ML|Humana Medicare Advantage|HUMANA MA|87.50||||||| 9514571|ERX|0250|PERMETHRIN 1% RINSE, 59ML|Managed Medicaid|MEDICAID SUPERIOR|87.50||||||| 9514571|ERX|0250|PERMETHRIN 1% RINSE, 59ML|Managed Medicaid|MEDICAID AMERIGROUP|87.50||||||| 9514571|ERX|0250|PERMETHRIN 1% RINSE, 59ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|87.50||||||| 9514589|ERX|0250|FISH OIL (OM3FA) 1000MG C|Humana Medicare Advantage|HUMANA MA|2.25||||||| 9514688|ERX|0250|ENALAPRILAT 2.5MG 2ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||254.25||| 9514688|ERX|0250|ENALAPRILAT 2.5MG 2ML|Medicare|MEDICARE ACUTE|254.25||||254.25||| 9514688|ERX|0250|ENALAPRILAT 2.5MG 2ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|254.25||||||| 9514688|ERX|0250|ENALAPRILAT 2.5MG 2ML|Cigna|CIGNA|||||254.25||| 9514688|ERX|0250|ENALAPRILAT 2.5MG 2ML|Blue Cross PPO Specialty|BCBSTX PPO|254.25||||254.25||| 9514688|ERX|0250|ENALAPRILAT 2.5MG 2ML|Managed Medicare|BCBS MEDICARE PPO MA|254.25||||||| 9514688|ERX|0250|ENALAPRILAT 2.5MG 2ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||254.25||| 9514688|ERX|0250|ENALAPRILAT 2.5MG 2ML|Humana Medicare Advantage|HUMANA MA|254.25||||254.25||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Managed Medicare|WELLCARE CHOICE MA|||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Managed Medicare|MA PART B ONLY IP|4.50||||||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Aetna|AETNA PPO|4.50||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Aetna|AETNA OTHER|||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|ChampVA|CHAMPVA CENTER|||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Cigna|CIGNA|||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Medicaid|HENDERSON COUNTY INDIGENT|||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Medicaid|MEDICAID HMO|||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Medicaid|MEDICAID|4.50||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Tricare|TRICARE EAST REGION|4.50||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|PHCS|MULTIPLAN PHCS OTHER|||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|United Healthcare|UNITED HEALTHCARE OTHER|||||4.50||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|Tricare|TRICARE EAST REGION|||||336.50||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|UTMB|UTMB CORRECTIONAL MANAGED CARE|336.50||||||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|United Healthcare|TML GROUP BENEFITS|||||336.50||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|Medicaid|HENDERSON COUNTY INDIGENT|||||336.50||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|Medicare|MEDICARE ACUTE|336.50||||336.50||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|Medicaid|MEDICAID TEXAS CHILDRENS|||||336.50||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|336.50||||336.50||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|336.50||||336.50||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|336.50||||336.50||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|Cigna|CIGNA|||||336.50||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|336.50||||336.50||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|Blue Cross HMO Specialty|BCBSTX HMO|336.50||||336.50||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|336.50||||||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|336.50||||336.50||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|336.50||||336.50||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|Managed Medicare|BCBS MEDICARE PPO MA|||||336.50||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|Managed Medicare|HEALTHSPRING MA|||||336.50||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|Humana Medicare Advantage|HUMANA MA|336.50||||336.50||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||336.50||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|Managed Medicaid|MEDICAID SUPERIOR|336.50||||||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|336.50||||336.50||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|Managed Medicaid|MEDICAID AMERIGROUP|336.50||||||| 9514761|ERX|0250|AMIODARONE 150MG/3ML|Humana Medicare Advantage|HUMANA MA|||||474.75||| 9514761|ERX|0250|AMIODARONE 150MG/3ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||474.75||| 9514761|ERX|0250|AMIODARONE 150MG/3ML|Managed Medicare|HEALTHSPRING MA|474.75||||||| 9514761|ERX|0250|AMIODARONE 150MG/3ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||474.75||| 9514761|ERX|0250|AMIODARONE 150MG/3ML|Blue Cross PPO Specialty|BCBSTX PPO|||||474.75||| 9514761|ERX|0250|AMIODARONE 150MG/3ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|474.75||||474.75||| 9514761|ERX|0250|AMIODARONE 150MG/3ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|474.75||||474.75||| 9514761|ERX|0250|AMIODARONE 150MG/3ML|Medicare|MEDICARE ACUTE|474.75||||474.75||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|NON CONTRACTED|COMMERCIAL OTHER 1|297.50||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|United Healthcare|UNITED HEALTHCARE|||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Medicare|MEDICARE ACUTE|297.50||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|297.50||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Medicaid|MEDICAID|||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Veterans Affairs|VETERANS ADMINISTRATION|||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|297.50||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Aetna|AETNA PPO|||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Aetna|BOON CHAPMAN|||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Aetna|AETNA OTHER|||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|297.50||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Cigna|CIGNA|||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Tricare|TRICARE EAST REGION|||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Blue Cross PPO Specialty|BCBSTX PPO|297.50||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Blue Cross HMO Specialty|BCBSTX HMO|||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Managed Medicare|HEALTHSPRING MA|||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Managed Medicaid|MEDICAID SUPERIOR|||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Managed Medicaid|MEDICAID AMERIGROUP|||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Humana Medicare Advantage|HUMANA MA|297.50||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||297.50||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||297.50||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Humana Medicare Advantage|HUMANA MA|0.66||||0.66||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.66||||0.66||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Managed Medicaid|MEDICAID SUPERIOR|0.66||||0.66||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|MTC Medical|VAN ZANDT COUNTY INMATE|0.66||||||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Managed Medicaid|MEDICAID AMERIGROUP|0.66||||0.66||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Managed Medicare|HEALTHSPRING MA|0.66||||0.66||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Managed Medicare|VAN ZANDT COUNTY INMATE|0.66||||||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Managed Medicare|BCBS MEDICARE PPO MA|||||0.66||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Managed Medicare|HOSPICE CARING HEARTS|0.66||||||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Blue Cross PPO Specialty|BCBSTX PPO|0.66||||0.66||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Blue Cross HMO Specialty|BCBSTX HMO|||||0.66||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Aetna|AETNA OTHER|||||0.66||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Aetna|AETNA PPO|0.66||||0.66||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.66||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.66||||0.66||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||0.66||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.66||||||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.66||||0.66||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.66||||0.66||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.66||||0.66||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Veterans Affairs|VETERANS ADMINISTRATION|0.66||||0.66||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Medicare|MEDICARE ACUTE|0.66||||0.66||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|0.66||||||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Medicaid|MEDICAID HMO|||||0.66||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Medicaid|MEDICAID|||||0.66||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Medicaid|HENDERSON COUNTY INDIGENT|||||0.66||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Medicaid|COUNTY INDIGENT HEALTH OTHER|0.66||||||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Tricare|TRICARE EAST REGION|0.66||||0.66||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|NON CONTRACTED|COMMERCIAL OTHER 1|0.66||||0.66||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|United Healthcare|UNITED HEALTHCARE|0.66||||0.66||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|United Healthcare|UNITED HEALTHCARE|0.66||||||| 9514829|ERX|0250|TERBUTALINE 1MG/ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|22.25||||||| 9514829|ERX|0250|TERBUTALINE 1MG/ML|United Healthcare|UNITED HEALTHCARE|22.25||||||| 9514829|ERX|0250|TERBUTALINE 1MG/ML|Medicare|MEDICARE ACUTE|22.25||||22.25||| 9514829|ERX|0250|TERBUTALINE 1MG/ML|Medicaid|MEDICAID HMO|22.25||||22.25||| 9514829|ERX|0250|TERBUTALINE 1MG/ML|Medicaid|MEDICAID|22.25||||22.25||| 9514829|ERX|0250|TERBUTALINE 1MG/ML|Veterans Affairs|VETERANS ADMINISTRATION|22.25||||||| 9514829|ERX|0250|TERBUTALINE 1MG/ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|22.25||||||| 9514829|ERX|0250|TERBUTALINE 1MG/ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|22.25||||22.25||| 9514829|ERX|0250|TERBUTALINE 1MG/ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||22.25||| 9514829|ERX|0250|TERBUTALINE 1MG/ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||22.25||| 9514829|ERX|0250|TERBUTALINE 1MG/ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|22.25||||22.25||| 9514829|ERX|0250|TERBUTALINE 1MG/ML|Aetna|AETNA PPO|22.25||||22.25||| 9514829|ERX|0250|TERBUTALINE 1MG/ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||22.25||| 9514829|ERX|0250|TERBUTALINE 1MG/ML|Cigna|CIGNA|||||22.25||| 9514829|ERX|0250|TERBUTALINE 1MG/ML|Blue Cross PPO Specialty|BCBSTX PPO|22.25||||22.25||| 9514829|ERX|0250|TERBUTALINE 1MG/ML|Humana Medicare Advantage|HUMANA MA|22.25||||||| 9514829|ERX|0250|TERBUTALINE 1MG/ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|22.25||||||| 9514829|ERX|0250|TERBUTALINE 1MG/ML|Managed Medicaid|MEDICAID SUPERIOR|22.25||||22.25||| 9514829|ERX|0250|TERBUTALINE 1MG/ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||22.25||| 9514829|ERX|0250|TERBUTALINE 1MG/ML|Managed Medicaid|MEDICAID AMERIGROUP|22.25||||22.25||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|93.25||||93.25||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|93.25||||93.25||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|93.25||||93.25||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|ChampVA|CHAMPVA CENTER|||||93.25||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Cigna|CIGNA|93.25||||||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|93.25||||93.25||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Blue Cross HMO Specialty|BCBSTX HMO|93.25||||||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Cigna|CIGNA|93.25||||93.25||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Aetna|AETNA PPO|93.25||||93.25||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|93.25||||93.25||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||93.25||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|93.25||||93.25||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||93.25||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||93.25||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|93.25||||93.25||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Medicare|MEDICARE ACUTE|93.25||||93.25||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Medicaid|MEDICAID|93.25||||93.25||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Medicaid|MEDICAID HMO|93.25||||||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|United Healthcare|UNITED HEALTHCARE|93.25||||93.25||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|93.25||||||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|United Healthcare|GEHA|93.25||||||| 9515057|ERX|0250|ACETAZOLAMIDE 500MG VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.28||||||| 9515057|ERX|0250|ACETAZOLAMIDE 500MG VIAL|Humana Medicare Advantage|HUMANA MA|4.28||||||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Tricare|TRICARE EAST REGION|4.50||||||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Managed Medicare|VAN ZANDT COUNTY INMATE|4.50||||||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|MTC Medical|VAN ZANDT COUNTY INMATE|4.50||||||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Aetna|AETNA PPO|4.50||||||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9515107|ERX|0250|BUMETANIDE 2.5MG/10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|68.50||||||| 9515107|ERX|0250|BUMETANIDE 2.5MG/10ML|Aetna|AETNA PPO|68.50||||||| 9515107|ERX|0250|BUMETANIDE 2.5MG/10ML|Blue Cross HMO Specialty|BCBSTX HMO|68.50||||||| 9515107|ERX|0250|BUMETANIDE 2.5MG/10ML|Humana Medicare Advantage|HUMANA MA|68.50||||||| 9515107|ERX|0250|BUMETANIDE 2.5MG/10ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|68.50||||||| 9515107|ERX|0250|BUMETANIDE 2.5MG/10ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|68.50||||||| 9515107|ERX|0250|BUMETANIDE 2.5MG/10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|68.50||||||| 9515107|ERX|0250|BUMETANIDE 2.5MG/10ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|68.50||||||| 9515107|ERX|0250|BUMETANIDE 2.5MG/10ML|Medicare|MEDICARE ACUTE|68.50||||||| 9515107|ERX|0250|BUMETANIDE 2.5MG/10ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|68.50||||||| 9515123|ERX|0250|ACYCLOVIR 500MG VIAL|Managed Medicaid|MEDICAID SUPERIOR|368.25||||||| 9515131|ERX|0250|ETOMIDATE 2MG/ML, 20ML|Medicare|MEDICARE ACUTE|1.33||||1.33||| 9515131|ERX|0250|ETOMIDATE 2MG/ML, 20ML|Veterans Affairs|VETERANS ADMINISTRATION|1.33||||1.33||| 9515131|ERX|0250|ETOMIDATE 2MG/ML, 20ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.33||||||| 9515131|ERX|0250|ETOMIDATE 2MG/ML, 20ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.33||| 9515131|ERX|0250|ETOMIDATE 2MG/ML, 20ML|Aetna|AETNA PPO|1.33||||||| 9515131|ERX|0250|ETOMIDATE 2MG/ML, 20ML|Aenta Medicare Advantage|AETNA MEDICARE MA|1.33||||||| 9515388|ERX|0250|PILOCARPINE 5MG TABLET|Managed Medicare|HEALTHSPRING MA|23.50||||||| 9515388|ERX|0250|PILOCARPINE 5MG TABLET|Medicare|MEDICARE ACUTE|23.50||||23.50||| 9515404|ERX|0250|HEPATITIS B VACCINE(PF) 0|Tricare|TRICARE EAST REGION|14.85||||||| 9515404|ERX|0250|HEPATITIS B VACCINE(PF) 0|NON CONTRACTED|COMMERCIAL OTHER 1|14.85||||||| 9515404|ERX|0250|HEPATITIS B VACCINE(PF) 0|United Healthcare|UNITED HEALTHCARE|14.85||||||| 9515404|ERX|0250|HEPATITIS B VACCINE(PF) 0|United Healthcare|UMR UNITED MEDICAL RESOURCES|14.85||||||| 9515404|ERX|0250|HEPATITIS B VACCINE(PF) 0|United Healthcare|TML GROUP BENEFITS|14.85||||||| 9515404|ERX|0250|HEPATITIS B VACCINE(PF) 0|PHCS|HUMANA|14.85||||||| 9515404|ERX|0250|HEPATITIS B VACCINE(PF) 0|Medicaid|MEDICAID HMO|14.85||||||| 9515404|ERX|0250|HEPATITIS B VACCINE(PF) 0|Medicaid|MEDICAID|14.85||||||| 9515404|ERX|0250|HEPATITIS B VACCINE(PF) 0|Blue Cross PPO Specialty|BCBSTX PPO|14.85||||||| 9515404|ERX|0250|HEPATITIS B VACCINE(PF) 0|Cigna|CIGNA|14.85||||||| 9515404|ERX|0250|HEPATITIS B VACCINE(PF) 0|Cigna|CIGNA OTHER|14.85||||||| 9515404|ERX|0250|HEPATITIS B VACCINE(PF) 0|Blue Cross HMO Specialty|BCBSTX HMO|14.85||||||| 9515404|ERX|0250|HEPATITIS B VACCINE(PF) 0|Aetna|AETNA PPO|14.85||||||| 9515404|ERX|0250|HEPATITIS B VACCINE(PF) 0|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|14.85||||||| 9515404|ERX|0250|HEPATITIS B VACCINE(PF) 0|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|14.85||||||| 9515404|ERX|0250|HEPATITIS B VACCINE(PF) 0|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|14.85||||||| 9515404|ERX|0250|HEPATITIS B VACCINE(PF) 0|Managed Medicaid|MEDICAID SUPERIOR|14.85||||||| 9515404|ERX|0250|HEPATITIS B VACCINE(PF) 0|Managed Medicaid|MEDICAID AMERIGROUP|14.85||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Managed Medicare|MA PART B ONLY IP|4.50||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Aetna|AETNA PPO|4.50||||4.50||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|4.50||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|ChampVA|CHAMPVA CENTER|||||4.50||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Medicaid|MEDICAID|4.50||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|UTMB|UTMB CORRECTIONAL MANAGED CARE|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|PHCS|HUMANA INSURANCE|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Medicaid|LAW ENFORCEMENT OTHER|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Medicaid|MEDICAID HMO|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Medicaid|MEDICAID|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Medicaid Out of State|MEDICAID LOUISIANA|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Workers Compensation|UT EMPLOYEE INJURY|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Blue Cross PPO Specialty|BCBSTX OTHER|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Cigna|CIGNA|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Aetna|AETNA PPO|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Aetna|AETNA OTHER|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|United Healthcare|TML GROUP BENEFITS|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Humana Medicare Advantage|HUMANA MA|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Managed Medicare|HEALTHSPRING MA|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|||||4.50||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Managed Medicare|HEALTHSPRING MA|0.03||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Managed Medicare|BCBS MEDICARE PPO MA|0.03||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Managed Medicare|VAN ZANDT COUNTY INMATE|||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.03||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Managed Medicaid|MEDICAID SUPERIOR|0.03||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.03||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|MTC Medical|VAN ZANDT COUNTY INMATE|||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.03||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Aetna|AETNA PPO|0.03||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|0.03||||||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Cigna|CIGNA OTHER|||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Cigna|CIGNA|||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|ChampVA|CHAMPVA CENTER|||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Managed Medicaid|MEDICAID AMERIGROUP|||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Humana Medicare Advantage|HUMANA MA|0.03||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|0.03||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|0.03||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.03||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.03||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|United Medicare Advantage|UHC AARP MCR HMO MA|||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.03||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Veterans Affairs|VETERANS ADMINISTRATION|0.03||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Medicaid|MEDICAID|0.03||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Medicaid|HENDERSON COUNTY INDIGENT|||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Medicare|MEDICARE PART B ONLY IP|0.03||||||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Medicare|MEDICARE ACUTE|0.03||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|Tricare|TRICARE EAST REGION|0.03||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|NON CONTRACTED|COMMERCIAL OTHER 1|0.03||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|United Healthcare|UNITED HEALTHCARE OTHER|||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|United Healthcare|UNITED HEALTHCARE|||||0.03||| 9515487|ERX|0250|NITROGLYCERIN 0.4MG TABLE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.03||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|United Healthcare|UNITED HEALTHCARE|0.12||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Medicare|MEDICARE ACUTE|0.12||||0.12||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Medicare|MEDICARE PART B ONLY IP|0.12||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Veterans Affairs|VETERANS ADMINISTRATION|0.12||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.12||||0.12||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|United Medicare Advantage|UHC MEDICARE GOLD MA|0.12||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.12||||0.12||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Blue Cross PPO Specialty|BCBSTX PPO|0.12||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Aenta Medicare Advantage|AETNA MEDICARE MA|0.12||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Humana Medicare Advantage|HUMANA MA|0.12||||0.12||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.12||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Managed Medicaid|MEDICAID SUPERIOR|0.12||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Managed Medicare|HEALTHSPRING MA|0.12||||||| 9515693|ERX|0250|OXYCODONE SR 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.25||||||| 9515693|ERX|0250|OXYCODONE SR 10MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|5.25||||||| 9515693|ERX|0250|OXYCODONE SR 10MG TABLET|Aetna|BOON CHAPMAN|5.25||||||| 9515693|ERX|0250|OXYCODONE SR 10MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|5.25||||||| 9515693|ERX|0250|OXYCODONE SR 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|5.25||||||| 9515693|ERX|0250|OXYCODONE SR 10MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|5.25||||||| 9515693|ERX|0250|OXYCODONE SR 10MG TABLET|Medicare|MEDICARE ACUTE|5.25||||5.25||| 9515693|ERX|0250|OXYCODONE SR 10MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|5.25||||||| 9515701|ERX|0250|OXYCODONE SR 20MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.50||| 9515701|ERX|0250|OXYCODONE SR 20MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9515701|ERX|0250|OXYCODONE SR 20MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9515719|ERX|0250|OXYCODONE SR 40MG TABLET|Tricare|TRICARE EAST REGION|4.50||||||| 9515719|ERX|0250|OXYCODONE SR 40MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9515750|ERX|0250|ARIPIPRAZOLE 2MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|20.25||||20.25||| 9515750|ERX|0250|ARIPIPRAZOLE 2MG TABLET|Humana Medicare Advantage|HUMANA MA|20.25||||||| 9515750|ERX|0250|ARIPIPRAZOLE 2MG TABLET|Medicare|MEDICARE ACUTE|20.25||||20.25||| 9515776|ERX|0250|ARIPIPRAZOLE 10MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.45||||0.45||| 9515776|ERX|0250|ARIPIPRAZOLE 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.45||| 9515776|ERX|0250|ARIPIPRAZOLE 10MG TABLET|Tricare|TRICARE EAST REGION|0.45||||||| 9515776|ERX|0250|ARIPIPRAZOLE 10MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.45||||0.45||| 9515776|ERX|0250|ARIPIPRAZOLE 10MG TABLET|Medicaid|MEDICAID|0.45||||||| 9515776|ERX|0250|ARIPIPRAZOLE 10MG TABLET|Medicare|MEDICARE ACUTE|0.45||||0.45||| 9515776|ERX|0250|ARIPIPRAZOLE 10MG TABLET|Managed Medicare|HEALTHSPRING MA|0.45||||0.45||| 9515776|ERX|0250|ARIPIPRAZOLE 10MG TABLET|Humana Medicare Advantage|HUMANA MA|0.45||||0.45||| 9515776|ERX|0250|ARIPIPRAZOLE 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.45||||0.45||| 9515776|ERX|0250|ARIPIPRAZOLE 10MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||0.45||| 9515776|ERX|0250|ARIPIPRAZOLE 10MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.45||||0.45||| 9515776|ERX|0250|ARIPIPRAZOLE 10MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|0.45||||||| 9515776|ERX|0250|ARIPIPRAZOLE 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||0.45||| 9515776|ERX|0250|ARIPIPRAZOLE 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.45||||||| 9515792|ERX|0250|OLANZAPINE 10MG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||239.25||| 9515792|ERX|0250|OLANZAPINE 10MG/2ML|Humana Medicare Advantage|HUMANA MA|239.25||||||| 9515792|ERX|0250|OLANZAPINE 10MG/2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|239.25||||||| 9515792|ERX|0250|OLANZAPINE 10MG/2ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|239.25||||239.25||| 9515792|ERX|0250|OLANZAPINE 10MG/2ML|Managed Medicare|HEALTHSPRING MA|239.25||||||| 9515792|ERX|0250|OLANZAPINE 10MG/2ML|Medicare|MEDICARE ACUTE|239.25||||||| 9515792|ERX|0250|OLANZAPINE 10MG/2ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|239.25||||239.25||| 9515792|ERX|0250|OLANZAPINE 10MG/2ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|239.25||||||| 9515917|ERX|0250|GLYCOPYRROLATE 1MG TABLET|Medicare|MEDICARE ACUTE|||||6.50||| 9515925|ERX|0250|NITROGLYCERIN SPRAY|Humana Medicare Advantage|HUMANA MA|||||1,264.50||| 9515925|ERX|0250|NITROGLYCERIN SPRAY|Aetna|AETNA PPO|||||1,264.50||| 9515925|ERX|0250|NITROGLYCERIN SPRAY|Medicare|MEDICARE ACUTE|||||1,264.50||| 9515941|ERX|0250|ORAPRED SOLUTION 15MG/5ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||35.25||| 9515941|ERX|0250|ORAPRED SOLUTION 15MG/5ML|NON CONTRACTED|COMMERCIAL OTHER 1|35.25||||35.25||| 9515941|ERX|0250|ORAPRED SOLUTION 15MG/5ML|United Healthcare|UNITED HEALTHCARE|35.25||||35.25||| 9515941|ERX|0250|ORAPRED SOLUTION 15MG/5ML|United Healthcare|UNITED HEALTHCARE|||||35.25||| 9515941|ERX|0250|ORAPRED SOLUTION 15MG/5ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||35.25||| 9515941|ERX|0250|ORAPRED SOLUTION 15MG/5ML|United Healthcare|UNITED HEALTHCARE OTHER|||||35.25||| 9515941|ERX|0250|ORAPRED SOLUTION 15MG/5ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||35.25||| 9515941|ERX|0250|ORAPRED SOLUTION 15MG/5ML|Medicaid|MEDICAID HMO|||||35.25||| 9515941|ERX|0250|ORAPRED SOLUTION 15MG/5ML|Tricare|TRICARE FOR LIFE|||||35.25||| 9515941|ERX|0250|ORAPRED SOLUTION 15MG/5ML|Medicaid|MEDICAID|||||35.25||| 9515941|ERX|0250|ORAPRED SOLUTION 15MG/5ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||35.25||| 9515941|ERX|0250|ORAPRED SOLUTION 15MG/5ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||35.25||| 9515941|ERX|0250|ORAPRED SOLUTION 15MG/5ML|Cigna|CIGNA|||||35.25||| 9515941|ERX|0250|ORAPRED SOLUTION 15MG/5ML|Blue Cross PPO Specialty|BCBSTX PPO|||||35.25||| 9515941|ERX|0250|ORAPRED SOLUTION 15MG/5ML|Blue Cross HMO Specialty|BCBSTX HMO|||||35.25||| 9515941|ERX|0250|ORAPRED SOLUTION 15MG/5ML|Aetna|AETNA PPO|||||35.25||| 9515941|ERX|0250|ORAPRED SOLUTION 15MG/5ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||35.25||| 9515941|ERX|0250|ORAPRED SOLUTION 15MG/5ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||35.25||| 9515941|ERX|0250|ORAPRED SOLUTION 15MG/5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||35.25||| 9515941|ERX|0250|ORAPRED SOLUTION 15MG/5ML|Managed Medicaid|MEDICAID SUPERIOR|35.25||||35.25||| 9515941|ERX|0250|ORAPRED SOLUTION 15MG/5ML|Managed Medicaid|MEDICAID AMERIGROUP|35.25||||35.25||| 9516006|ERX|0250|DEXAMETHASONE 0.5MG/5ML,3|Managed Medicaid|MEDICAID SUPERIOR|76.50||||76.50||| 9516006|ERX|0250|DEXAMETHASONE 0.5MG/5ML,3|Managed Medicaid|MEDICAID AMERIGROUP|||||76.50||| 9516006|ERX|0250|DEXAMETHASONE 0.5MG/5ML,3|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||76.50||| 9516006|ERX|0250|DEXAMETHASONE 0.5MG/5ML,3|Blue Cross PPO Specialty|BCBSTX PPO|||||76.50||| 9516006|ERX|0250|DEXAMETHASONE 0.5MG/5ML,3|Cigna|CIGNA|||||76.50||| 9516006|ERX|0250|DEXAMETHASONE 0.5MG/5ML,3|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||76.50||| 9516055|ERX|0250|NIACIN SR 500MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|23.50||||||| 9516055|ERX|0250|NIACIN SR 500MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||23.50||| 9516055|ERX|0250|NIACIN SR 500MG TABLET|Medicare|MEDICARE ACUTE|23.50||||23.50||| 9516055|ERX|0250|NIACIN SR 500MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||23.50||| 9516055|ERX|0250|NIACIN SR 500MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||23.50||| 9516055|ERX|0250|NIACIN SR 500MG TABLET|Humana Medicare Advantage|HUMANA MA|23.50||||23.50||| 9516055|ERX|0250|NIACIN SR 500MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|23.50||||||| 9516071|ERX|0250|METHIMAZOLE 10MG TABLET|Medicare|MEDICARE ACUTE|16.75||||16.75||| 9516071|ERX|0250|METHIMAZOLE 10MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|16.75||||16.75||| 9516089|ERX|0250|LIOTHYRONINE 5MCG TABLET|Medicare|MEDICARE ACUTE|11.75||||||| 9516139|ERX|0250|METAXALONE 800MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Managed Medicare|HOSPICE CARING HEARTS|4.50||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Managed Medicare|WELLCARE CHOICE MA|||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Managed Medicare|HOSPICE OF EAST TEXAS|4.50||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Managed Medicare|HOSPICE ETMC|4.50||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Aetna|AETNA OTHER|||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Aetna|AETNA PPO|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|4.50||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Cigna|CIGNA|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|ChampVA|CHAMPVA CENTER|||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Blue Cross PPO Specialty|BCBSTX OTHER|||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Cigna|CIGNA|||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Cigna|CIGNA OTHER|4.50||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Tricare|TRICARE EAST REGION|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|United Healthcare|GOLDEN RULE|||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|United Healthcare|UNITED HEALTHCARE OTHER|||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Managed Medicare|HOSPICE GENESIS|4.50||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Medicaid|MEDICAID|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Medicaid|MEDICAID HMO|||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Workers Compensation|UT EMPLOYEE INJURY|||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||4.50||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Medicaid|MEDICAID HMO|||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Medicaid|LAW ENFORCEMENT OTHER|0.13||||||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Medicaid|MEDICAID|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Medicaid|HENDERSON COUNTY INDIGENT|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Medicare|MEDICARE ACUTE|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Tricare|TRICARE EAST REGION|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|PHCS|MULTIPLAN PHCS OTHER|||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|United Healthcare|UNITED HEALTHCARE OTHER|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|United Healthcare|GEHA|||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|United Healthcare|UNITED HEALTHCARE|||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|United Healthcare|UNITED HEALTHCARE|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|United Healthcare|TML GROUP BENEFITS|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|NON CONTRACTED|COMMERCIAL OTHER 1|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Texas Workforce Commission|DIS DETER SERV (DDS)|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|ChampVA|CHAMPVA CENTER|||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Cigna|CIGNA|||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Cigna|CIGNA|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Cigna|CIGNA OTHER|||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Blue Cross HMO Specialty|BCBSTX HMO|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Veterans Affairs|VETERANS ADMINISTRATION|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Aetna|AETNA OTHER|||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Aetna|AETNA PPO|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UMR|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Managed Medicare|BCBS MEDICARE PPO MA|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Managed Medicare|HEALTHSPRING MA|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Humana Medicare Advantage|HUMANA MA|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.13||||0.13||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|0.13||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Humana Medicare Advantage|HUMANA MA|0.18||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.18||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Managed Medicaid|MEDICAID SUPERIOR|0.18||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.18||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|MTC Medical|VAN ZANDT COUNTY INMATE|||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Managed Medicare|HEALTHSPRING MA|0.18||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.18||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Aetna|AETNA PPO|0.18||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Aetna|BOON CHAPMAN|0.18||||||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.18||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.18||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.18||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|ChampVA|CHAMPVA CENTER|0.18||||||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|0.18||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Cigna|CIGNA|0.18||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Access Direct Platinum|HEALTHFIRST TPA UMR|||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Managed Medicare|VAN ZANDT COUNTY INMATE|||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Cigna|CIGNA|||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Blue Cross HMO Specialty|BCBSTX HMO|0.18||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|United Healthcare|TML GROUP BENEFITS|0.18||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Tricare|TRICARE EAST REGION|0.18||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Managed Medicaid|MEDICAID AMERIGROUP|0.18||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|NON CONTRACTED|COMMERCIAL OTHER 1|0.18||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|United Healthcare|GOLDEN RULE|||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|United Healthcare|UNITED HEALTHCARE|0.18||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|United Healthcare|UNITED HEALTHCARE OTHER|||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Medicaid|MEDICAID HMO|0.18||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Medicaid|MEDICAID|0.18||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Medicaid|HENDERSON COUNTY INDIGENT|||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|0.18||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Medicare|MEDICARE ACUTE|0.18||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Veterans Affairs|VETERANS ADMINISTRATION|||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.18||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.18||||0.18||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.18||||0.18||| 9516386|ERX|0250|TIMOLOL GEL 0.5% EYE DROP|United Medicare Advantage|UHC MEDICARE GOLD MA|2.95||||||| 9516386|ERX|0250|TIMOLOL GEL 0.5% EYE DROP|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.95||| 9516386|ERX|0250|TIMOLOL GEL 0.5% EYE DROP|Medicare|MEDICARE ACUTE|2.95||||||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|Cigna|CIGNA OTHER|||||48.25||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||48.25||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||48.25||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|Humana Medicare Advantage|HUMANA MA|||||48.25||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|Managed Medicaid|MEDICAID SUPERIOR|||||48.25||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|Managed Medicaid|MEDICAID AMERIGROUP|||||48.25||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|Medicaid|MEDICAID HMO|||||48.25||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|Medicaid|MEDICAID|||||48.25||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|Medicare|MEDICARE ACUTE|48.25||||48.25||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|48.25||||||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|48.25||||||| 9516410|ERX|0250|CIPROFLOXACIN 0.3% DROP,5|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||127.50||| 9516410|ERX|0250|CIPROFLOXACIN 0.3% DROP,5|United Medicare Advantage|UHC MEDICARE GOLD MA|||||127.50||| 9516410|ERX|0250|CIPROFLOXACIN 0.3% DROP,5|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||127.50||| 9516410|ERX|0250|CIPROFLOXACIN 0.3% DROP,5|Medicaid|HENDERSON COUNTY INDIGENT|||||127.50||| 9516410|ERX|0250|CIPROFLOXACIN 0.3% DROP,5|Medicare|MEDICARE ACUTE|127.50||||127.50||| 9516410|ERX|0250|CIPROFLOXACIN 0.3% DROP,5|Managed Medicare|HEALTHSPRING MA|||||127.50||| 9516410|ERX|0250|CIPROFLOXACIN 0.3% DROP,5|Humana Medicare Advantage|HUMANA MA|||||127.50||| 9516410|ERX|0250|CIPROFLOXACIN 0.3% DROP,5|Managed Medicaid|MEDICAID AMERIGROUP|||||127.50||| 9516410|ERX|0250|CIPROFLOXACIN 0.3% DROP,5|Aetna|AETNA PPO|||||127.50||| 9516410|ERX|0250|CIPROFLOXACIN 0.3% DROP,5|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||127.50||| 9516410|ERX|0250|CIPROFLOXACIN 0.3% DROP,5|Aenta Medicare Advantage|AETNA MEDICARE MA|||||127.50||| 9516410|ERX|0250|CIPROFLOXACIN 0.3% DROP,5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||127.50||| 9516410|ERX|0250|CIPROFLOXACIN 0.3% DROP,5|ChampVA|CHAMPVA CENTER|||||127.50||| 9516410|ERX|0250|CIPROFLOXACIN 0.3% DROP,5|Blue Cross PPO Specialty|BCBSTX PPO|||||127.50||| 9516410|ERX|0250|CIPROFLOXACIN 0.3% DROP,5|Cigna|CIGNA|||||127.50||| 9516410|ERX|0250|CIPROFLOXACIN 0.3% DROP,5|Blue Cross HMO Specialty|BCBSTX HMO|||||127.50||| 9516428|ERX|0250|OPIUM-BELLAD 16.2-60MG SU|Blue Cross PPO Specialty|BCBSTX PPO|153.75||||153.75||| 9516428|ERX|0250|OPIUM-BELLAD 16.2-60MG SU|Blue Cross HMO Specialty|BCBSTX HMO|||||153.75||| 9516428|ERX|0250|OPIUM-BELLAD 16.2-60MG SU|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|153.75||||153.75||| 9516428|ERX|0250|OPIUM-BELLAD 16.2-60MG SU|Aetna|AETNA PPO|||||153.75||| 9516428|ERX|0250|OPIUM-BELLAD 16.2-60MG SU|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||153.75||| 9516428|ERX|0250|OPIUM-BELLAD 16.2-60MG SU|Aenta Medicare Advantage|AETNA MEDICARE MA|153.75||||153.75||| 9516428|ERX|0250|OPIUM-BELLAD 16.2-60MG SU|Humana Medicare Advantage|HUMANA MA|153.75||||153.75||| 9516428|ERX|0250|OPIUM-BELLAD 16.2-60MG SU|Managed Medicaid|MEDICAID SUPERIOR|153.75||||153.75||| 9516428|ERX|0250|OPIUM-BELLAD 16.2-60MG SU|Managed Medicaid|MEDICAID UNITED HEALTHCARE|153.75||||153.75||| 9516428|ERX|0250|OPIUM-BELLAD 16.2-60MG SU|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||153.75||| 9516428|ERX|0250|OPIUM-BELLAD 16.2-60MG SU|Managed Medicare|BCBS MEDICARE PPO MA|153.75||||||| 9516428|ERX|0250|OPIUM-BELLAD 16.2-60MG SU|Managed Medicare|HEALTHSPRING MA|||||153.75||| 9516428|ERX|0250|OPIUM-BELLAD 16.2-60MG SU|Managed Medicare|OTHER INSTITUTIONS|||||153.75||| 9516428|ERX|0250|OPIUM-BELLAD 16.2-60MG SU|Multiplan|NALC|||||153.75||| 9516428|ERX|0250|OPIUM-BELLAD 16.2-60MG SU|Medicare|MEDICARE ACUTE|153.75||||153.75||| 9516428|ERX|0250|OPIUM-BELLAD 16.2-60MG SU|Veterans Affairs|VETERANS ADMINISTRATION|153.75||||153.75||| 9516428|ERX|0250|OPIUM-BELLAD 16.2-60MG SU|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|153.75||||153.75||| 9516428|ERX|0250|OPIUM-BELLAD 16.2-60MG SU|United Medicare Advantage|AARP UHC WEST COMPLETE MA|153.75||||153.75||| 9516428|ERX|0250|OPIUM-BELLAD 16.2-60MG SU|United Medicare Advantage|UHC MEDICARE GOLD MA|153.75||||153.75||| 9516469|ERX|0250|NEOMYC-POLYMYX-HC ,10ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.16||| 9516469|ERX|0250|NEOMYC-POLYMYX-HC ,10ML|Medicaid|MEDICAID|||||4.16||| 9516469|ERX|0250|NEOMYC-POLYMYX-HC ,10ML|Medicare|MEDICARE ACUTE|4.16||||4.16||| 9516469|ERX|0250|NEOMYC-POLYMYX-HC ,10ML|Tricare|TRICARE EAST REGION|||||4.16||| 9516469|ERX|0250|NEOMYC-POLYMYX-HC ,10ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.16||| 9516469|ERX|0250|NEOMYC-POLYMYX-HC ,10ML|United Healthcare|UNITED HEALTHCARE|||||4.16||| 9516469|ERX|0250|NEOMYC-POLYMYX-HC ,10ML|United Healthcare|UNITED HEALTHCARE OTHER|||||4.16||| 9516469|ERX|0250|NEOMYC-POLYMYX-HC ,10ML|Humana Medicare Advantage|HUMANA MA|||||4.16||| 9516469|ERX|0250|NEOMYC-POLYMYX-HC ,10ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.16||| 9516469|ERX|0250|NEOMYC-POLYMYX-HC ,10ML|Managed Medicaid|MEDICAID SUPERIOR|||||4.16||| 9516469|ERX|0250|NEOMYC-POLYMYX-HC ,10ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.16||| 9516469|ERX|0250|NEOMYC-POLYMYX-HC ,10ML|Managed Medicaid|MEDICAID AMERIGROUP|||||4.16||| 9516469|ERX|0250|NEOMYC-POLYMYX-HC ,10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.16||| 9516469|ERX|0250|NEOMYC-POLYMYX-HC ,10ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.16||| 9516469|ERX|0250|NEOMYC-POLYMYX-HC ,10ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||4.16||| 9516469|ERX|0250|NEOMYC-POLYMYX-HC ,10ML|Blue Cross PPO Specialty|BCBSTX PPO|||||4.16||| 9516469|ERX|0250|NEOMYC-POLYMYX-HC ,10ML|Cigna|CIGNA|||||4.16||| 9516477|ERX|0250|NEOMYC-POLYMYX-HC EAR,10M|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.16||| 9516477|ERX|0250|NEOMYC-POLYMYX-HC EAR,10M|Humana Medicare Advantage|HUMANA MA|||||4.16||| 9516477|ERX|0250|NEOMYC-POLYMYX-HC EAR,10M|Managed Medicaid|MEDICAID SUPERIOR|||||4.16||| 9516477|ERX|0250|NEOMYC-POLYMYX-HC EAR,10M|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.16||| 9516477|ERX|0250|NEOMYC-POLYMYX-HC EAR,10M|United Healthcare|UNITED HEALTHCARE|||||4.16||| 9516477|ERX|0250|NEOMYC-POLYMYX-HC EAR,10M|Medicare|MEDICARE ACUTE|||||4.16||| 9516535|ERX|0250|KETOROLAC 0.5% EYE DROP,|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.93||| 9516535|ERX|0250|KETOROLAC 0.5% EYE DROP,|United Medicare Advantage|UHC MEDICARE GOLD MA|4.93||||4.93||| 9516535|ERX|0250|KETOROLAC 0.5% EYE DROP,|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.93||| 9516535|ERX|0250|KETOROLAC 0.5% EYE DROP,|Medicare|MEDICARE ACUTE|4.93||||4.93||| 9516535|ERX|0250|KETOROLAC 0.5% EYE DROP,|Managed Medicare|HEALTHSPRING MA|||||4.93||| 9516535|ERX|0250|KETOROLAC 0.5% EYE DROP,|Humana Medicare Advantage|HUMANA MA|||||4.93||| 9516535|ERX|0250|KETOROLAC 0.5% EYE DROP,|ChampVA|CHAMPVA CENTER|||||4.93||| 9516535|ERX|0250|KETOROLAC 0.5% EYE DROP,|Blue Cross PPO Specialty|BCBSTX PPO|||||4.93||| 9516535|ERX|0250|KETOROLAC 0.5% EYE DROP,|Cigna|CIGNA|||||4.93||| 9516535|ERX|0250|KETOROLAC 0.5% EYE DROP,|Blue Cross HMO Specialty|BCBSTX HMO|||||4.93||| 9516535|ERX|0250|KETOROLAC 0.5% EYE DROP,|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.93||| 9516535|ERX|0250|KETOROLAC 0.5% EYE DROP,|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.93||| 9516576|ERX|0250|RAMIPRIL 2.5MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|||||0.24||| 9516576|ERX|0250|RAMIPRIL 2.5MG CAPSULE|Humana Medicare Advantage|HUMANA MA|0.24||||0.24||| 9516576|ERX|0250|RAMIPRIL 2.5MG CAPSULE|Medicare|MEDICARE ACUTE|0.24||||0.24||| 9516584|ERX|0250|RAMIPRIL 5MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||23.50||| 9516584|ERX|0250|RAMIPRIL 5MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|23.50||||||| 9516584|ERX|0250|RAMIPRIL 5MG CAPSULE|United Healthcare|UNITED HEALTHCARE|||||23.50||| 9516584|ERX|0250|RAMIPRIL 5MG CAPSULE|Medicaid|MOLINA HEALTHCARE OF TEXAS|23.50||||||| 9516584|ERX|0250|RAMIPRIL 5MG CAPSULE|Medicare|MEDICARE ACUTE|23.50||||23.50||| 9516584|ERX|0250|RAMIPRIL 5MG CAPSULE|Managed Medicare|BCBS MEDICARE PPO MA|23.50||||||| 9516584|ERX|0250|RAMIPRIL 5MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|23.50||||||| 9516584|ERX|0250|RAMIPRIL 5MG CAPSULE|Humana Medicare Advantage|HUMANA MA|23.50||||23.50||| 9516584|ERX|0250|RAMIPRIL 5MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|23.50||||||| 9516584|ERX|0250|RAMIPRIL 5MG CAPSULE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||23.50||| 9516584|ERX|0250|RAMIPRIL 5MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||23.50||| 9516584|ERX|0250|RAMIPRIL 5MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|||||23.50||| 9516600|ERX|0250|SILVER SULFADIAZINE 1% ,4|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||5.61||| 9516600|ERX|0250|SILVER SULFADIAZINE 1% ,4|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||5.61||| 9516600|ERX|0250|SILVER SULFADIAZINE 1% ,4|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||5.61||| 9516600|ERX|0250|SILVER SULFADIAZINE 1% ,4|Medicare|MEDICARE ACUTE|5.61||||5.61||| 9516634|ERX|0250|FLUDROCORTISONE 0.1MG TAB|Humana Medicare Advantage|HUMANA MA|2.75||||2.75||| 9516634|ERX|0250|FLUDROCORTISONE 0.1MG TAB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.75||| 9516634|ERX|0250|FLUDROCORTISONE 0.1MG TAB|Blue Cross PPO Specialty|BCBSTX PPO|2.75||||||| 9516634|ERX|0250|FLUDROCORTISONE 0.1MG TAB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.75||| 9516634|ERX|0250|FLUDROCORTISONE 0.1MG TAB|Medicare|MEDICARE ACUTE|2.75||||2.75||| 9516634|ERX|0250|FLUDROCORTISONE 0.1MG TAB|Medicaid|MEDICAID|||||2.75||| 9516634|ERX|0250|FLUDROCORTISONE 0.1MG TAB|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.75||||||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Tricare|TRICARE EAST REGION|0.53||||||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Humana Medicare Advantage|HUMANA MA|0.53||||0.53||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Managed Medicare|BCBS MEDICARE PPO MA|0.53||||||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Managed Medicaid|MEDICAID AMERIGROUP|0.53||||0.53||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.53||||0.53||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Veterans Affairs|VETERANS ADMINISTRATION|0.53||||0.53||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|United Medicare Advantage|UHC MEDICARE GOLD MA|0.53||||0.53||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Cigna|CIGNA|||||0.53||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Cigna|CIGNA OTHER|||||0.53||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Medicare|MEDICARE PART B ONLY IP|0.53||||||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.53||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.53||||0.53||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Managed Medicaid|MEDICAID SUPERIOR|0.53||||0.53||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Medicaid|HENDERSON COUNTY INDIGENT|0.53||||0.53||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Medicare|MEDICARE ACUTE|0.53||||0.53||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.53||||0.53||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Managed Medicare|WELLCARE CHOICE MA|||||0.53||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|NON CONTRACTED|COMMERCIAL OTHER 1|0.53||||||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|0.53||||||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Managed Medicare|HEALTHSPRING MA|||||0.53||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Blue Cross HMO Specialty|BCBSTX HMO|||||0.53||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|United Healthcare|UNITED HEALTHCARE OTHER|||||0.53||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Blue Cross PPO Specialty|BCBSTX PPO|0.53||||0.53||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.53||||0.53||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.53||||0.53||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|United Healthcare|UNITED HEALTHCARE|||||0.53||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Aetna|AETNA PPO|0.53||||||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Aetna|BOON CHAPMAN|0.53||||||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Medicaid|MEDICAID|0.53||||0.53||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|United Healthcare|UNITED HEALTHCARE|0.53||||||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.53||||0.53||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.53||||||| 9516691|ERX|0250|POLYMYXIN B-TMP EYE DROP,|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3.29||| 9516691|ERX|0250|POLYMYXIN B-TMP EYE DROP,|Managed Medicaid|MEDICAID SUPERIOR|||||3.29||| 9516766|ERX|0250|DILTIAZEM XL 300MG CAPSUL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.50||| 9516766|ERX|0250|DILTIAZEM XL 300MG CAPSUL|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9516766|ERX|0250|DILTIAZEM XL 300MG CAPSUL|Medicare|MEDICARE ACUTE|4.50||||||| 9516766|ERX|0250|DILTIAZEM XL 300MG CAPSUL|Aetna|AETNA PPO|4.50||||||| 9516766|ERX|0250|DILTIAZEM XL 300MG CAPSUL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9516766|ERX|0250|DILTIAZEM XL 300MG CAPSUL|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9516766|ERX|0250|DILTIAZEM XL 300MG CAPSUL|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9516774|ERX|0250|PERMETHRIN 5% CREAM, 60 G|Managed Medicaid|MEDICAID SUPERIOR|||||154.50||| 9516790|ERX|0250|DONEPEZIL 5MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9516790|ERX|0250|DONEPEZIL 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9516790|ERX|0250|DONEPEZIL 5MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9516790|ERX|0250|DONEPEZIL 5MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9516790|ERX|0250|DONEPEZIL 5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9516790|ERX|0250|DONEPEZIL 5MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9516790|ERX|0250|DONEPEZIL 5MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9516790|ERX|0250|DONEPEZIL 5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9516790|ERX|0250|DONEPEZIL 5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9516790|ERX|0250|DONEPEZIL 5MG TABLET|Aetna|AETNA PPO|4.50||||4.50||| 9516824|ERX|0250|ZONISAMIDE 100MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|||||28.50||| 9516824|ERX|0250|ZONISAMIDE 100MG CAPSULE|United Healthcare|UNITED HEALTHCARE|28.50||||||| 9516824|ERX|0250|ZONISAMIDE 100MG CAPSULE|Medicare|MEDICARE ACUTE|28.50||||28.50||| 9516907|ERX|0250|CEFADROXIL 500MG CAPSULE|Medicare|MEDICARE ACUTE|36.75||||||| 9517038|ERX|0250|OXYTOCIN 10 UNIT/1ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|11.75||||||| 9517038|ERX|0250|OXYTOCIN 10 UNIT/1ML|United Healthcare|UNITED HEALTHCARE|11.75||||||| 9517038|ERX|0250|OXYTOCIN 10 UNIT/1ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|11.75||||||| 9517038|ERX|0250|OXYTOCIN 10 UNIT/1ML|Medicaid|MEDICAID HMO|11.75||||||| 9517038|ERX|0250|OXYTOCIN 10 UNIT/1ML|Medicaid|MEDICAID|11.75||||||| 9517038|ERX|0250|OXYTOCIN 10 UNIT/1ML|Tricare|TRICARE EAST REGION|11.75||||||| 9517038|ERX|0250|OXYTOCIN 10 UNIT/1ML|Aetna|AETNA PPO|11.75||||||| 9517038|ERX|0250|OXYTOCIN 10 UNIT/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|11.75||||||| 9517038|ERX|0250|OXYTOCIN 10 UNIT/1ML|Blue Cross PPO Specialty|BCBSTX PPO|11.75||||11.75||| 9517038|ERX|0250|OXYTOCIN 10 UNIT/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|11.75||||11.75||| 9517038|ERX|0250|OXYTOCIN 10 UNIT/1ML|NON CONTRACTED|COMMERCIAL OTHER 1|11.75||||||| 9517038|ERX|0250|OXYTOCIN 10 UNIT/1ML|Managed Medicaid|MEDICAID SUPERIOR|11.75||||||| 9517038|ERX|0250|OXYTOCIN 10 UNIT/1ML|Managed Medicaid|MEDICAID AMERIGROUP|11.75||||11.75||| 9517038|ERX|0250|OXYTOCIN 10 UNIT/1ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|11.75||||||| 9517038|ERX|0250|OXYTOCIN 10 UNIT/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|11.75||||||| 9517038|ERX|0250|OXYTOCIN 10 UNIT/1ML|Blue Cross HMO Specialty|BCBSTX HMO|11.75||||||| 9517038|ERX|0250|OXYTOCIN 10 UNIT/1ML|ChampVA|CHAMPVA CENTER|11.75||||||| 9517038|ERX|0250|OXYTOCIN 10 UNIT/1ML|Cigna|CIGNA|11.75||||||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Cigna|CIGNA OTHER|||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Medicare|MEDICARE ACUTE|50.11||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Tricare|TRICARE EAST REGION|50.11||||||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|50.11||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|50.11||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|50.11||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|50.11||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|50.11||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|NON CONTRACTED|COMMERCIAL OTHER 1|50.11||||||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Medicaid|MEDICAID|50.11||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Medicaid|HENDERSON COUNTY INDIGENT|50.11||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Medicare|MEDICARE PART B ONLY IP|50.11||||||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Veterans Affairs|VETERANS ADMINISTRATION|50.11||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Aetna|AETNA PPO|50.11||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|50.11||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|50.11||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|50.11||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|50.11||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|50.11||||||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Managed Medicare|BCBS MEDICARE PPO MA|50.11||||||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Managed Medicaid|MEDICAID SUPERIOR|50.11||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Blue Cross HMO Specialty|BCBSTX HMO|||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|United Healthcare|UNITED HEALTHCARE|||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Managed Medicare|HEALTHSPRING MA|||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Managed Medicare|WELLCARE CHOICE MA|||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Blue Cross PPO Specialty|BCBSTX PPO|50.11||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|United Healthcare|UNITED HEALTHCARE OTHER|||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Cigna|CIGNA|||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Humana Medicare Advantage|HUMANA MA|50.11||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Managed Medicaid|MEDICAID AMERIGROUP|50.11||||50.11||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|United Healthcare|UNITED HEALTHCARE|50.11||||||| 9517053|ERX|0250|BIMATOPROST 0.03% DROP,2.|Medicare|MEDICARE ACUTE|381.25||||||| 9517053|ERX|0250|BIMATOPROST 0.03% DROP,2.|United Medicare Advantage|AARP UHC WEST COMPLETE MA|381.25||||||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.13||||0.13||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|Tricare|TRICARE EAST REGION|0.13||||||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|United Healthcare|UNITED HEALTHCARE OTHER|||||0.13||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.13||||||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.13||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|Medicare|MEDICARE ACUTE|0.13||||0.13||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|United Healthcare|UNITED HEALTHCARE|||||0.13||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|Medicaid|MEDICAID|0.13||||0.13||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|United Healthcare|UNITED HEALTHCARE|0.13||||||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|Medicaid|MOLINA HEALTHCARE OF TEXAS|0.13||||||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|Medicaid|MEDICAID HMO|||||0.13||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|United Medicare Advantage|UHC MEDICARE GOLD MA|0.13||||0.13||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.13||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|Veterans Affairs|VETERANS ADMINISTRATION|0.13||||0.13||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|Managed Medicare|HEALTHSPRING MA|0.13||||0.13||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|United Healthcare|UMR UNITED MEDICAL RESOURCES|0.13||||||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.13||||0.13||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|Managed Medicaid|MEDICAID SUPERIOR|||||0.13||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|Blue Cross HMO Specialty|BCBSTX HMO|||||0.13||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|Managed Medicaid|MEDICAID AMERIGROUP|0.13||||0.13||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|Aetna|BOON CHAPMAN|0.13||||||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.13||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|Humana Medicare Advantage|HUMANA MA|0.13||||0.13||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.13||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||0.13||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.13||||0.13||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|Managed Medicare|BCBS MEDICARE PPO MA|0.13||||||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Medicaid|HENDERSON COUNTY INDIGENT|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Medicare|MEDICARE ACUTE|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Tricare|TRICARE EAST REGION|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Medicaid|LAW ENFORCEMENT OTHER|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Medicaid|COUNTY INDIGENT HEALTH OTHER|0.43||||||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Medicaid|MEDICAID HMO|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Tricare|TRICARE FOR LIFE|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|United Healthcare|UNITED HEALTHCARE|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Medicaid|MEDICAID|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|PHCS|HUMANA|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|PHCS|HUMANA INSURANCE|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|United Healthcare|UNITED HEALTHCARE OTHER|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Workers Compensation|UT EMPLOYEE INJURY|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|UTMB|UTMB CORRECTIONAL MANAGED CARE|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Cigna|CIGNA|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Cigna|CIGNA|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Blue Cross HMO Specialty|BCBSTX HMO|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Blue Cross PPO Specialty|BCBSTX OTHER|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Aetna|BOON CHAPMAN|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Cigna|CIGNA OTHER|0.43||||||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Veterans Affairs|VETERANS ADMINISTRATION|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|United Healthcare|TML GROUP BENEFITS|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|ChampVA|CHAMPVA CENTER|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Managed Medicare|VAN ZANDT COUNTY INMATE|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|United Healthcare|UNITED HEALTHCARE|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|NON CONTRACTED|COMMERCIAL OTHER 1|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Workers Compensation|GALLAGHER BASSETT|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Managed Medicare|HEALTHSPRING MA|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Aetna|AETNA OTHER|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UMR|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Humana Medicare Advantage|HUMANA MA|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Workers Compensation|TEXAS MUTUAL INSURANCE|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Managed Medicare|BCBS MEDICARE PPO MA|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Aetna|AETNA PPO|0.43||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|Managed Medicare|WELLCARE CHOICE MA|||||0.43||| 9517103|ERX|0250|KETOROLAC 15MG/1ML|MTC Medical|VAN ZANDT COUNTY INMATE|||||0.43||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Managed Medicare|OTHER INSTITUTIONS|||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|MTC Medical|VAN ZANDT COUNTY INMATE|||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Managed Medicare|HEALTHSPRING MA|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Managed Medicare|HOSPICE CARING HEARTS|72.50||||||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Managed Medicare|VAN ZANDT COUNTY INMATE|||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UMR|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Aetna|AETNA OTHER|||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Aetna|AETNA PPO|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Humana Medicare Advantage|HUMANA MA|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Blue Cross PPO Specialty|BCBSTX OTHER|||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Cigna|CIGNA OTHER|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Cigna|CIGNA|||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|ChampVA|CHAMPVA CENTER|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|NON CONTRACTED|COMMERCIAL OTHER 1|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|United Healthcare|TML GROUP BENEFITS|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Tricare|TRICARE EAST REGION|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Blue Cross HMO Specialty|BCBSTX HMO|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Veterans Affairs|VETERANS ADMINISTRATION|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Managed Medicare|BCBS MEDICARE PPO MA|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|United Healthcare|UNITED HEALTHCARE|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|PHCS|MULTIPLAN PHCS OTHER|||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Cigna|CIGNA|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|United Healthcare|UNITED HEALTHCARE OTHER|||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Texas Workforce Commission|DIS DETER SERV (DDS)|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Medicaid|MEDICAID|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Medicaid|LAW ENFORCEMENT OTHER|72.50||||||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Multiplan|NALC|||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Medicare|MEDICARE ACUTE|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Medicaid|MEDICAID HMO|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Medicaid|HENDERSON COUNTY INDIGENT|72.50||||72.50||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|United Healthcare|GEHA|||||72.50||| 9517137|ERX|0250|GENTAMICIN PF 10MG/ML, 2M|Medicaid|MEDICAID|56.75||||||| 9517137|ERX|0250|GENTAMICIN PF 10MG/ML, 2M|Managed Medicaid|MEDICAID SUPERIOR|56.75||||56.75||| 9517137|ERX|0250|GENTAMICIN PF 10MG/ML, 2M|Blue Cross HMO Specialty|BCBSTX HMO|56.75||||||| 9517137|ERX|0250|GENTAMICIN PF 10MG/ML, 2M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|56.75||||||| 9517137|ERX|0250|GENTAMICIN PF 10MG/ML, 2M|Medicaid|MEDICAID HMO|56.75||||||| 9517137|ERX|0250|GENTAMICIN PF 10MG/ML, 2M|Managed Medicaid|MEDICAID AMERIGROUP|56.75||||56.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Medicaid|MEDICAID|15.75||||15.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Medicare|MEDICARE PART B ONLY IP|15.75||||||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|United Healthcare|UNITED HEALTHCARE|||||15.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Medicare|MEDICARE ACUTE|15.75||||15.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Veterans Affairs|VETERANS ADMINISTRATION|15.75||||15.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|United Healthcare|UNITED HEALTHCARE OTHER|||||15.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Cigna|CIGNA|||||15.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Managed Medicare|WELLCARE CHOICE MA|||||15.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|15.75||||15.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Managed Medicare|HEALTHSPRING MA|||||15.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|15.75||||15.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Aetna|AETNA PPO|15.75||||||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|15.75||||15.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Blue Cross PPO Specialty|BCBSTX PPO|15.75||||15.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|15.75||||15.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Managed Medicaid|MEDICAID SUPERIOR|15.75||||15.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Managed Medicaid|MEDICAID AMERIGROUP|15.75||||15.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Humana Medicare Advantage|HUMANA MA|15.75||||15.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Cigna|CIGNA OTHER|||||15.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|15.75||||15.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||15.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|15.75||||||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|15.75||||15.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Blue Cross HMO Specialty|BCBSTX HMO|||||15.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Tricare|TRICARE EAST REGION|15.75||||||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|NON CONTRACTED|COMMERCIAL OTHER 1|15.75||||||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|15.75||||15.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||15.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|United Healthcare|UNITED HEALTHCARE|15.75||||||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Medicaid|HENDERSON COUNTY INDIGENT|15.75||||15.75||| 9517236|ERX|0250|TOBRAMYCIN 40MG/ML, 2ML|Medicare|MEDICARE ACUTE|0.74||||||| 9517236|ERX|0250|TOBRAMYCIN 40MG/ML, 2ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.74||||||| 9517236|ERX|0250|TOBRAMYCIN 40MG/ML, 2ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.74||||||| 9517236|ERX|0250|TOBRAMYCIN 40MG/ML, 2ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.74||||||| 9517236|ERX|0250|TOBRAMYCIN 40MG/ML, 2ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.74||||||| 9517236|ERX|0250|TOBRAMYCIN 40MG/ML, 2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.74||||||| 9517236|ERX|0250|TOBRAMYCIN 40MG/ML, 2ML|Managed Medicare|HEALTHSPRING MA|0.74||||||| 9517236|ERX|0250|TOBRAMYCIN 40MG/ML, 2ML|Veterans Affairs|VETERANS ADMINISTRATION|0.74||||||| 9517236|ERX|0250|TOBRAMYCIN 40MG/ML, 2ML|Humana Medicare Advantage|HUMANA MA|0.74||||0.74||| 9517244|ERX|0250|CA GLUC 10% 0.465 MEQ/ML,|Aetna|BOON CHAPMAN|32.50||||||| 9517244|ERX|0250|CA GLUC 10% 0.465 MEQ/ML,|United Medicare Advantage|UHC MEDICARE GOLD MA|||||32.50||| 9517244|ERX|0250|CA GLUC 10% 0.465 MEQ/ML,|Managed Medicare|BCBS MEDICARE PPO MA|32.50||||||| 9517244|ERX|0250|CA GLUC 10% 0.465 MEQ/ML,|Blue Cross PPO Specialty|BCBSTX PPO|32.50||||||| 9517244|ERX|0250|CA GLUC 10% 0.465 MEQ/ML,|Humana Medicare Advantage|HUMANA MA|32.50||||32.50||| 9517244|ERX|0250|CA GLUC 10% 0.465 MEQ/ML,|Managed Medicare|HEALTHSPRING MA|||||32.50||| 9517244|ERX|0250|CA GLUC 10% 0.465 MEQ/ML,|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||32.50||| 9517244|ERX|0250|CA GLUC 10% 0.465 MEQ/ML,|Managed Medicaid|MEDICAID AMERIGROUP|||||32.50||| 9517244|ERX|0250|CA GLUC 10% 0.465 MEQ/ML,|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|32.50||||||| 9517244|ERX|0250|CA GLUC 10% 0.465 MEQ/ML,|United Medicare Advantage|AARP UHC WEST COMPLETE MA|32.50||||32.50||| 9517244|ERX|0250|CA GLUC 10% 0.465 MEQ/ML,|Medicare|MEDICARE ACUTE|32.50||||32.50||| 9517244|ERX|0250|CA GLUC 10% 0.465 MEQ/ML,|Managed Medicaid|MEDICAID UNITED HEALTHCARE|32.50||||32.50||| 9517244|ERX|0250|CA GLUC 10% 0.465 MEQ/ML,|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|32.50||||32.50||| 9517244|ERX|0250|CA GLUC 10% 0.465 MEQ/ML,|United Healthcare|UNITED HEALTHCARE|32.50||||||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Humana Medicare Advantage|HUMANA MA|1.87||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Medicaid|MEDICAID|1.87||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Medicaid|LAW ENFORCEMENT OTHER|1.87||||||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Medicare|MEDICARE ACUTE|1.87||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Tricare|TRICARE EAST REGION|||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|United Healthcare|TML GROUP BENEFITS|1.87||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|United Healthcare|UNITED HEALTHCARE OTHER|1.87||||||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|United Healthcare|UNITED HEALTHCARE|1.87||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|NON CONTRACTED|COMMERCIAL OTHER 1|1.87||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Texas Workforce Commission|DIS DETER SERV (DDS)|1.87||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|PHCS|MULTIPLAN PHCS OTHER|||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.87||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.87||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Aetna|AETNA PPO|1.87||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Veterans Affairs|VETERANS ADMINISTRATION|1.87||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Aetna|AETNA OTHER|||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.87||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UMR|1.87||||||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.87||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|United Healthcare|UNITED HEALTHCARE|||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|1.87||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Blue Cross HMO Specialty|BCBSTX HMO|1.87||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Medicaid|HENDERSON COUNTY INDIGENT|1.87||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Medicaid|MEDICAID HMO|||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Cigna|CIGNA OTHER|||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|ChampVA|CHAMPVA CENTER|||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|1.87||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.87||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|1.87||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.87||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Cigna|CIGNA|||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Managed Medicare|BCBS MEDICARE PPO MA|1.87||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|1.87||||1.87||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Managed Medicare|HEALTHSPRING MA|1.87||||1.87||| 9517301|ERX|0250|AMPICILLIN 250MG VIAL|Medicaid|MEDICAID|35.50||||||| 9517301|ERX|0250|AMPICILLIN 250MG VIAL|Managed Medicaid|MEDICAID SUPERIOR|35.50||||||| 9517301|ERX|0250|AMPICILLIN 250MG VIAL|Managed Medicaid|MEDICAID AMERIGROUP|35.50||||35.50||| 9517301|ERX|0250|AMPICILLIN 250MG VIAL|Blue Cross HMO Specialty|BCBSTX HMO|35.50||||||| 9517319|ERX|0250|AMPICILLIN 500MG VIAL|Managed Medicaid|MEDICAID AMERIGROUP|55.75||||||| 9517319|ERX|0250|AMPICILLIN 500MG VIAL|Managed Medicaid|MEDICAID SUPERIOR|55.75||||||| 9517319|ERX|0250|AMPICILLIN 500MG VIAL|Medicaid|MEDICAID|55.75||||||| 9517319|ERX|0250|AMPICILLIN 500MG VIAL|Medicare|MEDICARE ACUTE|||||55.75||| 9517319|ERX|0250|AMPICILLIN 500MG VIAL|Medicaid|MEDICAID HMO|55.75||||||| 9517327|ERX|0250|AMPICILLIN 1000MG VIAL|Medicaid|MEDICAID TEXAS CHILDRENS|||||80.50||| 9517327|ERX|0250|AMPICILLIN 1000MG VIAL|Managed Medicaid|MEDICAID AMERIGROUP|||||80.50||| 9517327|ERX|0250|AMPICILLIN 1000MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|||||80.50||| 9517368|ERX|0250|HEPARIN 10,000 UNIT/1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.28||||||| 9517368|ERX|0250|HEPARIN 10,000 UNIT/1ML|Tricare|TRICARE EAST REGION|||||0.28||| 9517368|ERX|0250|HEPARIN 10,000 UNIT/1ML|Medicare|MEDICARE ACUTE|0.28||||||| 9517368|ERX|0250|HEPARIN 10,000 UNIT/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.28||||||| 9517368|ERX|0250|HEPARIN 10,000 UNIT/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.28||||||| 9517368|ERX|0250|HEPARIN 10,000 UNIT/1ML|Aetna|AETNA PPO|0.28||||||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Managed Medicare|WELLCARE CHOICE MA|||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Managed Medicare|MA PART B ONLY IP|203.25||||||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Managed Medicaid|MEDICAID SUPERIOR|203.25||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|203.25||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|203.25||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|203.25||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Blue Cross HMO Specialty|BCBSTX HMO|||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|203.25||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Blue Cross PPO Specialty|BCBSTX PPO|203.25||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Cigna|CIGNA|203.25||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Managed Medicaid|MEDICAID AMERIGROUP|203.25||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|203.25||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|203.25||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Humana Medicare Advantage|HUMANA MA|203.25||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|ChampVA|CHAMPVA CENTER|||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Medicaid|LAW ENFORCEMENT OTHER|203.25||||||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Medicare|MEDICARE ACUTE|203.25||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Medicare|MEDICARE PART B ONLY IP|203.25||||||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Medicaid|HENDERSON COUNTY INDIGENT|203.25||||||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Aetna|AETNA PPO|203.25||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Managed Medicare|HEALTHSPRING MA|203.25||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Managed Medicare|BCBS MEDICARE PPO MA|203.25||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|United Healthcare|UNITED HEALTHCARE|203.25||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Tricare|TRICARE EAST REGION|||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|NON CONTRACTED|COMMERCIAL OTHER 1|203.25||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Veterans Affairs|VETERANS ADMINISTRATION|203.25||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Multiplan|NALC|||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|203.25||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Texas Workforce Commission|DIS DETER SERV (DDS)|203.25||||||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|203.25||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|203.25||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|Medicaid|MEDICAID|203.25||||203.25||| 9517376|ERX|0250|HYDRALAZINE 20MG 1ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||203.25||| 9517459|ERX|0250|LEVALBUTEROL NEB 0.31MG/3|Humana Medicare Advantage|HUMANA MA|42.50||||42.50||| 9517459|ERX|0250|LEVALBUTEROL NEB 0.31MG/3|Medicaid|MEDICAID|||||42.50||| 9517459|ERX|0250|LEVALBUTEROL NEB 0.31MG/3|Medicaid|MEDICAID HMO|||||42.50||| 9517459|ERX|0250|LEVALBUTEROL NEB 0.31MG/3|Managed Medicaid|MEDICAID AMERIGROUP|42.50||||42.50||| 9517459|ERX|0250|LEVALBUTEROL NEB 0.31MG/3|Managed Medicaid|MEDICAID SUPERIOR|42.50||||42.50||| 9517459|ERX|0250|LEVALBUTEROL NEB 0.31MG/3|Blue Cross PPO Specialty|BCBSTX PPO|42.50||||||| 9517459|ERX|0250|LEVALBUTEROL NEB 0.31MG/3|Medicare|MEDICARE ACUTE|42.50||||||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.18||||||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Blue Cross HMO Specialty|BCBSTX HMO|0.18||||||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.18||||||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Managed Medicaid|MEDICAID AMERIGROUP|0.18||||0.18||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Managed Medicaid|MEDICAID SUPERIOR|0.18||||0.18||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.18||||0.18||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.18||||||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Veterans Affairs|VETERANS ADMINISTRATION|0.18||||||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|United Medicare Advantage|UHC MEDICARE GOLD MA|0.18||||||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Medicaid|MEDICAID HMO|||||0.18||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Blue Cross PPO Specialty|BCBSTX PPO|||||0.18||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Aenta Medicare Advantage|AETNA MEDICARE MA|0.18||||||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Humana Medicare Advantage|HUMANA MA|0.18||||||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Medicare|MEDICARE ACUTE|0.18||||||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|Managed Medicaid|MEDICAID SUPERIOR|0.18||||0.18||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|Medicare|MEDICARE ACUTE|0.18||||0.18||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.18||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.18||||0.18||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|United Medicare Advantage|UHC MEDICARE GOLD MA|0.18||||0.18||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|Veterans Affairs|VETERANS ADMINISTRATION|||||0.18||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|Blue Cross PPO Specialty|BCBSTX PPO|||||0.18||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|Blue Cross HMO Specialty|BCBSTX HMO|||||0.18||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|Aenta Medicare Advantage|AETNA MEDICARE MA|0.18||||||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.18||||0.18||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.18||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|0.18||||||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|Humana Medicare Advantage|HUMANA MA|0.18||||0.18||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|Managed Medicare|HEALTHSPRING MA|0.18||||||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|Managed Medicaid|MEDICAID AMERIGROUP|||||0.18||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.18||||||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|Managed Medicare|BCBS MEDICARE PPO MA|0.18||||||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.18||||0.18||| 9517483|ERX|0250|MODAFINIL 100MG TABLET|Humana Medicare Advantage|HUMANA MA|0.74||||||| 9517483|ERX|0250|MODAFINIL 100MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.74||||||| 9517483|ERX|0250|MODAFINIL 100MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|0.74||||||| 9517483|ERX|0250|MODAFINIL 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.74||||0.74||| 9517566|ERX|0250|NALBUPHINE 10MG/1ML|Medicare|MEDICARE ACUTE|||||15.75||| 9517574|ERX|0250|OXYCODONE-ACETAM 5-325MG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.50||| 9517574|ERX|0250|OXYCODONE-ACETAM 5-325MG|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9517574|ERX|0250|OXYCODONE-ACETAM 5-325MG|Aetna|BOON CHAPMAN|4.50||||||| 9517574|ERX|0250|OXYCODONE-ACETAM 5-325MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9517574|ERX|0250|OXYCODONE-ACETAM 5-325MG|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9517574|ERX|0250|OXYCODONE-ACETAM 5-325MG|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9517574|ERX|0250|OXYCODONE-ACETAM 5-325MG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9517574|ERX|0250|OXYCODONE-ACETAM 5-325MG|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9517574|ERX|0250|OXYCODONE-ACETAM 5-325MG|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9517574|ERX|0250|OXYCODONE-ACETAM 5-325MG|Managed Medicare|BCBS MEDICARE PPO MA|||||4.50||| 9517574|ERX|0250|OXYCODONE-ACETAM 5-325MG|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||||| 9517574|ERX|0250|OXYCODONE-ACETAM 5-325MG|Medicare|MEDICARE ACUTE|4.50||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Medicare|MEDICARE ACUTE|76.50||||76.50||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|United Healthcare|GEHA|||||76.50||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Veterans Affairs|VETERANS ADMINISTRATION|76.50||||76.50||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|76.50||||76.50||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Medicaid|HENDERSON COUNTY INDIGENT|76.50||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|United Healthcare|UNITED HEALTHCARE|||||76.50||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Medicare|MEDICARE PART B ONLY IP|76.50||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|76.50||||76.50||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|76.50||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Managed Medicaid|MEDICAID SUPERIOR|76.50||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|United Medicare Advantage|UHC MEDICARE GOLD MA|||||76.50||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|United Medicare Advantage|AARP UHC WEST COMPLETE MA|76.50||||76.50||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Managed Medicare|HEALTHSPRING MA|76.50||||76.50||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Workers Compensation|WORKERS COMPENSATION OTHER|||||76.50||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Aenta Medicare Advantage|AETNA MEDICARE MA|||||76.50||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Humana Medicare Advantage|HUMANA MA|76.50||||76.50||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Cigna|CIGNA|||||76.50||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|49.25||||49.25||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|ChampVA|CHAMPVA CENTER|49.25||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Aetna|AETNA PPO|49.25||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UMR|||||49.25||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Managed Medicare|MA PART B ONLY IP|49.25||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||49.25||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|49.25||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|49.25||||49.25||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Managed Medicare|HEALTHSPRING MA|49.25||||49.25||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||49.25||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|49.25||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|49.25||||49.25||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|49.25||||49.25||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|49.25||||49.25||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|49.25||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|49.25||||49.25||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|49.25||||49.25||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|49.25||||49.25||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|49.25||||49.25||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|49.25||||49.25||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|||||49.25||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Tricare|TRICARE EAST REGION|49.25||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Humana Medicare Advantage|HUMANA MA|49.25||||49.25||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|49.25||||49.25||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Medicaid|LAW ENFORCEMENT OTHER|49.25||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Medicaid|MEDICAID|49.25||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Medicare|MEDICARE ACUTE|49.25||||49.25||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|United Healthcare|UNITED HEALTHCARE|||||49.25||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|49.25||||49.25||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|||||49.25||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|49.25||||||| 9517640|ERX|0250|PHENOBARBITAL 32.4MG TABL|Medicare|MEDICARE ACUTE|4.50||||||| 9517657|ERX|0250|TORSEMIDE 20MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9517657|ERX|0250|TORSEMIDE 20MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9517657|ERX|0250|TORSEMIDE 20MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9517657|ERX|0250|TORSEMIDE 20MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9517657|ERX|0250|TORSEMIDE 20MG TABLET|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9517657|ERX|0250|TORSEMIDE 20MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9517657|ERX|0250|TORSEMIDE 20MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9517657|ERX|0250|TORSEMIDE 20MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9517657|ERX|0250|TORSEMIDE 20MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9517657|ERX|0250|TORSEMIDE 20MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9517657|ERX|0250|TORSEMIDE 20MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Tricare|TRICARE EAST REGION|4.50||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Cigna|CIGNA|4.50||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Medicaid|MEDICAID HMO|||||4.50||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Aetna|AETNA PPO|4.50||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.50||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9517673|ERX|0250|GUAIFEN-DEXTROMETH 600-30|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9517673|ERX|0250|GUAIFEN-DEXTROMETH 600-30|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9517673|ERX|0250|GUAIFEN-DEXTROMETH 600-30|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9517673|ERX|0250|GUAIFEN-DEXTROMETH 600-30|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9517673|ERX|0250|GUAIFEN-DEXTROMETH 600-30|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9517673|ERX|0250|GUAIFEN-DEXTROMETH 600-30|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9517673|ERX|0250|GUAIFEN-DEXTROMETH 600-30|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9517673|ERX|0250|GUAIFEN-DEXTROMETH 600-30|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9517673|ERX|0250|GUAIFEN-DEXTROMETH 600-30|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9517673|ERX|0250|GUAIFEN-DEXTROMETH 600-30|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9517673|ERX|0250|GUAIFEN-DEXTROMETH 600-30|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9517699|ERX|0250|POTASSIUM CHLORIDE 8 MEQ|Medicaid|MEDICAID|||||0.10||| 9517699|ERX|0250|POTASSIUM CHLORIDE 8 MEQ|Humana Medicare Advantage|HUMANA MA|||||0.10||| 9517699|ERX|0250|POTASSIUM CHLORIDE 8 MEQ|Medicare|MEDICARE ACUTE|0.10||||||| 9517756|ERX|0250|DILTIAZEM XL 120MG CAPSUL|Aetna|AETNA PPO|4.50||||4.50||| 9517756|ERX|0250|DILTIAZEM XL 120MG CAPSUL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9517756|ERX|0250|DILTIAZEM XL 120MG CAPSUL|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9517756|ERX|0250|DILTIAZEM XL 120MG CAPSUL|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9517756|ERX|0250|DILTIAZEM XL 120MG CAPSUL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9517756|ERX|0250|DILTIAZEM XL 120MG CAPSUL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9517756|ERX|0250|DILTIAZEM XL 120MG CAPSUL|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9517756|ERX|0250|DILTIAZEM XL 120MG CAPSUL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9517756|ERX|0250|DILTIAZEM XL 120MG CAPSUL|Medicaid|MEDICAID|4.50||||||| 9517756|ERX|0250|DILTIAZEM XL 120MG CAPSUL|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9517756|ERX|0250|DILTIAZEM XL 120MG CAPSUL|Tricare|TRICARE EAST REGION|4.50||||||| 9517756|ERX|0250|DILTIAZEM XL 120MG CAPSUL|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9517756|ERX|0250|DILTIAZEM XL 120MG CAPSUL|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9517772|ERX|0250|DILTIAZEM XL 240MG CAPSUL|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9517772|ERX|0250|DILTIAZEM XL 240MG CAPSUL|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9517772|ERX|0250|DILTIAZEM XL 240MG CAPSUL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9517772|ERX|0250|DILTIAZEM XL 240MG CAPSUL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9517772|ERX|0250|DILTIAZEM XL 240MG CAPSUL|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9517772|ERX|0250|DILTIAZEM XL 240MG CAPSUL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9517772|ERX|0250|DILTIAZEM XL 240MG CAPSUL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9517772|ERX|0250|DILTIAZEM XL 240MG CAPSUL|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9517772|ERX|0250|DILTIAZEM XL 240MG CAPSUL|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9517772|ERX|0250|DILTIAZEM XL 240MG CAPSUL|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9517806|ERX|0250|LUBIPROSTONE 24MCG CAPSUL|Medicare|MEDICARE ACUTE|34.50||||||| 9517806|ERX|0250|LUBIPROSTONE 24MCG CAPSUL|United Medicare Advantage|UHC MEDICARE GOLD MA|34.50||||||| 9517806|ERX|0250|LUBIPROSTONE 24MCG CAPSUL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|34.50||||||| 9517806|ERX|0250|LUBIPROSTONE 24MCG CAPSUL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|34.50||||||| 9517806|ERX|0250|LUBIPROSTONE 24MCG CAPSUL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|34.50||||||| 9517806|ERX|0250|LUBIPROSTONE 24MCG CAPSUL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|34.50||||||| 9517806|ERX|0250|LUBIPROSTONE 24MCG CAPSUL|NON CONTRACTED|COMMERCIAL OTHER 1|34.50||||||| 9517806|ERX|0250|LUBIPROSTONE 24MCG CAPSUL|Humana Medicare Advantage|HUMANA MA|34.50||||||| 9517822|ERX|0250|INDOMETHACIN SR 75MG CAPS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||24.25||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9517830|ERX|0250|LACTOBACILLUS TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Medicaid|MEDICAID|4.50||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9517871|ERX|0250|AZATHIOPRINE 50MG TABLET|Humana Medicare Advantage|HUMANA MA|11.75||||||| 9517871|ERX|0250|AZATHIOPRINE 50MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||11.75||| 9517871|ERX|0250|AZATHIOPRINE 50MG TABLET|Medicare|MEDICARE ACUTE|11.75||||||| 9517889|ERX|0250|COLESEVELAM 625MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.75||||2.75||| 9517889|ERX|0250|COLESEVELAM 625MG TABLET|Humana Medicare Advantage|HUMANA MA|||||2.75||| 9517905|ERX|0250|HYDROCORTISONE 2.5% RECT|Managed Medicare|HOSPICE GENESIS|157.50||||||| 9517905|ERX|0250|HYDROCORTISONE 2.5% RECT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|157.50||||||| 9517905|ERX|0250|HYDROCORTISONE 2.5% RECT|Managed Medicare|HEALTHSPRING MA|||||157.50||| 9517905|ERX|0250|HYDROCORTISONE 2.5% RECT|Medicare|MEDICARE ACUTE|157.50||||157.50||| 9517905|ERX|0250|HYDROCORTISONE 2.5% RECT|United Medicare Advantage|UHC MEDICARE GOLD MA|157.50||||||| 9517905|ERX|0250|HYDROCORTISONE 2.5% RECT|Humana Medicare Advantage|HUMANA MA|157.50||||||| 9517947|ERX|0250|PROPAFENONE 150MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||14.50||| 9517947|ERX|0250|PROPAFENONE 150MG TABLET|Managed Medicare|HEALTHSPRING MA|14.50||||||| 9517947|ERX|0250|PROPAFENONE 150MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|14.50||||14.50||| 9517947|ERX|0250|PROPAFENONE 150MG TABLET|Medicare|MEDICARE ACUTE|14.50||||14.50||| 9517947|ERX|0250|PROPAFENONE 150MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||14.50||| 9518028|ERX|0250|CAPSAICIN 0.025% CREAM, 6|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||118.50||| 9518036|ERX|0250|AMINOCAPROIC 500MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|||||120.75||| 9518036|ERX|0250|AMINOCAPROIC 500MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||120.75||| 9518036|ERX|0250|AMINOCAPROIC 500MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|120.75||||||| 9518036|ERX|0250|AMINOCAPROIC 500MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||120.75||| 9518036|ERX|0250|AMINOCAPROIC 500MG TABLET|Humana Medicare Advantage|HUMANA MA|120.75||||120.75||| 9518036|ERX|0250|AMINOCAPROIC 500MG TABLET|Medicare|MEDICARE ACUTE|120.75||||120.75||| 9518036|ERX|0250|AMINOCAPROIC 500MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||120.75||| 9518069|ERX|0250|PHENYLEPHRINE 0.5% NASAL,|Medicare|MEDICARE ACUTE|30.75||||||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|8.75||||||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|8.75||||||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|8.75||||||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|Cigna|CIGNA|8.75||||8.75||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|Managed Medicare|HEALTHSPRING MA|||||8.75||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|8.75||||||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|8.75||||||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|8.75||||||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|8.75||||||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||8.75||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|United Healthcare|TML GROUP BENEFITS|8.75||||||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|Tricare|TRICARE EAST REGION|8.75||||||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|Medicare|MEDICARE ACUTE|8.75||||8.75||| 9518093|ERX|0250|PRIMIDONE 250MG TABLET|Humana Medicare Advantage|HUMANA MA|0.29||||||| 9518093|ERX|0250|PRIMIDONE 250MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.29||||0.29||| 9518101|ERX|0250|PSEUDOEPHEDRINE 30MG TABL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.25||| 9518101|ERX|0250|PSEUDOEPHEDRINE 30MG TABL|Blue Cross PPO Specialty|BCBSTX PPO|||||2.25||| 9518101|ERX|0250|PSEUDOEPHEDRINE 30MG TABL|Managed Medicare|BCBS MEDICARE PPO MA|||||2.25||| 9518101|ERX|0250|PSEUDOEPHEDRINE 30MG TABL|Humana Medicare Advantage|HUMANA MA|||||2.25||| 9518101|ERX|0250|PSEUDOEPHEDRINE 30MG TABL|Aenta Medicare Advantage|AETNA MEDICARE MA|2.25||||||| 9518101|ERX|0250|PSEUDOEPHEDRINE 30MG TABL|Managed Medicaid|MEDICAID SUPERIOR|||||2.25||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||4.50||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|Aetna|AETNA PPO|4.50||||4.50||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|4.50||||||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.50||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.50||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9518150|ERX|0250|EPINEPHRINE 30MG/30ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||43.25||| 9518150|ERX|0250|EPINEPHRINE 30MG/30ML|Managed Medicaid|MEDICAID AMERIGROUP|43.25||||||| 9518150|ERX|0250|EPINEPHRINE 30MG/30ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||43.25||| 9518150|ERX|0250|EPINEPHRINE 30MG/30ML|Medicare|MEDICARE ACUTE|||||43.25||| 9518150|ERX|0250|EPINEPHRINE 30MG/30ML|Managed Medicare|BCBS MEDICARE PPO MA|||||43.25||| 9518184|ERX|0250|RANOLAZINE 500MG TABLET|Medicaid|MEDICAID|14.50||||||| 9518184|ERX|0250|RANOLAZINE 500MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||14.50||| 9518184|ERX|0250|RANOLAZINE 500MG TABLET|Medicare|MEDICARE ACUTE|14.50||||14.50||| 9518184|ERX|0250|RANOLAZINE 500MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|14.50||||||| 9518184|ERX|0250|RANOLAZINE 500MG TABLET|Aetna|AETNA PPO|||||14.50||| 9518184|ERX|0250|RANOLAZINE 500MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|14.50||||||| 9518184|ERX|0250|RANOLAZINE 500MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|14.50||||14.50||| 9518184|ERX|0250|RANOLAZINE 500MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|14.50||||||| 9518184|ERX|0250|RANOLAZINE 500MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|14.50||||14.50||| 9518184|ERX|0250|RANOLAZINE 500MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|14.50||||14.50||| 9518184|ERX|0250|RANOLAZINE 500MG TABLET|Humana Medicare Advantage|HUMANA MA|14.50||||14.50||| 9518184|ERX|0250|RANOLAZINE 500MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|14.50||||||| 9518184|ERX|0250|RANOLAZINE 500MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|14.50||||||| 9518184|ERX|0250|RANOLAZINE 500MG TABLET|Managed Medicare|HEALTHSPRING MA|14.50||||14.50||| 9518184|ERX|0250|RANOLAZINE 500MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|14.50||||14.50||| 9518242|ERX|0250|NICARDIPINE 25MG/10ML|Humana Medicare Advantage|HUMANA MA|||||1,333.75||| 9518242|ERX|0250|NICARDIPINE 25MG/10ML|Blue Cross PPO Specialty|BCBSTX PPO|1,333.75||||||| 9518242|ERX|0250|NICARDIPINE 25MG/10ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,333.75||||||| 9518242|ERX|0250|NICARDIPINE 25MG/10ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1,333.75||||||| 9518309|ERX|0250|HYDROXYCHLOROQUINE 200MG|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9518309|ERX|0250|HYDROXYCHLOROQUINE 200MG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9518309|ERX|0250|HYDROXYCHLOROQUINE 200MG|Tricare|TRICARE EAST REGION|4.50||||||| 9518309|ERX|0250|HYDROXYCHLOROQUINE 200MG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9518309|ERX|0250|HYDROXYCHLOROQUINE 200MG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||||| 9518309|ERX|0250|HYDROXYCHLOROQUINE 200MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9518309|ERX|0250|HYDROXYCHLOROQUINE 200MG|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9518309|ERX|0250|HYDROXYCHLOROQUINE 200MG|Medicare|MEDICARE ACUTE|4.50||||||| 9518309|ERX|0250|HYDROXYCHLOROQUINE 200MG|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9518317|ERX|0250|BENZTROPINE 1MG/ML, 2ML|Medicare|MEDICARE ACUTE|72.50||||72.50||| 9518333|ERX|0250|CHLOROTHIAZIDE 500MG VIAL|NON CONTRACTED|COMMERCIAL OTHER 1|536.43||||||| 9518390|ERX|0250|MAGNESIUM CHLORIDE TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9518390|ERX|0250|MAGNESIUM CHLORIDE TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9518390|ERX|0250|MAGNESIUM CHLORIDE TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||4.50||| 9518390|ERX|0250|MAGNESIUM CHLORIDE TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9518390|ERX|0250|MAGNESIUM CHLORIDE TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9518390|ERX|0250|MAGNESIUM CHLORIDE TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Tricare|TRICARE EAST REGION|4.50||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Aetna|AETNA PPO|4.50||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Managed Medicare|MA PART B ONLY IP|4.50||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||4.50||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9518440|ERX|0250|MEGESTROL 400MG/10ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9518440|ERX|0250|MEGESTROL 400MG/10ML|Medicare|MEDICARE ACUTE|4.50||||||| 9518440|ERX|0250|MEGESTROL 400MG/10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9518440|ERX|0250|MEGESTROL 400MG/10ML|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9518440|ERX|0250|MEGESTROL 400MG/10ML|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9518457|ERX|0250|METHYL SALIC/MENTHOL ,120|Aenta Medicare Advantage|AETNA MEDICARE MA|0.50||||||| 9518457|ERX|0250|METHYL SALIC/MENTHOL ,120|Medicare|MEDICARE ACUTE|0.50||||||| 9518457|ERX|0250|METHYL SALIC/MENTHOL ,120|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.50||||||| 9518465|ERX|0250|LINDANE 1% SHAMPOO, 60ML|Humana Medicare Advantage|HUMANA MA|1,238.50||||||| 9518499|ERX|0250|PENTAZOCINE-NALOXONE TABL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.14||||||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|PHCS|HUMANA INSURANCE|||||4.50||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.50||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|Cigna|CIGNA|||||4.50||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.50||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||4.50||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|Aetna|AETNA PPO|||||4.50||| 9518580|ERX|0250|ETHAMBUTOL 400MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||21.25||| 9518655|ERX|0250|COD LIVER OIL-ZN OXIDE ,3|Managed Medicaid|MEDICAID SUPERIOR|||||27.50||| 9518655|ERX|0250|COD LIVER OIL-ZN OXIDE ,3|Medicaid|MEDICAID HMO|27.50||||||| 9518655|ERX|0250|COD LIVER OIL-ZN OXIDE ,3|Medicare|MEDICARE ACUTE|27.50||||||| 9518663|ERX|0250|CHOLECALCIFEROL 400 UNIT|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.25||| 9518663|ERX|0250|CHOLECALCIFEROL 400 UNIT|Medicare|MEDICARE ACUTE|2.25||||||| 9518663|ERX|0250|CHOLECALCIFEROL 400 UNIT|Managed Medicaid|MEDICAID AMERIGROUP|2.25||||||| 9518663|ERX|0250|CHOLECALCIFEROL 400 UNIT|Humana Medicare Advantage|HUMANA MA|2.25||||2.25||| 9518663|ERX|0250|CHOLECALCIFEROL 400 UNIT|Managed Medicare|HEALTHSPRING MA|||||2.25||| 9518689|ERX|0250|MENTHOL-CAMP-PHEN LIPBALM|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9518689|ERX|0250|MENTHOL-CAMP-PHEN LIPBALM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.50||| 9518689|ERX|0250|MENTHOL-CAMP-PHEN LIPBALM|Medicare|MEDICARE ACUTE|4.50||||||| 9518697|ERX|0250|FLUOCINONIDE 0.05% CREAM,|Humana Medicare Advantage|HUMANA MA|191.25||||||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.49||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.49||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|Medicaid|MOLINA HEALTHCARE OF TEXAS|0.49||||||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|Veterans Affairs|VETERANS ADMINISTRATION|0.49||||||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|Medicaid|MEDICAID HMO|0.49||||||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|Blue Cross PPO Specialty|BCBSTX PPO|0.49||||||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|Medicare|MEDICARE ACUTE|0.49||||0.49||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.49||||||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|Managed Medicaid|MEDICAID SUPERIOR|0.49||||0.49||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|Medicaid|MEDICAID|0.49||||||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.49||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|Humana Medicare Advantage|HUMANA MA|0.49||||0.49||| 9518796|ERX|0250|LEVOTHYROZINE 100MCG VIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|563.50||||||| 9518796|ERX|0250|LEVOTHYROZINE 100MCG VIAL|Medicare|MEDICARE ACUTE|563.50||||||| 9518796|ERX|0250|LEVOTHYROZINE 100MCG VIAL|Managed Medicare|HEALTHSPRING MA|563.50||||563.50||| 9518796|ERX|0250|LEVOTHYROZINE 100MCG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|563.50||||||| 9518796|ERX|0250|LEVOTHYROZINE 100MCG VIAL|Humana Medicare Advantage|HUMANA MA|563.50||||||| 9518796|ERX|0250|LEVOTHYROZINE 100MCG VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|563.50||||||| 9518820|ERX|0250|RIVASTIGMINE 9.5MG PATCH|Medicare|MEDICARE ACUTE|56.50||||56.50||| 9518903|ERX|0250|K-NA PHOS 280-160-250MG P|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|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|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.75||||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|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||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|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.75||||||| 9518903|ERX|0250|K-NA PHOS 280-160-250MG P|Medicare|MEDICARE ACUTE|4.75||||||| 9518952|ERX|0250|COENZYME Q10 100MG CAPSUL|Medicare|MEDICARE ACUTE|4.50||||||| 9518952|ERX|0250|COENZYME Q10 100MG CAPSUL|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9518952|ERX|0250|COENZYME Q10 100MG CAPSUL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9518952|ERX|0250|COENZYME Q10 100MG CAPSUL|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9518952|ERX|0250|COENZYME Q10 100MG CAPSUL|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9518952|ERX|0250|COENZYME Q10 100MG CAPSUL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.50||| 9518952|ERX|0250|COENZYME Q10 100MG CAPSUL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.50||| 9518952|ERX|0250|COENZYME Q10 100MG CAPSUL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|10.50||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|10.50||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|10.50||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|10.50||||10.50||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|10.50||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|10.50||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|10.50||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|10.50||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|NON CONTRACTED|COMMERCIAL OTHER 1|10.50||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|United Healthcare|UNITED HEALTHCARE|10.50||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||10.50||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|Medicaid|MEDICAID HMO|10.50||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|Medicaid|MEDICAID|10.50||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|Medicare|MEDICARE ACUTE|10.50||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|Aetna|AETNA PPO|10.50||||||| 9519018|ERX|0250|FERROUS GLUCONATE 325MG T|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||||| 9519018|ERX|0250|FERROUS GLUCONATE 325MG T|Medicaid|MEDICAID|4.50||||||| 9519018|ERX|0250|FERROUS GLUCONATE 325MG T|PHCS|HUMANA|4.50||||||| 9519018|ERX|0250|FERROUS GLUCONATE 325MG T|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9519018|ERX|0250|FERROUS GLUCONATE 325MG T|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9519018|ERX|0250|FERROUS GLUCONATE 325MG T|Tricare|TRICARE EAST REGION|4.50||||||| 9519018|ERX|0250|FERROUS GLUCONATE 325MG T|Cigna|CIGNA|4.50||||||| 9519018|ERX|0250|FERROUS GLUCONATE 325MG T|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9519018|ERX|0250|FERROUS GLUCONATE 325MG T|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9519018|ERX|0250|FERROUS GLUCONATE 325MG T|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9519018|ERX|0250|FERROUS GLUCONATE 325MG T|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9519018|ERX|0250|FERROUS GLUCONATE 325MG T|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9519018|ERX|0250|FERROUS GLUCONATE 325MG T|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9519018|ERX|0250|FERROUS GLUCONATE 325MG T|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9519075|ERX|0250|LACTOBACILLUS GRANULES 1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.12||||||| 9519075|ERX|0250|LACTOBACILLUS GRANULES 1|Cigna|CIGNA|0.12||||||| 9519075|ERX|0250|LACTOBACILLUS GRANULES 1|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.12||||||| 9519075|ERX|0250|LACTOBACILLUS GRANULES 1|Medicare|MEDICARE ACUTE|0.12||||||| 9519091|ERX|0250|LUBIPROSTONE 8MCG CAPSULE|Humana Medicare Advantage|HUMANA MA|28.50||||||| 9519091|ERX|0250|LUBIPROSTONE 8MCG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|28.50||||||| 9519091|ERX|0250|LUBIPROSTONE 8MCG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|28.50||||||| 9519091|ERX|0250|LUBIPROSTONE 8MCG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|||||28.50||| 9519091|ERX|0250|LUBIPROSTONE 8MCG CAPSULE|Medicare|MEDICARE ACUTE|28.50||||28.50||| 9519091|ERX|0250|LUBIPROSTONE 8MCG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|28.50||||28.50||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|Veterans Affairs|VETERANS ADMINISTRATION|||||4.50||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||33.50||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|Medicaid|MEDICAID|33.50||||||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|Medicare|MEDICARE ACUTE|33.50||||33.50||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||33.50||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|33.50||||||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|Humana Medicare Advantage|HUMANA MA|33.50||||33.50||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|Blue Cross PPO Specialty|BCBSTX PPO|33.50||||||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|33.50||||||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|Managed Medicaid|MEDICAID SUPERIOR|33.50||||||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|Blue Cross HMO Specialty|BCBSTX HMO|33.50||||||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||33.50||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|33.50||||||| 9519158|ERX|0250|FENTANYL 12MCG PATCH|Cigna|CIGNA|44.50||||||| 9519158|ERX|0250|FENTANYL 12MCG PATCH|Humana Medicare Advantage|HUMANA MA|||||44.50||| 9519158|ERX|0250|FENTANYL 12MCG PATCH|United Medicare Advantage|AARP UHC WEST COMPLETE MA|44.50||||||| 9519158|ERX|0250|FENTANYL 12MCG PATCH|Medicare|MEDICARE ACUTE|44.50||||||| 9519158|ERX|0250|FENTANYL 12MCG PATCH|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|44.50||||||| 9519158|ERX|0250|FENTANYL 12MCG PATCH|United Medicare Advantage|UHC MEDICARE GOLD MA|44.50||||||| 9519273|ERX|0250|AMPICILLIN 1 GM NS MB+ 10|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||54.50||| 9519273|ERX|0250|AMPICILLIN 1 GM NS MB+ 10|Medicare|MEDICARE ACUTE|54.50||||54.50||| 9519315|ERX|0250|CEFUROXIME 1.5 G/100ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||80.50||| 9519364|ERX|0250|NAFCILLIN 2 GM/100ML MB+|Medicare|MEDICARE ACUTE|209.25||||||| 9519398|ERX|0250|VANCOMYCIN 500MG/100ML NS|Medicare|MEDICARE ACUTE|||||53.75||| 9519455|ERX|0250|DRONEDARONE 400MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||65.25||| 9519455|ERX|0250|DRONEDARONE 400MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|65.25||||||| 9519455|ERX|0250|DRONEDARONE 400MG TABLET|Humana Medicare Advantage|HUMANA MA|65.25||||65.25||| 9519455|ERX|0250|DRONEDARONE 400MG TABLET|Medicare|MEDICARE ACUTE|65.25||||65.25||| 9519455|ERX|0250|DRONEDARONE 400MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||65.25||| 9519471|ERX|0250|HYDROCHLOROTHIAZIDE 12.5M|Medicare|MEDICARE ACUTE|5.75||||5.75||| 9519471|ERX|0250|HYDROCHLOROTHIAZIDE 12.5M|Medicaid|LAW ENFORCEMENT OTHER|5.75||||||| 9519471|ERX|0250|HYDROCHLOROTHIAZIDE 12.5M|Texas Workforce Commission|DIS DETER SERV (DDS)|5.75||||||| 9519471|ERX|0250|HYDROCHLOROTHIAZIDE 12.5M|Veterans Affairs|VETERANS ADMINISTRATION|5.75||||||| 9519471|ERX|0250|HYDROCHLOROTHIAZIDE 12.5M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|5.75||||5.75||| 9519471|ERX|0250|HYDROCHLOROTHIAZIDE 12.5M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|5.75||||5.75||| 9519471|ERX|0250|HYDROCHLOROTHIAZIDE 12.5M|Managed Medicare|HEALTHSPRING MA|5.75||||||| 9519471|ERX|0250|HYDROCHLOROTHIAZIDE 12.5M|Humana Medicare Advantage|HUMANA MA|5.75||||5.75||| 9519471|ERX|0250|HYDROCHLOROTHIAZIDE 12.5M|Blue Cross PPO Specialty|BCBSTX PPO|5.75||||5.75||| 9519471|ERX|0250|HYDROCHLOROTHIAZIDE 12.5M|Cigna|CIGNA|5.75||||||| 9519471|ERX|0250|HYDROCHLOROTHIAZIDE 12.5M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.75||||5.75||| 9519471|ERX|0250|HYDROCHLOROTHIAZIDE 12.5M|Aenta Medicare Advantage|AETNA MEDICARE MA|||||5.75||| 9519505|ERX|0250|FLUCONAZOLE 100MG IN NS 5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||109.50||| 9519505|ERX|0250|FLUCONAZOLE 100MG IN NS 5|United Medicare Advantage|UHC MEDICARE GOLD MA|109.50||||||| 9519505|ERX|0250|FLUCONAZOLE 100MG IN NS 5|United Medicare Advantage|AARP UHC WEST COMPLETE MA|109.50||||||| 9519513|ERX|0250|NICARDIPINE 20MG/200MLSAL|Medicare|MEDICARE ACUTE|7.69||||7.69||| 9519513|ERX|0250|NICARDIPINE 20MG/200MLSAL|United Healthcare|UNITED HEALTHCARE|||||7.69||| 9519513|ERX|0250|NICARDIPINE 20MG/200MLSAL|United Medicare Advantage|UHC AARP MCR HMO MA|||||7.69||| 9519513|ERX|0250|NICARDIPINE 20MG/200MLSAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||7.69||| 9519513|ERX|0250|NICARDIPINE 20MG/200MLSAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|7.69||||||| 9519513|ERX|0250|NICARDIPINE 20MG/200MLSAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|7.69||||7.69||| 9519513|ERX|0250|NICARDIPINE 20MG/200MLSAL|Humana Medicare Advantage|HUMANA MA|7.69||||7.69||| 9519513|ERX|0250|NICARDIPINE 20MG/200MLSAL|Medicaid|MEDICAID|||||7.69||| 9519513|ERX|0250|NICARDIPINE 20MG/200MLSAL|Managed Medicaid|MEDICAID AMERIGROUP|||||7.69||| 9519513|ERX|0250|NICARDIPINE 20MG/200MLSAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||7.69||| 9519513|ERX|0250|NICARDIPINE 20MG/200MLSAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|7.69||||||| 9519513|ERX|0250|NICARDIPINE 20MG/200MLSAL|Managed Medicare|HEALTHSPRING MA|||||7.69||| 9519513|ERX|0250|NICARDIPINE 20MG/200MLSAL|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||7.69||| 9519513|ERX|0250|NICARDIPINE 20MG/200MLSAL|Blue Cross PPO Specialty|BCBSTX PPO|7.69||||7.69||| 9519513|ERX|0250|NICARDIPINE 20MG/200MLSAL|Aetna|AETNA PPO|7.69||||7.69||| 9519513|ERX|0250|NICARDIPINE 20MG/200MLSAL|Aetna|AETNA OTHER|||||7.69||| 9519570|ERX|0250|CEFTRIAXONE 500MG/100ML N|Blue Cross PPO Specialty|BCBSTX PPO|152.25||||||| 9519612|ERX|0250|TOLVAPTAN 30MG TABLET|Humana Medicare Advantage|HUMANA MA|2,145.25||||||| 9519612|ERX|0250|TOLVAPTAN 30MG TABLET|Medicare|MEDICARE ACUTE|2,145.25||||2,145.25||| 9519661|ERX|0250|TOLVAPTAN 15MG (1/2 TABLE|Medicare|MEDICARE ACUTE|896.75||||||| 9519661|ERX|0250|TOLVAPTAN 15MG (1/2 TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|896.75||||||| 9519661|ERX|0250|TOLVAPTAN 15MG (1/2 TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|896.75||||||| 9519661|ERX|0250|TOLVAPTAN 15MG (1/2 TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|896.75||||||| 9519661|ERX|0250|TOLVAPTAN 15MG (1/2 TABLE|Humana Medicare Advantage|HUMANA MA|896.75||||||| 9519661|ERX|0250|TOLVAPTAN 15MG (1/2 TABLE|United Healthcare|UMR UNITED MEDICAL RESOURCES|896.75||||||| 9519661|ERX|0250|TOLVAPTAN 15MG (1/2 TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|896.75||||||| 9519661|ERX|0250|TOLVAPTAN 15MG (1/2 TABLE|Managed Medicare|BCBS MEDICARE PPO MA|||||896.75||| 9519687|ERX|0250|VANCO ORAL SOLN 250MG/5ML|Medicaid|MEDICAID|1.47||||||| 9519687|ERX|0250|VANCO ORAL SOLN 250MG/5ML|Medicare|MEDICARE ACUTE|1.47||||1.47||| 9519687|ERX|0250|VANCO ORAL SOLN 250MG/5ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.47||||||| 9519687|ERX|0250|VANCO ORAL SOLN 250MG/5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|1.47||||||| 9519687|ERX|0250|VANCO ORAL SOLN 250MG/5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.47||||||| 9519687|ERX|0250|VANCO ORAL SOLN 250MG/5ML|Managed Medicaid|MEDICAID AMERIGROUP|||||1.47||| 9519687|ERX|0250|VANCO ORAL SOLN 250MG/5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.47||||1.47||| 9519687|ERX|0250|VANCO ORAL SOLN 250MG/5ML|Managed Medicaid|MEDICAID SUPERIOR|1.47||||||| 9519687|ERX|0250|VANCO ORAL SOLN 250MG/5ML|Humana Medicare Advantage|HUMANA MA|1.47||||||| 9519687|ERX|0250|VANCO ORAL SOLN 250MG/5ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|1.47||||||| 9519687|ERX|0250|VANCO ORAL SOLN 250MG/5ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.47||||||| 9519752|ERX|0250|MISOPROSTOL 100MCG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|15.75||||||| 9519752|ERX|0250|MISOPROSTOL 100MCG TABLET|Managed Medicaid|MEDICAID SUPERIOR|15.75||||||| 9519752|ERX|0250|MISOPROSTOL 100MCG TABLET|United Healthcare|UNITED HEALTHCARE|15.75||||||| 9519752|ERX|0250|MISOPROSTOL 100MCG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|15.75||||||| 9519752|ERX|0250|MISOPROSTOL 100MCG TABLET|Aetna|AETNA PPO|15.75||||||| 9519752|ERX|0250|MISOPROSTOL 100MCG TABLET|Tricare|TRICARE EAST REGION|15.75||||||| 9519752|ERX|0250|MISOPROSTOL 100MCG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|15.75||||||| 9519752|ERX|0250|MISOPROSTOL 100MCG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|15.75||||||| 9519752|ERX|0250|MISOPROSTOL 100MCG TABLET|United Healthcare|TML GROUP BENEFITS|15.75||||||| 9519752|ERX|0250|MISOPROSTOL 100MCG TABLET|Cigna|CIGNA|15.75||||||| 9519752|ERX|0250|MISOPROSTOL 100MCG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|15.75||||||| 9519752|ERX|0250|MISOPROSTOL 100MCG TABLET|United Healthcare|GEHA|15.75||||||| 9519752|ERX|0250|MISOPROSTOL 100MCG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|15.75||||||| 9519752|ERX|0250|MISOPROSTOL 100MCG TABLET|Medicaid|MEDICAID HMO|15.75||||||| 9519752|ERX|0250|MISOPROSTOL 100MCG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|15.75||||||| 9519752|ERX|0250|MISOPROSTOL 100MCG TABLET|Medicaid|MEDICAID|15.75||||||| 9519752|ERX|0250|MISOPROSTOL 100MCG TABLET|Medicare|MEDICARE ACUTE|15.75||||||| 9519851|ERX|0250|MISOPROSTOL 200MCG TABLET|Medicaid|MEDICAID|23.50||||||| 9519851|ERX|0250|MISOPROSTOL 200MCG TABLET|Medicare|MEDICARE ACUTE|23.50||||||| 9519851|ERX|0250|MISOPROSTOL 200MCG TABLET|Medicaid|MEDICAID HMO|23.50||||23.50||| 9519851|ERX|0250|MISOPROSTOL 200MCG TABLET|Tricare|TRICARE EAST REGION|23.50||||||| 9519851|ERX|0250|MISOPROSTOL 200MCG TABLET|PHCS|HUMANA|23.50||||||| 9519851|ERX|0250|MISOPROSTOL 200MCG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|23.50||||||| 9519851|ERX|0250|MISOPROSTOL 200MCG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|23.50||||||| 9519851|ERX|0250|MISOPROSTOL 200MCG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|23.50||||||| 9519851|ERX|0250|MISOPROSTOL 200MCG TABLET|Cigna|CIGNA|23.50||||||| 9519851|ERX|0250|MISOPROSTOL 200MCG TABLET|Managed Medicaid|MEDICAID SUPERIOR|23.50||||23.50||| 9519851|ERX|0250|MISOPROSTOL 200MCG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|23.50||||23.50||| 9519869|ERX|0250|PRASUGREL 10MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|44.75||||||| 9519869|ERX|0250|PRASUGREL 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|44.75||||||| 9519869|ERX|0250|PRASUGREL 10MG TABLET|Humana Medicare Advantage|HUMANA MA|44.75||||||| 9519869|ERX|0250|PRASUGREL 10MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||44.75||| 9519869|ERX|0250|PRASUGREL 10MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|44.75||||44.75||| 9519869|ERX|0250|PRASUGREL 10MG TABLET|Medicare|MEDICARE ACUTE|44.75||||44.75||| 9519885|ERX|0250|CETIRIZINE SYRUP 30MG/30M|Medicare|MEDICARE PART B ONLY IP|24.25||||||| 9519885|ERX|0250|CETIRIZINE SYRUP 30MG/30M|Blue Cross PPO Specialty|BCBSTX PPO|24.25||||24.25||| 9519885|ERX|0250|CETIRIZINE SYRUP 30MG/30M|Medicare|MEDICARE ACUTE|24.25||||||| 9519885|ERX|0250|CETIRIZINE SYRUP 30MG/30M|Managed Medicaid|MEDICAID SUPERIOR|||||24.25||| 9519885|ERX|0250|CETIRIZINE SYRUP 30MG/30M|Managed Medicaid|MEDICAID AMERIGROUP|||||24.25||| 9519901|ERX|0250|MONTELUKAST CHEWABLE 4MG|Managed Medicaid|MEDICAID SUPERIOR|||||45.50||| 9519927|ERX|0250|RIFAMPIN 150MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.15||| 9519927|ERX|0250|RIFAMPIN 150MG CAPSULE|Medicare|MEDICARE ACUTE|0.15||||||| 9519927|ERX|0250|RIFAMPIN 150MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|0.15||||||| 9519950|ERX|0250|CELECOXIB 100MG CAPSULE|Aetna|AETNA PPO|||||4.50||| 9519950|ERX|0250|CELECOXIB 100MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9519950|ERX|0250|CELECOXIB 100MG CAPSULE|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9519950|ERX|0250|CELECOXIB 100MG CAPSULE|Medicare|MEDICARE ACUTE|4.50||||||| 9519950|ERX|0250|CELECOXIB 100MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9519950|ERX|0250|CELECOXIB 100MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9519950|ERX|0250|CELECOXIB 100MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.50||| 9519950|ERX|0250|CELECOXIB 100MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9519950|ERX|0250|CELECOXIB 100MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Veterans Affairs|VETERANS ADMINISTRATION|12.50||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|12.50||||12.50||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||12.50||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|United Healthcare|UMR UNITED MEDICAL RESOURCES|12.50||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Blue Cross PPO Specialty|BCBSTX PPO|12.50||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|United Healthcare|UNITED HEALTHCARE|||||12.50||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Aenta Medicare Advantage|AETNA MEDICARE MA|||||12.50||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|12.50||||12.50||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Managed Medicare|HEALTHSPRING MA|12.50||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Medicare|MEDICARE ACUTE|12.50||||12.50||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|12.50||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Humana Medicare Advantage|HUMANA MA|12.50||||12.50||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|12.50||||12.50||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|Tricare|TRICARE EAST REGION|39.75||||39.75||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||39.75||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|United Healthcare|UNITED HEALTHCARE|39.75||||39.75||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|Texas Workforce Commission|DIS DETER SERV (DDS)|39.75||||||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|39.75||||||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|United Healthcare|GEHA|||||39.75||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|39.75||||39.75||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|NON CONTRACTED|COMMERCIAL OTHER 1|39.75||||39.75||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|39.75||||39.75||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|Humana Medicare Advantage|HUMANA MA|39.75||||39.75||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|39.75||||39.75||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|39.75||||39.75||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|39.75||||||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|Managed Medicare|HEALTHSPRING MA|39.75||||39.75||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|||||39.75||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|39.75||||39.75||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|39.75||||39.75||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|ChampVA|CHAMPVA CENTER|39.75||||39.75||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|Cigna|CIGNA|||||39.75||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|Aetna|AETNA PPO|39.75||||||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|39.75||||39.75||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|39.75||||||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|39.75||||39.75||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|39.75||||39.75||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|39.75||||39.75||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|Medicaid|MEDICAID|||||39.75||| 9520040|ERX|0250|CELECOXIB 200MG CAPSULE|Medicare|MEDICARE ACUTE|39.75||||39.75||| 9520214|ERX|0250|METRONIDAZOLE 0.75% GEL,4|Medicare|MEDICARE ACUTE|344.25||||||| 9520214|ERX|0250|METRONIDAZOLE 0.75% GEL,4|Managed Medicaid|MEDICAID UNITED HEALTHCARE|344.25||||||| 9520214|ERX|0250|METRONIDAZOLE 0.75% GEL,4|Managed Medicaid|MEDICAID SUPERIOR|||||344.25||| 9520214|ERX|0250|METRONIDAZOLE 0.75% GEL,4|Humana Medicare Advantage|HUMANA MA|344.25||||||| 9520222|ERX|0250|NYSTATIN 500000 UNIT,5ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.10||||||| 9520222|ERX|0250|NYSTATIN 500000 UNIT,5ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.10||||||| 9520222|ERX|0250|NYSTATIN 500000 UNIT,5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.10||||||| 9520222|ERX|0250|NYSTATIN 500000 UNIT,5ML|Cigna|CIGNA|0.10||||||| 9520222|ERX|0250|NYSTATIN 500000 UNIT,5ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.10||||||| 9520222|ERX|0250|NYSTATIN 500000 UNIT,5ML|Managed Medicaid|MEDICAID SUPERIOR|0.10||||0.10||| 9520222|ERX|0250|NYSTATIN 500000 UNIT,5ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.10||||||| 9520222|ERX|0250|NYSTATIN 500000 UNIT,5ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.10||||||| 9520222|ERX|0250|NYSTATIN 500000 UNIT,5ML|Medicare|MEDICARE ACUTE|0.10||||0.10||| 9520222|ERX|0250|NYSTATIN 500000 UNIT,5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.10||||||| 9520222|ERX|0250|NYSTATIN 500000 UNIT,5ML|Humana Medicare Advantage|HUMANA MA|0.10||||||| 9520222|ERX|0250|NYSTATIN 500000 UNIT,5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.10||||||| 9520248|ERX|0250|BRIMONIDINE 0.1% EYE DROP|Medicare|MEDICARE ACUTE|5.10||||||| 9520248|ERX|0250|BRIMONIDINE 0.1% EYE DROP|Humana Medicare Advantage|HUMANA MA|5.10||||||| 9520255|ERX|0250|VERAPAMIL SR 240MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9520255|ERX|0250|VERAPAMIL SR 240MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.50||| 9520255|ERX|0250|VERAPAMIL SR 240MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9520255|ERX|0250|VERAPAMIL SR 240MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9520255|ERX|0250|VERAPAMIL SR 240MG TABLET|Medicare|MEDICARE ACUTE|4.50||||||| 9520289|ERX|0250|LIPASE-PROT-AMYL 6-19-30K|Medicare|MEDICARE ACUTE|11.50||||||| 9520404|ERX|0250|TETRACAINE 1% 2ML|Managed Medicare|HEALTHSPRING MA|0.46||||0.46||| 9520404|ERX|0250|TETRACAINE 1% 2ML|Humana Medicare Advantage|HUMANA MA|0.46||||||| 9520404|ERX|0250|TETRACAINE 1% 2ML|Blue Cross PPO Specialty|BCBSTX PPO|0.46||||||| 9520404|ERX|0250|TETRACAINE 1% 2ML|Medicare|MEDICARE ACUTE|0.46||||0.46||| 9520404|ERX|0250|TETRACAINE 1% 2ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.46||||||| 9520404|ERX|0250|TETRACAINE 1% 2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.46||||0.46||| 9520578|ERX|0250|NITROGLYCERIN 25MG/250ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||107.50||| 9520578|ERX|0250|NITROGLYCERIN 25MG/250ML|Medicare|MEDICARE ACUTE|107.50||||107.50||| 9520578|ERX|0250|NITROGLYCERIN 25MG/250ML|Blue Cross PPO Specialty|BCBSTX PPO|107.50||||107.50||| 9520578|ERX|0250|NITROGLYCERIN 25MG/250ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||107.50||| 9520578|ERX|0250|NITROGLYCERIN 25MG/250ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|107.50||||107.50||| 9520578|ERX|0250|NITROGLYCERIN 25MG/250ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||107.50||| 9520578|ERX|0250|NITROGLYCERIN 25MG/250ML|Humana Medicare Advantage|HUMANA MA|107.50||||107.50||| 9520578|ERX|0250|NITROGLYCERIN 25MG/250ML|Managed Medicare|BCBS MEDICARE PPO MA|107.50||||||| 9520578|ERX|0250|NITROGLYCERIN 25MG/250ML|Managed Medicare|HEALTHSPRING MA|107.50||||||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Managed Medicare|OTHER INSTITUTIONS|||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Managed Medicare|HEALTHSPRING MA|0.18||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.18||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Managed Medicaid|MEDICAID AMERIGROUP|0.18||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.18||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Humana Medicare Advantage|HUMANA MA|0.18||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Aetna|AETNA PPO|0.18||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Aetna|AETNA OTHER|||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.18||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Access Direct Platinum|HEALTHFIRST TPA UMR|||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.18||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Blue Cross HMO Specialty|BCBSTX HMO|0.18||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.18||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Cigna|CIGNA OTHER|0.18||||||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|ChampVA|CHAMPVA CENTER|||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Blue Cross PPO Specialty|BCBSTX PPO|0.18||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Cigna|CIGNA|||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Veterans Affairs|VETERANS ADMINISTRATION|0.18||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Managed Medicaid|MEDICAID SUPERIOR|0.18||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Veterans Affairs|VETERANS ADMINISTRATION|0.18||||||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.18||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.18||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Tricare|TRICARE EAST REGION|||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|NON CONTRACTED|COMMERCIAL OTHER 1|0.18||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|United Healthcare|GEHA|||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|United Healthcare|UNITED HEALTHCARE|0.18||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|0.18||||||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Medicaid|MEDICAID HMO|0.18||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Medicare|MEDICARE ACUTE|0.18||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Medicaid|MEDICAID|0.18||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Medicaid|HENDERSON COUNTY INDIGENT|0.18||||||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Texas Workforce Commission|DIS DETER SERV (DDS)|0.18||||||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.18||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|United Healthcare|TML GROUP BENEFITS|0.18||||||| 9520644|ERX|0250|FEBUXOSTAT 80MG TABLET|Humana Medicare Advantage|HUMANA MA|43.25||||||| 9520644|ERX|0250|FEBUXOSTAT 80MG TABLET|Medicare|MEDICARE ACUTE|43.25||||||| 9520826|ERX|0250|DABIGATRAN 150MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|||||35.50||| 9520826|ERX|0250|DABIGATRAN 150MG CAPSULE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|35.50||||||| 9520826|ERX|0250|DABIGATRAN 150MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|35.50||||35.50||| 9520826|ERX|0250|DABIGATRAN 150MG CAPSULE|Humana Medicare Advantage|HUMANA MA|35.50||||35.50||| 9520826|ERX|0250|DABIGATRAN 150MG CAPSULE|Medicare|MEDICARE ACUTE|35.50||||35.50||| 9520826|ERX|0250|DABIGATRAN 150MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|35.50||||||| 9520834|ERX|0250|DABIGATRAN 75MG CAPSULE|Humana Medicare Advantage|HUMANA MA|35.50||||||| 9520834|ERX|0250|DABIGATRAN 75MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|35.50||||||| 9520834|ERX|0250|DABIGATRAN 75MG CAPSULE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|35.50||||||| 9520909|ERX|0250|RIFAXIMIN 550MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|152.25||||||| 9520909|ERX|0250|RIFAXIMIN 550MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|152.25||||||| 9520909|ERX|0250|RIFAXIMIN 550MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|152.25||||||| 9520909|ERX|0250|RIFAXIMIN 550MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|152.25||||||| 9520909|ERX|0250|RIFAXIMIN 550MG TABLET|Managed Medicare|HEALTHSPRING MA|152.25||||||| 9520909|ERX|0250|RIFAXIMIN 550MG TABLET|Humana Medicare Advantage|HUMANA MA|152.25||||||| 9520909|ERX|0250|RIFAXIMIN 550MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|152.25||||||| 9520909|ERX|0250|RIFAXIMIN 550MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|152.25||||||| 9520909|ERX|0250|RIFAXIMIN 550MG TABLET|Medicare|MEDICARE ACUTE|152.25||||152.25||| 9520909|ERX|0250|RIFAXIMIN 550MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|152.25||||||| 9520909|ERX|0250|RIFAXIMIN 550MG TABLET|Medicaid|MEDICAID|152.25||||||| 9521147|ERX|0250|DICLOFENAC SODIUM EC 75MG|Humana Medicare Advantage|HUMANA MA|||||31.50||| 9521147|ERX|0250|DICLOFENAC SODIUM EC 75MG|United Healthcare|UNITED HEALTHCARE|31.50||||||| 9521147|ERX|0250|DICLOFENAC SODIUM EC 75MG|Medicare|MEDICARE ACUTE|31.50||||||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|91.50||||91.50||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|91.50||||91.50||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Medicaid|MEDICAID HMO|91.50||||||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Medicare|MEDICARE PART B ONLY IP|91.50||||||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Medicare|MEDICARE ACUTE|91.50||||91.50||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|United Healthcare|UNITED HEALTHCARE|||||91.50||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Blue Cross HMO Specialty|BCBSTX HMO|91.50||||91.50||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Blue Cross PPO Specialty|BCBSTX PPO|||||91.50||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Cigna|CIGNA|||||91.50||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|United Medicare Advantage|UHC MEDICARE GOLD MA|||||91.50||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||91.50||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Aetna|AETNA PPO|||||91.50||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Aenta Medicare Advantage|AETNA MEDICARE MA|91.50||||91.50||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||91.50||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Managed Medicare|BCBS MEDICARE PPO MA|91.50||||||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|91.50||||91.50||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Humana Medicare Advantage|HUMANA MA|91.50||||91.50||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Managed Medicaid|MEDICAID AMERIGROUP|||||91.50||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Managed Medicaid|MEDICAID SUPERIOR|||||91.50||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|91.50||||||| 9521188|ERX|0250|MUPIROCIN 2% CREAM, 15 G|Humana Medicare Advantage|HUMANA MA|||||22.25||| 9521253|ERX|0250|PAROXETINE 20MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.50||| 9521253|ERX|0250|PAROXETINE 20MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9521253|ERX|0250|PAROXETINE 20MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9521253|ERX|0250|PAROXETINE 20MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9521253|ERX|0250|PAROXETINE 20MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9521253|ERX|0250|PAROXETINE 20MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9521253|ERX|0250|PAROXETINE 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9521253|ERX|0250|PAROXETINE 20MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9521253|ERX|0250|PAROXETINE 20MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9521253|ERX|0250|PAROXETINE 20MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||4.50||| 9521253|ERX|0250|PAROXETINE 20MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9521311|ERX|0250|AMOX-CLAV 500-125MG TABLE|Managed Medicaid|MEDICAID SUPERIOR|||||4.50||| 9521311|ERX|0250|AMOX-CLAV 500-125MG TABLE|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9521311|ERX|0250|AMOX-CLAV 500-125MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.50||| 9521311|ERX|0250|AMOX-CLAV 500-125MG TABLE|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9521311|ERX|0250|AMOX-CLAV 500-125MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|||||4.50||| 9521311|ERX|0250|AMOX-CLAV 500-125MG TABLE|Cigna|CIGNA|||||4.50||| 9521311|ERX|0250|AMOX-CLAV 500-125MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.50||| 9521311|ERX|0250|AMOX-CLAV 500-125MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9521311|ERX|0250|AMOX-CLAV 500-125MG TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9521311|ERX|0250|AMOX-CLAV 500-125MG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9521311|ERX|0250|AMOX-CLAV 500-125MG TABLE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|UTMB|UTMB CORRECTIONAL MANAGED CARE|||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|United Healthcare|UNITED HEALTHCARE OTHER|||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Medicaid|COUNTY INDIGENT HEALTH OTHER|4.50||||||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|United Medicare Advantage|UHC AARP MCR HMO MA|||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Aetna|AETNA PPO|||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Aetna|AETNA OTHER|||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Medicaid|MEDICAID|4.50||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Blue Cross PPO Specialty|BCBSTX OTHER|||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Cigna|CIGNA|||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Managed Medicare|HEALTHSPRING MA|||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||4.50||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9521436|ERX|0250|LIPASE-PROT-AMYL 12-38-60|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|16.50||||16.50||| 9521436|ERX|0250|LIPASE-PROT-AMYL 12-38-60|Humana Medicare Advantage|HUMANA MA|16.50||||16.50||| 9521436|ERX|0250|LIPASE-PROT-AMYL 12-38-60|Managed Medicare|HEALTHSPRING MA|16.50||||||| 9521436|ERX|0250|LIPASE-PROT-AMYL 12-38-60|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|16.50||||16.50||| 9521436|ERX|0250|LIPASE-PROT-AMYL 12-38-60|United Medicare Advantage|AARP UHC WEST COMPLETE MA|16.50||||||| 9521436|ERX|0250|LIPASE-PROT-AMYL 12-38-60|Medicare|MEDICARE ACUTE|16.50||||||| 9521451|ERX|0250|AZELASTINE NASAL SPRAY, 3|Medicare|MEDICARE ACUTE|900.75||||900.75||| 9521451|ERX|0250|AZELASTINE NASAL SPRAY, 3|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|900.75||||||| 9521451|ERX|0250|AZELASTINE NASAL SPRAY, 3|United Medicare Advantage|AARP UHC WEST COMPLETE MA|900.75||||900.75||| 9521451|ERX|0250|AZELASTINE NASAL SPRAY, 3|Humana Medicare Advantage|HUMANA MA|900.75||||900.75||| 9521451|ERX|0250|AZELASTINE NASAL SPRAY, 3|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|900.75||||||| 9521451|ERX|0250|AZELASTINE NASAL SPRAY, 3|Aenta Medicare Advantage|AETNA MEDICARE MA|900.75||||||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|Managed Medicare|HEALTHSPRING MA|64.50||||64.50||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|Humana Medicare Advantage|HUMANA MA|64.50||||64.50||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|Managed Medicaid|MEDICAID AMERIGROUP|||||64.50||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|Managed Medicaid|MEDICAID SUPERIOR|||||64.50||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|Blue Cross PPO Specialty|BCBSTX PPO|64.50||||64.50||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|Cigna|CIGNA|64.50||||64.50||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|Aetna|AETNA PPO|||||64.50||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||64.50||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||64.50||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|Aenta Medicare Advantage|AETNA MEDICARE MA|||||64.50||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||64.50||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|Blue Cross HMO Specialty|BCBSTX HMO|||||64.50||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|Veterans Affairs|VETERANS ADMINISTRATION|64.50||||64.50||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|Workers Compensation|WORKERS COMPENSATION OTHER|||||64.50||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|64.50||||||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|United Medicare Advantage|UHC MEDICARE GOLD MA|64.50||||64.50||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||64.50||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|64.50||||64.50||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|Tricare|TRICARE EAST REGION|||||64.50||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|NON CONTRACTED|COMMERCIAL OTHER 1|||||64.50||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|United Healthcare|UNITED HEALTHCARE|||||64.50||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|United Healthcare|UNITED HEALTHCARE OTHER|||||64.50||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||64.50||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|United Healthcare|TML GROUP BENEFITS|||||64.50||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|Medicaid|MEDICAID HMO|||||64.50||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|Medicaid|MEDICAID|||||64.50||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|Medicare|MEDICARE ACUTE|64.50||||64.50||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|5.44||||||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Medicaid|MEDICAID|5.44||||||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Medicare|MEDICARE ACUTE|5.44||||5.44||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|United Healthcare|TML GROUP BENEFITS|5.44||||||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|United Healthcare|UNITED HEALTHCARE OTHER|||||5.44||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|5.44||||5.44||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|5.44||||5.44||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|United Medicare Advantage|UHC MEDICARE GOLD MA|5.44||||||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|United Healthcare|UNITED HEALTHCARE|5.44||||5.44||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Veterans Affairs|VETERANS ADMINISTRATION|5.44||||5.44||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Aetna|BOON CHAPMAN|5.44||||||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.44||||5.44||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Blue Cross HMO Specialty|BCBSTX HMO|5.44||||||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|5.44||||||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Aenta Medicare Advantage|AETNA MEDICARE MA|5.44||||5.44||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|ChampVA|CHAMPVA CENTER|5.44||||||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Blue Cross PPO Specialty|BCBSTX PPO|5.44||||||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Managed Medicaid|MEDICAID AMERIGROUP|5.44||||||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.44||||5.44||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|5.44||||||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Humana Medicare Advantage|HUMANA MA|5.44||||5.44||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Managed Medicaid|MEDICAID SUPERIOR|5.44||||5.44||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|5.44||||||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Managed Medicare|HEALTHSPRING MA|5.44||||||| 9521550|ERX|0250|LEVOFLOXACIN 250MG/50ML D|Humana Medicare Advantage|HUMANA MA|141.50||||141.50||| 9521550|ERX|0250|LEVOFLOXACIN 250MG/50ML D|Blue Cross PPO Specialty|BCBSTX PPO|141.50||||||| 9521550|ERX|0250|LEVOFLOXACIN 250MG/50ML D|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|141.50||||||| 9521550|ERX|0250|LEVOFLOXACIN 250MG/50ML D|Aenta Medicare Advantage|AETNA MEDICARE MA|141.50||||||| 9521550|ERX|0250|LEVOFLOXACIN 250MG/50ML D|United Medicare Advantage|UHC MEDICARE GOLD MA|141.50||||||| 9521550|ERX|0250|LEVOFLOXACIN 250MG/50ML D|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|141.50||||||| 9521550|ERX|0250|LEVOFLOXACIN 250MG/50ML D|United Medicare Advantage|AARP UHC WEST COMPLETE MA|141.50||||||| 9521550|ERX|0250|LEVOFLOXACIN 250MG/50ML D|Medicare|MEDICARE ACUTE|141.50||||||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|United Healthcare|UNITED HEALTHCARE|||||496.50||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Multiplan|NALC|||||496.50||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Medicaid|MEDICAID|496.50||||||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Medicare|MEDICARE ACUTE|496.50||||496.50||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Veterans Affairs|VETERANS ADMINISTRATION|||||496.50||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|496.50||||496.50||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|United Medicare Advantage|UHC MEDICARE GOLD MA|496.50||||496.50||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Aetna|AETNA PPO|496.50||||496.50||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|496.50||||496.50||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|496.50||||496.50||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Aenta Medicare Advantage|AETNA MEDICARE MA|496.50||||||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|496.50||||496.50||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Blue Cross HMO Specialty|BCBSTX HMO|||||496.50||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Cigna|CIGNA|||||496.50||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Blue Cross PPO Specialty|BCBSTX PPO|496.50||||496.50||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Managed Medicare|BCBS MEDICARE PPO MA|496.50||||496.50||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Managed Medicaid|MEDICAID SUPERIOR|496.50||||496.50||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|496.50||||496.50||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Tricare|TRICARE EAST REGION|496.50||||||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|496.50||||496.50||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Humana Medicare Advantage|HUMANA MA|496.50||||496.50||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|MTC Medical|VAN ZANDT COUNTY INMATE|496.50||||||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Managed Medicaid|MEDICAID AMERIGROUP|||||496.50||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Managed Medicare|HEALTHSPRING MA|496.50||||496.50||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||496.50||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Managed Medicare|OTHER INSTITUTIONS|||||496.50||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Managed Medicare|VAN ZANDT COUNTY INMATE|496.50||||||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Managed Medicaid|MEDICAID SUPERIOR|5.75||||5.75||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Managed Medicaid|MEDICAID AMERIGROUP|5.75||||5.75||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||5.75||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Humana Medicare Advantage|HUMANA MA|5.75||||||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Blue Cross HMO Specialty|BCBSTX HMO|||||5.75||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||5.75||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Blue Cross PPO Specialty|BCBSTX PPO|5.75||||5.75||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Blue Cross PPO Specialty|BCBSTX OTHER|||||5.75||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Aetna|AETNA PPO|||||5.75||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Cigna|CIGNA|||||5.75||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||5.75||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Access Direct Platinum|HEALTHFIRST TPA UMR|||||5.75||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||5.75||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||5.75||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||5.75||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||5.75||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Tricare|TRICARE EAST REGION|||||5.75||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||5.75||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|United Healthcare|UNITED HEALTHCARE OTHER|||||5.75||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||5.75||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|United Healthcare|UNITED HEALTHCARE|||||5.75||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Medicaid|MEDICAID|||||5.75||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Medicaid|MEDICAID HMO|||||5.75||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||98.25||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||98.25||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||98.25||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|98.25||||98.25||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Veterans Affairs|VETERANS ADMINISTRATION|98.25||||||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Tricare|TRICARE EAST REGION|||||98.25||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||98.25||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Medicaid|HENDERSON COUNTY INDIGENT|98.25||||||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Medicaid|MEDICAID|98.25||||98.25||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Medicare|MEDICARE PART B ONLY IP|98.25||||||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Medicare|MEDICARE ACUTE|98.25||||98.25||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||98.25||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Aetna|AETNA PPO|98.25||||98.25||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||98.25||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||98.25||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Blue Cross HMO Specialty|BCBSTX HMO|||||98.25||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||98.25||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Managed Medicare|HOSPICE ETMC|98.25||||||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|98.25||||98.25||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|98.25||||98.25||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|||||98.25||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|||||98.25||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Humana Medicare Advantage|HUMANA MA|98.25||||98.25||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||98.25||| 9521667|ERX|0250|TOPIRAMATE 25MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9521667|ERX|0250|TOPIRAMATE 25MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.50||| 9521667|ERX|0250|TOPIRAMATE 25MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||4.50||| 9521667|ERX|0250|TOPIRAMATE 25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9521667|ERX|0250|TOPIRAMATE 25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.50||| 9521667|ERX|0250|TOPIRAMATE 25MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9521667|ERX|0250|TOPIRAMATE 25MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.50||| 9521667|ERX|0250|TOPIRAMATE 25MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9521667|ERX|0250|TOPIRAMATE 25MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9521667|ERX|0250|TOPIRAMATE 25MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||4.50||| 9521667|ERX|0250|TOPIRAMATE 25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9521667|ERX|0250|TOPIRAMATE 25MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9521675|ERX|0250|TOPIRAMATE 100MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9521675|ERX|0250|TOPIRAMATE 100MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9521675|ERX|0250|TOPIRAMATE 100MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9521675|ERX|0250|TOPIRAMATE 100MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9521675|ERX|0250|TOPIRAMATE 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9521675|ERX|0250|TOPIRAMATE 100MG TABLET|Managed Medicare|HEALTHSPRING MA|||||4.50||| 9521675|ERX|0250|TOPIRAMATE 100MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9521675|ERX|0250|TOPIRAMATE 100MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9521675|ERX|0250|TOPIRAMATE 100MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9521675|ERX|0250|TOPIRAMATE 100MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9521675|ERX|0250|TOPIRAMATE 100MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Managed Medicare|VAN ZANDT COUNTY INMATE|||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Cigna|CIGNA OTHER|||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Cigna|CIGNA|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Aetna|AETNA PPO|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Blue Cross PPO Specialty|BCBSTX OTHER|||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Aetna|BOON CHAPMAN|||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UMR|||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|4.50||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Tricare|TRICARE FOR LIFE|||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Tricare|TRICARE EAST REGION|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 2|||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Texas Workforce Commission|DIS DETER SERV (DDS)|4.50||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Medicaid|MEDICAID HMO|||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|MTC Medical|VAN ZANDT COUNTY INMATE|||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|United Healthcare|GEHA|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Medicaid|MEDICAID|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Medicaid|LAW ENFORCEMENT OTHER|||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Medicaid|COUNTY INDIGENT HEALTH OTHER|4.50||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Workers Compensation|UT EMPLOYEE INJURY|4.50||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Workers Compensation|GALLAGHER BASSETT|||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Workers Compensation|BROOKSHIRES WORKERS COMP|||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Workers Compensation|WORKERS COMP PHYSICIAN|||||4.50||| 9521717|ERX|0250|LACTASE 9000 UNIT TABLET|Medicare|MEDICARE ACUTE|4.50||||||| 9521717|ERX|0250|LACTASE 9000 UNIT TABLET|Aetna|AETNA PPO|4.50||||||| 9521717|ERX|0250|LACTASE 9000 UNIT TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9521725|ERX|0250|LEVOFLOXACIN 250MG/10ML,3|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||227.50||| 9521725|ERX|0250|LEVOFLOXACIN 250MG/10ML,3|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||227.50||| 9521733|ERX|0250|LEVOFLOXACIN 250MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|111.75||||||| 9521733|ERX|0250|LEVOFLOXACIN 250MG TABLET|Medicare|MEDICARE ACUTE|111.75||||||| 9521733|ERX|0250|LEVOFLOXACIN 250MG TABLET|Humana Medicare Advantage|HUMANA MA|111.75||||||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Aetna|AETNA OTHER|||||4.50||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||4.50||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Aetna|AETNA PPO|4.50||||||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.50||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||4.50||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||4.50||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Medicaid|MEDICAID TEXAS CHILDRENS|||||4.50||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.50||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9521758|ERX|0250|LEVOFLOXACIN 750MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|238.50||||238.50||| 9521758|ERX|0250|LEVOFLOXACIN 750MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|238.50||||||| 9521758|ERX|0250|LEVOFLOXACIN 750MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||238.50||| 9521758|ERX|0250|LEVOFLOXACIN 750MG TABLET|United Healthcare|UNITED HEALTHCARE|238.50||||238.50||| 9521758|ERX|0250|LEVOFLOXACIN 750MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|238.50||||238.50||| 9521758|ERX|0250|LEVOFLOXACIN 750MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|||||238.50||| 9521758|ERX|0250|LEVOFLOXACIN 750MG TABLET|Medicare|MEDICARE ACUTE|238.50||||238.50||| 9521758|ERX|0250|LEVOFLOXACIN 750MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||238.50||| 9521758|ERX|0250|LEVOFLOXACIN 750MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|238.50||||||| 9521758|ERX|0250|LEVOFLOXACIN 750MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|238.50||||238.50||| 9521758|ERX|0250|LEVOFLOXACIN 750MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|238.50||||||| 9521758|ERX|0250|LEVOFLOXACIN 750MG TABLET|Humana Medicare Advantage|HUMANA MA|238.50||||238.50||| 9521758|ERX|0250|LEVOFLOXACIN 750MG TABLET|Managed Medicare|HEALTHSPRING MA|238.50||||238.50||| 9521758|ERX|0250|LEVOFLOXACIN 750MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||238.50||| 9521758|ERX|0250|LEVOFLOXACIN 750MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||238.50||| 9521758|ERX|0250|LEVOFLOXACIN 750MG TABLET|ChampVA|CHAMPVA CENTER|238.50||||||| 9521758|ERX|0250|LEVOFLOXACIN 750MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|238.50||||238.50||| 9521782|ERX|0250|ESTROGENS,CONJ 0.625MG TA|Medicare|MEDICARE ACUTE|4.50||||||| 9521790|ERX|0250|ESTROGENS,CONJ 0.3MG TABL|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9521790|ERX|0250|ESTROGENS,CONJ 0.3MG TABL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9521790|ERX|0250|ESTROGENS,CONJ 0.3MG TABL|Medicare|MEDICARE ACUTE|4.50||||||| 9521808|ERX|0250|ESTROGENS,CONJ VAG CRM,42|Medicaid|HENDERSON COUNTY INDIGENT|||||946.50||| 9521808|ERX|0250|ESTROGENS,CONJ VAG CRM,42|Medicare|MEDICARE ACUTE|946.50||||946.50||| 9521808|ERX|0250|ESTROGENS,CONJ VAG CRM,42|Veterans Affairs|VETERANS ADMINISTRATION|||||946.50||| 9521808|ERX|0250|ESTROGENS,CONJ VAG CRM,42|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||946.50||| 9521808|ERX|0250|ESTROGENS,CONJ VAG CRM,42|Blue Cross HMO Specialty|BCBSTX HMO|||||946.50||| 9521808|ERX|0250|ESTROGENS,CONJ VAG CRM,42|ChampVA|CHAMPVA CENTER|||||946.50||| 9521808|ERX|0250|ESTROGENS,CONJ VAG CRM,42|Blue Cross PPO Specialty|BCBSTX PPO|946.50||||946.50||| 9521808|ERX|0250|ESTROGENS,CONJ VAG CRM,42|Aetna|AETNA PPO|946.50||||||| 9521808|ERX|0250|ESTROGENS,CONJ VAG CRM,42|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||946.50||| 9521808|ERX|0250|ESTROGENS,CONJ VAG CRM,42|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||946.50||| 9521808|ERX|0250|ESTROGENS,CONJ VAG CRM,42|Aenta Medicare Advantage|AETNA MEDICARE MA|||||946.50||| 9521808|ERX|0250|ESTROGENS,CONJ VAG CRM,42|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|946.50||||946.50||| 9521808|ERX|0250|ESTROGENS,CONJ VAG CRM,42|Humana Medicare Advantage|HUMANA MA|946.50||||946.50||| 9521808|ERX|0250|ESTROGENS,CONJ VAG CRM,42|Managed Medicaid|MEDICAID AMERIGROUP|||||946.50||| 9521808|ERX|0250|ESTROGENS,CONJ VAG CRM,42|Managed Medicaid|MEDICAID SUPERIOR|946.50||||||| 9521899|ERX|0250|AMPICILLIN-SULBACTAM 3 G|Managed Medicaid|MEDICAID AMERIGROUP|143.25||||||| 9521899|ERX|0250|AMPICILLIN-SULBACTAM 3 G|Aenta Medicare Advantage|AETNA MEDICARE MA|||||143.25||| 9521899|ERX|0250|AMPICILLIN-SULBACTAM 3 G|Workers Compensation|WORKERS COMPENSATION OTHER|||||143.25||| 9521899|ERX|0250|AMPICILLIN-SULBACTAM 3 G|Medicare|MEDICARE ACUTE|143.25||||143.25||| 9521915|ERX|0250|PENICILLIN G POTASSIUM 5|Medicaid|MEDICAID HMO|141.50||||||| 9521964|ERX|0250|GLIPIZIDE XL 2.5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9521964|ERX|0250|GLIPIZIDE XL 2.5MG TABLET|Aetna|AETNA PPO|||||4.50||| 9521964|ERX|0250|GLIPIZIDE XL 2.5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9521964|ERX|0250|GLIPIZIDE XL 2.5MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9521964|ERX|0250|GLIPIZIDE XL 2.5MG TABLET|Humana Medicare Advantage|HUMANA MA|||||4.50||| 9521964|ERX|0250|GLIPIZIDE XL 2.5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9521964|ERX|0250|GLIPIZIDE XL 2.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9521964|ERX|0250|GLIPIZIDE XL 2.5MG TABLET|Medicare|MEDICARE ACUTE|4.50||||||| 9521980|ERX|0250|DOXAZOSIN 2MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9521980|ERX|0250|DOXAZOSIN 2MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9521980|ERX|0250|DOXAZOSIN 2MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9521980|ERX|0250|DOXAZOSIN 2MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9521980|ERX|0250|DOXAZOSIN 2MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9521980|ERX|0250|DOXAZOSIN 2MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9521980|ERX|0250|DOXAZOSIN 2MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9522038|ERX|0250|FLUCONAZOLE 200MG/100ML N|Humana Medicare Advantage|HUMANA MA|7.58||||||| 9522038|ERX|0250|FLUCONAZOLE 200MG/100ML N|United Medicare Advantage|UHC MEDICARE GOLD MA|7.58||||||| 9522038|ERX|0250|FLUCONAZOLE 200MG/100ML N|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|7.58||||||| 9522038|ERX|0250|FLUCONAZOLE 200MG/100ML N|Medicaid|MOLINA HEALTHCARE OF TEXAS|7.58||||||| 9522038|ERX|0250|FLUCONAZOLE 200MG/100ML N|Medicare|MEDICARE ACUTE|7.58||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Medicare|MEDICARE ACUTE|4.50||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.50||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.50||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|Managed Medicare|HEALTHSPRING MA|162.25||||162.25||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|Managed Medicare|BCBS MEDICARE PPO MA|162.25||||||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|162.25||||162.25||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|162.25||||162.25||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|Humana Medicare Advantage|HUMANA MA|162.25||||162.25||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|||||162.25||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||162.25||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|162.25||||162.25||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|Veterans Affairs|VETERANS ADMINISTRATION|162.25||||162.25||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|162.25||||162.25||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|162.25||||162.25||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|||||162.25||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|Medicare|MEDICARE ACUTE|162.25||||162.25||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|Medicaid|LAW ENFORCEMENT OTHER|||||162.25||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|Medicaid|HENDERSON COUNTY INDIGENT|162.25||||||| 9522111|ERX|0250|ZIPRASIDONE 20MG CAPSULE|Medicare|MEDICARE ACUTE|22.25||||||| 9522111|ERX|0250|ZIPRASIDONE 20MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||22.25||| 9522111|ERX|0250|ZIPRASIDONE 20MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|22.25||||||| 9522111|ERX|0250|ZIPRASIDONE 20MG CAPSULE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||22.25||| 9522111|ERX|0250|ZIPRASIDONE 20MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|22.25||||||| 9522111|ERX|0250|ZIPRASIDONE 20MG CAPSULE|United Healthcare|UNITED HEALTHCARE|22.25||||||| 9522111|ERX|0250|ZIPRASIDONE 20MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|||||22.25||| 9522111|ERX|0250|ZIPRASIDONE 20MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|22.25||||||| 9522111|ERX|0250|ZIPRASIDONE 20MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|22.25||||22.25||| 9522145|ERX|0250|ZIPRASIDONE 80MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|75.75||||75.75||| 9522145|ERX|0250|ZIPRASIDONE 80MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|75.75||||||| 9522145|ERX|0250|ZIPRASIDONE 80MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|75.75||||||| 9522145|ERX|0250|ZIPRASIDONE 80MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|75.75||||||| 9522145|ERX|0250|ZIPRASIDONE 80MG CAPSULE|Managed Medicare|HEALTHSPRING MA|||||75.75||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||4.50||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Medicaid|MEDICAID|4.50||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Aetna|AETNA PPO|4.50||||4.50||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|4.50||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Cigna|CIGNA|4.50||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|Cigna|CIGNA OTHER|67.75||||||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|Humana Medicare Advantage|HUMANA MA|67.75||||67.75||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|Medicare|MEDICARE ACUTE|67.75||||||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|125.50||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|125.50||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|125.50||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Veterans Affairs|VETERANS ADMINISTRATION|125.50||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Tricare|TRICARE EAST REGION|125.50||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|United Healthcare|UNITED HEALTHCARE|||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|United Healthcare|UNITED HEALTHCARE|125.50||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|United Healthcare|TML GROUP BENEFITS|125.50||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|PHCS|MULTIPLAN PHCS OTHER|||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Texas Workforce Commission|DIS DETER SERV (DDS)|125.50||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Medicaid|MEDICAID HMO|||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Medicaid|MEDICAID|125.50||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Medicaid|LAW ENFORCEMENT OTHER|125.50||||||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|United Healthcare|UNITED HEALTHCARE OTHER|125.50||||||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Medicaid|HENDERSON COUNTY INDIGENT|125.50||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Medicare|MEDICARE ACUTE|125.50||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Managed Medicare|HEALTHSPRING MA|125.50||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Humana Medicare Advantage|HUMANA MA|125.50||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Managed Medicaid|MEDICAID SUPERIOR|125.50||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|125.50||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|NON CONTRACTED|COMMERCIAL OTHER 1|125.50||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Managed Medicaid|MEDICAID AMERIGROUP|125.50||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Aetna|AETNA OTHER|||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Aetna|AETNA PPO|125.50||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|125.50||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Managed Medicare|BCBS MEDICARE PPO MA|125.50||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|125.50||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Aenta Medicare Advantage|AETNA MEDICARE MA|125.50||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|125.50||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Blue Cross HMO Specialty|BCBSTX HMO|125.50||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Cigna|CIGNA|||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Cigna|CIGNA OTHER|||||125.50||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Blue Cross PPO Specialty|BCBSTX PPO|125.50||||125.50||| 9522244|ERX|0250|ROCURONIUM 100MG/10ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|363.25||||||| 9522269|ERX|0250|NYSTATIN POWDER, 15 GM|Blue Cross HMO Specialty|BCBSTX HMO|||||1.69||| 9522269|ERX|0250|NYSTATIN POWDER, 15 GM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.69||||||| 9522269|ERX|0250|NYSTATIN POWDER, 15 GM|Managed Medicaid|MEDICAID SUPERIOR|1.69||||1.69||| 9522269|ERX|0250|NYSTATIN POWDER, 15 GM|Blue Cross PPO Specialty|BCBSTX PPO|1.69||||||| 9522269|ERX|0250|NYSTATIN POWDER, 15 GM|Humana Medicare Advantage|HUMANA MA|1.69||||1.69||| 9522269|ERX|0250|NYSTATIN POWDER, 15 GM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.69||||||| 9522269|ERX|0250|NYSTATIN POWDER, 15 GM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.69||||||| 9522269|ERX|0250|NYSTATIN POWDER, 15 GM|Managed Medicare|HEALTHSPRING MA|1.69||||||| 9522269|ERX|0250|NYSTATIN POWDER, 15 GM|Medicare|MEDICARE ACUTE|1.69||||1.69||| 9522269|ERX|0250|NYSTATIN POWDER, 15 GM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.69||||||| 9522269|ERX|0250|NYSTATIN POWDER, 15 GM|United Medicare Advantage|UHC MEDICARE GOLD MA|1.69||||||| 9522269|ERX|0250|NYSTATIN POWDER, 15 GM|Veterans Affairs|VETERANS ADMINISTRATION|1.69||||||| 9522269|ERX|0250|NYSTATIN POWDER, 15 GM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.69||||||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Tricare|TRICARE EAST REGION|4.50||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Medicaid|MEDICAID HMO|||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Medicaid|LAW ENFORCEMENT OTHER|||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Managed Medicare|VAN ZANDT COUNTY INMATE|4.50||||||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Medicaid|MEDICAID|4.50||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|United Healthcare|TML GROUP BENEFITS|||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|MTC Medical|VAN ZANDT COUNTY INMATE|4.50||||||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Aetna|AETNA PPO|4.50||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|4.50||||||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Cigna|CIGNA|||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|4.50||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Blue Cross PPO Specialty|BCBSTX OTHER|||||4.50||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Cigna|CIGNA|4.50||||4.50||| 9522327|ERX|0250|ZIDOVUDINE 300MG TABLET|Workers Compensation|UT EMPLOYEE INJURY|||||0.58||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|Blue Cross PPO Specialty|BCBSTX PPO|80.25||||||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|Aetna|AETNA PPO|||||80.25||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|Aenta Medicare Advantage|AETNA MEDICARE MA|80.25||||||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|Humana Medicare Advantage|HUMANA MA|80.25||||80.25||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|Managed Medicaid|MEDICAID UNITED HEALTHCARE|80.25||||80.25||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|Managed Medicaid|MEDICAID SUPERIOR|80.25||||||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||80.25||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|Managed Medicare|HEALTHSPRING MA|80.25||||||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|Medicare|MEDICARE ACUTE|80.25||||80.25||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|80.25||||80.25||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|United Medicare Advantage|UHC MEDICARE GOLD MA|80.25||||80.25||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|United Medicare Advantage|AARP UHC WEST COMPLETE MA|80.25||||||| 9522368|ERX|0250|BUTORPHANOL 10MG/ML, 2.5M|Workers Compensation|WORKERS COMPENSATION OTHER|||||7.54||| 9522368|ERX|0250|BUTORPHANOL 10MG/ML, 2.5M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||7.54||| 9522368|ERX|0250|BUTORPHANOL 10MG/ML, 2.5M|ChampVA|CHAMPVA CENTER|7.54||||||| 9522434|ERX|0250|HYDROXYUREA 500MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9522434|ERX|0250|HYDROXYUREA 500MG CAPSULE|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||||| 9522434|ERX|0250|HYDROXYUREA 500MG CAPSULE|Medicare|MEDICARE ACUTE|4.50||||||| 9522434|ERX|0250|HYDROXYUREA 500MG CAPSULE|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9522434|ERX|0250|HYDROXYUREA 500MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9522491|ERX|0250|PREDNISONE 5MG/5ML, 30ML|Managed Medicaid|MEDICAID SUPERIOR|0.47||||||| 9522491|ERX|0250|PREDNISONE 5MG/5ML, 30ML|Managed Medicaid|MEDICAID AMERIGROUP|||||0.47||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Workers Compensation|UT EMPLOYEE INJURY|4.50||||||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.50||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Medicaid|MEDICAID HMO|||||4.50||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Medicaid|MEDICAID|||||4.50||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Tricare|TRICARE EAST REGION|||||4.50||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||4.50||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Cigna|CIGNA OTHER|4.50||||4.50||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Managed Medicare|MA PART B ONLY IP|4.50||||||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||4.50||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Cigna|CIGNA|4.50||||4.50||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||4.50||| 9522632|ERX|0250|DICLOFENAC SODIUM 50MG TA|Managed Medicare|BCBS MEDICARE PPO MA|13.25||||||| 9522632|ERX|0250|DICLOFENAC SODIUM 50MG TA|Blue Cross PPO Specialty|BCBSTX PPO|13.25||||||| 9522632|ERX|0250|DICLOFENAC SODIUM 50MG TA|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||13.25||| 9522632|ERX|0250|DICLOFENAC SODIUM 50MG TA|Medicare|MEDICARE ACUTE|13.25||||||| 9522632|ERX|0250|DICLOFENAC SODIUM 50MG TA|Humana Medicare Advantage|HUMANA MA|13.25||||||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|United Medicare Advantage|AARP UHC WEST COMPLETE MA|15.75||||15.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Tricare|TRICARE EAST REGION|||||15.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|NON CONTRACTED|COMMERCIAL OTHER 1|15.75||||15.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|United Healthcare|UNITED HEALTHCARE|||||15.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|United Healthcare|UMR UNITED MEDICAL RESOURCES|15.75||||||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||15.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||15.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Medicaid|MEDICAID|||||15.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Medicare|MEDICARE ACUTE|15.75||||15.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Aenta Medicare Advantage|AETNA MEDICARE MA|||||15.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|15.75||||15.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Veterans Affairs|VETERANS ADMINISTRATION|||||15.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Blue Cross HMO Specialty|BCBSTX HMO|||||15.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Blue Cross PPO Specialty|BCBSTX PPO|15.75||||15.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Managed Medicare|HEALTHSPRING MA|||||15.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||15.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|15.75||||15.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Managed Medicaid|MEDICAID SUPERIOR|15.75||||15.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Managed Medicaid|MEDICAID AMERIGROUP|||||15.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Managed Medicaid|MEDICAID UNITED HEALTHCARE|15.75||||15.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Humana Medicare Advantage|HUMANA MA|15.75||||15.75||| 9522657|ERX|0250|LITHIUM 150MG CAPSULE|Humana Medicare Advantage|HUMANA MA|4.25||||||| 9522657|ERX|0250|LITHIUM 150MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.25||| 9522657|ERX|0250|LITHIUM 150MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.25||||||| 9522657|ERX|0250|LITHIUM 150MG CAPSULE|Managed Medicare|HEALTHSPRING MA|4.25||||||| 9522657|ERX|0250|LITHIUM 150MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.25||| 9522657|ERX|0250|LITHIUM 150MG CAPSULE|Medicare|MEDICARE ACUTE|4.25||||4.25||| 9522657|ERX|0250|LITHIUM 150MG CAPSULE|Tricare|TRICARE EAST REGION|4.25||||||| 9522673|ERX|0250|METHOTREXATE 2.5MG TABLET|Medicare|MEDICARE ACUTE|4.50||||||| 9522673|ERX|0250|METHOTREXATE 2.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9522707|ERX|0250|METHADONE 10MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9522707|ERX|0250|METHADONE 10MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9522707|ERX|0250|METHADONE 10MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9522707|ERX|0250|METHADONE 10MG TABLET|Medicaid|MEDICAID|4.50||||||| 9522707|ERX|0250|METHADONE 10MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9522707|ERX|0250|METHADONE 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9522707|ERX|0250|METHADONE 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9522707|ERX|0250|METHADONE 10MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9522707|ERX|0250|METHADONE 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9522731|ERX|0250|WARFARIN 1MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9522731|ERX|0250|WARFARIN 1MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9522731|ERX|0250|WARFARIN 1MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9522731|ERX|0250|WARFARIN 1MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9522731|ERX|0250|WARFARIN 1MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9522749|ERX|0250|WARFARIN 2MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|14.50||||||| 9522749|ERX|0250|WARFARIN 2MG TABLET|Humana Medicare Advantage|HUMANA MA|14.50||||||| 9522749|ERX|0250|WARFARIN 2MG TABLET|Medicare|MEDICARE ACUTE|14.50||||||| 9522749|ERX|0250|WARFARIN 2MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|14.50||||||| 9522749|ERX|0250|WARFARIN 2MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|14.50||||||| 9522749|ERX|0250|WARFARIN 2MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|14.50||||||| 9522756|ERX|0250|WARFARIN 5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|5.25||||||| 9522756|ERX|0250|WARFARIN 5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|5.25||||5.25||| 9522756|ERX|0250|WARFARIN 5MG TABLET|Medicaid|MEDICAID|5.25||||||| 9522756|ERX|0250|WARFARIN 5MG TABLET|Medicare|MEDICARE ACUTE|5.25||||5.25||| 9522756|ERX|0250|WARFARIN 5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|5.25||||||| 9522756|ERX|0250|WARFARIN 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.25||||||| 9522756|ERX|0250|WARFARIN 5MG TABLET|Managed Medicare|HEALTHSPRING MA|5.25||||||| 9522756|ERX|0250|WARFARIN 5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|5.25||||||| 9522756|ERX|0250|WARFARIN 5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.25||||5.25||| 9522756|ERX|0250|WARFARIN 5MG TABLET|Humana Medicare Advantage|HUMANA MA|5.25||||5.25||| 9522764|ERX|0250|WARFARIN 7.5MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9522764|ERX|0250|WARFARIN 7.5MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9522764|ERX|0250|WARFARIN 7.5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.50||| 9522764|ERX|0250|WARFARIN 7.5MG TABLET|Medicaid|MEDICAID|4.50||||||| 9522764|ERX|0250|WARFARIN 7.5MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9522764|ERX|0250|WARFARIN 7.5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.50||| 9522772|ERX|0250|WARFARIN 10MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|18.25||||||| 9522772|ERX|0250|WARFARIN 10MG TABLET|Medicare|MEDICARE ACUTE|18.25||||||| 9522772|ERX|0250|WARFARIN 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||18.25||| 9522772|ERX|0250|WARFARIN 10MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|18.25||||||| 9522772|ERX|0250|WARFARIN 10MG TABLET|Humana Medicare Advantage|HUMANA MA|18.25||||||| 9522780|ERX|0250|WARFARIN 2.5MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9522780|ERX|0250|WARFARIN 2.5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9522780|ERX|0250|WARFARIN 2.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9522780|ERX|0250|WARFARIN 2.5MG TABLET|Medicare|MEDICARE ACUTE|4.50||||||| 9522780|ERX|0250|WARFARIN 2.5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.50||| 9522780|ERX|0250|WARFARIN 2.5MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9522780|ERX|0250|WARFARIN 2.5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9522921|ERX|0250|CARBACHOL 0.01% 100MCG 1M|Medicare|MEDICARE ACUTE|||||291.25||| 9522921|ERX|0250|CARBACHOL 0.01% 100MCG 1M|United Medicare Advantage|UHC MEDICARE GOLD MA|||||291.25||| 9522921|ERX|0250|CARBACHOL 0.01% 100MCG 1M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||291.25||| 9522921|ERX|0250|CARBACHOL 0.01% 100MCG 1M|Blue Cross HMO Specialty|BCBSTX HMO|||||291.25||| 9522921|ERX|0250|CARBACHOL 0.01% 100MCG 1M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||291.25||| 9522921|ERX|0250|CARBACHOL 0.01% 100MCG 1M|ChampVA|CHAMPVA CENTER|||||291.25||| 9522921|ERX|0250|CARBACHOL 0.01% 100MCG 1M|Blue Cross PPO Specialty|BCBSTX PPO|||||291.25||| 9522921|ERX|0250|CARBACHOL 0.01% 100MCG 1M|Cigna|CIGNA|||||291.25||| 9522921|ERX|0250|CARBACHOL 0.01% 100MCG 1M|Aetna|AETNA PPO|||||291.25||| 9522921|ERX|0250|CARBACHOL 0.01% 100MCG 1M|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||291.25||| 9522921|ERX|0250|CARBACHOL 0.01% 100MCG 1M|Aenta Medicare Advantage|AETNA MEDICARE MA|||||291.25||| 9522921|ERX|0250|CARBACHOL 0.01% 100MCG 1M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||291.25||| 9522921|ERX|0250|CARBACHOL 0.01% 100MCG 1M|Humana Medicare Advantage|HUMANA MA|||||291.25||| 9522921|ERX|0250|CARBACHOL 0.01% 100MCG 1M|Managed Medicare|HEALTHSPRING MA|||||291.25||| 9522954|ERX|0250|OLOPATADINE 0.1% EYE DROP|Managed Medicare|HEALTHSPRING MA|||||442.50||| 9522954|ERX|0250|OLOPATADINE 0.1% EYE DROP|Humana Medicare Advantage|HUMANA MA|442.50||||||| 9522954|ERX|0250|OLOPATADINE 0.1% EYE DROP|Aetna|AETNA PPO|442.50||||||| 9522954|ERX|0250|OLOPATADINE 0.1% EYE DROP|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|442.50||||||| 9522954|ERX|0250|OLOPATADINE 0.1% EYE DROP|Medicare|MEDICARE ACUTE|442.50||||442.50||| 9522962|ERX|0250|BRINZOLAMIDE 1% EYE DROP,|Medicare|MEDICARE ACUTE|625.50||||||| 9523002|ERX|0250|CYCLOPENTOLATE 1% EYE DRO|Blue Cross HMO Specialty|BCBSTX HMO|||||161.25||| 9523002|ERX|0250|CYCLOPENTOLATE 1% EYE DRO|ChampVA|CHAMPVA CENTER|||||161.25||| 9523002|ERX|0250|CYCLOPENTOLATE 1% EYE DRO|Blue Cross PPO Specialty|BCBSTX PPO|||||161.25||| 9523002|ERX|0250|CYCLOPENTOLATE 1% EYE DRO|Cigna|CIGNA|||||161.25||| 9523002|ERX|0250|CYCLOPENTOLATE 1% EYE DRO|Aetna|AETNA PPO|||||161.25||| 9523002|ERX|0250|CYCLOPENTOLATE 1% EYE DRO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||161.25||| 9523002|ERX|0250|CYCLOPENTOLATE 1% EYE DRO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||161.25||| 9523002|ERX|0250|CYCLOPENTOLATE 1% EYE DRO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||161.25||| 9523002|ERX|0250|CYCLOPENTOLATE 1% EYE DRO|Humana Medicare Advantage|HUMANA MA|||||161.25||| 9523002|ERX|0250|CYCLOPENTOLATE 1% EYE DRO|Managed Medicare|HEALTHSPRING MA|||||161.25||| 9523002|ERX|0250|CYCLOPENTOLATE 1% EYE DRO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||161.25||| 9523002|ERX|0250|CYCLOPENTOLATE 1% EYE DRO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||161.25||| 9523002|ERX|0250|CYCLOPENTOLATE 1% EYE DRO|Medicare|MEDICARE ACUTE|||||161.25||| 9523002|ERX|0250|CYCLOPENTOLATE 1% EYE DRO|United Healthcare|TML GROUP BENEFITS|||||161.25||| 9523002|ERX|0250|CYCLOPENTOLATE 1% EYE DRO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||161.25||| 9523044|ERX|0250|TOBRAMYCIN 0.3% EYE DROP,|Medicare|MEDICARE ACUTE|117.50||||||| 9523044|ERX|0250|TOBRAMYCIN 0.3% EYE DROP,|United Healthcare|UNITED HEALTHCARE|117.50||||||| 9523044|ERX|0250|TOBRAMYCIN 0.3% EYE DROP,|Workers Compensation|WORKERS COMPENSATION OTHER|||||117.50||| 9523044|ERX|0250|TOBRAMYCIN 0.3% EYE DROP,|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||117.50||| 9523044|ERX|0250|TOBRAMYCIN 0.3% EYE DROP,|Managed Medicaid|MEDICAID SUPERIOR|||||117.50||| 9523051|ERX|0250|TOBRAMYCIN 0.3% EYE OINT,|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9523051|ERX|0250|TOBRAMYCIN 0.3% EYE OINT,|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9523051|ERX|0250|TOBRAMYCIN 0.3% EYE OINT,|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9523051|ERX|0250|TOBRAMYCIN 0.3% EYE OINT,|Managed Medicaid|MEDICAID AMERIGROUP|||||4.50||| 9523051|ERX|0250|TOBRAMYCIN 0.3% EYE OINT,|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.50||| 9523051|ERX|0250|TOBRAMYCIN 0.3% EYE OINT,|Medicare|MEDICARE ACUTE|||||4.50||| 9523069|ERX|0250|TOBRAMYCIN/DEXAMETH, 2.5M|Medicare|MEDICARE ACUTE|175.50||||175.50||| 9523069|ERX|0250|TOBRAMYCIN/DEXAMETH, 2.5M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||175.50||| 9523069|ERX|0250|TOBRAMYCIN/DEXAMETH, 2.5M|Humana Medicare Advantage|HUMANA MA|||||175.50||| 9523069|ERX|0250|TOBRAMYCIN/DEXAMETH, 2.5M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||175.50||| 9523069|ERX|0250|TOBRAMYCIN/DEXAMETH, 2.5M|Blue Cross HMO Specialty|BCBSTX HMO|||||175.50||| 9523069|ERX|0250|TOBRAMYCIN/DEXAMETH, 2.5M|Blue Cross PPO Specialty|BCBSTX PPO|||||175.50||| 9523069|ERX|0250|TOBRAMYCIN/DEXAMETH, 2.5M|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||175.50||| 9523069|ERX|0250|TOBRAMYCIN/DEXAMETH, 2.5M|Managed Medicaid|MEDICAID AMERIGROUP|||||175.50||| 9523069|ERX|0250|TOBRAMYCIN/DEXAMETH, 2.5M|Aenta Medicare Advantage|AETNA MEDICARE MA|||||175.50||| 9523077|ERX|0250|TOBRAMYCIN/DEXAMETH EYE ,|Cigna|CIGNA|||||4.50||| 9523077|ERX|0250|TOBRAMYCIN/DEXAMETH EYE ,|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 9523077|ERX|0250|TOBRAMYCIN/DEXAMETH EYE ,|ChampVA|CHAMPVA CENTER|||||4.50||| 9523077|ERX|0250|TOBRAMYCIN/DEXAMETH EYE ,|Blue Cross PPO Specialty|BCBSTX PPO|||||4.50||| 9523077|ERX|0250|TOBRAMYCIN/DEXAMETH EYE ,|Aetna|AETNA PPO|||||4.50||| 9523077|ERX|0250|TOBRAMYCIN/DEXAMETH EYE ,|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.50||| 9523077|ERX|0250|TOBRAMYCIN/DEXAMETH EYE ,|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.50||| 9523077|ERX|0250|TOBRAMYCIN/DEXAMETH EYE ,|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.50||| 9523077|ERX|0250|TOBRAMYCIN/DEXAMETH EYE ,|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9523077|ERX|0250|TOBRAMYCIN/DEXAMETH EYE ,|Humana Medicare Advantage|HUMANA MA|||||4.50||| 9523077|ERX|0250|TOBRAMYCIN/DEXAMETH EYE ,|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.50||| 9523077|ERX|0250|TOBRAMYCIN/DEXAMETH EYE ,|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.50||| 9523077|ERX|0250|TOBRAMYCIN/DEXAMETH EYE ,|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.50||| 9523077|ERX|0250|TOBRAMYCIN/DEXAMETH EYE ,|Medicare|MEDICARE ACUTE|||||4.50||| 9523077|ERX|0250|TOBRAMYCIN/DEXAMETH EYE ,|Managed Medicare|HEALTHSPRING MA|||||4.50||| 9523119|ERX|0250|APRACLONIDINE EYE DROP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||853.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Tricare|TRICARE EAST REGION|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|NON CONTRACTED|COMMERCIAL OTHER 1|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Medicaid|HENDERSON COUNTY INDIGENT|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Medicare|MEDICARE ACUTE|28.75||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Workers Compensation|TEXAS MUTUAL INSURANCE|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Veterans Affairs|VETERANS ADMINISTRATION|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Workers Compensation|BROOKSHIRES WORKERS COMP|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|United Medicare Advantage|UHC MEDICARE GOLD MA|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|United Medicare Advantage|UHC AARP MCR HMO MA|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Workers Compensation|WORKERS COMPENSATION OTHER|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Humana Medicare Advantage|HUMANA MA|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Workers Compensation|WORKERS COMP PHYSICIAN|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Managed Medicaid|MEDICAID SUPERIOR|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|United Healthcare|TML GROUP BENEFITS|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Managed Medicaid|MEDICAID AMERIGROUP|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Managed Medicare|HEALTHSPRING MA|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Blue Cross HMO Specialty|BCBSTX HMO|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Cigna|CIGNA OTHER|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|ChampVA|CHAMPVA CENTER|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Cigna|CIGNA|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Blue Cross PPO Specialty|BCBSTX PPO|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Aetna|AETNA PPO|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Aenta Medicare Advantage|AETNA MEDICARE MA|||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|28.75||||28.75||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||28.75||| 9523143|ERX|0250|BALANCED SALT SOLN 15ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.75||| 9523143|ERX|0250|BALANCED SALT SOLN 15ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.75||| 9523143|ERX|0250|BALANCED SALT SOLN 15ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.75||| 9523143|ERX|0250|BALANCED SALT SOLN 15ML|Aetna|AETNA PPO|||||0.75||| 9523143|ERX|0250|BALANCED SALT SOLN 15ML|Blue Cross HMO Specialty|BCBSTX HMO|||||0.75||| 9523143|ERX|0250|BALANCED SALT SOLN 15ML|ChampVA|CHAMPVA CENTER|||||0.75||| 9523143|ERX|0250|BALANCED SALT SOLN 15ML|Blue Cross PPO Specialty|BCBSTX PPO|||||0.75||| 9523143|ERX|0250|BALANCED SALT SOLN 15ML|Cigna|CIGNA|||||0.75||| 9523143|ERX|0250|BALANCED SALT SOLN 15ML|Managed Medicare|HEALTHSPRING MA|||||0.75||| 9523143|ERX|0250|BALANCED SALT SOLN 15ML|Humana Medicare Advantage|HUMANA MA|||||0.75||| 9523143|ERX|0250|BALANCED SALT SOLN 15ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.75||| 9523143|ERX|0250|BALANCED SALT SOLN 15ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.75||| 9523143|ERX|0250|BALANCED SALT SOLN 15ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.75||| 9523143|ERX|0250|BALANCED SALT SOLN 15ML|Medicare|MEDICARE ACUTE|||||0.75||| 9523168|ERX|0250|BALANCED SALT SOLN COMB 5|Medicare|MEDICARE ACUTE|||||655.25||| 9523168|ERX|0250|BALANCED SALT SOLN COMB 5|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||655.25||| 9523168|ERX|0250|BALANCED SALT SOLN COMB 5|United Medicare Advantage|UHC MEDICARE GOLD MA|||||655.25||| 9523168|ERX|0250|BALANCED SALT SOLN COMB 5|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||655.25||| 9523168|ERX|0250|BALANCED SALT SOLN COMB 5|Humana Medicare Advantage|HUMANA MA|||||655.25||| 9523168|ERX|0250|BALANCED SALT SOLN COMB 5|Managed Medicare|HEALTHSPRING MA|||||655.25||| 9523168|ERX|0250|BALANCED SALT SOLN COMB 5|Blue Cross HMO Specialty|BCBSTX HMO|||||655.25||| 9523168|ERX|0250|BALANCED SALT SOLN COMB 5|Cigna|CIGNA|||||655.25||| 9523168|ERX|0250|BALANCED SALT SOLN COMB 5|ChampVA|CHAMPVA CENTER|||||655.25||| 9523168|ERX|0250|BALANCED SALT SOLN COMB 5|Blue Cross PPO Specialty|BCBSTX PPO|||||655.25||| 9523168|ERX|0250|BALANCED SALT SOLN COMB 5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||655.25||| 9523168|ERX|0250|BALANCED SALT SOLN COMB 5|Aetna|AETNA PPO|||||655.25||| 9523168|ERX|0250|BALANCED SALT SOLN COMB 5|Aenta Medicare Advantage|AETNA MEDICARE MA|||||655.25||| 9523168|ERX|0250|BALANCED SALT SOLN COMB 5|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||655.25||| 9523184|ERX|0250|CIPROFLOX-DEXAMETH DROP,|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||353.50||| 9523184|ERX|0250|CIPROFLOX-DEXAMETH DROP,|Blue Cross HMO Specialty|BCBSTX HMO|||||353.50||| 9523184|ERX|0250|CIPROFLOX-DEXAMETH DROP,|Blue Cross PPO Specialty|BCBSTX PPO|||||353.50||| 9523184|ERX|0250|CIPROFLOX-DEXAMETH DROP,|Cigna|CIGNA|||||353.50||| 9523184|ERX|0250|CIPROFLOX-DEXAMETH DROP,|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||353.50||| 9523184|ERX|0250|CIPROFLOX-DEXAMETH DROP,|Managed Medicaid|MEDICAID AMERIGROUP|||||353.50||| 9523184|ERX|0250|CIPROFLOX-DEXAMETH DROP,|Humana Medicare Advantage|HUMANA MA|||||353.50||| 9523184|ERX|0250|CIPROFLOX-DEXAMETH DROP,|United Healthcare|UNITED HEALTHCARE|||||353.50||| 9523184|ERX|0250|CIPROFLOX-DEXAMETH DROP,|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||353.50||| 9523184|ERX|0250|CIPROFLOX-DEXAMETH DROP,|Managed Medicaid|MEDICAID SUPERIOR|||||353.50||| 9523184|ERX|0250|CIPROFLOX-DEXAMETH DROP,|Medicaid|MEDICAID|353.50||||||| 9523184|ERX|0250|CIPROFLOX-DEXAMETH DROP,|Medicare|MEDICARE PART B ONLY IP|353.50||||||| 9523184|ERX|0250|CIPROFLOX-DEXAMETH DROP,|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||353.50||| 9523234|ERX|0250|SCOPOLAMINE 1.5MG PATCH|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|38.50||||||| 9523234|ERX|0250|SCOPOLAMINE 1.5MG PATCH|United Medicare Advantage|AARP UHC WEST COMPLETE MA|38.50||||||| 9523234|ERX|0250|SCOPOLAMINE 1.5MG PATCH|UTMB|UTMB CORRECTIONAL MANAGED CARE|38.50||||||| 9523234|ERX|0250|SCOPOLAMINE 1.5MG PATCH|United Healthcare|UNITED HEALTHCARE|||||38.50||| 9523234|ERX|0250|SCOPOLAMINE 1.5MG PATCH|Medicare|MEDICARE ACUTE|38.50||||38.50||| 9523234|ERX|0250|SCOPOLAMINE 1.5MG PATCH|Managed Medicare|HOSPICE ETMC|38.50||||||| 9523234|ERX|0250|SCOPOLAMINE 1.5MG PATCH|Managed Medicare|HOSPICE GENESIS|38.50||||||| 9523234|ERX|0250|SCOPOLAMINE 1.5MG PATCH|Humana Medicare Advantage|HUMANA MA|38.50||||||| 9523234|ERX|0250|SCOPOLAMINE 1.5MG PATCH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|38.50||||||| 9523234|ERX|0250|SCOPOLAMINE 1.5MG PATCH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|38.50||||||| 9523234|ERX|0250|SCOPOLAMINE 1.5MG PATCH|Aetna|BOON CHAPMAN|38.50||||||| 9523234|ERX|0250|SCOPOLAMINE 1.5MG PATCH|Blue Cross PPO Specialty|BCBSTX PPO|38.50||||38.50||| 9523234|ERX|0250|SCOPOLAMINE 1.5MG PATCH|Aenta Medicare Advantage|AETNA MEDICARE MA|||||38.50||| 9523234|ERX|0250|SCOPOLAMINE 1.5MG PATCH|Blue Cross HMO Specialty|BCBSTX HMO|||||38.50||| 9523234|ERX|0250|SCOPOLAMINE 1.5MG PATCH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|38.50||||38.50||| 9523242|ERX|0250|NICOTINE 7MG PATCH|Blue Cross HMO Specialty|BCBSTX HMO|25.25||||||| 9523242|ERX|0250|NICOTINE 7MG PATCH|Blue Cross PPO Specialty|BCBSTX PPO|25.25||||||| 9523242|ERX|0250|NICOTINE 7MG PATCH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|25.25||||25.25||| 9523242|ERX|0250|NICOTINE 7MG PATCH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|25.25||||||| 9523242|ERX|0250|NICOTINE 7MG PATCH|Managed Medicaid|MEDICAID AMERIGROUP|||||25.25||| 9523242|ERX|0250|NICOTINE 7MG PATCH|Humana Medicare Advantage|HUMANA MA|25.25||||||| 9523242|ERX|0250|NICOTINE 7MG PATCH|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|25.25||||||| 9523242|ERX|0250|NICOTINE 7MG PATCH|Medicare|MEDICARE ACUTE|25.25||||||| 9523242|ERX|0250|NICOTINE 7MG PATCH|Managed Medicare|HEALTHSPRING MA|||||25.25||| 9523242|ERX|0250|NICOTINE 7MG PATCH|United Medicare Advantage|AARP UHC WEST COMPLETE MA|25.25||||25.25||| 9523242|ERX|0250|NICOTINE 7MG PATCH|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|25.25||||||| 9523259|ERX|0250|NICOTINE 14MG PATCH|Veterans Affairs|VETERANS ADMINISTRATION|||||6.25||| 9523259|ERX|0250|NICOTINE 14MG PATCH|United Medicare Advantage|UHC MEDICARE GOLD MA|6.25||||||| 9523259|ERX|0250|NICOTINE 14MG PATCH|United Medicare Advantage|AARP UHC WEST COMPLETE MA|6.25||||6.25||| 9523259|ERX|0250|NICOTINE 14MG PATCH|Medicaid|MOLINA HEALTHCARE OF TEXAS|6.25||||||| 9523259|ERX|0250|NICOTINE 14MG PATCH|Medicaid|MEDICAID|6.25||||||| 9523259|ERX|0250|NICOTINE 14MG PATCH|Medicare|MEDICARE ACUTE|6.25||||6.25||| 9523259|ERX|0250|NICOTINE 14MG PATCH|Managed Medicare|VAN ZANDT COUNTY INMATE|6.25||||||| 9523259|ERX|0250|NICOTINE 14MG PATCH|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|6.25||||||| 9523259|ERX|0250|NICOTINE 14MG PATCH|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|6.25||||6.25||| 9523259|ERX|0250|NICOTINE 14MG PATCH|Managed Medicare|HEALTHSPRING MA|6.25||||||| 9523259|ERX|0250|NICOTINE 14MG PATCH|MTC Medical|VAN ZANDT COUNTY INMATE|6.25||||||| 9523259|ERX|0250|NICOTINE 14MG PATCH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|6.25||||6.25||| 9523259|ERX|0250|NICOTINE 14MG PATCH|Managed Medicaid|MEDICAID SUPERIOR|6.25||||6.25||| 9523259|ERX|0250|NICOTINE 14MG PATCH|Humana Medicare Advantage|HUMANA MA|6.25||||6.25||| 9523259|ERX|0250|NICOTINE 14MG PATCH|Aenta Medicare Advantage|AETNA MEDICARE MA|6.25||||||| 9523259|ERX|0250|NICOTINE 14MG PATCH|Blue Cross HMO Specialty|BCBSTX HMO|||||6.25||| 9523259|ERX|0250|NICOTINE 14MG PATCH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||6.25||| 9523259|ERX|0250|NICOTINE 14MG PATCH|Blue Cross PPO Specialty|BCBSTX PPO|6.25||||6.25||| 9523259|ERX|0250|NICOTINE 14MG PATCH|Managed Medicaid|MEDICAID AMERIGROUP|6.25||||6.25||| 9523259|ERX|0250|NICOTINE 14MG PATCH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|6.25||||6.25||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Blue Cross PPO Specialty|BCBSTX PPO|0.05||||0.05||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.05||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Aenta Medicare Advantage|AETNA MEDICARE MA|0.05||||||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.05||||0.05||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.05||||0.05||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Managed Medicaid|MEDICAID AMERIGROUP|0.05||||0.05||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Humana Medicare Advantage|HUMANA MA|0.05||||0.05||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.05||||||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Managed Medicare|HOSPICE ETMC|0.05||||||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|0.05||||||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Managed Medicare|HEALTHSPRING MA|0.05||||0.05||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Managed Medicaid|MEDICAID SUPERIOR|0.05||||0.05||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Managed Medicare|WELLCARE CHOICE MA|0.05||||||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Tricare|TRICARE EAST REGION|0.05||||0.05||| 9523267|ERX|0250|NICOTINE 21MG PATCH|NON CONTRACTED|COMMERCIAL OTHER 1|0.05||||0.05||| 9523267|ERX|0250|NICOTINE 21MG PATCH|United Healthcare|UNITED HEALTHCARE OTHER|||||0.05||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.05||||0.05||| 9523267|ERX|0250|NICOTINE 21MG PATCH|United Healthcare|UNITED HEALTHCARE|||||0.05||| 9523267|ERX|0250|NICOTINE 21MG PATCH|United Healthcare|UNITED HEALTHCARE|0.05||||||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Medicaid|MEDICAID|0.05||||||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Medicaid|HENDERSON COUNTY INDIGENT|0.05||||0.05||| 9523267|ERX|0250|NICOTINE 21MG PATCH|United Medicare Advantage|UHC AARP MCR HMO MA|||||0.05||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Veterans Affairs|VETERANS ADMINISTRATION|0.05||||0.05||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.05||| 9523267|ERX|0250|NICOTINE 21MG PATCH|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.05||||0.05||| 9523267|ERX|0250|NICOTINE 21MG PATCH|United Medicare Advantage|UHC MEDICARE GOLD MA|0.05||||0.05||| 9523267|ERX|0250|NICOTINE 21MG PATCH|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.05||||0.05||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Medicare|MEDICARE ACUTE|0.05||||0.05||| 9523275|ERX|0250|DIBUCAINE, 30 G|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||38.50||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|26.75||||26.75||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|26.75||||26.75||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|26.75||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Managed Medicare|HEALTHSPRING MA|26.75||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|26.75||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Humana Medicare Advantage|HUMANA MA|26.75||||26.75||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|26.75||||26.75||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|26.75||||26.75||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|26.75||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||26.75||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|26.75||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||26.75||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|26.75||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|26.75||||26.75||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|26.75||||26.75||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|26.75||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Cigna|CIGNA|26.75||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|ChampVA|CHAMPVA CENTER|26.75||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|26.75||||26.75||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|26.75||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Medicaid|MEDICAID HMO|26.75||||26.75||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Medicaid|MEDICAID|26.75||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Medicare|MEDICARE ACUTE|26.75||||26.75||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Tricare|TRICARE EAST REGION|26.75||||26.75||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|United Healthcare|UNITED HEALTHCARE|26.75||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|United Healthcare|UNITED HEALTHCARE|||||26.75||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|26.75||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|26.75||||26.75||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Medicaid|MEDICAID|||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Medicaid|LAW ENFORCEMENT OTHER|4.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|ChampVA|CHAMPVA CENTER|||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Cigna|CIGNA|||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Aetna|AETNA PPO|4.50||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|4.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Managed Medicare|WELLCARE CHOICE MA|||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Managed Medicare|MA PART B ONLY IP|4.50||||||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|28.25||||28.25||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Managed Medicare|MA PART B ONLY IP|28.25||||||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|28.25||||28.25||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|28.25||||28.25||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|28.25||||||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Humana Medicare Advantage|HUMANA MA|28.25||||28.25||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|28.25||||28.25||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|28.25||||||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|28.25||||28.25||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Aetna|AETNA PPO|28.25||||28.25||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||28.25||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|28.25||||28.25||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|28.25||||||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Cigna|CIGNA|28.25||||||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|28.25||||28.25||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|28.25||||||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Medicaid|MEDICAID|28.25||||28.25||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Medicaid|LAW ENFORCEMENT OTHER|28.25||||||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Managed Medicare|HEALTHSPRING MA|28.25||||||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|28.25||||||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Medicare|MEDICARE PART B ONLY IP|28.25||||||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Medicare|MEDICARE ACUTE|28.25||||28.25||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Tricare|TRICARE EAST REGION|28.25||||||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|28.25||||||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|United Healthcare|UNITED HEALTHCARE|28.25||||28.25||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|United Healthcare|UNITED HEALTHCARE|28.25||||||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|United Healthcare|TML GROUP BENEFITS|||||28.25||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Managed Medicare|WELLCARE CHOICE MA|28.25||||28.25||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Texas Workforce Commission|DIS DETER SERV (DDS)|28.25||||||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|28.25||||28.25||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|28.25||||||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|28.25||||28.25||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|28.25||||28.25||| 9523416|ERX|0250|AMLODIPINE 10MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|28.25||||28.25||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|United Medicare Advantage|UHC AARP MCR HMO MA|||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|5.75||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|5.75||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Workers Compensation|UT EMPLOYEE INJURY|5.75||||||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|5.75||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Tricare|TRICARE EAST REGION|5.75||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|UTMB|UTMB CORRECTIONAL MANAGED CARE|5.75||||||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|5.75||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|United Healthcare|UNITED HEALTHCARE|5.75||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|United Healthcare|UNITED HEALTHCARE|||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Medicaid|MEDICAID|5.75||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|5.75||||||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Medicare|MEDICARE ACUTE|5.75||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|5.75||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|5.75||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Cigna|CIGNA|5.75||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Cigna|CIGNA|||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Aetna|AETNA PPO|5.75||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.75||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|5.75||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|5.75||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.75||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|5.75||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|5.75||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|5.75||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Humana Medicare Advantage|HUMANA MA|5.75||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|MTC Medical|VAN ZANDT COUNTY INMATE|5.75||||||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Managed Medicare|OTHER INSTITUTIONS|||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Managed Medicare|VAN ZANDT COUNTY INMATE|5.75||||||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Managed Medicare|HEALTHSPRING MA|5.75||||5.75||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|5.75||||||| 9523465|ERX|0250|AZITHROMYCIN 200MG/5ML,22|Managed Medicaid|MEDICAID AMERIGROUP|0.34||||0.34||| 9523465|ERX|0250|AZITHROMYCIN 200MG/5ML,22|Managed Medicaid|MEDICAID SUPERIOR|0.34||||0.34||| 9523465|ERX|0250|AZITHROMYCIN 200MG/5ML,22|Blue Cross HMO Specialty|BCBSTX HMO|||||0.34||| 9523465|ERX|0250|AZITHROMYCIN 200MG/5ML,22|Blue Cross PPO Specialty|BCBSTX PPO|0.34||||0.34||| 9523465|ERX|0250|AZITHROMYCIN 200MG/5ML,22|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.34||| 9523465|ERX|0250|AZITHROMYCIN 200MG/5ML,22|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.34||| 9523473|ERX|0250|AZITHROMYCIN 500MG VIAL|Veterans Affairs|VETERANS ADMINISTRATION|180.50||||||| 9523473|ERX|0250|AZITHROMYCIN 500MG VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||180.50||| 9523473|ERX|0250|AZITHROMYCIN 500MG VIAL|Medicare|MEDICARE ACUTE|180.50||||180.50||| 9523473|ERX|0250|AZITHROMYCIN 500MG VIAL|Managed Medicaid|MEDICAID AMERIGROUP|180.50||||||| 9523473|ERX|0250|AZITHROMYCIN 500MG VIAL|Humana Medicare Advantage|HUMANA MA|||||180.50||| 9523499|ERX|0250|SILDENAFIL 20MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|136.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Aetna|BOON CHAPMAN|4.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Cigna|CIGNA OTHER|4.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Cigna|CIGNA|4.50||||4.50||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||4.50||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Tricare|TRICARE EAST REGION|4.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|43.25||||43.25||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|43.25||||43.25||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|43.25||||43.25||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|43.25||||43.25||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Medicaid|MEDICAID|43.25||||43.25||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|43.25||||43.25||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Medicare|MEDICARE PART B ONLY IP|43.25||||||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Tricare|TRICARE EAST REGION|43.25||||43.25||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|43.25||||43.25||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|43.25||||||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Texas Workforce Commission|DIS DETER SERV (DDS)|43.25||||||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Humana Medicare Advantage|HUMANA MA|43.25||||43.25||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|United Healthcare|UNITED HEALTHCARE|43.25||||||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Medicare|MEDICARE ACUTE|43.25||||43.25||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|43.25||||43.25||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|43.25||||43.25||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|43.25||||43.25||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||43.25||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|43.25||||||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Managed Medicare|MA PART B ONLY IP|43.25||||||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|43.25||||||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Managed Medicare|HEALTHSPRING MA|43.25||||43.25||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|43.25||||43.25||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|43.25||||43.25||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|43.25||||||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|ChampVA|CHAMPVA CENTER|43.25||||43.25||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|43.25||||43.25||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Cigna|CIGNA|43.25||||||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Aetna|AETNA PPO|43.25||||||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|43.25||||43.25||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|43.25||||||| 9523531|ERX|0250|ATORVASTATIN 20MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|43.25||||43.25||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Aetna|AETNA PPO|4.50||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Cigna|CIGNA|4.50||||4.50||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Managed Medicare|OTHER INSTITUTIONS|||||4.50||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||4.50||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Cigna|CIGNA OTHER|||||4.50||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||4.50||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||4.50||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Medicaid|MEDICAID|4.50||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Medicaid|LAW ENFORCEMENT OTHER|4.50||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9523556|ERX|0250|ATORVASTATIN 80MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|43.25||||||| 9523556|ERX|0250|ATORVASTATIN 80MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|43.25||||43.25||| 9523556|ERX|0250|ATORVASTATIN 80MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|43.25||||43.25||| 9523556|ERX|0250|ATORVASTATIN 80MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|43.25||||||| 9523556|ERX|0250|ATORVASTATIN 80MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|||||43.25||| 9523556|ERX|0250|ATORVASTATIN 80MG TABLET|Medicare|MEDICARE PART B ONLY IP|43.25||||||| 9523556|ERX|0250|ATORVASTATIN 80MG TABLET|Medicare|MEDICARE ACUTE|43.25||||43.25||| 9523556|ERX|0250|ATORVASTATIN 80MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|43.25||||||| 9523556|ERX|0250|ATORVASTATIN 80MG TABLET|Humana Medicare Advantage|HUMANA MA|43.25||||43.25||| 9523556|ERX|0250|ATORVASTATIN 80MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|43.25||||43.25||| 9523556|ERX|0250|ATORVASTATIN 80MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|43.25||||43.25||| 9523556|ERX|0250|ATORVASTATIN 80MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|43.25||||43.25||| 9523556|ERX|0250|ATORVASTATIN 80MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|43.25||||||| 9523556|ERX|0250|ATORVASTATIN 80MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|43.25||||||| 9523556|ERX|0250|ATORVASTATIN 80MG TABLET|Managed Medicare|HEALTHSPRING MA|43.25||||43.25||| 9523556|ERX|0250|ATORVASTATIN 80MG TABLET|Managed Medicare|OTHER INSTITUTIONS|||||43.25||| 9523556|ERX|0250|ATORVASTATIN 80MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|43.25||||43.25||| 9523556|ERX|0250|ATORVASTATIN 80MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|43.25||||||| 9523556|ERX|0250|ATORVASTATIN 80MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||43.25||| 9523556|ERX|0250|ATORVASTATIN 80MG TABLET|Cigna|CIGNA OTHER|||||43.25||| 9523556|ERX|0250|ATORVASTATIN 80MG TABLET|Aetna|AETNA PPO|||||43.25||| 9523556|ERX|0250|ATORVASTATIN 80MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|43.25||||||| 9523556|ERX|0250|ATORVASTATIN 80MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|43.25||||43.25||| 9523598|ERX|0250|PHENYTOIN 100MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9523598|ERX|0250|PHENYTOIN 100MG CAPSULE|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9523598|ERX|0250|PHENYTOIN 100MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9523598|ERX|0250|PHENYTOIN 100MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9523598|ERX|0250|PHENYTOIN 100MG CAPSULE|Medicaid|HENDERSON COUNTY INDIGENT|||||4.50||| 9523598|ERX|0250|PHENYTOIN 100MG CAPSULE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9523598|ERX|0250|PHENYTOIN 100MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9523598|ERX|0250|PHENYTOIN 100MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.50||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Tricare|TRICARE EAST REGION|4.50||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Medicaid|MEDICAID|4.50||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Managed Medicare|MA PART B ONLY IP|4.50||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Aetna|AETNA PPO|4.50||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|4.50||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|4.50||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Cigna|CIGNA|4.50||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Blue Cross PPO Specialty|BCBSTX OTHER|||||4.50||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Cigna|CIGNA|4.50||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Aetna|AETNA PPO|4.50||||4.50||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|4.50||||4.50||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||4.50||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||4.50||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Managed Medicare|MA PART B ONLY IP|4.50||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||4.50||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Medicaid|MEDICAID|4.50||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Tricare|TRICARE EAST REGION|4.50||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|United Medicare Advantage|UHC AARP MCR HMO MA|4.50||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||4.50||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|Medicaid|MEDICAID|4.50||||||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|Managed Medicare|OTHER INSTITUTIONS|||||0.17||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|Managed Medicare|HEALTHSPRING MA|||||4.50||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|||||4.50||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|Aetna|AETNA PPO|4.50||||||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.50||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|Cigna|CIGNA|4.50||||||| 9523648|ERX|0250|PREGABALIN 25MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|||||30.25||| 9523648|ERX|0250|PREGABALIN 25MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|30.25||||||| 9523648|ERX|0250|PREGABALIN 25MG CAPSULE|Tricare|TRICARE EAST REGION|30.25||||||| 9523648|ERX|0250|PREGABALIN 25MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||30.25||| 9523648|ERX|0250|PREGABALIN 25MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|30.25||||||| 9523655|ERX|0250|PREGABALIN 50MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|34.75||||34.75||| 9523655|ERX|0250|PREGABALIN 50MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|34.75||||34.75||| 9523655|ERX|0250|PREGABALIN 50MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|34.75||||||| 9523655|ERX|0250|PREGABALIN 50MG CAPSULE|Medicare|MEDICARE ACUTE|34.75||||34.75||| 9523655|ERX|0250|PREGABALIN 50MG CAPSULE|Humana Medicare Advantage|HUMANA MA|34.75||||34.75||| 9523655|ERX|0250|PREGABALIN 50MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|34.75||||||| 9523655|ERX|0250|PREGABALIN 50MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|||||34.75||| 9523655|ERX|0250|PREGABALIN 50MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|34.75||||||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.37||||0.37||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|0.37||||||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|Cigna|CIGNA|0.37||||||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|Managed Medicare|HEALTHSPRING MA|0.37||||0.37||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|Humana Medicare Advantage|HUMANA MA|0.37||||0.37||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.37||||0.37||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|0.37||||0.37||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|0.37||||0.37||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.37||||||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|United Healthcare|UNITED HEALTHCARE|0.37||||||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|United Healthcare|UMR UNITED MEDICAL RESOURCES|0.37||||||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|Medicare|MEDICARE ACUTE|0.37||||0.37||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|0.37||||||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.37||||||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.37||||||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.37||||||| 9523671|ERX|0250|PREGABALIN 100MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|23.50||||23.50||| 9523671|ERX|0250|PREGABALIN 100MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|23.50||||23.50||| 9523671|ERX|0250|PREGABALIN 100MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|23.50||||||| 9523671|ERX|0250|PREGABALIN 100MG CAPSULE|Medicare|MEDICARE ACUTE|23.50||||23.50||| 9523671|ERX|0250|PREGABALIN 100MG CAPSULE|United Healthcare|UNITED HEALTHCARE|23.50||||||| 9523671|ERX|0250|PREGABALIN 100MG CAPSULE|Humana Medicare Advantage|HUMANA MA|23.50||||23.50||| 9523671|ERX|0250|PREGABALIN 100MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|23.50||||||| 9523671|ERX|0250|PREGABALIN 100MG CAPSULE|Managed Medicare|HEALTHSPRING MA|||||23.50||| 9523671|ERX|0250|PREGABALIN 100MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|23.50||||||| 9523671|ERX|0250|PREGABALIN 100MG CAPSULE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||23.50||| 9523671|ERX|0250|PREGABALIN 100MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|23.50||||23.50||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Aetna|AETNA PPO|4.50||||||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Managed Medicare|WELLCARE CHOICE MA|4.50||||||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.50||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Tricare|TRICARE EAST REGION|||||4.50||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||4.50||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Medicaid|MEDICAID|4.50||||||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.50||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.50||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9523697|ERX|0250|GABAPENTIN 250MG/5ML|Medicare|MEDICARE ACUTE|86.25||||||| 9523739|ERX|0250|AMMONIUM LACTATE 12%, 225|Humana Medicare Advantage|HUMANA MA|414.75||||||| 9523739|ERX|0250|AMMONIUM LACTATE 12%, 225|Managed Medicaid|MEDICAID UNITED HEALTHCARE|414.75||||||| 9523739|ERX|0250|AMMONIUM LACTATE 12%, 225|United Medicare Advantage|UHC MEDICARE GOLD MA|414.75||||||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||16.75||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Medicaid|MEDICAID|16.75||||||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|16.75||||||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|16.75||||16.75||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|16.75||||||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Medicare|MEDICARE ACUTE|16.75||||16.75||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|16.75||||16.75||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|ChampVA|CHAMPVA CENTER|||||16.75||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|16.75||||16.75||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|16.75||||||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||16.75||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|16.75||||16.75||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Managed Medicare|OTHER INSTITUTIONS|||||16.75||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||16.75||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Managed Medicare|HEALTHSPRING MA|||||16.75||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||16.75||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|16.75||||||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|16.75||||||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||16.75||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Humana Medicare Advantage|HUMANA MA|16.75||||||| 9523762|ERX|0250|VALPROATE 500MG 5ML|Managed Medicaid|MEDICAID SUPERIOR|177.50||||||| 9523762|ERX|0250|VALPROATE 500MG 5ML|Medicare|MEDICARE PART B ONLY IP|177.50||||||| 9523762|ERX|0250|VALPROATE 500MG 5ML|Medicare|MEDICARE ACUTE|177.50||||177.50||| 9523804|ERX|0250|HYDROMORPHONE 2MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||5.75||| 9523804|ERX|0250|HYDROMORPHONE 2MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|5.75||||||| 9523804|ERX|0250|HYDROMORPHONE 2MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|5.75||||5.75||| 9523804|ERX|0250|HYDROMORPHONE 2MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||5.75||| 9523804|ERX|0250|HYDROMORPHONE 2MG TABLET|Medicaid|MEDICAID|||||5.75||| 9523804|ERX|0250|HYDROMORPHONE 2MG TABLET|Medicare|MEDICARE ACUTE|5.75||||5.75||| 9523804|ERX|0250|HYDROMORPHONE 2MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.75||||5.75||| 9523804|ERX|0250|HYDROMORPHONE 2MG TABLET|Aetna|BOON CHAPMAN|5.75||||||| 9523804|ERX|0250|HYDROMORPHONE 2MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||5.75||| 9523804|ERX|0250|HYDROMORPHONE 2MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|5.75||||5.75||| 9523804|ERX|0250|HYDROMORPHONE 2MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|5.75||||5.75||| 9523804|ERX|0250|HYDROMORPHONE 2MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.75||||5.75||| 9523804|ERX|0250|HYDROMORPHONE 2MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|5.75||||5.75||| 9523804|ERX|0250|HYDROMORPHONE 2MG TABLET|Humana Medicare Advantage|HUMANA MA|5.75||||||| 9523861|ERX|0250|CLARITHROMYCIN 500MG TABL|Managed Medicaid|MEDICAID AMERIGROUP|0.56||||||| 9523895|ERX|0250|DULOXETINE 20MG CAPSULE|Medicare|MEDICARE ACUTE|15.75||||15.75||| 9523895|ERX|0250|DULOXETINE 20MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|15.75||||||| 9523895|ERX|0250|DULOXETINE 20MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||15.75||| 9523895|ERX|0250|DULOXETINE 20MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|15.75||||||| 9523895|ERX|0250|DULOXETINE 20MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|15.75||||||| 9523895|ERX|0250|DULOXETINE 20MG CAPSULE|Humana Medicare Advantage|HUMANA MA|15.75||||||| 9523895|ERX|0250|DULOXETINE 20MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|15.75||||||| 9523903|ERX|0250|BUMETANIDE 0.5MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|10.50||||||| 9523903|ERX|0250|BUMETANIDE 0.5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|10.50||||||| 9523903|ERX|0250|BUMETANIDE 0.5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||10.50||| 9523903|ERX|0250|BUMETANIDE 0.5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||10.50||| 9523903|ERX|0250|BUMETANIDE 0.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|10.50||||||| 9523903|ERX|0250|BUMETANIDE 0.5MG TABLET|Medicare|MEDICARE ACUTE|||||10.50||| 9523952|ERX|0250|BUMETANIDE 2MG TABLET|Medicare|MEDICARE ACUTE|20.50||||20.50||| 9523952|ERX|0250|BUMETANIDE 2MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|20.50||||||| 9523952|ERX|0250|BUMETANIDE 2MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|20.50||||||| 9523952|ERX|0250|BUMETANIDE 2MG TABLET|Humana Medicare Advantage|HUMANA MA|20.50||||||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.14||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|Managed Medicare|HEALTHSPRING MA|0.14||||||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|Managed Medicare|BCBS MEDICARE PPO MA|0.14||||||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|Humana Medicare Advantage|HUMANA MA|0.14||||0.14||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|||||0.14||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.14||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|0.14||||0.14||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|||||0.14||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.14||||0.14||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.14||||0.14||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.14||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.14||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|Tricare|TRICARE EAST REGION|0.14||||||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.14||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|United Healthcare|UNITED HEALTHCARE|0.14||||||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|Medicaid|MEDICAID HMO|||||0.14||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|Medicaid|HENDERSON COUNTY INDIGENT|||||0.14||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|Medicare|MEDICARE ACUTE|0.14||||0.14||| 9523986|ERX|0250|TERAZOSIN 1MG CAPSULE|Medicare|MEDICARE ACUTE|4.50||||||| 9523986|ERX|0250|TERAZOSIN 1MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9523986|ERX|0250|TERAZOSIN 1MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9523986|ERX|0250|TERAZOSIN 1MG CAPSULE|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9524000|ERX|0250|TERAZOSIN 5MG CAPSULE|Managed Medicare|HEALTHSPRING MA|23.50||||||| 9524000|ERX|0250|TERAZOSIN 5MG CAPSULE|Humana Medicare Advantage|HUMANA MA|23.50||||23.50||| 9524000|ERX|0250|TERAZOSIN 5MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|23.50||||||| 9524000|ERX|0250|TERAZOSIN 5MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|23.50||||23.50||| 9524000|ERX|0250|TERAZOSIN 5MG CAPSULE|Medicare|MEDICARE ACUTE|23.50||||23.50||| 9524018|ERX|0250|DIVALPROEX ER 250MG TABLE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9524018|ERX|0250|DIVALPROEX ER 250MG TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.50||| 9524018|ERX|0250|DIVALPROEX ER 250MG TABLE|Aetna|AETNA PPO|||||4.50||| 9524018|ERX|0250|DIVALPROEX ER 250MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9524018|ERX|0250|DIVALPROEX ER 250MG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9524018|ERX|0250|DIVALPROEX ER 250MG TABLE|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9524109|ERX|0250|DIVALPROEX 125MG TABLET|Managed Medicare|HEALTHSPRING MA|14.50||||||| 9524109|ERX|0250|DIVALPROEX 125MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|14.50||||14.50||| 9524109|ERX|0250|DIVALPROEX 125MG TABLET|Medicare|MEDICARE ACUTE|14.50||||||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|Medicare|MEDICARE PART B ONLY IP|23.50||||||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|Medicare|MEDICARE ACUTE|23.50||||23.50||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|23.50||||||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|23.50||||23.50||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|23.50||||||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||23.50||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|23.50||||23.50||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|Aetna|AETNA PPO|||||23.50||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|23.50||||||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|Humana Medicare Advantage|HUMANA MA|23.50||||23.50||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||23.50||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|23.50||||||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|23.50||||23.50||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|23.50||||||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|Managed Medicare|HEALTHSPRING MA|23.50||||23.50||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|23.50||||||| 9524133|ERX|0250|ERYTHROMYCIN BASE 500MG T|Humana Medicare Advantage|HUMANA MA|630.25||||||| 9524133|ERX|0250|ERYTHROMYCIN BASE 500MG T|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|630.25||||||| 9524133|ERX|0250|ERYTHROMYCIN BASE 500MG T|Blue Cross PPO Specialty|BCBSTX PPO|630.25||||||| 9524133|ERX|0250|ERYTHROMYCIN BASE 500MG T|United Medicare Advantage|AARP UHC WEST COMPLETE MA|630.25||||||| 9524133|ERX|0250|ERYTHROMYCIN BASE 500MG T|United Healthcare|UNITED HEALTHCARE|630.25||||||| 9524133|ERX|0250|ERYTHROMYCIN BASE 500MG T|Texas Workforce Commission|DIS DETER SERV (DDS)|630.25||||||| 9524133|ERX|0250|ERYTHROMYCIN BASE 500MG T|Medicare|MEDICARE ACUTE|630.25||||||| 9524208|ERX|0250|DIVALPROEX ER 500MG TABLE|Medicaid|MEDICAID|28.75||||||| 9524208|ERX|0250|DIVALPROEX ER 500MG TABLE|Medicare|MEDICARE ACUTE|28.75||||28.75||| 9524208|ERX|0250|DIVALPROEX ER 500MG TABLE|Veterans Affairs|VETERANS ADMINISTRATION|||||28.75||| 9524208|ERX|0250|DIVALPROEX ER 500MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||28.75||| 9524208|ERX|0250|DIVALPROEX ER 500MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|||||28.75||| 9524208|ERX|0250|DIVALPROEX ER 500MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|28.75||||||| 9524208|ERX|0250|DIVALPROEX ER 500MG TABLE|Managed Medicare|WELLCARE CHOICE MA|||||28.75||| 9524208|ERX|0250|DIVALPROEX ER 500MG TABLE|Humana Medicare Advantage|HUMANA MA|28.75||||||| 9524208|ERX|0250|DIVALPROEX ER 500MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|28.75||||28.75||| 9524208|ERX|0250|DIVALPROEX ER 500MG TABLE|Managed Medicaid|MEDICAID SUPERIOR|28.75||||||| 9524208|ERX|0250|DIVALPROEX ER 500MG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|28.75||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Managed Medicaid|MEDICAID AMERIGROUP|75.75||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Managed Medicaid|MEDICAID SUPERIOR|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Managed Medicare|VAN ZANDT COUNTY INMATE|75.75||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Managed Medicare|BCBS MEDICARE PPO MA|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Aetna|BOON CHAPMAN|75.75||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Aetna|AETNA PPO|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Aenta Medicare Advantage|AETNA MEDICARE MA|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Blue Cross HMO Specialty|BCBSTX HMO|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Blue Cross PPO Specialty|BCBSTX PPO|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Cigna|CIGNA|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Cigna|CIGNA|75.75||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Cigna|CIGNA OTHER|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|United Medicare Advantage|UHC MEDICARE GOLD MA|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Managed Medicare|HEALTHSPRING MA|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Workers Compensation|UT EMPLOYEE INJURY|75.75||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Humana Medicare Advantage|HUMANA MA|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Veterans Affairs|VETERANS ADMINISTRATION|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Tricare|TRICARE EAST REGION|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|NON CONTRACTED|COMMERCIAL OTHER 1|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|United Healthcare|TML GROUP BENEFITS|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|MTC Medical|VAN ZANDT COUNTY INMATE|75.75||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|PHCS|HUMANA|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|United Healthcare|UNITED HEALTHCARE|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Medicaid|MEDICAID|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Medicaid|LAW ENFORCEMENT OTHER|75.75||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Medicaid|HENDERSON COUNTY INDIGENT|75.75||||75.75||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Medicaid|COUNTY INDIGENT HEALTH OTHER|75.75||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Medicare|MEDICARE PART B ONLY IP|75.75||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Medicare|MEDICARE ACUTE|75.75||||75.75||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Medicaid|HENDERSON COUNTY INDIGENT|212.25||||||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Medicare|MEDICARE ACUTE|212.25||||212.25||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|United Healthcare|UNITED HEALTHCARE|||||212.25||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Veterans Affairs|VETERANS ADMINISTRATION|212.25||||212.25||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|212.25||||||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|United Medicare Advantage|UHC MEDICARE GOLD MA|212.25||||||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|212.25||||212.25||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Blue Cross HMO Specialty|BCBSTX HMO|212.25||||||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Cigna|CIGNA|||||212.25||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Blue Cross PPO Specialty|BCBSTX PPO|||||212.25||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Aetna|AETNA PPO|212.25||||||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Aenta Medicare Advantage|AETNA MEDICARE MA|212.25||||||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Managed Medicare|VAN ZANDT COUNTY INMATE|||||212.25||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Managed Medicare|HEALTHSPRING MA|212.25||||212.25||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Humana Medicare Advantage|HUMANA MA|212.25||||212.25||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|MTC Medical|VAN ZANDT COUNTY INMATE|||||212.25||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Managed Medicaid|MEDICAID SUPERIOR|212.25||||||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|212.25||||||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Managed Medicaid|MEDICAID AMERIGROUP|212.25||||||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|584.25||||584.25||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Managed Medicaid|MEDICAID SUPERIOR|584.25||||584.25||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Managed Medicaid|MEDICAID AMERIGROUP|584.25||||584.25||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||584.25||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Managed Medicare|HEALTHSPRING MA|584.25||||584.25||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Aetna|AETNA PPO|||||584.25||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Aetna|AETNA OTHER|||||584.25||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Aenta Medicare Advantage|AETNA MEDICARE MA|584.25||||584.25||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Managed Medicare|BCBS MEDICARE PPO MA|584.25||||||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|584.25||||||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|584.25||||||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Blue Cross HMO Specialty|BCBSTX HMO|584.25||||||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||584.25||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Humana Medicare Advantage|HUMANA MA|584.25||||584.25||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Blue Cross PPO Specialty|BCBSTX PPO|584.25||||584.25||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|584.25||||584.25||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|United Medicare Advantage|UHC MEDICARE GOLD MA|584.25||||584.25||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|584.25||||584.25||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Veterans Affairs|VETERANS ADMINISTRATION|584.25||||584.25||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||584.25||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|United Healthcare|UNITED HEALTHCARE|||||584.25||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||584.25||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Medicaid|MEDICAID HMO|||||584.25||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Medicaid|MEDICAID|584.25||||||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Medicaid|COUNTY INDIGENT HEALTH OTHER|584.25||||||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Medicare|MEDICARE ACUTE|584.25||||584.25||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|413.75||||||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Medicaid|MEDICAID|413.75||||||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Medicaid|COUNTY INDIGENT HEALTH OTHER|413.75||||||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Medicare|MEDICARE ACUTE|413.75||||413.75||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|NON CONTRACTED|COMMERCIAL OTHER 1|413.75||||413.75||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|United Healthcare|UNITED HEALTHCARE|413.75||||||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|United Healthcare|UNITED HEALTHCARE|||||413.75||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Veterans Affairs|VETERANS ADMINISTRATION|413.75||||413.75||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Veterans Affairs|VETERANS ADMINISTRATION|413.75||||||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|413.75||||||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|413.75||||413.75||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|413.75||||413.75||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Blue Cross HMO Specialty|BCBSTX HMO|||||413.75||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|413.75||||||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|413.75||||413.75||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Cigna|CIGNA|||||413.75||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Aetna|AETNA PPO|413.75||||413.75||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|413.75||||413.75||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|413.75||||413.75||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Managed Medicare|HEALTHSPRING MA|413.75||||413.75||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Managed Medicare|BCBS MEDICARE PPO MA|413.75||||||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Humana Medicare Advantage|HUMANA MA|413.75||||413.75||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|413.75||||||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|413.75||||413.75||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|||||413.75||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Managed Medicaid|MEDICAID SUPERIOR|209.25||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|209.25||||209.25||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Managed Medicaid|MEDICAID AMERIGROUP|209.25||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||209.25||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Managed Medicare|HEALTHSPRING MA|209.25||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Managed Medicare|BCBS MEDICARE PPO MA|209.25||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Aetna|AETNA PPO|209.25||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Aenta Medicare Advantage|AETNA MEDICARE MA|209.25||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|209.25||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Blue Cross HMO Specialty|BCBSTX HMO|209.25||||209.25||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Humana Medicare Advantage|HUMANA MA|209.25||||209.25||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|209.25||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Blue Cross PPO Specialty|BCBSTX PPO|||||209.25||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|209.25||||209.25||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|United Medicare Advantage|UHC MEDICARE GOLD MA|209.25||||209.25||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|209.25||||209.25||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Veterans Affairs|VETERANS ADMINISTRATION|209.25||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|209.25||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Medicaid|HENDERSON COUNTY INDIGENT|209.25||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Medicaid|COUNTY INDIGENT HEALTH OTHER|209.25||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Medicare|MEDICARE ACUTE|209.25||||209.25||| 9524315|ERX|0250|DESMOPRESSIN 0.01% NASAL,|NON CONTRACTED|COMMERCIAL OTHER 1|2,135.75||||||| 9524323|ERX|0250|ENOXAPARIN 120MG/0.8ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||779.50||| 9524323|ERX|0250|ENOXAPARIN 120MG/0.8ML|Blue Cross PPO Specialty|BCBSTX PPO|||||779.50||| 9524323|ERX|0250|ENOXAPARIN 120MG/0.8ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||779.50||| 9524323|ERX|0250|ENOXAPARIN 120MG/0.8ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|779.50||||||| 9524323|ERX|0250|ENOXAPARIN 120MG/0.8ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||779.50||| 9524323|ERX|0250|ENOXAPARIN 120MG/0.8ML|Managed Medicare|HEALTHSPRING MA|779.50||||||| 9524323|ERX|0250|ENOXAPARIN 120MG/0.8ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|779.50||||||| 9524323|ERX|0250|ENOXAPARIN 120MG/0.8ML|Managed Medicaid|MEDICAID SUPERIOR|779.50||||779.50||| 9524323|ERX|0250|ENOXAPARIN 120MG/0.8ML|Cigna|CIGNA|||||779.50||| 9524323|ERX|0250|ENOXAPARIN 120MG/0.8ML|Managed Medicaid|MEDICAID AMERIGROUP|779.50||||||| 9524323|ERX|0250|ENOXAPARIN 120MG/0.8ML|Humana Medicare Advantage|HUMANA MA|779.50||||779.50||| 9524323|ERX|0250|ENOXAPARIN 120MG/0.8ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|779.50||||779.50||| 9524323|ERX|0250|ENOXAPARIN 120MG/0.8ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|779.50||||||| 9524323|ERX|0250|ENOXAPARIN 120MG/0.8ML|United Medicare Advantage|UHC MEDICARE GOLD MA|779.50||||779.50||| 9524323|ERX|0250|ENOXAPARIN 120MG/0.8ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||779.50||| 9524323|ERX|0250|ENOXAPARIN 120MG/0.8ML|Medicaid|HENDERSON COUNTY INDIGENT|||||779.50||| 9524323|ERX|0250|ENOXAPARIN 120MG/0.8ML|Medicare|MEDICARE ACUTE|779.50||||779.50||| 9524323|ERX|0250|ENOXAPARIN 120MG/0.8ML|Tricare|TRICARE EAST REGION|779.50||||||| 9524323|ERX|0250|ENOXAPARIN 120MG/0.8ML|NON CONTRACTED|COMMERCIAL OTHER 1|779.50||||||| 9524323|ERX|0250|ENOXAPARIN 120MG/0.8ML|UTMB|UTMB CORRECTIONAL MANAGED CARE|779.50||||||| 9524349|ERX|0250|ENOXAPARIN 150MG/1ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|974.25||||||| 9524349|ERX|0250|ENOXAPARIN 150MG/1ML|Medicaid|HENDERSON COUNTY INDIGENT|||||974.25||| 9524349|ERX|0250|ENOXAPARIN 150MG/1ML|Medicare|MEDICARE ACUTE|974.25||||||| 9524349|ERX|0250|ENOXAPARIN 150MG/1ML|Tricare|TRICARE FOR LIFE|||||974.25||| 9524349|ERX|0250|ENOXAPARIN 150MG/1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|974.25||||||| 9524349|ERX|0250|ENOXAPARIN 150MG/1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|974.25||||||| 9524349|ERX|0250|ENOXAPARIN 150MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|974.25||||||| 9524349|ERX|0250|ENOXAPARIN 150MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|974.25||||||| 9524349|ERX|0250|ENOXAPARIN 150MG/1ML|Humana Medicare Advantage|HUMANA MA|974.25||||||| 9524349|ERX|0250|ENOXAPARIN 150MG/1ML|Managed Medicare|BCBS MEDICARE PPO MA|974.25||||||| 9524349|ERX|0250|ENOXAPARIN 150MG/1ML|Aetna|AETNA PPO|||||974.25||| 9524349|ERX|0250|ENOXAPARIN 150MG/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||974.25||| 9524349|ERX|0250|ENOXAPARIN 150MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||974.25||| 9524349|ERX|0250|ENOXAPARIN 150MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||974.25||| 9524349|ERX|0250|ENOXAPARIN 150MG/1ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||974.25||| 9524398|ERX|0250|METHYLERGONOVINE 0.2MG/1M|Blue Cross PPO Specialty|BCBSTX PPO|0.74||||||| 9524398|ERX|0250|METHYLERGONOVINE 0.2MG/1M|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.74||||||| 9524398|ERX|0250|METHYLERGONOVINE 0.2MG/1M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.74||||0.74||| 9524398|ERX|0250|METHYLERGONOVINE 0.2MG/1M|Managed Medicaid|MEDICAID SUPERIOR|0.74||||||| 9524398|ERX|0250|METHYLERGONOVINE 0.2MG/1M|Managed Medicaid|MEDICAID AMERIGROUP|0.74||||||| 9524398|ERX|0250|METHYLERGONOVINE 0.2MG/1M|Medicaid|MEDICAID HMO|0.74||||||| 9524398|ERX|0250|METHYLERGONOVINE 0.2MG/1M|Medicaid|MEDICAID|0.74||||0.74||| 9524406|ERX|0250|METHYLERGONOVINE 0.2MG TA|Tricare|TRICARE EAST REGION|324.45||||||| 9524406|ERX|0250|METHYLERGONOVINE 0.2MG TA|Medicaid|MEDICAID|324.45||||||| 9524406|ERX|0250|METHYLERGONOVINE 0.2MG TA|Managed Medicaid|MEDICAID SUPERIOR|324.45||||||| 9524406|ERX|0250|METHYLERGONOVINE 0.2MG TA|Managed Medicaid|MEDICAID AMERIGROUP|324.45||||||| 9524471|ERX|0250|TERBINAFINE 250MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9524471|ERX|0250|TERBINAFINE 250MG TABLET|Medicare|MEDICARE ACUTE|4.50||||||| 9524539|ERX|0250|LETROZOLE 2.5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|112.25||||112.25||| 9524539|ERX|0250|LETROZOLE 2.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|112.25||||||| 9524539|ERX|0250|LETROZOLE 2.5MG TABLET|United Healthcare|UNITED HEALTHCARE|112.25||||||| 9524539|ERX|0250|LETROZOLE 2.5MG TABLET|Medicare|MEDICARE ACUTE|112.25||||112.25||| 9524539|ERX|0250|LETROZOLE 2.5MG TABLET|Humana Medicare Advantage|HUMANA MA|112.25||||||| 9524539|ERX|0250|LETROZOLE 2.5MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||112.25||| 9524539|ERX|0250|LETROZOLE 2.5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||112.25||| 9524554|ERX|0250|CALCITONIN 200 UNITS, 3.7|Managed Medicare|BCBS MEDICARE PPO MA|||||1,252.50||| 9524554|ERX|0250|CALCITONIN 200 UNITS, 3.7|Medicare|MEDICARE ACUTE|1,252.50||||||| 9524554|ERX|0250|CALCITONIN 200 UNITS, 3.7|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1,252.50||| 9524562|ERX|0250|RIVASTIGMINE 1.5MG CAPSUL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.50||||||| 9524562|ERX|0250|RIVASTIGMINE 1.5MG CAPSUL|Medicare|MEDICARE ACUTE|1.50||||1.50||| 9524562|ERX|0250|RIVASTIGMINE 1.5MG CAPSUL|Blue Cross PPO Specialty|BCBSTX PPO|||||1.50||| 9524570|ERX|0250|ENTACAPONE 200MG TABLET|Medicare|MEDICARE ACUTE|28.75||||28.75||| 9524596|ERX|0250|OXCARBAZEPINE 300MG TABLE|Humana Medicare Advantage|HUMANA MA|0.31||||||| 9524596|ERX|0250|OXCARBAZEPINE 300MG TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.31||||0.31||| 9524596|ERX|0250|OXCARBAZEPINE 300MG TABLE|Medicare|MEDICARE ACUTE|0.31||||||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|United Healthcare|UNITED HEALTHCARE|40.50||||40.50||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|United Healthcare|UNITED HEALTHCARE|40.50||||||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|Medicaid|MEDICAID|40.50||||||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|Medicare|MEDICARE ACUTE|40.50||||40.50||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|40.50||||40.50||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|40.50||||40.50||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|40.50||||40.50||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|40.50||||40.50||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|40.50||||||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|40.50||||||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|40.50||||40.50||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|40.50||||||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|ChampVA|CHAMPVA CENTER|40.50||||||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|Blue Cross PPO Specialty|BCBSTX OTHER|||||40.50||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|40.50||||||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|Tricare|TRICARE EAST REGION|40.50||||||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|40.50||||40.50||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|Managed Medicare|MA PART B ONLY IP|40.50||||||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|40.50||||||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|Managed Medicare|HEALTHSPRING MA|40.50||||40.50||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|Managed Medicare|BCBS MEDICARE PPO MA|40.50||||40.50||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|40.50||||||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|Humana Medicare Advantage|HUMANA MA|40.50||||40.50||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|40.50||||40.50||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|40.50||||40.50||| 9524620|ERX|0250|DULOXETINE 60MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|40.50||||40.50||| 9524679|ERX|0250|VALSARTAN 80MG TABLET|Humana Medicare Advantage|HUMANA MA|11.75||||||| 9524679|ERX|0250|VALSARTAN 80MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||11.75||| 9524679|ERX|0250|VALSARTAN 80MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|11.75||||||| 9524679|ERX|0250|VALSARTAN 80MG TABLET|Aetna|AETNA PPO|11.75||||11.75||| 9524679|ERX|0250|VALSARTAN 80MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||11.75||| 9524679|ERX|0250|VALSARTAN 80MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||11.75||| 9524679|ERX|0250|VALSARTAN 80MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||11.75||| 9524679|ERX|0250|VALSARTAN 80MG TABLET|Medicare|MEDICARE ACUTE|11.75||||11.75||| 9524687|ERX|0250|VALSARTAN 160MG TABLET|Medicare|MEDICARE ACUTE|24.25||||||| 9524687|ERX|0250|VALSARTAN 160MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|24.25||||||| 9524687|ERX|0250|VALSARTAN 160MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|24.25||||||| 9524687|ERX|0250|VALSARTAN 160MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||24.25||| 9524687|ERX|0250|VALSARTAN 160MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|24.25||||24.25||| 9524687|ERX|0250|VALSARTAN 160MG TABLET|Humana Medicare Advantage|HUMANA MA|24.25||||||| 9524877|ERX|0250|METHYLPHENIDATE 10MG TABL|Medicare|MEDICARE ACUTE|14.50||||||| 9524950|ERX|0250|CARBAMAZEPINE 100MG TABLE|Medicare|MEDICARE ACUTE|0.08||||||| 9524976|ERX|0250|RIVASTIGMINE 4.6MG PATCH|Managed Medicare|BCBS MEDICARE PPO MA|29.75||||||| 9524976|ERX|0250|RIVASTIGMINE 4.6MG PATCH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|29.75||||||| 9524976|ERX|0250|RIVASTIGMINE 4.6MG PATCH|Aenta Medicare Advantage|AETNA MEDICARE MA|||||29.75||| 9524976|ERX|0250|RIVASTIGMINE 4.6MG PATCH|Medicare|MEDICARE ACUTE|29.75||||||| 9524984|ERX|0250|CARBAMAZEPINE 100MG/5ML,3|Medicare|MEDICARE ACUTE|0.38||||||| 9525056|ERX|0250|FERROUS SULFATE 160MG TAB|ChampVA|CHAMPVA CENTER|4.75||||||| 9525056|ERX|0250|FERROUS SULFATE 160MG TAB|Blue Cross PPO Specialty|BCBSTX PPO|4.75||||||| 9525056|ERX|0250|FERROUS SULFATE 160MG TAB|Aetna|AETNA PPO|||||4.75||| 9525056|ERX|0250|FERROUS SULFATE 160MG TAB|Aenta Medicare Advantage|AETNA MEDICARE MA|4.75||||||| 9525056|ERX|0250|FERROUS SULFATE 160MG TAB|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.75||||||| 9525056|ERX|0250|FERROUS SULFATE 160MG TAB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.75||| 9525056|ERX|0250|FERROUS SULFATE 160MG TAB|Humana Medicare Advantage|HUMANA MA|4.75||||||| 9525056|ERX|0250|FERROUS SULFATE 160MG TAB|Managed Medicaid|MEDICAID SUPERIOR|4.75||||||| 9525056|ERX|0250|FERROUS SULFATE 160MG TAB|Managed Medicaid|MEDICAID AMERIGROUP|4.75||||||| 9525056|ERX|0250|FERROUS SULFATE 160MG TAB|Veterans Affairs|VETERANS ADMINISTRATION|4.75||||||| 9525056|ERX|0250|FERROUS SULFATE 160MG TAB|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.75||||||| 9525056|ERX|0250|FERROUS SULFATE 160MG TAB|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.75||||||| 9525056|ERX|0250|FERROUS SULFATE 160MG TAB|Medicaid|MEDICAID|4.75||||||| 9525056|ERX|0250|FERROUS SULFATE 160MG TAB|Medicare|MEDICARE ACUTE|4.75||||4.75||| 9525072|ERX|0250|CELESTONE SOLUSPAN 30MG/5|Tricare|TRICARE EAST REGION|||||356.50||| 9525072|ERX|0250|CELESTONE SOLUSPAN 30MG/5|United Healthcare|UNITED HEALTHCARE|||||356.50||| 9525072|ERX|0250|CELESTONE SOLUSPAN 30MG/5|United Healthcare|UMR UNITED MEDICAL RESOURCES|356.50||||||| 9525072|ERX|0250|CELESTONE SOLUSPAN 30MG/5|Medicaid|MOLINA HEALTHCARE OF TEXAS|356.50||||||| 9525072|ERX|0250|CELESTONE SOLUSPAN 30MG/5|Medicaid|MEDICAID HMO|||||356.50||| 9525072|ERX|0250|CELESTONE SOLUSPAN 30MG/5|Medicaid|MEDICAID|356.50||||||| 9525072|ERX|0250|CELESTONE SOLUSPAN 30MG/5|Managed Medicaid|MEDICAID SUPERIOR|356.50||||356.50||| 9525072|ERX|0250|CELESTONE SOLUSPAN 30MG/5|Managed Medicaid|MEDICAID AMERIGROUP|356.50||||356.50||| 9525072|ERX|0250|CELESTONE SOLUSPAN 30MG/5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||356.50||| 9525072|ERX|0250|CELESTONE SOLUSPAN 30MG/5|Blue Cross PPO Specialty|BCBSTX PPO|356.50||||356.50||| 9525072|ERX|0250|CELESTONE SOLUSPAN 30MG/5|Cigna|CIGNA|||||356.50||| 9525106|ERX|0250|CLOTRIMAZ-BETAMETHASONE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3.72||||||| 9525106|ERX|0250|CLOTRIMAZ-BETAMETHASONE|Medicare|MEDICARE ACUTE|3.72||||3.72||| 9525189|ERX|0250|NIFEDIPINE SA 30MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9525189|ERX|0250|NIFEDIPINE SA 30MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9525189|ERX|0250|NIFEDIPINE SA 30MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.50||| 9525189|ERX|0250|NIFEDIPINE SA 30MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9525189|ERX|0250|NIFEDIPINE SA 30MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9525189|ERX|0250|NIFEDIPINE SA 30MG TABLET|Aetna|AETNA PPO|4.50||||4.50||| 9525189|ERX|0250|NIFEDIPINE SA 30MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.50||| 9525189|ERX|0250|NIFEDIPINE SA 30MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9525189|ERX|0250|NIFEDIPINE SA 30MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9525189|ERX|0250|NIFEDIPINE SA 30MG TABLET|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9525189|ERX|0250|NIFEDIPINE SA 30MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4.50||| 9525189|ERX|0250|NIFEDIPINE SA 30MG TABLET|Medicaid|MEDICAID HMO|4.50||||4.50||| 9525189|ERX|0250|NIFEDIPINE SA 30MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9525189|ERX|0250|NIFEDIPINE SA 30MG TABLET|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9525189|ERX|0250|NIFEDIPINE SA 30MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9525189|ERX|0250|NIFEDIPINE SA 30MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9525189|ERX|0250|NIFEDIPINE SA 30MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9525189|ERX|0250|NIFEDIPINE SA 30MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|53.75||||53.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|53.75||||53.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|53.75||||53.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|||||53.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||53.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||53.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Medicare|MEDICARE ACUTE|53.75||||53.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|United Healthcare|UNITED HEALTHCARE OTHER|||||53.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|NON CONTRACTED|COMMERCIAL OTHER 1|53.75||||53.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Medicaid|MEDICAID|||||53.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||53.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|United Healthcare|UNITED HEALTHCARE|||||53.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|United Healthcare|UNITED HEALTHCARE|53.75||||||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||53.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|53.75||||53.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|53.75||||53.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|53.75||||53.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|||||53.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Humana Medicare Advantage|HUMANA MA|53.75||||||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Aetna|AETNA PPO|||||53.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||53.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||53.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|53.75||||53.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|||||53.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||53.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|53.75||||53.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Blue Cross PPO Specialty|BCBSTX OTHER|||||53.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Cigna|CIGNA|||||53.75||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Blue Cross HMO Specialty|BCBSTX HMO|183.25||||183.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Aetna|AETNA OTHER|||||183.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Aetna|AETNA PPO|183.25||||||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Aenta Medicare Advantage|AETNA MEDICARE MA|183.25||||||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||183.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|183.25||||183.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Humana Medicare Advantage|HUMANA MA|183.25||||183.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|183.25||||183.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Managed Medicaid|MEDICAID SUPERIOR|183.25||||183.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|183.25||||||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|183.25||||||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||183.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Managed Medicare|HEALTHSPRING MA|183.25||||183.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Managed Medicare|BCBS MEDICARE PPO MA|||||183.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|United Healthcare|UNITED HEALTHCARE OTHER|||||183.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|NON CONTRACTED|COMMERCIAL OTHER 1|183.25||||||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Blue Cross PPO Specialty|BCBSTX PPO|183.25||||183.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|183.25||||183.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|United Healthcare|UNITED HEALTHCARE|||||183.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|183.25||||||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Medicaid|MEDICAID|183.25||||||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Medicaid|HENDERSON COUNTY INDIGENT|183.25||||||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Medicare|MEDICARE ACUTE|183.25||||183.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Veterans Affairs|VETERANS ADMINISTRATION|183.25||||183.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|183.25||||183.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|United Medicare Advantage|UHC MEDICARE GOLD MA|183.25||||183.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|183.25||||183.25||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Veterans Affairs|VETERANS ADMINISTRATION|||||4.50||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Medicaid|MEDICAID|||||4.50||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Medicaid|HENDERSON COUNTY INDIGENT|||||4.50||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.50||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|United Healthcare|UNITED HEALTHCARE OTHER|||||4.50||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|United Healthcare|UNITED HEALTHCARE|||||4.50||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.50||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||4.50||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.50||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.50||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Cigna|CIGNA|||||4.50||| 9525270|ERX|0250|CIPROFLOXACIN 200MG/100ML|Blue Cross PPO Specialty|BCBSTX PPO|182.50||||182.50||| 9525270|ERX|0250|CIPROFLOXACIN 200MG/100ML|Humana Medicare Advantage|HUMANA MA|182.50||||||| 9525270|ERX|0250|CIPROFLOXACIN 200MG/100ML|Medicare|MEDICARE ACUTE|182.50||||||| 9525296|ERX|0250|CIPROFLOXACIN 250MG TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.50||| 9525296|ERX|0250|CIPROFLOXACIN 250MG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||||| 9525296|ERX|0250|CIPROFLOXACIN 250MG TABLE|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9525296|ERX|0250|CIPROFLOXACIN 250MG TABLE|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9525379|ERX|0250|K BICARB-CIT AC 25 MEQ TA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|15.75||||||| 9525379|ERX|0250|K BICARB-CIT AC 25 MEQ TA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||15.75||| 9525379|ERX|0250|K BICARB-CIT AC 25 MEQ TA|Medicaid|HENDERSON COUNTY INDIGENT|15.75||||||| 9525379|ERX|0250|K BICARB-CIT AC 25 MEQ TA|Medicare|MEDICARE ACUTE|15.75||||||| 9525403|ERX|0250|TRAZODONE 150MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|33.50||||||| 9525403|ERX|0250|TRAZODONE 150MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|33.50||||33.50||| 9525403|ERX|0250|TRAZODONE 150MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|33.50||||33.50||| 9525403|ERX|0250|TRAZODONE 150MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|33.50||||33.50||| 9525403|ERX|0250|TRAZODONE 150MG TABLET|United Healthcare|UNITED HEALTHCARE|33.50||||||| 9525403|ERX|0250|TRAZODONE 150MG TABLET|Multiplan|NALC|||||33.50||| 9525403|ERX|0250|TRAZODONE 150MG TABLET|Medicaid|MEDICAID|33.50||||||| 9525403|ERX|0250|TRAZODONE 150MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|33.50||||||| 9525403|ERX|0250|TRAZODONE 150MG TABLET|Medicare|MEDICARE ACUTE|33.50||||33.50||| 9525403|ERX|0250|TRAZODONE 150MG TABLET|Managed Medicare|HEALTHSPRING MA|33.50||||33.50||| 9525403|ERX|0250|TRAZODONE 150MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|||||33.50||| 9525403|ERX|0250|TRAZODONE 150MG TABLET|Humana Medicare Advantage|HUMANA MA|33.50||||33.50||| 9525403|ERX|0250|TRAZODONE 150MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|33.50||||33.50||| 9525403|ERX|0250|TRAZODONE 150MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|33.50||||||| 9525403|ERX|0250|TRAZODONE 150MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|33.50||||||| 9525403|ERX|0250|TRAZODONE 150MG TABLET|Blue Cross PPO Specialty|BCBSTX OTHER|||||33.50||| 9525403|ERX|0250|TRAZODONE 150MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|33.50||||||| 9525403|ERX|0250|TRAZODONE 150MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|33.50||||||| 9525403|ERX|0250|TRAZODONE 150MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|33.50||||33.50||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Cigna|CIGNA|4.50||||||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||4.50||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Aetna|AETNA PPO|4.50||||4.50||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||4.50||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Medicaid|MEDICAID|4.50||||||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9525437|ERX|0250|BUSPIRONE 15MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|28.25||||||| 9525437|ERX|0250|BUSPIRONE 15MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|28.25||||28.25||| 9525437|ERX|0250|BUSPIRONE 15MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|28.25||||28.25||| 9525437|ERX|0250|BUSPIRONE 15MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|28.25||||||| 9525437|ERX|0250|BUSPIRONE 15MG TABLET|Medicaid|MEDICAID HMO|||||28.25||| 9525437|ERX|0250|BUSPIRONE 15MG TABLET|Medicare|MEDICARE ACUTE|28.25||||28.25||| 9525437|ERX|0250|BUSPIRONE 15MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|28.25||||||| 9525437|ERX|0250|BUSPIRONE 15MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|28.25||||28.25||| 9525437|ERX|0250|BUSPIRONE 15MG TABLET|Humana Medicare Advantage|HUMANA MA|28.25||||28.25||| 9525437|ERX|0250|BUSPIRONE 15MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|28.25||||28.25||| 9525437|ERX|0250|BUSPIRONE 15MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|28.25||||||| 9525437|ERX|0250|BUSPIRONE 15MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|28.25||||||| 9525437|ERX|0250|BUSPIRONE 15MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||28.25||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Aetna|AETNA PPO|4.50||||4.50||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||4.50||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|4.50||||4.50||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Cigna|CIGNA|4.50||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.50||||4.50||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||4.50||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Medicaid|MEDICAID HMO|||||4.50||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||4.50||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Medicare|MEDICARE PART B ONLY IP|4.50||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9525460|ERX|0250|METFORMIN 500MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||4.50||| 9525460|ERX|0250|METFORMIN 500MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||4.50||| 9525486|ERX|0250|METFORMIN XL 500MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9525486|ERX|0250|METFORMIN XL 500MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.50||| 9525486|ERX|0250|METFORMIN XL 500MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9525486|ERX|0250|METFORMIN XL 500MG TABLET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9525486|ERX|0250|METFORMIN XL 500MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9525486|ERX|0250|METFORMIN XL 500MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||4.50||| 9525486|ERX|0250|METFORMIN XL 500MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9525486|ERX|0250|METFORMIN XL 500MG TABLET|Aetna|AETNA PPO|4.50||||4.50||| 9525486|ERX|0250|METFORMIN XL 500MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9525494|ERX|0250|METFORMIN 850MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9525494|ERX|0250|METFORMIN 850MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.50||| 9525494|ERX|0250|METFORMIN 850MG TABLET|Managed Medicare|HEALTHSPRING MA|||||4.50||| 9525494|ERX|0250|METFORMIN 850MG TABLET|Medicare|MEDICARE ACUTE|4.50||||||| 9525494|ERX|0250|METFORMIN 850MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9525494|ERX|0250|METFORMIN 850MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.50||| 9525494|ERX|0250|METFORMIN 850MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9525510|ERX|0250|CEFPROZIL 250MG TABLET|Medicare|MEDICARE ACUTE|46.50||||||| 9525577|ERX|0250|CALCIUM CARB 500 W/VIT D|Managed Medicare|BCBS MEDICARE PPO MA|5.25||||||| 9525577|ERX|0250|CALCIUM CARB 500 W/VIT D|Humana Medicare Advantage|HUMANA MA|5.25||||5.25||| 9525577|ERX|0250|CALCIUM CARB 500 W/VIT D|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|5.25||||||| 9525577|ERX|0250|CALCIUM CARB 500 W/VIT D|Blue Cross HMO Specialty|BCBSTX HMO|||||5.25||| 9525577|ERX|0250|CALCIUM CARB 500 W/VIT D|Blue Cross PPO Specialty|BCBSTX PPO|5.25||||||| 9525577|ERX|0250|CALCIUM CARB 500 W/VIT D|Aenta Medicare Advantage|AETNA MEDICARE MA|5.25||||5.25||| 9525577|ERX|0250|CALCIUM CARB 500 W/VIT D|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|5.25||||5.25||| 9525577|ERX|0250|CALCIUM CARB 500 W/VIT D|Veterans Affairs|VETERANS ADMINISTRATION|5.25||||||| 9525577|ERX|0250|CALCIUM CARB 500 W/VIT D|Tricare|TRICARE EAST REGION|5.25||||||| 9525577|ERX|0250|CALCIUM CARB 500 W/VIT D|Medicare|MEDICARE ACUTE|5.25||||5.25||| 9525585|ERX|0250|LEFLUNOMIDE 20MG TABLET|Medicare|MEDICARE ACUTE|35.50||||35.50||| 9525585|ERX|0250|LEFLUNOMIDE 20MG TABLET|Humana Medicare Advantage|HUMANA MA|35.50||||||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|Aetna|AETNA PPO|||||73.50||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|Aenta Medicare Advantage|AETNA MEDICARE MA|73.50||||73.50||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|73.50||||||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|73.50||||73.50||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|Blue Cross HMO Specialty|BCBSTX HMO|73.50||||73.50||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|Cigna|CIGNA|73.50||||||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|Blue Cross PPO Specialty|BCBSTX PPO|73.50||||73.50||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|Managed Medicare|HEALTHSPRING MA|73.50||||73.50||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||73.50||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|Managed Medicaid|MEDICAID AMERIGROUP|73.50||||||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|73.50||||73.50||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|Managed Medicaid|MEDICAID SUPERIOR|73.50||||73.50||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|73.50||||73.50||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|Humana Medicare Advantage|HUMANA MA|73.50||||73.50||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|Veterans Affairs|VETERANS ADMINISTRATION|73.50||||73.50||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|73.50||||73.50||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|73.50||||73.50||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|United Medicare Advantage|UHC AARP MCR HMO MA|73.50||||||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|73.50||||73.50||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|Tricare|TRICARE EAST REGION|73.50||||||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|NON CONTRACTED|COMMERCIAL OTHER 1|73.50||||73.50||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||73.50||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|Medicaid|MEDICAID|73.50||||||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|Medicaid|HENDERSON COUNTY INDIGENT|73.50||||73.50||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|Medicaid|COUNTY INDIGENT HEALTH OTHER|73.50||||||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|Medicare|MEDICARE PART B ONLY IP|73.50||||||| 9525593|ERX|0250|LANTUS 100 UNIT 1ML 10ML|Medicare|MEDICARE ACUTE|73.50||||73.50||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Medicaid|MEDICAID HMO|||||70.75||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Medicaid|MEDICAID|||||70.75||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Medicare|MEDICARE ACUTE|||||70.75||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||70.75||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|United Healthcare|UNITED HEALTHCARE|||||70.75||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||70.75||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Tricare|TRICARE EAST REGION|||||70.75||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||70.75||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||70.75||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|70.75||||70.75||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||70.75||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||70.75||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Managed Medicaid|MEDICAID SUPERIOR|||||70.75||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||70.75||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Humana Medicare Advantage|HUMANA MA|||||70.75||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Managed Medicare|HEALTHSPRING MA|||||70.75||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|||||70.75||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Cigna|CIGNA|||||70.75||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||70.75||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||70.75||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Aetna|AETNA PPO|||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|514.50||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|514.50||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|514.50||||||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Blue Cross HMO Specialty|BCBSTX HMO|||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|ChampVA|CHAMPVA CENTER|||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Cigna|CIGNA|514.50||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Blue Cross PPO Specialty|BCBSTX PPO|514.50||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Cigna|CIGNA|||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Managed Medicare|HEALTHSPRING MA|||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Managed Medicaid|MEDICAID SUPERIOR|514.50||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|514.50||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Cigna|CIGNA OTHER|||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Managed Medicaid|MEDICAID AMERIGROUP|514.50||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Humana Medicare Advantage|HUMANA MA|514.50||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Veterans Affairs|VETERANS ADMINISTRATION|514.50||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Workers Compensation|WORKERS COMPENSATION OTHER|||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|514.50||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|United Healthcare|UNITED HEALTHCARE|||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|United Healthcare|TML GROUP BENEFITS|||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Medicaid|MEDICAID TEXAS CHILDRENS|||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Medicaid|MEDICAID|514.50||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Medicaid|MEDICAID HMO|||||514.50||| 9525676|ERX|0250|CEFTRIAXONE 1 G VIAL|Medicare|MEDICARE ACUTE|514.50||||514.50||| 9525684|ERX|0250|HYOSCYAMINE ER 0.375MG TA|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9525684|ERX|0250|HYOSCYAMINE ER 0.375MG TA|Humana Medicare Advantage|HUMANA MA|||||4.50||| 9525684|ERX|0250|HYOSCYAMINE ER 0.375MG TA|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9525684|ERX|0250|HYOSCYAMINE ER 0.375MG TA|Cigna|CIGNA|4.50||||||| 9525718|ERX|0250|HYOSCYAMINE 0.125MG/ML, 1|Medicare|MEDICARE ACUTE|4.50||||||| 9525759|ERX|0250|ALBUTEROL 2MG/5ML, 30ML|Medicare|MEDICARE ACUTE|23.25||||23.25||| 9525775|ERX|0250|NORTRIPTYLINE 25MG CAPSUL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.50||| 9525775|ERX|0250|NORTRIPTYLINE 25MG CAPSUL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9525775|ERX|0250|NORTRIPTYLINE 25MG CAPSUL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||4.50||| 9525775|ERX|0250|NORTRIPTYLINE 25MG CAPSUL|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9525775|ERX|0250|NORTRIPTYLINE 25MG CAPSUL|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9525775|ERX|0250|NORTRIPTYLINE 25MG CAPSUL|Medicaid|MEDICAID|4.50||||||| 9525775|ERX|0250|NORTRIPTYLINE 25MG CAPSUL|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9525775|ERX|0250|NORTRIPTYLINE 25MG CAPSUL|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9525783|ERX|0250|KETOCONAZOLE 2% CREAM, 15|Medicare|MEDICARE ACUTE|156.50||||||| 9525783|ERX|0250|KETOCONAZOLE 2% CREAM, 15|Veterans Affairs|VETERANS ADMINISTRATION|156.50||||||| 9525783|ERX|0250|KETOCONAZOLE 2% CREAM, 15|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|156.50||||156.50||| 9525783|ERX|0250|KETOCONAZOLE 2% CREAM, 15|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|156.50||||||| 9525817|ERX|0250|SOTALOL 120MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.30||||0.30||| 9525817|ERX|0250|SOTALOL 120MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||0.30||| 9525817|ERX|0250|SOTALOL 120MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|0.30||||||| 9525817|ERX|0250|SOTALOL 120MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.30||||||| 9525817|ERX|0250|SOTALOL 120MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.30||||||| 9525817|ERX|0250|SOTALOL 120MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|||||0.30||| 9525817|ERX|0250|SOTALOL 120MG TABLET|Humana Medicare Advantage|HUMANA MA|0.30||||0.30||| 9525817|ERX|0250|SOTALOL 120MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.30||||||| 9525817|ERX|0250|SOTALOL 120MG TABLET|Medicare|MEDICARE ACUTE|0.30||||0.30||| 9525825|ERX|0250|CEFTRIAXONE 2 G VIAL|Medicare|MEDICARE ACUTE|||||6.82||| 9525825|ERX|0250|CEFTRIAXONE 2 G VIAL|Humana Medicare Advantage|HUMANA MA|6.82||||||| 9525825|ERX|0250|CEFTRIAXONE 2 G VIAL|Blue Cross PPO Specialty|BCBSTX PPO|||||6.82||| 9525888|ERX|0250|GUAIFENSESIN DM (SF) 5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||10.50||| 9525888|ERX|0250|GUAIFENSESIN DM (SF) 5ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|10.50||||||| 9525888|ERX|0250|GUAIFENSESIN DM (SF) 5ML|Medicare|MEDICARE ACUTE|10.50||||||| 9525890|ERX|0250|AMOXICILLIN 250MG/5ML,100|Tricare|TRICARE EAST REGION|||||5.25||| 9525890|ERX|0250|AMOXICILLIN 250MG/5ML,100|Managed Medicaid|MEDICAID SUPERIOR|||||5.25||| 9525957|ERX|0250|TORSEMIDE 100MG TABLET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9525957|ERX|0250|TORSEMIDE 100MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9525957|ERX|0250|TORSEMIDE 100MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||4.50||| 9525957|ERX|0250|TORSEMIDE 100MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||||| 9525957|ERX|0250|TORSEMIDE 100MG TABLET|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9525973|ERX|0250|VENLAFAXINE 37.5MG TABLET|Medicare|MEDICARE ACUTE|23.50||||||| 9525973|ERX|0250|VENLAFAXINE 37.5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|23.50||||||| 9525973|ERX|0250|VENLAFAXINE 37.5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|23.50||||||| 9525981|ERX|0250|VENLAFAXINE 50MG TABLET|Humana Medicare Advantage|HUMANA MA|23.50||||23.50||| 9525981|ERX|0250|VENLAFAXINE 50MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|23.50||||||| 9526005|ERX|0250|MEXILETINE 150MG CAPSULE|Medicare|MEDICARE ACUTE|||||0.13||| 9526005|ERX|0250|MEXILETINE 150MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.13||||||| 9526005|ERX|0250|MEXILETINE 150MG CAPSULE|Managed Medicare|HEALTHSPRING MA|0.13||||||| 9526005|ERX|0250|MEXILETINE 150MG CAPSULE|Managed Medicare|BCBS MEDICARE PPO MA|0.13||||||| 9526013|ERX|0250|MEXILETINE 200MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|14.50||||||| 9526054|ERX|0250|HALOPERIDOL CONC 2MG/ML,|United Medicare Advantage|AARP UHC WEST COMPLETE MA|123.75||||||| 9526070|ERX|0250|ORPHENADRINE 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||23.50||| 9526070|ERX|0250|ORPHENADRINE 100MG TABLET|Cigna|CIGNA|||||23.50||| 9526070|ERX|0250|ORPHENADRINE 100MG TABLET|Aetna|AETNA PPO|||||23.50||| 9526070|ERX|0250|ORPHENADRINE 100MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||23.50||| 9526070|ERX|0250|ORPHENADRINE 100MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||23.50||| 9526070|ERX|0250|ORPHENADRINE 100MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||23.50||| 9526070|ERX|0250|ORPHENADRINE 100MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||23.50||| 9526070|ERX|0250|ORPHENADRINE 100MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||23.50||| 9526070|ERX|0250|ORPHENADRINE 100MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|||||23.50||| 9526070|ERX|0250|ORPHENADRINE 100MG TABLET|United Healthcare|UNITED HEALTHCARE|||||23.50||| 9526070|ERX|0250|ORPHENADRINE 100MG TABLET|Medicaid|MEDICAID|||||23.50||| 9526070|ERX|0250|ORPHENADRINE 100MG TABLET|Medicare|MEDICARE ACUTE|||||23.50||| 9526070|ERX|0250|ORPHENADRINE 100MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|||||23.50||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.50||||4.50||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.50||||4.50||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Veterans Affairs|VETERANS ADMINISTRATION|4.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Veterans Affairs|VETERANS ADMINISTRATION|||||4.50||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Medicaid|HENDERSON COUNTY INDIGENT|4.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Medicaid|MEDICAID|4.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Tricare|TRICARE EAST REGION|4.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|NON CONTRACTED|COMMERCIAL OTHER 1|4.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|United Healthcare|UNITED HEALTHCARE|4.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Medicaid|MEDICAID HMO|4.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|PHCS|HUMANA|4.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||4.50||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Managed Medicaid|MEDICAID AMERIGROUP|4.50||||4.50||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Humana Medicare Advantage|HUMANA MA|4.50||||4.50||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Managed Medicaid|MEDICAID SUPERIOR|4.50||||4.50||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Aetna|AETNA PPO|4.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||4.50||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Access Direct Platinum|HEALTHFIRST TPA UMR|4.50||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||4.50||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||4.50||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Cigna|CIGNA|4.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Blue Cross HMO Specialty|BCBSTX HMO|2.25||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Cigna|CIGNA|2.25||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Blue Cross PPO Specialty|BCBSTX PPO|2.25||||2.25||| 9526161|ERX|0250|MELATONIN 3MG TAB|Aenta Medicare Advantage|AETNA MEDICARE MA|2.25||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.25||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Humana Medicare Advantage|HUMANA MA|2.25||||2.25||| 9526161|ERX|0250|MELATONIN 3MG TAB|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.25||| 9526161|ERX|0250|MELATONIN 3MG TAB|Managed Medicare|HEALTHSPRING MA|2.25||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Managed Medicare|BCBS MEDICARE PPO MA|2.25||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Medicare|MEDICARE ACUTE|2.25||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Veterans Affairs|VETERANS ADMINISTRATION|2.25||||2.25||| 9526161|ERX|0250|MELATONIN 3MG TAB|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.25||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.25||||2.25||| 9526187|ERX|0250|QUETIAPINE 300MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|114.50||||114.50||| 9526187|ERX|0250|QUETIAPINE 300MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|114.50||||||| 9526187|ERX|0250|QUETIAPINE 300MG TABLET|Medicare|MEDICARE ACUTE|114.50||||114.50||| 9526187|ERX|0250|QUETIAPINE 300MG TABLET|Managed Medicare|OTHER INSTITUTIONS|||||114.50||| 9526187|ERX|0250|QUETIAPINE 300MG TABLET|Managed Medicare|HEALTHSPRING MA|||||114.50||| 9526187|ERX|0250|QUETIAPINE 300MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|114.50||||114.50||| 9526187|ERX|0250|QUETIAPINE 300MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|114.50||||114.50||| 9526187|ERX|0250|QUETIAPINE 300MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|114.50||||||| 9526187|ERX|0250|QUETIAPINE 300MG TABLET|Humana Medicare Advantage|HUMANA MA|114.50||||||| 9526302|ERX|0250|SODIUM CHLORIDE INHALANT,|Managed Medicaid|MEDICAID SUPERIOR|||||11.50||| 9526302|ERX|0250|SODIUM CHLORIDE INHALANT,|Managed Medicaid|MEDICAID AMERIGROUP|||||11.50||| 9526302|ERX|0250|SODIUM CHLORIDE INHALANT,|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||11.50||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Tricare|TRICARE EAST REGION|||||6.75||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|United Healthcare|UNITED HEALTHCARE|||||6.75||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|United Healthcare|UNITED HEALTHCARE OTHER|||||6.75||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||6.75||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||6.75||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||6.75||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Medicaid|MEDICAID TEXAS CHILDRENS|||||6.75||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Medicaid|MEDICAID HMO|||||6.75||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Medicaid|MEDICAID|||||6.75||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|United Healthcare|GOLDEN RULE|||||6.75||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Medicare|MEDICARE ACUTE|||||6.75||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||6.75||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|United Medicare Advantage|UHC MEDICARE GOLD MA|||||6.75||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Aetna|AETNA PPO|||||6.75||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||6.75||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|6.75||||6.75||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|NON CONTRACTED|COMMERCIAL OTHER 1|||||6.75||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|6.75||||6.75||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Blue Cross HMO Specialty|BCBSTX HMO|||||6.75||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||6.75||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Blue Cross PPO Specialty|BCBSTX PPO|6.75||||6.75||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Cigna|CIGNA|||||6.75||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Managed Medicare|HEALTHSPRING MA|6.75||||||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Managed Medicaid|MEDICAID AMERIGROUP|6.75||||6.75||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||6.75||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Managed Medicaid|MEDICAID SUPERIOR|6.75||||6.75||| 9526336|ERX|0250|CEFAZOLIN 1 GM/100 ML MB+|Managed Medicaid|MEDICAID UNITED HEALTHCARE|21.25||||21.25||| 9526336|ERX|0250|CEFAZOLIN 1 GM/100 ML MB+|Managed Medicaid|MEDICAID AMERIGROUP|21.25||||||| 9526336|ERX|0250|CEFAZOLIN 1 GM/100 ML MB+|Humana Medicare Advantage|HUMANA MA|21.25||||21.25||| 9526336|ERX|0250|CEFAZOLIN 1 GM/100 ML MB+|Managed Medicare|WELLCARE CHOICE MA|21.25||||||| 9526336|ERX|0250|CEFAZOLIN 1 GM/100 ML MB+|Managed Medicaid|MEDICAID SUPERIOR|21.25||||||| 9526336|ERX|0250|CEFAZOLIN 1 GM/100 ML MB+|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||21.25||| 9526336|ERX|0250|CEFAZOLIN 1 GM/100 ML MB+|Managed Medicare|HEALTHSPRING MA|21.25||||21.25||| 9526336|ERX|0250|CEFAZOLIN 1 GM/100 ML MB+|Blue Cross HMO Specialty|BCBSTX HMO|21.25||||||| 9526336|ERX|0250|CEFAZOLIN 1 GM/100 ML MB+|Blue Cross PPO Specialty|BCBSTX PPO|21.25||||21.25||| 9526336|ERX|0250|CEFAZOLIN 1 GM/100 ML MB+|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|21.25||||||| 9526336|ERX|0250|CEFAZOLIN 1 GM/100 ML MB+|Veterans Affairs|VETERANS ADMINISTRATION|21.25||||||| 9526336|ERX|0250|CEFAZOLIN 1 GM/100 ML MB+|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|21.25||||21.25||| 9526336|ERX|0250|CEFAZOLIN 1 GM/100 ML MB+|United Medicare Advantage|AARP UHC WEST COMPLETE MA|21.25||||21.25||| 9526336|ERX|0250|CEFAZOLIN 1 GM/100 ML MB+|Medicaid|MEDICAID|||||21.25||| 9526336|ERX|0250|CEFAZOLIN 1 GM/100 ML MB+|Medicare|MEDICARE ACUTE|21.25||||21.25||| 9526336|ERX|0250|CEFAZOLIN 1 GM/100 ML MB+|United Healthcare|UNITED HEALTHCARE|||||21.25||| 9526401|ERX|0250|SILVER NITRATE STK 10CT.|United Healthcare|UNITED HEALTHCARE|5.25||||||| 9526401|ERX|0250|SILVER NITRATE STK 10CT.|Medicaid|MEDICAID HMO|||||5.25||| 9526401|ERX|0250|SILVER NITRATE STK 10CT.|Medicare|MEDICARE ACUTE|5.25||||5.25||| 9526401|ERX|0250|SILVER NITRATE STK 10CT.|Aenta Medicare Advantage|AETNA MEDICARE MA|||||5.25||| 9526401|ERX|0250|SILVER NITRATE STK 10CT.|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||5.25||| 9526401|ERX|0250|SILVER NITRATE STK 10CT.|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||5.25||| 9526401|ERX|0250|SILVER NITRATE STK 10CT.|Cigna|CIGNA|||||5.25||| 9526401|ERX|0250|SILVER NITRATE STK 10CT.|Blue Cross PPO Specialty|BCBSTX PPO|5.25||||5.25||| 9526401|ERX|0250|SILVER NITRATE STK 10CT.|Managed Medicare|HEALTHSPRING MA|||||5.25||| 9526401|ERX|0250|SILVER NITRATE STK 10CT.|Humana Medicare Advantage|HUMANA MA|||||5.25||| 9526401|ERX|0250|SILVER NITRATE STK 10CT.|Managed Medicaid|MEDICAID SUPERIOR|5.25||||5.25||| 9526401|ERX|0250|SILVER NITRATE STK 10CT.|Managed Medicaid|MEDICAID AMERIGROUP|5.25||||5.25||| 9526534|ERX|0250|NON-FORMULARY DRUG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|24.50||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Managed Medicaid|MEDICAID SUPERIOR|24.50||||24.50||| 9526534|ERX|0250|NON-FORMULARY DRUG|Managed Medicaid|MEDICAID AMERIGROUP|24.50||||24.50||| 9526534|ERX|0250|NON-FORMULARY DRUG|Humana Medicare Advantage|HUMANA MA|24.50||||24.50||| 9526534|ERX|0250|NON-FORMULARY DRUG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|24.50||||24.50||| 9526534|ERX|0250|NON-FORMULARY DRUG|Managed Medicare|HEALTHSPRING MA|24.50||||24.50||| 9526534|ERX|0250|NON-FORMULARY DRUG|Blue Cross HMO Specialty|BCBSTX HMO|24.50||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Blue Cross PPO Specialty|BCBSTX PPO|24.50||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Aetna|AETNA PPO|24.50||||24.50||| 9526534|ERX|0250|NON-FORMULARY DRUG|Aenta Medicare Advantage|AETNA MEDICARE MA|24.50||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|24.50||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|24.50||||24.50||| 9526534|ERX|0250|NON-FORMULARY DRUG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|24.50||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|24.50||||24.50||| 9526534|ERX|0250|NON-FORMULARY DRUG|United Medicare Advantage|UHC MEDICARE GOLD MA|24.50||||24.50||| 9526534|ERX|0250|NON-FORMULARY DRUG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|24.50||||24.50||| 9526534|ERX|0250|NON-FORMULARY DRUG|Veterans Affairs|VETERANS ADMINISTRATION|24.50||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Medicare|MEDICARE ACUTE|24.50||||24.50||| 9526575|ERX|0250|COMBIGAN 5 ML OPTH DROP|Medicare|MEDICARE ACUTE|547.75||||547.75||| 9526575|ERX|0250|COMBIGAN 5 ML OPTH DROP|United Medicare Advantage|AARP UHC WEST COMPLETE MA|547.75||||||| 9526575|ERX|0250|COMBIGAN 5 ML OPTH DROP|Humana Medicare Advantage|HUMANA MA|547.75||||||| 9526609|ERX|0250|RANITIDINE 50MG INJECTION|Blue Cross PPO Specialty|BCBSTX PPO|45.50||||45.50||| 9526609|ERX|0250|RANITIDINE 50MG INJECTION|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|45.50||||||| 9526609|ERX|0250|RANITIDINE 50MG INJECTION|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||45.50||| 9526609|ERX|0250|RANITIDINE 50MG INJECTION|Medicare|MEDICARE ACUTE|45.50||||45.50||| 9526716|ERX|0250|0.45% SODIUM CHLORIDE KCL|Medicare|MEDICARE ACUTE|202.50||||||| 9526716|ERX|0250|0.45% SODIUM CHLORIDE KCL|Veterans Affairs|VETERANS ADMINISTRATION|202.50||||||| 9526716|ERX|0250|0.45% SODIUM CHLORIDE KCL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|202.50||||||| 9526716|ERX|0250|0.45% SODIUM CHLORIDE KCL|Managed Medicare|HEALTHSPRING MA|202.50||||||| 9526716|ERX|0250|0.45% SODIUM CHLORIDE KCL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|202.50||||||| 9526716|ERX|0250|0.45% SODIUM CHLORIDE KCL|Managed Medicaid|MEDICAID SUPERIOR|202.50||||||| 9526716|ERX|0250|0.45% SODIUM CHLORIDE KCL|Humana Medicare Advantage|HUMANA MA|202.50||||||| 9526716|ERX|0250|0.45% SODIUM CHLORIDE KCL|Aenta Medicare Advantage|AETNA MEDICARE MA|202.50||||||| 9526716|ERX|0250|0.45% SODIUM CHLORIDE KCL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|202.50||||||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Blue Cross HMO Specialty|BCBSTX HMO|13.25||||||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||13.25||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Cigna|CIGNA|||||13.25||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Aetna|AETNA PPO|13.25||||13.25||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Aenta Medicare Advantage|AETNA MEDICARE MA|13.25||||||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|13.25||||13.25||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||13.25||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Humana Medicare Advantage|HUMANA MA|13.25||||13.25||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Managed Medicaid|MEDICAID UNITED HEALTHCARE|13.25||||13.25||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Managed Medicaid|MEDICAID SUPERIOR|13.25||||13.25||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|13.25||||||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Managed Medicaid|MEDICAID AMERIGROUP|||||13.25||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Managed Medicare|HEALTHSPRING MA|13.25||||||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Blue Cross PPO Specialty|BCBSTX PPO|13.25||||13.25||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|13.25||||13.25||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|United Medicare Advantage|UHC MEDICARE GOLD MA|13.25||||13.25||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||13.25||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Veterans Affairs|VETERANS ADMINISTRATION|13.25||||||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Tricare|TRICARE EAST REGION|||||13.25||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|NON CONTRACTED|COMMERCIAL OTHER 1|13.25||||||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|United Healthcare|UNITED HEALTHCARE OTHER|||||13.25||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|United Healthcare|UNITED HEALTHCARE|||||13.25||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|PHCS|HUMANA|||||13.25||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Medicaid|MEDICAID HMO|||||13.25||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Medicaid|MEDICAID|||||13.25||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||13.25||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Medicare|MEDICARE ACUTE|13.25||||13.25||| 9526773|ERX|0250|RIVAROXABAN 10 MG TABLET|Medicare|MEDICARE ACUTE|59.25||||||| 9526773|ERX|0250|RIVAROXABAN 10 MG TABLET|United Healthcare|UNITED HEALTHCARE|||||59.25||| 9526773|ERX|0250|RIVAROXABAN 10 MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|59.25||||||| 9526773|ERX|0250|RIVAROXABAN 10 MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|59.25||||||| 9526773|ERX|0250|RIVAROXABAN 10 MG TABLET|Humana Medicare Advantage|HUMANA MA|59.25||||||| 9526773|ERX|0250|RIVAROXABAN 10 MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||59.25||| 9526773|ERX|0250|RIVAROXABAN 10 MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|59.25||||||| 9526773|ERX|0250|RIVAROXABAN 10 MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|59.25||||||| 9526781|ERX|0250|HEPARIN 100UNIT/ML 5 ML|Blue Cross HMO Specialty|BCBSTX HMO|11.50||||||| 9526781|ERX|0250|HEPARIN 100UNIT/ML 5 ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||11.50||| 9526781|ERX|0250|HEPARIN 100UNIT/ML 5 ML|ChampVA|CHAMPVA CENTER|||||11.50||| 9526781|ERX|0250|HEPARIN 100UNIT/ML 5 ML|Blue Cross PPO Specialty|BCBSTX PPO|||||11.50||| 9526781|ERX|0250|HEPARIN 100UNIT/ML 5 ML|Aenta Medicare Advantage|AETNA MEDICARE MA|11.50||||11.50||| 9526781|ERX|0250|HEPARIN 100UNIT/ML 5 ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|11.50||||11.50||| 9526781|ERX|0250|HEPARIN 100UNIT/ML 5 ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||11.50||| 9526781|ERX|0250|HEPARIN 100UNIT/ML 5 ML|Managed Medicare|HEALTHSPRING MA|||||11.50||| 9526781|ERX|0250|HEPARIN 100UNIT/ML 5 ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|11.50||||11.50||| 9526781|ERX|0250|HEPARIN 100UNIT/ML 5 ML|Managed Medicaid|MEDICAID SUPERIOR|||||11.50||| 9526781|ERX|0250|HEPARIN 100UNIT/ML 5 ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||11.50||| 9526781|ERX|0250|HEPARIN 100UNIT/ML 5 ML|Humana Medicare Advantage|HUMANA MA|11.50||||11.50||| 9526781|ERX|0250|HEPARIN 100UNIT/ML 5 ML|Managed Medicaid|MEDICAID AMERIGROUP|11.50||||11.50||| 9526781|ERX|0250|HEPARIN 100UNIT/ML 5 ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|11.50||||11.50||| 9526781|ERX|0250|HEPARIN 100UNIT/ML 5 ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||11.50||| 9526781|ERX|0250|HEPARIN 100UNIT/ML 5 ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|11.50||||11.50||| 9526781|ERX|0250|HEPARIN 100UNIT/ML 5 ML|Veterans Affairs|VETERANS ADMINISTRATION|||||11.50||| 9526781|ERX|0250|HEPARIN 100UNIT/ML 5 ML|Tricare|TRICARE EAST REGION|||||11.50||| 9526781|ERX|0250|HEPARIN 100UNIT/ML 5 ML|Medicare|MEDICARE ACUTE|11.50||||11.50||| 9526807|ERX|0250|HYDROCORTISONE 2.5% CREAM|Medicare|MEDICARE ACUTE|||||80.50||| 9526807|ERX|0250|HYDROCORTISONE 2.5% CREAM|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||80.50||| 9526807|ERX|0250|HYDROCORTISONE 2.5% CREAM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||80.50||| 9526807|ERX|0250|HYDROCORTISONE 2.5% CREAM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|80.50||||||| 9526807|ERX|0250|HYDROCORTISONE 2.5% CREAM|Blue Cross PPO Specialty|BCBSTX PPO|||||80.50||| 9526831|ERX|0250|TICAGRELOR 90 MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|38.50||||||| 9526831|ERX|0250|TICAGRELOR 90 MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|38.50||||38.50||| 9526831|ERX|0250|TICAGRELOR 90 MG TABLET|Managed Medicare|HEALTHSPRING MA|38.50||||38.50||| 9526831|ERX|0250|TICAGRELOR 90 MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|38.50||||38.50||| 9526831|ERX|0250|TICAGRELOR 90 MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||38.50||| 9526831|ERX|0250|TICAGRELOR 90 MG TABLET|Humana Medicare Advantage|HUMANA MA|38.50||||38.50||| 9526831|ERX|0250|TICAGRELOR 90 MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|38.50||||38.50||| 9526831|ERX|0250|TICAGRELOR 90 MG TABLET|Medicare|MEDICARE ACUTE|38.50||||38.50||| 9526948|ERX|0250|RIVAROXABAN 15MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|0.55||||||| 9526948|ERX|0250|RIVAROXABAN 15MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.55||||||| 9526948|ERX|0250|RIVAROXABAN 15MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.55||||||| 9526948|ERX|0250|RIVAROXABAN 15MG TABLET|Medicare|MEDICARE ACUTE|0.55||||0.55||| 9526948|ERX|0250|RIVAROXABAN 15MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.55||||0.55||| 9526948|ERX|0250|RIVAROXABAN 15MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.55||||||| 9526948|ERX|0250|RIVAROXABAN 15MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|0.55||||0.55||| 9526948|ERX|0250|RIVAROXABAN 15MG TABLET|Humana Medicare Advantage|HUMANA MA|0.55||||||| 9526948|ERX|0250|RIVAROXABAN 15MG TABLET|Managed Medicare|HEALTHSPRING MA|0.55||||0.55||| 9526948|ERX|0250|RIVAROXABAN 15MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|0.55||||||| 9526948|ERX|0250|RIVAROXABAN 15MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|0.55||||||| 9526948|ERX|0250|RIVAROXABAN 15MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.55||||0.55||| 9526948|ERX|0250|RIVAROXABAN 15MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|0.55||||0.55||| 9526948|ERX|0250|RIVAROXABAN 15MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.55||||||| 9526955|ERX|0250|RIVAROXABAN 20MG TABLET|Aetna|AETNA PPO|0.55||||||| 9526955|ERX|0250|RIVAROXABAN 20MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|0.55||||||| 9526955|ERX|0250|RIVAROXABAN 20MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.55||||||| 9526955|ERX|0250|RIVAROXABAN 20MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||0.55||| 9526955|ERX|0250|RIVAROXABAN 20MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.55||||||| 9526955|ERX|0250|RIVAROXABAN 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.55||||0.55||| 9526955|ERX|0250|RIVAROXABAN 20MG TABLET|Managed Medicare|HEALTHSPRING MA|0.55||||||| 9526955|ERX|0250|RIVAROXABAN 20MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.55||||0.55||| 9526955|ERX|0250|RIVAROXABAN 20MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|0.55||||||| 9526955|ERX|0250|RIVAROXABAN 20MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.55||||||| 9526955|ERX|0250|RIVAROXABAN 20MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|0.55||||||| 9526955|ERX|0250|RIVAROXABAN 20MG TABLET|Humana Medicare Advantage|HUMANA MA|0.55||||0.55||| 9526955|ERX|0250|RIVAROXABAN 20MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.55||||||| 9526955|ERX|0250|RIVAROXABAN 20MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.55||||0.55||| 9526955|ERX|0250|RIVAROXABAN 20MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.55||||0.55||| 9526955|ERX|0250|RIVAROXABAN 20MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|0.55||||||| 9526955|ERX|0250|RIVAROXABAN 20MG TABLET|United Healthcare|UNITED HEALTHCARE|0.55||||||| 9526955|ERX|0250|RIVAROXABAN 20MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|0.55||||||| 9526955|ERX|0250|RIVAROXABAN 20MG TABLET|Medicare|MEDICARE ACUTE|0.55||||0.55||| 9527029|ERX|0250|SORBITOL 70% SOLUTION, 30|Managed Medicare|HEALTHSPRING MA|||||10.50||| 9527060|ERX|0250|PHENYLEPHRINE 60 MG/250 M|Medicare|MEDICARE ACUTE|213.25||||||| 9527060|ERX|0250|PHENYLEPHRINE 60 MG/250 M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|213.25||||||| 9527060|ERX|0250|PHENYLEPHRINE 60 MG/250 M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|213.25||||||| 9527060|ERX|0250|PHENYLEPHRINE 60 MG/250 M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||213.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|MTC Medical|VAN ZANDT COUNTY INMATE|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Managed Medicaid|MEDICAID SUPERIOR|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Managed Medicaid|MEDICAID AMERIGROUP|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Humana Medicare Advantage|HUMANA MA|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Managed Medicare|OTHER INSTITUTIONS|||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Managed Medicare|VAN ZANDT COUNTY INMATE|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Managed Medicare|MA PART B ONLY IP|2.50||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Managed Medicare|HOSPICE GENESIS|2.50||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Managed Medicare|HOSPICE ETMC|||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Managed Medicare|BCBS MEDICARE PPO MA|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Blue Cross HMO Specialty|BCBSTX HMO|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Cigna|CIGNA OTHER|||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|ChampVA|CHAMPVA CENTER|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Aetna|AETNA OTHER|||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Aetna|AETNA PPO|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Aenta Medicare Advantage|AETNA MEDICARE MA|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Cigna|CIGNA|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Managed Medicare|HEALTHSPRING MA|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Veterans Affairs|VETERANS ADMINISTRATION|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|United Medicare Advantage|UHC AARP MCR HMO MA|||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Tricare|TRICARE EAST REGION|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Managed Medicare|WELLCARE CHOICE MA|||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|NON CONTRACTED|COMMERCIAL OTHER 1|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|UTMB|UTMB CORRECTIONAL MANAGED CARE|2.50||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|United Healthcare|UNITED HEALTHCARE|||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|United Healthcare|UNITED HEALTHCARE OTHER|||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|United Healthcare|TML GROUP BENEFITS|||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|United Healthcare|UNITED HEALTHCARE|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|United Healthcare|UMR UNITED MEDICAL RESOURCES|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Medicaid|MOLINA HEALTHCARE OF TEXAS|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Medicaid|MEDICAID HMO|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Medicaid|MEDICAID|2.50||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.50||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Medicaid|HENDERSON COUNTY INDIGENT|2.50||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Medicare|MEDICARE PART B ONLY IP|2.50||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Medicare|MEDICARE ACUTE|2.50||||2.50||| 9527235|ERX|0250|WARFARIN 4MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|0.13||||||| 9527235|ERX|0250|WARFARIN 4MG TABLET|Medicare|MEDICARE ACUTE|0.13||||0.13||| 9527235|ERX|0250|WARFARIN 4MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.13||||||| 9527235|ERX|0250|WARFARIN 4MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.13||||||| 9527235|ERX|0250|WARFARIN 4MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|0.13||||||| 9527235|ERX|0250|WARFARIN 4MG TABLET|Humana Medicare Advantage|HUMANA MA|0.13||||||| 9527235|ERX|0250|WARFARIN 4MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.13||||||| 9527250|ERX|0250|FELODIPINE 5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|12.50||||||| 9527250|ERX|0250|FELODIPINE 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|12.50||||||| 9527250|ERX|0250|FELODIPINE 5MG TABLET|Managed Medicare|HEALTHSPRING MA|12.50||||12.50||| 9527250|ERX|0250|FELODIPINE 5MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|12.50||||||| 9527250|ERX|0250|FELODIPINE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|12.50||||||| 9527250|ERX|0250|FELODIPINE 5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|12.50||||||| 9527250|ERX|0250|FELODIPINE 5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|12.50||||12.50||| 9527250|ERX|0250|FELODIPINE 5MG TABLET|Medicare|MEDICARE ACUTE|12.50||||12.50||| 9527284|ERX|0250|PRAMIPEXOLE 0.5MG TABLET|Tricare|TRICARE EAST REGION|||||24.25||| 9527284|ERX|0250|PRAMIPEXOLE 0.5MG TABLET|Medicare|MEDICARE ACUTE|24.25||||24.25||| 9527284|ERX|0250|PRAMIPEXOLE 0.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|24.25||||||| 9527284|ERX|0250|PRAMIPEXOLE 0.5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|24.25||||24.25||| 9527284|ERX|0250|PRAMIPEXOLE 0.5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|24.25||||||| 9527284|ERX|0250|PRAMIPEXOLE 0.5MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|24.25||||||| 9527284|ERX|0250|PRAMIPEXOLE 0.5MG TABLET|Humana Medicare Advantage|HUMANA MA|24.25||||24.25||| 9527284|ERX|0250|PRAMIPEXOLE 0.5MG TABLET|Managed Medicare|HEALTHSPRING MA|24.25||||||| 9527284|ERX|0250|PRAMIPEXOLE 0.5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||24.25||| 9527284|ERX|0250|PRAMIPEXOLE 0.5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|24.25||||||| 9527417|ERX|0250|ROFLUMILAST 500MG TABLET|Managed Medicare|HEALTHSPRING MA|||||46.75||| 9527417|ERX|0250|ROFLUMILAST 500MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|46.75||||||| 9527417|ERX|0250|ROFLUMILAST 500MG TABLET|Humana Medicare Advantage|HUMANA MA|46.75||||46.75||| 9527417|ERX|0250|ROFLUMILAST 500MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|46.75||||||| 9527417|ERX|0250|ROFLUMILAST 500MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|46.75||||||| 9527417|ERX|0250|ROFLUMILAST 500MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|46.75||||46.75||| 9527417|ERX|0250|ROFLUMILAST 500MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|46.75||||46.75||| 9527417|ERX|0250|ROFLUMILAST 500MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|46.75||||46.75||| 9527417|ERX|0250|ROFLUMILAST 500MG TABLET|Medicare|MEDICARE ACUTE|46.75||||46.75||| 9527425|ERX|0250|INHALATION ANESTHETIC|Tricare|TRICARE EAST REGION|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|United Healthcare|TML GROUP BENEFITS|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|PHCS|HUMANA INSURANCE|||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|United Healthcare|UNITED HEALTHCARE|||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|United Healthcare|UNITED HEALTHCARE|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|United Healthcare|UNITED HEALTHCARE OTHER|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|United Healthcare|GEHA|||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Texas Workforce Commission|DIS DETER SERV (DDS)|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Multiplan|NALC|||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Medicaid|MEDICAID HMO|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Medicaid|MEDICAID|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Medicaid|LAW ENFORCEMENT OTHER|11.35||||||| 9527425|ERX|0250|INHALATION ANESTHETIC|Medicare|MEDICARE ACUTE|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Workers Compensation|WORKERS COMPENSATION OTHER|||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Veterans Affairs|VETERANS ADMINISTRATION|11.35||||||| 9527425|ERX|0250|INHALATION ANESTHETIC|Veterans Affairs|VETERANS ADMINISTRATION|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|United Medicare Advantage|UHC MEDICARE GOLD MA|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|United Medicare Advantage|UHC AARP MCR HMO MA|||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Medicaid|HENDERSON COUNTY INDIGENT|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Blue Cross HMO Specialty|BCBSTX HMO|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|ChampVA|CHAMPVA CENTER|||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Blue Cross PPO Specialty|BCBSTX PPO|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Cigna|CIGNA|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Cigna|CIGNA|||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Cigna|CIGNA OTHER|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Aetna|AETNA PPO|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|PHCS|MULTIPLAN PHCS OTHER|||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|United Healthcare|UMR UNITED MEDICAL RESOURCES|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Aetna|AETNA OTHER|||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Aenta Medicare Advantage|AETNA MEDICARE MA|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Access Direct Platinum|HEALTHFIRST TPA UMR|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|NON CONTRACTED|COMMERCIAL OTHER 1|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Managed Medicaid|MEDICAID SUPERIOR|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Managed Medicaid|MEDICAID AMERIGROUP|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Humana Medicare Advantage|HUMANA MA|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Managed Medicare|OTHER INSTITUTIONS|||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Managed Medicare|HEALTHSPRING MA|11.35||||11.35||| 9527425|ERX|0250|INHALATION ANESTHETIC|Managed Medicare|BCBS MEDICARE PPO MA|11.35||||11.35||| 9527441|ERX|0250|MOXIFLOXACIN 0.5% EYE DRO|Managed Medicare|HEALTHSPRING MA|||||513.75||| 9527441|ERX|0250|MOXIFLOXACIN 0.5% EYE DRO|Humana Medicare Advantage|HUMANA MA|||||513.75||| 9527441|ERX|0250|MOXIFLOXACIN 0.5% EYE DRO|Aetna|AETNA PPO|||||513.75||| 9527441|ERX|0250|MOXIFLOXACIN 0.5% EYE DRO|Aenta Medicare Advantage|AETNA MEDICARE MA|513.75||||513.75||| 9527441|ERX|0250|MOXIFLOXACIN 0.5% EYE DRO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||513.75||| 9527441|ERX|0250|MOXIFLOXACIN 0.5% EYE DRO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||513.75||| 9527441|ERX|0250|MOXIFLOXACIN 0.5% EYE DRO|Blue Cross HMO Specialty|BCBSTX HMO|513.75||||513.75||| 9527441|ERX|0250|MOXIFLOXACIN 0.5% EYE DRO|ChampVA|CHAMPVA CENTER|||||513.75||| 9527441|ERX|0250|MOXIFLOXACIN 0.5% EYE DRO|Cigna|CIGNA|||||513.75||| 9527441|ERX|0250|MOXIFLOXACIN 0.5% EYE DRO|Blue Cross PPO Specialty|BCBSTX PPO|||||513.75||| 9527441|ERX|0250|MOXIFLOXACIN 0.5% EYE DRO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|513.75||||513.75||| 9527441|ERX|0250|MOXIFLOXACIN 0.5% EYE DRO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||513.75||| 9527441|ERX|0250|MOXIFLOXACIN 0.5% EYE DRO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||513.75||| 9527441|ERX|0250|MOXIFLOXACIN 0.5% EYE DRO|Medicare|MEDICARE ACUTE|||||513.75||| 9527458|ERX|0250|FENOFIBRATE 145MG TABLET|United Healthcare|UNITED HEALTHCARE|43.25||||||| 9527458|ERX|0250|FENOFIBRATE 145MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|43.25||||||| 9527458|ERX|0250|FENOFIBRATE 145MG TABLET|Medicare|MEDICARE ACUTE|43.25||||43.25||| 9527458|ERX|0250|FENOFIBRATE 145MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|43.25||||||| 9527458|ERX|0250|FENOFIBRATE 145MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|43.25||||43.25||| 9527458|ERX|0250|FENOFIBRATE 145MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|43.25||||43.25||| 9527458|ERX|0250|FENOFIBRATE 145MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|43.25||||43.25||| 9527458|ERX|0250|FENOFIBRATE 145MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||43.25||| 9527458|ERX|0250|FENOFIBRATE 145MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|43.25||||43.25||| 9527458|ERX|0250|FENOFIBRATE 145MG TABLET|Aetna|AETNA PPO|||||43.25||| 9527458|ERX|0250|FENOFIBRATE 145MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||43.25||| 9527458|ERX|0250|FENOFIBRATE 145MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|43.25||||||| 9527458|ERX|0250|FENOFIBRATE 145MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|43.25||||||| 9527458|ERX|0250|FENOFIBRATE 145MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|43.25||||||| 9527458|ERX|0250|FENOFIBRATE 145MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||43.25||| 9527458|ERX|0250|FENOFIBRATE 145MG TABLET|Humana Medicare Advantage|HUMANA MA|43.25||||43.25||| 9527458|ERX|0250|FENOFIBRATE 145MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|43.25||||||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Managed Medicare|VAN ZANDT COUNTY INMATE|||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Managed Medicare|HEALTHSPRING MA|99.50||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Managed Medicaid|MEDICAID SUPERIOR|99.50||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Managed Medicaid|MEDICAID AMERIGROUP|||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Aetna|AETNA PPO|||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Aetna|BOON CHAPMAN|99.50||||||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Aenta Medicare Advantage|AETNA MEDICARE MA|99.50||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|99.50||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Blue Cross HMO Specialty|BCBSTX HMO|||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Cigna|CIGNA|||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Blue Cross PPO Specialty|BCBSTX OTHER|||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Blue Cross PPO Specialty|BCBSTX PPO|99.50||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Humana Medicare Advantage|HUMANA MA|99.50||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|MTC Medical|VAN ZANDT COUNTY INMATE|||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Cigna|CIGNA OTHER|||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|United Medicare Advantage|UHC MEDICARE GOLD MA|||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|United Medicare Advantage|AARP UHC WEST COMPLETE MA|99.50||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Workers Compensation|WORKERS COMPENSATION OTHER|||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Veterans Affairs|VETERANS ADMINISTRATION|||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Medicaid|MEDICAID|99.50||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Medicaid|MEDICAID HMO|99.50||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Medicare|MEDICARE ACUTE|99.50||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|NON CONTRACTED|COMMERCIAL OTHER 1|||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|United Healthcare|UNITED HEALTHCARE OTHER|||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|United Healthcare|TML GROUP BENEFITS|||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|United Healthcare|UNITED HEALTHCARE|||||99.50||| 9527532|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Texas Workforce Commission|DIS DETER SERV (DDS)|||||99.50||| 9527573|ERX|0250|PRAVASTATIN 10 MG TABLET|Medicare|MEDICARE ACUTE|39.75||||39.75||| 9527573|ERX|0250|PRAVASTATIN 10 MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||39.75||| 9527573|ERX|0250|PRAVASTATIN 10 MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|39.75||||||| 9527573|ERX|0250|PRAVASTATIN 10 MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|39.75||||||| 9527573|ERX|0250|PRAVASTATIN 10 MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|39.75||||||| 9527573|ERX|0250|PRAVASTATIN 10 MG TABLET|Humana Medicare Advantage|HUMANA MA|||||39.75||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|40.50||||||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|40.50||||40.50||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|40.50||||||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|40.50||||40.50||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Managed Medicare|HEALTHSPRING MA|40.50||||40.50||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Humana Medicare Advantage|HUMANA MA|40.50||||40.50||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|40.50||||40.50||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Aetna|AETNA PPO|40.50||||||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||40.50||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|40.50||||||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|40.50||||||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|40.50||||40.50||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|40.50||||40.50||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|40.50||||||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|40.50||||40.50||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|40.50||||||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|United Healthcare|UNITED HEALTHCARE|||||40.50||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Medicare|MEDICARE ACUTE|40.50||||40.50||| 9527599|ERX|0250|PRAVASTATIN 40 MG TABLET|Medicaid|COUNTY INDIGENT HEALTH OTHER|46.50||||||| 9527599|ERX|0250|PRAVASTATIN 40 MG TABLET|Medicare|MEDICARE ACUTE|46.50||||46.50||| 9527599|ERX|0250|PRAVASTATIN 40 MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|46.50||||46.50||| 9527599|ERX|0250|PRAVASTATIN 40 MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|46.50||||46.50||| 9527599|ERX|0250|PRAVASTATIN 40 MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|46.50||||46.50||| 9527599|ERX|0250|PRAVASTATIN 40 MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|46.50||||||| 9527599|ERX|0250|PRAVASTATIN 40 MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|46.50||||||| 9527599|ERX|0250|PRAVASTATIN 40 MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|46.50||||||| 9527599|ERX|0250|PRAVASTATIN 40 MG TABLET|Aetna|AETNA PPO|46.50||||||| 9527599|ERX|0250|PRAVASTATIN 40 MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|46.50||||46.50||| 9527599|ERX|0250|PRAVASTATIN 40 MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|46.50||||46.50||| 9527599|ERX|0250|PRAVASTATIN 40 MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|46.50||||||| 9527599|ERX|0250|PRAVASTATIN 40 MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|46.50||||46.50||| 9527599|ERX|0250|PRAVASTATIN 40 MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|46.50||||||| 9527599|ERX|0250|PRAVASTATIN 40 MG TABLET|Humana Medicare Advantage|HUMANA MA|46.50||||46.50||| 9527599|ERX|0250|PRAVASTATIN 40 MG TABLET|Managed Medicare|MA PART B ONLY IP|46.50||||||| 9527599|ERX|0250|PRAVASTATIN 40 MG TABLET|Managed Medicare|HEALTHSPRING MA|46.50||||46.50||| 9527599|ERX|0250|PRAVASTATIN 40 MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|46.50||||||| 9527615|ERX|0250|ACYCLOVIR 500MG/100ML NS|Humana Medicare Advantage|HUMANA MA|99.50||||||| 9527615|ERX|0250|ACYCLOVIR 500MG/100ML NS|Medicare|MEDICARE ACUTE|99.50||||99.50||| 9527623|ERX|0250|AMIODARONE 150MG/100ML D5|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|99.50||||99.50||| 9527623|ERX|0250|AMIODARONE 150MG/100ML D5|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||99.50||| 9527623|ERX|0250|AMIODARONE 150MG/100ML D5|Medicare|MEDICARE ACUTE|99.50||||99.50||| 9527623|ERX|0250|AMIODARONE 150MG/100ML D5|Medicare|MEDICARE PART B ONLY IP|99.50||||||| 9527623|ERX|0250|AMIODARONE 150MG/100ML D5|Aenta Medicare Advantage|AETNA MEDICARE MA|||||99.50||| 9527623|ERX|0250|AMIODARONE 150MG/100ML D5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|99.50||||||| 9527623|ERX|0250|AMIODARONE 150MG/100ML D5|Blue Cross PPO Specialty|BCBSTX PPO|||||99.50||| 9527623|ERX|0250|AMIODARONE 150MG/100ML D5|Managed Medicare|HEALTHSPRING MA|99.50||||||| 9527623|ERX|0250|AMIODARONE 150MG/100ML D5|Managed Medicaid|MEDICAID UNITED HEALTHCARE|99.50||||||| 9527623|ERX|0250|AMIODARONE 150MG/100ML D5|Managed Medicaid|MEDICAID SUPERIOR|99.50||||||| 9527623|ERX|0250|AMIODARONE 150MG/100ML D5|Humana Medicare Advantage|HUMANA MA|99.50||||99.50||| 9527631|ERX|0250|AMIODARONE 450MG/250ML D5|Managed Medicaid|MEDICAID SUPERIOR|99.50||||||| 9527631|ERX|0250|AMIODARONE 450MG/250ML D5|Humana Medicare Advantage|HUMANA MA|99.50||||99.50||| 9527631|ERX|0250|AMIODARONE 450MG/250ML D5|Managed Medicare|HEALTHSPRING MA|99.50||||||| 9527631|ERX|0250|AMIODARONE 450MG/250ML D5|Blue Cross PPO Specialty|BCBSTX PPO|||||99.50||| 9527631|ERX|0250|AMIODARONE 450MG/250ML D5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|99.50||||||| 9527631|ERX|0250|AMIODARONE 450MG/250ML D5|Medicare|MEDICARE ACUTE|99.50||||99.50||| 9527631|ERX|0250|AMIODARONE 450MG/250ML D5|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|99.50||||99.50||| 9527631|ERX|0250|AMIODARONE 450MG/250ML D5|United Medicare Advantage|AARP UHC WEST COMPLETE MA|99.50||||99.50||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Veterans Affairs|VETERANS ADMINISTRATION|||||201.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Workers Compensation|UT EMPLOYEE INJURY|201.25||||||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|201.25||||201.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|United Medicare Advantage|UHC MEDICARE GOLD MA|201.25||||201.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|201.25||||201.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Tricare|TRICARE EAST REGION|201.25||||||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|NON CONTRACTED|COMMERCIAL OTHER 1|201.25||||201.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|201.25||||201.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|United Healthcare|UNITED HEALTHCARE|201.25||||||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Medicare|MEDICARE PART B ONLY IP|201.25||||||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Medicaid|MEDICAID HMO|||||201.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Medicaid|MEDICAID|201.25||||201.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Medicaid|HENDERSON COUNTY INDIGENT|201.25||||||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|201.25||||||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Medicare|MEDICARE ACUTE|201.25||||201.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|201.25||||201.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|United Healthcare|UNITED HEALTHCARE|||||201.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Aetna|AETNA PPO|201.25||||||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Aenta Medicare Advantage|AETNA MEDICARE MA|201.25||||201.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|201.25||||||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Blue Cross HMO Specialty|BCBSTX HMO|201.25||||201.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Cigna|CIGNA|||||201.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Blue Cross PPO Specialty|BCBSTX PPO|201.25||||201.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Veterans Affairs|VETERANS ADMINISTRATION|201.25||||201.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Cigna|CIGNA|201.25||||||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||201.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Managed Medicare|VAN ZANDT COUNTY INMATE|||||201.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|201.25||||||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Managed Medicare|HEALTHSPRING MA|201.25||||201.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Managed Medicare|BCBS MEDICARE PPO MA|201.25||||||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|MTC Medical|VAN ZANDT COUNTY INMATE|||||201.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Managed Medicaid|MEDICAID AMERIGROUP|201.25||||||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|201.25||||201.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Managed Medicaid|MEDICAID SUPERIOR|201.25||||||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|201.25||||201.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Humana Medicare Advantage|HUMANA MA|201.25||||201.25||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||238.50||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|Humana Medicare Advantage|HUMANA MA|238.50||||238.50||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|Managed Medicare|HEALTHSPRING MA|||||238.50||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|Cigna|CIGNA|||||238.50||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|Managed Medicare|BCBS MEDICARE PPO MA|238.50||||||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|Blue Cross HMO Specialty|BCBSTX HMO|||||238.50||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|||||238.50||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|Aetna|AETNA PPO|||||238.50||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||238.50||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|238.50||||238.50||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||238.50||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|238.50||||||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|Medicare|MEDICARE ACUTE|238.50||||238.50||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|United Healthcare|TML GROUP BENEFITS|||||238.50||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|United Healthcare|UNITED HEALTHCARE OTHER|||||238.50||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|United Healthcare|UNITED HEALTHCARE|||||238.50||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||238.50||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||238.50||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||238.50||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|Veterans Affairs|VETERANS ADMINISTRATION|||||238.50||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Veterans Affairs|VETERANS ADMINISTRATION|135.75||||135.75||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|135.75||||135.75||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|United Medicare Advantage|UHC AARP MCR HMO MA|||||135.75||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|135.75||||135.75||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|NON CONTRACTED|COMMERCIAL OTHER 1|135.75||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|United Healthcare|UNITED HEALTHCARE|135.75||||135.75||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||135.75||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Medicaid|MOLINA HEALTHCARE OF TEXAS|135.75||||135.75||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Medicaid|MEDICAID HMO|||||135.75||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Medicaid|MEDICAID|||||135.75||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Medicare|MEDICARE PART B ONLY IP|135.75||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Medicare|MEDICARE ACUTE|135.75||||135.75||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Aetna|AETNA PPO|135.75||||135.75||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Aenta Medicare Advantage|AETNA MEDICARE MA|135.75||||135.75||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|135.75||||135.75||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|135.75||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|135.75||||135.75||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Blue Cross HMO Specialty|BCBSTX HMO|135.75||||135.75||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|135.75||||135.75||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Cigna|CIGNA|135.75||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|135.75||||135.75||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Managed Medicare|MA PART B ONLY IP|135.75||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Managed Medicare|HEALTHSPRING MA|135.75||||135.75||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Managed Medicare|BCBS MEDICARE PPO MA|135.75||||135.75||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|135.75||||135.75||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Managed Medicaid|MEDICAID SUPERIOR|135.75||||135.75||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|135.75||||135.75||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Managed Medicaid|MEDICAID AMERIGROUP|||||135.75||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Humana Medicare Advantage|HUMANA MA|135.75||||135.75||| 9527722|ERX|0250|CEFOXITIN 1G/100ML NS|Humana Medicare Advantage|HUMANA MA|99.50||||||| 9527722|ERX|0250|CEFOXITIN 1G/100ML NS|Medicaid|MEDICAID|99.50||||||| 9527730|ERX|0250|CEFTAZIDIME 1G/100ML NS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|99.75||||99.75||| 9527730|ERX|0250|CEFTAZIDIME 1G/100ML NS|Medicare|MEDICARE ACUTE|99.75||||||| 9527730|ERX|0250|CEFTAZIDIME 1G/100ML NS|Managed Medicare|BCBS MEDICARE PPO MA|99.75||||||| 9527730|ERX|0250|CEFTAZIDIME 1G/100ML NS|Humana Medicare Advantage|HUMANA MA|99.75||||||| 9527748|ERX|0250|CEFTAZIDIME 2G/100ML NS|Medicare|MEDICARE ACUTE|169.25||||||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Blue Cross HMO Specialty|BCBSTX HMO|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Cigna|CIGNA OTHER|469.50||||||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Cigna|CIGNA|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|ChampVA|CHAMPVA CENTER|||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Cigna|CIGNA|||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Blue Cross PPO Specialty|BCBSTX OTHER|||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Aetna|AETNA PPO|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Aetna|BOON CHAPMAN|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Aenta Medicare Advantage|AETNA MEDICARE MA|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|MTC Medical|VAN ZANDT COUNTY INMATE|||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Managed Medicaid|MEDICAID SUPERIOR|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Humana Medicare Advantage|HUMANA MA|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Managed Medicare|OTHER INSTITUTIONS|||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Managed Medicare|VAN ZANDT COUNTY INMATE|||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Managed Medicaid|MEDICAID AMERIGROUP|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Managed Medicare|MA PART B ONLY IP|469.50||||||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Managed Medicare|HEALTHSPRING MA|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Managed Medicare|BCBS MEDICARE PPO MA|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Workers Compensation|UT EMPLOYEE INJURY|469.50||||||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Veterans Affairs|VETERANS ADMINISTRATION|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|United Medicare Advantage|UHC AARP MCR HMO MA|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Tricare|TRICARE EAST REGION|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|NON CONTRACTED|COMMERCIAL OTHER 1|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|UTMB|UTMB CORRECTIONAL MANAGED CARE|469.50||||||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|United Healthcare|UNITED HEALTHCARE|||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|PHCS|HUMANA|||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|United Healthcare|UNITED HEALTHCARE OTHER|||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|United Healthcare|UNITED HEALTHCARE|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|United Healthcare|TML GROUP BENEFITS|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|United Healthcare|UMR UNITED MEDICAL RESOURCES|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Medicaid|MEDICAID TEXAS CHILDRENS|||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Medicaid|MEDICAID HMO|||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Medicaid|MEDICAID|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Medicaid|HENDERSON COUNTY INDIGENT|469.50||||||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Medicaid|MOLINA HEALTHCARE OF TEXAS|469.50||||469.50||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Medicare|MEDICARE PART B ONLY IP|469.50||||||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Medicare|MEDICARE ACUTE|469.50||||469.50||| 9527763|ERX|0250|CEFTRIAXONE 2G/100ML NS|Medicare|MEDICARE ACUTE|2.12||||2.12||| 9527763|ERX|0250|CEFTRIAXONE 2G/100ML NS|United Healthcare|UMR UNITED MEDICAL RESOURCES|2.12||||||| 9527763|ERX|0250|CEFTRIAXONE 2G/100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|2.12||||||| 9527763|ERX|0250|CEFTRIAXONE 2G/100ML NS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.12||||||| 9527763|ERX|0250|CEFTRIAXONE 2G/100ML NS|Managed Medicare|HEALTHSPRING MA|2.12||||||| 9527763|ERX|0250|CEFTRIAXONE 2G/100ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.12||||||| 9527763|ERX|0250|CEFTRIAXONE 2G/100ML NS|Managed Medicaid|MEDICAID SUPERIOR|2.12||||2.12||| 9527763|ERX|0250|CEFTRIAXONE 2G/100ML NS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.12||||||| 9527763|ERX|0250|CEFTRIAXONE 2G/100ML NS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.12||| 9527763|ERX|0250|CEFTRIAXONE 2G/100ML NS|Humana Medicare Advantage|HUMANA MA|2.12||||2.12||| 9527763|ERX|0250|CEFTRIAXONE 2G/100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|2.12||||2.12||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Aetna|AETNA PPO|||||117.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Aetna|AETNA OTHER|||||117.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||117.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Blue Cross HMO Specialty|BCBSTX HMO|||||117.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|||||117.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||117.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Cigna|CIGNA|||||117.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|MTC Medical|VAN ZANDT COUNTY INMATE|||||117.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||117.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Managed Medicaid|MEDICAID SUPERIOR|117.50||||117.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Managed Medicaid|MEDICAID AMERIGROUP|117.50||||117.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Managed Medicare|VAN ZANDT COUNTY INMATE|||||117.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||117.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Veterans Affairs|VETERANS ADMINISTRATION|||||117.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||117.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Tricare|TRICARE EAST REGION|||||117.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||117.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||117.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|United Healthcare|UNITED HEALTHCARE|||||117.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Medicaid|MEDICAID|||||117.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||117.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||117.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Medicare|MEDICARE ACUTE|||||117.50||| 9527789|ERX|0250|CEFTRIAXONE 500MG VIAL|Medicaid|MEDICAID TEXAS CHILDRENS|||||302.50||| 9527789|ERX|0250|CEFTRIAXONE 500MG VIAL|Medicaid|MEDICAID|302.50||||302.50||| 9527789|ERX|0250|CEFTRIAXONE 500MG VIAL|Medicaid|MEDICAID HMO|302.50||||302.50||| 9527789|ERX|0250|CEFTRIAXONE 500MG VIAL|Medicare|MEDICARE ACUTE|||||302.50||| 9527789|ERX|0250|CEFTRIAXONE 500MG VIAL|NON CONTRACTED|COMMERCIAL OTHER 1|302.50||||||| 9527789|ERX|0250|CEFTRIAXONE 500MG VIAL|United Healthcare|UNITED HEALTHCARE|||||302.50||| 9527789|ERX|0250|CEFTRIAXONE 500MG VIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||302.50||| 9527789|ERX|0250|CEFTRIAXONE 500MG VIAL|Managed Medicaid|MEDICAID SUPERIOR|302.50||||302.50||| 9527789|ERX|0250|CEFTRIAXONE 500MG VIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||302.50||| 9527789|ERX|0250|CEFTRIAXONE 500MG VIAL|Managed Medicaid|MEDICAID AMERIGROUP|302.50||||302.50||| 9527789|ERX|0250|CEFTRIAXONE 500MG VIAL|Blue Cross HMO Specialty|BCBSTX HMO|||||302.50||| 9527789|ERX|0250|CEFTRIAXONE 500MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|302.50||||302.50||| 9527789|ERX|0250|CEFTRIAXONE 500MG VIAL|Cigna|CIGNA OTHER|||||302.50||| 9527789|ERX|0250|CEFTRIAXONE 500MG VIAL|Aetna|AETNA PPO|||||302.50||| 9527789|ERX|0250|CEFTRIAXONE 500MG VIAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||302.50||| 9527805|ERX|0250|CLINDAMYCIN 600MG/100ML N|Medicare|MEDICARE ACUTE|102.50||||102.50||| 9527813|ERX|0250|CLINDAMYCIN 900MG/100ML N|Medicare|MEDICARE ACUTE|124.75||||124.75||| 9527862|ERX|0250|DILTIAZEM 125MG/100ML NS|Aetna|AETNA OTHER|||||99.50||| 9527862|ERX|0250|DILTIAZEM 125MG/100ML NS|Aenta Medicare Advantage|AETNA MEDICARE MA|99.50||||||| 9527862|ERX|0250|DILTIAZEM 125MG/100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|99.50||||99.50||| 9527862|ERX|0250|DILTIAZEM 125MG/100ML NS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|99.50||||||| 9527862|ERX|0250|DILTIAZEM 125MG/100ML NS|Blue Cross HMO Specialty|BCBSTX HMO|||||99.50||| 9527862|ERX|0250|DILTIAZEM 125MG/100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|||||99.50||| 9527862|ERX|0250|DILTIAZEM 125MG/100ML NS|Managed Medicare|HEALTHSPRING MA|99.50||||||| 9527862|ERX|0250|DILTIAZEM 125MG/100ML NS|Humana Medicare Advantage|HUMANA MA|99.50||||99.50||| 9527862|ERX|0250|DILTIAZEM 125MG/100ML NS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||99.50||| 9527862|ERX|0250|DILTIAZEM 125MG/100ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|99.50||||99.50||| 9527862|ERX|0250|DILTIAZEM 125MG/100ML NS|Managed Medicaid|MEDICAID SUPERIOR|99.50||||||| 9527862|ERX|0250|DILTIAZEM 125MG/100ML NS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|99.50||||99.50||| 9527862|ERX|0250|DILTIAZEM 125MG/100ML NS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|99.50||||99.50||| 9527862|ERX|0250|DILTIAZEM 125MG/100ML NS|NON CONTRACTED|COMMERCIAL OTHER 1|99.50||||||| 9527862|ERX|0250|DILTIAZEM 125MG/100ML NS|United Healthcare|UMR UNITED MEDICAL RESOURCES|99.50||||||| 9527862|ERX|0250|DILTIAZEM 125MG/100ML NS|United Healthcare|UNITED HEALTHCARE|99.50||||||| 9527862|ERX|0250|DILTIAZEM 125MG/100ML NS|Medicare|MEDICARE ACUTE|99.50||||99.50||| 9527870|ERX|0250|DOXYCYCLINE 100MG/100ML N|Medicare|MEDICARE ACUTE|99.50||||||| 9527870|ERX|0250|DOXYCYCLINE 100MG/100ML N|United Healthcare|UNITED HEALTHCARE|||||99.50||| 9527870|ERX|0250|DOXYCYCLINE 100MG/100ML N|United Medicare Advantage|UHC MEDICARE GOLD MA|99.50||||||| 9527870|ERX|0250|DOXYCYCLINE 100MG/100ML N|Humana Medicare Advantage|HUMANA MA|99.50||||||| 9527870|ERX|0250|DOXYCYCLINE 100MG/100ML N|Managed Medicaid|MEDICAID SUPERIOR|99.50||||||| 9527870|ERX|0250|DOXYCYCLINE 100MG/100ML N|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||99.50||| 9527870|ERX|0250|DOXYCYCLINE 100MG/100ML N|Managed Medicaid|MEDICAID AMERIGROUP|||||99.50||| 9527870|ERX|0250|DOXYCYCLINE 100MG/100ML N|Blue Cross PPO Specialty|BCBSTX PPO|99.50||||||| 9527870|ERX|0250|DOXYCYCLINE 100MG/100ML N|Cigna|CIGNA|||||99.50||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|Aetna|AETNA PPO|||||380.50||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|380.50||||||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|Blue Cross PPO Specialty|BCBSTX PPO|380.50||||380.50||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|380.50||||||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|380.50||||||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|Managed Medicare|HEALTHSPRING MA|||||380.50||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|Humana Medicare Advantage|HUMANA MA|380.50||||||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|Managed Medicaid|MEDICAID SUPERIOR|380.50||||||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|380.50||||380.50||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|Managed Medicaid|MEDICAID AMERIGROUP|380.50||||||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|380.50||||||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|United Healthcare|UNITED HEALTHCARE|||||380.50||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|380.50||||380.50||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|Medicaid|HENDERSON COUNTY INDIGENT|380.50||||||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|Medicare|MEDICARE ACUTE|380.50||||380.50||| 9528001|ERX|0250|NITROPRUSSIDE 50MG/250ML|United Healthcare|UNITED HEALTHCARE|15.48||||||| 9528001|ERX|0250|NITROPRUSSIDE 50MG/250ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|15.48||||||| 9528001|ERX|0250|NITROPRUSSIDE 50MG/250ML|Aetna|AETNA PPO|||||15.48||| 9528019|ERX|0250|NOREPINEPHRINE 4MG/250ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||99.50||| 9528019|ERX|0250|NOREPINEPHRINE 4MG/250ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|99.50||||99.50||| 9528019|ERX|0250|NOREPINEPHRINE 4MG/250ML|Managed Medicaid|MEDICAID AMERIGROUP|99.50||||||| 9528019|ERX|0250|NOREPINEPHRINE 4MG/250ML|Humana Medicare Advantage|HUMANA MA|99.50||||99.50||| 9528019|ERX|0250|NOREPINEPHRINE 4MG/250ML|Managed Medicare|HEALTHSPRING MA|99.50||||||| 9528019|ERX|0250|NOREPINEPHRINE 4MG/250ML|Managed Medicare|BCBS MEDICARE PPO MA|||||99.50||| 9528019|ERX|0250|NOREPINEPHRINE 4MG/250ML|Blue Cross PPO Specialty|BCBSTX PPO|||||99.50||| 9528019|ERX|0250|NOREPINEPHRINE 4MG/250ML|Aetna|AETNA PPO|99.50||||||| 9528019|ERX|0250|NOREPINEPHRINE 4MG/250ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|99.50||||||| 9528019|ERX|0250|NOREPINEPHRINE 4MG/250ML|Veterans Affairs|VETERANS ADMINISTRATION|99.50||||||| 9528019|ERX|0250|NOREPINEPHRINE 4MG/250ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|99.50||||99.50||| 9528019|ERX|0250|NOREPINEPHRINE 4MG/250ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||99.50||| 9528019|ERX|0250|NOREPINEPHRINE 4MG/250ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|99.50||||||| 9528019|ERX|0250|NOREPINEPHRINE 4MG/250ML|Medicare|MEDICARE ACUTE|99.50||||99.50||| 9528118|ERX|0250|UNASYN 1.5G/100ML NS|Medicaid|HENDERSON COUNTY INDIGENT|99.50||||||| 9528118|ERX|0250|UNASYN 1.5G/100ML NS|Medicare|MEDICARE ACUTE|99.50||||||| 9528118|ERX|0250|UNASYN 1.5G/100ML NS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|99.50||||||| 9528118|ERX|0250|UNASYN 1.5G/100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|99.50||||||| 9528118|ERX|0250|UNASYN 1.5G/100ML NS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|99.50||||||| 9528118|ERX|0250|UNASYN 1.5G/100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|99.50||||||| 9528118|ERX|0250|UNASYN 1.5G/100ML NS|Blue Cross HMO Specialty|BCBSTX HMO|99.50||||||| 9528118|ERX|0250|UNASYN 1.5G/100ML NS|Managed Medicare|HEALTHSPRING MA|99.50||||||| 9528118|ERX|0250|UNASYN 1.5G/100ML NS|Humana Medicare Advantage|HUMANA MA|99.50||||||| 9528118|ERX|0250|UNASYN 1.5G/100ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|99.50||||||| 9528118|ERX|0250|UNASYN 1.5G/100ML NS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|99.50||||||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.17||||1.17||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Managed Medicaid|MEDICAID SUPERIOR|1.17||||1.17||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.17||||1.17||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Managed Medicaid|MEDICAID AMERIGROUP|1.17||||1.17||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Managed Medicare|HEALTHSPRING MA|1.17||||1.17||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Blue Cross HMO Specialty|BCBSTX HMO|1.17||||1.17||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1.17||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Cigna|CIGNA|1.17||||||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Cigna|CIGNA|||||1.17||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Aetna|AETNA PPO|1.17||||1.17||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|1.17||||1.17||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Aenta Medicare Advantage|AETNA MEDICARE MA|1.17||||1.17||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.17||||1.17||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.17||||||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Workers Compensation|UT EMPLOYEE INJURY|1.17||||||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Veterans Affairs|VETERANS ADMINISTRATION|1.17||||1.17||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Veterans Affairs|VETERANS ADMINISTRATION|||||1.17||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Humana Medicare Advantage|HUMANA MA|1.17||||1.17||| 9528126|ERX|0250|UNASYN 3G/100ML NS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.17||||1.17||| 9528126|ERX|0250|UNASYN 3G/100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|1.17||||1.17||| 9528126|ERX|0250|UNASYN 3G/100ML NS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.17||||1.17||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Tricare|TRICARE EAST REGION|1.17||||||| 9528126|ERX|0250|UNASYN 3G/100ML NS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.17||| 9528126|ERX|0250|UNASYN 3G/100ML NS|United Healthcare|UNITED HEALTHCARE|1.17||||||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Medicaid|HENDERSON COUNTY INDIGENT|1.17||||||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Medicaid|MEDICAID HMO|1.17||||||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Medicaid|MOLINA HEALTHCARE OF TEXAS|1.17||||||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Medicaid|MEDICAID|1.17||||1.17||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Medicare|MEDICARE ACUTE|1.17||||1.17||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Medicaid|MOLINA HEALTHCARE OF TEXAS|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Medicaid|COUNTY INDIGENT HEALTH OTHER|99.50||||||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Medicaid|LAW ENFORCEMENT OTHER|99.50||||||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Medicaid|HENDERSON COUNTY INDIGENT|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Medicare|MEDICARE ACUTE|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Tricare|TRICARE EAST REGION|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|United Healthcare|UNITED HEALTHCARE|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|NON CONTRACTED|COMMERCIAL OTHER 1|99.50||||||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|United Healthcare|TML GROUP BENEFITS|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|United Healthcare|UNITED HEALTHCARE|||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|United Healthcare|UNITED HEALTHCARE OTHER|||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|PHCS|MULTIPLAN PHCS OTHER|||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Texas Workforce Commission|DIS DETER SERV (DDS)|||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|United Medicare Advantage|UHC AARP MCR HMO MA|||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Veterans Affairs|VETERANS ADMINISTRATION|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Aetna|AETNA PPO|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Aetna|AETNA OTHER|||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Aenta Medicare Advantage|AETNA MEDICARE MA|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Medicaid|MEDICAID|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Blue Cross HMO Specialty|BCBSTX HMO|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Cigna|CIGNA|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Cigna|CIGNA OTHER|99.50||||||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Blue Cross PPO Specialty|BCBSTX PPO|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Managed Medicare|HEALTHSPRING MA|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Managed Medicare|BCBS MEDICARE PPO MA|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Humana Medicare Advantage|HUMANA MA|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Managed Medicaid|MEDICAID SUPERIOR|99.50||||99.50||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Managed Medicaid|MEDICAID AMERIGROUP|99.50||||99.50||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|Medicare|MEDICARE ACUTE|124.25||||124.25||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|Managed Medicaid|MEDICAID SUPERIOR|||||124.25||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|124.25||||124.25||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|Blue Cross HMO Specialty|BCBSTX HMO|124.25||||||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||124.25||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|124.25||||||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|124.25||||||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|Managed Medicare|HEALTHSPRING MA|124.25||||||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|Veterans Affairs|VETERANS ADMINISTRATION|124.25||||||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|124.25||||||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|124.25||||124.25||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|Managed Medicaid|MEDICAID AMERIGROUP|||||124.25||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|Managed Medicare|BCBS MEDICARE PPO MA|124.25||||||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|||||124.25||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|Humana Medicare Advantage|HUMANA MA|124.25||||124.25||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|United Healthcare|UMR UNITED MEDICAL RESOURCES|124.25||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|United Healthcare|UNITED HEALTHCARE|||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Tricare|TRICARE EAST REGION|135.75||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|United Healthcare|UMR UNITED MEDICAL RESOURCES|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Medicaid|MEDICAID HMO|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Managed Medicare|HOSPICE ETMC|||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|135.75||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Cigna|CIGNA|||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Cigna|CIGNA OTHER|135.75||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Medicaid|COUNTY INDIGENT HEALTH OTHER|135.75||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Managed Medicare|HEALTHSPRING MA|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Medicaid|HENDERSON COUNTY INDIGENT|135.75||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Aenta Medicare Advantage|AETNA MEDICARE MA|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|United Medicare Advantage|UHC AARP MCR HMO MA|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|United Healthcare|UNITED HEALTHCARE|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Medicare|MEDICARE ACUTE|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Texas Workforce Commission|DIS DETER SERV (DDS)|135.75||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Workers Compensation|WORKERS COMPENSATION OTHER|||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Managed Medicaid|MEDICAID SUPERIOR|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Aetna|AETNA PPO|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Managed Medicare|BCBS MEDICARE PPO MA|135.75||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Veterans Affairs|VETERANS ADMINISTRATION|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Workers Compensation|UT EMPLOYEE INJURY|135.75||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|ChampVA|CHAMPVA CENTER|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Medicaid|MEDICAID|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Managed Medicaid|MEDICAID AMERIGROUP|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Cigna|CIGNA|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|United Healthcare|UNITED HEALTHCARE OTHER|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Humana Medicare Advantage|HUMANA MA|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|135.75||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|NON CONTRACTED|COMMERCIAL OTHER 1|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Medicaid|MOLINA HEALTHCARE OF TEXAS|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|United Healthcare|TML GROUP BENEFITS|135.75||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Blue Cross HMO Specialty|BCBSTX HMO|135.75||||135.75||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Medicaid|LAW ENFORCEMENT OTHER|135.75||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|135.75||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Access Direct Platinum|HEALTHFIRST TPA UMR|||||135.75||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|169.50||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|United Healthcare|UMR UNITED MEDICAL RESOURCES|169.50||||||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|169.50||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Medicaid|COUNTY INDIGENT HEALTH OTHER|169.50||||||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Medicare|MEDICARE ACUTE|169.50||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Managed Medicare|BCBS MEDICARE PPO MA|||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Managed Medicaid|MEDICAID SUPERIOR|169.50||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|169.50||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Managed Medicaid|MEDICAID AMERIGROUP|169.50||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Aetna|AETNA PPO|169.50||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|169.50||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Cigna|CIGNA OTHER|169.50||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Humana Medicare Advantage|HUMANA MA|169.50||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Managed Medicare|HEALTHSPRING MA|169.50||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Cigna|CIGNA|169.50||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|169.50||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Aenta Medicare Advantage|AETNA MEDICARE MA|169.50||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Medicaid|LAW ENFORCEMENT OTHER|||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Veterans Affairs|VETERANS ADMINISTRATION|169.50||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Blue Cross HMO Specialty|BCBSTX HMO|169.50||||||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|169.50||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Workers Compensation|WORKERS COMPENSATION OTHER|||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|169.50||||||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|169.50||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|United Healthcare|TML GROUP BENEFITS|||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Cigna|CIGNA|||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|169.50||||||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Medicaid|HENDERSON COUNTY INDIGENT|169.50||||||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|169.50||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|ChampVA|CHAMPVA CENTER|||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Medicaid|MOLINA HEALTHCARE OF TEXAS|169.50||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|NON CONTRACTED|COMMERCIAL OTHER 1|169.50||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|United Healthcare|UNITED HEALTHCARE OTHER|||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Tricare|TRICARE EAST REGION|169.50||||||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Medicaid|MEDICAID|169.50||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|United Healthcare|UNITED HEALTHCARE|||||169.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Blue Cross PPO Specialty|BCBSTX OTHER|||||169.50||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Aenta Medicare Advantage|AETNA MEDICARE MA|99.75||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|United Healthcare|UNITED HEALTHCARE|99.75||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|United Medicare Advantage|AARP UHC WEST COMPLETE MA|99.75||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|99.75||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Aetna|AETNA PPO|99.75||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Veterans Affairs|VETERANS ADMINISTRATION|99.75||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|United Medicare Advantage|UHC MEDICARE GOLD MA|99.75||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Blue Cross HMO Specialty|BCBSTX HMO|99.75||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|99.75||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|99.75||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Humana Medicare Advantage|HUMANA MA|99.75||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|99.75||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|ChampVA|CHAMPVA CENTER|99.75||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|99.75||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|NON CONTRACTED|COMMERCIAL OTHER 1|99.75||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|99.75||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Managed Medicare|OTHER INSTITUTIONS|||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|99.75||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|99.75||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Managed Medicare|BCBS MEDICARE PPO MA|99.75||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Blue Cross PPO Specialty|BCBSTX PPO|99.75||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Managed Medicare|HEALTHSPRING MA|99.75||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Managed Medicare|MA PART B ONLY IP|99.75||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|99.75||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Managed Medicaid|MEDICAID SUPERIOR|99.75||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|United Healthcare|UMR UNITED MEDICAL RESOURCES|99.75||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Managed Medicaid|MEDICAID AMERIGROUP|99.75||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Medicare|MEDICARE PART B ONLY IP|99.75||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Cigna|CIGNA|99.75||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Tricare|TRICARE EAST REGION|99.75||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Medicaid|MEDICAID HMO|99.75||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Medicaid|MOLINA HEALTHCARE OF TEXAS|99.75||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Medicare|MEDICARE ACUTE|99.75||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Medicaid|HENDERSON COUNTY INDIGENT|99.75||||99.75||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Medicaid|MEDICAID|99.75||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Medicaid|COUNTY INDIGENT HEALTH OTHER|99.75||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Medicaid|LAW ENFORCEMENT OTHER|99.75||||||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Medicaid|HENDERSON COUNTY INDIGENT|57.25||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Managed Medicaid|MEDICAID AMERIGROUP|57.25||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|United Healthcare|UNITED HEALTHCARE|57.25||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Managed Medicare|VAN ZANDT COUNTY INMATE|||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|57.25||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Managed Medicare|HEALTHSPRING MA|57.25||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Managed Medicaid|MEDICAID SUPERIOR|57.25||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Humana Medicare Advantage|HUMANA MA|57.25||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|NON CONTRACTED|COMMERCIAL OTHER 1|57.25||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Blue Cross HMO Specialty|BCBSTX HMO|57.25||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|MTC Medical|VAN ZANDT COUNTY INMATE|||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Managed Medicare|BCBS MEDICARE PPO MA|57.25||||||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Aenta Medicare Advantage|AETNA MEDICARE MA|57.25||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|57.25||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|57.25||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Blue Cross PPO Specialty|BCBSTX PPO|57.25||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Veterans Affairs|VETERANS ADMINISTRATION|57.25||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|57.25||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Aetna|AETNA PPO|||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|57.25||||||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|United Medicare Advantage|UHC MEDICARE GOLD MA|57.25||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|57.25||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Medicaid|MOLINA HEALTHCARE OF TEXAS|57.25||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Tricare|TRICARE EAST REGION|57.25||||||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|United Healthcare|UNITED HEALTHCARE|||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Medicare|MEDICARE ACUTE|57.25||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|United Medicare Advantage|UHC AARP MCR HMO MA|||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Cigna|CIGNA|57.25||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|57.25||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|United Healthcare|UMR UNITED MEDICAL RESOURCES|57.25||||57.25||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Medicaid|COUNTY INDIGENT HEALTH OTHER|57.25||||||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|United Healthcare|UMR UNITED MEDICAL RESOURCES|57.25||||||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|Medicaid|HENDERSON COUNTY INDIGENT|57.25||||||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|57.25||||57.25||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|57.25||||||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|Medicaid|MOLINA HEALTHCARE OF TEXAS|57.25||||||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|Humana Medicare Advantage|HUMANA MA|57.25||||||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|United Medicare Advantage|UHC MEDICARE GOLD MA|57.25||||57.25||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|United Healthcare|UNITED HEALTHCARE|||||57.25||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|Veterans Affairs|VETERANS ADMINISTRATION|57.25||||||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|Medicare|MEDICARE ACUTE|57.25||||57.25||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|Managed Medicaid|MEDICAID AMERIGROUP|57.25||||57.25||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|Blue Cross PPO Specialty|BCBSTX PPO|57.25||||||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|57.25||||||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|57.25||||||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|Managed Medicaid|MEDICAID SUPERIOR|57.25||||||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|57.25||||||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|NON CONTRACTED|COMMERCIAL OTHER 1|53.25||||||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|Aenta Medicare Advantage|AETNA MEDICARE MA|53.25||||||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|Blue Cross PPO Specialty|BCBSTX PPO|53.25||||53.25||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|Humana Medicare Advantage|HUMANA MA|53.25||||53.25||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|Veterans Affairs|VETERANS ADMINISTRATION|53.25||||||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|Medicaid|MEDICAID|53.25||||||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|53.25||||||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|Medicaid|HENDERSON COUNTY INDIGENT|53.25||||||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|53.25||||||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|United Medicare Advantage|AARP UHC WEST COMPLETE MA|53.25||||53.25||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|United Medicare Advantage|UHC MEDICARE GOLD MA|53.25||||||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||53.25||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|Managed Medicaid|MEDICAID SUPERIOR|53.25||||||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|53.25||||53.25||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|53.25||||53.25||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|Medicare|MEDICARE ACUTE|53.25||||53.25||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|Medicaid|MOLINA HEALTHCARE OF TEXAS|53.25||||53.25||| 9528258|ERX|0250|CEPACOL LOZENGE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|10.50||||||| 9528258|ERX|0250|CEPACOL LOZENGE|Cigna|CIGNA|10.50||||10.50||| 9528258|ERX|0250|CEPACOL LOZENGE|Managed Medicaid|MEDICAID SUPERIOR|10.50||||10.50||| 9528258|ERX|0250|CEPACOL LOZENGE|Aenta Medicare Advantage|AETNA MEDICARE MA|10.50||||||| 9528258|ERX|0250|CEPACOL LOZENGE|United Healthcare|UNITED HEALTHCARE|||||10.50||| 9528258|ERX|0250|CEPACOL LOZENGE|Blue Cross HMO Specialty|BCBSTX HMO|10.50||||||| 9528258|ERX|0250|CEPACOL LOZENGE|United Medicare Advantage|UHC MEDICARE GOLD MA|10.50||||||| 9528258|ERX|0250|CEPACOL LOZENGE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|10.50||||10.50||| 9528258|ERX|0250|CEPACOL LOZENGE|Blue Cross PPO Specialty|BCBSTX PPO|||||10.50||| 9528258|ERX|0250|CEPACOL LOZENGE|Medicaid|LAW ENFORCEMENT OTHER|10.50||||||| 9528258|ERX|0250|CEPACOL LOZENGE|Medicare|MEDICARE ACUTE|10.50||||||| 9528258|ERX|0250|CEPACOL LOZENGE|Humana Medicare Advantage|HUMANA MA|10.50||||||| 9528258|ERX|0250|CEPACOL LOZENGE|United Healthcare|UNITED HEALTHCARE|10.50||||10.50||| 9528258|ERX|0250|CEPACOL LOZENGE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|10.50||||||| 9528258|ERX|0250|CEPACOL LOZENGE|Managed Medicaid|MEDICAID AMERIGROUP|||||10.50||| 9528324|ERX|0250|PHENYEPHRINE 0.25% NASAL|Blue Cross PPO Specialty|BCBSTX PPO|||||31.25||| 9528324|ERX|0250|PHENYEPHRINE 0.25% NASAL|Medicare|MEDICARE ACUTE|31.25||||||| 9528324|ERX|0250|PHENYEPHRINE 0.25% NASAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||31.25||| 9528357|ERX|0250|PHENOBARBITOL UD 20ML/5ML|Medicare|MEDICARE PART B ONLY IP|10.50||||||| 9528415|ERX|0250|CALCIUM CHLORIDE 1G IN 25|Medicare|MEDICARE ACUTE|99.50||||||| 9528415|ERX|0250|CALCIUM CHLORIDE 1G IN 25|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||99.50||| 9528415|ERX|0250|CALCIUM CHLORIDE 1G IN 25|NON CONTRACTED|COMMERCIAL OTHER 1|||||99.50||| 9528415|ERX|0250|CALCIUM CHLORIDE 1G IN 25|Humana Medicare Advantage|HUMANA MA|99.50||||||| 9528423|ERX|0250|CALCIUM GLUC 1G IN 250ML|Blue Cross PPO Specialty|BCBSTX PPO|||||99.50||| 9528423|ERX|0250|CALCIUM GLUC 1G IN 250ML|United Medicare Advantage|UHC MEDICARE GOLD MA|99.50||||99.50||| 9528423|ERX|0250|CALCIUM GLUC 1G IN 250ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||99.50||| 9528423|ERX|0250|CALCIUM GLUC 1G IN 250ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|99.50||||99.50||| 9528423|ERX|0250|CALCIUM GLUC 1G IN 250ML|Aenta Medicare Advantage|AETNA MEDICARE MA|99.50||||||| 9528423|ERX|0250|CALCIUM GLUC 1G IN 250ML|Humana Medicare Advantage|HUMANA MA|99.50||||99.50||| 9528423|ERX|0250|CALCIUM GLUC 1G IN 250ML|Managed Medicaid|MEDICAID AMERIGROUP|99.50||||||| 9528423|ERX|0250|CALCIUM GLUC 1G IN 250ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|99.50||||||| 9528423|ERX|0250|CALCIUM GLUC 1G IN 250ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|99.50||||99.50||| 9528423|ERX|0250|CALCIUM GLUC 1G IN 250ML|Medicare|MEDICARE ACUTE|99.50||||99.50||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Aenta Medicare Advantage|AETNA MEDICARE MA|251.75||||251.75||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|251.75||||251.75||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Aetna|AETNA OTHER|||||251.75||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Managed Medicaid|MEDICAID AMERIGROUP|251.75||||251.75||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|United Healthcare|UNITED HEALTHCARE|||||251.75||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|251.75||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|United Healthcare|UMR UNITED MEDICAL RESOURCES|251.75||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|NON CONTRACTED|COMMERCIAL OTHER 1|251.75||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Blue Cross HMO Specialty|BCBSTX HMO|||||251.75||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Medicaid|LAW ENFORCEMENT OTHER|||||251.75||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Blue Cross PPO Specialty|BCBSTX OTHER|||||251.75||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|United Healthcare|TML GROUP BENEFITS|251.75||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Managed Medicaid|MEDICAID SUPERIOR|251.75||||251.75||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Medicare|MEDICARE ACUTE|251.75||||251.75||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Medicaid|MEDICAID|251.75||||251.75||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Medicaid|MEDICAID TEXAS CHILDRENS|||||251.75||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|251.75||||251.75||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Veterans Affairs|VETERANS ADMINISTRATION|251.75||||251.75||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|251.75||||251.75||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Tricare|TRICARE EAST REGION|251.75||||251.75||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|251.75||||251.75||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|251.75||||251.75||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|251.75||||251.75||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Managed Medicare|BCBS MEDICARE PPO MA|251.75||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Humana Medicare Advantage|HUMANA MA|251.75||||251.75||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|251.75||||251.75||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Managed Medicare|HEALTHSPRING MA|251.75||||251.75||| 9528449|ERX|0250|CEFUROXIME 750MG IN 100ML|Medicare|MEDICARE ACUTE|99.50||||||| 9528456|ERX|0250|ERTAPENEM 1G IN 100ML NS|Medicaid|MEDICAID HMO|||||504.25||| 9528456|ERX|0250|ERTAPENEM 1G IN 100ML NS|Managed Medicare|BCBS MEDICARE PPO MA|504.25||||||| 9528456|ERX|0250|ERTAPENEM 1G IN 100ML NS|Medicare|MEDICARE ACUTE|504.25||||504.25||| 9528456|ERX|0250|ERTAPENEM 1G IN 100ML NS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|504.25||||504.25||| 9528456|ERX|0250|ERTAPENEM 1G IN 100ML NS|NON CONTRACTED|COMMERCIAL OTHER 1|504.25||||||| 9528456|ERX|0250|ERTAPENEM 1G IN 100ML NS|Veterans Affairs|VETERANS ADMINISTRATION|||||504.25||| 9528456|ERX|0250|ERTAPENEM 1G IN 100ML NS|Texas Workforce Commission|DIS DETER SERV (DDS)|504.25||||||| 9528456|ERX|0250|ERTAPENEM 1G IN 100ML NS|United Healthcare|UNITED HEALTHCARE|504.25||||504.25||| 9528456|ERX|0250|ERTAPENEM 1G IN 100ML NS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|504.25||||||| 9528456|ERX|0250|ERTAPENEM 1G IN 100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|504.25||||504.25||| 9528456|ERX|0250|ERTAPENEM 1G IN 100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|504.25||||504.25||| 9528456|ERX|0250|ERTAPENEM 1G IN 100ML NS|Medicaid|LAW ENFORCEMENT OTHER|504.25||||||| 9528456|ERX|0250|ERTAPENEM 1G IN 100ML NS|Aenta Medicare Advantage|AETNA MEDICARE MA|504.25||||||| 9528456|ERX|0250|ERTAPENEM 1G IN 100ML NS|Blue Cross HMO Specialty|BCBSTX HMO|504.25||||||| 9528456|ERX|0250|ERTAPENEM 1G IN 100ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|504.25||||||| 9528456|ERX|0250|ERTAPENEM 1G IN 100ML NS|Humana Medicare Advantage|HUMANA MA|504.25||||504.25||| 9528456|ERX|0250|ERTAPENEM 1G IN 100ML NS|Aetna|AETNA PPO|504.25||||||| 9528456|ERX|0250|ERTAPENEM 1G IN 100ML NS|Cigna|CIGNA OTHER|504.25||||||| 9528456|ERX|0250|ERTAPENEM 1G IN 100ML NS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|504.25||||||| 9528464|ERX|0250|PENICILLIN G 5MU IN 100ML|Tricare|TRICARE EAST REGION|99.50||||||| 9528464|ERX|0250|PENICILLIN G 5MU IN 100ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|99.50||||||| 9528464|ERX|0250|PENICILLIN G 5MU IN 100ML|Medicare|MEDICARE ACUTE|99.50||||||| 9528464|ERX|0250|PENICILLIN G 5MU IN 100ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|99.50||||||| 9528464|ERX|0250|PENICILLIN G 5MU IN 100ML|United Healthcare|UNITED HEALTHCARE|99.50||||||| 9528464|ERX|0250|PENICILLIN G 5MU IN 100ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|99.50||||||| 9528464|ERX|0250|PENICILLIN G 5MU IN 100ML|Medicaid|MEDICAID|99.50||||||| 9528464|ERX|0250|PENICILLIN G 5MU IN 100ML|Blue Cross HMO Specialty|BCBSTX HMO|99.50||||||| 9528464|ERX|0250|PENICILLIN G 5MU IN 100ML|Managed Medicaid|MEDICAID AMERIGROUP|99.50||||||| 9528464|ERX|0250|PENICILLIN G 5MU IN 100ML|NON CONTRACTED|COMMERCIAL OTHER 1|99.50||||||| 9528464|ERX|0250|PENICILLIN G 5MU IN 100ML|Managed Medicaid|MEDICAID SUPERIOR|99.50||||99.50||| 9528464|ERX|0250|PENICILLIN G 5MU IN 100ML|Cigna|CIGNA OTHER|99.50||||||| 9528464|ERX|0250|PENICILLIN G 5MU IN 100ML|Cigna|CIGNA|99.50||||||| 9528464|ERX|0250|PENICILLIN G 5MU IN 100ML|Aetna|AETNA PPO|99.50||||||| 9528464|ERX|0250|PENICILLIN G 5MU IN 100ML|Blue Cross PPO Specialty|BCBSTX PPO|99.50||||||| 9528464|ERX|0250|PENICILLIN G 5MU IN 100ML|Medicaid|MEDICAID HMO|99.50||||||| 9528464|ERX|0250|PENICILLIN G 5MU IN 100ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|99.50||||||| 9528464|ERX|0250|PENICILLIN G 5MU IN 100ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|99.50||||||| 9528506|ERX|0250|FLEET ENEMA (PEDI) 66ML|Cigna|CIGNA|||||0.12||| 9528506|ERX|0250|FLEET ENEMA (PEDI) 66ML|Managed Medicaid|MEDICAID SUPERIOR|||||0.12||| 9528506|ERX|0250|FLEET ENEMA (PEDI) 66ML|Medicare|MEDICARE ACUTE|0.12||||||| 9528506|ERX|0250|FLEET ENEMA (PEDI) 66ML|Managed Medicaid|MEDICAID AMERIGROUP|||||0.12||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||88.50||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||88.50||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|Humana Medicare Advantage|HUMANA MA|||||88.50||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|Managed Medicare|HEALTHSPRING MA|||||88.50||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|Medicare|MEDICARE ACUTE|||||88.50||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||88.50||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|Aetna|AETNA PPO|||||88.50||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|Aenta Medicare Advantage|AETNA MEDICARE MA|||||88.50||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|Blue Cross PPO Specialty|BCBSTX PPO|88.50||||88.50||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||88.50||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|ChampVA|CHAMPVA CENTER|||||88.50||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|Blue Cross HMO Specialty|BCBSTX HMO|||||88.50||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|United Medicare Advantage|UHC MEDICARE GOLD MA|||||88.50||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|Cigna|CIGNA|||||88.50||| 9528654|ERX|0250|ROXANOL 20MG/1ML ORAL SYR|Medicare|MEDICARE ACUTE|10.50||||10.50||| 9528654|ERX|0250|ROXANOL 20MG/1ML ORAL SYR|Medicaid|MOLINA HEALTHCARE OF TEXAS|10.50||||||| 9528654|ERX|0250|ROXANOL 20MG/1ML ORAL SYR|Managed Medicare|HOSPICE ETMC|10.50||||||| 9528654|ERX|0250|ROXANOL 20MG/1ML ORAL SYR|Humana Medicare Advantage|HUMANA MA|10.50||||||| 9528654|ERX|0250|ROXANOL 20MG/1ML ORAL SYR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|10.50||||||| 9528654|ERX|0250|ROXANOL 20MG/1ML ORAL SYR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|10.50||||10.50||| 9528654|ERX|0250|ROXANOL 20MG/1ML ORAL SYR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|10.50||||||| 9528654|ERX|0250|ROXANOL 20MG/1ML ORAL SYR|Managed Medicare|HOSPICE GENESIS|10.50||||||| 9528654|ERX|0250|ROXANOL 20MG/1ML ORAL SYR|Managed Medicare|HOSPICE CARING HEARTS|10.50||||||| 9528878|ERX|0250|FENTANYL 2000MCG/100ML NS|Aenta Medicare Advantage|AETNA MEDICARE MA|135.75||||||| 9528878|ERX|0250|FENTANYL 2000MCG/100ML NS|Humana Medicare Advantage|HUMANA MA|135.75||||||| 9528878|ERX|0250|FENTANYL 2000MCG/100ML NS|Medicare|MEDICARE ACUTE|135.75||||135.75||| 9528878|ERX|0250|FENTANYL 2000MCG/100ML NS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||135.75||| 9528928|ERX|0250|CEFOXITIN 2G IN 100ML NS|Managed Medicaid|MEDICAID SUPERIOR|99.50||||99.50||| 9528928|ERX|0250|CEFOXITIN 2G IN 100ML NS|Managed Medicaid|MEDICAID AMERIGROUP|99.50||||||| 9528928|ERX|0250|CEFOXITIN 2G IN 100ML NS|Aenta Medicare Advantage|AETNA MEDICARE MA|99.50||||||| 9528928|ERX|0250|CEFOXITIN 2G IN 100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|99.50||||||| 9528928|ERX|0250|CEFOXITIN 2G IN 100ML NS|United Healthcare|UNITED HEALTHCARE|||||99.50||| 9528928|ERX|0250|CEFOXITIN 2G IN 100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|99.50||||99.50||| 9529009|ERX|0250|VANCOMYCIN 500MG IN 100ML|United Medicare Advantage|UHC MEDICARE GOLD MA|99.50||||||| 9529009|ERX|0250|VANCOMYCIN 500MG IN 100ML|Humana Medicare Advantage|HUMANA MA|99.50||||||| 9529009|ERX|0250|VANCOMYCIN 500MG IN 100ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|99.50||||||| 9529009|ERX|0250|VANCOMYCIN 500MG IN 100ML|Medicare|MEDICARE ACUTE|99.50||||||| 9529009|ERX|0250|VANCOMYCIN 500MG IN 100ML|Managed Medicare|HEALTHSPRING MA|99.50||||99.50||| 9529009|ERX|0250|VANCOMYCIN 500MG IN 100ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|99.50||||||| 9529009|ERX|0250|VANCOMYCIN 500MG IN 100ML|Blue Cross HMO Specialty|BCBSTX HMO|||||99.50||| 9529009|ERX|0250|VANCOMYCIN 500MG IN 100ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|99.50||||||| 9529009|ERX|0250|VANCOMYCIN 500MG IN 100ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|99.50||||||| 9529017|ERX|0250|MEROPENEM 500MG IN 100ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|228.75||||||| 9529017|ERX|0250|MEROPENEM 500MG IN 100ML|Aenta Medicare Advantage|AETNA MEDICARE MA|228.75||||||| 9529017|ERX|0250|MEROPENEM 500MG IN 100ML|Humana Medicare Advantage|HUMANA MA|228.75||||||| 9529017|ERX|0250|MEROPENEM 500MG IN 100ML|Aetna|AETNA PPO|228.75||||||| 9529017|ERX|0250|MEROPENEM 500MG IN 100ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|228.75||||||| 9529017|ERX|0250|MEROPENEM 500MG IN 100ML|Managed Medicaid|MEDICAID SUPERIOR|228.75||||||| 9529017|ERX|0250|MEROPENEM 500MG IN 100ML|Managed Medicare|HEALTHSPRING MA|228.75||||||| 9529017|ERX|0250|MEROPENEM 500MG IN 100ML|United Healthcare|UNITED HEALTHCARE|228.75||||||| 9529017|ERX|0250|MEROPENEM 500MG IN 100ML|Blue Cross PPO Specialty|BCBSTX PPO|228.75||||||| 9529017|ERX|0250|MEROPENEM 500MG IN 100ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|228.75||||||| 9529017|ERX|0250|MEROPENEM 500MG IN 100ML|Veterans Affairs|VETERANS ADMINISTRATION|228.75||||228.75||| 9529017|ERX|0250|MEROPENEM 500MG IN 100ML|Medicare|MEDICARE ACUTE|228.75||||228.75||| 9529017|ERX|0250|MEROPENEM 500MG IN 100ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|228.75||||228.75||| 9529017|ERX|0250|MEROPENEM 500MG IN 100ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|228.75||||||| 9529017|ERX|0250|MEROPENEM 500MG IN 100ML|United Medicare Advantage|UHC MEDICARE GOLD MA|228.75||||||| 9529017|ERX|0250|MEROPENEM 500MG IN 100ML|Medicare|MEDICARE PART B ONLY IP|228.75||||||| 9529017|ERX|0250|MEROPENEM 500MG IN 100ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|228.75||||228.75||| 9529017|ERX|0250|MEROPENEM 500MG IN 100ML|Blue Cross HMO Specialty|BCBSTX HMO|228.75||||||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|457.25||||457.25||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|Medicare|MEDICARE ACUTE|457.25||||457.25||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|457.25||||||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|United Healthcare|UNITED HEALTHCARE|457.25||||||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|Aetna|AETNA PPO|457.25||||||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|457.25||||||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|457.25||||||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|Aetna|BOON CHAPMAN|457.25||||||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|Aenta Medicare Advantage|AETNA MEDICARE MA|457.25||||||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|Humana Medicare Advantage|HUMANA MA|457.25||||||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|Medicare|MEDICARE PART B ONLY IP|457.25||||||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|Managed Medicaid|MEDICAID SUPERIOR|457.25||||||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|Managed Medicare|HEALTHSPRING MA|457.25||||||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|457.25||||||| 9529074|ERX|0250|TELMISARTAN 40MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.19||||||| 9529074|ERX|0250|TELMISARTAN 40MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.19||||0.19||| 9529074|ERX|0250|TELMISARTAN 40MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.19||||||| 9529074|ERX|0250|TELMISARTAN 40MG TABLET|Medicare|MEDICARE ACUTE|0.19||||||| 9529199|ERX|0250|TICAGRELOR 60MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.36||| 9529298|ERX|0250|TRAVOPROST 0.004% (PF) DR|Humana Medicare Advantage|HUMANA MA|773.48||||||| 9529298|ERX|0250|TRAVOPROST 0.004% (PF) DR|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|773.48||||773.48||| 9529298|ERX|0250|TRAVOPROST 0.004% (PF) DR|Medicare|MEDICARE ACUTE|773.48||||773.48||| 9529306|ERX|0250|AMOXICILLIN 400 MG/5 ML S|Blue Cross HMO Specialty|BCBSTX HMO|8.80||||8.80||| 9529306|ERX|0250|AMOXICILLIN 400 MG/5 ML S|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||8.80||| 9529306|ERX|0250|AMOXICILLIN 400 MG/5 ML S|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||8.80||| 9529306|ERX|0250|AMOXICILLIN 400 MG/5 ML S|United Healthcare|UNITED HEALTHCARE|||||8.80||| 9529306|ERX|0250|AMOXICILLIN 400 MG/5 ML S|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||8.80||| 9529306|ERX|0250|AMOXICILLIN 400 MG/5 ML S|NON CONTRACTED|COMMERCIAL OTHER 1|||||8.80||| 9529306|ERX|0250|AMOXICILLIN 400 MG/5 ML S|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||8.80||| 9529306|ERX|0250|AMOXICILLIN 400 MG/5 ML S|Managed Medicaid|MEDICAID AMERIGROUP|||||8.80||| 9529306|ERX|0250|AMOXICILLIN 400 MG/5 ML S|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||8.80||| 9529306|ERX|0250|AMOXICILLIN 400 MG/5 ML S|Medicaid|MEDICAID HMO|||||8.80||| 9529306|ERX|0250|AMOXICILLIN 400 MG/5 ML S|Blue Cross PPO Specialty|BCBSTX PPO|||||8.80||| 9529306|ERX|0250|AMOXICILLIN 400 MG/5 ML S|Aetna|AETNA PPO|||||8.80||| 9529306|ERX|0250|AMOXICILLIN 400 MG/5 ML S|ChampVA|CHAMPVA CENTER|||||8.80||| 9529306|ERX|0250|AMOXICILLIN 400 MG/5 ML S|Medicaid|MEDICAID|||||8.80||| 9529306|ERX|0250|AMOXICILLIN 400 MG/5 ML S|Managed Medicaid|MEDICAID SUPERIOR|||||8.80||| 9529322|ERX|0250|METHYLENE BLUE 0.5%(5MG/M|Managed Medicaid|MEDICAID AMERIGROUP|962.04||||||| 9529322|ERX|0250|METHYLENE BLUE 0.5%(5MG/M|Blue Cross PPO Specialty|BCBSTX PPO|962.04||||||| 9529322|ERX|0250|METHYLENE BLUE 0.5%(5MG/M|Humana Medicare Advantage|HUMANA MA|962.04||||||| 9529397|ERX|0250|SACUBITRIL-VALSARTAN 24-2|United Medicare Advantage|AARP UHC WEST COMPLETE MA|46.92||||||| 9529397|ERX|0250|SACUBITRIL-VALSARTAN 24-2|United Medicare Advantage|UHC MEDICARE GOLD MA|46.92||||||| 9529397|ERX|0250|SACUBITRIL-VALSARTAN 24-2|Aenta Medicare Advantage|AETNA MEDICARE MA|46.92||||||| 9529397|ERX|0250|SACUBITRIL-VALSARTAN 24-2|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|46.92||||||| 9529397|ERX|0250|SACUBITRIL-VALSARTAN 24-2|Medicare|MEDICARE ACUTE|46.92||||46.92||| 9529397|ERX|0250|SACUBITRIL-VALSARTAN 24-2|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|46.92||||||| 9529397|ERX|0250|SACUBITRIL-VALSARTAN 24-2|Managed Medicare|HEALTHSPRING MA|46.92||||||| 9529397|ERX|0250|SACUBITRIL-VALSARTAN 24-2|Managed Medicaid|MEDICAID UNITED HEALTHCARE|46.92||||||| 9529397|ERX|0250|SACUBITRIL-VALSARTAN 24-2|Humana Medicare Advantage|HUMANA MA|46.92||||||| 9529405|ERX|0250|SACUBITRIL-VALSARTAN 49-5|Aenta Medicare Advantage|AETNA MEDICARE MA|46.92||||||| 9529405|ERX|0250|SACUBITRIL-VALSARTAN 49-5|Veterans Affairs|VETERANS ADMINISTRATION|46.92||||||| 9529405|ERX|0250|SACUBITRIL-VALSARTAN 49-5|Managed Medicare|HEALTHSPRING MA|46.92||||||| 9529405|ERX|0250|SACUBITRIL-VALSARTAN 49-5|United Medicare Advantage|UHC MEDICARE GOLD MA|46.92||||||| 9529405|ERX|0250|SACUBITRIL-VALSARTAN 49-5|Medicare|MEDICARE ACUTE|46.92||||46.92||| 9529413|ERX|0250|SACUBITRIL-VALSARTAN 97-1|United Medicare Advantage|AARP UHC WEST COMPLETE MA|46.92||||||| 9529413|ERX|0250|SACUBITRIL-VALSARTAN 97-1|Aenta Medicare Advantage|AETNA MEDICARE MA|46.92||||||| 9529413|ERX|0250|SACUBITRIL-VALSARTAN 97-1|Blue Cross PPO Specialty|BCBSTX PPO|46.92||||46.92||| 9529413|ERX|0250|SACUBITRIL-VALSARTAN 97-1|United Medicare Advantage|UHC MEDICARE GOLD MA|46.92||||||| 9529587|ERX|0250|MULTIVITAMIN LIQUID 30 ML|United Healthcare|UNITED HEALTHCARE|8.80||||||| 9529587|ERX|0250|MULTIVITAMIN LIQUID 30 ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|8.80||||||| 9529587|ERX|0250|MULTIVITAMIN LIQUID 30 ML|Medicare|MEDICARE ACUTE|8.80||||||| 956|DRG||LIMB REATTACHMENT, HIP & FEMUR PROC FOR MULTIPLE SIGNIFICANT TRAUMA|Medicare|MEDICARE ACUTE|71,326.10|26462.52|26462.52|26462.52|||| 95819|EAP|0740|EEG|ChampVA|CHAMPVA CENTER|||||9.99||| 95819|EAP|0740|EEG|Humana Medicare Advantage|HUMANA MA|9.99||||9.99||| 95819|EAP|0740|EEG|Veterans Affairs|VETERANS ADMINISTRATION|9.99||||||| 95819|EAP|0740|EEG|Blue Cross PPO Specialty|BCBSTX PPO|9.99||||9.99||| 95819|EAP|0740|EEG|Managed Medicaid|MEDICAID SUPERIOR|9.99||||9.99||| 95819|EAP|0740|EEG|Aenta Medicare Advantage|AETNA MEDICARE MA|||||9.99||| 95819|EAP|0740|EEG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||9.99||| 95819|EAP|0740|EEG|Blue Cross HMO Specialty|BCBSTX HMO|9.99||||9.99||| 95819|EAP|0740|EEG|Aetna|AETNA PPO|||||9.99||| 95819|EAP|0740|EEG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|9.99||||9.99||| 95819|EAP|0740|EEG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||9.99||| 95819|EAP|0740|EEG|United Medicare Advantage|UHC MEDICARE GOLD MA|9.99||||9.99||| 95819|EAP|0740|EEG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|9.99||||||| 95819|EAP|0740|EEG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|9.99||||9.99||| 95819|EAP|0740|EEG|Managed Medicare|BCBS MEDICARE PPO MA|9.99||||9.99||| 95819|EAP|0740|EEG|Managed Medicare|MA PART B ONLY IP|9.99||||||| 95819|EAP|0740|EEG|Medicare|MEDICARE PART B ONLY IP|9.99||||||| 95819|EAP|0740|EEG|United Healthcare|UNITED HEALTHCARE|||||9.99||| 95819|EAP|0740|EEG|NON CONTRACTED|COMMERCIAL OTHER 1|||||9.99||| 95819|EAP|0740|EEG|Managed Medicare|HEALTHSPRING MA|9.99||||9.99||| 95819|EAP|0740|EEG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|9.99||||9.99||| 95819|EAP|0740|EEG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|9.99||||9.99||| 95819|EAP|0740|EEG|Managed Medicaid|MEDICAID AMERIGROUP|||||9.99||| 95819|EAP|0740|EEG|Medicaid|MEDICAID|9.99||||||| 95819|EAP|0740|EEG|Blue Cross PPO Specialty|BCBSTX OTHER|||||9.99||| 95819|EAP|0740|EEG|Medicare|MEDICARE ACUTE|9.99||||9.99||| 9582958|ERX|0250|BENAZEPRIL 10MG TABLET|Managed Medicare|HEALTHSPRING MA|10.50||||10.50||| 9582958|ERX|0250|BENAZEPRIL 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||10.50||| 9582958|ERX|0250|BENAZEPRIL 10MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|10.50||||||| 9582958|ERX|0250|BENAZEPRIL 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||10.50||| 9582958|ERX|0250|BENAZEPRIL 10MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|10.50||||||| 9582958|ERX|0250|BENAZEPRIL 10MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||10.50||| 9582958|ERX|0250|BENAZEPRIL 10MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|10.50||||10.50||| 9582958|ERX|0250|BENAZEPRIL 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|10.50||||10.50||| 9582958|ERX|0250|BENAZEPRIL 10MG TABLET|Multiplan|NALC|||||10.50||| 9582958|ERX|0250|BENAZEPRIL 10MG TABLET|Medicare|MEDICARE ACUTE|10.50||||10.50||| 9582958|ERX|0250|BENAZEPRIL 10MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|10.50||||||| 9582958|ERX|0250|BENAZEPRIL 10MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|10.50||||||| 9582958|ERX|0250|BENAZEPRIL 10MG TABLET|Humana Medicare Advantage|HUMANA MA|10.50||||10.50||| 9582966|ERX|0250|DIPHENHYDRAMINE 12.5MG 5M|Blue Cross HMO Specialty|BCBSTX HMO|||||10.50||| 9582966|ERX|0250|DIPHENHYDRAMINE 12.5MG 5M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||10.50||| 9582966|ERX|0250|DIPHENHYDRAMINE 12.5MG 5M|Cigna|CIGNA|||||10.50||| 9582966|ERX|0250|DIPHENHYDRAMINE 12.5MG 5M|Blue Cross PPO Specialty|BCBSTX OTHER|||||10.50||| 9582966|ERX|0250|DIPHENHYDRAMINE 12.5MG 5M|Blue Cross PPO Specialty|BCBSTX PPO|10.50||||10.50||| 9582966|ERX|0250|DIPHENHYDRAMINE 12.5MG 5M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||10.50||| 9582966|ERX|0250|DIPHENHYDRAMINE 12.5MG 5M|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||10.50||| 9582966|ERX|0250|DIPHENHYDRAMINE 12.5MG 5M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||10.50||| 9582966|ERX|0250|DIPHENHYDRAMINE 12.5MG 5M|Managed Medicaid|MEDICAID AMERIGROUP|||||10.50||| 9582966|ERX|0250|DIPHENHYDRAMINE 12.5MG 5M|Humana Medicare Advantage|HUMANA MA|||||10.50||| 9582966|ERX|0250|DIPHENHYDRAMINE 12.5MG 5M|Managed Medicaid|MEDICAID SUPERIOR|||||10.50||| 9582966|ERX|0250|DIPHENHYDRAMINE 12.5MG 5M|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||10.50||| 9582966|ERX|0250|DIPHENHYDRAMINE 12.5MG 5M|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||10.50||| 9582966|ERX|0250|DIPHENHYDRAMINE 12.5MG 5M|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||10.50||| 9582966|ERX|0250|DIPHENHYDRAMINE 12.5MG 5M|Aetna|AETNA PPO|||||10.50||| 9582966|ERX|0250|DIPHENHYDRAMINE 12.5MG 5M|Medicare|MEDICARE ACUTE|10.50||||10.50||| 9582966|ERX|0250|DIPHENHYDRAMINE 12.5MG 5M|Tricare|TRICARE FOR LIFE|||||10.50||| 9582966|ERX|0250|DIPHENHYDRAMINE 12.5MG 5M|Medicaid|MEDICAID HMO|||||10.50||| 9582966|ERX|0250|DIPHENHYDRAMINE 12.5MG 5M|United Healthcare|UNITED HEALTHCARE|||||10.50||| 9582966|ERX|0250|DIPHENHYDRAMINE 12.5MG 5M|Medicaid|MEDICAID|||||10.50||| 9582966|ERX|0250|DIPHENHYDRAMINE 12.5MG 5M|NON CONTRACTED|COMMERCIAL OTHER 1|||||10.50||| 9582966|ERX|0250|DIPHENHYDRAMINE 12.5MG 5M|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||10.50||| 9583014|ERX|0250|WARFARIN 3MG TABLET|Medicare|MEDICARE ACUTE|12.75||||12.75||| 9583014|ERX|0250|WARFARIN 3MG TABLET|Humana Medicare Advantage|HUMANA MA|12.75||||||| 9583014|ERX|0250|WARFARIN 3MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||12.75||| 9583014|ERX|0250|WARFARIN 3MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||12.75||| 9583014|ERX|0250|WARFARIN 3MG TABLET|Medicaid|MEDICAID|12.75||||||| 9583014|ERX|0250|WARFARIN 3MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|12.75||||||| 9583030|ERX|0250|VANCOMYCIN 250MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|||||337.50||| 9583030|ERX|0250|VANCOMYCIN 250MG CAPSULE|Medicare|MEDICARE ACUTE|337.50||||337.50||| 9583030|ERX|0250|VANCOMYCIN 250MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|337.50||||||| 9583063|ERX|0250|OLMESARTAN 20MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||30.75||| 9583063|ERX|0250|OLMESARTAN 20MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|30.75||||||| 9583063|ERX|0250|OLMESARTAN 20MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|30.75||||||| 9583063|ERX|0250|OLMESARTAN 20MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|30.75||||||| 9583063|ERX|0250|OLMESARTAN 20MG TABLET|United Healthcare|UNITED HEALTHCARE|||||30.75||| 9583063|ERX|0250|OLMESARTAN 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|30.75||||30.75||| 9583063|ERX|0250|OLMESARTAN 20MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||30.75||| 9583063|ERX|0250|OLMESARTAN 20MG TABLET|Humana Medicare Advantage|HUMANA MA|30.75||||||| 9583063|ERX|0250|OLMESARTAN 20MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|30.75||||30.75||| 9583063|ERX|0250|OLMESARTAN 20MG TABLET|Medicare|MEDICARE ACUTE|30.75||||30.75||| 9583063|ERX|0250|OLMESARTAN 20MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||30.75||| 9583063|ERX|0250|OLMESARTAN 20MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|30.75||||||| 9583063|ERX|0250|OLMESARTAN 20MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|30.75||||||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|99.50||||99.50||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|United Medicare Advantage|UHC MEDICARE GOLD MA|99.50||||99.50||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|United Medicare Advantage|AARP UHC WEST COMPLETE MA|99.50||||99.50||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|99.50||||||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||99.50||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|Managed Medicare|HEALTHSPRING MA|99.50||||99.50||| 9583097|ERX|0636||Access Direct Platinum|HEALTHFIRST TPA UTH UMR|99.50||||99.50||| 9583097|ERX|0636||Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|99.50||||99.50||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|Humana Medicare Advantage|HUMANA MA|99.50||||99.50||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|Managed Medicaid|MEDICAID SUPERIOR|99.50||||99.50||| 9583097|ERX|0636||Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|99.50||||||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|Managed Medicaid|MEDICAID AMERIGROUP|99.50||||99.50||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|Managed Medicaid|MEDICAID UNITED HEALTHCARE|99.50||||99.50||| 9583097|ERX|0636||Cigna|CIGNA|99.50||||||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|99.50||||99.50||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|Aetna|AETNA PPO|99.50||||99.50||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|Aenta Medicare Advantage|AETNA MEDICARE MA|99.50||||99.50||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|Texas Workforce Commission|DIS DETER SERV (DDS)|||||99.50||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|Managed Medicare|BCBS MEDICARE PPO MA|||||99.50||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|Cigna|CIGNA|99.50||||99.50||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|United Healthcare|UNITED HEALTHCARE|99.50||||99.50||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|Blue Cross HMO Specialty|BCBSTX HMO|99.50||||99.50||| 9583097|ERX|0636||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|99.50||||99.50||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|Blue Cross PPO Specialty|BCBSTX PPO|99.50||||99.50||| 9583097|ERX|0636||Medicaid|MEDICAID|99.50||||99.50||| 9583097|ERX|0636||Managed Medicare|HEALTHSPRING MA|99.50||||99.50||| 9583097|ERX|0636||Medicaid|MOLINA HEALTHCARE OF TEXAS|99.50||||||| 9583097|ERX|0636||Blue Cross HMO Specialty|BCBSTX HMO|99.50||||99.50||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|Medicaid|MEDICAID|99.50||||||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|Medicaid|MEDICAID HMO|99.50||||||| 9583097|ERX|0636||Medicaid|HENDERSON COUNTY INDIGENT|99.50||||||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||99.50||| 9583097|ERX|0636||Aetna|AETNA PPO|99.50||||99.50||| 9583097|ERX|0636||Tricare|TRICARE EAST REGION|99.50||||||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|United Healthcare|TML GROUP BENEFITS|99.50||||||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|Tricare|TRICARE EAST REGION|||||99.50||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|99.50||||99.50||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|Medicare|MEDICARE ACUTE|99.50||||99.50||| 9583097|ERX|0636||Medicaid|MEDICAID HMO|99.50||||||| 9583097|ERX|0636||Blue Cross PPO Specialty|BCBSTX PPO|99.50||||99.50||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|NON CONTRACTED|COMMERCIAL OTHER 1|99.50||||99.50||| 9583097|ERX|0636||NON CONTRACTED|COMMERCIAL OTHER 1|99.50||||99.50||| 9583097|ERX|0636||Managed Medicaid|MEDICAID UNITED HEALTHCARE|99.50||||99.50||| 9583097|ERX|0636||Humana Medicare Advantage|HUMANA MA|99.50||||99.50||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|Veterans Affairs|VETERANS ADMINISTRATION|99.50||||99.50||| 9583097|ERX|0636||Aenta Medicare Advantage|AETNA MEDICARE MA|99.50||||99.50||| 9583097|ERX|0636||Managed Medicaid|MEDICAID AMERIGROUP|99.50||||99.50||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|Workers Compensation|WORKERS COMPENSATION OTHER|||||99.50||| 9583097|ERX|0636||Veterans Affairs|VETERANS ADMINISTRATION|99.50||||99.50||| 9583097|ERX|0636||Veterans Affairs|VETERANS ADMINISTRATION|99.50||||||| 9583097|ERX|0636||Managed Medicaid|MEDICAID SUPERIOR|99.50||||99.50||| 9583097|ERX|0636||United Medicare Advantage|AARP UHC WEST COMPLETE MA|99.50||||99.50||| 9583097|ERX|0636||Medicare|MEDICARE ACUTE|99.50||||99.50||| 9583097|ERX|0636||United Medicare Advantage|UHC MEDICARE GOLD MA|99.50||||||| 9583097|ERX|0636||United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|99.50||||99.50||| 9583097|ERX|0636||ChampVA|CHAMPVA CENTER|99.50||||||| 9583097|ERX|0636||Workers Compensation|WORKERS COMPENSATION OTHER|||||99.50||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|United Healthcare|UNITED HEALTHCARE|||||99.50||| 9583097|ERX|0636||United Healthcare|UNITED HEALTHCARE|99.50||||99.50||| 9583097|ERX|0636||United Healthcare|UNITED HEALTHCARE|99.50||||||| 9583097|ERX|0250|CEFAZOLIN 2GM 50ML D5W|Blue Cross PPO Specialty|BCBSTX OTHER|||||99.50||| 9583097|ERX|0636||United Healthcare|GEHA|||||99.50||| 9583253|ERX|0250|DOPAMINE 400MG/250ML D5W|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|99.50||||||| 9583253|ERX|0250|DOPAMINE 400MG/250ML D5W|United Medicare Advantage|UHC MEDICARE GOLD MA|99.50||||99.50||| 9583253|ERX|0250|DOPAMINE 400MG/250ML D5W|United Medicare Advantage|AARP UHC WEST COMPLETE MA|99.50||||99.50||| 9583253|ERX|0250|DOPAMINE 400MG/250ML D5W|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||99.50||| 9583253|ERX|0250|DOPAMINE 400MG/250ML D5W|Humana Medicare Advantage|HUMANA MA|99.50||||99.50||| 9583253|ERX|0250|DOPAMINE 400MG/250ML D5W|Medicare|MEDICARE ACUTE|99.50||||99.50||| 9583253|ERX|0250|DOPAMINE 400MG/250ML D5W|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||99.50||| 9583253|ERX|0250|DOPAMINE 400MG/250ML D5W|Blue Cross PPO Specialty|BCBSTX PPO|||||99.50||| 9583253|ERX|0250|DOPAMINE 400MG/250ML D5W|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||99.50||| 9583253|ERX|0250|DOPAMINE 400MG/250ML D5W|United Healthcare|UMR UNITED MEDICAL RESOURCES|99.50||||||| 9583253|ERX|0250|DOPAMINE 400MG/250ML D5W|Managed Medicare|HEALTHSPRING MA|||||99.50||| 9583279|ERX|0250|DILTIAZEM 125MG/25ML VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|46.75||||||| 9583279|ERX|0250|DILTIAZEM 125MG/25ML VIAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|46.75||||||| 9583279|ERX|0250|DILTIAZEM 125MG/25ML VIAL|Humana Medicare Advantage|HUMANA MA|46.75||||||| 9583279|ERX|0250|DILTIAZEM 125MG/25ML VIAL|Managed Medicare|HEALTHSPRING MA|46.75||||||| 9583279|ERX|0250|DILTIAZEM 125MG/25ML VIAL|Medicare|MEDICARE ACUTE|46.75||||46.75||| 9583295|ERX|0250|ATROPINE 0.4MG/ML 20ML VI|Medicare|MEDICARE ACUTE|205.25||||205.25||| 9583295|ERX|0250|ATROPINE 0.4MG/ML 20ML VI|Medicaid|MEDICAID|205.25||||205.25||| 9583295|ERX|0250|ATROPINE 0.4MG/ML 20ML VI|Blue Cross HMO Specialty|BCBSTX HMO|||||205.25||| 9583295|ERX|0250|ATROPINE 0.4MG/ML 20ML VI|Managed Medicaid|MEDICAID SUPERIOR|205.25||||205.25||| 9583295|ERX|0250|ATROPINE 0.4MG/ML 20ML VI|Blue Cross PPO Specialty|BCBSTX PPO|205.25||||205.25||| 9583295|ERX|0250|ATROPINE 0.4MG/ML 20ML VI|Managed Medicaid|MEDICAID AMERIGROUP|205.25||||205.25||| 9583295|ERX|0250|ATROPINE 0.4MG/ML 20ML VI|United Medicare Advantage|UHC MEDICARE GOLD MA|||||205.25||| 9583295|ERX|0250|ATROPINE 0.4MG/ML 20ML VI|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||205.25||| 9583329|ERX|0250|FLEET ENEMA (ADULT) 4.5OZ|Managed Medicare|HEALTHSPRING MA|||||0.14||| 9583329|ERX|0250|FLEET ENEMA (ADULT) 4.5OZ|Humana Medicare Advantage|HUMANA MA|0.14||||0.14||| 9583329|ERX|0250|FLEET ENEMA (ADULT) 4.5OZ|Managed Medicaid|MEDICAID SUPERIOR|0.14||||0.14||| 9583329|ERX|0250|FLEET ENEMA (ADULT) 4.5OZ|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.14||||0.14||| 9583329|ERX|0250|FLEET ENEMA (ADULT) 4.5OZ|Cigna|CIGNA|||||0.14||| 9583329|ERX|0250|FLEET ENEMA (ADULT) 4.5OZ|Blue Cross HMO Specialty|BCBSTX HMO|||||0.14||| 9583329|ERX|0250|FLEET ENEMA (ADULT) 4.5OZ|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.14||||||| 9583329|ERX|0250|FLEET ENEMA (ADULT) 4.5OZ|Blue Cross PPO Specialty|BCBSTX PPO|||||0.14||| 9583329|ERX|0250|FLEET ENEMA (ADULT) 4.5OZ|Medicaid|MEDICAID|0.14||||||| 9583329|ERX|0250|FLEET ENEMA (ADULT) 4.5OZ|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.14||||||| 9583329|ERX|0250|FLEET ENEMA (ADULT) 4.5OZ|Medicare|MEDICARE ACUTE|0.14||||0.14||| 9583329|ERX|0250|FLEET ENEMA (ADULT) 4.5OZ|Managed Medicaid|MEDICAID AMERIGROUP|||||0.14||| 9583329|ERX|0250|FLEET ENEMA (ADULT) 4.5OZ|Veterans Affairs|VETERANS ADMINISTRATION|||||0.14||| 9583329|ERX|0250|FLEET ENEMA (ADULT) 4.5OZ|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.14||| 9583329|ERX|0250|FLEET ENEMA (ADULT) 4.5OZ|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.14||||0.14||| 9583329|ERX|0250|FLEET ENEMA (ADULT) 4.5OZ|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.14||||0.14||| 9583329|ERX|0250|FLEET ENEMA (ADULT) 4.5OZ|Medicaid|HENDERSON COUNTY INDIGENT|0.14||||||| 9583329|ERX|0250|FLEET ENEMA (ADULT) 4.5OZ|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.14||||0.14||| 9583337|ERX|0250|LORATADINE SYRUP 5MG/5ML|United Healthcare|UNITED HEALTHCARE|10.50||||||| 9583337|ERX|0250|LORATADINE SYRUP 5MG/5ML|Managed Medicaid|MEDICAID AMERIGROUP|||||10.50||| 9583337|ERX|0250|LORATADINE SYRUP 5MG/5ML|Medicare|MEDICARE ACUTE|10.50||||||| 9583337|ERX|0250|LORATADINE SYRUP 5MG/5ML|Blue Cross HMO Specialty|BCBSTX HMO|10.50||||||| 9583337|ERX|0250|LORATADINE SYRUP 5MG/5ML|Blue Cross PPO Specialty|BCBSTX PPO|||||10.50||| 9583469|ERX|0250|ALBUTEROL 2MG/5ML SYRUP 5|United Medicare Advantage|AARP UHC WEST COMPLETE MA|10.50||||||| 9583501|ERX|0250|MENTHOLATUM OINTMENT 1 OZ|Medicare|MEDICARE ACUTE|0.14||||||| 9583535|ERX|0250|ALBUTEROL .42% 1.25MG/3ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|13.50||||||| 9583543|ERX|0250|FELODIPINE ER 2.5MG TABLE|Medicare|MEDICARE ACUTE|12.50||||||| 9583543|ERX|0250|FELODIPINE ER 2.5MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|12.50||||||| 9583543|ERX|0250|FELODIPINE ER 2.5MG TABLE|Humana Medicare Advantage|HUMANA MA|12.50||||||| 9583576|ERX|0250|PROMETHAZINE W.COD 6.25MG|Managed Medicaid|MEDICAID SUPERIOR|||||10.50||| 9583576|ERX|0250|PROMETHAZINE W.COD 6.25MG|Humana Medicare Advantage|HUMANA MA|||||10.50||| 9583576|ERX|0250|PROMETHAZINE W.COD 6.25MG|Medicare|MEDICARE ACUTE|10.50||||||| 9583576|ERX|0250|PROMETHAZINE W.COD 6.25MG|Blue Cross PPO Specialty|BCBSTX PPO|10.50||||10.50||| 9583576|ERX|0250|PROMETHAZINE W.COD 6.25MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|10.50||||||| 9583576|ERX|0250|PROMETHAZINE W.COD 6.25MG|Aenta Medicare Advantage|AETNA MEDICARE MA|10.50||||||| 9583576|ERX|0250|PROMETHAZINE W.COD 6.25MG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|10.50||||||| 9583576|ERX|0250|PROMETHAZINE W.COD 6.25MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|10.50||||||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Blue Cross PPO Specialty|BCBSTX PPO|25.25||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|25.25||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Cigna|CIGNA|||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Aetna|AETNA PPO|25.25||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Cigna|CIGNA|25.25||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|25.25||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|ChampVA|CHAMPVA CENTER|||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Managed Medicaid|MEDICAID AMERIGROUP|25.25||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Blue Cross HMO Specialty|BCBSTX HMO|25.25||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Managed Medicare|BCBS MEDICARE PPO MA|25.25||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Humana Medicare Advantage|HUMANA MA|25.25||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|25.25||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|25.25||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|25.25||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Medicaid|MEDICAID|25.25||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Medicaid|MEDICAID HMO|25.25||||||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Veterans Affairs|VETERANS ADMINISTRATION|25.25||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Access Direct Platinum|HEALTHFIRST TPA UMR|25.25||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Medicaid|HENDERSON COUNTY INDIGENT|||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|United Healthcare|UNITED HEALTHCARE|||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|United Healthcare|UNITED HEALTHCARE OTHER|||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|25.25||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|United Healthcare|UNITED HEALTHCARE|25.25||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Managed Medicaid|MEDICAID SUPERIOR|25.25||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Texas Workforce Commission|DIS DETER SERV (DDS)|||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Medicare|MEDICARE ACUTE|25.25||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Managed Medicare|HEALTHSPRING MA|25.25||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Workers Compensation|WORKERS COMPENSATION OTHER|||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|NON CONTRACTED|COMMERCIAL OTHER 1|25.25||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|25.25||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|25.25||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|United Healthcare|TML GROUP BENEFITS|25.25||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|Tricare|TRICARE EAST REGION|||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|25.25||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|PHCS|MULTIPLAN PHCS OTHER|||||25.25||| 9583618|ERX|0250|LIDOCAINE 2%MFP,2ML VIAL|United Medicare Advantage|UHC AARP MCR HMO MA|||||25.25||| 9583683|ERX|0250|MINERAL OIL ENEMA 133ML|Aenta Medicare Advantage|AETNA MEDICARE MA|19.75||||||| 9583683|ERX|0250|MINERAL OIL ENEMA 133ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|19.75||||||| 9583683|ERX|0250|MINERAL OIL ENEMA 133ML|Medicare|MEDICARE ACUTE|19.75||||19.75||| 9583683|ERX|0250|MINERAL OIL ENEMA 133ML|Humana Medicare Advantage|HUMANA MA|19.75||||||| 9583683|ERX|0250|MINERAL OIL ENEMA 133ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||19.75||| 9583683|ERX|0250|MINERAL OIL ENEMA 133ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|19.75||||||| 9583709|ERX|0250|PIOGLITAZONE 30MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.41||||||| 9583709|ERX|0250|PIOGLITAZONE 30MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.41||||||| 9583709|ERX|0250|PIOGLITAZONE 30MG TABLET|Humana Medicare Advantage|HUMANA MA|0.41||||||| 9583709|ERX|0250|PIOGLITAZONE 30MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.41||| 9583709|ERX|0250|PIOGLITAZONE 30MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.41||||||| 9583709|ERX|0250|PIOGLITAZONE 30MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.41||||0.41||| 9583709|ERX|0250|PIOGLITAZONE 30MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.41||||0.41||| 9583709|ERX|0250|PIOGLITAZONE 30MG TABLET|Medicare|MEDICARE ACUTE|0.41||||0.41||| 9583725|ERX|0250|LOPERAMIDE 1MG/ 7.5ML 4OZ|Medicare|MEDICARE ACUTE|23.50||||||| 9583725|ERX|0250|LOPERAMIDE 1MG/ 7.5ML 4OZ|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|23.50||||||| 9583725|ERX|0250|LOPERAMIDE 1MG/ 7.5ML 4OZ|Humana Medicare Advantage|HUMANA MA|23.50||||||| 9583766|ERX|0250|LEVALBUTEROL 1.25MG/.05ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|50.50||||||| 9583766|ERX|0250|LEVALBUTEROL 1.25MG/.05ML|Managed Medicare|HEALTHSPRING MA|||||50.50||| 9583766|ERX|0250|LEVALBUTEROL 1.25MG/.05ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||50.50||| 9583766|ERX|0250|LEVALBUTEROL 1.25MG/.05ML|Aenta Medicare Advantage|AETNA MEDICARE MA|50.50||||||| 9583766|ERX|0250|LEVALBUTEROL 1.25MG/.05ML|Medicare|MEDICARE ACUTE|50.50||||50.50||| 9583766|ERX|0250|LEVALBUTEROL 1.25MG/.05ML|Humana Medicare Advantage|HUMANA MA|50.50||||||| 9583782|ERX|0250|NAPROXEN 250MG TABLET|Medicare|MEDICARE ACUTE|12.50||||12.50||| 9583782|ERX|0250|NAPROXEN 250MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||12.50||| 9583782|ERX|0250|NAPROXEN 250MG TABLET|Humana Medicare Advantage|HUMANA MA|||||12.50||| 9583782|ERX|0250|NAPROXEN 250MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|12.50||||||| 9583782|ERX|0250|NAPROXEN 250MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|12.50||||||| 9583782|ERX|0250|NAPROXEN 250MG TABLET|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||12.50||| 9583782|ERX|0250|NAPROXEN 250MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|12.50||||||| 9583782|ERX|0250|NAPROXEN 250MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||12.50||| 9583782|ERX|0250|NAPROXEN 250MG TABLET|Managed Medicare|HEALTHSPRING MA|12.50||||||| 9583790|ERX|0250|TRIAMCIN ACET .025% CREAM|Medicare|MEDICARE ACUTE|||||0.37||| 9583816|ERX|0250|PROCALAMINE 1000ML BOTTLE|Blue Cross PPO Specialty|BCBSTX PPO|7.50||||||| 9583816|ERX|0250|PROCALAMINE 1000ML BOTTLE|Aetna|BOON CHAPMAN|7.50||||||| 9583816|ERX|0250|PROCALAMINE 1000ML BOTTLE|Blue Cross HMO Specialty|BCBSTX HMO|7.50||||||| 9583816|ERX|0250|PROCALAMINE 1000ML BOTTLE|Managed Medicare|BCBS MEDICARE PPO MA|7.50||||||| 9583816|ERX|0250|PROCALAMINE 1000ML BOTTLE|Humana Medicare Advantage|HUMANA MA|7.50||||||| 9583816|ERX|0250|PROCALAMINE 1000ML BOTTLE|Managed Medicaid|MEDICAID SUPERIOR|7.50||||||| 9583816|ERX|0250|PROCALAMINE 1000ML BOTTLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|7.50||||||| 9583816|ERX|0250|PROCALAMINE 1000ML BOTTLE|Medicare|MEDICARE ACUTE|7.50||||||| 9583816|ERX|0250|PROCALAMINE 1000ML BOTTLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|7.50||||||| 9583816|ERX|0250|PROCALAMINE 1000ML BOTTLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|7.50||||||| 9583816|ERX|0250|PROCALAMINE 1000ML BOTTLE|United Healthcare|UNITED HEALTHCARE|7.50||||||| 9583865|ERX|0250|GUAIFENSEIN 200MG/10ML 10|Managed Medicaid|MEDICAID UNITED HEALTHCARE|10.50||||||| 9583865|ERX|0250|GUAIFENSEIN 200MG/10ML 10|Medicare|MEDICARE PART B ONLY IP|10.50||||||| 9583865|ERX|0250|GUAIFENSEIN 200MG/10ML 10|Blue Cross PPO Specialty|BCBSTX PPO|10.50||||||| 9583865|ERX|0250|GUAIFENSEIN 200MG/10ML 10|United Healthcare|UNITED HEALTHCARE|10.50||||||| 9583865|ERX|0250|GUAIFENSEIN 200MG/10ML 10|Blue Cross HMO Specialty|BCBSTX HMO|10.50||||||| 9583865|ERX|0250|GUAIFENSEIN 200MG/10ML 10|Medicare|MEDICARE ACUTE|10.50||||||| 9583865|ERX|0250|GUAIFENSEIN 200MG/10ML 10|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|10.50||||||| 9583865|ERX|0250|GUAIFENSEIN 200MG/10ML 10|Managed Medicare|HEALTHSPRING MA|||||10.50||| 9583865|ERX|0250|GUAIFENSEIN 200MG/10ML 10|Veterans Affairs|VETERANS ADMINISTRATION|10.50||||||| 9583865|ERX|0250|GUAIFENSEIN 200MG/10ML 10|Managed Medicaid|MEDICAID AMERIGROUP|10.50||||||| 9583865|ERX|0250|GUAIFENSEIN 200MG/10ML 10|United Medicare Advantage|UHC MEDICARE GOLD MA|10.50||||||| 9583865|ERX|0250|GUAIFENSEIN 200MG/10ML 10|Humana Medicare Advantage|HUMANA MA|10.50||||10.50||| 9583865|ERX|0250|GUAIFENSEIN 200MG/10ML 10|Managed Medicaid|MEDICAID SUPERIOR|10.50||||||| 9583865|ERX|0250|GUAIFENSEIN 200MG/10ML 10|United Medicare Advantage|AARP UHC WEST COMPLETE MA|10.50||||||| 9583865|ERX|0250|GUAIFENSEIN 200MG/10ML 10|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|10.50||||||| 9583865|ERX|0250|GUAIFENSEIN 200MG/10ML 10|Cigna|CIGNA|10.50||||||| 9583949|ERX|0250|FOSINOPRIL 10MG TABLET|Medicare|MEDICARE ACUTE|10.50||||||| 9584046|ERX|0250|QUINAPRIL 10MG TABLET|Medicare|MEDICARE ACUTE|10.50||||||| 9584087|ERX|0250|IRBESARTAN 150MG TABLET|Medicare|MEDICARE ACUTE|25.25||||25.25||| 9584087|ERX|0250|IRBESARTAN 150MG TABLET|Tricare|TRICARE EAST REGION|||||25.25||| 9584087|ERX|0250|IRBESARTAN 150MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|25.25||||25.25||| 9584087|ERX|0250|IRBESARTAN 150MG TABLET|Humana Medicare Advantage|HUMANA MA|25.25||||25.25||| 9584129|ERX|0250|VALPROATE SOD LIQ 250MG/5|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|10.50||||||| 9584129|ERX|0250|VALPROATE SOD LIQ 250MG/5|Medicare|MEDICARE ACUTE|10.50||||||| 9584129|ERX|0250|VALPROATE SOD LIQ 250MG/5|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|10.50||||||| 9584129|ERX|0250|VALPROATE SOD LIQ 250MG/5|Managed Medicaid|MEDICAID SUPERIOR|10.50||||||| 9584202|ERX|0250|FENOFIBRATE 48 TABLET|Blue Cross PPO Specialty|BCBSTX PPO|15.50||||||| 9584202|ERX|0250|FENOFIBRATE 48 TABLET|Managed Medicaid|MEDICAID SUPERIOR|15.50||||15.50||| 9584202|ERX|0250|FENOFIBRATE 48 TABLET|Medicare|MEDICARE ACUTE|15.50||||||| 9584202|ERX|0250|FENOFIBRATE 48 TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||15.50||| 9584202|ERX|0250|FENOFIBRATE 48 TABLET|Humana Medicare Advantage|HUMANA MA|15.50||||||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|NON CONTRACTED|COMMERCIAL OTHER 1|0.78||||0.78||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.78||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Managed Medicaid|MEDICAID AMERIGROUP|0.78||||0.78||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Veterans Affairs|VETERANS ADMINISTRATION|||||0.78||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.78||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|United Medicare Advantage|UHC MEDICARE GOLD MA|0.78||||0.78||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|PHCS|HUMANA|0.78||||||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.78||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.78||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.78||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Medicaid|MEDICAID|0.78||||0.78||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Medicaid|HENDERSON COUNTY INDIGENT|||||0.78||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Workers Compensation|WORKERS COMP PHYSICIAN|||||0.78||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Medicare|MEDICARE ACUTE|0.78||||0.78||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|United Healthcare|UNITED HEALTHCARE|0.78||||||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|United Healthcare|UMR UNITED MEDICAL RESOURCES|0.78||||||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.78||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Tricare|TRICARE EAST REGION|0.78||||0.78||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Humana Medicare Advantage|HUMANA MA|0.78||||0.78||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Managed Medicaid|MEDICAID SUPERIOR|0.78||||0.78||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.78||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Aetna|AETNA PPO|0.78||||0.78||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Medicaid|MEDICAID TEXAS CHILDRENS|||||0.78||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.78||||0.78||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|United Healthcare|TML GROUP BENEFITS|0.78||||||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Medicaid|MEDICAID HMO|0.78||||0.78||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.78||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Blue Cross HMO Specialty|BCBSTX HMO|0.78||||0.78||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Cigna|CIGNA|0.78||||||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Blue Cross PPO Specialty|BCBSTX PPO|0.78||||0.78||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.78||||||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Cigna|CIGNA OTHER|0.78||||||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.78||||||| 9584251|ERX|0250|ERYTHROMYCIN .5% OPHR OIN|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.78||| 9584343|ERX|0250|AMPICILLIN 2G IN 100ML NS|Humana Medicare Advantage|HUMANA MA|||||99.50||| 9584343|ERX|0250|AMPICILLIN 2G IN 100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|99.50||||||| 9584343|ERX|0250|AMPICILLIN 2G IN 100ML NS|Cigna|CIGNA|||||99.50||| 9584343|ERX|0250|AMPICILLIN 2G IN 100ML NS|Managed Medicaid|MEDICAID AMERIGROUP|99.50||||||| 9584343|ERX|0250|AMPICILLIN 2G IN 100ML NS|Managed Medicaid|MEDICAID SUPERIOR|99.50||||||| 9584343|ERX|0250|AMPICILLIN 2G IN 100ML NS|Medicare|MEDICARE ACUTE|||||99.50||| 9584343|ERX|0250|AMPICILLIN 2G IN 100ML NS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|99.50||||||| 9584343|ERX|0250|AMPICILLIN 2G IN 100ML NS|United Healthcare|UMR UNITED MEDICAL RESOURCES|99.50||||||| 9584343|ERX|0250|AMPICILLIN 2G IN 100ML NS|Tricare|TRICARE EAST REGION|99.50||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|United Medicare Advantage|AARP UHC WEST COMPLETE MA|10.50||||10.50||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|10.50||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|United Medicare Advantage|UHC MEDICARE GOLD MA|10.50||||10.50||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|United Healthcare|UNITED HEALTHCARE|10.50||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Managed Medicare|HEALTHSPRING MA|10.50||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Managed Medicaid|MEDICAID AMERIGROUP|10.50||||10.50||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|10.50||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Medicare|MEDICARE ACUTE|10.50||||10.50||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Veterans Affairs|VETERANS ADMINISTRATION|10.50||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Access Direct Platinum|HEALTHFIRST TPA UMR|10.50||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Aenta Medicare Advantage|AETNA MEDICARE MA|10.50||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|10.50||||10.50||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Blue Cross PPO Specialty|BCBSTX PPO|10.50||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Cigna|CIGNA|10.50||||10.50||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Blue Cross HMO Specialty|BCBSTX HMO|10.50||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Humana Medicare Advantage|HUMANA MA|10.50||||10.50||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Managed Medicaid|MEDICAID SUPERIOR|10.50||||10.50||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||10.50||| 9584608|ERX|0250|SULFA-TRIMETH LIQUID 200-|Blue Cross PPO Specialty|BCBSTX PPO|||||10.50||| 9584608|ERX|0250|SULFA-TRIMETH LIQUID 200-|Managed Medicaid|MEDICAID SUPERIOR|||||10.50||| 9584608|ERX|0250|SULFA-TRIMETH LIQUID 200-|Medicaid|MEDICAID|||||10.50||| 9584608|ERX|0250|SULFA-TRIMETH LIQUID 200-|PHCS|HUMANA|||||10.50||| 9584608|ERX|0250|SULFA-TRIMETH LIQUID 200-|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||10.50||| 9584608|ERX|0250|SULFA-TRIMETH LIQUID 200-|Managed Medicaid|MEDICAID AMERIGROUP|||||10.50||| 9584608|ERX|0250|SULFA-TRIMETH LIQUID 200-|United Healthcare|UNITED HEALTHCARE|||||10.50||| 9584608|ERX|0250|SULFA-TRIMETH LIQUID 200-|Medicaid|MEDICAID HMO|||||10.50||| 9584624|ERX|0250|DILTIAZEM 100MG IN 100ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|99.50||||||| 9584624|ERX|0250|DILTIAZEM 100MG IN 100ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|99.50||||||| 9584624|ERX|0250|DILTIAZEM 100MG IN 100ML|Cigna|CIGNA|||||99.50||| 9584624|ERX|0250|DILTIAZEM 100MG IN 100ML|Blue Cross PPO Specialty|BCBSTX PPO|99.50||||99.50||| 9584624|ERX|0250|DILTIAZEM 100MG IN 100ML|NON CONTRACTED|COMMERCIAL OTHER 1|99.50||||||| 9584624|ERX|0250|DILTIAZEM 100MG IN 100ML|Aenta Medicare Advantage|AETNA MEDICARE MA|99.50||||||| 9584624|ERX|0250|DILTIAZEM 100MG IN 100ML|Managed Medicare|HEALTHSPRING MA|99.50||||||| 9584624|ERX|0250|DILTIAZEM 100MG IN 100ML|Managed Medicaid|MEDICAID SUPERIOR|99.50||||||| 9584624|ERX|0250|DILTIAZEM 100MG IN 100ML|Humana Medicare Advantage|HUMANA MA|99.50||||||| 9584624|ERX|0250|DILTIAZEM 100MG IN 100ML|Medicaid|MEDICAID|99.50||||||| 9584624|ERX|0250|DILTIAZEM 100MG IN 100ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|99.50||||||| 9584624|ERX|0250|DILTIAZEM 100MG IN 100ML|Medicare|MEDICARE ACUTE|99.50||||99.50||| 9584624|ERX|0250|DILTIAZEM 100MG IN 100ML|Managed Medicare|BCBS MEDICARE PPO MA|99.50||||||| 9584624|ERX|0250|DILTIAZEM 100MG IN 100ML|United Medicare Advantage|UHC MEDICARE GOLD MA|99.50||||99.50||| 9584624|ERX|0250|DILTIAZEM 100MG IN 100ML|Veterans Affairs|VETERANS ADMINISTRATION|99.50||||||| 9584640|ERX|0250|DEXTROSE 5% NS KCI 40MEQ|Texas Workforce Commission|DIS DETER SERV (DDS)|99.50||||||| 9584640|ERX|0250|DEXTROSE 5% NS KCI 40MEQ|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|99.50||||||| 9584640|ERX|0250|DEXTROSE 5% NS KCI 40MEQ|Medicare|MEDICARE ACUTE|99.50||||||| 9584640|ERX|0250|DEXTROSE 5% NS KCI 40MEQ|United Medicare Advantage|AARP UHC WEST COMPLETE MA|99.50||||||| 9584640|ERX|0250|DEXTROSE 5% NS KCI 40MEQ|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|99.50||||||| 9584640|ERX|0250|DEXTROSE 5% NS KCI 40MEQ|Humana Medicare Advantage|HUMANA MA|99.50||||||| 9584772|ERX|0250|FERROUS SULFATE 300MG/5ML|Medicare|MEDICARE ACUTE|10.50||||||| 9584772|ERX|0250|FERROUS SULFATE 300MG/5ML|Humana Medicare Advantage|HUMANA MA|10.50||||||| 9584772|ERX|0250|FERROUS SULFATE 300MG/5ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|10.50||||||| 9584772|ERX|0250|FERROUS SULFATE 300MG/5ML|Aetna|AETNA PPO|10.50||||||| 9584814|ERX|0250|LANOLIN 7G TUBE|Medicaid|MEDICAID HMO|0.13||||||| 9584814|ERX|0250|LANOLIN 7G TUBE|Managed Medicaid|MEDICAID SUPERIOR|0.13||||||| 9584814|ERX|0250|LANOLIN 7G TUBE|Cigna|CIGNA|0.13||||||| 9584814|ERX|0250|LANOLIN 7G TUBE|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||||| 9584814|ERX|0250|LANOLIN 7G TUBE|Blue Cross HMO Specialty|BCBSTX HMO|0.13||||||| 9584814|ERX|0250|LANOLIN 7G TUBE|Managed Medicaid|MEDICAID AMERIGROUP|0.13||||||| 9584814|ERX|0250|LANOLIN 7G TUBE|Medicaid|MEDICAID|0.13||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|0.28||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.28||||0.28||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Tricare|TRICARE EAST REGION|0.28||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|0.28||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Medicare|MEDICARE PART B ONLY IP|0.28||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Humana Medicare Advantage|HUMANA MA|0.28||||0.28||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Medicare|MEDICARE ACUTE|0.28||||0.28||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.28||||0.28||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Managed Medicare|HEALTHSPRING MA|0.28||||0.28||| 9584830|ERX|0250|APIXABAN 5MG TABLET|ChampVA|CHAMPVA CENTER|||||0.28||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|0.28||||0.28||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|0.28||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.28||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.28||||0.28||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Aetna|AETNA PPO|0.28||||0.28||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.28||||0.28||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.28||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|United Healthcare|UNITED HEALTHCARE|0.28||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.28||||0.28||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|0.28||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.28||||0.28||| 9584830|ERX|0250|APIXABAN 5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.28||||0.28||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|0.28||||0.28||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|Managed Medicare|MA PART B ONLY IP|0.28||||||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|Humana Medicare Advantage|HUMANA MA|0.28||||0.28||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.28||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.28||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.28||||||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|0.28||||||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|Medicare|MEDICARE ACUTE|0.28||||0.28||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.28||||0.28||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.28||||||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|Managed Medicare|HEALTHSPRING MA|0.28||||0.28||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.28||||||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.28||| 9585001|ERX|0250|AMOXICILLIN ORAL 250MG/5|United Healthcare|UNITED HEALTHCARE|||||10.50||| 9585001|ERX|0250|AMOXICILLIN ORAL 250MG/5|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||10.50||| 9585001|ERX|0250|AMOXICILLIN ORAL 250MG/5|Medicaid|MEDICAID HMO|||||10.50||| 9585001|ERX|0250|AMOXICILLIN ORAL 250MG/5|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||10.50||| 9585001|ERX|0250|AMOXICILLIN ORAL 250MG/5|Medicaid|MEDICAID|||||10.50||| 9585001|ERX|0250|AMOXICILLIN ORAL 250MG/5|Blue Cross PPO Specialty|BCBSTX PPO|||||10.50||| 9585001|ERX|0250|AMOXICILLIN ORAL 250MG/5|Tricare|TRICARE EAST REGION|||||10.50||| 9585001|ERX|0250|AMOXICILLIN ORAL 250MG/5|Managed Medicaid|MEDICAID SUPERIOR|||||10.50||| 9585001|ERX|0250|AMOXICILLIN ORAL 250MG/5|Managed Medicaid|MEDICAID AMERIGROUP|||||10.50||| 9585068|ERX|0250|PAMIDRONATE 90MG/10ML SDV|Humana Medicare Advantage|HUMANA MA|251.75||||||| 9585068|ERX|0636||Medicare|MEDICARE ACUTE|251.75||||||| 9585134|ERX|0250|AZITHROMYCIN ORAL 200MG/5|NON CONTRACTED|COMMERCIAL OTHER 1|39.50||||||| 9585134|ERX|0250|AZITHROMYCIN ORAL 200MG/5|Aetna|AETNA PPO|||||39.50||| 9585134|ERX|0250|AZITHROMYCIN ORAL 200MG/5|Blue Cross PPO Specialty|BCBSTX PPO|39.50||||39.50||| 9585134|ERX|0250|AZITHROMYCIN ORAL 200MG/5|Managed Medicaid|MEDICAID AMERIGROUP|39.50||||39.50||| 9585134|ERX|0250|AZITHROMYCIN ORAL 200MG/5|Medicare|MEDICARE ACUTE|39.50||||||| 9585134|ERX|0250|AZITHROMYCIN ORAL 200MG/5|Medicaid|MEDICAID HMO|||||39.50||| 9585134|ERX|0250|AZITHROMYCIN ORAL 200MG/5|Blue Cross HMO Specialty|BCBSTX HMO|||||39.50||| 9585134|ERX|0250|AZITHROMYCIN ORAL 200MG/5|Managed Medicaid|MEDICAID SUPERIOR|39.50||||39.50||| 9585134|ERX|0250|AZITHROMYCIN ORAL 200MG/5|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||39.50||| 9585142|ERX|0250|CEFPROZIL ORAL 250MG/5ML|Managed Medicaid|MEDICAID AMERIGROUP|||||32.25||| 9585159|ERX|0250|AZTREONAM 2 G NS MB+|Medicare|MEDICARE ACUTE|||||407.25||| 9585159|ERX|0250|AZTREONAM 2 G NS MB+|Managed Medicaid|MEDICAID UNITED HEALTHCARE|407.25||||||| 9585159|ERX|0250|AZTREONAM 2 G NS MB+|Blue Cross PPO Specialty|BCBSTX PPO|407.25||||||| 9585159|ERX|0250|AZTREONAM 2 G NS MB+|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||407.25||| 9585183|ERX|0250|MAGNESIUM SULFATE 40G/100|United Healthcare|UMR UNITED MEDICAL RESOURCES|99.50||||||| 9585183|ERX|0250|MAGNESIUM SULFATE 40G/100|Blue Cross PPO Specialty|BCBSTX PPO|99.50||||99.50||| 9585183|ERX|0250|MAGNESIUM SULFATE 40G/100|Cigna|CIGNA|99.50||||||| 9585183|ERX|0250|MAGNESIUM SULFATE 40G/100|Managed Medicaid|MEDICAID AMERIGROUP|99.50||||||| 9585183|ERX|0250|MAGNESIUM SULFATE 40G/100|Managed Medicaid|MEDICAID SUPERIOR|99.50||||99.50||| 9585183|ERX|0250|MAGNESIUM SULFATE 40G/100|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|99.50||||||| 9585183|ERX|0250|MAGNESIUM SULFATE 40G/100|Medicaid|MEDICAID|99.50||||||| 9585233|ERX|0250|FLUTICASONE 110 MCG INHAL|Medicare|MEDICARE ACUTE|1,354.25||||||| 9585233|ERX|0250|FLUTICASONE 110 MCG INHAL|Managed Medicaid|MEDICAID SUPERIOR|||||1,354.25||| 9585274|ERX|0250|VANCOMYCIN 750 MG VIAL|Medicare|MEDICARE ACUTE|88.50||||||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|Managed Medicare|HEALTHSPRING MA|||||99.50||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|Blue Cross HMO Specialty|BCBSTX HMO|99.50||||99.50||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|99.50||||||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|Blue Cross PPO Specialty|BCBSTX PPO|99.50||||||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|Aetna|AETNA PPO|99.50||||||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|Humana Medicare Advantage|HUMANA MA|99.50||||99.50||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|Managed Medicaid|MEDICAID SUPERIOR|99.50||||||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|99.50||||||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|Veterans Affairs|VETERANS ADMINISTRATION|99.50||||||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|Managed Medicaid|MEDICAID AMERIGROUP|99.50||||||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|99.50||||99.50||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|Medicaid|MEDICAID|99.50||||||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|United Healthcare|UNITED HEALTHCARE|99.50||||||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|Medicaid|HENDERSON COUNTY INDIGENT|||||99.50||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|Medicaid|MOLINA HEALTHCARE OF TEXAS|99.50||||||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|NON CONTRACTED|COMMERCIAL OTHER 1|99.50||||||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|United Medicare Advantage|UHC MEDICARE GOLD MA|99.50||||||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|99.50||||||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|99.50||||||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|Medicare|MEDICARE ACUTE|99.50||||99.50||| 9585308|ERX|0250|ISOFLURANE, 100 ML BOTTLE|Managed Medicaid|MEDICAID SUPERIOR|||||140.50||| 9585373|ERX|0250|D50%-WATER,VIAL 25 G/50ML|Humana Medicare Advantage|HUMANA MA|16.50||||||| 9585373|ERX|0250|D50%-WATER,VIAL 25 G/50ML|Managed Medicaid|MEDICAID AMERIGROUP|||||16.50||| 9585373|ERX|0250|D50%-WATER,VIAL 25 G/50ML|Blue Cross PPO Specialty|BCBSTX PPO|||||16.50||| 9585373|ERX|0250|D50%-WATER,VIAL 25 G/50ML|Medicare|MEDICARE ACUTE|16.50||||||| 9585423|ERX|0250|FLOVENT 220 MCG INHALER|Medicare|MEDICARE ACUTE|2,103.50||||||| 9585514|ERX|0250|CEFOTETAN 2 GRAM DUPLEX|Cigna|CIGNA|||||147.25||| 9585514|ERX|0250|CEFOTETAN 2 GRAM DUPLEX|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||147.25||| 9585514|ERX|0250|CEFOTETAN 2 GRAM DUPLEX|Blue Cross PPO Specialty|BCBSTX PPO|147.25||||147.25||| 9585514|ERX|0250|CEFOTETAN 2 GRAM DUPLEX|Humana Medicare Advantage|HUMANA MA|||||147.25||| 9585514|ERX|0250|CEFOTETAN 2 GRAM DUPLEX|Managed Medicaid|MEDICAID SUPERIOR|147.25||||147.25||| 9585514|ERX|0250|CEFOTETAN 2 GRAM DUPLEX|Managed Medicaid|MEDICAID AMERIGROUP|147.25||||147.25||| 9585514|ERX|0250|CEFOTETAN 2 GRAM DUPLEX|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||147.25||| 9585514|ERX|0250|CEFOTETAN 2 GRAM DUPLEX|Access Direct Platinum|HEALTHFIRST TPA UMR|147.25||||147.25||| 9585514|ERX|0250|CEFOTETAN 2 GRAM DUPLEX|Aenta Medicare Advantage|AETNA MEDICARE MA|||||147.25||| 9585514|ERX|0250|CEFOTETAN 2 GRAM DUPLEX|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|147.25||||147.25||| 9585514|ERX|0250|CEFOTETAN 2 GRAM DUPLEX|Blue Cross HMO Specialty|BCBSTX HMO|147.25||||147.25||| 9585514|ERX|0250|CEFOTETAN 2 GRAM DUPLEX|Managed Medicaid|MEDICAID UNITED HEALTHCARE|147.25||||147.25||| 9585514|ERX|0250|CEFOTETAN 2 GRAM DUPLEX|Cigna|CIGNA OTHER|||||147.25||| 9585514|ERX|0250|CEFOTETAN 2 GRAM DUPLEX|ChampVA|CHAMPVA CENTER|||||147.25||| 9585514|ERX|0250|CEFOTETAN 2 GRAM DUPLEX|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|147.25||||||| 9585514|ERX|0250|CEFOTETAN 2 GRAM DUPLEX|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||147.25||| 9585514|ERX|0250|CEFOTETAN 2 GRAM DUPLEX|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||147.25||| 9585514|ERX|0250|CEFOTETAN 2 GRAM DUPLEX|Medicare|MEDICARE ACUTE|147.25||||147.25||| 9585514|ERX|0250|CEFOTETAN 2 GRAM DUPLEX|Tricare|TRICARE EAST REGION|||||147.25||| 9585514|ERX|0250|CEFOTETAN 2 GRAM DUPLEX|United Healthcare|UNITED HEALTHCARE|||||147.25||| 9585514|ERX|0250|CEFOTETAN 2 GRAM DUPLEX|United Healthcare|UNITED HEALTHCARE|147.25||||147.25||| 9585514|ERX|0250|CEFOTETAN 2 GRAM DUPLEX|Medicaid|MEDICAID|147.25||||147.25||| 9585514|ERX|0250|CEFOTETAN 2 GRAM DUPLEX|Texas Workforce Commission|DIS DETER SERV (DDS)|147.25||||||| 9585514|ERX|0250|CEFOTETAN 2 GRAM DUPLEX|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||147.25||| 9585514|ERX|0250|CEFOTETAN 2 GRAM DUPLEX|NON CONTRACTED|COMMERCIAL OTHER 1|147.25||||147.25||| 9585555|ERX|0250|DESFLURANE, 240 ML|United Healthcare|UNITED HEALTHCARE|||||912.50||| 9585555|ERX|0250|DESFLURANE, 240 ML|Managed Medicaid|MEDICAID AMERIGROUP|912.50||||912.50||| 9585555|ERX|0250|DESFLURANE, 240 ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|912.50||||912.50||| 9585555|ERX|0250|DESFLURANE, 240 ML|Humana Medicare Advantage|HUMANA MA|||||912.50||| 9585555|ERX|0250|DESFLURANE, 240 ML|Texas Workforce Commission|DIS DETER SERV (DDS)|||||912.50||| 9585555|ERX|0250|DESFLURANE, 240 ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||912.50||| 9585555|ERX|0250|DESFLURANE, 240 ML|Managed Medicaid|MEDICAID SUPERIOR|912.50||||912.50||| 9585555|ERX|0250|DESFLURANE, 240 ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||912.50||| 9585555|ERX|0250|DESFLURANE, 240 ML|Medicare|MEDICARE ACUTE|912.50||||912.50||| 9585563|ERX|0250|GI COCKTAIL-ATHENS 30ML|Medicaid|MEDICAID|||||0.81||| 9585563|ERX|0250|GI COCKTAIL-ATHENS 30ML|Humana Medicare Advantage|HUMANA MA|||||0.81||| 9585589|ERX|0250|GROSS COCKTAIL-ATHENS, 21|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|126.25||||||| 9585589|ERX|0250|GROSS COCKTAIL-ATHENS, 21|Medicare|MEDICARE ACUTE|126.25||||||| 9585597|ERX|0250|HEPATITIS A VIRUS VACCINE|Medicare|MEDICARE ACUTE|446.25||||||| 9585613|ERX|0250|LA SOLUTION, 10ML|Medicaid|MEDICAID HMO|||||52.25||| 9585613|ERX|0250|LA SOLUTION, 10ML|Tricare|TRICARE FOR LIFE|||||52.25||| 9585613|ERX|0250|LA SOLUTION, 10ML|United Healthcare|UNITED HEALTHCARE OTHER|||||52.25||| 9585613|ERX|0250|LA SOLUTION, 10ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||52.25||| 9585613|ERX|0250|LA SOLUTION, 10ML|Medicare|MEDICARE ACUTE|||||52.25||| 9585613|ERX|0250|LA SOLUTION, 10ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||52.25||| 9585613|ERX|0250|LA SOLUTION, 10ML|Cigna|CIGNA|||||52.25||| 9585613|ERX|0250|LA SOLUTION, 10ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||52.25||| 9585613|ERX|0250|LA SOLUTION, 10ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||52.25||| 9585613|ERX|0250|LA SOLUTION, 10ML|Humana Medicare Advantage|HUMANA MA|||||52.25||| 9585613|ERX|0250|LA SOLUTION, 10ML|Managed Medicaid|MEDICAID SUPERIOR|||||52.25||| 9585613|ERX|0250|LA SOLUTION, 10ML|Managed Medicaid|MEDICAID AMERIGROUP|||||52.25||| 9585613|ERX|0250|LA SOLUTION, 10ML|United Healthcare|UNITED HEALTHCARE|||||52.25||| 9585613|ERX|0250|LA SOLUTION, 10ML|Tricare|TRICARE EAST REGION|||||52.25||| 9585613|ERX|0250|LA SOLUTION, 10ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||52.25||| 9585613|ERX|0250|LA SOLUTION, 10ML|Blue Cross PPO Specialty|BCBSTX PPO|||||52.25||| 9585621|ERX|0250|MAGIC MOUTHWASH-ATHENS, 1|Tricare|TRICARE EAST REGION|34.50||||34.50||| 9585621|ERX|0250|MAGIC MOUTHWASH-ATHENS, 1|Medicare|MEDICARE ACUTE|34.50||||34.50||| 9585621|ERX|0250|MAGIC MOUTHWASH-ATHENS, 1|United Medicare Advantage|AARP UHC WEST COMPLETE MA|34.50||||||| 9585621|ERX|0250|MAGIC MOUTHWASH-ATHENS, 1|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||34.50||| 9585621|ERX|0250|MAGIC MOUTHWASH-ATHENS, 1|Managed Medicare|HEALTHSPRING MA|34.50||||||| 9585621|ERX|0250|MAGIC MOUTHWASH-ATHENS, 1|Managed Medicaid|MEDICAID SUPERIOR|34.50||||34.50||| 9585621|ERX|0250|MAGIC MOUTHWASH-ATHENS, 1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|34.50||||||| 9585621|ERX|0250|MAGIC MOUTHWASH-ATHENS, 1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|34.50||||||| 9585621|ERX|0250|MAGIC MOUTHWASH-ATHENS, 1|Blue Cross PPO Specialty|BCBSTX PPO|34.50||||34.50||| 9585621|ERX|0250|MAGIC MOUTHWASH-ATHENS, 1|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|34.50||||||| 9585621|ERX|0250|MAGIC MOUTHWASH-ATHENS, 1|Blue Cross PPO Specialty|BCBSTX OTHER|||||34.50||| 9585621|ERX|0250|MAGIC MOUTHWASH-ATHENS, 1|United Healthcare|UNITED HEALTHCARE|||||34.50||| 9585621|ERX|0250|MAGIC MOUTHWASH-ATHENS, 1|United Medicare Advantage|UHC MEDICARE GOLD MA|34.50||||||| 9585654|ERX|0250|PHENERGAN-DM, 30ML|Medicaid|MEDICAID|20.50||||||| 9585654|ERX|0250|PHENERGAN-DM, 30ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|20.50||||||| 9585670|ERX|0250|POWELL'S SOLUTION, 240ML|Humana Medicare Advantage|HUMANA MA|58.50||||||| 9585688|ERX|0250|QUETIAPINE 400MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|135.25||||||| 9585688|ERX|0250|QUETIAPINE 400MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|135.25||||135.25||| 9585688|ERX|0250|QUETIAPINE 400MG TABLET|Managed Medicare|HEALTHSPRING MA|||||135.25||| 9585688|ERX|0250|QUETIAPINE 400MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|135.25||||||| 9585688|ERX|0250|QUETIAPINE 400MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|135.25||||||| 9585688|ERX|0250|QUETIAPINE 400MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|135.25||||135.25||| 9585688|ERX|0250|QUETIAPINE 400MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|135.25||||||| 9585688|ERX|0250|QUETIAPINE 400MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|135.25||||||| 9585688|ERX|0250|QUETIAPINE 400MG TABLET|Humana Medicare Advantage|HUMANA MA|135.25||||||| 9585688|ERX|0250|QUETIAPINE 400MG TABLET|Medicare|MEDICARE ACUTE|135.25||||135.25||| 9585720|ERX|0250|PROMETHAZINE 6.25MG IN 50|Humana Medicare Advantage|HUMANA MA|||||99.50||| 9585720|ERX|0250|PROMETHAZINE 6.25MG IN 50|Managed Medicaid|MEDICAID SUPERIOR|||||99.50||| 9585720|ERX|0250|PROMETHAZINE 6.25MG IN 50|Medicare|MEDICARE ACUTE|||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|NON CONTRACTED|COMMERCIAL OTHER 1|99.50||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|United Medicare Advantage|AARP UHC WEST COMPLETE MA|99.50||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|Veterans Affairs|VETERANS ADMINISTRATION|99.50||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|99.50||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|United Medicare Advantage|UHC MEDICARE GOLD MA|||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|Medicaid|MEDICAID HMO|99.50||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|Medicaid|MEDICAID|||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|United Healthcare|UNITED HEALTHCARE OTHER|||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|Medicare|MEDICARE ACUTE|99.50||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|99.50||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|Aetna|AETNA OTHER|||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|Aenta Medicare Advantage|AETNA MEDICARE MA|99.50||||||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|Blue Cross PPO Specialty|BCBSTX PPO|99.50||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|Blue Cross HMO Specialty|BCBSTX HMO|99.50||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|Cigna|CIGNA OTHER|||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|Managed Medicare|HEALTHSPRING MA|99.50||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|Humana Medicare Advantage|HUMANA MA|99.50||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|Managed Medicaid|MEDICAID UNITED HEALTHCARE|99.50||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|Cigna|CIGNA|99.50||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|Managed Medicaid|MEDICAID SUPERIOR|99.50||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|99.50||||99.50||| 9585738|ERX|0250|PROMETHAZINE 12.5MG IN 50|Managed Medicaid|MEDICAID AMERIGROUP|99.50||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Humana Medicare Advantage|HUMANA MA|99.50||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Managed Medicaid|MEDICAID SUPERIOR|99.50||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Managed Medicaid|MEDICAID AMERIGROUP|99.50||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Managed Medicare|BCBS MEDICARE PPO MA|||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Blue Cross HMO Specialty|BCBSTX HMO|99.50||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Blue Cross PPO Specialty|BCBSTX PPO|99.50||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Cigna|CIGNA OTHER|99.50||||||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Aetna|AETNA OTHER|||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Aenta Medicare Advantage|AETNA MEDICARE MA|99.50||||||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|99.50||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Tricare|TRICARE EAST REGION|99.50||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|99.50||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|United Healthcare|UNITED HEALTHCARE|99.50||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|99.50||||||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|United Healthcare|UNITED HEALTHCARE|||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Aetna|BOON CHAPMAN|99.50||||||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|United Healthcare|TML GROUP BENEFITS|99.50||||||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Aetna|AETNA PPO|99.50||||||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Medicare|MEDICARE ACUTE|99.50||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Cigna|CIGNA|99.50||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Medicaid|MEDICAID HMO|99.50||||||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Cigna|CIGNA|||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Medicaid|MEDICAID|99.50||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Medicaid|HENDERSON COUNTY INDIGENT|99.50||||||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|99.50||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|United Medicare Advantage|UHC MEDICARE GOLD MA|99.50||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|99.50||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Managed Medicare|MA PART B ONLY IP|99.50||||||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Veterans Affairs|VETERANS ADMINISTRATION|||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||99.50||| 9585746|ERX|0250|PROMETHAZINE 25MG IN 50ML|Managed Medicare|HEALTHSPRING MA|99.50||||99.50||| 9585753|ERX|0250|PENICILLIN G 2.5MU IN 100|Medicaid|MOLINA HEALTHCARE OF TEXAS|99.50||||||| 9585753|ERX|0250|PENICILLIN G 2.5MU IN 100|Medicaid|MEDICAID HMO|99.50||||||| 9585753|ERX|0250|PENICILLIN G 2.5MU IN 100|Medicaid|MEDICAID|99.50||||||| 9585753|ERX|0250|PENICILLIN G 2.5MU IN 100|Tricare|TRICARE EAST REGION|99.50||||||| 9585753|ERX|0250|PENICILLIN G 2.5MU IN 100|NON CONTRACTED|COMMERCIAL OTHER 1|99.50||||||| 9585753|ERX|0250|PENICILLIN G 2.5MU IN 100|United Healthcare|UMR UNITED MEDICAL RESOURCES|99.50||||||| 9585753|ERX|0250|PENICILLIN G 2.5MU IN 100|Medicare|MEDICARE ACUTE|99.50||||||| 9585753|ERX|0250|PENICILLIN G 2.5MU IN 100|United Healthcare|UNITED HEALTHCARE|99.50||||||| 9585753|ERX|0250|PENICILLIN G 2.5MU IN 100|Aetna|AETNA PPO|99.50||||||| 9585753|ERX|0250|PENICILLIN G 2.5MU IN 100|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|99.50||||||| 9585753|ERX|0250|PENICILLIN G 2.5MU IN 100|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|99.50||||||| 9585753|ERX|0250|PENICILLIN G 2.5MU IN 100|Managed Medicaid|MEDICAID SUPERIOR|99.50||||99.50||| 9585753|ERX|0250|PENICILLIN G 2.5MU IN 100|Managed Medicaid|MEDICAID UNITED HEALTHCARE|99.50||||||| 9585753|ERX|0250|PENICILLIN G 2.5MU IN 100|Managed Medicaid|MEDICAID AMERIGROUP|99.50||||||| 9585753|ERX|0250|PENICILLIN G 2.5MU IN 100|Blue Cross PPO Specialty|BCBSTX PPO|99.50||||||| 9585753|ERX|0250|PENICILLIN G 2.5MU IN 100|Cigna|CIGNA|99.50||||||| 9585753|ERX|0250|PENICILLIN G 2.5MU IN 100|Blue Cross HMO Specialty|BCBSTX HMO|99.50||||||| 9585761|ERX|0250|RIZATRIPTAN-ODT 5MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|194.75||||||| 9585761|ERX|0250|RIZATRIPTAN-ODT 5MG TABLE|Tricare|TRICARE EAST REGION|194.75||||||| 9585803|ERX|0250|WARFARIN 6 MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.19||||0.19||| 9585803|ERX|0250|WARFARIN 6 MG TABLET|Medicare|MEDICARE ACUTE|0.19||||||| 9585803|ERX|0250|WARFARIN 6 MG TABLET|Humana Medicare Advantage|HUMANA MA|0.19||||||| 9585811|ERX|0250|OSELTAMIVIR 30MG/5ML UD|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||71.50||| 9585811|ERX|0250|OSELTAMIVIR 30MG/5ML UD|Managed Medicaid|MEDICAID SUPERIOR|71.50||||71.50||| 9585811|ERX|0250|OSELTAMIVIR 30MG/5ML UD|Medicaid|MEDICAID TEXAS CHILDRENS|||||71.50||| 9585811|ERX|0250|OSELTAMIVIR 30MG/5ML UD|Medicaid|MEDICAID HMO|||||71.50||| 9585811|ERX|0250|OSELTAMIVIR 30MG/5ML UD|NON CONTRACTED|COMMERCIAL OTHER 1|71.50||||||| 9585811|ERX|0250|OSELTAMIVIR 30MG/5ML UD|Medicare|MEDICARE ACUTE|71.50||||71.50||| 9585811|ERX|0250|OSELTAMIVIR 30MG/5ML UD|Medicaid|MEDICAID|||||71.50||| 9585811|ERX|0250|OSELTAMIVIR 30MG/5ML UD|Veterans Affairs|VETERANS ADMINISTRATION|71.50||||||| 9585811|ERX|0250|OSELTAMIVIR 30MG/5ML UD|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||71.50||| 9585811|ERX|0250|OSELTAMIVIR 30MG/5ML UD|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|71.50||||||| 9585811|ERX|0250|OSELTAMIVIR 30MG/5ML UD|Managed Medicaid|MEDICAID AMERIGROUP|||||71.50||| 9585811|ERX|0250|OSELTAMIVIR 30MG/5ML UD|Blue Cross PPO Specialty|BCBSTX PPO|||||71.50||| 9585811|ERX|0250|OSELTAMIVIR 30MG/5ML UD|Humana Medicare Advantage|HUMANA MA|||||71.50||| 9585811|ERX|0250|OSELTAMIVIR 30MG/5ML UD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|71.50||||||| 9585811|ERX|0250|OSELTAMIVIR 30MG/5ML UD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||71.50||| 9585837|ERX|0250|METFORMIN 1000MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.12||||0.12||| 9585837|ERX|0250|METFORMIN 1000MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.12||||0.12||| 9585837|ERX|0250|METFORMIN 1000MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|0.12||||0.12||| 9585837|ERX|0250|METFORMIN 1000MG TABLET|Medicare|MEDICARE ACUTE|0.12||||0.12||| 9585837|ERX|0250|METFORMIN 1000MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|0.12||||||| 9585837|ERX|0250|METFORMIN 1000MG TABLET|United Healthcare|UNITED HEALTHCARE|||||0.12||| 9585837|ERX|0250|METFORMIN 1000MG TABLET|Medicare|MEDICARE PART B ONLY IP|0.12||||||| 9585837|ERX|0250|METFORMIN 1000MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.12||||0.12||| 9585837|ERX|0250|METFORMIN 1000MG TABLET|Medicaid|MEDICAID|0.12||||||| 9585837|ERX|0250|METFORMIN 1000MG TABLET|Medicaid|COUNTY INDIGENT HEALTH OTHER|0.12||||||| 9585837|ERX|0250|METFORMIN 1000MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.12||||0.12||| 9585837|ERX|0250|METFORMIN 1000MG TABLET|Managed Medicare|HEALTHSPRING MA|0.12||||0.12||| 9585837|ERX|0250|METFORMIN 1000MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|0.12||||||| 9585837|ERX|0250|METFORMIN 1000MG TABLET|Humana Medicare Advantage|HUMANA MA|0.12||||0.12||| 9585837|ERX|0250|METFORMIN 1000MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.12||||0.12||| 9585837|ERX|0250|METFORMIN 1000MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.12||||0.12||| 9585837|ERX|0250|METFORMIN 1000MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|0.12||||0.12||| 9585837|ERX|0250|METFORMIN 1000MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.12||||0.12||| 9585837|ERX|0250|METFORMIN 1000MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|0.12||||0.12||| 9585837|ERX|0250|METFORMIN 1000MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.12||||0.12||| 9585852|ERX|0250|QUINAPRIL 40MG TABLET|Medicare|MEDICARE ACUTE|10.50||||10.50||| 9585878|ERX|0250|GUAIFENESIN-PSEUDO 600MG-|Humana Medicare Advantage|HUMANA MA|10.50||||||| 9585878|ERX|0250|GUAIFENESIN-PSEUDO 600MG-|Managed Medicaid|MEDICAID UNITED HEALTHCARE|10.50||||||| 9585878|ERX|0250|GUAIFENESIN-PSEUDO 600MG-|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|10.50||||||| 9585878|ERX|0250|GUAIFENESIN-PSEUDO 600MG-|Medicaid|MEDICAID HMO|10.50||||||| 9585878|ERX|0250|GUAIFENESIN-PSEUDO 600MG-|Managed Medicaid|MEDICAID SUPERIOR|10.50||||10.50||| 9585878|ERX|0250|GUAIFENESIN-PSEUDO 600MG-|Medicaid|MEDICAID|10.50||||||| 9585878|ERX|0250|GUAIFENESIN-PSEUDO 600MG-|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|10.50||||||| 9585878|ERX|0250|GUAIFENESIN-PSEUDO 600MG-|Aenta Medicare Advantage|AETNA MEDICARE MA|10.50||||||| 9585886|ERX|0250|OCUVITE TABLET|Medicare|MEDICARE ACUTE|10.50||||10.50||| 9585886|ERX|0250|OCUVITE TABLET|Veterans Affairs|VETERANS ADMINISTRATION|10.50||||||| 9585886|ERX|0250|OCUVITE TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|10.50||||10.50||| 9585886|ERX|0250|OCUVITE TABLET|Managed Medicare|HEALTHSPRING MA|||||10.50||| 9585886|ERX|0250|OCUVITE TABLET|Humana Medicare Advantage|HUMANA MA|10.50||||10.50||| 9585886|ERX|0250|OCUVITE TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|10.50||||||| 9585894|ERX|0250|ZOLMITRIPTAN ODT 5MG TABL|Medicare|MEDICARE ACUTE|324.25||||||| 9585902|ERX|0250|NIACIN TIME RELEASE 500MG|Blue Cross PPO Specialty|BCBSTX PPO|10.50||||||| 9585902|ERX|0250|NIACIN TIME RELEASE 500MG|Aenta Medicare Advantage|AETNA MEDICARE MA|||||10.50||| 9585902|ERX|0250|NIACIN TIME RELEASE 500MG|Managed Medicaid|MEDICAID SUPERIOR|10.50||||||| 9585902|ERX|0250|NIACIN TIME RELEASE 500MG|Medicare|MEDICARE ACUTE|10.50||||||| 9585944|ERX|0250|ACYCLOVIR 1G IN 250ML NS|Medicare|MEDICARE ACUTE|196.50||||||| 9585944|ERX|0250|ACYCLOVIR 1G IN 250ML NS|Managed Medicaid|MEDICAID SUPERIOR|||||196.50||| 9585944|ERX|0250|ACYCLOVIR 1G IN 250ML NS|Blue Cross PPO Specialty|BCBSTX PPO|196.50||||196.50||| 9585969|ERX|0250|FLUCONAZOLE 150MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.41||||||| 9585969|ERX|0250|FLUCONAZOLE 150MG TABLET|Aetna|BOON CHAPMAN|||||0.41||| 9585969|ERX|0250|FLUCONAZOLE 150MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.41||| 9585969|ERX|0250|FLUCONAZOLE 150MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.41||||0.41||| 9585969|ERX|0250|FLUCONAZOLE 150MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||0.41||| 9585969|ERX|0250|FLUCONAZOLE 150MG TABLET|Managed Medicare|HEALTHSPRING MA|0.41||||||| 9585969|ERX|0250|FLUCONAZOLE 150MG TABLET|Humana Medicare Advantage|HUMANA MA|0.41||||0.41||| 9585969|ERX|0250|FLUCONAZOLE 150MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|0.41||||0.41||| 9585969|ERX|0250|FLUCONAZOLE 150MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.41||||0.41||| 9585969|ERX|0250|FLUCONAZOLE 150MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||0.41||| 9585969|ERX|0250|FLUCONAZOLE 150MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.41||||0.41||| 9585969|ERX|0250|FLUCONAZOLE 150MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.41||| 9585969|ERX|0250|FLUCONAZOLE 150MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.41||||||| 9585969|ERX|0250|FLUCONAZOLE 150MG TABLET|United Healthcare|UNITED HEALTHCARE|0.41||||||| 9585969|ERX|0250|FLUCONAZOLE 150MG TABLET|Medicare|MEDICARE ACUTE|0.41||||0.41||| 9585969|ERX|0250|FLUCONAZOLE 150MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|0.41||||||| 9585977|ERX|0250|TRANDOLAPRIL 4MG TABLET|Medicare|MEDICARE ACUTE|10.50||||10.50||| 9585993|ERX|0250|GUAIFENESIN-DM 200-20MG/1|Humana Medicare Advantage|HUMANA MA|10.50||||10.50||| 9585993|ERX|0250|GUAIFENESIN-DM 200-20MG/1|Managed Medicaid|MEDICAID AMERIGROUP|||||10.50||| 9585993|ERX|0250|GUAIFENESIN-DM 200-20MG/1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||10.50||| 9585993|ERX|0250|GUAIFENESIN-DM 200-20MG/1|Managed Medicaid|MEDICAID SUPERIOR|||||10.50||| 9585993|ERX|0250|GUAIFENESIN-DM 200-20MG/1|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||10.50||| 9585993|ERX|0250|GUAIFENESIN-DM 200-20MG/1|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|10.50||||||| 9585993|ERX|0250|GUAIFENESIN-DM 200-20MG/1|Managed Medicare|HEALTHSPRING MA|10.50||||||| 9585993|ERX|0250|GUAIFENESIN-DM 200-20MG/1|Managed Medicare|BCBS MEDICARE PPO MA|10.50||||||| 9585993|ERX|0250|GUAIFENESIN-DM 200-20MG/1|Blue Cross PPO Specialty|BCBSTX PPO|10.50||||10.50||| 9585993|ERX|0250|GUAIFENESIN-DM 200-20MG/1|Workers Compensation|UT EMPLOYEE INJURY|10.50||||||| 9585993|ERX|0250|GUAIFENESIN-DM 200-20MG/1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||10.50||| 9585993|ERX|0250|GUAIFENESIN-DM 200-20MG/1|Veterans Affairs|VETERANS ADMINISTRATION|10.50||||||| 9585993|ERX|0250|GUAIFENESIN-DM 200-20MG/1|Blue Cross HMO Specialty|BCBSTX HMO|10.50||||||| 9585993|ERX|0250|GUAIFENESIN-DM 200-20MG/1|United Medicare Advantage|AARP UHC WEST COMPLETE MA|10.50||||10.50||| 9585993|ERX|0250|GUAIFENESIN-DM 200-20MG/1|Medicare|MEDICARE ACUTE|10.50||||||| 9585993|ERX|0250|GUAIFENESIN-DM 200-20MG/1|Aenta Medicare Advantage|AETNA MEDICARE MA|10.50||||||| 9586009|ERX|0250|OXYTOCIN 20UNITS/1000ML N|Medicaid|MOLINA HEALTHCARE OF TEXAS|296.50||||||| 9586009|ERX|0250|OXYTOCIN 20UNITS/1000ML N|Medicaid|MEDICAID|296.50||||||| 9586009|ERX|0250|OXYTOCIN 20UNITS/1000ML N|Medicare|MEDICARE ACUTE|296.50||||||| 9586009|ERX|0250|OXYTOCIN 20UNITS/1000ML N|Tricare|TRICARE EAST REGION|296.50||||||| 9586009|ERX|0250|OXYTOCIN 20UNITS/1000ML N|NON CONTRACTED|COMMERCIAL OTHER 1|296.50||||||| 9586009|ERX|0250|OXYTOCIN 20UNITS/1000ML N|United Healthcare|UMR UNITED MEDICAL RESOURCES|296.50||||||| 9586009|ERX|0250|OXYTOCIN 20UNITS/1000ML N|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|296.50||||||| 9586009|ERX|0250|OXYTOCIN 20UNITS/1000ML N|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|296.50||||||| 9586009|ERX|0250|OXYTOCIN 20UNITS/1000ML N|Aetna|AETNA PPO|296.50||||||| 9586009|ERX|0250|OXYTOCIN 20UNITS/1000ML N|United Healthcare|UNITED HEALTHCARE|296.50||||||| 9586009|ERX|0250|OXYTOCIN 20UNITS/1000ML N|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|296.50||||||| 9586009|ERX|0250|OXYTOCIN 20UNITS/1000ML N|Medicaid|MEDICAID HMO|296.50||||||| 9586009|ERX|0250|OXYTOCIN 20UNITS/1000ML N|Blue Cross PPO Specialty|BCBSTX PPO|296.50||||||| 9586009|ERX|0250|OXYTOCIN 20UNITS/1000ML N|Blue Cross HMO Specialty|BCBSTX HMO|296.50||||||| 9586009|ERX|0250|OXYTOCIN 20UNITS/1000ML N|Cigna|CIGNA OTHER|296.50||||||| 9586009|ERX|0250|OXYTOCIN 20UNITS/1000ML N|Cigna|CIGNA|296.50||||||| 9586009|ERX|0250|OXYTOCIN 20UNITS/1000ML N|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|296.50||||||| 9586009|ERX|0250|OXYTOCIN 20UNITS/1000ML N|Managed Medicaid|MEDICAID UNITED HEALTHCARE|296.50||||||| 9586009|ERX|0250|OXYTOCIN 20UNITS/1000ML N|United Healthcare|GEHA|296.50||||||| 9586009|ERX|0250|OXYTOCIN 20UNITS/1000ML N|Managed Medicaid|MEDICAID SUPERIOR|296.50||||296.50||| 9586009|ERX|0250|OXYTOCIN 20UNITS/1000ML N|Managed Medicaid|MEDICAID AMERIGROUP|296.50||||||| 9586017|ERX|0250|GABAPENTIN 600MG TABLET|Humana Medicare Advantage|HUMANA MA|10.50||||10.50||| 9586017|ERX|0250|GABAPENTIN 600MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||10.50||| 9586017|ERX|0250|GABAPENTIN 600MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|10.50||||10.50||| 9586017|ERX|0250|GABAPENTIN 600MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|10.50||||10.50||| 9586017|ERX|0250|GABAPENTIN 600MG TABLET|Managed Medicare|HEALTHSPRING MA|10.50||||||| 9586017|ERX|0250|GABAPENTIN 600MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|10.50||||||| 9586017|ERX|0250|GABAPENTIN 600MG TABLET|ChampVA|CHAMPVA CENTER|10.50||||||| 9586017|ERX|0250|GABAPENTIN 600MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|10.50||||10.50||| 9586017|ERX|0250|GABAPENTIN 600MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|10.50||||10.50||| 9586017|ERX|0250|GABAPENTIN 600MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|10.50||||10.50||| 9586017|ERX|0250|GABAPENTIN 600MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|10.50||||||| 9586017|ERX|0250|GABAPENTIN 600MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|10.50||||10.50||| 9586017|ERX|0250|GABAPENTIN 600MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|10.50||||10.50||| 9586017|ERX|0250|GABAPENTIN 600MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|10.50||||10.50||| 9586017|ERX|0250|GABAPENTIN 600MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|10.50||||10.50||| 9586017|ERX|0250|GABAPENTIN 600MG TABLET|Medicare|MEDICARE ACUTE|10.50||||10.50||| 9586017|ERX|0250|GABAPENTIN 600MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|10.50||||||| 9586017|ERX|0250|GABAPENTIN 600MG TABLET|United Healthcare|UNITED HEALTHCARE|10.50||||||| 9586017|ERX|0250|GABAPENTIN 600MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|10.50||||||| 9586058|ERX|0250|PROMETHAZINE SYRUP 12.5MG|Medicaid|MEDICAID|||||10.50||| 9586140|ERX|0250|AUGMENTIN 200-28.5MG/5ML|Blue Cross HMO Specialty|BCBSTX HMO|||||10.50||| 9586140|ERX|0250|AUGMENTIN 200-28.5MG/5ML|Blue Cross PPO Specialty|BCBSTX PPO|||||10.50||| 9586140|ERX|0250|AUGMENTIN 200-28.5MG/5ML|Managed Medicaid|MEDICAID SUPERIOR|||||10.50||| 9586140|ERX|0250|AUGMENTIN 200-28.5MG/5ML|Managed Medicaid|MEDICAID AMERIGROUP|||||10.50||| 9586140|ERX|0250|AUGMENTIN 200-28.5MG/5ML|Tricare|TRICARE EAST REGION|||||10.50||| 9586140|ERX|0250|AUGMENTIN 200-28.5MG/5ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||10.50||| 9586140|ERX|0250|AUGMENTIN 200-28.5MG/5ML|Medicaid|MEDICAID HMO|||||10.50||| 9586157|ERX|0250|CEFDINIR 125MG/5ML UD|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||10.50||| 9586157|ERX|0250|CEFDINIR 125MG/5ML UD|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||10.50||| 9586157|ERX|0250|CEFDINIR 125MG/5ML UD|Managed Medicaid|MEDICAID SUPERIOR|10.50||||10.50||| 9586157|ERX|0250|CEFDINIR 125MG/5ML UD|Blue Cross PPO Specialty|BCBSTX PPO|||||10.50||| 9586157|ERX|0250|CEFDINIR 125MG/5ML UD|Blue Cross PPO Specialty|BCBSTX OTHER|||||10.50||| 9586157|ERX|0250|CEFDINIR 125MG/5ML UD|Managed Medicaid|MEDICAID AMERIGROUP|10.50||||10.50||| 9586157|ERX|0250|CEFDINIR 125MG/5ML UD|Cigna|CIGNA|||||10.50||| 9586157|ERX|0250|CEFDINIR 125MG/5ML UD|United Healthcare|UNITED HEALTHCARE|10.50||||||| 9586157|ERX|0250|CEFDINIR 125MG/5ML UD|Medicaid|MEDICAID|||||10.50||| 9586157|ERX|0250|CEFDINIR 125MG/5ML UD|Aetna|AETNA PPO|||||10.50||| 9586157|ERX|0250|CEFDINIR 125MG/5ML UD|Medicaid|MEDICAID HMO|||||10.50||| 9586157|ERX|0250|CEFDINIR 125MG/5ML UD|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||10.50||| 9586173|ERX|0250|CEPHALEXIN 250MG/5ML UD|Blue Cross PPO Specialty|BCBSTX PPO|||||10.50||| 9586173|ERX|0250|CEPHALEXIN 250MG/5ML UD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||10.50||| 9586173|ERX|0250|CEPHALEXIN 250MG/5ML UD|Managed Medicaid|MEDICAID SUPERIOR|||||10.50||| 9586173|ERX|0250|CEPHALEXIN 250MG/5ML UD|Managed Medicaid|MEDICAID AMERIGROUP|||||10.50||| 9586173|ERX|0250|CEPHALEXIN 250MG/5ML UD|Medicare|MEDICARE ACUTE|10.50||||||| 9586173|ERX|0250|CEPHALEXIN 250MG/5ML UD|Medicaid|MEDICAID HMO|||||10.50||| 9586173|ERX|0250|CEPHALEXIN 250MG/5ML UD|Medicaid|MEDICAID|||||10.50||| 9586223|ERX|0250|FERROUS SULFATE 325MG EC|Veterans Affairs|VETERANS ADMINISTRATION|10.50||||||| 9586223|ERX|0250|FERROUS SULFATE 325MG EC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|10.50||||10.50||| 9586223|ERX|0250|FERROUS SULFATE 325MG EC|United Medicare Advantage|UHC AARP MCR HMO MA|10.50||||||| 9586223|ERX|0250|FERROUS SULFATE 325MG EC|Medicaid|MOLINA HEALTHCARE OF TEXAS|10.50||||||| 9586223|ERX|0250|FERROUS SULFATE 325MG EC|Medicaid|MEDICAID HMO|10.50||||10.50||| 9586223|ERX|0250|FERROUS SULFATE 325MG EC|NON CONTRACTED|COMMERCIAL OTHER 1|10.50||||10.50||| 9586223|ERX|0250|FERROUS SULFATE 325MG EC|Managed Medicare|BCBS MEDICARE PPO MA|10.50||||||| 9586223|ERX|0250|FERROUS SULFATE 325MG EC|Humana Medicare Advantage|HUMANA MA|10.50||||10.50||| 9586223|ERX|0250|FERROUS SULFATE 325MG EC|United Healthcare|UMR UNITED MEDICAL RESOURCES|10.50||||||| 9586223|ERX|0250|FERROUS SULFATE 325MG EC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|10.50||||||| 9586223|ERX|0250|FERROUS SULFATE 325MG EC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|10.50||||10.50||| 9586223|ERX|0250|FERROUS SULFATE 325MG EC|Managed Medicare|HEALTHSPRING MA|10.50||||10.50||| 9586223|ERX|0250|FERROUS SULFATE 325MG EC|Managed Medicaid|MEDICAID SUPERIOR|10.50||||||| 9586223|ERX|0250|FERROUS SULFATE 325MG EC|Managed Medicaid|MEDICAID AMERIGROUP|10.50||||||| 9586223|ERX|0250|FERROUS SULFATE 325MG EC|Aetna|AETNA PPO|10.50||||||| 9586223|ERX|0250|FERROUS SULFATE 325MG EC|Aenta Medicare Advantage|AETNA MEDICARE MA|10.50||||||| 9586223|ERX|0250|FERROUS SULFATE 325MG EC|Medicaid|MEDICAID|10.50||||||| 9586223|ERX|0250|FERROUS SULFATE 325MG EC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|10.50||||10.50||| 9586223|ERX|0250|FERROUS SULFATE 325MG EC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|10.50||||10.50||| 9586223|ERX|0250|FERROUS SULFATE 325MG EC|Blue Cross HMO Specialty|BCBSTX HMO|10.50||||||| 9586223|ERX|0250|FERROUS SULFATE 325MG EC|Cigna|CIGNA|10.50||||10.50||| 9586223|ERX|0250|FERROUS SULFATE 325MG EC|United Medicare Advantage|UHC MEDICARE GOLD MA|10.50||||10.50||| 9586223|ERX|0250|FERROUS SULFATE 325MG EC|Blue Cross PPO Specialty|BCBSTX PPO|10.50||||||| 9586223|ERX|0250|FERROUS SULFATE 325MG EC|United Healthcare|TML GROUP BENEFITS|10.50||||||| 9586223|ERX|0250|FERROUS SULFATE 325MG EC|Medicare|MEDICARE ACUTE|10.50||||10.50||| 9586231|ERX|0250|LIDOCAINE 1% (PF), 5ML AM|Managed Medicaid|MEDICAID SUPERIOR|11.25||||||| 9586231|ERX|0250|LIDOCAINE 1% (PF), 5ML AM|Medicare|MEDICARE ACUTE|11.25||||||| 9586231|ERX|0250|LIDOCAINE 1% (PF), 5ML AM|Blue Cross PPO Specialty|BCBSTX PPO|11.25||||||| 9586231|ERX|0250|LIDOCAINE 1% (PF), 5ML AM|Managed Medicaid|MEDICAID AMERIGROUP|11.25||||||| 9586298|ERX|0250|EYE MED PACKS|Managed Medicare|HEALTHSPRING MA|||||309.50||| 9586298|ERX|0250|EYE MED PACKS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||309.50||| 9586298|ERX|0250|EYE MED PACKS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||309.50||| 9586298|ERX|0250|EYE MED PACKS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||309.50||| 9586298|ERX|0250|EYE MED PACKS|Medicare|MEDICARE ACUTE|||||309.50||| 9586298|ERX|0250|EYE MED PACKS|Humana Medicare Advantage|HUMANA MA|||||309.50||| 9586298|ERX|0250|EYE MED PACKS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||309.50||| 9586298|ERX|0250|EYE MED PACKS|Aetna|AETNA PPO|||||309.50||| 9586298|ERX|0250|EYE MED PACKS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||309.50||| 9586298|ERX|0250|EYE MED PACKS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||309.50||| 9586298|ERX|0250|EYE MED PACKS|Blue Cross HMO Specialty|BCBSTX HMO|||||309.50||| 9586298|ERX|0250|EYE MED PACKS|ChampVA|CHAMPVA CENTER|||||309.50||| 9586298|ERX|0250|EYE MED PACKS|Cigna|CIGNA|||||309.50||| 9586298|ERX|0250|EYE MED PACKS|Blue Cross PPO Specialty|BCBSTX PPO|||||309.50||| 9586405|ERX|0250|DOXYLAMINE 25 MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||8.80||| 9586405|ERX|0250|DOXYLAMINE 25 MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||8.80||| 9586561|ERX|0250|CLINIMIX 5%-20%, 1000 ML|Medicare|MEDICARE ACUTE|235.10||||||| 9586561|ERX|0250|CLINIMIX 5%-20%, 1000 ML|United Healthcare|UNITED HEALTHCARE|235.10||||||| 9586561|ERX|0250|CLINIMIX 5%-20%, 1000 ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|235.10||||||| 9586561|ERX|0250|CLINIMIX 5%-20%, 1000 ML|Managed Medicare|BCBS MEDICARE PPO MA|235.10||||||| 9586561|ERX|0250|CLINIMIX 5%-20%, 1000 ML|Humana Medicare Advantage|HUMANA MA|235.10||||||| 9586561|ERX|0250|CLINIMIX 5%-20%, 1000 ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|235.10||||||| 9586561|ERX|0250|CLINIMIX 5%-20%, 1000 ML|Aetna|BOON CHAPMAN|235.10||||||| 9587007|ERX|0250|DICLOFENAC 0.1% DROP, 5 M|Humana Medicare Advantage|HUMANA MA|||||81.20||| 9587007|ERX|0250|DICLOFENAC 0.1% DROP, 5 M|Cigna|CIGNA|||||81.20||| 9587007|ERX|0250|DICLOFENAC 0.1% DROP, 5 M|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||81.20||| 9587007|ERX|0250|DICLOFENAC 0.1% DROP, 5 M|Blue Cross HMO Specialty|BCBSTX HMO|||||81.20||| 9587007|ERX|0250|DICLOFENAC 0.1% DROP, 5 M|Aetna|AETNA PPO|||||81.20||| 9587007|ERX|0250|DICLOFENAC 0.1% DROP, 5 M|Aenta Medicare Advantage|AETNA MEDICARE MA|||||81.20||| 9587007|ERX|0250|DICLOFENAC 0.1% DROP, 5 M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||81.20||| 9587007|ERX|0250|DICLOFENAC 0.1% DROP, 5 M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||81.20||| 9587007|ERX|0250|DICLOFENAC 0.1% DROP, 5 M|Medicare|MEDICARE ACUTE|||||81.20||| 9587023|ERX|0250|FLUTICASONE FUROATE 100 M|Medicare|MEDICARE ACUTE|393.15||||||| 9587023|ERX|0250|FLUTICASONE FUROATE 100 M|Humana Medicare Advantage|HUMANA MA|393.15||||||| 9587023|ERX|0250|FLUTICASONE FUROATE 100 M|Blue Cross HMO Specialty|BCBSTX HMO|393.15||||||| 9587023|ERX|0250|FLUTICASONE FUROATE 100 M|Blue Cross PPO Specialty|BCBSTX PPO|393.15||||||| 9587023|ERX|0250|FLUTICASONE FUROATE 100 M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|393.15||||||| 9587023|ERX|0250|FLUTICASONE FUROATE 100 M|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|393.15||||||| 9587023|ERX|0250|FLUTICASONE FUROATE 100 M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|393.15||||||| 9587023|ERX|0250|FLUTICASONE FUROATE 100 M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|393.15||||||| 9587023|ERX|0250|FLUTICASONE FUROATE 100 M|United Medicare Advantage|UHC MEDICARE GOLD MA|393.15||||||| 9587023|ERX|0250|FLUTICASONE FUROATE 100 M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|393.15||||||| 9587023|ERX|0250|FLUTICASONE FUROATE 100 M|Cigna|CIGNA|393.15||||||| 9587031|ERX|0250|FLUTICASONE FUROATE 50 MC|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|724.55||||||| 9587031|ERX|0250|FLUTICASONE FUROATE 50 MC|Humana Medicare Advantage|HUMANA MA|724.55||||||| 9587031|ERX|0250|FLUTICASONE FUROATE 50 MC|Medicare|MEDICARE ACUTE|724.55||||||| 9587031|ERX|0250|FLUTICASONE FUROATE 50 MC|Cigna|CIGNA|724.55||||||| 9587114|ERX|0250|LABETALOL 20 MG/4 ML SYRI|Blue Cross PPO Specialty|BCBSTX PPO|||||98.02||| 9587114|ERX|0250|LABETALOL 20 MG/4 ML SYRI|Blue Cross HMO Specialty|BCBSTX HMO|||||98.02||| 9587114|ERX|0250|LABETALOL 20 MG/4 ML SYRI|Humana Medicare Advantage|HUMANA MA|98.02||||||| 9587171|ERX|0250|QUESTRAN 5% OINTMENT|Humana Medicare Advantage|HUMANA MA|119.25||||||| 9587171|ERX|0250|QUESTRAN 5% OINTMENT|Medicare|MEDICARE ACUTE|119.25||||||| 9587171|ERX|0250|QUESTRAN 5% OINTMENT|United Medicare Advantage|UHC MEDICARE GOLD MA|119.25||||||| 9587171|ERX|0250|QUESTRAN 5% OINTMENT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|119.25||||||| 9587254|ERX|0250|ACETYLCYSTEINE 600MG CAPU|Medicare|MEDICARE ACUTE|8.80||||||| 9587254|ERX|0250|ACETYLCYSTEINE 600MG CAPU|Humana Medicare Advantage|HUMANA MA|8.80||||||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|17.60||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Veterans Affairs|VETERANS ADMINISTRATION|||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|17.60||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|United Medicare Advantage|UHC MEDICARE GOLD MA|17.60||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Medicaid|MEDICAID|||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Medicaid|HENDERSON COUNTY INDIGENT|||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|NON CONTRACTED|COMMERCIAL OTHER 1|17.60||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Medicare|MEDICARE ACUTE|17.60||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|PHCS|MULTIPLAN PHCS OTHER|||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|United Healthcare|UNITED HEALTHCARE OTHER|||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|United Healthcare|UNITED HEALTHCARE|||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Tricare|TRICARE EAST REGION|||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Aetna|AETNA PPO|17.60||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Aetna|AETNA OTHER|||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Aenta Medicare Advantage|AETNA MEDICARE MA|17.60||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|17.60||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Blue Cross HMO Specialty|BCBSTX HMO|||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Cigna|CIGNA|||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Workers Compensation|TEXAS MUTUAL INSURANCE|||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Blue Cross PPO Specialty|BCBSTX OTHER|||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Blue Cross PPO Specialty|BCBSTX PPO|17.60||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Managed Medicaid|MEDICAID AMERIGROUP|||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|17.60||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|17.60||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Managed Medicaid|MEDICAID SUPERIOR|17.60||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Humana Medicare Advantage|HUMANA MA|17.60||||17.60||| 9587270|ERX|0250|MAALOX-V.LIDOCAINE(GI COM|Managed Medicare|HEALTHSPRING MA|17.60||||17.60||| 9587338|ERX|0250|REMDESIVIR 100 MG VIAL-PO|Blue Cross PPO Specialty|BCBSTX PPO|6.50||||||| 9587338|ERX|0250|REMDESIVIR 100 MG VIAL-PO|Medicare|MEDICARE ACUTE|6.50||||||| 9587338|ERX|0250|REMDESIVIR 100 MG VIAL-PO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|6.50||||||| 9587338|ERX|0250|REMDESIVIR 100 MG VIAL-PO|UTMB|UTMB CORRECTIONAL MANAGED CARE|6.50||||||| 9587338|ERX|0250|REMDESIVIR 100 MG VIAL-PO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|6.50||||||| 9587338|ERX|0250|REMDESIVIR 100 MG VIAL-PO|Humana Medicare Advantage|HUMANA MA|6.50||||||| 9589185|ERX|0250|HYDROC-ACET 2.5-108MG/5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.32||| 9589185|ERX|0250|HYDROC-ACET 2.5-108MG/5ML|Managed Medicaid|MEDICAID AMERIGROUP|||||0.32||| 9589185|ERX|0250|HYDROC-ACET 2.5-108MG/5ML|Cigna|CIGNA|||||0.32||| 9589185|ERX|0250|HYDROC-ACET 2.5-108MG/5ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.32||||||| 9589185|ERX|0250|HYDROC-ACET 2.5-108MG/5ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.32||||||| 9589185|ERX|0250|HYDROC-ACET 2.5-108MG/5ML|Medicare|MEDICARE ACUTE|0.32||||0.32||| 9589466|ERX|0250|IVABRADINE 5 MG TABLET|Humana Medicare Advantage|HUMANA MA|49.82||||||| 9589466|ERX|0250|IVABRADINE 5 MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|49.82||||49.82||| 9589466|ERX|0250|IVABRADINE 5 MG TABLET|Blue Cross PPO Specialty|BCBSTX OTHER|||||49.82||| 9589466|ERX|0250|IVABRADINE 5 MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|49.82||||||| 9589466|ERX|0250|IVABRADINE 5 MG TABLET|Medicare|MEDICARE ACUTE|49.82||||||| 9589466|ERX|0250|IVABRADINE 5 MG TABLET|Medicaid|HENDERSON COUNTY INDIGENT|49.82||||||| 9589466|ERX|0250|IVABRADINE 5 MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|49.82||||||| 9589573|ERX|0250|ACETYLCYSTEINE 20%, 2ML I|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.10||||||| 9589672|ERX|0250|LIDOCAINE 4%, LTA KIT, 4M|Blue Cross PPO Specialty|BCBSTX PPO|112.25||||||| 9589672|ERX|0250|LIDOCAINE 4%, LTA KIT, 4M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||112.25||| 9589672|ERX|0250|LIDOCAINE 4%, LTA KIT, 4M|United Medicare Advantage|UHC MEDICARE GOLD MA|||||112.25||| 9589672|ERX|0250|LIDOCAINE 4%, LTA KIT, 4M|Medicare|MEDICARE ACUTE|112.25||||||| 9589672|ERX|0250|LIDOCAINE 4%, LTA KIT, 4M|Humana Medicare Advantage|HUMANA MA|||||112.25||| 9589672|ERX|0250|LIDOCAINE 4%, LTA KIT, 4M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||112.25||| 9589680|ERX|0250|INDIA INK VIAL|NON CONTRACTED|COMMERCIAL OTHER 1|319.50||||||| 9589680|ERX|0250|INDIA INK VIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||319.50||| 9589680|ERX|0250|INDIA INK VIAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||319.50||| 9589680|ERX|0250|INDIA INK VIAL|Medicaid|HENDERSON COUNTY INDIGENT|||||319.50||| 9589680|ERX|0250|INDIA INK VIAL|Tricare|TRICARE EAST REGION|||||319.50||| 9589680|ERX|0250|INDIA INK VIAL|Medicare|MEDICARE ACUTE|319.50||||319.50||| 9589680|ERX|0250|INDIA INK VIAL|United Healthcare|UNITED HEALTHCARE|319.50||||319.50||| 9589680|ERX|0250|INDIA INK VIAL|United Healthcare|UNITED HEALTHCARE|||||319.50||| 9589680|ERX|0250|INDIA INK VIAL|Managed Medicare|HEALTHSPRING MA|||||319.50||| 9589680|ERX|0250|INDIA INK VIAL|Humana Medicare Advantage|HUMANA MA|319.50||||319.50||| 9589680|ERX|0250|INDIA INK VIAL|Managed Medicaid|MEDICAID AMERIGROUP|319.50||||||| 9589680|ERX|0250|INDIA INK VIAL|Blue Cross HMO Specialty|BCBSTX HMO|||||319.50||| 9589680|ERX|0250|INDIA INK VIAL|Cigna|CIGNA|||||319.50||| 9589680|ERX|0250|INDIA INK VIAL|Blue Cross PPO Specialty|BCBSTX PPO|||||319.50||| 9589680|ERX|0250|INDIA INK VIAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||319.50||| 9589680|ERX|0250|INDIA INK VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||319.50||| 9589680|ERX|0250|INDIA INK VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||319.50||| 9589680|ERX|0250|INDIA INK VIAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||319.50||| 9589698|ERX|0250|SOTRADECOL 3%, 2ML VIAL|Medicare|MEDICARE ACUTE|||||337.50||| 9589706|ERX|0250|RASAGLINE 1MG TABLET|Humana Medicare Advantage|HUMANA MA|113.50||||||| 9589706|ERX|0250|RASAGLINE 1MG TABLET|Medicare|MEDICARE ACUTE|||||113.50||| 9589896|ERX|0250|TRAMCIN ACET 55 MCG NASL|Managed Medicaid|MEDICAID AMERIGROUP|3.92||||3.92||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Medicaid|MEDICAID HMO|||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Medicaid|MEDICAID|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|United Medicare Advantage|UHC AARP MCR HMO MA|||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Medicaid|HENDERSON COUNTY INDIGENT|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Tricare|TRICARE FOR LIFE|||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Tricare|TRICARE EAST REGION|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|United Healthcare|UNITED HEALTHCARE OTHER|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|NON CONTRACTED|COMMERCIAL OTHER 1|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Medicare|MEDICARE ACUTE|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Workers Compensation|WORKERS COMPENSATION OTHER|||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|United Medicare Advantage|UHC MEDICARE GOLD MA|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|PHCS|HUMANA|||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|United Healthcare|GOLDEN RULE|||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|United Healthcare|UNITED HEALTHCARE|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Aetna|BOON CHAPMAN|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|ChampVA|CHAMPVA CENTER|||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Cigna|CIGNA|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Managed Medicare|VAN ZANDT COUNTY INMATE|3.64||||||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Managed Medicare|MA PART B ONLY IP|3.64||||||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Managed Medicare|HEALTHSPRING MA|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Managed Medicare|WELLCARE CHOICE MA|3.64||||||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Humana Medicare Advantage|HUMANA MA|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Managed Medicare|BCBS MEDICARE PPO MA|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|MTC Medical|VAN ZANDT COUNTY INMATE|3.64||||||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Workers Compensation|UT EMPLOYEE INJURY|3.64||||||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Veterans Affairs|VETERANS ADMINISTRATION|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Medicaid|COUNTY INDIGENT HEALTH OTHER|3.64||||||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Managed Medicaid|MEDICAID SUPERIOR|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Managed Medicaid|MEDICAID AMERIGROUP|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Medicaid|MOLINA HEALTHCARE OF TEXAS|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Cigna|CIGNA OTHER|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Blue Cross PPO Specialty|BCBSTX PPO|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Blue Cross PPO Specialty|BCBSTX OTHER|||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Blue Cross HMO Specialty|BCBSTX HMO|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Aenta Medicare Advantage|AETNA MEDICARE MA|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Aetna|AETNA PPO|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|3.64||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|Aetna|AETNA OTHER|||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|United Healthcare|UNITED HEALTHCARE|||||3.64||| 9589912|ERX|0250|CONTRAST AGENT INJ OR PO|United Healthcare|TML GROUP BENEFITS|3.64||||3.64||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.92||||0.92||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|Managed Medicaid|MEDICAID SUPERIOR|0.92||||0.92||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.92||||0.92||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|Managed Medicare|HEALTHSPRING MA|0.92||||0.92||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|Blue Cross HMO Specialty|BCBSTX HMO|0.92||||||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|Cigna|CIGNA|||||0.92||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|Cigna|CIGNA|0.92||||0.92||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.92||||0.92||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.92||||||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|Tricare|TRICARE EAST REGION|0.92||||||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|UTMB|UTMB CORRECTIONAL MANAGED CARE|0.92||||||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|NON CONTRACTED|COMMERCIAL OTHER 1|0.92||||||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|0.92||||0.92||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|Medicare|MEDICARE ACUTE|0.92||||0.92||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|0.92||||||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|United Healthcare|UNITED HEALTHCARE|||||0.92||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|United Healthcare|UNITED HEALTHCARE OTHER|||||0.92||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|Humana Medicare Advantage|HUMANA MA|0.92||||0.92||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|United Healthcare|UNITED HEALTHCARE|0.92||||||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|Blue Cross PPO Specialty|BCBSTX PPO|0.92||||0.92||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.92||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|Medicaid|MEDICAID|0.92||||||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|Medicaid|HENDERSON COUNTY INDIGENT|0.92||||0.92||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.92||||0.92||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.92||||0.92||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.92||||0.92||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|Veterans Affairs|VETERANS ADMINISTRATION|0.92||||0.92||| 9590050|ERX|0250|PANTOPRAZOLE 80 MG/160 ML|Aetna|AETNA PPO|0.92||||0.92||| 9590142|ERX|0250|BENZOCAINE ORAL SPRAY 0.5|United Healthcare|UNITED HEALTHCARE|||||73.25||| 9590142|ERX|0250|BENZOCAINE ORAL SPRAY 0.5|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||73.25||| 9590142|ERX|0250|BENZOCAINE ORAL SPRAY 0.5|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|73.25||||73.25||| 9590142|ERX|0250|BENZOCAINE ORAL SPRAY 0.5|United Medicare Advantage|AARP UHC WEST COMPLETE MA|73.25||||||| 9590142|ERX|0250|BENZOCAINE ORAL SPRAY 0.5|Medicaid|MOLINA HEALTHCARE OF TEXAS|73.25||||||| 9590142|ERX|0250|BENZOCAINE ORAL SPRAY 0.5|Medicaid|MEDICAID|73.25||||73.25||| 9590142|ERX|0250|BENZOCAINE ORAL SPRAY 0.5|Medicaid|HENDERSON COUNTY INDIGENT|73.25||||||| 9590142|ERX|0250|BENZOCAINE ORAL SPRAY 0.5|NON CONTRACTED|COMMERCIAL OTHER 1|73.25||||||| 9590142|ERX|0250|BENZOCAINE ORAL SPRAY 0.5|Medicare|MEDICARE ACUTE|73.25||||73.25||| 9590142|ERX|0250|BENZOCAINE ORAL SPRAY 0.5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|73.25||||||| 9590142|ERX|0250|BENZOCAINE ORAL SPRAY 0.5|Cigna|CIGNA|73.25||||||| 9590142|ERX|0250|BENZOCAINE ORAL SPRAY 0.5|Blue Cross PPO Specialty|BCBSTX PPO|73.25||||||| 9590142|ERX|0250|BENZOCAINE ORAL SPRAY 0.5|Humana Medicare Advantage|HUMANA MA|73.25||||73.25||| 9590142|ERX|0250|BENZOCAINE ORAL SPRAY 0.5|Managed Medicaid|MEDICAID UNITED HEALTHCARE|73.25||||||| 9590142|ERX|0250|BENZOCAINE ORAL SPRAY 0.5|Managed Medicaid|MEDICAID SUPERIOR|||||73.25||| 9590241|ERX|0250|RIBAVIRIN 200MG CAPSULE|Managed Medicare|HEALTHSPRING MA|62.25||||||| 9590241|ERX|0250|RIBAVIRIN 200MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|62.25||||||| 9590241|ERX|0250|RIBAVIRIN 200MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|62.25||||||| 9590241|ERX|0250|RIBAVIRIN 200MG CAPSULE|United Healthcare|UMR UNITED MEDICAL RESOURCES|62.25||||||| 9590241|ERX|0250|RIBAVIRIN 200MG CAPSULE|United Healthcare|UNITED HEALTHCARE|||||62.25||| 9590241|ERX|0250|RIBAVIRIN 200MG CAPSULE|Workers Compensation|UT EMPLOYEE INJURY|62.25||||||| 9590241|ERX|0250|RIBAVIRIN 200MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|62.25||||||| 9590241|ERX|0250|RIBAVIRIN 200MG CAPSULE|Medicare|MEDICARE ACUTE|62.25||||||| 9590241|ERX|0250|RIBAVIRIN 200MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|62.25||||||| 9590241|ERX|0250|RIBAVIRIN 200MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|62.25||||||| 9590241|ERX|0250|RIBAVIRIN 200MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|62.25||||||| 9590241|ERX|0250|RIBAVIRIN 200MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|62.25||||||| 9590241|ERX|0250|RIBAVIRIN 200MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|62.25||||||| 9590241|ERX|0250|RIBAVIRIN 200MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|62.25||||||| 9590241|ERX|0250|RIBAVIRIN 200MG CAPSULE|Humana Medicare Advantage|HUMANA MA|62.25||||||| 9590241|ERX|0250|RIBAVIRIN 200MG CAPSULE|Cigna|CIGNA|62.25||||||| 9590241|ERX|0250|RIBAVIRIN 200MG CAPSULE|UTMB|UTMB CORRECTIONAL MANAGED CARE|62.25||||||| 9590241|ERX|0250|RIBAVIRIN 200MG CAPSULE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|62.25||||||| 9590274|ERX|0250|VILAZADONE 20MG TABLET|United Healthcare|UNITED HEALTHCARE|||||47.50||| 9590274|ERX|0250|VILAZADONE 20MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|47.50||||47.50||| 9590274|ERX|0250|VILAZADONE 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|47.50||||47.50||| 9590274|ERX|0250|VILAZADONE 20MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|47.50||||47.50||| 9590274|ERX|0250|VILAZADONE 20MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||47.50||| 9590274|ERX|0250|VILAZADONE 20MG TABLET|Humana Medicare Advantage|HUMANA MA|47.50||||47.50||| 9590274|ERX|0250|VILAZADONE 20MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||47.50||| 9590274|ERX|0250|VILAZADONE 20MG TABLET|Cigna|CIGNA|||||47.50||| 9590274|ERX|0250|VILAZADONE 20MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||47.50||| 9590274|ERX|0250|VILAZADONE 20MG TABLET|Aetna|AETNA PPO|||||47.50||| 9590274|ERX|0250|VILAZADONE 20MG TABLET|Aetna|AETNA OTHER|||||47.50||| 9590274|ERX|0250|VILAZADONE 20MG TABLET|Medicare|MEDICARE ACUTE|47.50||||47.50||| 9590274|ERX|0250|VILAZADONE 20MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|47.50||||47.50||| 9590308|ERX|0250|LISDEXAMFETAMINE 30MG CAP|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||54.25||| 9590308|ERX|0250|LISDEXAMFETAMINE 30MG CAP|Humana Medicare Advantage|HUMANA MA|54.25||||54.25||| 9590308|ERX|0250|LISDEXAMFETAMINE 30MG CAP|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||54.25||| 9590308|ERX|0250|LISDEXAMFETAMINE 30MG CAP|Managed Medicaid|MEDICAID SUPERIOR|54.25||||54.25||| 9590308|ERX|0250|LISDEXAMFETAMINE 30MG CAP|Blue Cross HMO Specialty|BCBSTX HMO|||||54.25||| 9590308|ERX|0250|LISDEXAMFETAMINE 30MG CAP|Blue Cross PPO Specialty|BCBSTX PPO|54.25||||54.25||| 9590308|ERX|0250|LISDEXAMFETAMINE 30MG CAP|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||54.25||| 9590308|ERX|0250|LISDEXAMFETAMINE 30MG CAP|Aenta Medicare Advantage|AETNA MEDICARE MA|||||54.25||| 9590308|ERX|0250|LISDEXAMFETAMINE 30MG CAP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|54.25||||54.25||| 9590308|ERX|0250|LISDEXAMFETAMINE 30MG CAP|Medicaid|HENDERSON COUNTY INDIGENT|54.25||||||| 9590308|ERX|0250|LISDEXAMFETAMINE 30MG CAP|Medicare|MEDICARE ACUTE|54.25||||54.25||| 9590308|ERX|0250|LISDEXAMFETAMINE 30MG CAP|United Healthcare|UNITED HEALTHCARE|54.25||||54.25||| 9590308|ERX|0250|LISDEXAMFETAMINE 30MG CAP|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|54.25||||54.25||| 9590316|ERX|0250|LIDOCAINE JELLY 2% 11ML S|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|47.75||||47.75||| 9590316|ERX|0250|LIDOCAINE JELLY 2% 11ML S|United Medicare Advantage|UHC MEDICARE GOLD MA|47.75||||47.75||| 9590316|ERX|0250|LIDOCAINE JELLY 2% 11ML S|United Medicare Advantage|AARP UHC WEST COMPLETE MA|47.75||||||| 9590316|ERX|0250|LIDOCAINE JELLY 2% 11ML S|Medicare|MEDICARE ACUTE|47.75||||47.75||| 9590316|ERX|0250|LIDOCAINE JELLY 2% 11ML S|United Healthcare|UNITED HEALTHCARE|||||47.75||| 9590316|ERX|0250|LIDOCAINE JELLY 2% 11ML S|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||47.75||| 9590316|ERX|0250|LIDOCAINE JELLY 2% 11ML S|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||47.75||| 9590316|ERX|0250|LIDOCAINE JELLY 2% 11ML S|Blue Cross HMO Specialty|BCBSTX HMO|47.75||||47.75||| 9590316|ERX|0250|LIDOCAINE JELLY 2% 11ML S|Humana Medicare Advantage|HUMANA MA|47.75||||47.75||| 9590316|ERX|0250|LIDOCAINE JELLY 2% 11ML S|Managed Medicaid|MEDICAID UNITED HEALTHCARE|47.75||||47.75||| 9590316|ERX|0250|LIDOCAINE JELLY 2% 11ML S|Blue Cross PPO Specialty|BCBSTX PPO|47.75||||47.75||| 9590316|ERX|0250|LIDOCAINE JELLY 2% 11ML S|Cigna|CIGNA|||||47.75||| 9590316|ERX|0250|LIDOCAINE JELLY 2% 11ML S|Managed Medicare|BCBS MEDICARE PPO MA|||||47.75||| 9590316|ERX|0250|LIDOCAINE JELLY 2% 11ML S|Aenta Medicare Advantage|AETNA MEDICARE MA|||||47.75||| 9590316|ERX|0250|LIDOCAINE JELLY 2% 11ML S|Aetna|AETNA PPO|||||47.75||| 9590357|ERX|0250|PRAZOSIN 5MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|||||11.50||| 9590399|ERX|0250|METRONIDAZOLE 250MG/50ML|United Medicare Advantage|UHC MEDICARE GOLD MA|125.50||||||| 9590399|ERX|0250|METRONIDAZOLE 250MG/50ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|125.50||||||| 9590399|ERX|0250|METRONIDAZOLE 250MG/50ML|Medicare|MEDICARE ACUTE|125.50||||125.50||| 9590407|ERX|0250|HEPARIN LOCK 10 UNIT/ML 5|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||27.25||| 9590472|ERX|0250|EPINEPHRINE(PF-SF) 1MG/ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||66.50||| 9590472|ERX|0250|EPINEPHRINE(PF-SF) 1MG/ML|Managed Medicaid|MEDICAID SUPERIOR|||||66.50||| 9590472|ERX|0250|EPINEPHRINE(PF-SF) 1MG/ML|Blue Cross PPO Specialty|BCBSTX PPO|||||66.50||| 9590472|ERX|0250|EPINEPHRINE(PF-SF) 1MG/ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||66.50||| 9590472|ERX|0250|EPINEPHRINE(PF-SF) 1MG/ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||66.50||| 9590472|ERX|0250|EPINEPHRINE(PF-SF) 1MG/ML|Aetna|AETNA PPO|||||66.50||| 9590472|ERX|0250|EPINEPHRINE(PF-SF) 1MG/ML|Medicare|MEDICARE ACUTE|||||66.50||| 9590472|ERX|0250|EPINEPHRINE(PF-SF) 1MG/ML|United Healthcare|UNITED HEALTHCARE|||||66.50||| 9590514|ERX|0250|VANCOMYCIN 1500MG IN 250M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.92||||||| 9590514|ERX|0250|VANCOMYCIN 1500MG IN 250M|Blue Cross PPO Specialty|BCBSTX PPO|0.92||||||| 9590514|ERX|0250|VANCOMYCIN 1500MG IN 250M|Managed Medicare|HEALTHSPRING MA|0.92||||||| 9590514|ERX|0250|VANCOMYCIN 1500MG IN 250M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.92||||||| 9590514|ERX|0250|VANCOMYCIN 1500MG IN 250M|Medicare|MEDICARE ACUTE|||||0.92||| 9590522|ERX|0250|DEXMEDETOMIDINE 200MCG/50|Humana Medicare Advantage|HUMANA MA|360.50||||360.50||| 9590522|ERX|0250|DEXMEDETOMIDINE 200MCG/50|Managed Medicaid|MEDICAID UNITED HEALTHCARE|360.50||||||| 9590522|ERX|0250|DEXMEDETOMIDINE 200MCG/50|Managed Medicaid|MEDICAID SUPERIOR|360.50||||||| 9590522|ERX|0250|DEXMEDETOMIDINE 200MCG/50|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|360.50||||||| 9590522|ERX|0250|DEXMEDETOMIDINE 200MCG/50|Blue Cross PPO Specialty|BCBSTX PPO|||||360.50||| 9590522|ERX|0250|DEXMEDETOMIDINE 200MCG/50|Medicaid|MEDICAID|360.50||||||| 9590522|ERX|0250|DEXMEDETOMIDINE 200MCG/50|Veterans Affairs|VETERANS ADMINISTRATION|360.50||||360.50||| 9590522|ERX|0250|DEXMEDETOMIDINE 200MCG/50|Medicare|MEDICARE ACUTE|360.50||||360.50||| 9590605|ERX|0250|NEOSTIGMINE 3MG/3ML SYRIN|Veterans Affairs|VETERANS ADMINISTRATION|1.77||||||| 9590605|ERX|0250|NEOSTIGMINE 3MG/3ML SYRIN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.77||||||| 9590605|ERX|0636||United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.77||||||| 9590605|ERX|0250|NEOSTIGMINE 3MG/3ML SYRIN|Medicare|MEDICARE ACUTE|1.77||||||| 9590605|ERX|0636||Medicare|MEDICARE ACUTE|1.77||||||| 9590605|ERX|0636||Blue Cross PPO Specialty|BCBSTX PPO|1.77||||||| 9590605|ERX|0636||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.77||| 9590605|ERX|0636||Blue Cross HMO Specialty|BCBSTX HMO|1.77||||||| 9590605|ERX|0636||Managed Medicaid|MEDICAID SUPERIOR|1.77||||||| 9590605|ERX|0636||Managed Medicaid|MEDICAID AMERIGROUP|1.77||||||| 9590605|ERX|0250|NEOSTIGMINE 3MG/3ML SYRIN|Humana Medicare Advantage|HUMANA MA|1.77||||||| 9590605|ERX|0250|NEOSTIGMINE 3MG/3ML SYRIN|Managed Medicaid|MEDICAID AMERIGROUP|1.77||||||| 9590639|ERX|0250|PHENYLEPH-SHARK LIVER-CCB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|9.25||||||| 9590753|ERX|0250|THEOPHYLLINE SR 400MG TAB|Medicare|MEDICARE ACUTE|0.10||||||| 9591066|ERX|0250|MIDAZOLAM 100 MG/100 ML N|Humana Medicare Advantage|HUMANA MA|0.85||||||| 9591074|ERX|0250|NOREPINEPHRINE 8 MG/250 M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|101.50||||||| 9591074|ERX|0250|NOREPINEPHRINE 8 MG/250 M|Medicare|MEDICARE ACUTE|101.50||||||| 963|DRG||OTHER MULTIPLE SIGNIFICANT TRAUMA W MCC|Humana Medicare Advantage|HUMANA MA|626.43|18981.16|18981.16|11795.5|||| 963|DRG||OTHER MULTIPLE SIGNIFICANT TRAUMA W MCC|Medicare|MEDICARE ACUTE|50,031.06|11795.5|18981.16|11795.5|||| 96360|EAP|0450|IV INFUSION HYDRATION UP|United Healthcare|UNITED HEALTHCARE OTHER|||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|United Medicare Advantage|UHC MEDICARE GOLD MA|411.25||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Veterans Affairs|VETERANS ADMINISTRATION|411.25||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Workers Compensation|WORKERS COMPENSATION OTHER|||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|United Medicare Advantage|UHC AARP MCR HMO MA|||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|United Medicare Advantage|AARP UHC WEST COMPLETE MA|411.25||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|411.25||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|United Healthcare|UNITED HEALTHCARE|411.25||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|United Healthcare|UNITED HEALTHCARE|||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|United Healthcare|GEHA|||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Medicare|MEDICARE ACUTE|411.25||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|NON CONTRACTED|COMMERCIAL OTHER 1|411.25||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|PHCS|MULTIPLAN PHCS OTHER|||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Managed Medicare|VAN ZANDT COUNTY INMATE|||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Medicaid|MEDICAID TEXAS CHILDRENS|||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Medicaid|MEDICAID HMO|||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Medicaid|MEDICAID|411.25||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Medicaid|HENDERSON COUNTY INDIGENT|411.25||||||| 96360|EAP|0450|IV INFUSION HYDRATION UP|United Healthcare|TML GROUP BENEFITS|411.25||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|411.25||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Managed Medicare|HEALTHSPRING MA|411.25||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Managed Medicare|BCBS MEDICARE PPO MA|411.25||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Aetna|AETNA PPO|||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Blue Cross PPO Specialty|BCBSTX OTHER|||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Managed Medicaid|MEDICAID SUPERIOR|411.25||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|411.25||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Managed Medicaid|MEDICAID AMERIGROUP|||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Cigna|CIGNA|||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Humana Medicare Advantage|HUMANA MA|411.25||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|ChampVA|CHAMPVA CENTER|||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|MTC Medical|VAN ZANDT COUNTY INMATE|||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Blue Cross HMO Specialty|BCBSTX HMO|||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Blue Cross PPO Specialty|BCBSTX PPO|411.25||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Managed Medicaid|MEDICAID UNITED HEALTHCARE|411.25||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|411.25||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Aenta Medicare Advantage|AETNA MEDICARE MA|411.25||||411.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||411.25||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Cigna|CIGNA OTHER|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Humana Medicare Advantage|HUMANA MA|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|MTC Medical|VAN ZANDT COUNTY INMATE|||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Managed Medicaid|MEDICAID SUPERIOR|218.50||||218.50||| 96361|EAP|0761|IV INF HYDRATION EA ADL H|Humana Medicare Advantage|HUMANA MA|||||255.25||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Managed Medicaid|MEDICAID AMERIGROUP|218.50||||218.50||| 96361|EAP|0761|IV INF HYDRATION EA ADL H|Managed Medicaid|MEDICAID SUPERIOR|||||255.25||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Blue Cross PPO Specialty|BCBSTX OTHER|||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|ChampVA|CHAMPVA CENTER|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Blue Cross HMO Specialty|BCBSTX HMO|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Access Direct Platinum|HEALTHFIRST TPA UMR|||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Aetna|AETNA PPO|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Aetna|AETNA OTHER|||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Managed Medicare|VAN ZANDT COUNTY INMATE|||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Medicaid|MEDICAID TEXAS CHILDRENS|||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Medicaid|MEDICAID|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Medicaid|LAW ENFORCEMENT OTHER|||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|218.50||||218.50||| 96361|EAP|0260|IV INFUSION HYDRATION EA|Medicare|MEDICARE ACUTE|||||349.25||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Medicare|MEDICARE PART B ONLY IP|218.50||||||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|NON CONTRACTED|COMMERCIAL OTHER 1|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|PHCS|HUMANA|||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Healthcare|UNITED HEALTHCARE|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Healthcare|TML GROUP BENEFITS|||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Healthcare|GOLDEN RULE|||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Workers Compensation|UT EMPLOYEE INJURY|218.50||||||| 96361|EAP|0761|IV INF HYDRATION EA ADL H|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||255.25||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Blue Cross PPO Specialty|BCBSTX PPO|218.50||||218.50||| 96361|EAP|0761|IV INF HYDRATION EA ADL H|Blue Cross PPO Specialty|BCBSTX PPO|||||255.25||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Aenta Medicare Advantage|AETNA MEDICARE MA|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Workers Compensation|WORKERS COMPENSATION OTHER|||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Medicare Advantage|UHC MEDICARE GOLD MA|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Veterans Affairs|VETERANS ADMINISTRATION|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Healthcare|UMR UNITED MEDICAL RESOURCES|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Medicare Advantage|UHC AARP WELLMED HMO MA|||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Medicare Advantage|UHC AARP MCR HMO MA|||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Medicare Advantage|AARP UHC WEST COMPLETE MA|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Healthcare|UNITED HEALTHCARE OTHER|||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Medicare|MEDICARE ACUTE|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Managed Medicaid|MEDICAID UNITED HEALTHCARE|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|UTMB|UTMB CORRECTIONAL MANAGED CARE|||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Tricare|TRICARE FOR LIFE|||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Tricare|TRICARE EAST REGION|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Cigna|CIGNA|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|NON CONTRACTED|COMMERCIAL OTHER 2|||||218.50||| 96361|EAP|0761|IV INF HYDRATION EA ADL H|Managed Medicare|HEALTHSPRING MA|||||255.25||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Managed Medicare|BCBS MEDICARE PPO MA|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Managed Medicare|HEALTHSPRING MA|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Medicaid|HENDERSON COUNTY INDIGENT|218.50||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Medicaid|COUNTY INDIGENT HEALTH OTHER|218.50||||||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Medicaid|MEDICAID BCBSTX|||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Managed Medicare|MA PART B ONLY IP|218.50||||||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Medicaid|MEDICAID HMO|||||218.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Medicaid|MOLINA HEALTHCARE OF TEXAS|218.50||||218.50||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Veterans Affairs|VETERANS ADMINISTRATION|||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Veterans Affairs|VETERANS ADMINISTRATION|411.25||||411.25||| 96365|EAP|0761|THER/PROPH/DIAG IV INF IN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||528.25||| 96365|EAP|0761|THER/PROPH/DIAG IV INF IN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||528.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Workers Compensation|WORKERS COMPENSATION OTHER|||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Workers Compensation|UT EMPLOYEE INJURY|411.25||||||| 96365|EAP|0450|IV INF THER PROPH DX UP T|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|United Medicare Advantage|UHC AARP MCR HMO MA|411.25||||411.25||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||589.50||| 96365|EAP|0450|IV INF THER PROPH DX UP T|United Healthcare|UNITED HEALTHCARE OTHER|||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|United Healthcare|UMR UNITED MEDICAL RESOURCES|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|United Healthcare|TML GROUP BENEFITS|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|United Healthcare|GOLDEN RULE|||||411.25||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Medicare|MEDICARE ACUTE|||||589.50||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Tricare|TRICARE EAST REGION|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|UTMB|UTMB CORRECTIONAL MANAGED CARE|||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|NON CONTRACTED|COMMERCIAL OTHER 1|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Medicare|MEDICARE PART B ONLY IP|411.25||||||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Medicare|MEDICARE ACUTE|411.25||||411.25||| 96365|EAP|0761|THER/PROPH/DIAG IV INF IN|Medicare|MEDICARE ACUTE|||||528.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Managed Medicare|MA PART B ONLY IP|411.25||||||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Medicaid|MOLINA HEALTHCARE OF TEXAS|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Medicaid|MEDICAID|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Medicaid|HENDERSON COUNTY INDIGENT|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Managed Medicare|BCBS MEDICARE PPO MA|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Medicaid|COUNTY INDIGENT HEALTH OTHER|411.25||||||| 96365|EAP|0761|THER/PROPH/DIAG IV INF IN|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||528.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Medicaid|LAW ENFORCEMENT OTHER|||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Managed Medicare|OTHER INSTITUTIONS|||||411.25||| 96365|EAP|0761|THER/PROPH/DIAG IV INF IN|Managed Medicare|BCBS MEDICARE PPO MA|||||528.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Aenta Medicare Advantage|AETNA MEDICARE MA|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Medicaid|MEDICAID TEXAS CHILDRENS|||||411.25||| 96365|EAP|0761|THER/PROPH/DIAG IV INF IN|Aenta Medicare Advantage|AETNA MEDICARE MA|||||528.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Managed Medicare|HEALTHSPRING MA|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Access Direct Platinum|HEALTHFIRST TPA UMR|||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Managed Medicare|HOSPICE ETMC|||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Medicaid|MEDICAID HMO|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Aetna|AETNA PPO|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Blue Cross PPO Specialty|BCBSTX PPO|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Blue Cross PPO Specialty|BCBSTX OTHER|||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Brinson Benefits|THE HEALTH PLAN SMITH CO|||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|United Healthcare|UNITED HEALTHCARE|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|ChampVA|CHAMPVA CENTER|||||411.25||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Blue Cross PPO Specialty|BCBSTX PPO|||||589.50||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Blue Cross HMO Specialty|BCBSTX HMO|411.25||||411.25||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||589.50||| 96365|EAP|0450|IV INF THER PROPH DX UP T|United Medicare Advantage|UHC MEDICARE GOLD MA|411.25||||411.25||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Managed Medicaid|MEDICAID SUPERIOR|||||589.50||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||589.50||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Managed Medicaid|MEDICAID UNITED HEALTHCARE|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Managed Medicaid|MEDICAID SUPERIOR|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|United Medicare Advantage|AARP UHC WEST COMPLETE MA|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Managed Medicaid|MEDICAID AMERIGROUP|411.25||||411.25||| 96365|EAP|0761|THER/PROPH/DIAG IV INF IN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||528.25||| 96365|EAP|0761|THER/PROPH/DIAG IV INF IN|Managed Medicaid|MEDICAID SUPERIOR|||||528.25||| 96365|EAP|0761|THER/PROPH/DIAG IV INF IN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||528.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Cigna|CIGNA OTHER|411.25||||411.25||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Humana Medicare Advantage|HUMANA MA|||||589.50||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Cigna|CIGNA|||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Humana Medicare Advantage|HUMANA MA|411.25||||411.25||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Cigna|CIGNA|411.25||||411.25||| 96365|EAP|0761|THER/PROPH/DIAG IV INF IN|Humana Medicare Advantage|HUMANA MA|528.25||||528.25||| 96366|EAP|0260|IV INFUSION EA HR UP TO 8|Humana Medicare Advantage|HUMANA MA|||||2.08||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Humana Medicare Advantage|HUMANA MA|241.50||||241.50||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Managed Medicaid|MEDICAID SUPERIOR|241.50||||||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|241.50||||241.50||| 96366|EAP|0761|INFUSION THERAPY ADDN HOU|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.82||| 96366|EAP|0761|INFUSION THERAPY ADDN HOU|Blue Cross PPO Specialty|BCBSTX PPO|||||2.82||| 96366|EAP|0450|IV INF THER PROPH DX EA A|ChampVA|CHAMPVA CENTER|||||241.50||| 96366|EAP|0761|INFUSION THERAPY ADDN HOU|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.82||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Aenta Medicare Advantage|AETNA MEDICARE MA|241.50||||241.50||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Medicaid|MEDICAID|241.50||||||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Medicaid|HENDERSON COUNTY INDIGENT|241.50||||241.50||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||241.50||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|241.50||||||| 96366|EAP|0761|INFUSION THERAPY ADDN HOU|Managed Medicare|HEALTHSPRING MA|||||2.82||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Managed Medicare|HEALTHSPRING MA|241.50||||241.50||| 96366|EAP|0260|IV INFUSION EA HR UP TO 8|Medicare|MEDICARE ACUTE|||||2.08||| 96366|EAP|0450|IV INF THER PROPH DX EA A|NON CONTRACTED|COMMERCIAL OTHER 1|||||241.50||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Blue Cross HMO Specialty|BCBSTX HMO|||||241.50||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Medicare|MEDICARE ACUTE|241.50||||241.50||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Blue Cross PPO Specialty|BCBSTX PPO|241.50||||241.50||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Aetna|AETNA PPO|241.50||||241.50||| 96366|EAP|0450|IV INF THER PROPH DX EA A|United Healthcare|UMR UNITED MEDICAL RESOURCES|241.50||||||| 96366|EAP|0260|IV INFUSION EA HR UP TO 8|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.08||| 96366|EAP|0450|IV INF THER PROPH DX EA A|United Healthcare|UNITED HEALTHCARE|||||241.50||| 96366|EAP|0450|IV INF THER PROPH DX EA A|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|241.50||||241.50||| 96366|EAP|0450|IV INF THER PROPH DX EA A|United Medicare Advantage|UHC MEDICARE GOLD MA|241.50||||241.50||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|241.50||||241.50||| 96366|EAP|0450|IV INF THER PROPH DX EA A|United Medicare Advantage|UHC AARP MCR HMO MA|||||241.50||| 96366|EAP|0450|IV INF THER PROPH DX EA A|United Medicare Advantage|AARP UHC WEST COMPLETE MA|241.50||||241.50||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Managed Medicaid|MEDICAID AMERIGROUP|241.50||||241.50||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Veterans Affairs|VETERANS ADMINISTRATION|||||241.50||| 96366|EAP|0761|INFUSION THERAPY ADDN HOU|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.82||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Managed Medicaid|MEDICAID UNITED HEALTHCARE|241.50||||241.50||| 96366|EAP|0761|INFUSION THERAPY ADDN HOU|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.82||| 96366|EAP|0761|INFUSION THERAPY ADDN HOU|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.82||| 96366|EAP|0761|INFUSION THERAPY ADDN HOU|Humana Medicare Advantage|HUMANA MA|2.82||||2.82||| 96366|EAP|0260|IV INFUSION EA HR UP TO 8|Blue Cross PPO Specialty|BCBSTX PPO|||||2.08||| 96366|EAP|0260|IV INFUSION EA HR UP TO 8|Managed Medicaid|MEDICAID SUPERIOR|||||2.08||| 96366|EAP|0761|INFUSION THERAPY ADDN HOU|Cigna|CIGNA|||||2.82||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Cigna|CIGNA|||||241.50||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Cigna|CIGNA|241.50||||241.50||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|231.25||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|United Medicare Advantage|AARP UHC WEST COMPLETE MA|231.25||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Veterans Affairs|VETERANS ADMINISTRATION|231.25||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Veterans Affairs|VETERANS ADMINISTRATION|||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|United Healthcare|UNITED HEALTHCARE OTHER|||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|United Healthcare|UNITED HEALTHCARE|||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Tricare|TRICARE EAST REGION|231.25||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Medicare|MEDICARE ACUTE|231.25||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Medicaid|MOLINA HEALTHCARE OF TEXAS|231.25||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Medicaid|MEDICAID TEXAS CHILDRENS|||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Managed Medicare|HEALTHSPRING MA|231.25||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|NON CONTRACTED|COMMERCIAL OTHER 1|||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Aenta Medicare Advantage|AETNA MEDICARE MA|231.25||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Workers Compensation|UT EMPLOYEE INJURY|231.25||||||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Aetna|AETNA PPO|231.25||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Medicaid|MEDICAID HMO|231.25||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|231.25||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|United Medicare Advantage|UHC MEDICARE GOLD MA|231.25||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Blue Cross PPO Specialty|BCBSTX PPO|231.25||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Blue Cross PPO Specialty|BCBSTX OTHER|||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|ChampVA|CHAMPVA CENTER|||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Blue Cross HMO Specialty|BCBSTX HMO|231.25||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Managed Medicaid|MEDICAID UNITED HEALTHCARE|231.25||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Managed Medicaid|MEDICAID SUPERIOR|231.25||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Managed Medicaid|MEDICAID AMERIGROUP|231.25||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Cigna|CIGNA|||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Humana Medicare Advantage|HUMANA MA|231.25||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|231.25||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Medicaid|HENDERSON COUNTY INDIGENT|||||231.25||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Cigna|CIGNA|231.25||||231.25||| 96368|EAP|0260|IV INFUSION CONCURRENT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||129.25||| 96372|EAP|0450|INJ SUBQ/IM|Blue Cross PPO Specialty|BCBSTX PPO|167.25||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Managed Medicaid|MEDICAID AMERIGROUP|167.25||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|MTC Medical|VAN ZANDT COUNTY INMATE|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Cigna|CIGNA OTHER|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Cigna|CIGNA|167.25||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Cigna|CIGNA|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Humana Medicare Advantage|HUMANA MA|167.25||||167.25||| 96372|EAP|0761|INJ SUBQ/IMM|Humana Medicare Advantage|HUMANA MA|214.25||||214.25||| 96372|EAP|0940|INJ ADMIN THERP OR DIAGNO|Humana Medicare Advantage|HUMANA MA|||||291.25||| 96372|EAP|0450|INJ SUBQ/IM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|167.25||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Managed Medicaid|MEDICAID SUPERIOR|167.25||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|167.25||||167.25||| 96372|EAP|0761|INJ SUBQ/IMM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||214.25||| 96372|EAP|0761|INJ SUBQ/IMM|Managed Medicaid|MEDICAID SUPERIOR|||||214.25||| 96372|EAP|0761|INJ SUBQ/IMM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||214.25||| 96372|EAP|0761|INJ SUBQ/IMM|Managed Medicaid|MEDICAID AMERIGROUP|||||214.25||| 96372|EAP|0761|INJ SUBQ/IMM|Blue Cross HMO Specialty|BCBSTX HMO|||||214.25||| 96372|EAP|0450|INJ SUBQ/IM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|167.25||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Blue Cross PPO Specialty|BLUE SHIELD PHYSICIAN|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Blue Cross PPO Specialty|BCBSTX OTHER|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|167.25||||167.25||| 96372|EAP|0761|INJ SUBQ/IMM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||214.25||| 96372|EAP|0450|INJ SUBQ/IM|Blue Cross HMO Specialty|BCBSTX HMO|167.25||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Aenta Medicare Advantage|AETNA MEDICARE MA|167.25||||167.25||| 96372|EAP|0761|INJ SUBQ/IMM|Aenta Medicare Advantage|AETNA MEDICARE MA|||||214.25||| 96372|EAP|0450|INJ SUBQ/IM|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|167.25||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||167.25||| 96372|EAP|0761|INJ SUBQ/IMM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||214.25||| 96372|EAP|0761|INJ SUBQ/IMM|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||214.25||| 96372|EAP|0940|INJ ADMIN THERP OR DIAGNO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||291.25||| 96372|EAP|0450|INJ SUBQ/IM|Aetna|AETNA OTHER|||||167.25||| 96372|EAP|0761|INJ SUBQ/IMM|Aetna|AETNA PPO|||||214.25||| 96372|EAP|0761|INJ SUBQ/IMM|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||214.25||| 96372|EAP|0761|INJ SUBQ/IMM|Managed Medicare|BCBS MEDICARE PPO MA|||||214.25||| 96372|EAP|0450|INJ SUBQ/IM|Medicaid|MOLINA HEALTHCARE OF TEXAS|167.25||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Medicaid|MEDICAID TEXAS CHILDRENS|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Medicaid|MEDICAID HMO|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Medicaid|MEDICAID|167.25||||167.25||| 96372|EAP|0761|INJ SUBQ/IMM|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||214.25||| 96372|EAP|0450|INJ SUBQ/IM|Medicaid|LAW ENFORCEMENT OTHER|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Medicaid|HENDERSON COUNTY INDIGENT|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Medicaid|COUNTY INDIGENT HEALTH OTHER|167.25||||||| 96372|EAP|0761|INJ SUBQ/IMM|Managed Medicare|HEALTHSPRING MA|||||214.25||| 96372|EAP|0450|INJ SUBQ/IM|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||167.25||| 96372|EAP|0761|INJ SUBQ/IMM|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||214.25||| 96372|EAP|0761|INJ SUBQ/IMM|Medicaid|MEDICAID HMO|||||214.25||| 96372|EAP|0761|INJ SUBQ/IMM|Medicaid|HENDERSON COUNTY INDIGENT|||||214.25||| 96372|EAP|0450|INJ SUBQ/IM|Managed Medicare|WELLCARE CHOICE MA|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Aetna|BOON CHAPMAN|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Managed Medicare|VAN ZANDT COUNTY INMATE|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|167.25||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Aetna|AETNA PPO|167.25||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|167.25||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Managed Medicare|HEALTHSPRING MA|167.25||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Managed Medicare|BCBS MEDICARE PPO MA|167.25||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Tricare|TRICARE EAST REGION|167.25||||167.25||| 96372|EAP|0761|INJ SUBQ/IMM|Tricare|TRICARE EAST REGION|||||214.25||| 96372|EAP|0450|INJ SUBQ/IM|NON CONTRACTED|COMMERCIAL OTHER 2|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|NON CONTRACTED|COMMERCIAL OTHER 1|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Medicare|MEDICARE ACUTE|167.25||||167.25||| 96372|EAP|0761|INJ SUBQ/IMM|NON CONTRACTED|COMMERCIAL OTHER 1|||||214.25||| 96372|EAP|0450|INJ SUBQ/IM|ChampVA|CHAMPVA CENTER|||||167.25||| 96372|EAP|0761|INJ SUBQ/IMM|Blue Cross PPO Specialty|BCBSTX PPO|||||214.25||| 96372|EAP|0450|INJ SUBQ/IM|PHCS|MULTIPLAN PHCS OTHER|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|PHCS|HUMANA INSURANCE|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|PHCS|HUMANA|||||167.25||| 96372|EAP|0761|INJ SUBQ/IMM|Medicare|MEDICARE PART B ONLY IP|214.25||||||| 96372|EAP|0761|INJ SUBQ/IMM|Medicare|MEDICARE ACUTE|214.25||||214.25||| 96372|EAP|0940|INJ ADMIN THERP OR DIAGNO|Medicare|MEDICARE ACUTE|||||291.25||| 96372|EAP|0450|INJ SUBQ/IM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|167.25||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Veterans Affairs|VETERANS ADMINISTRATION|167.25||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Veterans Affairs|VETERANS ADMINISTRATION|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Tricare|TRICARE FOR LIFE|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|United Medicare Advantage|UHC MEDICARE GOLD MA|167.25||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|United Medicare Advantage|UHC AARP MCR HMO MA|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|167.25||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Workers Compensation|GALLAGHER BASSETT|||||167.25||| 96372|EAP|0761|INJ SUBQ/IMM|Veterans Affairs|VETERANS ADMINISTRATION|214.25||||214.25||| 96372|EAP|0761|INJ SUBQ/IMM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||214.25||| 96372|EAP|0761|INJ SUBQ/IMM|United Medicare Advantage|UHC MEDICARE GOLD MA|||||214.25||| 96372|EAP|0761|INJ SUBQ/IMM|Cigna|CIGNA|||||214.25||| 96372|EAP|0761|INJ SUBQ/IMM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||214.25||| 96372|EAP|0450|INJ SUBQ/IM|Workers Compensation|WORKERS COMPENSATION OTHER|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Workers Compensation|UT EMPLOYEE INJURY|||||167.25||| 96372|EAP|0761|INJ SUBQ/IMM|Workers Compensation|WORKERS COMPENSATION OTHER|||||214.25||| 96372|EAP|0761|INJ SUBQ/IMM|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||214.25||| 96372|EAP|0450|INJ SUBQ/IM|United Healthcare|UNITED HEALTHCARE OTHER|167.25||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Workers Compensation|TEXAS MUTUAL INSURANCE|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|United Healthcare|UNITED HEALTHCARE|167.25||||167.25||| 96372|EAP|0761|INJ SUBQ/IMM|United Healthcare|UNITED HEALTHCARE|||||214.25||| 96372|EAP|0450|INJ SUBQ/IM|United Healthcare|UNITED HEALTHCARE|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|Workers Compensation|WORKERS COMP PHYSICIAN|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|United Healthcare|TML GROUP BENEFITS|||||167.25||| 96372|EAP|0450|INJ SUBQ/IM|United Healthcare|GOLDEN RULE|||||167.25||| 96374|EAP|0940|IV PUSH THERAP/DIAGNOSTIC|Medicare|MEDICARE ACUTE|||||387.25||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|305.75||||305.75||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|Managed Medicare|HEALTHSPRING MA|||||357.25||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicare|HOSPICE OF EAST TEXAS|305.75||||||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicare|HEALTHSPRING MA|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicare|WELLCARE CHOICE MA|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicaid|MOLINA HEALTHCARE OF TEXAS|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicaid|MEDICAID TEXAS CHILDRENS|||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicaid|MEDICAID HMO|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicaid|MEDICAID BCBSTX|||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicaid|MEDICAID|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicaid|HENDERSON COUNTY INDIGENT|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicaid|COUNTY INDIGENT HEALTH OTHER|305.75||||||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||357.25||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|Medicaid|MEDICAID|||||357.25||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|Medicaid|HENDERSON COUNTY INDIGENT|||||357.25||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicare|VAN ZANDT COUNTY INMATE|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|305.75||||305.75||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||357.25||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Aetna|AETNA OTHER|||||305.75||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|Blue Cross HMO Specialty|BCBSTX HMO|||||357.25||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|Blue Cross PPO Specialty|BCBSTX PPO|||||357.25||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Blue Cross HMO Specialty|BCBSTX HMO|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicaid|MEDICAID AMERIGROUP|305.75||||305.75||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|Managed Medicaid|MEDICAID AMERIGROUP|357.25||||357.25||| 96374|EAP|0940|IV PUSH THERAP/DIAGNOSTIC|Managed Medicaid|MEDICAID SUPERIOR|||||387.25||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Cigna|CIGNA|305.75||||305.75||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|Medicaid|MEDICAID HMO|||||357.25||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|Cigna|CIGNA OTHER|||||357.25||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Humana Medicare Advantage|HUMANA MA|305.75||||305.75||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|Humana Medicare Advantage|HUMANA MA|357.25||||357.25||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Cigna|CIGNA OTHER|305.75||||305.75||| 96374|EAP|0940|IV PUSH THERAP/DIAGNOSTIC|Humana Medicare Advantage|HUMANA MA|||||387.25||| 96374|EAP|0940|IV PUSH THERAP/DIAGNOSTIC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||387.25||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|MTC Medical|VAN ZANDT COUNTY INMATE|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicaid|LAW ENFORCEMENT OTHER|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicaid|MEDICAID SUPERIOR|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicare|BCBS MEDICARE PPO MA|305.75||||305.75||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||357.25||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|ChampVA|CHAMPVA CENTER|305.75||||305.75||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||357.25||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicare|MA PART B ONLY IP|305.75||||||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Blue Cross PPO Specialty|BCBSTX PPO|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|305.75||||305.75||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|Aetna|AETNA PPO|||||357.25||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Aetna|AETNA PPO|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Blue Cross PPO Specialty|BCBSTX OTHER|||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Aetna|BOON CHAPMAN|305.75||||305.75||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|Medicare|MEDICARE ACUTE|||||357.25||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|305.75||||305.75||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|Aenta Medicare Advantage|AETNA MEDICARE MA|||||357.25||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Access Direct Platinum|HEALTHFIRST TPA UMR|||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Aenta Medicare Advantage|AETNA MEDICARE MA|305.75||||305.75||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|Managed Medicaid|MEDICAID SUPERIOR|357.25||||357.25||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||305.75||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||357.25||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|United Healthcare|UNITED HEALTHCARE|||||357.25||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||357.25||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Healthcare|UNITED HEALTHCARE|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Healthcare|UMR UNITED MEDICAL RESOURCES|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Healthcare|TML GROUP BENEFITS|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Veterans Affairs|VETERANS ADMINISTRATION|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Medicare Advantage|UHC MEDICARE GOLD MA|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Medicare Advantage|UHC AARP WELLMED HMO MA|||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Medicare Advantage|UHC AARP MCR HMO MA|||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|305.75||||305.75||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||357.25||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|United Medicare Advantage|UHC MEDICARE GOLD MA|||||357.25||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||357.25||| 96374|EAP|0940|IV PUSH THERAP/DIAGNOSTIC|United Medicare Advantage|UHC MEDICARE GOLD MA|||||387.25||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|Veterans Affairs|VETERANS ADMINISTRATION|||||357.25||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Healthcare|GOLDEN RULE|||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Workers Compensation|WORKERS COMPENSATION OTHER|||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Workers Compensation|UT EMPLOYEE INJURY|||||305.75||| 96374|EAP|0940|IV PUSH THERAP/DIAGNOSTIC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||387.25||| 96374|EAP|0940|IV PUSH THERAP/DIAGNOSTIC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||387.25||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Healthcare|UNITED HEALTHCARE OTHER|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Tricare|TRICARE FOR LIFE|||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Tricare|TRICARE EAST REGION|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|UTMB|UTMB CORRECTIONAL MANAGED CARE|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|NON CONTRACTED|COMMERCIAL OTHER 2|||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|NON CONTRACTED|COMMERCIAL OTHER 1|305.75||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicare|MEDICARE PART B ONLY IP|305.75||||||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicare|MEDICARE ACUTE|305.75||||305.75||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|NON CONTRACTED|COMMERCIAL OTHER 1|||||357.25||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|PHCS|MULTIPLAN PHCS OTHER|||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|PHCS|HUMANA INSURANCE|||||305.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|PHCS|HUMANA|||||305.75||| 96374|EAP|0761|INJ IV PUSH INITIAL DRUG|Medicare|MEDICARE PART B ONLY IP|357.25||||||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|Humana Medicare Advantage|HUMANA MA|357.25||||357.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Cigna|CIGNA OTHER|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Cigna|CIGNA|305.75||||305.75||| 96375|EAP|0761||Cigna|CIGNA|||||357.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Humana Medicare Advantage|HUMANA MA|305.75||||305.75||| 96375|EAP|0761||Humana Medicare Advantage|HUMANA MA|357.25||||357.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|MTC Medical|VAN ZANDT COUNTY INMATE|305.75||||305.75||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|Managed Medicaid|MEDICAID SUPERIOR|||||357.25||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||357.25||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|Managed Medicaid|MEDICAID AMERIGROUP|||||357.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicaid|MEDICAID SUPERIOR|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicaid|MEDICAID AMERIGROUP|305.75||||305.75||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|Managed Medicare|MA PART B ONLY IP|357.25||||||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|Managed Medicare|BCBS MEDICARE PPO MA|||||357.25||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|Managed Medicare|HEALTHSPRING MA|||||357.25||| 96375|EAP|0761||Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||357.25||| 96375|EAP|0761||Managed Medicaid|MEDICAID SUPERIOR|357.25||||357.25||| 96375|EAP|0761||Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||357.25||| 96375|EAP|0761||Managed Medicaid|MEDICAID AMERIGROUP|357.25||||357.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Blue Cross PPO Specialty|BCBSTX PPO|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Blue Cross PPO Specialty|BCBSTX OTHER|||||305.75||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|Blue Cross HMO Specialty|BCBSTX HMO|||||357.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|ChampVA|CHAMPVA CENTER|||||305.75||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|Cigna|CIGNA|||||357.25||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|Cigna|CIGNA OTHER|||||357.25||| 96375|EAP|0761||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||357.25||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|Blue Cross PPO Specialty|BCBSTX PPO|||||357.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Blue Cross HMO Specialty|BCBSTX HMO|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Aenta Medicare Advantage|AETNA MEDICARE MA|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Access Direct Platinum|HEALTHFIRST TPA UMR|||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||305.75||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||357.25||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|Aetna|AETNA PPO|||||357.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Aetna|BOON CHAPMAN|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Aetna|AETNA PPO|305.75||||305.75||| 96375|EAP|0761||Aetna|AETNA PPO|||||357.25||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|Aenta Medicare Advantage|AETNA MEDICARE MA|||||357.25||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||357.25||| 96375|EAP|0260|IV PUSH THERAP/DIAGNOSTIC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||317.25||| 96375|EAP|0761||Managed Medicare|HEALTHSPRING MA|||||357.25||| 96375|EAP|0761||Managed Medicare|BCBS MEDICARE PPO MA|||||357.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicare|WELLCARE CHOICE MA|||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Medicaid|MOLINA HEALTHCARE OF TEXAS|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Medicaid|MEDICAID TEXAS CHILDRENS|||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Medicaid|MEDICAID HMO|||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Medicaid|MEDICAID|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Medicaid|LAW ENFORCEMENT OTHER|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Medicaid|HENDERSON COUNTY INDIGENT|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Medicaid|COUNTY INDIGENT HEALTH OTHER|305.75||||||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicare|VAN ZANDT COUNTY INMATE|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicare|OTHER INSTITUTIONS|||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicare|MA PART B ONLY IP|305.75||||||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicare|HOSPICE OF EAST TEXAS|305.75||||||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Aetna|AETNA OTHER|||||305.75||| 96375|EAP|0761||Medicaid|MOLINA HEALTHCARE OF TEXAS|||||357.25||| 96375|EAP|0761||Medicaid|MEDICAID|||||357.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicare|HOSPICE ETMC|||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|305.75||||305.75||| 96375|EAP|0761||Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||357.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicare|HEALTHSPRING MA|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicare|BCBS MEDICARE PPO MA|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|305.75||||305.75||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|Medicaid|MEDICAID|||||357.25||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||357.25||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|Medicaid|HENDERSON COUNTY INDIGENT|||||357.25||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|United Healthcare|UNITED HEALTHCARE|||||357.25||| 96375|EAP|0260|IV PUSH THERAP/DIAGNOSTIC|Medicare|MEDICARE ACUTE|||||317.25||| 96375|EAP|0761||ChampVA|CHAMPVA CENTER|||||357.25||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|Medicare|MEDICARE PART B ONLY IP|357.25||||||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|Medicare|MEDICARE ACUTE|||||357.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Tricare|TRICARE FOR LIFE|||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Tricare|TRICARE EAST REGION|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|NON CONTRACTED|COMMERCIAL OTHER 2|||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|NON CONTRACTED|COMMERCIAL OTHER 1|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Medicare|MEDICARE ACUTE|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|PHCS|MULTIPLAN PHCS OTHER|||||305.75||| 96375|EAP|0761||Blue Cross PPO Specialty|BCBSTX PPO|||||357.25||| 96375|EAP|0761||Blue Cross HMO Specialty|BCBSTX HMO|||||357.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|PHCS|HUMANA|||||305.75||| 96375|EAP|0761||Medicare|MEDICARE PART B ONLY IP|357.25||||||| 96375|EAP|0761||Medicare|MEDICARE ACUTE|357.25||||357.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Veterans Affairs|VETERANS ADMINISTRATION|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Veterans Affairs|VETERANS ADMINISTRATION|||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Workers Compensation|UT EMPLOYEE INJURY|||||305.75||| 96375|EAP|0761||Veterans Affairs|VETERANS ADMINISTRATION|357.25||||357.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|305.75||||305.75||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||357.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Medicare Advantage|UHC MEDICARE GOLD MA|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Medicare Advantage|UHC AARP WELLMED HMO MA|||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Medicare Advantage|UHC AARP MCR HMO MA|||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Medicare Advantage|AARP UHC WEST COMPLETE MA|305.75||||305.75||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||357.25||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|Workers Compensation|WORKERS COMPENSATION OTHER|||||357.25||| 96375|EAP|0761||United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||357.25||| 96375|EAP|0761||United Medicare Advantage|UHC MEDICARE GOLD MA|357.25||||357.25||| 96375|EAP|0761||United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||357.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Workers Compensation|WORKERS COMPENSATION OTHER|||||305.75||| 96375|EAP|0761||Workers Compensation|WORKERS COMPENSATION OTHER|||||357.25||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|Veterans Affairs|VETERANS ADMINISTRATION|||||357.25||| 96375|EAP|0761||United Healthcare|UNITED HEALTHCARE|||||357.25||| 96375|EAP|0260|IV PUSH THERAP/DIAGNOSTIC|Humana Medicare Advantage|HUMANA MA|357.25||||317.25||| 96375|EAP|0260|IV PUSH THERAP/DIAGNOSTIC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|357.25||||317.25||| 96375|EAP|0260|IV PUSH THERAP/DIAGNOSTIC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||317.25||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|357.25||||357.25||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|United Medicare Advantage|UHC MEDICARE GOLD MA|||||357.25||| 96375|EAP|0260|INJ IV PUSH ADDL SEQ NEW|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||357.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Healthcare|UNITED HEALTHCARE OTHER|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Healthcare|UNITED HEALTHCARE|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Healthcare|UMR UNITED MEDICAL RESOURCES|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Healthcare|TML GROUP BENEFITS|305.75||||305.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Healthcare|GOLDEN RULE|||||305.75||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|United Healthcare|UNITED HEALTHCARE|||||190.50||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|United Healthcare|UNITED HEALTHCARE OTHER|||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|United Healthcare|UNITED HEALTHCARE|163.25||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|United Healthcare|TML GROUP BENEFITS|163.25||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Veterans Affairs|VETERANS ADMINISTRATION|163.25||||163.25||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|Veterans Affairs|VETERANS ADMINISTRATION|190.50||||190.50||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|United Medicare Advantage|UHC MEDICARE GOLD MA|163.25||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|United Medicare Advantage|UHC AARP MCR HMO MA|||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|United Medicare Advantage|AARP UHC WEST COMPLETE MA|163.25||||163.25||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|190.50||||190.50||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|United Medicare Advantage|UHC MEDICARE GOLD MA|||||190.50||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||190.50||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Workers Compensation|WORKERS COMPENSATION OTHER|||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Tricare|TRICARE EAST REGION|163.25||||163.25||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|Tricare|TRICARE EAST REGION|||||190.50||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|NON CONTRACTED|COMMERCIAL OTHER 1|163.25||||163.25||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|NON CONTRACTED|COMMERCIAL OTHER 1|||||190.50||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|PHCS|HUMANA|||||163.25||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|Medicare|MEDICARE PART B ONLY IP|190.50||||||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|Managed Medicare|HEALTHSPRING MA|||||190.50||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|Managed Medicare|BCBS MEDICARE PPO MA|||||190.50||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Medicaid|MEDICAID HMO|||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Medicaid|MEDICAID|163.25||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Medicaid|HENDERSON COUNTY INDIGENT|163.25||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Managed Medicare|WELLCARE CHOICE MA|||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|163.25||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|163.25||||163.25||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||190.50||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Managed Medicare|HEALTHSPRING MA|163.25||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Managed Medicare|BCBS MEDICARE PPO MA|||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Aenta Medicare Advantage|AETNA MEDICARE MA|163.25||||163.25||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|Aenta Medicare Advantage|AETNA MEDICARE MA|||||190.50||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|163.25||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|163.25||||163.25||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|Medicare|MEDICARE ACUTE|||||190.50||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Access Direct Platinum|HEALTHFIRST TPA UMR|||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||163.25||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||190.50||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Aetna|AETNA OTHER|||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Aetna|BOON CHAPMAN|||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Aetna|AETNA PPO|163.25||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Medicare|MEDICARE ACUTE|163.25||||163.25||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|Workers Compensation|WORKERS COMPENSATION OTHER|||||190.50||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|Aetna|AETNA PPO|||||190.50||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|Blue Cross HMO Specialty|BCBSTX HMO|||||190.50||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|163.25||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Blue Cross PPO Specialty|BCBSTX PPO|163.25||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Blue Cross PPO Specialty|BCBSTX OTHER|||||163.25||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|Blue Cross PPO Specialty|BCBSTX PPO|||||190.50||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|ChampVA|CHAMPVA CENTER|||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|163.25||||163.25||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|ChampVA|CHAMPVA CENTER|||||190.50||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||190.50||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|United Healthcare|UMR UNITED MEDICAL RESOURCES|163.25||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Blue Cross HMO Specialty|BCBSTX HMO|163.25||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Managed Medicaid|MEDICAID UNITED HEALTHCARE|163.25||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Managed Medicaid|MEDICAID SUPERIOR|163.25||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|163.25||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Managed Medicaid|MEDICAID AMERIGROUP|163.25||||163.25||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||190.50||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|Managed Medicaid|MEDICAID SUPERIOR|||||190.50||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||190.50||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|Managed Medicaid|MEDICAID AMERIGROUP|||||190.50||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Cigna|CIGNA OTHER|163.25||||163.25||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Cigna|CIGNA|163.25||||163.25||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|Cigna|CIGNA|||||190.50||| 96376|EAP|0450|IV PUSH EA ADD SEQ SAME D|Humana Medicare Advantage|HUMANA MA|163.25||||163.25||| 96376|EAP|0761|IV PUSH EA ADD SEQ SAME D|Humana Medicare Advantage|HUMANA MA|190.50||||190.50||| 96413|EAP|0335|IV INFUSION 1 HR CHEMO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||740.50||| 96413|EAP|0335|IV INFUSION 1 HR CHEMO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||740.50||| 96413|EAP|0335|IV INFUSION 1 HR CHEMO|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||740.50||| 96413|EAP|0335|IV INFUSION 1 HR CHEMO|Medicare|MEDICARE ACUTE|||||740.50||| 96413|EAP|0335|IV INFUSION 1 HR CHEMO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||740.50||| 96415|EAP|0335|IV INFUSION CHEMO EA ADDL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.08||| 96415|EAP|0335|IV INFUSION CHEMO EA ADDL|Medicare|MEDICARE ACUTE|||||2.08||| 96415|EAP|0335|IV INFUSION CHEMO EA ADDL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.08||| 96415|EAP|0335|IV INFUSION CHEMO EA ADDL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.08||| 96415|EAP|0335|IV INFUSION CHEMO EA ADDL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.08||| 965|DRG||OTHER MULTIPLE SIGNIFICANT TRAUMA W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|27,442.35|1225.11|7785.69|1225.11|||| 965|DRG||OTHER MULTIPLE SIGNIFICANT TRAUMA W/O CC/MCC|Medicare|MEDICARE ACUTE|30,297.55|7785.69|7785.69|1225.11|||| 96523|EAP|0269|IRRGATION DRUG DELIVERY D|Medicare|MEDICARE ACUTE|||||182.25||| 96523|EAP|0260|IRRIG DRUG DELIVERY DEVIC|Blue Cross PPO Specialty|BCBSTX PPO|||||1.50||| 96523|EAP|0269|IRRGATION DRUG DELIVERY D|Blue Cross PPO Specialty|BCBSTX PPO|||||182.25||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|Cigna|CIGNA|2.43||||||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|Humana Medicare Advantage|HUMANA MA|2.43||||2.43||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|Managed Medicaid|MEDICAID SUPERIOR|2.43||||||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.43||||||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|Managed Medicaid|MEDICAID AMERIGROUP|2.43||||||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|Managed Medicare|MA PART B ONLY IP|2.43||||||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|Managed Medicare|HEALTHSPRING MA|2.43||||2.43||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|Managed Medicare|BCBS MEDICARE PPO MA|2.43||||2.43||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.43||||||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|Aenta Medicare Advantage|AETNA MEDICARE MA|2.43||||2.43||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.43||||||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.43||||||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|Aetna|AETNA PPO|2.43||||||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.43||||2.43||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|Blue Cross PPO Specialty|BCBSTX PPO|2.43||||||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|ChampVA|CHAMPVA CENTER|2.43||||||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|Blue Cross HMO Specialty|BCBSTX HMO|2.43||||||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.43||||2.43||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|Veterans Affairs|VETERANS ADMINISTRATION|2.43||||||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.43||||2.43||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|United Medicare Advantage|UHC MEDICARE GOLD MA|2.43||||2.43||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.43||||2.43||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|United Healthcare|UNITED HEALTHCARE|2.43||||||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|United Healthcare|UMR UNITED MEDICAL RESOURCES|2.43||||||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|United Healthcare|GEHA|||||2.43||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|Medicaid|MEDICAID|2.43||||||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|Medicaid|LAW ENFORCEMENT OTHER|2.43||||||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|Medicaid|HENDERSON COUNTY INDIGENT|2.43||||||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|Tricare|TRICARE EAST REGION|2.43||||||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|Medicare|MEDICARE PART B ONLY IP|2.43||||||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|Medicare|MEDICARE ACUTE|2.43||||2.43||| 97110|EAP|0420|THERAPEUTIC PROCEDURE 15|NON CONTRACTED|COMMERCIAL OTHER 1|2.43||||||| 97161|EAP|0424|EVAL INIT/DIS|Tricare|TRICARE EAST REGION|482.25||||||| 97161|EAP|0424|EVAL INIT/DIS|Medicare|MEDICARE PART B ONLY IP|482.25||||||| 97161|EAP|0424|EVAL INIT/DIS|Medicare|MEDICARE ACUTE|482.25||||482.25||| 97161|EAP|0424|EVAL INIT/DIS|Medicaid|MOLINA HEALTHCARE OF TEXAS|482.25||||||| 97161|EAP|0424|EVAL INIT/DIS|Medicaid|MEDICAID|482.25||||||| 97161|EAP|0424|EVAL INIT/DIS|Medicaid|LAW ENFORCEMENT OTHER|482.25||||||| 97161|EAP|0424|EVAL INIT/DIS|United Healthcare|UNITED HEALTHCARE|482.25||||||| 97161|EAP|0424|EVAL INIT/DIS|United Healthcare|GEHA|||||482.25||| 97161|EAP|0424|EVAL INIT/DIS|Veterans Affairs|VETERANS ADMINISTRATION|482.25||||482.25||| 97161|EAP|0424|EVAL INIT/DIS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|482.25||||482.25||| 97161|EAP|0424|EVAL INIT/DIS|United Medicare Advantage|UHC MEDICARE GOLD MA|482.25||||482.25||| 97161|EAP|0424|EVAL INIT/DIS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|482.25||||482.25||| 97161|EAP|0424|EVAL INIT/DIS|Workers Compensation|WORKERS COMPENSATION OTHER|||||482.25||| 97161|EAP|0424|EVAL INIT/DIS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|482.25||||482.25||| 97161|EAP|0424|EVAL INIT/DIS|Blue Cross PPO Specialty|BCBSTX PPO|482.25||||482.25||| 97161|EAP|0424|EVAL INIT/DIS|ChampVA|CHAMPVA CENTER|482.25||||||| 97161|EAP|0424|EVAL INIT/DIS|Veterans Affairs|VETERANS ADMINISTRATION|482.25||||||| 97161|EAP|0424|EVAL INIT/DIS|Medicaid|HENDERSON COUNTY INDIGENT|482.25||||||| 97161|EAP|0424|EVAL INIT/DIS|Blue Cross HMO Specialty|BCBSTX HMO|482.25||||482.25||| 97161|EAP|0424|EVAL INIT/DIS|Aenta Medicare Advantage|AETNA MEDICARE MA|482.25||||482.25||| 97161|EAP|0424|EVAL INIT/DIS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|482.25||||482.25||| 97161|EAP|0424|EVAL INIT/DIS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|482.25||||||| 97161|EAP|0424|EVAL INIT/DIS|NON CONTRACTED|COMMERCIAL OTHER 1|482.25||||||| 97161|EAP|0424|EVAL INIT/DIS|Aetna|BOON CHAPMAN|482.25||||||| 97161|EAP|0424|EVAL INIT/DIS|Aetna|AETNA PPO|482.25||||482.25||| 97161|EAP|0424|EVAL INIT/DIS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|482.25||||482.25||| 97161|EAP|0424|EVAL INIT/DIS|Managed Medicaid|MEDICAID SUPERIOR|482.25||||||| 97161|EAP|0424|EVAL INIT/DIS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|482.25||||482.25||| 97161|EAP|0424|EVAL INIT/DIS|Managed Medicaid|MEDICAID AMERIGROUP|482.25||||||| 97161|EAP|0424|EVAL INIT/DIS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|482.25||||||| 97161|EAP|0424|EVAL INIT/DIS|Managed Medicare|WELLCARE CHOICE MA|482.25||||||| 97161|EAP|0424|EVAL INIT/DIS|Managed Medicare|MA PART B ONLY IP|482.25||||||| 97161|EAP|0424|EVAL INIT/DIS|Managed Medicare|HEALTHSPRING MA|482.25||||482.25||| 97161|EAP|0424|EVAL INIT/DIS|Managed Medicare|BCBS MEDICARE PPO MA|482.25||||482.25||| 97161|EAP|0424|EVAL INIT/DIS|Cigna|CIGNA OTHER|482.25||||||| 97161|EAP|0424|EVAL INIT/DIS|Cigna|CIGNA|482.25||||||| 97161|EAP|0424|EVAL INIT/DIS|Humana Medicare Advantage|HUMANA MA|482.25||||482.25||| 97597|EAP|0420|DRESSING CHANGE MED|Humana Medicare Advantage|HUMANA MA|196.50||||196.50||| 97597|EAP|0420|DEBRIDEMENT MINOR|Humana Medicare Advantage|HUMANA MA|2.43||||2.43||| 97597|EAP|0420|DRESSING CHANGE MED|Managed Medicaid|MEDICAID UNITED HEALTHCARE|196.50||||||| 97597|EAP|0420|DEBRIDEMENT MINOR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.43||||||| 97597|EAP|0420|DEBRIDEMENT MINOR|Managed Medicaid|MEDICAID SUPERIOR|2.43||||||| 97597|EAP|0420|DRESSING CHANGE MED|Managed Medicare|HEALTHSPRING MA|196.50||||||| 97597|EAP|0420|DEBRIDEMENT MINOR|Aenta Medicare Advantage|AETNA MEDICARE MA|196.50||||2.43||| 97597|EAP|0420|DRESSING CHANGE MED|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|196.50||||||| 97597|EAP|0420|DEBRIDEMENT MINOR|Blue Cross PPO Specialty|BCBSTX PPO|2.43||||||| 97597|EAP|0420|DRESSING CHANGE MED|United Medicare Advantage|AARP UHC WEST COMPLETE MA|196.50||||||| 97597|EAP|0420|DEBRIDEMENT MINOR|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.43||||||| 97597|EAP|0420|DEBRIDEMENT MINOR|United Medicare Advantage|UHC MEDICARE GOLD MA|2.43||||||| 97597|EAP|0420|DEBRIDEMENT MINOR|Veterans Affairs|VETERANS ADMINISTRATION|2.43||||||| 97597|EAP|0420|DRESSING CHANGE MED|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|196.50||||||| 97597|EAP|0420|DRESSING CHANGE MED|Tricare|TRICARE EAST REGION|196.50||||||| 97597|EAP|0420|DEBRIDEMENT MINOR|Tricare|TRICARE EAST REGION|2.43||||||| 97597|EAP|0420|DRESSING CHANGE MED|Medicare|MEDICARE ACUTE|196.50||||196.50||| 97597|EAP|0420|DEBRIDEMENT MINOR|Medicare|MEDICARE ACUTE|2.43||||2.43||| 97602|EAP|0420|DRESSING CHANGE SMALL|Medicare|MEDICARE ACUTE|107.50||||3.83||| 97602|EAP|0420|DRESSING CHANGE LARGE|Medicare|MEDICARE ACUTE|4.61||||3.83||| 97602|EAP|0420|DRESSING CHANGE LARGE|Medicare|MEDICARE ACUTE|3.83||||3.83||| 97602|EAP|0420|DRESSING CHANGE LARGE|Veterans Affairs|VETERANS ADMINISTRATION|3.83||||||| 97602|EAP|0420|DEBRIDEMENT MAJOR|Veterans Affairs|VETERANS ADMINISTRATION|4.61||||||| 97602|EAP|0420|DRESSING CHANGE SMALL|United Medicare Advantage|UHC MEDICARE GOLD MA|107.50||||||| 97602|EAP|0420|DRESSING CHANGE SMALL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|107.50||||||| 97602|EAP|0420|DRESSING CHANGE LARGE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3.83||||||| 97602|EAP|0420|DEBRIDEMENT MAJOR|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.61||||||| 97602|EAP|0420|DRESSING CHANGE SMALL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.83||||107.50||| 97602|EAP|0420|DRESSING CHANGE SMALL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|107.50||||||| 97602|EAP|0420|DRESSING CHANGE LARGE|Medicaid|MOLINA HEALTHCARE OF TEXAS|3.83||||||| 97602|EAP|0420|DRESSING CHANGE SMALL|Blue Cross PPO Specialty|BCBSTX PPO|107.50||||||| 97602|EAP|0420|DRESSING CHANGE SMALL|Aenta Medicare Advantage|AETNA MEDICARE MA|107.50||||107.50||| 97602|EAP|0420|DRESSING CHANGE SMALL|Aetna|AETNA PPO|107.50||||||| 97602|EAP|0420|DRESSING CHANGE SMALL|Managed Medicaid|MEDICAID SUPERIOR|107.50||||||| 97602|EAP|0420|DRESSING CHANGE LARGE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.83||||3.83||| 97602|EAP|0420|DRESSING CHANGE LARGE|Managed Medicaid|MEDICAID SUPERIOR|3.83||||||| 97602|EAP|0420|DRESSING CHANGE LARGE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|3.83||||||| 97602|EAP|0420|DEBRIDEMENT MAJOR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.83||||4.61||| 97602|EAP|0420|DEBRIDEMENT MAJOR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.61||||||| 97602|EAP|0420|DRESSING CHANGE SMALL|Humana Medicare Advantage|HUMANA MA|107.50||||107.50||| 97602|EAP|0420|DEBRIDEMENT MAJOR|Humana Medicare Advantage|HUMANA MA|3.83||||4.61||| 97799|EAP|0420|INSTR PROGRAM 15 MIN|Aetna|AETNA PPO|2.43||||||| 97799|EAP|0420|INSTR PROGRAM 15 MIN|Blue Cross PPO Specialty|BCBSTX PPO|2.43||||||| 97799|EAP|0420|INSTR PROGRAM 15 MIN|Medicare|MEDICARE ACUTE|2.43||||||| 981|DRG||EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W MCC|Managed Medicaid|MEDICAID AMERIGROUP|178,909.10|29923.09|29927.43|21926.8|||| 981|DRG||EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W MCC|Humana Medicare Advantage|HUMANA MA|1,047.00|29927.43|29927.43|21926.8|||| 981|DRG||EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W MCC|Blue Cross PPO Specialty|BCBSTX PPO|148,810.27|21926.8|29927.43|21926.8|||| 982|DRG||EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|48,234.55|15238.37|17207.83|15238.37|||| 982|DRG||EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W CC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|92,459.50|17207.83|17207.83|15238.37|||| 987|DRG||NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W MCC|Humana Medicare Advantage|HUMANA MA|83,921.05|22760.17|22760.17|18387.04|||| 987|DRG||NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W MCC|Medicare|MEDICARE ACUTE|73,126.20|18387.04|22760.17|18387.04|||| 988|DRG||NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W CC|Medicare|MEDICARE ACUTE|46,152.35|12839.575|12839.575|8810.89|||| 988|DRG||NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|38,483.45|8810.89|12839.575|8810.89|||| 989|DRG||NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|46,501.05|5415.8|5415.8|5415.8|||| 99|DRG||NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|37,354.55|6386.14|6386.14|6386.14|||| 99001|EAP|0300|SPECIAL HANDLING|Veterans Affairs|VETERANS ADMINISTRATION|2.51||||2.51||| 99001|EAP|0410|SPUTUM COLLECTION|United Medicare Advantage|UHC MEDICARE GOLD MA|222.50||||||| 99001|EAP|0300|HANDLING CHARGE|United Healthcare|UNITED HEALTHCARE OTHER|||||107.75||| 99001|EAP|0300|HANDLING CHARGE|United Healthcare|UNITED HEALTHCARE|107.75||||107.75||| 99001|EAP|0300|HANDLING CHARGE|United Healthcare|UMR UNITED MEDICAL RESOURCES|107.75||||107.75||| 99001|EAP|0300|HANDLING CHARGE|United Healthcare|TML GROUP BENEFITS|107.75||||107.75||| 99001|EAP|0300|SPECIAL HANDLING|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.51||||2.51||| 99001|EAP|0300|SPECIAL HANDLING|United Medicare Advantage|UHC MEDICARE GOLD MA|2.51||||2.51||| 99001|EAP|0300|SPECIAL HANDLING|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.51||||2.51||| 99001|EAP|0300|HANDLING CHARGE|Tricare|TRICARE EAST REGION|107.75||||107.75||| 99001|EAP|0300|HANDLING CHARGE|NON CONTRACTED|COMMERCIAL OTHER 1|107.75||||107.75||| 99001|EAP|0410|SPUTUM COLLECTION|Medicare|MEDICARE ACUTE|222.50||||||| 99001|EAP|0300|SPECIAL HANDLING|Medicaid|MEDICAID HMO|107.75||||2.51||| 99001|EAP|0300|HANDLING CHARGE|Medicaid|MEDICAID|107.75||||107.75||| 99001|EAP|0300|SPECIAL HANDLING|Medicaid|MEDICAID|2.51||||2.51||| 99001|EAP|0300|HANDLING CHARGE|Medicaid|MEDICAID HMO|107.75||||107.75||| 99001|EAP|0300|HANDLING CHARGE|Medicaid|MEDICAID TEXAS CHILDRENS|||||107.75||| 99001|EAP|0300|SPECIAL HANDLING|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.51||| 99001|EAP|0300|SPECIAL HANDLING|Medicaid|HENDERSON COUNTY INDIGENT|2.51||||||| 99001|EAP|0300|SPECIAL HANDLING|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.51||| 99001|EAP|0410|SPUTUM COLLECTION|Managed Medicaid|MEDICAID AMERIGROUP|222.50||||222.50||| 99001|EAP|0300|SPECIAL HANDLING|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.51||||2.51||| 99001|EAP|0300|HANDLING CHARGE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||107.75||| 99001|EAP|0300|HANDLING CHARGE|PHCS|HUMANA|107.75||||107.75||| 99001|EAP|0300|SPECIAL HANDLING|Managed Medicaid|MEDICAID SUPERIOR|2.51||||2.51||| 99001|EAP|0300|SPECIAL HANDLING|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.51||| 99001|EAP|0300|SPECIAL HANDLING|Medicare|MEDICARE ACUTE|2.51||||2.51||| 99001|EAP|0300|SPECIAL HANDLING|Managed Medicaid|MEDICAID AMERIGROUP|2.51||||2.51||| 99001|EAP|0300|HANDLING CHARGE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.51||||107.75||| 99001|EAP|0300|HANDLING CHARGE|Managed Medicaid|MEDICAID SUPERIOR|107.75||||107.75||| 99001|EAP|0300|HANDLING CHARGE|Managed Medicaid|MEDICAID AMERIGROUP|107.75||||107.75||| 99001|EAP|0300|SPECIAL HANDLING|Managed Medicare|HEALTHSPRING MA|2.51||||2.51||| 99001|EAP|0300|SPECIAL HANDLING|Humana Medicare Advantage|HUMANA MA|2.51||||2.51||| 99001|EAP|0300|SPECIAL HANDLING|United Healthcare|UMR UNITED MEDICAL RESOURCES|107.75||||2.51||| 99001|EAP|0410|SPUTUM COLLECTION|Humana Medicare Advantage|HUMANA MA|222.50||||||| 99001|EAP|0300|HANDLING CHARGE|Aetna|AETNA PPO|107.75||||107.75||| 99001|EAP|0300|HANDLING CHARGE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|107.75||||107.75||| 99001|EAP|0300|HANDLING CHARGE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|107.75||||107.75||| 99001|EAP|0300|HANDLING CHARGE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||107.75||| 99001|EAP|0300|SPECIAL HANDLING|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.51||||2.51||| 99001|EAP|0300|HANDLING CHARGE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|107.75||||107.75||| 99001|EAP|0300|SPECIAL HANDLING|Blue Cross PPO Specialty|BCBSTX PPO|2.51||||2.51||| 99001|EAP|0300|HANDLING CHARGE|Blue Cross PPO Specialty|BCBSTX PPO|107.75||||107.75||| 99001|EAP|0300|SPECIAL HANDLING|Blue Cross HMO Specialty|BCBSTX HMO|107.75||||2.51||| 99001|EAP|0300|HANDLING CHARGE|Blue Cross HMO Specialty|BCBSTX HMO|107.75||||107.75||| 99001|EAP|0300|HANDLING CHARGE|Cigna|CIGNA OTHER|107.75||||107.75||| 99001|EAP|0300|SPECIAL HANDLING|Cigna|CIGNA|107.75||||2.51||| 99001|EAP|0300|HANDLING CHARGE|Cigna|CIGNA|107.75||||107.75||| 99152|EAP|0450|MOD SEDATION GREATER THAN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||495.75||| 99152|EAP|0450|MOD SEDATION GREATER THAN|Blue Cross HMO Specialty|BCBSTX HMO|||||495.75||| 99152|EAP|0450|MOD SEDATION GREATER THAN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||495.75||| 99152|EAP|0450|MOD SEDATION GREATER THAN|Cigna|CIGNA|||||495.75||| 99152|EAP|0450|MOD SEDATION GREATER THAN|Humana Medicare Advantage|HUMANA MA|||||495.75||| 99152|EAP|0450|MOD SEDATION GREATER THAN|Managed Medicaid|MEDICAID SUPERIOR|||||495.75||| 99152|EAP|0450|MOD SEDATION GREATER THAN|Blue Cross PPO Specialty|BCBSTX PPO|||||495.75||| 99152|EAP|0450|MOD SEDATION GREATER THAN|Managed Medicaid|MEDICAID AMERIGROUP|||||495.75||| 99152|EAP|0450|MOD SEDATION GREATER THAN|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||495.75||| 99152|EAP|0450|MOD SEDATION GREATER THAN|Medicaid|MEDICAID HMO|||||495.75||| 99152|EAP|0450|MOD SEDATION GREATER THAN|Medicaid|MEDICAID|||||495.75||| 99152|EAP|0450|MOD SEDATION GREATER THAN|NON CONTRACTED|COMMERCIAL OTHER 1|||||495.75||| 99152|EAP|0450|MOD SEDATION GREATER THAN|Medicare|MEDICARE ACUTE|495.75||||495.75||| 99152|EAP|0450|MOD SEDATION GREATER THAN|United Healthcare|UNITED HEALTHCARE|||||495.75||| 99152|EAP|0450|MOD SEDATION GREATER THAN|United Healthcare|TML GROUP BENEFITS|||||495.75||| 99152|EAP|0450|MOD SEDATION GREATER THAN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||495.75||| 99152|EAP|0450|MOD SEDATION GREATER THAN|United Medicare Advantage|UHC MEDICARE GOLD MA|||||495.75||| 99152|EAP|0450|MOD SEDATION GREATER THAN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|495.75||||||| 99152|EAP|0450|MOD SEDATION GREATER THAN|Workers Compensation|WORKERS COMPENSATION OTHER|||||495.75||| 99153|EAP|0450|MOD SEDATION ADD'L 5 MINS|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.50||| 99153|EAP|0450|MOD SEDATION ADD'L 5 MINS|Medicare|MEDICARE ACUTE|||||3.50||| 99153|EAP|0450|MOD SEDATION ADD'L 5 MINS|Medicaid|MEDICAID|||||3.50||| 99153|EAP|0450|MOD SEDATION ADD'L 5 MINS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||3.50||| 99213|EAP|0519||Blue Cross PPO Specialty|BCBSTX PPO|||||391.50||| 99213|EAP|0519||Blue Cross PPO Specialty|BCBSTX OTHER|||||391.50||| 99213|EAP|0519||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||391.50||| 99213|EAP|0519||Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||391.50||| 99213|EAP|0519||Blue Cross HMO Specialty|BCBSTX HMO|||||391.50||| 99213|EAP|0519||Veterans Affairs|VETERANS ADMINISTRATION|||||391.50||| 99213|EAP|0519||Tricare|TRICARE FOR LIFE|||||391.50||| 99213|EAP|0519||Tricare|TRICARE EAST REGION|||||391.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Medicaid|MEDICAID TEXAS CHILDRENS|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Medicaid|MEDICAID HMO|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Medicaid|MEDICAID CSHCN|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Managed Medicare|HEALTHSPRING MA|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Multiplan|NALC|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Tricare|TRICARE FOR LIFE|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Tricare|TRICARE EAST REGION|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Medicare|MEDICARE ACUTE|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|United Healthcare|UNITED HEALTHCARE OTHER|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|United Healthcare|UNITED HEALTHCARE|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|United Healthcare|TML GROUP BENEFITS|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Veterans Affairs|VETERANS ADMINISTRATION|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Workers Compensation|UT EMPLOYEE INJURY|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|NON CONTRACTED|COMMERCIAL OTHER 1|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|United Medicare Advantage|UHC MEDICARE GOLD MA|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Workers Compensation|WORKERS COMPENSATION OTHER|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Managed Medicare|BCBS MEDICARE PPO MA|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Managed Medicaid|MEDICAID SUPERIOR|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Managed Medicaid|MEDICAID AMERIGROUP|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Medicaid|MEDICAID|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Cigna|CIGNA OTHER|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Cigna|CIGNA|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Humana Medicare Advantage|HUMANA MA|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Aenta Medicare Advantage|AETNA MEDICARE MA|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Aetna|AETNA PPO|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Aetna|AETNA OTHER|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1 W/PROC|Blue Cross PPO Specialty|BCBSTX PPO|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Blue Cross PPO Specialty|BCBSTX PPO|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Blue Cross PPO Specialty|BCBSTX OTHER|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|ChampVA|CHAMPVA CENTER|||||223.50||| 99281|EAP|0450|ER VISIT LEVEL 1|Blue Cross HMO Specialty|BCBSTX HMO|||||223.50||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Blue Cross PPO Specialty|BCBSTX PPO|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Blue Cross PPO Specialty|BCBSTX PPO|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Blue Cross PPO Specialty|BCBSTX OTHER|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|ChampVA|CHAMPVA CENTER|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Blue Cross HMO Specialty|BCBSTX HMO|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Blue Cross HMO Specialty|BCBSTX HMO|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Aetna|AETNA PPO|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Aetna|AETNA PPO|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Cigna|CIGNA|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Cigna|CIGNA|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Humana Medicare Advantage|HUMANA MA|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Humana Medicare Advantage|HUMANA MA|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Managed Medicaid|MEDICAID SUPERIOR|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Managed Medicaid|MEDICAID AMERIGROUP|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Managed Medicaid|MEDICAID SUPERIOR|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Managed Medicaid|MEDICAID AMERIGROUP|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Veterans Affairs|VETERANS ADMINISTRATION|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Veterans Affairs|VETERANS ADMINISTRATION|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Workers Compensation|WORKERS COMPENSATION OTHER|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Workers Compensation|WORKERS COMPENSATION OTHER|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Workers Compensation|BROOKSHIRES WORKERS COMP|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|United Healthcare|UNITED HEALTHCARE|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|United Healthcare|TML GROUP BENEFITS|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Cigna|CIGNA OTHER|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|United Healthcare|UNITED HEALTHCARE OTHER|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|United Healthcare|UNITED HEALTHCARE|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|United Healthcare|UNITED HEALTHCARE OTHER|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Tricare|TRICARE EAST REGION|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Tricare|TRICARE EAST REGION|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|UTMB|UTMB CORRECTIONAL MANAGED CARE|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|UTMB|UTMB CORRECTIONAL MANAGED CARE|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Medicare|MEDICARE ACUTE|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Medicare|MEDICARE ACUTE|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|PHCS|MULTIPLAN PHCS OTHER|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|PHCS|HUMANA INSURANCE|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Medicaid|MEDICAID HMO|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Blue Cross PPO Specialty|BCBSTX OTHER|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Medicaid|MEDICAID|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Medicaid|LAW ENFORCEMENT OTHER|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Medicaid|HENDERSON COUNTY INDIGENT|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Medicaid|MEDICAID PCCM|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Medicaid|MEDICAID HMO|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Medicaid|MEDICAID|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2 W/PROC|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||3.78||| 99282|EAP|0450|ER VISIT LEVEL 2|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||3.78||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Managed Medicare|HEALTHSPRING MA|11.00||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Managed Medicare|BCBS MEDICARE PPO MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Managed Medicare|OTHER INSTITUTIONS|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Managed Medicare|HEALTHSPRING MA|11.00||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Managed Medicare|BCBS MEDICARE PPO MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Medicaid|MEDICAID PCCM|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Medicaid|MEDICAID HMO|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Medicaid|MEDICAID BCBSTX|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Medicaid|LAW ENFORCEMENT OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Medicaid|HENDERSON COUNTY INDIGENT|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Medicaid|MEDICAID TEXAS CHILDRENS|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Medicaid|MEDICAID PCCM|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Medicaid|MEDICAID HMO|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Medicaid|LAW ENFORCEMENT OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Medicaid|HENDERSON COUNTY INDIGENT|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Medicaid Out of State|MEDICAID LOUISIANA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Managed Medicare|WELLCARE CHOICE MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Managed Medicare|VAN ZANDT COUNTY INMATE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Multiplan|NALC|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Multiplan|NALC|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Tricare|TRICARE FOR LIFE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Tricare|TRICARE FOR LIFE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Tricare|TRICARE EAST REGION|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Tricare|TRICARE EAST REGION|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|NON CONTRACTED|COMMERCIAL OTHER 2|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|NON CONTRACTED|COMMERCIAL OTHER 2|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|NON CONTRACTED|COMMERCIAL OTHER 1|11.00||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Medicare|MEDICARE ACUTE|11.00||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|PHCS|MULTIPLAN PHCS OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|PHCS|HUMANA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|PHCS|MULTIPLAN PHCS OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|PHCS|HUMANA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|United Healthcare|UNITED HEALTHCARE OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|United Healthcare|UNITED HEALTHCARE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|United Healthcare|TML GROUP BENEFITS|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|United Healthcare|GOLDEN RULE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|United Healthcare|GEHA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|United Healthcare|UNITED HEALTHCARE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|United Healthcare|TML GROUP BENEFITS|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|United Healthcare|GEHA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Veterans Affairs|VETERANS ADMINISTRATION|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Veterans Affairs|VETERANS ADMINISTRATION|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|United Healthcare|GOLDEN RULE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|11.00||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Workers Compensation|UT EMPLOYEE INJURY|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|11.00||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Workers Compensation|WORKERS COMPENSATION OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Workers Compensation|WORKERS COMP PHYSICIAN|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Workers Compensation|UT EMPLOYEE INJURY|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|United Medicare Advantage|UHC MEDICARE GOLD MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Workers Compensation|GALLAGHER BASSETT|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|United Healthcare|UNITED HEALTHCARE OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Workers Compensation|WORKERS COMPENSATION OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Workers Compensation|WORKERS COMP PHYSICIAN|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Workers Compensation|TEXAS MUTUAL INSURANCE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Workers Compensation|BROOKSHIRES WORKERS COMP|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|PHCS|HUMANA INSURANCE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|United Medicare Advantage|UHC AARP MCR HMO MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|11.00||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|United Medicare Advantage|UHC MEDICARE GOLD MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|United Medicare Advantage|UHC AARP MCR HMO MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Medicare|MEDICARE ACUTE|11.00||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|NON CONTRACTED|COMMERCIAL OTHER 1|11.00||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|United Medicare Advantage|AARP UHC WEST COMPLETE MA|11.00||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|11.00||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Managed Medicaid|MEDICAID SUPERIOR|11.00||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|11.00||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Managed Medicaid|MEDICAID AMERIGROUP|11.00||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Managed Medicaid|MEDICAID UNITED HEALTHCARE|11.00||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Managed Medicaid|MEDICAID SUPERIOR|11.00||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|11.00||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Managed Medicaid|MEDICAID AMERIGROUP|11.00||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Cigna|CIGNA OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Cigna|CIGNA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Cigna|CIGNA OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Medicaid Out of State|MEDICAID LOUISIANA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Cigna|CIGNA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Humana Medicare Advantage|HUMANA MA|11.00||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Humana Medicare Advantage|HUMANA MA|11.00||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|MTC Medical|VAN ZANDT COUNTY INMATE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Medicaid|MEDICAID|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|MTC Medical|VAN ZANDT COUNTY INMATE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Aenta Medicare Advantage|AETNA MEDICARE MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Aenta Medicare Advantage|AETNA MEDICARE MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Access Direct Platinum|HEALTHFIRST TPA UMR|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Medicaid|MEDICAID|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Medicaid|MEDICAID TEXAS CHILDRENS|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Access Direct Platinum|HEALTHFIRST TPA UMR|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Managed Medicare|VAN ZANDT COUNTY INMATE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Aetna|AETNA PPO|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Aetna|AETNA OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Aetna|BOON CHAPMAN|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Aetna|AETNA PPO|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Aetna|AETNA OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Blue Cross PPO Specialty|BCBSTX PPO|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Blue Cross PPO Specialty|BCBSTX OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Blue Cross PPO Specialty|BCBSTX PPO|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Blue Cross PPO Specialty|BCBSTX OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|ChampVA|CHAMPVA CENTER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|ChampVA|CHAMPVA CENTER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 W/PROC|Blue Cross HMO Specialty|BCBSTX HMO|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Blue Cross HMO Specialty|BCBSTX HMO|||||11.00||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Blue Cross PPO Specialty|BLUE SHIELD PHYSICIAN|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Blue Cross PPO Specialty|BCBSTX PPO|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Blue Cross PPO Specialty|BCBSTX OTHER|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Blue Cross PPO Specialty|BCBSTX OTHER|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Brinson Benefits|THE HEALTH PLAN SMITH CO|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|ChampVA|CHAMPVA CENTER|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Blue Cross HMO Specialty|BCBSTX HMO|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Blue Cross HMO Specialty|BCBSTX HMO|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Aenta Medicare Advantage|AETNA MEDICARE MA|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Access Direct Platinum|HEALTHFIRST TPA UMR|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Aetna|BOON CHAPMAN|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Aetna|AETNA PPO|20.80||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Aetna|AETNA OTHER|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Aetna|AETNA OTHER|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Cigna|CIGNA OTHER|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Cigna|CIGNA|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Cigna|CIGNA|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Humana Medicare Advantage|HUMANA MA|20.80||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Humana Medicare Advantage|HUMANA MA|20.80||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|MTC Medical|VAN ZANDT COUNTY INMATE|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|20.80||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Managed Medicaid|MEDICAID SUPERIOR|20.80||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|20.80||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Managed Medicaid|MEDICAID AMERIGROUP|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Managed Medicaid|MEDICAID UNITED HEALTHCARE|20.80||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Managed Medicaid|MEDICAID SUPERIOR|20.80||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Managed Medicaid|MEDICAID AMERIGROUP|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Veterans Affairs|VETERANS ADMINISTRATION|20.80||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Veterans Affairs|VETERANS ADMINISTRATION|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Workers Compensation|WORKERS COMPENSATION OTHER|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Workers Compensation|WORKERS COMP PHYSICIAN|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Workers Compensation|UT EMPLOYEE INJURY|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Workers Compensation|WORKERS COMPENSATION OTHER|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Workers Compensation|UT EMPLOYEE INJURY|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Workers Compensation|TEXAS MUTUAL INSURANCE|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Workers Compensation|GALLAGHER BASSETT|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|20.80||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|United Medicare Advantage|UHC MEDICARE GOLD MA|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|United Medicare Advantage|UHC AARP MCR HMO MA|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Workers Compensation|WORKERS COMP PHYSICIAN|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|20.80||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|20.80||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|United Medicare Advantage|UHC MEDICARE GOLD MA|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Workers Compensation|TEXAS MUTUAL INSURANCE|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|United Medicare Advantage|UHC AARP MCR HMO MA|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|United Medicare Advantage|AARP UHC WEST COMPLETE MA|20.80||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|United Healthcare|UNITED HEALTHCARE OTHER|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|United Healthcare|UNITED HEALTHCARE|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Veterans Affairs|VETERANS ADMINISTRATION|20.80||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|20.80||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|United Healthcare|TML GROUP BENEFITS|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|United Healthcare|GOLDEN RULE|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|United Healthcare|GEHA|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|United Healthcare|UNITED HEALTHCARE OTHER|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|United Healthcare|UNITED HEALTHCARE|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|United Healthcare|TML GROUP BENEFITS|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|MTC Medical|VAN ZANDT COUNTY INMATE|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Tricare|TRICARE FOR LIFE|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Tricare|TRICARE EAST REGION|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Tricare|TRICARE EAST REGION|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|UTMB|UTMB CORRECTIONAL MANAGED CARE|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Cigna|CIGNA OTHER|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|NON CONTRACTED|COMMERCIAL OTHER 2|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|NON CONTRACTED|COMMERCIAL OTHER 1|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|NON CONTRACTED|COMMERCIAL OTHER 2|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|NON CONTRACTED|COMMERCIAL OTHER 1|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Aetna|AETNA PPO|20.80||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Medicare|MEDICARE ACUTE|20.80||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Medicare|MEDICARE ACUTE|20.80||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|PHCS|MULTIPLAN PHCS OTHER|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|PHCS|HUMANA INSURANCE|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|PHCS|HUMANA|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|PHCS|MULTIPLAN PHCS OTHER|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|PHCS|HUMANA|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Managed Medicare|WELLCARE CHOICE MA|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Aenta Medicare Advantage|AETNA MEDICARE MA|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Managed Medicare|HEALTHSPRING MA|20.80||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Managed Medicare|WELLCARE CHOICE MA|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|ChampVA|CHAMPVA CENTER|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Managed Medicare|VAN ZANDT COUNTY INMATE|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Medicaid|MEDICAID TEXAS CHILDRENS|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Medicaid|MEDICAID HMO|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Medicaid|MEDICAID|20.80||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Blue Cross PPO Specialty|BCBSTX PPO|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Medicaid|LAW ENFORCEMENT OTHER|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Medicaid|HENDERSON COUNTY INDIGENT|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Medicaid|MEDICAID TEXAS CHILDRENS|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Medicaid|MEDICAID HMO|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Medicaid|MEDICAID|20.80||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Medicaid|HENDERSON COUNTY INDIGENT|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Managed Medicare|HEALTHSPRING MA|20.80||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Managed Medicare|BCBS MEDICARE PPO MA|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Managed Medicare|VAN ZANDT COUNTY INMATE|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4 W/PROC|Medicaid Out of State|MEDICAID LOUISIANA|||||20.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Medicaid Out of State|MEDICAID LOUISIANA|||||20.80||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Medicaid|MOLINA HEALTHCARE OF TEXAS|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Medicaid|MEDICAID TEXAS CHILDRENS|||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Medicaid|MEDICAID HMO|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Medicaid|MEDICAID|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Medicaid|LAW ENFORCEMENT OTHER|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Medicaid|HENDERSON COUNTY INDIGENT|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Medicaid|MOLINA HEALTHCARE OF TEXAS|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Medicaid|MEDICAID TEXAS CHILDRENS|||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Medicaid|MEDICAID HMO|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Medicaid|MEDICAID|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Managed Medicare|WELLCARE CHOICE MA|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Managed Medicare|OTHER INSTITUTIONS|||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Managed Medicare|MA PART B ONLY IP|34.20||||||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Managed Medicare|HEALTHSPRING MA|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Managed Medicare|HEALTHSPRING MA|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Managed Medicare|HOSPICE ETMC|||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Tricare|TRICARE EAST REGION|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Tricare|TRICARE EAST REGION|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Tricare|TRICARE FOR LIFE|||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|UTMB|UTMB CORRECTIONAL MANAGED CARE|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|NON CONTRACTED|COMMERCIAL OTHER 2|||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|NON CONTRACTED|COMMERCIAL OTHER 1|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Medicare|MEDICARE PART B ONLY IP|34.20||||||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Medicare|MEDICARE ACUTE|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Medicare|MEDICARE PART B ONLY IP|34.20||||||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|PHCS|HUMANA INSURANCE|||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|PHCS|HUMANA|||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|United Healthcare|UNITED HEALTHCARE OTHER|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|United Healthcare|UMR UNITED MEDICAL RESOURCES|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|United Healthcare|TML GROUP BENEFITS|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|United Healthcare|GOLDEN RULE|||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|United Healthcare|GEHA|||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|United Healthcare|UNITED HEALTHCARE OTHER|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|United Healthcare|UNITED HEALTHCARE|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|United Healthcare|UMR UNITED MEDICAL RESOURCES|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Veterans Affairs|VETERANS ADMINISTRATION|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Workers Compensation|WORKERS COMPENSATION OTHER|||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Workers Compensation|UT EMPLOYEE INJURY|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Veterans Affairs|VETERANS ADMINISTRATION|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Workers Compensation|WORKERS COMP PHYSICIAN|||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|United Medicare Advantage|UHC MEDICARE GOLD MA|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|United Medicare Advantage|UHC AARP MCR HMO MA|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|United Healthcare|UNITED HEALTHCARE|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|United Medicare Advantage|UHC MEDICARE GOLD MA|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|United Medicare Advantage|UHC AARP MCR HMO MA|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|United Medicare Advantage|AARP UHC WEST COMPLETE MA|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Managed Medicaid|MEDICAID SUPERIOR|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Medicare|MEDICARE ACUTE|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|NON CONTRACTED|COMMERCIAL OTHER 1|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Managed Medicaid|MEDICAID AMERIGROUP|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Managed Medicaid|MEDICAID UNITED HEALTHCARE|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Managed Medicaid|MEDICAID SUPERIOR|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Managed Medicaid|MEDICAID AMERIGROUP|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Humana Medicare Advantage|HUMANA MA|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Humana Medicare Advantage|HUMANA MA|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Cigna|CIGNA OTHER|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Managed Medicare|VAN ZANDT COUNTY INMATE|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Cigna|CIGNA|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Cigna|CIGNA OTHER|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Managed Medicare|BCBS MEDICARE PPO MA|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Cigna|CIGNA|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|MTC Medical|VAN ZANDT COUNTY INMATE|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Aenta Medicare Advantage|AETNA MEDICARE MA|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Aenta Medicare Advantage|AETNA MEDICARE MA|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Access Direct Platinum|HEALTHFIRST TPA UMR|||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Medicaid|COUNTY INDIGENT HEALTH OTHER|34.20||||||| 99285|EAP|0450|ER VISIT LEVEL 5|Aetna|AETNA PPO|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Aetna|AETNA OTHER|||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Aetna|BOON CHAPMAN|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Aetna|AETNA PPO|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Medicaid|MEDICAID BCBSTX|||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Aetna|AETNA OTHER|||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Blue Cross PPO Specialty|BCBSTX PPO|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Blue Cross PPO Specialty|BCBSTX OTHER|||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Blue Cross PPO Specialty|BCBSTX PPO|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Blue Cross PPO Specialty|BCBSTX OTHER|||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|ChampVA|CHAMPVA CENTER|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|ChampVA|CHAMPVA CENTER|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5 W/PROC|Blue Cross HMO Specialty|BCBSTX HMO|34.20||||34.20||| 99285|EAP|0450|ER VISIT LEVEL 5|Blue Cross HMO Specialty|BCBSTX HMO|34.20||||34.20||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Blue Cross PPO Specialty|BCBSTX PPO|2,302.75||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2,302.75||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Blue Cross HMO Specialty|BCBSTX HMO|2,302.75||||||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Aenta Medicare Advantage|AETNA MEDICARE MA|2,302.75||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2,302.75||||||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Aetna|AETNA PPO|||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Aetna|AETNA OTHER|||||2,302.75||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Humana Medicare Advantage|HUMANA MA|2,302.75||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Cigna|CIGNA|||||2,302.75||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2,302.75||||2,302.75||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2,302.75||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Managed Medicaid|MEDICAID SUPERIOR|2,302.75||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2,302.75||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Managed Medicaid|MEDICAID AMERIGROUP|2,302.75||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2,302.75||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Veterans Affairs|VETERANS ADMINISTRATION|2,302.75||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2,302.75||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Workers Compensation|WORKERS COMPENSATION OTHER|||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2,302.75||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|United Medicare Advantage|UHC MEDICARE GOLD MA|2,302.75||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|United Medicare Advantage|UHC AARP WELLMED HMO MA|||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|United Healthcare|UNITED HEALTHCARE OTHER|||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|United Healthcare|UNITED HEALTHCARE|2,302.75||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Humana Medicare Advantage|HUMANA MA|2,302.75||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|United Healthcare|UNITED HEALTHCARE|||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|United Healthcare|UMR UNITED MEDICAL RESOURCES|2,302.75||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|United Healthcare|TML GROUP BENEFITS|||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Tricare|TRICARE EAST REGION|||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Blue Cross PPO Specialty|BCBSTX PPO|2,302.75||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Tricare|TRICARE FOR LIFE|||||2,302.75||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Medicare|MEDICARE ACUTE|2,302.75||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Medicare|MEDICARE ACUTE|2,302.75||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Medicaid|MOLINA HEALTHCARE OF TEXAS|2,302.75||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Medicaid|MEDICAID TEXAS CHILDRENS|||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Medicaid|MEDICAID|2,302.75||||2,302.75||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Managed Medicare|HEALTHSPRING MA|2,302.75||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Managed Medicare|OTHER INSTITUTIONS|||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Managed Medicare|HEALTHSPRING MA|2,302.75||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Managed Medicare|BCBS MEDICARE PPO MA|2,302.75||||2,302.75||| 99291|EAP|0450|CRITICAL CARE 1ST HR W/PR|Managed Medicare|HOSPICE OF EAST TEXAS|2,302.75||||||| 99292|EAP|0450|CRITICAL CARE EA ADDL 30|Managed Medicare|HEALTHSPRING MA|||||873.50||| 99292|EAP|0450|CRITICAL CARE EA ADDL 30|Medicare|MEDICARE ACUTE|873.50||||873.50||| 99292|EAP|0450|CRITICAL CARE EA ADDL 30|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|873.50||||||| 99292|EAP|0450|CRITICAL CARE EA ADDL 30|United Medicare Advantage|AARP UHC WEST COMPLETE MA|873.50||||873.50||| 99292|EAP|0450|CRITICAL CARE EA ADDL 30|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||873.50||| 99292|EAP|0450|CRITICAL CARE EA ADDL 30|Managed Medicaid|MEDICAID AMERIGROUP|873.50||||||| 99292|EAP|0450|CRITICAL CARE EA ADDL 30|Humana Medicare Advantage|HUMANA MA|873.50||||873.50||| 99292|EAP|0450|CRITICAL CARE EA ADDL 30|Aenta Medicare Advantage|AETNA MEDICARE MA|||||873.50||| 99292|EAP|0450|CRITICAL CARE EA ADDL 30|Blue Cross PPO Specialty|BCBSTX PPO|||||873.50||| 99292|EAP|0450|CRITICAL CARE EA ADDL 30|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||873.50||| 998|DRG||PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS|Blue Cross PPO Specialty|BCBSTX PPO|14,623.50||||||| 998|DRG||PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS|Cigna|CIGNA|13,735.50|31.5|3753.2|31.5|||| 998|DRG||PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS|Managed Medicaid|MEDICAID AMERIGROUP|14,113.30|2567.865|3753.2|31.5|||| 998|DRG||PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS|Managed Medicaid|MEDICAID SUPERIOR|145.30|3753.2|3753.2|31.5|||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.75||||2.75||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|United Medicare Advantage|UHC MEDICARE GOLD MA|2.75||||2.75||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.75||||2.75||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.75||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|Veterans Affairs|VETERANS ADMINISTRATION|2.75||||2.75||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.75||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|Medicare|MEDICARE ACUTE|2.75||||2.75||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|United Healthcare|TML GROUP BENEFITS|||||2.75||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|United Healthcare|UNITED HEALTHCARE|2.75||||||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|Managed Medicare|HEALTHSPRING MA|||||2.75||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|Humana Medicare Advantage|HUMANA MA|2.75||||2.75||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.75||||2.75||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.75||||2.75||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|United Medicare Advantage|UHC AARP MCR HMO MA|||||2.75||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|Managed Medicaid|MEDICAID SUPERIOR|||||2.75||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|Managed Medicaid|MEDICAID AMERIGROUP|||||2.75||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|Access Direct Platinum|HEALTHFIRST TPA UMR|||||2.75||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.75||||2.75||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|Blue Cross HMO Specialty|BCBSTX HMO|||||2.75||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|Cigna|CIGNA|||||2.75||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|Cigna|CIGNA OTHER|||||2.75||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|Blue Cross PPO Specialty|BCBSTX PPO|||||2.75||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.75||| A4217|ERX|0258|NA CHLORIDE 0.9%,250ML AD|Cigna|CIGNA OTHER|234.75||||||| A4217|ERX|0258|NA CHLORIDE 0.9%,250ML AD|Blue Cross PPO Specialty|BCBSTX PPO|234.75||||||| A4217|ERX|0258|NA CHLORIDE 0.9%,250ML AD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|234.75||||||| A4217|ERX|0258|NA CHLORIDE 0.9%,250ML AD|Humana Medicare Advantage|HUMANA MA|234.75||||234.75||| A4217|ERX|0258|NA CHLORIDE 0.9%,250ML AD|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|234.75||||||| A4217|ERX|0258|NA CHLORIDE 0.9%,250ML AD|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|234.75||||||| A4217|ERX|0258|NA CHLORIDE 0.9%,250ML AD|Medicare|MEDICARE ACUTE|234.75||||||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.93||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|Veterans Affairs|VETERANS ADMINISTRATION|||||86.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Veterans Affairs|VETERANS ADMINISTRATION|1.93||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Veterans Affairs|VETERANS ADMINISTRATION|210.75||||210.75||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||86.75||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|86.75||||86.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|210.75||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|United Medicare Advantage|UHC AARP MCR HMO MA|||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|210.75||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.93||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|United Medicare Advantage|UHC MEDICARE GOLD MA|1.93||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.93||||1.93||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||86.75||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|Medicaid|MEDICAID HMO|86.75||||||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|1.93||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Medicaid|MEDICAID HMO|210.75||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Medicaid|HENDERSON COUNTY INDIGENT|1.93||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Medicaid|MOLINA HEALTHCARE OF TEXAS|210.75||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Medicaid|MEDICAID HMO|210.75||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Medicaid|HENDERSON COUNTY INDIGENT|1.93||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Medicare|MEDICARE ACUTE|210.75||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Medicare|MEDICARE PART B ONLY IP|210.75||||||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Medicare|MEDICARE ACUTE|1.93||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Tricare|TRICARE EAST REGION|210.75||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Tricare|TRICARE EAST REGION|1.93||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|UTMB|UTMB CORRECTIONAL MANAGED CARE|1.93||||||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||86.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|NON CONTRACTED|COMMERCIAL OTHER 1|210.75||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|NON CONTRACTED|COMMERCIAL OTHER 1|210.75||||210.75||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|Medicare|MEDICARE ACUTE|86.75||||86.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|PHCS|MULTIPLAN PHCS OTHER|||||210.75||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|United Healthcare|UNITED HEALTHCARE OTHER|||||86.75||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|United Healthcare|UNITED HEALTHCARE|||||86.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|United Healthcare|GEHA|||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|United Healthcare|UNITED HEALTHCARE|210.75||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|United Healthcare|TML GROUP BENEFITS|1.93||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|210.75||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|United Healthcare|UNITED HEALTHCARE|1.93||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|United Healthcare|UNITED HEALTHCARE OTHER|||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|United Healthcare|TML GROUP BENEFITS|210.75||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|United Healthcare|UNITED HEALTHCARE OTHER|||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Texas Workforce Commission|DIS DETER SERV (DDS)|||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.93||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Managed Medicaid|MEDICAID SUPERIOR|1.93||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.93||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Managed Medicaid|MEDICAID AMERIGROUP|1.93||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|210.75||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Managed Medicaid|MEDICAID SUPERIOR|210.75||||210.75||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|Managed Medicare|HEALTHSPRING MA|86.75||||86.75||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|Managed Medicare|BCBS MEDICARE PPO MA|86.75||||||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|210.75||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Managed Medicaid|MEDICAID AMERIGROUP|210.75||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|210.75||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Managed Medicare|HEALTHSPRING MA|1.93||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|United Healthcare|UNITED HEALTHCARE|1.93||||1.93||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|United Healthcare|UNITED HEALTHCARE|86.75||||||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Managed Medicare|BCBS MEDICARE PPO MA|1.93||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Managed Medicare|OTHER INSTITUTIONS|||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|United Healthcare|GEHA|||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|210.75||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Managed Medicare|HOSPICE OF EAST TEXAS|210.75||||||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|UTMB|UTMB CORRECTIONAL MANAGED CARE|210.75||||||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Managed Medicare|HOSPICE ETMC|210.75||||||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Managed Medicare|HEALTHSPRING MA|210.75||||210.75||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|Humana Medicare Advantage|HUMANA MA|86.75||||86.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Humana Medicare Advantage|HUMANA MA|210.75||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Humana Medicare Advantage|HUMANA MA|1.93||||1.93||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|86.75||||86.75||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|Managed Medicaid|MEDICAID SUPERIOR|86.75||||86.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Medicaid|MEDICAID|210.75||||210.75||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||86.75||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|Managed Medicaid|MEDICAID AMERIGROUP|86.75||||86.75||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||86.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Medicaid|MEDICAID|1.93||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.93||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Access Direct Platinum|HEALTHFIRST TPA UMR|1.93||||210.75||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|Medicaid|MEDICAID|86.75||||86.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.93||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Access Direct Platinum|HEALTHFIRST TPA UMR|1.93||||1.93||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|Aetna|AETNA PPO|86.75||||86.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Aetna|AETNA PPO|1.93||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Aetna|AETNA PPO|1.93||||210.75||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|Aenta Medicare Advantage|AETNA MEDICARE MA|86.75||||||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|United Medicare Advantage|UHC MEDICARE GOLD MA|210.75||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Aenta Medicare Advantage|AETNA MEDICARE MA|210.75||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Aenta Medicare Advantage|AETNA MEDICARE MA|1.93||||1.93||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|86.75||||86.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.93||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|210.75||||210.75||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|Blue Cross HMO Specialty|BCBSTX HMO|||||86.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Blue Cross HMO Specialty|BCBSTX HMO|1.93||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Blue Cross HMO Specialty|BCBSTX HMO|210.75||||210.75||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|86.75||||86.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Workers Compensation|WORKERS COMPENSATION OTHER|||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|210.75||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|210.75||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|ChampVA|CHAMPVA CENTER|1.93||||210.75||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|Cigna|CIGNA|86.75||||||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Cigna|CIGNA OTHER|210.75||||||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Cigna|CIGNA|210.75||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Cigna|CIGNA|1.93||||1.93||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Cigna|CIGNA|||||1.93||| A4218|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|Blue Cross PPO Specialty|BCBSTX PPO|||||86.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Blue Cross PPO Specialty|BCBSTX PPO|210.75||||210.75||| A4218|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Blue Cross PPO Specialty|BCBSTX PPO|1.93||||1.93||| A9500|EAP|0343|CARDIOLITE PER 10MCI|Blue Cross PPO Specialty|BCBSTX PPO|||||630.75||| A9500|EAP|0343|CARDIOLITE PER 10MCI|Humana Medicare Advantage|HUMANA MA|||||630.75||| A9500|EAP|0343|CARDIOLITE PER 10MCI|Medicare|MEDICARE ACUTE|||||630.75||| A9500|EAP|0343|CARDIOLITE PER 10MCI|United Medicare Advantage|UHC MEDICARE GOLD MA|||||630.75||| A9502|EAP|0255|MYOVIEW NM|Veterans Affairs|VETERANS ADMINISTRATION|15.12||||||| A9502|EAP|0255|MYOVIEW NM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|15.12||||15.12||| A9502|EAP|0255|MYOVIEW NM|United Medicare Advantage|UHC MEDICARE GOLD MA|15.12||||15.12||| A9502|EAP|0255|MYOVIEW NM|United Medicare Advantage|UHC AARP MCR HMO MA|||||15.12||| A9502|EAP|0255|MYOVIEW NM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|15.12||||15.12||| A9502|EAP|0255|MYOVIEW NM|Medicaid|MEDICAID|15.12||||||| A9502|EAP|0255|MYOVIEW NM|Medicaid|HENDERSON COUNTY INDIGENT|15.12||||15.12||| A9502|EAP|0255|MYOVIEW NM|NON CONTRACTED|COMMERCIAL OTHER 1|||||15.12||| A9502|EAP|0255|MYOVIEW NM|PHCS|HUMANA|||||15.12||| A9502|EAP|0255|MYOVIEW NM|United Healthcare|UNITED HEALTHCARE|15.12||||15.12||| A9502|EAP|0255|MYOVIEW NM|Medicare|MEDICARE PART B ONLY IP|15.12||||||| A9502|EAP|0255|MYOVIEW NM|Medicare|MEDICARE ACUTE|15.12||||15.12||| A9502|EAP|0255|MYOVIEW NM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|15.12||||15.12||| A9502|EAP|0255|MYOVIEW NM|United Healthcare|UNITED HEALTHCARE|||||15.12||| A9502|EAP|0255|MYOVIEW NM|Tricare|TRICARE EAST REGION|||||15.12||| A9502|EAP|0255|MYOVIEW NM|Managed Medicaid|MEDICAID SUPERIOR|15.12||||15.12||| A9502|EAP|0255|MYOVIEW NM|Managed Medicaid|MEDICAID AMERIGROUP|15.12||||||| A9502|EAP|0255|MYOVIEW NM|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||15.12||| A9502|EAP|0255|MYOVIEW NM|Managed Medicare|HEALTHSPRING MA|15.12||||15.12||| A9502|EAP|0255|MYOVIEW NM|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|15.12||||15.12||| A9502|EAP|0255|MYOVIEW NM|Managed Medicare|BCBS MEDICARE PPO MA|||||15.12||| A9502|EAP|0255|MYOVIEW NM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|15.12||||15.12||| A9502|EAP|0255|MYOVIEW NM|Humana Medicare Advantage|HUMANA MA|15.12||||15.12||| A9502|EAP|0255|MYOVIEW NM|Veterans Affairs|VETERANS ADMINISTRATION|15.12||||15.12||| A9502|EAP|0255|MYOVIEW NM|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||15.12||| A9502|EAP|0255|MYOVIEW NM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||15.12||| A9502|EAP|0255|MYOVIEW NM|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|15.12||||||| A9502|EAP|0255|MYOVIEW NM|Aetna|AETNA PPO|15.12||||15.12||| A9502|EAP|0255|MYOVIEW NM|Aetna|AETNA OTHER|||||15.12||| A9502|EAP|0255|MYOVIEW NM|Aenta Medicare Advantage|AETNA MEDICARE MA|15.12||||15.12||| A9502|EAP|0255|MYOVIEW NM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|15.12||||15.12||| A9502|EAP|0255|MYOVIEW NM|Blue Cross HMO Specialty|BCBSTX HMO|15.12||||15.12||| A9502|EAP|0255|MYOVIEW NM|Cigna|CIGNA OTHER|||||15.12||| A9502|EAP|0255|MYOVIEW NM|Cigna|CIGNA|||||15.12||| A9502|EAP|0255|MYOVIEW NM|Blue Cross PPO Specialty|BCBSTX PPO|15.12||||15.12||| A9503|EAP|0343|MDP UP TO 30MCI|Blue Cross PPO Specialty|BCBSTX PPO|||||110.75||| A9503|EAP|0343|MDP UP TO 30MCI|Blue Cross HMO Specialty|BCBSTX HMO|||||110.75||| A9503|EAP|0343|MDP UP TO 30MCI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||110.75||| A9503|EAP|0343|MDP UP TO 30MCI|Aetna|AETNA PPO|||||110.75||| A9503|EAP|0343|MDP UP TO 30MCI|Cigna|CIGNA|||||110.75||| A9503|EAP|0343|MDP UP TO 30MCI|Aenta Medicare Advantage|AETNA MEDICARE MA|||||110.75||| A9503|EAP|0343|MDP UP TO 30MCI|Humana Medicare Advantage|HUMANA MA|110.75||||110.75||| A9503|EAP|0343|MDP UP TO 30MCI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||110.75||| A9503|EAP|0343|MDP UP TO 30MCI|Managed Medicaid|MEDICAID SUPERIOR|||||110.75||| A9503|EAP|0343|MDP UP TO 30MCI|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||110.75||| A9503|EAP|0343|MDP UP TO 30MCI|Managed Medicare|BCBS MEDICARE PPO MA|||||110.75||| A9503|EAP|0343|MDP UP TO 30MCI|Managed Medicare|HEALTHSPRING MA|||||110.75||| A9503|EAP|0343|MDP UP TO 30MCI|Medicare|MEDICARE ACUTE|110.75||||110.75||| A9503|EAP|0343|MDP UP TO 30MCI|United Healthcare|UNITED HEALTHCARE OTHER|||||110.75||| A9503|EAP|0343|MDP UP TO 30MCI|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||110.75||| A9503|EAP|0343|MDP UP TO 30MCI|United Medicare Advantage|UHC MEDICARE GOLD MA|||||110.75||| A9503|EAP|0343|MDP UP TO 30MCI|United Medicare Advantage|UHC AARP MCR HMO MA|||||110.75||| A9503|EAP|0343|MDP UP TO 30MCI|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||110.75||| A9503|EAP|0343|MDP UP TO 30MCI|Veterans Affairs|VETERANS ADMINISTRATION|110.75||||110.75||| A9531|EAP|0343|IODINE-123 200MCI|United Healthcare|UNITED HEALTHCARE|||||199.75||| A9531|EAP|0343|IODINE-123 200MCI|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||199.75||| A9531|EAP|0343|IODINE-123 200MCI|Medicare|MEDICARE ACUTE|||||199.75||| A9531|EAP|0343|IODINE-123 200MCI|Managed Medicare|HEALTHSPRING MA|||||199.75||| A9531|EAP|0343|IODINE-123 200MCI|Humana Medicare Advantage|HUMANA MA|||||199.75||| A9531|EAP|0343|IODINE-123 200MCI|Blue Cross PPO Specialty|BCBSTX PPO|||||199.75||| A9531|EAP|0343|IODINE-123 200MCI|Cigna|CIGNA|||||199.75||| A9537|EAP|0343|CHOLETEC 6MCI|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.61||| A9537|EAP|0343|CHOLETEC 6MCI|Access Direct Platinum|HEALTHFIRST TPA UMR|||||2.61||| A9537|EAP|0343|CHOLETEC 6MCI|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.61||| A9537|EAP|0343|CHOLETEC 6MCI|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.61||| A9537|EAP|0343|CHOLETEC 6MCI|Blue Cross HMO Specialty|BCBSTX HMO|||||2.61||| A9537|EAP|0343|CHOLETEC 6MCI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.61||| A9537|EAP|0343|CHOLETEC 6MCI|Cigna|CIGNA|||||2.61||| A9537|EAP|0343|CHOLETEC 6MCI|Humana Medicare Advantage|HUMANA MA|2.61||||2.61||| A9537|EAP|0343|CHOLETEC 6MCI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.61||| A9537|EAP|0343|CHOLETEC 6MCI|Managed Medicaid|MEDICAID SUPERIOR|2.61||||2.61||| A9537|EAP|0343|CHOLETEC 6MCI|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.61||||2.61||| A9537|EAP|0343|CHOLETEC 6MCI|Blue Cross PPO Specialty|BCBSTX PPO|2.61||||2.61||| A9537|EAP|0343|CHOLETEC 6MCI|Managed Medicare|HEALTHSPRING MA|2.61||||2.61||| A9537|EAP|0343|CHOLETEC 6MCI|Managed Medicare|BCBS MEDICARE PPO MA|||||2.61||| A9537|EAP|0343|CHOLETEC 6MCI|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.61||| A9537|EAP|0343|CHOLETEC 6MCI|Medicaid|HENDERSON COUNTY INDIGENT|2.61||||2.61||| A9537|EAP|0343|CHOLETEC 6MCI|Tricare|TRICARE EAST REGION|2.61||||2.61||| A9537|EAP|0343|CHOLETEC 6MCI|Medicare|MEDICARE ACUTE|2.61||||2.61||| A9537|EAP|0343|CHOLETEC 6MCI|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.61||| A9537|EAP|0343|CHOLETEC 6MCI|Veterans Affairs|VETERANS ADMINISTRATION|2.61||||||| A9537|EAP|0343|CHOLETEC 6MCI|United Healthcare|UNITED HEALTHCARE OTHER|2.61||||||| A9537|EAP|0343|CHOLETEC 6MCI|United Healthcare|UNITED HEALTHCARE|||||2.61||| A9537|EAP|0343|CHOLETEC 6MCI|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.61||| A9537|EAP|0343|CHOLETEC 6MCI|United Healthcare|TML GROUP BENEFITS|||||2.61||| A9537|EAP|0343|CHOLETEC 6MCI|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.61||||2.61||| A9537|EAP|0343|CHOLETEC 6MCI|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.61||| A9537|EAP|0343|CHOLETEC 6MCI|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.61||||2.61||| A9540|EAP|0343|MAA PER MCI|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||110.75||| A9540|EAP|0343|MAA PER MCI|Medicare|MEDICARE ACUTE|110.75||||||| A9540|EAP|0343|MAA PER MCI|Managed Medicare|BCBS MEDICARE PPO MA|110.75||||||| A9541|EAP|0343|SULFA COLLOID PER MCI|Blue Cross PPO Specialty|BCBSTX PPO|||||105.75||| A9541|EAP|0343|SULFA COLLOID PER MCI|Blue Cross HMO Specialty|BCBSTX HMO|||||105.75||| A9541|EAP|0343|SULFA COLLOID PER MCI|Cigna|CIGNA|||||105.75||| A9541|EAP|0343|SULFA COLLOID PER MCI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||105.75||| A9541|EAP|0343|SULFA COLLOID PER MCI|Aetna|AETNA PPO|||||105.75||| A9541|EAP|0343|SULFA COLLOID PER MCI|Aenta Medicare Advantage|AETNA MEDICARE MA|||||105.75||| A9541|EAP|0343|SULFA COLLOID PER MCI|Humana Medicare Advantage|HUMANA MA|105.75||||||| A9541|EAP|0343|SULFA COLLOID PER MCI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||105.75||| A9541|EAP|0343|SULFA COLLOID PER MCI|Managed Medicaid|MEDICAID SUPERIOR|||||105.75||| A9541|EAP|0343|SULFA COLLOID PER MCI|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||105.75||| A9541|EAP|0343|SULFA COLLOID PER MCI|Medicare|MEDICARE ACUTE|||||105.75||| A9541|EAP|0343|SULFA COLLOID PER MCI|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||105.75||| A9541|EAP|0343|SULFA COLLOID PER MCI|United Medicare Advantage|UHC MEDICARE GOLD MA|||||105.75||| A9550|EAP|0343|MAG3 UP TO 25MCI|United Medicare Advantage|UHC MEDICARE GOLD MA|||||11.44||| A9550|EAP|0343|MAG3 UP TO 25MCI|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||11.44||| A9550|EAP|0343|MAG3 UP TO 25MCI|Medicare|MEDICARE ACUTE|11.44||||11.44||| A9550|EAP|0343|MAG3 UP TO 25MCI|Humana Medicare Advantage|HUMANA MA|||||11.44||| A9550|EAP|0343|MAG3 UP TO 25MCI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||11.44||| A9550|EAP|0343|MAG3 UP TO 25MCI|Blue Cross PPO Specialty|BCBSTX PPO|||||11.44||| A9560|EAP|0343|ULTRATAG KIT|Humana Medicare Advantage|HUMANA MA|333.25||||||| A9560|EAP|0343|ULTRATAG KIT|Medicare|MEDICARE ACUTE|333.25||||||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|Workers Compensation|WORKERS COMPENSATION OTHER|||||16.78||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|Veterans Affairs|VETERANS ADMINISTRATION|9.87||||9.87||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|Veterans Affairs|VETERANS ADMINISTRATION|9.24||||9.87||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|9.24||||9.87||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|United Medicare Advantage|UHC MEDICARE GOLD MA|16.78||||9.87||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|United Medicare Advantage|UHC AARP MCR HMO MA|||||9.87||| A9576|EAP|0255|MRI PROHANCE CONTRAST 15/|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|785.40||||1,178.10||| A9576|EAP|0255|MRI PROHANCE CONTRAST 15/|United Medicare Advantage|UHC MEDICARE GOLD MA|16.78||||9.24||| A9576|EAP|0255|MRI PROHANCE CONTRAST 15/|United Medicare Advantage|UHC AARP MCR HMO MA|||||9.24||| A9576|EAP|0255|MRI PROHANCE CONTRAST 10/|United Medicare Advantage|UHC MEDICARE GOLD MA|16.78||||785.40||| A9576|EAP|0255|MRI PROHANCE CONTRAST 10/|United Medicare Advantage|AARP UHC WEST COMPLETE MA|9.24||||9.24||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|Medicaid|MEDICAID|9.87||||785.40||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|Medicaid|COUNTY INDIGENT HEALTH OTHER|9.87||||||| A9576|EAP|0255|MRI PROHANCE CONTRAST 10/|Medicaid|MEDICAID|9.24||||785.40||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|Medicare|MEDICARE ACUTE|9.87||||9.87||| A9576|EAP|0255|MRI PROHANCE CONTRAST 15/|Medicare|MEDICARE ACUTE|9.24||||9.24||| A9576|EAP|0255|MRI PROHANCE CONTRAST 10/|Tricare|TRICARE EAST REGION|||||785.40||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|NON CONTRACTED|COMMERCIAL OTHER 1|16.78||||9.87||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|United Healthcare|UNITED HEALTHCARE OTHER|||||16.78||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|United Healthcare|UNITED HEALTHCARE|||||843.94||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|United Healthcare|TML GROUP BENEFITS|9.87||||||| A9576|EAP|0255|MRI PROHANCE CONTRAST 15/|United Healthcare|UNITED HEALTHCARE|||||593.67||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||843.94||| A9576|EAP|0255|MRI PROHANCE CONTRAST 10/|United Healthcare|UNITED HEALTHCARE|||||397.32||| A9576|EAP|0255|MRI PROHANCE CONTRAST 15/|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||9.24||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||16.78||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|Aetna|AETNA PPO|||||843.94||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|Aenta Medicare Advantage|AETNA MEDICARE MA|9.87||||16.78||| A9576|EAP|0255|MRI PROHANCE CONTRAST 15/|Aenta Medicare Advantage|AETNA MEDICARE MA|9.24||||593.67||| A9576|EAP|0255|MRI PROHANCE CONTRAST 10/|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|397.32||||9.24||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|United Healthcare|UNITED HEALTHCARE|1,178.10||||9.87||| A9576|EAP|0255|MRI PROHANCE CONTRAST 10/|Medicare|MEDICARE ACUTE|9.24||||9.24||| A9576|EAP|0255|MRI PROHANCE CONTRAST 15/|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.87||||9.24||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.87||||9.87||| A9576|EAP|0255|MRI PROHANCE CONTRAST 15/|Blue Cross HMO Specialty|BCBSTX HMO|9.24||||1,178.10||| A9576|EAP|0255|MRI PROHANCE CONTRAST 10/|Blue Cross HMO Specialty|BCBSTX HMO|9.24||||785.40||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|Blue Cross HMO Specialty|BCBSTX HMO|9.24||||16.78||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|Cigna|CIGNA OTHER|16.78||||||| A9576|EAP|0255|MRI PROHANCE CONTRAST 15/|Cigna|CIGNA|||||9.24||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|Blue Cross PPO Specialty|BCBSTX PPO|843.94||||9.87||| A9576|EAP|0255|MRI PROHANCE CONTRAST 15/|United Medicare Advantage|AARP UHC WEST COMPLETE MA|9.87||||9.24||| A9576|EAP|0255|MRI PROHANCE CONTRAST 15/|Blue Cross PPO Specialty|BCBSTX PPO|9.24||||9.24||| A9576|EAP|0255|MRI PROHANCE CONTRAST 10/|Blue Cross PPO Specialty|BCBSTX PPO|9.24||||9.24||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|United Medicare Advantage|AARP UHC WEST COMPLETE MA|9.87||||9.87||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|Managed Medicaid|MEDICAID UNITED HEALTHCARE|9.87||||9.87||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|Managed Medicaid|MEDICAID SUPERIOR|9.24||||9.87||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|9.87||||9.87||| A9576|EAP|0255|MRI PROHANCE CONTRAST 10/|Managed Medicaid|MEDICAID SUPERIOR|9.24||||785.40||| A9576|EAP|0255|MRI PROHANCE CONTRAST 15/|Managed Medicaid|MEDICAID SUPERIOR|9.24||||9.24||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|Managed Medicare|BCBS MEDICARE PPO MA|||||197.40||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|9.87||||9.87||| A9576|EAP|0255|MRI PROHANCE CONTRAST 15/|Managed Medicare|HEALTHSPRING MA|9.87||||9.24||| A9576|EAP|0255|MRI PROHANCE CONTRAST 10/|Managed Medicare|HEALTHSPRING MA|9.87||||9.24||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|Managed Medicare|HEALTHSPRING MA|9.87||||9.87||| A9576|EAP|0255|MRI PROHANCE CONTRAST 15/|Managed Medicaid|MEDICAID AMERIGROUP|9.24||||9.24||| A9576|EAP|0255|MRI PROHANCE CONTRAST 10/|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|9.24||||9.24||| A9576|EAP|0255|MRI PROHANCE CONTRAST 15/|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|9.87||||31.62||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|Managed Medicaid|MEDICAID AMERIGROUP|9.24||||9.87||| A9576|EAP|0255|MRI PROHANCE CONTRAST 15/|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1,178.10||||9.24||| A9576|EAP|0255|MRI PROHANCE CONTRAST 20/|Humana Medicare Advantage|HUMANA MA|9.87||||9.87||| A9576|EAP|0255|MRI PROHANCE CONTRAST 15/|Humana Medicare Advantage|HUMANA MA|9.24||||9.24||| A9576|EAP|0255|MRI PROHANCE CONTRAST 10/|Humana Medicare Advantage|HUMANA MA|785.40||||9.24||| A9579|EAP|0636|GADOLINIUM PER ML|Blue Cross PPO Specialty|BCBSTX PPO|||||549.75||| A9579|EAP|0636|GADOLINIUM PER ML|Blue Cross HMO Specialty|BCBSTX HMO|549.75||||549.75||| A9579|EAP|0636|GADOLINIUM PER ML|Aetna|AETNA PPO|||||549.75||| A9579|EAP|0636|GADOLINIUM PER ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||549.75||| A9579|EAP|0636|GADOLINIUM PER ML|Medicare|MEDICARE ACUTE|549.75||||549.75||| A9579|EAP|0636|GADOLINIUM PER ML|Veterans Affairs|VETERANS ADMINISTRATION|||||549.75||| A9579|EAP|0636|GADOLINIUM PER ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||549.75||| A9579|EAP|0636|GADOLINIUM PER ML|United Medicare Advantage|UHC MEDICARE GOLD MA|549.75||||||| C1713|EAP|0278|SCREW PERIATRICULAR|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|164.25||||94.50||| C1713|EAP|0278|SCREW PERIATRICULAR|United Medicare Advantage|UHC MEDICARE GOLD MA|129.75||||94.50||| C1713|EAP|0278|SCREW PERIATRICULAR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|376.50||||94.50||| C1713|EAP|0278|SCREW LOCKING T2 FT|United Medicare Advantage|UHC MEDICARE GOLD MA|376.50||||94.50||| C1713|EAP|0278|SCREW LOCKING|United Medicare Advantage|UHC MEDICARE GOLD MA|2.79||||94.50||| C1713|EAP|0278|SCREW LAG U-BLADE TI|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1,753.25||||94.50||| C1713|EAP|0278|SCREW LAG TI|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|9.83||||94.50||| C1713|EAP|0278|SCREW LAG OMEGA PLUS|United Medicare Advantage|UHC MEDICARE GOLD MA|5.70||||94.50||| C1713|EAP|0278|SCREW LAG OMEGA PLUS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,753.25||||5.70||| C1713|EAP|0278|SCREW COMPRESSION|United Medicare Advantage|UHC MEDICARE GOLD MA|164.25||||94.50||| C1713|EAP|0278|SCREW BONE T7|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.79||||205.50||| C1713|EAP|0278|SCREW BONE T7|United Medicare Advantage|AARP UHC WEST COMPLETE MA|164.25||||205.50||| C1713|EAP|0278|SCREW BONE T10|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.79||||129.75||| C1713|EAP|0278|SCREW BONE PART THREAD T7|United Medicare Advantage|AARP UHC WEST COMPLETE MA|502.75||||249.75||| C1713|EAP|0278|SCREW COMPRESSION|Workers Compensation|WORKERS COMPENSATION OTHER|||||164.25||| C1713|EAP|0278|SCREW BONE T7|Workers Compensation|WORKERS COMPENSATION OTHER|||||205.50||| C1713|EAP|0278|SCREW BONE T7|Medicaid|HENDERSON COUNTY INDIGENT|||||205.50||| C1713|EAP|0278|SCREW BONE T10|Medicaid|HENDERSON COUNTY INDIGENT|||||129.75||| C1713|EAP|0278|SCREW LAG TI|United Healthcare|UNITED HEALTHCARE|||||9.83||| C1713|EAP|0272|SCREWS BG LOCKING 2.5 X 1|Medicare|MEDICARE ACUTE|376.50||||8.69||| C1713|EAP|0272|HIP BIPOLAR COMPONENT|Medicare|MEDICARE ACUTE|1,514.25||||8.69||| C1713|EAP|0272||Medicare|MEDICARE ACUTE|2,736.50||||8.69||| C1713|EAP|0278|SCREW PERIATRICULAR|NON CONTRACTED|COMMERCIAL OTHER 1|||||94.50||| C1713|EAP|0278|SCREWS BG LOCKING 2.5 X 0|Medicare|MEDICARE ACUTE|192.50||||8.69||| C1713|EAP|0278|SCREW TOE CANNULATED|Medicare|MEDICARE ACUTE|192.50||||413.25||| C1713|EAP|0278|SCREW PERIPROSTH|Medicare|MEDICARE ACUTE|192.50||||352.50||| C1713|EAP|0278|SCREW LOCKING|Medicare|MEDICARE ACUTE|192.50||||2.79||| C1713|EAP|0278|SCREW LAG TI|Medicare|MEDICARE ACUTE|192.50||||9.83||| C1713|EAP|0278|SCREW LAG OMEGA PLUS|Medicare|MEDICARE ACUTE|192.50||||5.70||| C1713|EAP|0278|SCREW BONE T7|Medicare|MEDICARE ACUTE|376.50||||205.50||| C1713|EAP|0278|SCREW BONE T10|Medicare|MEDICARE ACUTE|1,753.25||||129.75||| C1713|EAP|0278|SCREW BONE PART THREAD T7|Medicare|MEDICARE ACUTE|9.83||||249.75||| C1713|EAP|0278|SCREW BG NON-LOCKING 2.5|Medicare|MEDICARE ACUTE|5.70||||7.26||| C1713|EAP|0278|SCREW ANCHORAGE LOCKING|Medicare|MEDICARE ACUTE|502.75||||502.75||| C1713|EAP|0278|SCREW PERIATRICULAR|United Healthcare|UNITED HEALTHCARE|||||94.50||| C1713|EAP|0278|SCREW BONE T7|United Healthcare|UNITED HEALTHCARE|||||205.50||| C1713|EAP|0278|SCREW PERIATRICULAR|Texas Workforce Commission|DIS DETER SERV (DDS)|||||94.50||| C1713|EAP|0272|HIP BIPOLAR COMPONENT|Humana Medicare Advantage|HUMANA MA|1,514.25||||||| C1713|EAP|0278|SCREW TOE CANNULATED|Humana Medicare Advantage|HUMANA MA|413.25||||413.25||| C1713|EAP|0278|SCREW PERIATRICULAR|Humana Medicare Advantage|HUMANA MA|352.50||||94.50||| C1713|EAP|0278|SCREW LOCKING|Humana Medicare Advantage|HUMANA MA|376.50||||2.79||| C1713|EAP|0278|SCREW BONE T7|Humana Medicare Advantage|HUMANA MA|1,753.25||||205.50||| C1713|EAP|0278|SCREW BONE PART THREAD T7|Humana Medicare Advantage|HUMANA MA|5.70||||249.75||| C1713|EAP|0272|HIP BIPOLAR COMPONENT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1,514.25||||||| C1713|EAP|0278|SCREW LAG TI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|376.50||||9.83||| C1713|EAP|0278|SCREW LOCKING|Managed Medicaid|MEDICAID SUPERIOR|376.50||||2.79||| C1713|EAP|0272|HIP BIPOLAR COMPONENT|Managed Medicare|HEALTHSPRING MA|1,514.25||||||| C1713|EAP|0278|SCREW LAG OMEGA PLUS|Managed Medicare|HEALTHSPRING MA|||||5.70||| C1713|EAP|0278|SCREW BONE T7|Managed Medicare|HEALTHSPRING MA|||||205.50||| C1713|EAP|0278|SCREW BONE T10|Humana Medicare Advantage|HUMANA MA|9.83||||129.75||| C1713|EAP|0278|SCREW BONE T10|Managed Medicare|HEALTHSPRING MA|||||129.75||| C1713|EAP|0278|SCREW TOE CANNULATED|Managed Medicaid|MEDICAID SUPERIOR|376.50||||413.25||| C1713|EAP|0278|SCREW TOE CANNULATED|Managed Medicaid|MEDICAID AMERIGROUP|376.50||||413.25||| C1713|EAP|0278|SCREW PERIATRICULAR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||94.50||| C1713|EAP|0278|SCREW PERIPROSTH|Humana Medicare Advantage|HUMANA MA|413.25||||352.50||| C1713|EAP|0278|SCREW PERIPROSTH|Managed Medicaid|MEDICAID SUPERIOR|376.50||||352.50||| C1713|EAP|0278|SCREW BONE PART THREAD T7|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1,753.25||||249.75||| C1713|EAP|0278|SCREW PERIATRICULAR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|376.50||||94.50||| C1713|EAP|0278|SCREW PERIATRICULAR|Managed Medicaid|MEDICAID AMERIGROUP|376.50||||94.50||| C1713|EAP|0272||Texas Workforce Commission|DIS DETER SERV (DDS)|||||1,091.25||| C1713|EAP|0278|SCREW BONE T10|Managed Medicaid|MEDICAID SUPERIOR|167.50||||129.75||| C1713|EAP|0278|SCREW BONE T7|Managed Medicaid|MEDICAID SUPERIOR|9.83||||205.50||| C1713|EAP|0278|SCREW PERIPROSTH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|376.50||||352.50||| C1713|EAP|0278|SCREW PERIPROSTH|Managed Medicaid|MEDICAID AMERIGROUP|376.50||||352.50||| C1713|EAP|0278|SCREW BONE T7|Managed Medicaid|MEDICAID UNITED HEALTHCARE|376.50||||205.50||| C1713|EAP|0278|SCREW BONE T7|Managed Medicaid|MEDICAID AMERIGROUP|376.50||||205.50||| C1713|EAP|0278|SCREW BONE PART THREAD T7|Managed Medicaid|MEDICAID AMERIGROUP|1,753.25||||249.75||| C1713|EAP|0272||Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1,091.25||| C1713|EAP|0278|SCREW COMPRESSION|Medicare|MEDICARE ACUTE|94.50||||164.25||| C1713|EAP|0278|SCREW PERIATRICULAR|Medicare|MEDICARE ACUTE|192.50||||94.50||| C1713|EAP|0278|SCREW PERIPROSTH|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||352.50||| C1713|EAP|0278|SCREW PERIATRICULAR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||94.50||| C1713|EAP|0278|SCREW PERIATRICULAR|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||94.50||| C1713|EAP|0278|SCREW PERIATRICULAR|Access Direct Platinum|HEALTHFIRST TPA UMR|||||94.50||| C1713|EAP|0278|SCREWS BG LOCKING 2.5 X 1|Medicare|MEDICARE ACUTE|192.50||||8.69||| C1713|EAP|0278|SCREW BONE T7|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||205.50||| C1713|EAP|0278|SCREW BONE PART THREAD T7|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||249.75||| C1713|EAP|0278|SCREW TOE CANNULATED|Aetna|AETNA PPO|||||413.25||| C1713|EAP|0278|SCREW PERIATRICULAR|Aetna|AETNA PPO|||||94.50||| C1713|EAP|0278|SCREW PERIATRICULAR|Aetna|AETNA OTHER|||||94.50||| C1713|EAP|0278|SCREW BONE T7|Aetna|AETNA PPO|||||205.50||| C1713|EAP|0278|SCREW TOE CANNULATED|Veterans Affairs|VETERANS ADMINISTRATION|||||413.25||| C1713|EAP|0278|SCREW TOE CANNULATED|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|376.50||||413.25||| C1713|EAP|0278|SCREW BONE T7|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,753.25||||205.50||| C1713|EAP|0278|SCREW PERIATRICULAR|Aenta Medicare Advantage|AETNA MEDICARE MA|376.50||||94.50||| C1713|EAP|0278|SCREW LOCKING|Aenta Medicare Advantage|AETNA MEDICARE MA|376.50||||2.79||| C1713|EAP|0278|SCREW LAG TI|Aenta Medicare Advantage|AETNA MEDICARE MA|376.50||||9.83||| C1713|EAP|0278|SCREW BONE T10|Aenta Medicare Advantage|AETNA MEDICARE MA|1,753.25||||129.75||| C1713|EAP|0278|SCREW BONE PART THREAD T7|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|502.75||||249.75||| C1713|EAP|0278|SCREW COMPRESSION|United Medicare Advantage|AARP UHC WEST COMPLETE MA|9.83||||164.25||| C1713|EAP|0278|SCREW PERIATRICULAR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|376.50||||94.50||| C1713|EAP|0278|SCREW LAG TI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|376.50||||9.83||| C1713|EAP|0278|SCREW COMPRESSION|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|376.50||||164.25||| C1713|EAP|0278|SCREW BONE PART THREAD T7|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.83||||249.75||| C1713|EAP|0278|SCREW PERIATRICULAR|Blue Cross HMO Specialty|BCBSTX HMO|||||94.50||| C1713|EAP|0278|SCREW LOCKING|Blue Cross HMO Specialty|BCBSTX HMO|||||2.79||| C1713|EAP|0278|SCREW LAG TI|Blue Cross HMO Specialty|BCBSTX HMO|||||9.83||| C1713|EAP|0278|SCREW BONE T10|Blue Cross HMO Specialty|BCBSTX HMO|||||129.75||| C1713|EAP|0278|SCREW LOCKING T2 FT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|376.50||||94.50||| C1713|EAP|0278|SCREW PERIATRICULAR|Cigna|CIGNA|||||94.50||| C1713|EAP|0278|SCREW LAG TI|Cigna|CIGNA|||||9.83||| C1713|EAP|0278|SCREW COMPRESSION|Cigna|CIGNA|||||164.25||| C1713|EAP|0278|SCREW BONE T7|Cigna|CIGNA|||||205.50||| C1713|EAP|0278|SCREW COMPRESSION|Blue Cross PPO Specialty|BCBSTX PPO|||||164.25||| C1713|EAP|0278|SCREW LOCKING T2 FT|Blue Cross PPO Specialty|BCBSTX PPO|||||376.50||| C1713|EAP|0278|SCREW LOCKING|Blue Cross PPO Specialty|BCBSTX PPO|||||2.79||| C1713|EAP|0278|SCREW LAG OMEGA PLUS|Blue Cross PPO Specialty|BCBSTX PPO|||||5.70||| C1713|EAP|0272|HIP BIPOLAR COMPONENT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1,514.25||||||| C1713|EAP|0278|SCREW BONE T7|Blue Cross PPO Specialty|BCBSTX PPO|||||205.50||| C1713|EAP|0278|SCREW BONE T10|Blue Cross PPO Specialty|BCBSTX PPO|||||129.75||| C1713|EAP|0278|SCREW PERIATRICULAR|Blue Cross PPO Specialty|BCBSTX PPO|||||94.50||| C1713|EAP|0278|SCREW PERIPROSTH|Blue Cross PPO Specialty|BCBSTX PPO|||||352.50||| C1713|EAP|0278|SCREW TOE CANNULATED|Blue Cross PPO Specialty|BCBSTX PPO|||||413.25||| C1726|EAP|0270||Blue Cross PPO Specialty|BCBSTX PPO|||||1,084.75||| C1727|EAP|0272|TROCAR R1011|Medicare|MEDICARE ACUTE|810.50||||810.50||| C1727|EAP|0272|TROCAR LR005|Medicare|MEDICARE ACUTE|810.50||||711.25||| C1727|EAP|0272|TROCAR R1011|NON CONTRACTED|COMMERCIAL OTHER 1|810.50||||||| C1727|EAP|0272|TROCAR R1011|United Healthcare|UNITED HEALTHCARE|||||810.50||| C1727|EAP|0272|TROCAR LR005|United Healthcare|UNITED HEALTHCARE|||||711.25||| C1727|EAP|0272|TROCAR LR005|Medicaid|MEDICAID|711.25||||711.25||| C1727|EAP|0272|TROCAR R1011|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||810.50||| C1727|EAP|0272|TROCAR R1011|United Medicare Advantage|UHC MEDICARE GOLD MA|||||810.50||| C1727|EAP|0272|TROCAR R1011|United Medicare Advantage|UHC AARP MCR HMO MA|||||810.50||| C1727|EAP|0272|TROCAR R1011|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||810.50||| C1727|EAP|0272|TROCAR LR005|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||711.25||| C1727|EAP|0272|TROCAR LR005|United Medicare Advantage|UHC MEDICARE GOLD MA|||||711.25||| C1727|EAP|0272|TROCAR LR005|United Medicare Advantage|UHC AARP MCR HMO MA|||||711.25||| C1727|EAP|0272|TROCAR LR005|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||711.25||| C1727|EAP|0272|TROCAR R1011|Managed Medicaid|MEDICAID SUPERIOR|||||810.50||| C1727|EAP|0272|TROCAR R1011|Medicaid|MEDICAID|810.50||||711.25||| C1727|EAP|0272|TROCAR LR005|Managed Medicaid|MEDICAID UNITED HEALTHCARE|711.25||||||| C1727|EAP|0272|TROCAR LR005|Managed Medicaid|MEDICAID AMERIGROUP|||||711.25||| C1727|EAP|0272|TROCAR LR005|NON CONTRACTED|COMMERCIAL OTHER 1|711.25||||||| C1727|EAP|0272|TROCAR LR005|Managed Medicaid|MEDICAID SUPERIOR|||||711.25||| C1727|EAP|0272|TROCAR R1011|Managed Medicaid|MEDICAID UNITED HEALTHCARE|810.50||||||| C1727|EAP|0272|TROCAR R1011|Managed Medicaid|MEDICAID AMERIGROUP|||||810.50||| C1727|EAP|0272|TROCAR R1011|Humana Medicare Advantage|HUMANA MA|810.50||||810.50||| C1727|EAP|0272|TROCAR LR005|Humana Medicare Advantage|HUMANA MA|711.25||||711.25||| C1727|EAP|0272|TROCAR R1011|Aetna|AETNA PPO|810.50||||||| C1727|EAP|0272|TROCAR LR005|Aetna|AETNA PPO|711.25||||||| C1727|EAP|0272|TROCAR LR005|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|711.25||||711.25||| C1727|EAP|0272|TROCAR R1011|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|810.50||||810.50||| C1727|EAP|0272|TROCAR R1011|Blue Cross HMO Specialty|BCBSTX HMO|||||810.50||| C1727|EAP|0272|TROCAR LR005|Blue Cross HMO Specialty|BCBSTX HMO|||||711.25||| C1727|EAP|0272|TROCAR LR005|Cigna|CIGNA|||||711.25||| C1727|EAP|0272|TROCAR R1011|Cigna|CIGNA|||||810.50||| C1727|EAP|0272|TROCAR LR005|Blue Cross PPO Specialty|BCBSTX PPO|||||711.25||| C1727|EAP|0272|TROCAR R1011|Blue Cross PPO Specialty|BCBSTX PPO|||||810.50||| C1734|EAP|0278||Medicare|MEDICARE ACUTE|||||1,542.25||| C1751|EAP|0272|CATH CENTR VEIN MULTI LU|Blue Cross PPO Specialty|BCBSTX PPO|||||6.80||| C1751|EAP|0272|CATH CENTR VEIN MULTI LU|Humana Medicare Advantage|HUMANA MA|6.80||||6.80||| C1751|EAP|0272|CATH CENTR VEIN MULTI LU|Managed Medicaid|MEDICAID AMERIGROUP|6.80||||||| C1751|EAP|0272|CATH CENTR VEIN MULTI LU|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||6.80||| C1751|EAP|0272|CATH CENTR VEIN MULTI LU|Managed Medicaid|MEDICAID UNITED HEALTHCARE|6.80||||||| C1751|EAP|0272|CATH CENTR VEIN MULTI LU|Managed Medicare|HEALTHSPRING MA|6.80||||||| C1751|EAP|0272|CATH CENTR VEIN MULTI LU|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|6.80||||||| C1751|EAP|0272|CATH CENTR VEIN MULTI LU|United Medicare Advantage|UHC MEDICARE GOLD MA|6.80||||6.80||| C1751|EAP|0272|CATH CENTR VEIN MULTI LU|United Medicare Advantage|AARP UHC WEST COMPLETE MA|6.80||||||| C1751|EAP|0272|CATH CENTR VEIN MULTI LU|Medicaid|MEDICAID|6.80||||||| C1751|EAP|0272|CATH CENTR VEIN MULTI LU|Medicare|MEDICARE ACUTE|6.80||||6.80||| C1758|EAP|0272|CATH URETERAL SPIRAL|Medicare|MEDICARE ACUTE|226.25||||226.25||| C1758|EAP|0272|CATH URETERAL SPIRAL|United Healthcare|UNITED HEALTHCARE|||||226.25||| C1758|EAP|0272|CATH URETERAL SPIRAL|Medicaid|MEDICAID|226.25||||||| C1758|EAP|0272|CATH URETERAL SPIRAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|226.25||||||| C1758|EAP|0272|CATH URETERAL SPIRAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||226.25||| C1758|EAP|0272|CATH URETERAL SPIRAL|United Medicare Advantage|UHC MEDICARE GOLD MA|226.25||||226.25||| C1758|EAP|0272|CATH URETERAL SPIRAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||226.25||| C1758|EAP|0272|CATH URETERAL SPIRAL|Managed Medicaid|MEDICAID SUPERIOR|||||226.25||| C1758|EAP|0272|CATH URETERAL SPIRAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||226.25||| C1758|EAP|0272|CATH URETERAL SPIRAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||226.25||| C1758|EAP|0272|CATH URETERAL SPIRAL|Managed Medicare|BCBS MEDICARE PPO MA|226.25||||||| C1758|EAP|0272|CATH URETERAL SPIRAL|Humana Medicare Advantage|HUMANA MA|226.25||||226.25||| C1758|EAP|0272|CATH URETERAL SPIRAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|226.25||||226.25||| C1758|EAP|0272|CATH URETERAL SPIRAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||226.25||| C1758|EAP|0272|CATH URETERAL SPIRAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|226.25||||226.25||| C1758|EAP|0272|CATH URETERAL SPIRAL|Blue Cross HMO Specialty|BCBSTX HMO|||||226.25||| C1758|EAP|0272|CATH URETERAL SPIRAL|Cigna|CIGNA|||||226.25||| C1758|EAP|0272|CATH URETERAL SPIRAL|Blue Cross PPO Specialty|BCBSTX PPO|226.25||||226.25||| C1762|EAP|0278|GRAFT MATRIX LARGE PELVIC|Cigna|CIGNA|||||29.64||| C1762|EAP|0278|GRAFT MATRIX LARGE PELVIC|Blue Cross PPO Specialty|BCBSTX PPO|29.64||||29.64||| C1762|EAP|0278|GRAFT MATRIX LARGE PELVIC|Aetna|AETNA PPO|29.64||||||| C1762|EAP|0278|GRAFT MATRIX LARGE PELVIC|Aenta Medicare Advantage|AETNA MEDICARE MA|29.64||||||| C1762|EAP|0278|GRAFT MATRIX LARGE PELVIC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|29.64||||29.64||| C1762|EAP|0278|GRAFT MATRIX LARGE PELVIC|Humana Medicare Advantage|HUMANA MA|29.64||||||| C1762|EAP|0278|GRAFT MATRIX LARGE PELVIC|Managed Medicaid|MEDICAID SUPERIOR|29.64||||||| C1762|EAP|0278|GRAFT MATRIX LARGE PELVIC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|29.64||||||| C1762|EAP|0278|GRAFT MATRIX LARGE PELVIC|United Medicare Advantage|UHC MEDICARE GOLD MA|||||29.64||| C1762|EAP|0278|GRAFT MATRIX LARGE PELVIC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|29.64||||||| C1762|EAP|0278|GRAFT MATRIX LARGE PELVIC|Tricare|TRICARE EAST REGION|29.64||||||| C1762|EAP|0278|GRAFT MATRIX LARGE PELVIC|Medicare|MEDICARE ACUTE|29.64||||29.64||| C1767|EAP|0278|INTERSTEM GENERATOR|Medicare|MEDICARE ACUTE|||||16,164.25||| C1767|EAP|0278|INTERSTEM GENERATOR|Humana Medicare Advantage|HUMANA MA|||||16,164.25||| C1767|EAP|0278|INTERSTEM GENERATOR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||16,164.25||| C1767|EAP|0278|INTERSTEM GENERATOR|Blue Cross HMO Specialty|BCBSTX HMO|||||16,164.25||| C1767|EAP|0278|INTERSTEM GENERATOR|Blue Cross PPO Specialty|BCBSTX PPO|||||16,164.25||| C1768|EAP|0272||Blue Cross HMO Specialty|BCBSTX HMO|||||14.42||| C1768|EAP|0272||Blue Cross PPO Specialty|BCBSTX PPO|||||14.42||| C1768|EAP|0272||Aenta Medicare Advantage|AETNA MEDICARE MA|||||14.42||| C1768|EAP|0272||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||14.42||| C1768|EAP|0272||Humana Medicare Advantage|HUMANA MA|||||14.42||| C1768|EAP|0272||United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||14.42||| C1768|EAP|0272||Medicare|MEDICARE ACUTE|||||14.42||| C1769|EAP|0272|GUIDEWIRE BALL TIP STERIL|Medicaid|HENDERSON COUNTY INDIGENT|14.42||||390.50||| C1769|EAP|0272|GUIDE WIRE|Medicaid|MEDICAID|214.25||||||| C1769|EAP|0272|GUIDEWIRE JAGWIRE|Medicaid|HENDERSON COUNTY INDIGENT|14.42||||546.50||| C1769|EAP|0270||Medicare|MEDICARE ACUTE|546.50||||||| C1769|EAP|0272|KIRSCHNER WIRE PLAIN|Medicare|MEDICARE ACUTE|546.50||||75.25||| C1769|EAP|0272|GUIDEWIRE JAGWIRE|Medicare|MEDICARE ACUTE|546.50||||546.50||| C1769|EAP|0272|GUIDEWIRE BALL TIP STERIL|Medicare|MEDICARE ACUTE|546.50||||390.50||| C1769|EAP|0272|GRAFT SURGISES 4X7|NON CONTRACTED|COMMERCIAL OTHER 1|||||14.42||| C1769|EAP|0272|GUIDE WIRE|NON CONTRACTED|COMMERCIAL OTHER 1|||||214.25||| C1769|EAP|0272|GUIDE WIRE|Medicare|MEDICARE ACUTE|214.25||||214.25||| C1769|EAP|0272|GLIDEWIRE 5193|Medicare|MEDICARE ACUTE|14.42||||1,074.50||| C1769|EAP|0272|GUIDE WIRE|United Healthcare|TML GROUP BENEFITS|||||214.25||| C1769|EAP|0272|GUIDE WIRE|United Healthcare|UNITED HEALTHCARE|214.25||||214.25||| C1769|EAP|0272|GUIDE WIRE|United Healthcare|UNITED HEALTHCARE|||||214.25||| C1769|EAP|0272|GRAFT SURGISES 4X7|United Healthcare|UNITED HEALTHCARE|||||14.42||| C1769|EAP|0272|GUIDEWIRE JAGWIRE|Veterans Affairs|VETERANS ADMINISTRATION|546.50||||214.25||| C1769|EAP|0272|GUIDE WIRE|Veterans Affairs|VETERANS ADMINISTRATION|214.25||||214.25||| C1769|EAP|0272|KIRSCHNER WIRE PLAIN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|390.50||||75.25||| C1769|EAP|0272|GUIDEWIRE JAGWIRE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|546.50||||75.25||| C1769|EAP|0272|GUIDEWIRE JAGWIRE|United Medicare Advantage|UHC MEDICARE GOLD MA|546.50||||214.25||| C1769|EAP|0272|GUIDEWIRE JAGWIRE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|546.50||||214.25||| C1769|EAP|0272|GUIDEWIRE BALL TIP STERIL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|214.25||||390.50||| C1769|EAP|0272|GUIDE WIRE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|14.42||||214.25||| C1769|EAP|0272|GUIDE WIRE|United Medicare Advantage|UHC MEDICARE GOLD MA|14.42||||214.25||| C1769|EAP|0272|GUIDE WIRE|United Medicare Advantage|UHC MEDICARE GOLD MA|214.25||||214.25||| C1769|EAP|0272|GUIDE WIRE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|214.25||||214.25||| C1769|EAP|0272|KIRSCHNER WIRE PLAIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|546.50||||75.25||| C1769|EAP|0272|GUIDEWIRE BALL TIP STERIL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|14.42||||390.50||| C1769|EAP|0272|GUIDE WIRE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|14.42||||214.25||| C1769|EAP|0272|KIRSCHNER WIRE PLAIN|Managed Medicaid|MEDICAID SUPERIOR|||||75.25||| C1769|EAP|0272|GUIDE WIRE|Managed Medicaid|MEDICAID AMERIGROUP|546.50||||214.25||| C1769|EAP|0272|GUIDEWIRE BALL TIP STERIL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|390.50||||214.25||| C1769|EAP|0272|GUIDEWIRE ASNIS|Managed Medicaid|MEDICAID SUPERIOR|||||95.25||| C1769|EAP|0272|GUIDE WIRE|Managed Medicaid|MEDICAID SUPERIOR|||||214.25||| C1769|EAP|0272|GUIDE WIRE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|546.50||||214.25||| C1769|EAP|0272|GUIDE WIRE|Managed Medicare|BCBS MEDICARE PPO MA|214.25||||214.25||| C1769|EAP|0272|GUIDE WIRE|Managed Medicare|HEALTHSPRING MA|||||214.25||| C1769|EAP|0272|KIRSCHNER WIRE PLAIN|Humana Medicare Advantage|HUMANA MA|546.50||||75.25||| C1769|EAP|0272|GRAFT SURGISES 4X7|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||14.42||| C1769|EAP|0272|GUIDEWIRE ASNIS|Humana Medicare Advantage|HUMANA MA|546.50||||95.25||| C1769|EAP|0272|GUIDE WIRE|Humana Medicare Advantage|HUMANA MA|390.50||||214.25||| C1769|EAP|0272|GLIDEWIRE 5193|Humana Medicare Advantage|HUMANA MA|214.25||||1,074.50||| C1769|EAP|0272|GUIDE WIRE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|214.25||||214.25||| C1769|EAP|0272|GUIDEWIRE BALL TIP STERIL|United Healthcare|UNITED HEALTHCARE|||||390.50||| C1769|EAP|0272|GRAFT SURGISES 4X7|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|214.25||||14.42||| C1769|EAP|0272|GLIDEWIRE 5193|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1,074.50||| C1769|EAP|0272|GUIDEWIRE ASNIS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|214.25||||95.25||| C1769|EAP|0272|GUIDE WIRE|Aetna|AETNA PPO|390.50||||214.25||| C1769|EAP|0272|GUIDEWIRE ASNIS|Medicare|MEDICARE ACUTE|390.50||||95.25||| C1769|EAP|0272|KIRSCHNER WIRE PLAIN|Aenta Medicare Advantage|AETNA MEDICARE MA|546.50||||75.25||| C1769|EAP|0272|GUIDEWIRE BALL TIP STERIL|Aenta Medicare Advantage|AETNA MEDICARE MA|546.50||||390.50||| C1769|EAP|0272|GUIDE WIRE|Aenta Medicare Advantage|AETNA MEDICARE MA|546.50||||214.25||| C1769|EAP|0272|GUIDEWIRE JAGWIRE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|546.50||||75.25||| C1769|EAP|0272|GUIDEWIRE BALL TIP STERIL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|214.25||||390.50||| C1769|EAP|0272|GUIDE WIRE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|14.42||||214.25||| C1769|EAP|0272|KIRSCHNER WIRE PLAIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|390.50||||75.25||| C1769|EAP|0272|KIRSCHNER WIRE PLAIN|Blue Cross HMO Specialty|BCBSTX HMO|||||75.25||| C1769|EAP|0272|GUIDEWIRE BALL TIP STERIL|Blue Cross HMO Specialty|BCBSTX HMO|||||390.50||| C1769|EAP|0272|GUIDE WIRE|Blue Cross HMO Specialty|BCBSTX HMO|||||214.25||| C1769|EAP|0272|KIRSCHNER WIRE PLAIN|Cigna|CIGNA|||||75.25||| C1769|EAP|0272|GUIDEWIRE BALL TIP STERIL|Cigna|CIGNA|||||390.50||| C1769|EAP|0272|GUIDE WIRE|Cigna|CIGNA|||||214.25||| C1769|EAP|0272|GRAFT SURGISES 4X7|Cigna|CIGNA|||||14.42||| C1769|EAP|0272|GUIDEWIRE BALL TIP STERIL|Blue Cross PPO Specialty|BCBSTX PPO|546.50||||390.50||| C1769|EAP|0272|KIRSCHNER WIRE PLAIN|Blue Cross PPO Specialty|BCBSTX PPO|546.50||||75.25||| C1769|EAP|0272|GLIDEWIRE 5193|Blue Cross PPO Specialty|BCBSTX PPO|214.25||||1,074.50||| C1769|EAP|0272|GUIDEWIRE ASNIS|Blue Cross PPO Specialty|BCBSTX PPO|546.50||||95.25||| C1769|EAP|0272|GUIDE WIRE|Blue Cross PPO Specialty|BCBSTX PPO|546.50||||214.25||| C1771|EAP|0278|HALO KIT AVAULTA|Blue Cross HMO Specialty|BCBSTX HMO|||||3,285.50||| C1771|EAP|0278|HALO KIT AVAULTA|Blue Cross PPO Specialty|BCBSTX PPO|||||3,285.50||| C1771|EAP|0278|HALO KIT AVAULTA|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3,285.50||| C1771|EAP|0278|HALO KIT AVAULTA|Aetna|AETNA PPO|3,285.50||||3,285.50||| C1771|EAP|0278|HALO KIT AVAULTA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3,285.50||||3,285.50||| C1771|EAP|0278|HALO KIT AVAULTA|Humana Medicare Advantage|HUMANA MA|||||3,285.50||| C1771|EAP|0278|HALO KIT AVAULTA|Managed Medicaid|MEDICAID AMERIGROUP|3,285.50||||||| C1771|EAP|0278|HALO KIT AVAULTA|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||3,285.50||| C1771|EAP|0278|HALO KIT AVAULTA|Tricare|TRICARE EAST REGION|||||3,285.50||| C1771|EAP|0278|HALO KIT AVAULTA|Medicare|MEDICARE ACUTE|||||3,285.50||| C1771|EAP|0278|HALO KIT AVAULTA|Texas Workforce Commission|DIS DETER SERV (DDS)|3,285.50||||||| C1776|EAP|0278|PLATE DORSAL SMARTLOCK|Medicaid|HENDERSON COUNTY INDIGENT|||||1,542.25||| C1776|EAP|0278|WASHER ASNIS|Medicare|MEDICARE ACUTE|187.25||||187.25||| C1776|EAP|0278|TK PREP KIT TIB & FEMORAL|Medicare|MEDICARE ACUTE|297.50||||187.25||| C1776|EAP|0278|PLATE T OBLIGUE|Medicare|MEDICARE ACUTE|3,028.50||||10.46||| C1776|EAP|0278|PLATE DORSAL SMARTLOCK|Medicare|MEDICARE ACUTE|259.50||||1,542.25||| C1776|EAP|0278|PLATE DISTAL LAT FIB 3-6H|Medicare|MEDICARE ACUTE|2,163.25||||10.46||| C1776|EAP|0278|PLATE ANCHORAGE UTILITY|Medicare|MEDICARE ACUTE|2,944.25||||187.25||| C1776|EAP|0278|PLATE ANCHORAGE UTILITY|Medicare|MEDICARE ACUTE|1,081.50||||2,944.25||| C1776|EAP|0278|NAIL TIBIA T2 STD|Medicare|MEDICARE ACUTE|2,736.50||||187.25||| C1776|EAP|0278|NAIL KIT LONG|Medicare|MEDICARE ACUTE|3,514.25||||187.25||| C1776|EAP|0278|KNEE TIBIAL INSERT|Medicare|MEDICARE ACUTE|1,838.75||||187.25||| C1776|EAP|0278|TK PREP KIT TIB & FEMORAL|United Healthcare|GEHA|||||297.50||| C1776|EAP|0278|SCREW ACL|United Healthcare|UNITED HEALTHCARE|||||2.60||| C1776|EAP|0278|PLATE DORSAL SMARTLOCK|United Healthcare|UNITED HEALTHCARE|||||1,542.25||| C1776|EAP|0278|KNEE FEMORAL HEAD|United Healthcare|GEHA|||||3,028.50||| C1776|EAP|0278|KNEE BASEPLATE|United Healthcare|GEHA|||||2,812.25||| C1776|EAP|0278|PLATE DORSAL SMARTLOCK|Workers Compensation|WORKERS COMPENSATION OTHER|||||1,542.25||| C1776|EAP|0278|TK PREP KIT TIB & FEMORAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3,514.25||||297.50||| C1776|EAP|0278|TK PREP KIT TIB & FEMORAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|297.50||||297.50||| C1776|EAP|0278|TK PREP KIT TIB & FEMORAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|297.50||||297.50||| C1776|EAP|0278|PLATE DORSAL SMARTLOCK DR|United Medicare Advantage|UHC MEDICARE GOLD MA|2,944.25||||1,744.50||| C1776|EAP|0278|PLATE DORSAL SMARTLOCK|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1,838.75||||1,542.25||| C1776|EAP|0278|PLATE DISTAL MEDIAL TIBIA|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3,028.50||||16.38||| C1776|EAP|0278|PLATE DISTAL LAT FIB 3-6H|United Medicare Advantage|UHC MEDICARE GOLD MA|10.46||||1,744.50||| C1776|EAP|0278|PLATE ANCHORAGE UTILITY|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2,944.25||||297.50||| C1776|EAP|0278|PLATE ANCHORAGE UTILITY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2,736.50||||2,944.25||| C1776|EAP|0278|NAIL TIBIA T2 STD|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2,736.50||||297.50||| C1776|EAP|0278|KNEE TIBIAL INSERT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,838.75||||1,838.75||| C1776|EAP|0278|KNEE PATELLA|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|19.47||||7.57||| C1776|EAP|0278|KNEE PATELLA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|7.57||||7.57||| C1776|EAP|0278|KNEE FEMORAL HEAD|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3,028.50||||3,028.50||| C1776|EAP|0278|KNEE BASEPLATE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1,081.50||||2,812.25||| C1776|EAP|0278|KNEE BASEPLATE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2,812.25||||2,812.25||| C1776|EAP|0278|ANCHOR SUTURE IMPLANT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3,785.50||||1,091.25||| C1776|EAP|0278|KNEE BASEPLATE|Managed Medicaid|MEDICAID SUPERIOR|2,812.25||||1,744.50||| C1776|EAP|0278|KNEE BASEPLATE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2,812.25||||||| C1776|EAP|0278|KNEE PATELLA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2,736.50||||7.57||| C1776|EAP|0278|KNEE TIBIAL INSERT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1,838.75||||||| C1776|EAP|0278|KNEE FEMORAL HEAD|Managed Medicaid|MEDICAID SUPERIOR|3,028.50||||1,744.50||| C1776|EAP|0278|KNEE TIBIAL INSERT|Managed Medicare|HEALTHSPRING MA|1,081.50||||1,838.75||| C1776|EAP|0278|TK PREP KIT TIB & FEMORAL|Managed Medicare|HEALTHSPRING MA|1,081.50||||297.50||| C1776|EAP|0278|KNEE BASEPLATE|Managed Medicare|HEALTHSPRING MA|3,785.50||||2,812.25||| C1776|EAP|0278|PLATE ANCHORAGE UTILITY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2,736.50||||2,944.25||| C1776|EAP|0278|PLATE DORSAL SMARTLOCK|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2,736.50||||1,542.25||| C1776|EAP|0278|TK PREP KIT TIB & FEMORAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2,736.50||||297.50||| C1776|EAP|0278|PLATE T OBLIGUE|Managed Medicaid|MEDICAID AMERIGROUP|2,736.50||||10.46||| C1776|EAP|0278|PLATE DORSAL SMARTLOCK DR|Managed Medicaid|MEDICAID SUPERIOR|3,785.50||||1,744.50||| C1776|EAP|0278|TK PREP KIT TIB & FEMORAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|297.50||||||| C1776|EAP|0278|NAIL TIBIA T2 STD|Managed Medicaid|MEDICAID SUPERIOR|2,736.50||||1,744.50||| C1776|EAP|0278|PLATE ANCHORAGE UTILITY|Managed Medicaid|MEDICAID AMERIGROUP|2,736.50||||2,944.25||| C1776|EAP|0278|KNEE PATELLA|Managed Medicaid|MEDICAID SUPERIOR|7.57||||1,744.50||| C1776|EAP|0278|KNEE TIBIAL INSERT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2,736.50||||1,838.75||| C1776|EAP|0278|KNEE TIBIAL INSERT|Managed Medicaid|MEDICAID SUPERIOR|1,838.75||||1,744.50||| C1776|EAP|0278|KNEE FEMORAL HEAD|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|3,028.50||||||| C1776|EAP|0278|KNEE FEMORAL HEAD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1,081.50||||3,028.50||| C1776|EAP|0278|TK PREP KIT TIB & FEMORAL|Humana Medicare Advantage|HUMANA MA|3,514.25||||297.50||| C1776|EAP|0278|TK PREP KIT TIB & FEMORAL|Humana Medicare Advantage|HUMANA MA|297.50||||297.50||| C1776|EAP|0278|PLATE T OBLIGUE|Humana Medicare Advantage|HUMANA MA|10.46||||297.50||| C1776|EAP|0278|TK PREP KIT TIB & FEMORAL|Managed Medicaid|MEDICAID SUPERIOR|297.50||||1,744.50||| C1776|EAP|0278|KNEE FEMORAL HEAD|Managed Medicare|HEALTHSPRING MA|1,081.50||||3,028.50||| C1776|EAP|0278|PLATE DORSAL SMARTLOCK|Humana Medicare Advantage|HUMANA MA|1,838.75||||1,542.25||| C1776|EAP|0278|PLATE DISTAL MEDIAL TIBIA|Humana Medicare Advantage|HUMANA MA|7.57||||16.38||| C1776|EAP|0278|PLATE ANCHORAGE UTILITY|Humana Medicare Advantage|HUMANA MA|3,028.50||||2,944.25||| C1776|EAP|0278|PLATE ANCHORAGE UTILITY|Humana Medicare Advantage|HUMANA MA|2,944.25||||297.50||| C1776|EAP|0278|NAIL TIBIA T2 STD|Humana Medicare Advantage|HUMANA MA|2,736.50||||297.50||| C1776|EAP|0278|NAIL RECONSTRUCTION|Humana Medicare Advantage|HUMANA MA|2,684.50||||297.50||| C1776|EAP|0278|KNEE TIBIAL INSERT|Humana Medicare Advantage|HUMANA MA|2,812.25||||1,838.75||| C1776|EAP|0278|KNEE PATELLA|Humana Medicare Advantage|HUMANA MA|19.47||||7.57||| C1776|EAP|0278|KNEE BASEPLATE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3,785.50||||2,812.25||| C1776|EAP|0278|KNEE FEMORAL HEAD|Humana Medicare Advantage|HUMANA MA|259.50||||3,028.50||| C1776|EAP|0278|KNEE BASEPLATE|Humana Medicare Advantage|HUMANA MA|1,081.50||||2,812.25||| C1776|EAP|0278|ANCHOR SUTURE IMPLANT|Humana Medicare Advantage|HUMANA MA|3,785.50||||1,091.25||| C1776|EAP|0278|WASHER ASNIS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2,812.25||||187.25||| C1776|EAP|0278|KNEE FEMORAL HEAD|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|259.50||||3,028.50||| C1776|EAP|0278|TK PREP KIT TIB & FEMORAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|297.50||||187.25||| C1776|EAP|0278|KNEE TIBIAL INSERT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1,838.75||||187.25||| C1776|EAP|0278|KNEE TIBIAL INSERT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1,838.75||||||| C1776|EAP|0278|KNEE PATELLA|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|7.57||||||| C1776|EAP|0278|KNEE TIBIAL INSERT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2,812.25||||1,838.75||| C1776|EAP|0278|PLATE DISTAL LAT FIB 3-6H|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2,944.25||||10.46||| C1776|EAP|0278|KNEE FEMORAL HEAD|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|3,028.50||||187.25||| C1776|EAP|0278|KNEE FEMORAL HEAD|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|3,028.50||||||| C1776|EAP|0278|KNEE BASEPLATE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2,812.25||||||| C1776|EAP|0278|TK PREP KIT TIB & FEMORAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|297.50||||||| C1776|EAP|0278|HIP SHELL|Aetna|AETNA PPO|19.47||||||| C1776|EAP|0278|HIP SCREW|Aetna|AETNA PPO|259.50||||||| C1776|EAP|0278|HIP LINER|Aetna|AETNA PPO|2,163.25||||||| C1776|EAP|0278|HIP HEAD|Aetna|AETNA PPO|1,081.50||||||| C1776|EAP|0278|PLATE ANCHORAGE UTILITY|Veterans Affairs|VETERANS ADMINISTRATION|||||2,944.25||| C1776|EAP|0278|HIP FEMORAL STEM|Aetna|AETNA PPO|3,785.50||||||| C1776|EAP|0278|KNEE BASEPLATE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3,785.50||||2,812.25||| C1776|EAP|0278|TK PREP KIT TIB & FEMORAL|Aenta Medicare Advantage|AETNA MEDICARE MA|297.50||||10.46||| C1776|EAP|0278|PLATE T OBLIGUE|Aenta Medicare Advantage|AETNA MEDICARE MA|2,812.25||||10.46||| C1776|EAP|0278|KNEE TIBIAL INSERT|United Healthcare|GEHA|||||1,838.75||| C1776|EAP|0278|NAIL TIBIA T2 STD|Aenta Medicare Advantage|AETNA MEDICARE MA|2,736.50||||10.46||| C1776|EAP|0278|KNEE TIBIAL INSERT|Aenta Medicare Advantage|AETNA MEDICARE MA|1,838.75||||10.46||| C1776|EAP|0278|KNEE FEMORAL HEAD|Aenta Medicare Advantage|AETNA MEDICARE MA|3,028.50||||10.46||| C1776|EAP|0278|PLATE ANCHORAGE UTILITY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2,736.50||||2,944.25||| C1776|EAP|0278|ANCHOR SUTURE IMPLANT|Medicare|MEDICARE ACUTE|3,785.50||||1,091.25||| C1776|EAP|0278|TK PREP KIT TIB & FEMORAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2,944.25||||297.50||| C1776|EAP|0278|SCREW ACL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2,944.25||||2.60||| C1776|EAP|0278|KNEE TIBIAL INSERT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|19.47||||1,838.75||| C1776|EAP|0278|KNEE PATELLA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|259.50||||7.57||| C1776|EAP|0278|KNEE FEMORAL HEAD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2,163.25||||3,028.50||| C1776|EAP|0278|KNEE PATELLA|Blue Cross HMO Specialty|BCBSTX HMO|7.57||||10.46||| C1776|EAP|0278|ANCHOR SUTURE IMPLANT|Blue Cross HMO Specialty|BCBSTX HMO|2,812.25||||1,091.25||| C1776|EAP|0278|TK PREP KIT TIB & FEMORAL|Blue Cross HMO Specialty|BCBSTX HMO|297.50||||10.46||| C1776|EAP|0278|PLATE HOOK 6 HOLE|Medicare|MEDICARE ACUTE|2,812.25||||39.90||| C1776|EAP|0278|WASHER ASNIS|Medicare|MEDICARE ACUTE|7.57||||187.25||| C1776|EAP|0278|PLATE DISTAL LAT FIB 3-6H|Blue Cross HMO Specialty|BCBSTX HMO|3,028.50||||10.46||| C1776|EAP|0278|KNEE TIBIAL INSERT|Blue Cross HMO Specialty|BCBSTX HMO|1,838.75||||10.46||| C1776|EAP|0278|KNEE BASEPLATE|ChampVA|CHAMPVA CENTER|2,812.25||||||| C1776|EAP|0278|KNEE FEMORAL HEAD|ChampVA|CHAMPVA CENTER|3,028.50||||||| C1776|EAP|0278|TK PREP KIT TIB & FEMORAL|ChampVA|CHAMPVA CENTER|297.50||||||| C1776|EAP|0278|KNEE TIBIAL INSERT|ChampVA|CHAMPVA CENTER|1,838.75||||||| C1776|EAP|0278|WASHER ASNIS|Blue Cross PPO Specialty|BCBSTX PPO|||||187.25||| C1776|EAP|0278|SCREW ACL|Blue Cross PPO Specialty|BCBSTX PPO|||||2.60||| C1776|EAP|0278|PLATE DISTAL MEDIAL TIBIA|Blue Cross PPO Specialty|BCBSTX PPO|||||16.38||| C1776|EAP|0278|PLATE DISTAL LAT FIB 3-6H|Blue Cross PPO Specialty|BCBSTX PPO|||||10.46||| C1776|EAP|0278|PLATE ANCHORAGE UTILITY|Blue Cross PPO Specialty|BCBSTX PPO|||||2,944.25||| C1776|EAP|0278|ANCHOR SUTURE IMPLANT|Blue Cross PPO Specialty|BCBSTX PPO|||||1,091.25||| C1778|EAP|0278|INTERSTEM LEAD|Blue Cross HMO Specialty|BCBSTX HMO|||||16,164.25||| C1778|EAP|0278|INTERSTEM LEAD|Blue Cross PPO Specialty|BCBSTX PPO|||||16,164.25||| C1778|EAP|0278|INTERSTEM LEAD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||16,164.25||| C1778|EAP|0278|INTERSTEM LEAD|Humana Medicare Advantage|HUMANA MA|||||16,164.25||| C1778|EAP|0278|INTERSTEM LEAD|Medicare|MEDICARE ACUTE|||||16,164.25||| C1781|EAP|0278|PATCH HERNIA MEDIUM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1,406.25||| C1781|EAP|0278|PATCH HERNIA MEDIUM|Veterans Affairs|VETERANS ADMINISTRATION|||||1,406.25||| C1781|EAP|0278|PATCH HERNIA SMALL|Veterans Affairs|VETERANS ADMINISTRATION|||||1,284.75||| C1781|EAP|0278|PATCH HERNIA SMALL|Tricare|TRICARE EAST REGION|||||1,284.75||| C1781|EAP|0278|PATCH HERNIA SMALL|Medicare|MEDICARE ACUTE|||||1,284.75||| C1781|EAP|0278|MESH DUAL PLUS|Medicare|MEDICARE ACUTE|||||17.90||| C1781|EAP|0278|PATCH HERNIA MEDIUM|PHCS|MULTIPLAN PHCS OTHER|||||1,406.25||| C1781|EAP|0278|PATCH HERNIA SMALL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1,284.75||| C1781|EAP|0278|PATCH HERNIA SMALL|Texas Workforce Commission|DIS DETER SERV (DDS)|||||1,284.75||| C1781|EAP|0278|PATCH HERNIA SMALL|Managed Medicaid|MEDICAID AMERIGROUP|||||1,284.75||| C1781|EAP|0278|PATCH HERNIA SMALL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,284.75||| C1781|EAP|0278|PATCH HERNIA SMALL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1,284.75||| C1781|EAP|0278|MESH DUAL PLUS|Managed Medicaid|MEDICAID AMERIGROUP|||||29.33||| C1781|EAP|0278|PATCH HERNIA SMALL|Humana Medicare Advantage|HUMANA MA|||||1,284.75||| C1781|EAP|0278|PATCH HERNIA SMALL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1,284.75||| C1781|EAP|0278|PATCH HERNIA SMALL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1,284.75||| C1781|EAP|0278|PATCH HERNIA SMALL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1,284.75||| C1781|EAP|0278|PATCH HERNIA SMALL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,284.75||| C1781|EAP|0278|PATCH HERNIA SMALL|Blue Cross HMO Specialty|BCBSTX HMO|||||1,284.75||| C1781|EAP|0278|PATCH HERNIA MEDIUM|Blue Cross HMO Specialty|BCBSTX HMO|||||1,406.25||| C1781|EAP|0278|PATCH HERNIA SMALL|Cigna|CIGNA|||||1,284.75||| C1781|EAP|0278|PATCH HERNIA SMALL|Blue Cross PPO Specialty|BCBSTX PPO|1,284.75||||1,284.75||| C1787|EAP|0278|INTERSTIM STAGE 1|Medicare|MEDICARE ACUTE|||||7,281.25||| C1788|EAP|0278|CATHETER BARDPORT|Cigna|CIGNA|||||1,733.75||| C1788|EAP|0278|CATHETER BARDPORT|Blue Cross PPO Specialty|BCBSTX PPO|||||1,733.75||| C1788|EAP|0278|CATHETER BARDPORT|Aenta Medicare Advantage|AETNA MEDICARE MA|1,733.75||||||| C1788|EAP|0278|CATHETER BARDPORT|Cigna|CIGNA OTHER|1,733.75||||||| C1788|EAP|0278|CATHETER BARDPORT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,733.75||| C1788|EAP|0278|CATHETER BARDPORT|Humana Medicare Advantage|HUMANA MA|1,733.75||||1,733.75||| C1788|EAP|0278|CATHETER BARDPORT|Managed Medicaid|MEDICAID AMERIGROUP|||||1,733.75||| C1788|EAP|0278|CATHETER BARDPORT|Managed Medicare|HEALTHSPRING MA|||||1,733.75||| C1788|EAP|0278|CATHETER BARDPORT|Veterans Affairs|VETERANS ADMINISTRATION|||||1,733.75||| C1788|EAP|0278|CATHETER BARDPORT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1,733.75||| C1788|EAP|0278|CATHETER BARDPORT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,733.75||| C1788|EAP|0278|CATHETER BARDPORT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,733.75||||1,733.75||| C1788|EAP|0278|CATHETER BARDPORT|Medicare|MEDICARE ACUTE|||||1,733.75||| C1788|EAP|0278|CATHETER BARDPORT|United Healthcare|UNITED HEALTHCARE|1,733.75||||||| C1788|EAP|0278|CATHETER BARDPORT|United Healthcare|TML GROUP BENEFITS|||||1,733.75||| C1813|EAP|0278|PENILE PROSTHESIS|United Healthcare|UNITED HEALTHCARE|||||16,217.46||| C1813|EAP|0278|PENILE PROSTHESIS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||16,217.46||| C1876|EAP|0278|STENT BILIARY ERCP|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.82||||||| C1876|EAP|0278|STENT BILIARY ERCP|Aenta Medicare Advantage|AETNA MEDICARE MA|2.82||||||| C1876|EAP|0278|STENT BILIARY ERCP|Blue Cross PPO Specialty|BCBSTX PPO|2.82||||||| C1876|EAP|0278|STENT BILIARY ERCP|Veterans Affairs|VETERANS ADMINISTRATION|2.82||||||| C1876|EAP|0278|STENT BILIARY ERCP|United Medicare Advantage|UHC MEDICARE GOLD MA|2.82||||||| C1876|EAP|0278|STENT BILIARY ERCP|Medicare|MEDICARE ACUTE|2.82||||2.82||| C2617|EAP|0278|STENT MULTI-LGTH 035532|Medicaid|MEDICAID|1,026.75||||||| C2617|EAP|0278|STENT MULTI-LGTH 035532|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,026.75||| C2617|EAP|0272||Medicare|MEDICARE ACUTE|1,026.75||||1,026.75||| C2617|EAP|0278|STENT MULTI-LGTH 035532|United Healthcare|UNITED HEALTHCARE|1,026.75||||||| C2617|EAP|0278|STENT MULTI-LGTH 035532|United Healthcare|UNITED HEALTHCARE|||||1,026.75||| C2617|EAP|0278|STENT MULTI-LGTH 035532|United Healthcare|TML GROUP BENEFITS|||||1,026.75||| C2617|EAP|0278|STENT MULTI-LGTH 035532|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1,026.75||||1,026.75||| C2617|EAP|0278|STENT MULTI-LGTH 035532|United Medicare Advantage|UHC MEDICARE GOLD MA|1,026.75||||||| C2617|EAP|0278|STENT MULTI-LGTH 035532|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,026.75||||1,026.75||| C2617|EAP|0278|STENT MULTI-LGTH 035532|Veterans Affairs|VETERANS ADMINISTRATION|||||1,026.75||| C2617|EAP|0272||Blue Cross HMO Specialty|BCBSTX HMO|||||1,026.75||| C2617|EAP|0278|STENT MULTI-LGTH 035532|Blue Cross HMO Specialty|BCBSTX HMO|||||1,026.75||| C2617|EAP|0278|STENT MULTI-LGTH 035532|Medicare|MEDICARE ACUTE|1,026.75||||1,026.75||| C2617|EAP|0278|STENT MULTI-LGTH 035532|Cigna|CIGNA|||||1,026.75||| C2617|EAP|0272||Blue Cross PPO Specialty|BCBSTX PPO|||||1,026.75||| C2617|EAP|0278|STENT MULTI-LGTH 035532|Blue Cross PPO Specialty|BCBSTX PPO|1,026.75||||1,026.75||| C2617|EAP|0278|STENT MULTI-LGTH 035532|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1,026.75||||1,026.75||| C2617|EAP|0278|STENT MULTI-LGTH 035532|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1,026.75||| C2617|EAP|0272||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,026.75||| C2617|EAP|0278|STENT MULTI-LGTH 035532|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,026.75||||1,026.75||| C2617|EAP|0272||Humana Medicare Advantage|HUMANA MA|||||1,026.75||| C2617|EAP|0278|STENT MULTI-LGTH 035532|Humana Medicare Advantage|HUMANA MA|1,026.75||||1,026.75||| C2617|EAP|0278|STENT MULTI-LGTH 035532|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,026.75||| C2617|EAP|0278|STENT MULTI-LGTH 035532|Managed Medicaid|MEDICAID SUPERIOR|||||1,026.75||| C2617|EAP|0278|STENT MULTI-LGTH 035532|Managed Medicaid|MEDICAID AMERIGROUP|||||1,026.75||| C2617|EAP|0278|STENT MULTI-LGTH 035532|Managed Medicare|HEALTHSPRING MA|||||1,026.75||| C2617|EAP|0278|STENT MULTI-LGTH 035532|Managed Medicare|BCBS MEDICARE PPO MA|1,026.75||||1,026.75||| C2618|EAP|0272|PROBE, CRYOABLATION|Humana Medicare Advantage|HUMANA MA|||||31.50||| C2618|EAP|0272|PROBE, CRYOABLATION|Veterans Affairs|VETERANS ADMINISTRATION|||||31.50||| C2618|EAP|0272|PROBE, CRYOABLATION|Medicare|MEDICARE ACUTE|||||31.50||| C2625|EAP|0278|STENT NASAL PROPEL|Medicare|MEDICARE ACUTE|||||1,579.25||| C2625|EAP|0278|STENT NASAL PROPEL|Blue Cross HMO Specialty|BCBSTX HMO|||||1,579.25||| C2625|EAP|0278|STENT NASAL PROPEL|Blue Cross PPO Specialty|BCBSTX PPO|||||1,579.25||| C2625|EAP|0278|STENT NASAL PROPEL|Humana Medicare Advantage|HUMANA MA|||||1,579.25||| C8901|EAP|0610||United Medicare Advantage|UHC MEDICARE GOLD MA|||||9,609.75||| C8914|EAP|0610|MRA LOWER EXTERMITY WO|Medicare|MEDICARE ACUTE|||||9,609.75||| C8929|EAP|0480||Humana Medicare Advantage|HUMANA MA|||||27.68||| C8929|EAP|0480||Aenta Medicare Advantage|AETNA MEDICARE MA|||||27.68||| C8929|EAP|0480||Medicare|MEDICARE ACUTE|||||27.68||| C8930|EAP|0483||Humana Medicare Advantage|HUMANA MA|||||27.68||| C9132|ERX|0250|KCENTRA 500, 1 UNIT CHG|Medicare|MEDICARE ACUTE|5.83||||5.83||| C9132|ERX|0250|KCENTRA 500, 1 UNIT CHG|Managed Medicare|HEALTHSPRING MA|5.83||||||| G0008|EAP|0771|ADMINISTRATION OF FLU VAC|Blue Cross HMO Specialty|BCBSTX HMO|||||0.30||| G0008|EAP|0771|ADMINISTRATION OF FLU VAC|Blue Cross PPO Specialty|BCBSTX PPO|||||0.30||| G0008|EAP|0771|ADMINISTRATION OF FLU VAC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.30||| G0008|EAP|0771|ADMINISTRATION OF FLU VAC|Aetna|AETNA PPO|||||0.30||| G0008|EAP|0771|ADMINISTRATION OF FLU VAC|Cigna|CIGNA|||||0.30||| G0008|EAP|0771|ADMINISTRATION OF FLU VAC|Humana Medicare Advantage|HUMANA MA|||||0.30||| G0008|EAP|0771|ADMINISTRATION OF FLU VAC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.30||| G0008|EAP|0771|ADMINISTRATION OF FLU VAC|United Healthcare|UNITED HEALTHCARE|||||0.30||| G0008|EAP|0771|ADMINISTRATION OF FLU VAC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.30||| G0008|EAP|0771|ADMINISTRATION OF FLU VAC|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.30||| G0008|EAP|0771|ADMINISTRATION OF FLU VAC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.30||| G0008|EAP|0771|ADMINISTRATION OF FLU VAC|Managed Medicare|HEALTHSPRING MA|||||0.30||| G0008|EAP|0771|ADMINISTRATION OF FLU VAC|Managed Medicare|BCBS MEDICARE PPO MA|||||0.30||| G0008|EAP|0771|ADMINISTRATION OF FLU VAC|Medicaid|MEDICAID|||||0.30||| G0008|EAP|0771|ADMINISTRATION OF FLU VAC|Medicare|MEDICARE ACUTE|0.30||||0.30||| G0008|EAP|0771|ADMINISTRATION OF FLU VAC|Medicare|MEDICARE ACUTE|0.30||||0.04||| G0009|EAP|0771|ADMINSTRATION OF PNEU VAC|Medicare|MEDICARE ACUTE|0.30||||0.30||| G0009|EAP|0771|ADMINSTRATION OF PNEU VAC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.30||| G0009|EAP|0771|ADMINSTRATION OF PNEU VAC|Managed Medicare|HEALTHSPRING MA|||||0.30||| G0009|EAP|0771|ADMINSTRATION OF PNEU VAC|Medicaid|MEDICAID|||||0.30||| G0009|EAP|0771|ADMINSTRATION OF PNEU VAC|Veterans Affairs|VETERANS ADMINISTRATION|||||0.30||| G0009|EAP|0771|ADMINSTRATION OF PNEU VAC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.30||| G0009|EAP|0771|ADMINSTRATION OF PNEU VAC|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.30||| G0009|EAP|0771|ADMINSTRATION OF PNEU VAC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.30||| G0009|EAP|0771|ADMINSTRATION OF PNEU VAC|United Healthcare|UNITED HEALTHCARE|||||0.30||| G0009|EAP|0771|ADMINSTRATION OF PNEU VAC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.30||| G0009|EAP|0771|ADMINSTRATION OF PNEU VAC|Managed Medicaid|MEDICAID SUPERIOR|||||0.30||| G0009|EAP|0771|ADMINSTRATION OF PNEU VAC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.30||| G0009|EAP|0771|ADMINSTRATION OF PNEU VAC|Managed Medicaid|MEDICAID AMERIGROUP|||||0.30||| G0009|EAP|0771|ADMINSTRATION OF PNEU VAC|Humana Medicare Advantage|HUMANA MA|||||0.30||| G0009|EAP|0771|ADMINSTRATION OF PNEU VAC|Blue Cross HMO Specialty|BCBSTX HMO|||||0.30||| G0009|EAP|0771|ADMINSTRATION OF PNEU VAC|Blue Cross PPO Specialty|BCBSTX PPO|||||0.30||| G0009|EAP|0771|ADMINSTRATION OF PNEU VAC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.30||| G0103|EAP|0300|PSA SCREENING|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.75||| G0103|EAP|0300|PSA SCREENING|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.75||| G0103|EAP|0300|PSA SCREENING|Blue Cross PPO Specialty|BCBSTX PPO|||||2.75||| G0103|EAP|0300|PSA SCREENING|Blue Cross HMO Specialty|BCBSTX HMO|||||2.75||| G0103|EAP|0300|PSA SCREENING|Humana Medicare Advantage|HUMANA MA|2.75||||2.75||| G0103|EAP|0300|PSA SCREENING|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.75||| G0103|EAP|0300|PSA SCREENING|Managed Medicaid|MEDICAID AMERIGROUP|||||2.75||| G0103|EAP|0300|PSA SCREENING|Managed Medicare|HEALTHSPRING MA|||||2.75||| G0103|EAP|0300|PSA SCREENING|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.75||| G0103|EAP|0300|PSA SCREENING|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.75||| G0103|EAP|0300|PSA SCREENING|United Medicare Advantage|UHC MEDICARE GOLD MA|2.75||||2.75||| G0103|EAP|0300|PSA SCREENING|United Medicare Advantage|UHC AARP MCR HMO MA|||||2.75||| G0103|EAP|0300|PSA SCREENING|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.75||| G0103|EAP|0300|PSA SCREENING|Medicare|MEDICARE ACUTE|2.75||||2.75||| G0108|EAP|0940|NUTRITIONAL ASSESSMENT|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||112.25||| G0108|EAP|0942|DIETARY CONSULTATION|Medicaid|MEDICAID HMO|||||112.25||| G0108|EAP|0942|DIETARY CONSULTATION|Tricare|TRICARE EAST REGION|||||112.25||| G0108|EAP|0940|NUTRITIONAL ASSESSMENT|Medicare|MEDICARE ACUTE|||||112.25||| G0108|EAP|0942|DIETARY CONSULTATION|Medicare|MEDICARE ACUTE|||||112.25||| G0108|EAP|0940|NUTRITIONAL ASSESSMENT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||112.25||| G0108|EAP|0940|NUTRITIONAL ASSESSMENT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||112.25||| G0108|EAP|0942|DIETARY CONSULTATION|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||112.25||| G0108|EAP|0942|DIETARY CONSULTATION|United Medicare Advantage|UHC MEDICARE GOLD MA|||||112.25||| G0108|EAP|0942|DIETARY CONSULTATION|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||112.25||| G0108|EAP|0942|DIETARY CONSULTATION|United Healthcare|UNITED HEALTHCARE|||||112.25||| G0108|EAP|0940|NUTRITIONAL ASSESSMENT|United Healthcare|UNITED HEALTHCARE|||||112.25||| G0108|EAP|0942|DIETARY CONSULTATION|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||112.25||| G0108|EAP|0940|NUTRITIONAL ASSESSMENT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||112.25||| G0108|EAP|0940|NUTRITIONAL ASSESSMENT|Managed Medicaid|MEDICAID SUPERIOR|||||112.25||| G0108|EAP|0940|NUTRITIONAL ASSESSMENT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||112.25||| G0108|EAP|0940|NUTRITIONAL ASSESSMENT|Managed Medicaid|MEDICAID AMERIGROUP|||||112.25||| G0108|EAP|0942|DIETARY CONSULTATION|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||112.25||| G0108|EAP|0942|DIETARY CONSULTATION|NON CONTRACTED|COMMERCIAL OTHER 1|||||112.25||| G0108|EAP|0942|DIETARY CONSULTATION|Managed Medicaid|MEDICAID AMERIGROUP|||||112.25||| G0108|EAP|0942|DIETARY CONSULTATION|Cigna|CIGNA|||||112.25||| G0108|EAP|0940|NUTRITIONAL ASSESSMENT|Humana Medicare Advantage|HUMANA MA|||||112.25||| G0108|EAP|0942|DIETARY CONSULTATION|Humana Medicare Advantage|HUMANA MA|||||112.25||| G0108|EAP|0940|NUTRITIONAL ASSESSMENT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||112.25||| G0108|EAP|0942|DIETARY CONSULTATION|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||112.25||| G0108|EAP|0940|NUTRITIONAL ASSESSMENT|Blue Cross HMO Specialty|BCBSTX HMO|||||112.25||| G0108|EAP|0940|NUTRITIONAL ASSESSMENT|Blue Cross PPO Specialty|BCBSTX PPO|||||112.25||| G0108|EAP|0942|DIETARY CONSULTATION|Blue Cross PPO Specialty|BCBSTX PPO|||||112.25||| G0108|EAP|0940|NUTRITIONAL ASSESSMENT|Aenta Medicare Advantage|AETNA MEDICARE MA|||||112.25||| G0108|EAP|0940|NUTRITIONAL ASSESSMENT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||112.25||| G0108|EAP|0940|NUTRITIONAL ASSESSMENT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||112.25||| G0108|EAP|0942|DIETARY CONSULTATION|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||112.25||| G0108|EAP|0942|DIETARY CONSULTATION|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||112.25||| G0108|EAP|0942|DIETARY CONSULTATION|Aetna|AETNA PPO|||||112.25||| G0297|EAP|0770|CT SCREENING LUNG|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.50||| G0297|EAP|0770|CT SCREENING LUNG|Aetna|AETNA PPO|||||1.50||| G0297|EAP|0770|CT SCREENING LUNG|Blue Cross HMO Specialty|BCBSTX HMO|||||1.50||| G0297|EAP|0770|CT SCREENING LUNG|Blue Cross PPO Specialty|BCBSTX PPO|||||1.50||| G0297|EAP|0770|CT SCREENING LUNG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.50||| G0297|EAP|0770|CT SCREENING LUNG|Cigna|CIGNA|||||1.50||| G0297|EAP|0770|CT SCREENING LUNG|Humana Medicare Advantage|HUMANA MA|||||1.50||| G0297|EAP|0770|CT SCREENING LUNG|ChampVA|CHAMPVA CENTER|||||1.50||| G0297|EAP|0770|CT SCREENING LUNG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.50||| G0297|EAP|0770|CT SCREENING LUNG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.50||| G0297|EAP|0770|CT SCREENING LUNG|Managed Medicaid|MEDICAID SUPERIOR|||||1.50||| G0297|EAP|0770|CT SCREENING LUNG|United Healthcare|UNITED HEALTHCARE OTHER|||||1.50||| G0297|EAP|0770|CT SCREENING LUNG|United Healthcare|UNITED HEALTHCARE|||||1.50||| G0297|EAP|0770|CT SCREENING LUNG|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.50||| G0297|EAP|0770|CT SCREENING LUNG|Veterans Affairs|VETERANS ADMINISTRATION|||||1.50||| G0297|EAP|0770|CT SCREENING LUNG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.50||||1.50||| G0297|EAP|0770|CT SCREENING LUNG|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.50||| G0297|EAP|0770|CT SCREENING LUNG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.50||| G0297|EAP|0770|CT SCREENING LUNG|Tricare|TRICARE EAST REGION|||||1.50||| G0297|EAP|0770|CT SCREENING LUNG|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.50||| G0297|EAP|0770|CT SCREENING LUNG|Medicare|MEDICARE ACUTE|||||1.50||| G0297|EAP|0770|CT SCREENING LUNG|Managed Medicare|HEALTHSPRING MA|||||1.50||| G0378|EAP|0762|OBS PER HOUR ED|PHCS|HUMANA|||||1.27||| G0378|EAP|0762|OBSERVATION 8HRS MSI|Medicare|MEDICARE ACUTE|126.50||||1,372.50||| G0378|EAP|0762|OBS PER HOUR MSII|Medicare|MEDICARE PART B ONLY IP|126.50||||||| G0378|EAP|0762|OBS PER HOUR MSI|Medicare|MEDICARE ACUTE|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR ICU|Medicare|MEDICARE PART B ONLY IP|126.50||||||| G0378|EAP|0762|OBS PER HOUR ICU|Medicare|MEDICARE ACUTE|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR ED|Medicare|MEDICARE ACUTE|126.50||||1.27||| G0378|EAP|0762|MONITOR ROOM PER HOUR OB|Medicare|MEDICARE ACUTE|1.27||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|Veterans Affairs|VETERANS ADMINISTRATION|1,372.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|Veterans Affairs|VETERANS ADMINISTRATION|126.50||||||| G0378|EAP|0762|OBS PER HOUR MSI|Veterans Affairs|VETERANS ADMINISTRATION|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR ICU|Veterans Affairs|VETERANS ADMINISTRATION|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR ED|Veterans Affairs|VETERANS ADMINISTRATION|1.27||||1.27||| G0378|EAP|0762|OBS PER HOUR MSII|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|United Medicare Advantage|UHC MEDICARE GOLD MA|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|United Medicare Advantage|AARP UHC WEST COMPLETE MA|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|United Medicare Advantage|UHC MEDICARE GOLD MA|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|United Medicare Advantage|AARP UHC WEST COMPLETE MA|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR ICU|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR ICU|United Medicare Advantage|AARP UHC WEST COMPLETE MA|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR ED|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.27||||1.27||| G0378|EAP|0762|OBS PER HOUR ED|United Medicare Advantage|UHC MEDICARE GOLD MA|126.50||||1.27||| G0378|EAP|0762|OBS PER HOUR ED|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.27||||1.27||| G0378|EAP|0762|OBS PER HOUR MSII|Workers Compensation|WORKERS COMPENSATION OTHER|||||126.50||| G0378|EAP|0762|OBS PER HOUR ICU|Workers Compensation|WORKERS COMPENSATION OTHER|||||126.50||| G0378|EAP|0762|OBS PER HOUR ED|Workers Compensation|WORKERS COMPENSATION OTHER|||||126.75||| G0378|EAP|0762|OBS PER HOUR MSII|United Healthcare|UNITED HEALTHCARE|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|United Healthcare|UMR UNITED MEDICAL RESOURCES|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|United Healthcare|TML GROUP BENEFITS|||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|United Healthcare|UNITED HEALTHCARE|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|United Healthcare|UMR UNITED MEDICAL RESOURCES|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR ICU|United Healthcare|UNITED HEALTHCARE|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR ED|United Healthcare|UNITED HEALTHCARE|1.27||||126.75||| G0378|EAP|0762|OBS PER HOUR ED|United Healthcare|UNITED HEALTHCARE|126.50||||1.27||| G0378|EAP|0762|OBS PER HOUR ED|United Healthcare|UMR UNITED MEDICAL RESOURCES|1.27||||1.27||| G0378|EAP|0762|OBS PER HOUR ED|United Healthcare|TML GROUP BENEFITS|||||1.27||| G0378|EAP|0762|OBSERVATION MAX DAILY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|18.84||||126.50||| G0378|EAP|0762|OBSERVATION MAX DAILY|Managed Medicaid|MEDICAID SUPERIOR|18.84||||18.84||| G0378|EAP|0762|OBSERVATION MAX DAILY|Managed Medicaid|MEDICAID AMERIGROUP|18.84||||18.84||| G0378|EAP|0762|OBSERVATION 4 HRS|Managed Medicaid|MEDICAID SUPERIOR|766.75||||766.75||| G0378|EAP|0762|OBSERVATION 4 HRS|Managed Medicaid|MEDICAID AMERIGROUP|18.84||||766.75||| G0378|EAP|0762|OBS PER HOUR OB|Managed Medicaid|MEDICAID SUPERIOR|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|Managed Medicaid|MEDICAID UNITED HEALTHCARE|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|Managed Medicaid|MEDICAID SUPERIOR|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|Managed Medicaid|MEDICAID SUPERIOR|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|Managed Medicaid|MEDICAID AMERIGROUP|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR ICU|Managed Medicaid|MEDICAID UNITED HEALTHCARE|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR ICU|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR ED|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.27||||126.75||| G0378|EAP|0762|OBS PER HOUR ED|Managed Medicaid|MEDICAID SUPERIOR|126.50||||1.27||| G0378|EAP|0762|OBS PER HOUR ED|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.27||||1.27||| G0378|EAP|0762|OBS PER HOUR ED|Managed Medicaid|MEDICAID AMERIGROUP|126.50||||1.27||| G0378|EAP|0762|MONITOR ROOM PER HOUR OB|Managed Medicaid|MEDICAID SUPERIOR|1.27||||126.50||| G0378|EAP|0762|MONITOR ROOM PER HOUR OB|Managed Medicaid|MEDICAID AMERIGROUP|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR OB|Cigna|CIGNA|18.84||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|Cigna|CIGNA OTHER|||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|Cigna|CIGNA|18.84||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|Managed Medicaid|MEDICAID AMERIGROUP|766.75||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|Cigna|CIGNA|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|Cigna|CIGNA OTHER|||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|Cigna|CIGNA|18.84||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|Cigna|CIGNA|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR ED|Cigna|CIGNA OTHER|||||1.27||| G0378|EAP|0762|OBS PER HOUR ED|Cigna|CIGNA|1.27||||126.75||| G0378|EAP|0762|OBS PER HOUR ED|Cigna|CIGNA|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|Humana Medicare Advantage|HUMANA MA|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR OB|Managed Medicaid|MEDICAID AMERIGROUP|18.84||||126.50||| G0378|EAP|0762|OBSERVATION 8 HRS|Managed Medicaid|MEDICAID SUPERIOR|18.84||||1,427.50||| G0378|EAP|0762|OBS PER HOUR MSI|Humana Medicare Advantage|HUMANA MA|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR ICU|Humana Medicare Advantage|HUMANA MA|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR ED|Humana Medicare Advantage|HUMANA MA|1.27||||1.27||| G0378|EAP|0762|OBSERVATION 4 HRS|Blue Cross HMO Specialty|BCBSTX HMO|18.84||||766.75||| G0378|EAP|0762|OBS PER HOUR ED|United Healthcare|UNITED HEALTHCARE OTHER|1.27||||||| G0378|EAP|0762|OBS PER HOUR OB|Blue Cross HMO Specialty|BCBSTX HMO|18.84||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|Blue Cross HMO Specialty|BCBSTX HMO|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|Blue Cross HMO Specialty|BCBSTX HMO|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR ED|Blue Cross HMO Specialty|BCBSTX HMO|1.27||||1.27||| G0378|EAP|0762|OBS PER HOUR MSI|United Healthcare|UNITED HEALTHCARE OTHER|126.50||||||| G0378|EAP|0762|OBSERVATION MAX DAILY|Blue Cross PPO Specialty|BCBSTX PPO|18.84||||18.84||| G0378|EAP|0762|OBSERVATION 8 HRS|Blue Cross PPO Specialty|BCBSTX PPO|18.84||||1,427.50||| G0378|EAP|0762|OBS PER HOUR OB|United Healthcare|UNITED HEALTHCARE|126.50||||126.50||| G0378|EAP|0762|OBSERVATION 4 HRS|Blue Cross PPO Specialty|BCBSTX PPO|766.75||||766.75||| G0378|EAP|0762|OBS PER HOUR OB|Blue Cross PPO Specialty|BCBSTX PPO|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|Blue Cross PPO Specialty|BCBSTX PPO|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|Blue Cross PPO Specialty|BCBSTX PPO|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|Blue Cross PPO Specialty|BCBSTX OTHER|||||126.50||| G0378|EAP|0762|OBS PER HOUR ED|Blue Cross PPO Specialty|BCBSTX PPO|126.50||||1.27||| G0378|EAP|0762|OBS PER HOUR ICU|United Medicare Advantage|UHC MEDICARE GOLD MA|126.50||||126.50||| G0378|EAP|0762|OBSERVATION MAX DAILY|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||18.84||| G0378|EAP|0762|OBS PER HOUR OB|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||126.50||| G0378|EAP|0762|OBS PER HOUR ED|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1.27||| G0378|EAP|0762|OBS PER HOUR MSI|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|ChampVA|CHAMPVA CENTER|||||126.50||| G0378|EAP|0762|OBS PER HOUR ED|ChampVA|CHAMPVA CENTER|||||126.50||| G0378|EAP|0762|OBSERVATION 4 HRS|ChampVA|CHAMPVA CENTER|||||766.75||| G0378|EAP|0762|OBSERVATION 8 HRS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|126.50||||1,427.50||| G0378|EAP|0762|OBS PER HOUR ED|Veterans Affairs|VETERANS ADMINISTRATION|126.50||||||| G0378|EAP|0762|OBS PER HOUR OB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR ICU|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR ED|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|126.50||||1.27||| G0378|EAP|0762|MONITOR ROOM PER HOUR OB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.27||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|Aenta Medicare Advantage|AETNA MEDICARE MA|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|Aenta Medicare Advantage|AETNA MEDICARE MA|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR ED|Medicare|MEDICARE PART B ONLY IP|1.27||||||| G0378|EAP|0762|OBS PER HOUR MSII|Medicare|MEDICARE ACUTE|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR ED|Aenta Medicare Advantage|AETNA MEDICARE MA|1.27||||1.27||| G0378|EAP|0762|OBSERVATION MAX DAILY|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|126.50||||18.84||| G0378|EAP|0762|OBS PER HOUR OB|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|PHCS|HUMANA|||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|Access Direct Platinum|HEALTHFIRST TPA UMR|||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|126.50||||||| G0378|EAP|0762|OBS PER HOUR ED|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.27||||1.27||| G0378|EAP|0762|OBS PER HOUR ED|Access Direct Platinum|HEALTHFIRST TPA UMR|||||1.27||| G0378|EAP|0762|OBS PER HOUR ED|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.27||||||| G0378|EAP|0762|OBS PER HOUR MSII|Aetna|AETNA PPO|18.84||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|Aetna|AETNA PPO|18.84||||126.50||| G0378|EAP|0762|OBS PER HOUR ED|Aetna|AETNA PPO|126.50||||1.27||| G0378|EAP|0762|MONITOR ROOM PER HOUR OB|Aetna|AETNA PPO|1.27||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|Tricare|TRICARE EAST REGION|18.84||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||126.50||| G0378|EAP|0762|OBS PER HOUR ED|Medicaid|MEDICAID|126.50||||1.27||| G0378|EAP|0762|OBS PER HOUR ED|Medicaid|HENDERSON COUNTY INDIGENT|||||1.27||| G0378|EAP|0762|OBS PER HOUR ED|Managed Medicare|BCBS MEDICARE PPO MA|1.27||||1.27||| G0378|EAP|0762|OBS PER HOUR ED|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.27||| G0378|EAP|0762|OBS PER HOUR ED|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|1.27||||1.27||| G0378|EAP|0762|OBS PER HOUR ED|NON CONTRACTED|COMMERCIAL OTHER 1|1.27||||126.50||| G0378|EAP|0762|OBS PER HOUR OB|Medicaid|MEDICAID|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|NON CONTRACTED|COMMERCIAL OTHER 1|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR ICU|Managed Medicare|WELLCARE CHOICE MA|||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|Managed Medicare|WELLCARE CHOICE MA|||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR ED|Tricare|TRICARE EAST REGION|126.50||||1.27||| G0378|EAP|0762|OBS PER HOUR MSII|Managed Medicare|HEALTHSPRING MA|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR OB|Tricare|TRICARE EAST REGION|18.84||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|Managed Medicare|BCBS MEDICARE PPO MA|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR OB|NON CONTRACTED|COMMERCIAL OTHER 1|18.84||||126.50||| G0378|EAP|0762|OBS PER HOUR ED|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||1.27||| G0378|EAP|0762|OBSERVATION 4 HRS|NON CONTRACTED|COMMERCIAL OTHER 1|18.84||||766.75||| G0378|EAP|0762|OBS PER HOUR MSI|Medicaid|MEDICAID|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|Tricare|TRICARE EAST REGION|18.84||||126.50||| G0378|EAP|0762|OBS PER HOUR ED|Medicaid|MEDICAID HMO|||||1.27||| G0378|EAP|0762|OBS PER HOUR MSII|NON CONTRACTED|COMMERCIAL OTHER 1|18.84||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||126.50||| G0378|EAP|0762|MONITOR ROOM PER HOUR OB|Tricare|TRICARE EAST REGION|1.27||||126.50||| G0378|EAP|0762|OBS PER HOUR ICU|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||126.50||| G0378|EAP|0762|OBS PER HOUR ED|Managed Medicare|HEALTHSPRING MA|1.27||||1.27||| G0378|EAP|0762|OBS PER HOUR MSI|Medicaid|HENDERSON COUNTY INDIGENT|||||126.50||| G0378|EAP|0762|OBS PER HOUR ICU|Managed Medicare|HEALTHSPRING MA|126.50||||126.50||| G0378|EAP|0762|OBSERVATION MAX DAILY|Tricare|TRICARE EAST REGION|18.84||||18.84||| G0378|EAP|0762|OBSERVATION MAX DAILY|Medicaid|MEDICAID HMO|||||18.84||| G0378|EAP|0762|OBS PER HOUR OB|Medicaid|MEDICAID HMO|||||126.50||| G0378|EAP|0762|OBSERVATION MAX DAILY|Medicaid|MEDICAID|18.84||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|Medicaid|MEDICAID HMO|||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|Managed Medicare|BCBS MEDICARE PPO MA|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSI|Managed Medicare|HEALTHSPRING MA|126.50||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||126.50||| G0378|EAP|0762|OBS PER HOUR MSII|Medicaid|MEDICAID|126.50||||126.50||| G0379|EAP|0000|OBS DIRECT ADMIT MSII|Blue Cross PPO Specialty|BCBSTX PPO|532.40||||532.40||| G0379|EAP|0000|OBS DIRECT ADMIT MSII|Managed Medicaid|MEDICAID SUPERIOR|532.40||||532.40||| G0379|EAP|0000|OBS DIRECT ADMIT MSII|Managed Medicaid|MEDICAID AMERIGROUP|532.40||||532.40||| G0379|EAP|0762|OBS DIRECT ADMIT OB|Managed Medicaid|MEDICAID SUPERIOR|532.40||||532.40||| G0379|EAP|0762|OBS DIRECT ADMIT OB|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||532.40||| G0379|EAP|0762|OBS DIRECT ADMIT OB|Cigna|CIGNA|||||532.40||| G0379|EAP|0762|OBS DIRECT ADMIT OB|Blue Cross PPO Specialty|BCBSTX PPO|532.40||||532.40||| G0379|EAP|0762|OBS DIRECT ADMIT OB|Medicaid|MEDICAID|532.40||||532.40||| G0379|EAP|0762|OBS DIRECT ADMIT OB|NON CONTRACTED|COMMERCIAL OTHER 1|||||532.40||| G0379|EAP|0000|OBS DIRECT ADMIT MSII|Medicare|MEDICARE ACUTE|532.40||||532.40||| G0379|EAP|0762|OBS DIRECT ADMIT OB|Managed Medicaid|MEDICAID AMERIGROUP|||||532.40||| G0379|EAP|0000|OBS DIRECT ADMIT MSII|United Medicare Advantage|UHC MEDICARE GOLD MA|532.40||||||| G0379|EAP|0000|OBS DIRECT ADMIT MSII|United Healthcare|UNITED HEALTHCARE|||||532.40||| G0379|EAP|0000|OBS DIRECT ADMIT MSII|United Medicare Advantage|AARP UHC WEST COMPLETE MA|532.40||||||| G0379|EAP|0000|OBS DIRECT ADMIT MSII|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||532.40||| G0379|EAP|0000|OBS DIRECT ADMIT MSII|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||532.40||| G0379|EAP|0762|OBS DIRECT ADMIT OB|Tricare|TRICARE EAST REGION|||||532.40||| G0379|EAP|0000|OBS DIRECT ADMIT MSII|Humana Medicare Advantage|HUMANA MA|532.40||||532.40||| G0379|EAP|0000|OBS DIRECT ADMIT MSII|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||532.40||| G0379|EAP|0762|OBS DIRECT ADMIT OB|Medicaid|MEDICAID HMO|||||532.40||| G0379|EAP|0762|OBS DIRECT ADMIT OB|ChampVA|CHAMPVA CENTER|||||532.40||| G0379|EAP|0000|OBS DIRECT ADMIT MSII|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|532.40||||||| G0379|EAP|0000|OBS DIRECT ADMIT MSII|Medicaid|MEDICAID|||||532.40||| G0379|EAP|0762|OBS DIRECT ADMIT OB|Blue Cross HMO Specialty|BCBSTX HMO|||||532.40||| G0379|EAP|0762|OBS DIRECT ADMIT OB|United Healthcare|UNITED HEALTHCARE|||||532.40||| G0379|EAP|0000|OBS DIRECT ADMIT MSII|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||532.40||| G0379|EAP|0000|OBS DIRECT ADMIT MSII|Blue Cross HMO Specialty|BCBSTX HMO|||||532.40||| G0379|EAP|0762|OBS DIRECT ADMIT OB|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||532.40||| G0434|EAP|0300|MECONIUM DRUG TEST|Medicaid|MEDICAID HMO|548.75||||||| G0434|EAP|0300|MECONIUM DRUG TEST|Medicaid|MEDICAID|548.75||||||| G0434|EAP|0300|MECONIUM DRUG TEST|Blue Cross PPO Specialty|BCBSTX PPO|548.75||||||| G0434|EAP|0300|MECONIUM DRUG TEST|Managed Medicaid|MEDICAID SUPERIOR|548.75||||||| G0434|EAP|0300|MECONIUM DRUG TEST|Managed Medicaid|MEDICAID AMERIGROUP|548.75||||||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||391.50||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||391.50||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|NON CONTRACTED|COMMERCIAL OTHER 1|||||391.50||| G0463|EAP|0761|MONITOR ROOM 8 HOURS|Managed Medicaid|MEDICAID AMERIGROUP|1,427.50||||1,427.50||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|Cigna|CIGNA|||||391.50||| G0463|EAP|0761|MONITOR ROOM MAX 24 HOURS|Managed Medicaid|MEDICAID AMERIGROUP|18.84||||18.84||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||391.50||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|Managed Medicaid|MEDICAID AMERIGROUP|766.75||||766.75||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||391.50||| G0463|EAP|0761|MONITOR ROOM 8 HOURS|Managed Medicaid|MEDICAID SUPERIOR|1,427.50||||1,427.50||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|Veterans Affairs|VETERANS ADMINISTRATION|||||391.50||| G0463|EAP|0761|AMBULATORY ROOM SERVICE F|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||465.75||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|Managed Medicaid|MEDICAID SUPERIOR|766.75||||766.75||| G0463|EAP|0761|AMBULATORY ROOM SERVICE F|Humana Medicare Advantage|HUMANA MA|||||465.75||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|United Healthcare|UNITED HEALTHCARE|||||391.50||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|United Medicare Advantage|UHC AARP MCR HMO MA|||||391.50||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||766.75||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|United Healthcare|UNITED HEALTHCARE|766.75||||766.75||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|Tricare|TRICARE EAST REGION|||||766.75||| G0463|EAP|0761|MONITOR ROOM MAX 24 HOURS|Tricare|TRICARE EAST REGION|||||18.84||| G0463|EAP|0761|AMBULATORY ROOM SERVICE F|Medicare|MEDICARE ACUTE|||||465.75||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|Medicare|MEDICARE ACUTE|||||766.75||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|PHCS|HUMANA INSURANCE|||||391.50||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||766.75||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||766.75||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|Medicare|MEDICARE ACUTE|||||391.50||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|PHCS|HUMANA|||||391.50||| G0463|EAP|0761|MONITOR ROOM MAX 24 HOURS|United Healthcare|UNITED HEALTHCARE|18.84||||766.75||| G0463|EAP|0761|MONITOR ROOM 8 HOURS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|18.84||||1,427.50||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|Humana Medicare Advantage|HUMANA MA|||||391.50||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|766.75||||766.75||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|NON CONTRACTED|COMMERCIAL OTHER 2|||||391.50||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|United Healthcare|TML GROUP BENEFITS|||||391.50||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|MTC Medical|VAN ZANDT COUNTY INMATE|||||766.75||| G0463|EAP|0761|MONITOR ROOM MAX 24 HOURS|Managed Medicaid|MEDICAID SUPERIOR|18.84||||18.84||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||766.75||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|Medicaid|MEDICAID|||||391.50||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|Medicaid|MEDICAID|766.75||||766.75||| G0463|EAP|0761|MONITOR ROOM MAX 24 HOURS|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||18.84||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||766.75||| G0463|EAP|0761|MONITOR ROOM MAX 24 HOURS|United Healthcare|TML GROUP BENEFITS|18.84||||||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|Medicaid|LAW ENFORCEMENT OTHER|||||766.75||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|NON CONTRACTED|COMMERCIAL OTHER 1|766.75||||766.75||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|United Healthcare|UNITED HEALTHCARE|1,427.50||||766.75||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|Cigna|CIGNA OTHER|||||391.50||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||391.50||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||391.50||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|Blue Cross PPO Specialty|BCBSTX PPO|766.75||||766.75||| G0463|EAP|0761|MONITOR ROOM 8 HOURS|Cigna|CIGNA|18.84||||1,427.50||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|Medicaid|MEDICAID|18.84||||766.75||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|Aetna|AETNA PPO|||||391.50||| G0463|EAP|0761|MONITOR ROOM MAX 24 HOURS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||18.84||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||766.75||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||766.75||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|United Healthcare|UNITED HEALTHCARE OTHER|||||391.50||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||391.50||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||391.50||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||391.50||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|Aetna|AETNA OTHER|||||391.50||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||391.50||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|Blue Cross HMO Specialty|BCBSTX HMO|||||391.50||| G0463|EAP|0761|MONITOR ROOM MAX 24 HOURS|Blue Cross HMO Specialty|BCBSTX HMO|18.84||||||| G0463|EAP|0761|MONITOR ROOM MAX 24 HOURS|Aetna|AETNA PPO|18.84||||18.84||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||766.75||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|Managed Medicare|BCBS MEDICARE PPO MA|||||391.50||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||391.50||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||391.50||| G0463|EAP|0761|MONITOR ROOM MAX 24 HOURS|Blue Cross PPO Specialty|BCBSTX PPO|766.75||||18.84||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|Aetna|AETNA PPO|766.75||||766.75||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|Blue Cross HMO Specialty|BCBSTX HMO|766.75||||||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|Managed Medicare|VAN ZANDT COUNTY INMATE|||||766.75||| G0463|EAP|0519|OFFICE/OUTPAT VISIT L3 NE|Managed Medicare|HEALTHSPRING MA|||||391.50||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|766.75||||766.75||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|Cigna|CIGNA|766.75||||766.75||| G0463|EAP|0761|MONITOR ROOM 8 HOURS|Blue Cross PPO Specialty|BCBSTX PPO|18.84||||1,427.50||| G0463|EAP|0761|MONITOR ROOM UP TO 4 HR|Medicaid|MEDICAID HMO|766.75||||766.75||| G0479|EAP|0300||Medicare|MEDICARE ACUTE|||||527.75||| G0480|EAP|0300|UDS CONF-OPIATE|Managed Medicaid|MEDICAID SUPERIOR|527.75||||237.50||| G0480|EAP|0300|UDS CONF-OPIATE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|527.75||||430.50||| G0480|EAP|0300|GCMS CONFIRMATION OF AMPH|Managed Medicaid|MEDICAID SUPERIOR|237.50||||237.50||| G0480|EAP|0300||Managed Medicaid|MEDICAID UNITED HEALTHCARE|430.50||||430.50||| G0480|EAP|0300||Managed Medicaid|MEDICAID SUPERIOR|430.50||||430.50||| G0480|EAP|0300||Aetna|AETNA OTHER|||||430.50||| G0480|EAP|0300||Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|430.50||||430.50||| G0480|EAP|0300||Humana Medicare Advantage|HUMANA MA|430.50||||430.50||| G0480|EAP|0300||Managed Medicare|BCBS MEDICARE PPO MA|430.50||||430.50||| G0480|EAP|0300||Cigna|CIGNA OTHER|430.50||||430.50||| G0480|EAP|0300||Managed Medicare|MEDICARE ADVANTAGE OTHER MA|430.50||||430.50||| G0480|EAP|0300|GCMS CONFIRMATION OF AMPH|Cigna|CIGNA|||||237.50||| G0480|EAP|0300||Cigna|CIGNA|||||430.50||| G0480|EAP|0300||ChampVA|CHAMPVA CENTER|||||430.50||| G0480|EAP|0300|GCMS CONFIRMATION OF AMPH|Blue Cross PPO Specialty|BCBSTX PPO|237.50||||430.50||| G0480|EAP|0300|GCMS CONFIRMATION OF AMPH|Humana Medicare Advantage|HUMANA MA|527.75||||237.50||| G0480|EAP|0300||Veterans Affairs|VETERANS ADMINISTRATION|430.50||||430.50||| G0480|EAP|0300|GCMS CONFIRMATION OF AMPH|Managed Medicare|HEALTHSPRING MA|430.50||||237.50||| G0480|EAP|0300||Blue Cross PPO Specialty|BCBSTX PPO|430.50||||430.50||| G0480|EAP|0300||Managed Medicare|MA PART B ONLY IP|430.50||||||| G0480|EAP|0300||Managed Medicare|WELLCARE CHOICE MA|||||430.50||| G0480|EAP|0300||Workers Compensation|WORKERS COMPENSATION OTHER|||||430.50||| G0480|EAP|0300||Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||430.50||| G0480|EAP|0300||Managed Medicare|OTHER INSTITUTIONS|||||19.75||| G0480|EAP|0300||United Medicare Advantage|UHC AARP MCR HMO MA|430.50||||430.50||| G0480|EAP|0300||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|430.50||||430.50||| G0480|EAP|0300||United Healthcare|UNITED HEALTHCARE OTHER|||||430.50||| G0480|EAP|0300||United Healthcare|GOLDEN RULE|||||430.50||| G0480|EAP|0300|UDS CONF-OPIATE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|527.75||||527.75||| G0480|EAP|0300|GCMS CONFIRMATION OF AMPH|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|527.75||||237.50||| G0480|EAP|0300||Aenta Medicare Advantage|AETNA MEDICARE MA|||||430.50||| G0480|EAP|0300||United Healthcare|UMR UNITED MEDICAL RESOURCES|430.50||||430.50||| G0480|EAP|0300||United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|430.50||||430.50||| G0480|EAP|0300||United Healthcare|TML GROUP BENEFITS|||||430.50||| G0480|EAP|0300||Managed Medicaid|MEDICAID AMERIGROUP|430.50||||430.50||| G0480|EAP|0300||United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|237.50||||527.75||| G0480|EAP|0300||United Medicare Advantage|AARP UHC WEST COMPLETE MA|430.50||||430.50||| G0480|EAP|0300|GCMS CONFIRMATION OF AMPH|Medicaid|HENDERSON COUNTY INDIGENT|237.50||||430.50||| G0480|EAP|0300||Medicaid|MEDICAID HMO|||||430.50||| G0480|EAP|0300||United Medicare Advantage|UHC MEDICARE GOLD MA|430.50||||430.50||| G0480|EAP|0300||Medicaid|HENDERSON COUNTY INDIGENT|430.50||||430.50||| G0480|EAP|0300|GCMS CONFIRMATION OF AMPH|Managed Medicaid|MEDICAID AMERIGROUP|237.50||||430.50||| G0480|EAP|0300|GCMS CONFIRMATION OF AMPH|Medicare|MEDICARE ACUTE|237.50||||237.50||| G0480|EAP|0300||Tricare|TRICARE EAST REGION|430.50||||||| G0480|EAP|0300||Managed Medicare|HENDERSON CNTY INMATE INDIGENT|430.50||||430.50||| G0480|EAP|0300||Access Direct Platinum|HEALTHFIRST TPA UMR|||||430.50||| G0480|EAP|0300||Aetna|AETNA PPO|430.50||||430.50||| G0480|EAP|0300||Workers Compensation|UT EMPLOYEE INJURY|||||430.50||| G0480|EAP|0300||Medicaid|SUPERIOR HEALTHPLAN CHIP|||||430.50||| G0480|EAP|0300||Managed Medicare|HEALTHSPRING MA|430.50||||430.50||| G0480|EAP|0300||Medicaid|MEDICAID TEXAS CHILDRENS|||||430.50||| G0480|EAP|0300||Medicaid|MEDICAID|430.50||||430.50||| G0480|EAP|0300||United Healthcare|UNITED HEALTHCARE|||||430.50||| G0480|EAP|0300|UDS CONF-OPIATE|Medicaid|MEDICAID|237.50||||527.75||| G0480|EAP|0300|UDS CONF-OPIATE|Medicare|MEDICARE ACUTE|527.75||||527.75||| G0480|EAP|0300||Medicare|MEDICARE PART B ONLY IP|430.50||||||| G0480|EAP|0300||Medicare|MEDICARE ACUTE|527.75||||527.75||| G0480|EAP|0300||Medicare|MEDICARE ACUTE|430.50||||430.50||| G0480|EAP|0300|GCMS CONFIRMATION OF AMPH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|237.50||||430.50||| G0480|EAP|0300||PHCS|HUMANA|||||430.50||| G0480|EAP|0300||Multiplan|NALC|||||430.50||| G0480|EAP|0300||NON CONTRACTED|COMMERCIAL OTHER 2|||||430.50||| G0480|EAP|0300||Medicaid|LAW ENFORCEMENT OTHER|||||430.50||| G0480|EAP|0300||NON CONTRACTED|COMMERCIAL OTHER 1|||||430.50||| G0480|EAP|0300|GCMS CONFIRMATION OF AMPH|Medicaid|MOLINA HEALTHCARE OF TEXAS|237.50||||430.50||| G0480|EAP|0300||Medicaid|MOLINA HEALTHCARE OF TEXAS|430.50||||430.50||| G6011|EAP|0333||Medicaid|MEDICAID|||||461.25||| G6011|EAP|0333||Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||461.25||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Cigna|CIGNA|||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Veterans Affairs|VETERANS ADMINISTRATION|94.50||||||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Managed Medicaid|MEDICAID UNITED HEALTHCARE|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Blue Cross PPO Specialty|BCBSTX PPO|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Humana Medicare Advantage|HUMANA MA|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Managed Medicare|HEALTHSPRING MA|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Managed Medicare|BCBS MEDICARE PPO MA|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Managed Medicaid|MEDICAID SUPERIOR|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Managed Medicaid|MEDICAID AMERIGROUP|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|United Healthcare|GEHA|||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Cigna|CIGNA|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|PHCS|MULTIPLAN PHCS OTHER|||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Medicare|MEDICARE ACUTE|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Tricare|TRICARE EAST REGION|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|NON CONTRACTED|COMMERCIAL OTHER 1|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|United Healthcare|UNITED HEALTHCARE|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|United Medicare Advantage|UHC MEDICARE GOLD MA|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Veterans Affairs|VETERANS ADMINISTRATION|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|United Healthcare|UMR UNITED MEDICAL RESOURCES|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|United Healthcare|TML GROUP BENEFITS|||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|United Medicare Advantage|UHC AARP MCR HMO MA|||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|United Medicare Advantage|AARP UHC WEST COMPLETE MA|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Texas Workforce Commission|DIS DETER SERV (DDS)|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Workers Compensation|WORKERS COMPENSATION OTHER|||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Medicaid|MEDICAID HMO|94.50||||||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|94.50||||||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Medicaid|MEDICAID|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Cigna|CIGNA OTHER|||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Medicaid|HENDERSON COUNTY INDIGENT|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Blue Cross HMO Specialty|BCBSTX HMO|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|ChampVA|CHAMPVA CENTER|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Access Direct Platinum|HEALTHFIRST TPA UMR|94.50||||||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Aetna|AETNA PPO|94.50||||94.50||| J0131|ERX|0250|ACETAMINOPHEN INJ 100ML B|Aenta Medicare Advantage|AETNA MEDICARE MA|94.50||||94.50||| J0132|ERX|0636|ACETYLCYSTEINE 20%, 30ML|Medicare|MEDICARE ACUTE|1,315.20||||1,315.20||| J0132|ERX|0636|ACETYLCYSTEINE 20%, 30ML|United Healthcare|UNITED HEALTHCARE OTHER|||||1,315.20||| J0132|ERX|0636|ACETYLCYSTEINE 20%, 30ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,315.20||| J0132|ERX|0636|ACETYLCYSTEINE 20%, 30ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1,315.20||| J0132|ERX|0636|ACETYLCYSTEINE 20%, 30ML|Managed Medicaid|MEDICAID SUPERIOR|||||1,315.20||| J0132|ERX|0636|ACETYLCYSTEINE 20%, 30ML|Cigna|CIGNA|||||1,315.20||| J0132|ERX|0636|ACETYLCYSTEINE 20%, 30ML|Blue Cross PPO Specialty|BCBSTX PPO|||||1,315.20||| J0132|ERX|0636|ACETYLCYSTEINE 20%, 30ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,315.20||||||| J0153|ERX|0636|ADENOSINE 3MG/ML, 2ML VIA|Aetna|AETNA PPO|||||166.25||| J0153|ERX|0636|ADENOSINE 3MG/ML, 2ML VIA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||166.25||| J0153|ERX|0636|ADENOSINE 3MG/ML, 2ML VIA|Humana Medicare Advantage|HUMANA MA|||||166.25||| J0153|ERX|0636|ADENOSINE 3MG/ML, 2ML VIA|Blue Cross HMO Specialty|BCBSTX HMO|||||166.25||| J0153|ERX|0636|ADENOSINE 3MG/ML, 2ML VIA|United Medicare Advantage|UHC MEDICARE GOLD MA|||||166.25||| J0153|ERX|0636|ADENOSINE 3MG/ML, 2ML VIA|United Healthcare|UNITED HEALTHCARE|||||166.25||| J0153|ERX|0636|ADENOSINE 3MG/ML, 2ML VIA|Medicaid|LAW ENFORCEMENT OTHER|||||166.25||| J0153|ERX|0636|ADENOSINE 3MG/ML, 2ML VIA|Managed Medicaid|MEDICAID SUPERIOR|166.25||||||| J0153|ERX|0636|ADENOSINE 3MG/ML, 2ML VIA|Medicare|MEDICARE ACUTE|166.25||||166.25||| J0153|ERX|0636|ADENOSINE 3MG/ML, 2ML VIA|Cigna|CIGNA|||||166.25||| J0153|ERX|0636|ADENOSINE 3MG/ML, 2ML VIA|Blue Cross PPO Specialty|BCBSTX PPO|||||166.25||| J0153|ERX|0636|ADENOSINE 3MG/ML, 2ML VIA|Medicaid|MOLINA HEALTHCARE OF TEXAS|166.25||||||| J0289|ERX|0250|AMPHOTERICIN B LIPOSOME 5|Blue Cross PPO Specialty|BCBSTX PPO|||||322.50||| J0558|ERX|0636|PEN G BENZ-PROCAINE 1.2MU|Managed Medicaid|MEDICAID SUPERIOR|||||44.95||| J0561|ERX|0636|PENICILLIN G BENZATHINE 1|Managed Medicaid|MEDICAID SUPERIOR|||||42.79||| J0561|ERX|0636|PENICILLIN G BENZ 600000|Managed Medicaid|MEDICAID AMERIGROUP|||||50.29||| J0561|ERX|0636|PENICILLIN G BENZATHINE 1|Managed Medicaid|MEDICAID AMERIGROUP|||||42.79||| J0561|ERX|0636|PENICILLIN G BENZATHINE 1|Cigna|CIGNA|||||42.79||| J0561|ERX|0636|PENICILLIN G BENZ 600000|Blue Cross PPO Specialty|BCBSTX OTHER|||||50.29||| J0561|ERX|0636|PENICILLIN G BENZATHINE 1|Veterans Affairs|VETERANS ADMINISTRATION|||||42.79||| J0561|ERX|0636|PENICILLIN G BENZATHINE 1|Medicaid|MEDICAID|||||42.79||| J0561|ERX|0636|PENICILLIN G BENZATHINE 1|United Healthcare|UNITED HEALTHCARE|||||42.79||| J0561|ERX|0636|PENICILLIN G BENZATHINE 1|Medicaid|MEDICAID HMO|||||42.79||| J0561|ERX|0636|PENICILLIN G BENZATHINE 2|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||35.70||| J0561|ERX|0636|PENICILLIN G BENZATHINE 1|Medicare|MEDICARE ACUTE|||||42.79||| J0561|ERX|0636|PENICILLIN G BENZATHINE 1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||42.79||| J0561|ERX|0636|PENICILLIN G BENZATHINE 1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||42.79||| J0585|ERX|0636|BOTULINUM TOXIN 100 UNIT|Medicare|MEDICARE ACUTE|||||27.40||| J0630|ERX|0636|CALCITONIN,SYNTH 400 UNIT|Medicare|MEDICARE ACUTE|9,490.75||||||| J0630|ERX|0636|CALCITONIN,SYNTH 400 UNIT|Managed Medicare|HEALTHSPRING MA|9,490.75||||||| J0630|ERX|0636|CALCITONIN,SYNTH 400 UNIT|Medicaid|MEDICAID|9,490.75||||||| J0630|ERX|0636|CALCITONIN,SYNTH 400 UNIT|Humana Medicare Advantage|HUMANA MA|9,490.75||||||| J0834|ERX|0636|COSYNTROPIN 0.25MG VIAL|Medicare|MEDICARE ACUTE|549.97||||||| J0840|ERX|0636|ANTIVENIN,CROTALIDAE 1 VI|Medicaid|MEDICAID|12,912.75||||||| J0840|ERX|0636|ANTIVENIN,CROTALIDAE 1 VI|Medicare|MEDICARE ACUTE|||||12,912.75||| J0840|ERX|0636|ANTIVENIN,CROTALIDAE 1 VI|Humana Medicare Advantage|HUMANA MA|||||12,912.75||| J0878|ERX|0636|DAPTOMYCIN 500MG VIAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3.81||||3.81||| J0878|ERX|0636|DAPTOMYCIN 500MG VIAL|Medicare|MEDICARE ACUTE|3.81||||3.81||| J0878|ERX|0636|DAPTOMYCIN 500MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|||||3.81||| J0878|ERX|0636|DAPTOMYCIN 500MG VIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3.81||||||| J0884|ERX|0636|ARGATROBAN 100MG/ML, 2.5|Aenta Medicare Advantage|AETNA MEDICARE MA|8.66||||||| J0885|ERX|0636|EPOETIN 40000 UNIT/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|134.86||||||| J0885|ERX|0636|EPOETIN 20000 UNIT/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|133.90||||||| J0885|ERX|0636|EPOETIN 40000 UNIT/1ML|Medicare|MEDICARE ACUTE|133.90||||134.86||| J0885|ERX|0636|EPOETIN 40000 UNIT/1ML|Medicare|MEDICARE ACUTE|134.86||||134.86||| J0897|ERX|0636|DENOSUMAB 60 MG/ML SYRING|Medicare|MEDICARE ACUTE|||||73.35||| J0897|ERX|0636|DENOSUMAB 60 MG/ML SYRING|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||73.35||| J0897|ERX|0636|DENOSUMAB 60 MG/ML SYRING|Humana Medicare Advantage|HUMANA MA|||||73.35||| J1110|ERX|0636|DIHYDROERGOTAMINE 1MG/ML|Tricare|TRICARE EAST REGION|642.85||||||| J1110|ERX|0636|DIHYDROERGOTAMINE 1MG/ML|Medicare|MEDICARE ACUTE|||||642.85||| J1110|ERX|0636|DIHYDROERGOTAMINE 1MG/ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||642.85||| J1110|ERX|0636|DIHYDROERGOTAMINE 1MG/ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||642.85||| J1160|ERX|0636|DIGOXIN 250MCG 1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|32.28||||||| J1160|ERX|0636|DIGOXIN 250MCG 1ML|United Healthcare|UNITED HEALTHCARE|32.28||||||| J1160|ERX|0636|DIGOXIN 250MCG 1ML|Managed Medicaid|MEDICAID SUPERIOR|32.28||||||| J1160|ERX|0636|DIGOXIN 250MCG 1ML|Humana Medicare Advantage|HUMANA MA|32.28||||||| J1160|ERX|0636|DIGOXIN 250MCG 1ML|Medicare|MEDICARE ACUTE|32.28||||32.28||| J1160|ERX|0636|DIGOXIN 250MCG 1ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|32.28||||||| J1160|ERX|0636|DIGOXIN 250MCG 1ML|Managed Medicare|HEALTHSPRING MA|32.28||||||| J1160|ERX|0636|DIGOXIN 250MCG 1ML|Managed Medicare|BCBS MEDICARE PPO MA|32.28||||||| J1160|ERX|0636|DIGOXIN 250MCG 1ML|Medicaid|MEDICAID|32.28||||||| J1160|ERX|0636|DIGOXIN 250MCG 1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||32.28||| J1160|ERX|0636|DIGOXIN 250MCG 1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|32.28||||||| J1160|ERX|0636|DIGOXIN 250MCG 1ML|Blue Cross PPO Specialty|BCBSTX PPO|32.28||||||| J1160|ERX|0636|DIGOXIN 250MCG 1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|32.28||||||| J1160|ERX|0636|DIGOXIN 250MCG 1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|32.28||||||| J1162|ERX|0636|DIGOXIN IMMUNE FAB 40MG V|Humana Medicare Advantage|HUMANA MA|149.10||||||| J1300|ERX|0636|ECULIZUMAB 300MG/30ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||695.77||| J1442|ERX|0636|FILGRASTIM 480MCG/1.6ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|7.03||||||| J1442|ERX|0636|FILGRASTIM 480MCG/1.6ML|Medicare|MEDICARE ACUTE|7.03||||||| J1442|ERX|0636|FILGRASTIM 480MCG/1.6ML|Managed Medicare|HEALTHSPRING MA|7.03||||||| J1442|ERX|0636|FILGRASTIM 480MCG/1.6ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|7.03||||||| J1442|ERX|0636|FILGRASTIM 480MCG/1.6ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.03||||||| J1447|ERX|0636|TBO-FILGRASTIM 300MCG/0.5|Medicare|MEDICARE ACUTE|4.62||||||| J1568|ERX|0636|OCTAGAM (5%) 10 GM/200 ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|301.70||||||| J1568|ERX|0636|OCTAGAM (5%) 10 GM/200 ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||301.70||| J1568|ERX|0636|OCTAGAM (5%) 10 GM/200 ML|Medicare|MEDICARE ACUTE|301.70||||301.70||| J1568|ERX|0636|OCTAGAM (5%) 5 GM/100 ML|Medicare|MEDICARE ACUTE|301.70||||340.20||| J1610|ERX|0636|GLUCAGON 1MG VIAL|Managed Medicare|WELLCARE CHOICE MA|891.50||||||| J1610|ERX|0636|GLUCAGON 1MG VIAL|Medicaid|MEDICAID|||||891.50||| J1610|ERX|0636|GLUCAGON 1MG VIAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||891.50||| J1610|ERX|0636|GLUCAGON 1MG VIAL|Medicare|MEDICARE ACUTE|891.50||||891.50||| J1610|ERX|0636|GLUCAGON 1MG VIAL|Medicare|MEDICARE PART B ONLY IP|891.50||||||| J1610|ERX|0636|GLUCAGON 1MG VIAL|United Healthcare|TML GROUP BENEFITS|||||891.50||| J1610|ERX|0636|GLUCAGON 1MG VIAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||891.50||| J1610|ERX|0636|GLUCAGON 1MG VIAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||891.50||| J1610|ERX|0636|GLUCAGON 1MG VIAL|United Healthcare|UNITED HEALTHCARE|||||891.50||| J1610|ERX|0636|GLUCAGON 1MG VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||891.50||| J1610|ERX|0636|GLUCAGON 1MG VIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|891.50||||891.50||| J1610|ERX|0636|GLUCAGON 1MG VIAL|Veterans Affairs|VETERANS ADMINISTRATION|||||891.50||| J1610|ERX|0636|GLUCAGON 1MG VIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||891.50||| J1610|ERX|0636|GLUCAGON 1MG VIAL|Managed Medicare|BCBS MEDICARE PPO MA|||||891.50||| J1610|ERX|0636|GLUCAGON 1MG VIAL|Humana Medicare Advantage|HUMANA MA|891.50||||891.50||| J1610|ERX|0636|GLUCAGON 1MG VIAL|Managed Medicaid|MEDICAID AMERIGROUP|891.50||||||| J1610|ERX|0636|GLUCAGON 1MG VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||891.50||| J1610|ERX|0636|GLUCAGON 1MG VIAL|Access Direct Platinum|HEALTHFIRST TPA UMR|||||891.50||| J1610|ERX|0636|GLUCAGON 1MG VIAL|Aetna|AETNA PPO|||||891.50||| J1610|ERX|0636|GLUCAGON 1MG VIAL|Blue Cross HMO Specialty|BCBSTX HMO|891.50||||891.50||| J1610|ERX|0636|GLUCAGON 1MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|||||891.50||| J1610|ERX|0636|GLUCAGON 1MG VIAL|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||891.50||| J1610|ERX|0636|GLUCAGON 1MG VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||891.50||| J1750|ERX|0636|IRON DEXTRAN 50MG/ML, 2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||193.63||| J1750|ERX|0636|IRON DEXTRAN 50MG/ML, 2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|193.63||||||| J1750|ERX|0636|IRON DEXTRAN 50MG/ML, 2ML|Blue Cross PPO Specialty|BCBSTX PPO|193.63||||||| J1750|ERX|0636|IRON DEXTRAN 50MG/ML, 2ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|193.63||||193.63||| J1750|ERX|0636|IRON DEXTRAN 50MG/ML, 2ML|Medicare|MEDICARE ACUTE|193.63||||||| J1750|ERX|0636|IRON DEXTRAN 50MG/ML, 2ML|Veterans Affairs|VETERANS ADMINISTRATION|193.63||||||| J1750|ERX|0636|IRON DEXTRAN 50MG/ML, 2ML|Humana Medicare Advantage|HUMANA MA|193.63||||193.63||| J1750|ERX|0636|IRON DEXTRAN 50MG/ML, 2ML|Aetna|AETNA PPO|193.63||||||| J1750|ERX|0636|IRON DEXTRAN 50MG/ML, 2ML|Managed Medicaid|MEDICAID SUPERIOR|193.63||||||| J1756|ERX|0636|IRON SUCROSE COMPL. 100/M|Humana Medicare Advantage|HUMANA MA|588.50||||588.50||| J1756|ERX|0636|IRON SUCROSE COMPL. 100/M|Cigna|CIGNA OTHER|||||588.50||| J1756|ERX|0636|IRON SUCROSE COMPL. 100/M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|588.50||||||| J1756|ERX|0636|IRON SUCROSE COMPL. 100/M|Medicare|MEDICARE ACUTE|588.50||||588.50||| J1756|ERX|0636|IRON SUCROSE COMPL. 100/M|Managed Medicaid|MEDICAID AMERIGROUP|588.50||||||| J1756|ERX|0636|IRON SUCROSE COMPL. 100/M|Managed Medicaid|MEDICAID SUPERIOR|588.50||||588.50||| J1756|ERX|0636|IRON SUCROSE COMPL. 100/M|Managed Medicare|HEALTHSPRING MA|588.50||||||| J1756|ERX|0636|IRON SUCROSE COMPL. 100/M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|588.50||||||| J1756|ERX|0636|IRON SUCROSE COMPL. 100/M|Aenta Medicare Advantage|AETNA MEDICARE MA|588.50||||||| J1756|ERX|0636|IRON SUCROSE COMPL. 100/M|Blue Cross PPO Specialty|BCBSTX PPO|588.50||||||| J1953|ERX|0636|LEVETIRACETAM 500MG IN 10|Blue Cross PPO Specialty|BCBSTX PPO|||||271.50||| J1953|ERX|0636|LEVETIRACETAM 500MG IN 10|Managed Medicaid|MEDICAID AMERIGROUP|||||271.50||| J1953|ERX|0636|LEVETIRACETAM 1000MG IN 1|Managed Medicaid|MEDICAID SUPERIOR|542.50||||542.50||| J1953|ERX|0636|LEVETIRACETAM 500MG IN 10|Managed Medicaid|MEDICAID UNITED HEALTHCARE|271.50||||542.50||| J1953|ERX|0636|LEVETIRACETAM 1000MG IN 1|Humana Medicare Advantage|HUMANA MA|542.50||||542.50||| J1953|ERX|0636|LEVETIRACETAM 1000MG IN 1|United Healthcare|UNITED HEALTHCARE|||||542.50||| J1953|ERX|0636|LEVETIRACETAM 500MG IN 10|United Medicare Advantage|AARP UHC WEST COMPLETE MA|271.50||||||| J1953|ERX|0636|LEVETIRACETAM 1000MG IN 1|Veterans Affairs|VETERANS ADMINISTRATION|542.50||||542.50||| J1953|ERX|0636|LEVETIRACETAM 1000MG IN 1|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||542.50||| J1953|ERX|0636|LEVETIRACETAM 1000MG IN 1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|542.50||||542.50||| J1953|ERX|0636|LEVETIRACETAM 1000MG IN 1|Medicare|MEDICARE ACUTE|542.50||||542.50||| J1953|ERX|0636|LEVETIRACETAM 500MG IN 10|Medicare|MEDICARE ACUTE|271.50||||271.50||| J1953|ERX|0636|LEVETIRACETAM 1000MG IN 1|Medicaid|LAW ENFORCEMENT OTHER|||||542.50||| J1953|ERX|0636|LEVETIRACETAM 1000MG IN 1|Medicaid|MEDICAID HMO|||||542.50||| J1953|ERX|0636|LEVETIRACETAM 1000MG IN 1|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||542.50||| J1953|ERX|0636|LEVETIRACETAM 500MG IN 10|Humana Medicare Advantage|HUMANA MA|271.50||||542.50||| J1953|ERX|0636|LEVETIRACETAM 1000MG IN 1|United Medicare Advantage|UHC MEDICARE GOLD MA|542.50||||542.50||| J1953|ERX|0636|LEVETIRACETAM 1000MG IN 1|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||542.50||| J1953|ERX|0636|LEVETIRACETAM 1000MG IN 1|Cigna|CIGNA|||||542.50||| J1953|ERX|0636|LEVETIRACETAM 1000MG IN 1|Managed Medicaid|MEDICAID AMERIGROUP|||||542.50||| J1953|ERX|0636|LEVETIRACETAM 1000MG IN 1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||542.50||| J1953|ERX|0636|LEVETIRACETAM 1000MG IN 1|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||542.50||| J1953|ERX|0636|LEVETIRACETAM 1000MG IN 1|Blue Cross PPO Specialty|BCBSTX PPO|||||542.50||| J1953|ERX|0636|LEVETIRACETAM 1000MG IN 1|Aenta Medicare Advantage|AETNA MEDICARE MA|542.50||||||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|Humana Medicare Advantage|HUMANA MA|4.80||||||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|Medicare|MEDICARE ACUTE|4.80||||4.80||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.80||||||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.80||||||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|Managed Medicaid|MEDICAID SUPERIOR|4.80||||||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|Aenta Medicare Advantage|AETNA MEDICARE MA|4.80||||||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|Blue Cross PPO Specialty|BCBSTX PPO|4.80||||||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|Medicaid|MEDICAID HMO|4.80||||||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.80||||||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|MTC Medical|VAN ZANDT COUNTY INMATE|||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|United Healthcare|UNITED HEALTHCARE|17.50||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|United Healthcare|UNITED HEALTHCARE|1.24||||0.16||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|United Healthcare|UNITED HEALTHCARE|1.24||||1.24||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|1.24||||0.16||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|United Healthcare|UNITED HEALTHCARE|0.16||||1.24||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|United Healthcare|UMR UNITED MEDICAL RESOURCES|0.16||||0.16||| J2270|ERX|0636|MORPHINE 10MG/1ML|United Healthcare|UNITED HEALTHCARE|0.16||||17.50||| J2270|ERX|0636|MORPHINE 10MG/1ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|0.16||||17.50||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|United Healthcare|UNITED HEALTHCARE OTHER|0.16||||0.16||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.24||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.24||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|United Medicare Advantage|UHC MEDICARE GOLD MA|17.50||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|United Medicare Advantage|UHC AARP MCR HMO MA|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.16||||0.16||| J2270|ERX|0636|MORPHINE 10MG/1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.16||||17.50||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|0.16||||0.16||| J2270|ERX|0636|MORPHINE 10MG/1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|17.50||||17.50||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Veterans Affairs|VETERANS ADMINISTRATION|1.24||||0.16||| J2270|ERX|0636|MORPHINE 10MG/1ML|Veterans Affairs|VETERANS ADMINISTRATION|0.16||||17.50||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Workers Compensation|UT EMPLOYEE INJURY|||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Tricare|TRICARE FOR LIFE|||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|United Healthcare|UNITED HEALTHCARE OTHER|17.50||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Tricare|TRICARE EAST REGION|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Tricare|TRICARE EAST REGION|0.16||||0.16||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|NON CONTRACTED|COMMERCIAL OTHER 1|1.24||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|NON CONTRACTED|COMMERCIAL OTHER 1|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Medicare|MEDICARE ACUTE|0.16||||0.16||| J2270|ERX|0636|MORPHINE 10MG/1ML|Medicare|MEDICARE ACUTE|17.50||||17.50||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Medicare|MEDICARE ACUTE|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Medicare|MEDICARE PART B ONLY IP|0.16||||||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|PHCS|HUMANA|||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|PHCS|HUMANA INSURANCE|||||0.16||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.24||||1.24||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|Texas Workforce Commission|DIS DETER SERV (DDS)|1.24||||||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|NON CONTRACTED|COMMERCIAL OTHER 1|0.16||||0.16||| J2270|ERX|0636|MORPHINE 10MG/1ML|Texas Workforce Commission|DIS DETER SERV (DDS)|17.50||||||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|Medicaid|MEDICAID HMO|1.24||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|UTMB|UTMB CORRECTIONAL MANAGED CARE|0.16||||||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|United Healthcare|TML GROUP BENEFITS|0.16||||0.16||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|Tricare|TRICARE EAST REGION|1.24||||0.16||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|Medicaid|MEDICAID|1.24||||0.16||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|Medicaid|HENDERSON COUNTY INDIGENT|1.24||||0.16||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|United Healthcare|UNITED HEALTHCARE OTHER|1.24||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|United Healthcare|UNITED HEALTHCARE|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Veterans Affairs|VETERANS ADMINISTRATION|0.16||||0.16||| J2270|ERX|0636|MORPHINE 10MG/1ML|NON CONTRACTED|COMMERCIAL OTHER 1|17.50||||17.50||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Medicaid|MOLINA HEALTHCARE OF TEXAS|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Medicaid|MEDICAID TEXAS CHILDRENS|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Medicaid|MEDICAID HMO|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Medicaid|MEDICAID|0.16||||0.16||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|Medicare|MEDICARE ACUTE|1.24||||1.24||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Medicaid|HENDERSON COUNTY INDIGENT|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|United Medicare Advantage|UHC AARP MCR HMO MA|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Medicaid|MOLINA HEALTHCARE OF TEXAS|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Medicaid|MEDICAID HMO|17.50||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Medicaid|MEDICAID|17.50||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Medicaid|LAW ENFORCEMENT OTHER|||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Medicaid|HENDERSON COUNTY INDIGENT|17.50||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Medicaid|COUNTY INDIGENT HEALTH OTHER|0.16||||||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|Managed Medicare|HOSPICE ETMC|1.24||||0.16||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|Managed Medicare|HEALTHSPRING MA|1.24||||1.24||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Managed Medicare|VAN ZANDT COUNTY INMATE|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Managed Medicare|MA PART B ONLY IP|0.16||||||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Managed Medicare|HOSPICE GENESIS|0.16||||||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Managed Medicare|HOSPICE ETMC|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Managed Medicare|HEALTHSPRING MA|1.24||||0.16||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|United Healthcare|GEHA|||||1.24||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Humana Medicare Advantage|HUMANA MA|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|United Healthcare|UNITED HEALTHCARE|1.24||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Managed Medicare|BCBS MEDICARE PPO MA|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicare|HOSPICE OF EAST TEXAS|0.16||||||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|United Healthcare|TML GROUP BENEFITS|1.24||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicare|HOSPICE ETMC|17.50||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicare|OTHER INSTITUTIONS|||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicare|HOSPICE ETMC|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicare|BCBS MEDICARE PPO MA|0.16||||0.16||| J2270|ERX|0636|MORPHINE 10MG/1ML|Managed Medicare|HEALTHSPRING MA|0.16||||17.50||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicare|HEALTHSPRING MA|0.16||||0.16||| J2270|ERX|0636|MORPHINE 10MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|17.50||||17.50||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Blue Cross HMO Specialty|BCBSTX HMO|1.24||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Blue Cross HMO Specialty|BCBSTX HMO|0.16||||0.16||| J2270|ERX|0636|MORPHINE 10MG/1ML|Blue Cross HMO Specialty|BCBSTX HMO|0.16||||17.50||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Blue Cross PPO Specialty|BCBSTX OTHER|||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Blue Cross PPO Specialty|BCBSTX PPO|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Blue Cross PPO Specialty|BCBSTX OTHER|||||0.16||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|Blue Cross PPO Specialty|BCBSTX PPO|1.24||||1.24||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|ChampVA|CHAMPVA CENTER|1.24||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|ChampVA|CHAMPVA CENTER|1.24||||0.16||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.24||||1.24||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|1.24||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Aenta Medicare Advantage|AETNA MEDICARE MA|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.24||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.24||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.24||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Access Direct Platinum|HEALTHFIRST TPA UMR|1.24||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.16||| J2270|ERX|0636|MORPHINE 10MG/1ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.16||||17.50||| J2270|ERX|0636|MORPHINE 10MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.24||||17.50||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|Aetna|AETNA PPO|1.24||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Aetna|AETNA PPO|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Aetna|AETNA PPO|0.16||||0.16||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.24||||1.24||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.16||||0.16||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|Managed Medicaid|MEDICAID SUPERIOR|1.24||||0.16||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.24||||1.24||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|Managed Medicaid|MEDICAID AMERIGROUP|1.24||||1.24||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Aetna|AETNA OTHER|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.16||||0.16||| J2270|ERX|0636|MORPHINE 10MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|17.50||||17.50||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Managed Medicaid|MEDICAID SUPERIOR|0.16||||0.16||| J2270|ERX|0636|MORPHINE 10MG/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.16||||17.50||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Aetna|AETNA OTHER|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Managed Medicaid|MEDICAID AMERIGROUP|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicaid|MEDICAID SUPERIOR|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicaid|MEDICAID AMERIGROUP|0.16||||0.16||| J2270|ERX|0636|MORPHINE 10MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|17.50||||17.50||| J2270|ERX|0636|MORPHINE 10MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|17.50||||17.50||| J2270|ERX|0636|MORPHINE 10MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|17.50||||17.50||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|Cigna|CIGNA OTHER|1.24||||1.24||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Blue Cross PPO Specialty|BCBSTX PPO|0.16||||0.16||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|Cigna|CIGNA|1.24||||1.24||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Cigna|CIGNA|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Cigna|CIGNA|||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Cigna|CIGNA OTHER|17.50||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Cigna|CIGNA OTHER|0.16||||0.16||| J2270|ERX|0636|MORPHINE 10MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|17.50||||17.50||| J2270|ERX|0636|MORPHINE 10MG/1ML|Cigna|CIGNA|0.16||||17.50||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Cigna|CIGNA|1.24||||0.16||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|Cigna|CIGNA OTHER|0.16||||1.24||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Cigna|CIGNA|0.16||||0.16||| J2270|ERX|0636|MORPHINE 10MG/1ML|Humana Medicare Advantage|HUMANA MA|17.50||||17.50||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Humana Medicare Advantage|HUMANA MA|0.16||||0.16||| J2270|ERX|0636|MORPHINE PCA 1MG/ML 30MG/|Humana Medicare Advantage|HUMANA MA|1.24||||1.24||| J2274|ERX|0636|MORPHINE (PF) 10MG, 10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||135.75||| J2274|ERX|0636|MORPHINE (PF) 10MG, 10ML|Medicare|MEDICARE ACUTE|135.75||||135.75||| J2274|ERX|0636|MORPHINE (PF) 10MG, 10ML|Texas Workforce Commission|DIS DETER SERV (DDS)|||||135.75||| J2274|ERX|0636|MORPHINE (PF) 10MG, 10ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||135.75||| J2274|ERX|0636|MORPHINE (PF) 10MG, 10ML|United Healthcare|UNITED HEALTHCARE|||||135.75||| J2274|ERX|0636|MORPHINE (PF) 10MG, 10ML|Cigna|CIGNA|||||135.75||| J2274|ERX|0636|MORPHINE (PF) 10MG, 10ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||135.75||| J2274|ERX|0636|MORPHINE (PF) 10MG, 10ML|Managed Medicaid|MEDICAID AMERIGROUP|||||135.75||| J2274|ERX|0636|MORPHINE (PF) 10MG, 10ML|Humana Medicare Advantage|HUMANA MA|||||135.75||| J2274|ERX|0636|MORPHINE (PF) 10MG, 10ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||135.75||| J2274|ERX|0636|MORPHINE (PF) 10MG, 10ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||135.75||| J2274|ERX|0636|MORPHINE (PF) 10MG, 10ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||135.75||| J2274|ERX|0636|MORPHINE (PF) 10MG, 10ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||135.75||| J2274|ERX|0636|MORPHINE (PF) 10MG, 10ML|Aetna|AETNA PPO|||||135.75||| J2274|ERX|0636|MORPHINE (PF) 10MG, 10ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|135.75||||135.75||| J2274|ERX|0636|MORPHINE (PF) 10MG, 10ML|Aetna|AETNA OTHER|||||135.75||| J2274|ERX|0636|MORPHINE (PF) 10MG, 10ML|Managed Medicaid|MEDICAID SUPERIOR|||||135.75||| J2274|ERX|0636|MORPHINE (PF) 10MG, 10ML|Blue Cross HMO Specialty|BCBSTX HMO|||||135.75||| J2274|ERX|0636|MORPHINE (PF) 10MG, 10ML|Blue Cross PPO Specialty|BCBSTX PPO|||||135.75||| J2274|ERX|0636|MORPHINE (PF) 10MG, 10ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||135.75||| J2354|ERX|0636|OCTREOTIDE 500MCG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|2.29||||883.75||| J2354|ERX|0636|OCTREOTIDE 100MCG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.29||||||| J2354|ERX|0636|OCTREOTIDE 500MCG/1ML|Aetna|AETNA PPO|||||883.75||| J2354|ERX|0636|OCTREOTIDE 100MCG/1ML|Aetna|AETNA PPO|||||2.29||| J2354|ERX|0636|OCTREOTIDE 100MCG/1ML|Humana Medicare Advantage|HUMANA MA|2.29||||||| J2354|ERX|0636|OCTREOTIDE 500MCG/1ML|Humana Medicare Advantage|HUMANA MA|883.75||||||| J2354|ERX|0636|OCTREOTIDE 500MCG/1ML|Veterans Affairs|VETERANS ADMINISTRATION|||||883.75||| J2354|ERX|0636|OCTREOTIDE 500MCG/1ML|Medicaid|HENDERSON COUNTY INDIGENT|||||883.75||| J2354|ERX|0636|OCTREOTIDE 500MCG/1ML|Medicare|MEDICARE ACUTE|883.75||||883.75||| J2354|ERX|0636|OCTREOTIDE 500MCG/1ML|Managed Medicare|HEALTHSPRING MA|883.75||||||| J2354|ERX|0636|OCTREOTIDE 100MCG/1ML|Medicaid|MEDICAID|2.29||||||| J2354|ERX|0636|OCTREOTIDE 500MCG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|883.75||||||| J2354|ERX|0636|OCTREOTIDE 100MCG/1ML|Medicare|MEDICARE ACUTE|2.29||||2.29||| J2354|ERX|0636|OCTREOTIDE 100MCG/1ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2.29||| J2354|ERX|0636|OCTREOTIDE 500MCG/1ML|Medicaid|MEDICAID|883.75||||||| J2354|ERX|0636|OCTREOTIDE 500MCG/1ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||883.75||| J2354|ERX|0636|OCTREOTIDE 100MCG/1ML|Veterans Affairs|VETERANS ADMINISTRATION|||||2.29||| J2354|ERX|0636|OCTREOTIDE 100MCG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.29||| J2354|ERX|0636|OCTREOTIDE 500MCG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||883.75||| J2354|ERX|0636|OCTREOTIDE 500MCG/1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|883.75||||||| J2354|ERX|0636|OCTREOTIDE 100MCG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.29||||2.29||| J2354|ERX|0636|OCTREOTIDE 500MCG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|883.75||||883.75||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Tricare|TRICARE EAST REGION|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Tricare|TRICARE FOR LIFE|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Medicare|MEDICARE PART B ONLY IP|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Medicare|MEDICARE ACUTE|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|PHCS|HUMANA|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|NON CONTRACTED|COMMERCIAL OTHER 1|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Medicaid|MEDICAID HMO|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Medicaid|MEDICAID|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Medicaid|HENDERSON COUNTY INDIGENT|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|UTMB|UTMB CORRECTIONAL MANAGED CARE|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Managed Medicare|WELLCARE CHOICE MA|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Managed Medicare|OTHER INSTITUTIONS|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Managed Medicare|MA PART B ONLY IP|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Managed Medicare|HOSPICE ETMC|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Managed Medicare|HEALTHSPRING MA|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Managed Medicare|BCBS MEDICARE PPO MA|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|United Healthcare|UNITED HEALTHCARE|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|United Healthcare|GEHA|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|United Healthcare|TML GROUP BENEFITS|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|United Healthcare|UNITED HEALTHCARE OTHER|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|United Healthcare|GOLDEN RULE|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|United Medicare Advantage|UHC AARP WELLMED HMO MA|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|United Medicare Advantage|UHC AARP MCR HMO MA|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Veterans Affairs|VETERANS ADMINISTRATION|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Veterans Affairs|VETERANS ADMINISTRATION|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Workers Compensation|UT EMPLOYEE INJURY|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Cigna|CIGNA OTHER|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Medicaid|COUNTY INDIGENT HEALTH OTHER|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Multiplan|NALC|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Medicaid|LAW ENFORCEMENT OTHER|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|PHCS|MULTIPLAN PHCS OTHER|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Texas Workforce Commission|DIS DETER SERV (DDS)|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Access Direct Platinum|HEALTHFIRST TPA UMR|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Aetna|AETNA OTHER|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Aetna|BOON CHAPMAN|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Aetna|AETNA PPO|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Aenta Medicare Advantage|AETNA MEDICARE MA|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Blue Cross HMO Specialty|BCBSTX HMO|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Managed Medicaid|MEDICAID AMERIGROUP|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Blue Cross PPO Specialty|BCBSTX OTHER|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Managed Medicaid|MEDICAID SUPERIOR|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|ChampVA|CHAMPVA CENTER|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Humana Medicare Advantage|HUMANA MA|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Cigna|CIGNA|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|16.80||||16.80||| J2597|ERX|0636|DESMOPRESSIN 4MCG/1ML|Medicare|MEDICARE ACUTE|98.38||||||| J2704|ERX|0636|PROPOFOL 100 MG/ 10 ML|Blue Cross HMO Specialty|BCBSTX HMO|1.75||||1.50||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Blue Cross HMO Specialty|BCBSTX HMO|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Blue Cross PPO Specialty|BCBSTX PPO|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 1000MG/100ML|Blue Cross PPO Specialty|BCBSTX PPO|0.92||||1.75||| J2704|ERX|0636|PROPOFOL 100 MG/ 10 ML|Blue Cross PPO Specialty|BCBSTX PPO|1.50||||1.50||| J2704|ERX|0636|PROPOFOL 100 MG/ 10 ML|ChampVA|CHAMPVA CENTER|1.50||||1.50||| J2704|ERX|0636|PROPOFOL 100 MG/ 10 ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.50||||1.50||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 1000MG/100ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.92||||1.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Aetna|AETNA PPO|1.75||||0.92||| J2704|ERX|0636|PROPOFOL 100 MG/ 10 ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.92||||1.50||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Aetna|AETNA OTHER|||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.75||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Managed Medicaid|MEDICAID SUPERIOR|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 1000MG/100ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.50||||1.75||| J2704|ERX|0636|PROPOFOL 1000MG/100ML|Managed Medicaid|MEDICAID SUPERIOR|1.75||||1.75||| J2704|ERX|0636|PROPOFOL 1000MG/100ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.50||||1.75||| J2704|ERX|0636|PROPOFOL 100 MG/ 10 ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.50||| J2704|ERX|0636|PROPOFOL 100 MG/ 10 ML|Managed Medicaid|MEDICAID SUPERIOR|1.50||||1.50||| J2704|ERX|0636|PROPOFOL 100 MG/ 10 ML|Managed Medicaid|MEDICAID AMERIGROUP|1.75||||1.50||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Cigna|CIGNA|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 100 MG/ 10 ML|Cigna|CIGNA|0.92||||1.50||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Cigna|CIGNA OTHER|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 1000MG/100ML|Humana Medicare Advantage|HUMANA MA|1.75||||1.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Managed Medicaid|MEDICAID AMERIGROUP|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 100 MG/ 10 ML|Humana Medicare Advantage|HUMANA MA|1.50||||1.50||| J2704|ERX|0636|PROPOFOL 200MG/20ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||0.92||| J2704|ERX|0636|PROPOFOL 1000MG/100ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.92||||1.75||| J2704|ERX|0636|PROPOFOL 1000MG/100ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.92||||1.75||| J2704|ERX|0636|PROPOFOL 100 MG/ 10 ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.75||||1.50||| J2704|ERX|0636|PROPOFOL 100 MG/ 10 ML|United Medicare Advantage|UHC MEDICARE GOLD MA|1.75||||1.50||| J2704|ERX|0636|PROPOFOL 100 MG/ 10 ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.75||||1.50||| J2704|ERX|0636|PROPOFOL 200MG/20ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Veterans Affairs|VETERANS ADMINISTRATION|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Veterans Affairs|VETERANS ADMINISTRATION|0.92||||||| J2704|ERX|0636|PROPOFOL 200MG/20ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 1000MG/100ML|Veterans Affairs|VETERANS ADMINISTRATION|0.92||||1.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Humana Medicare Advantage|HUMANA MA|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.92||| J2704|ERX|0636|PROPOFOL 100 MG/ 10 ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|1.75||||1.50||| J2704|ERX|0636|PROPOFOL 100 MG/ 10 ML|United Healthcare|UNITED HEALTHCARE OTHER|0.92||||1.50||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.75||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Cigna|CIGNA|||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|United Healthcare|UNITED HEALTHCARE OTHER|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|United Healthcare|TML GROUP BENEFITS|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|United Healthcare|GEHA|||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|United Healthcare|UNITED HEALTHCARE|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 100 MG/ 10 ML|United Healthcare|UNITED HEALTHCARE|0.92||||1.50||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.92||| J2704|ERX|0636|PROPOFOL 1000MG/100ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.92||||1.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Medicaid|MEDICAID HMO|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 100 MG/ 10 ML|Aenta Medicare Advantage|AETNA MEDICARE MA|1.75||||1.50||| J2704|ERX|0636|PROPOFOL 100 MG/ 10 ML|Aetna|AETNA PPO|1.50||||1.50||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Aetna|AETNA PPO|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Access Direct Platinum|HEALTHFIRST TPA UMR|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Medicaid|MEDICAID|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Medicaid|LAW ENFORCEMENT OTHER|0.92||||||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Medicaid|HENDERSON COUNTY INDIGENT|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Managed Medicare|OTHER INSTITUTIONS|||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.92||||||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Medicaid|MEDICAID|1.50||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Managed Medicare|HEALTHSPRING MA|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Managed Medicare|BCBS MEDICARE PPO MA|1.75||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Managed Medicare|BCBS MEDICARE PPO MA|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|ChampVA|CHAMPVA CENTER|1.50||||0.92||| J2704|ERX|0636|PROPOFOL 1000MG/100ML|Managed Medicare|HEALTHSPRING MA|1.75||||1.75||| J2704|ERX|0636|PROPOFOL 100 MG/ 10 ML|Managed Medicare|HEALTHSPRING MA|1.50||||1.50||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Multiplan|NALC|||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Tricare|TRICARE EAST REGION|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 100 MG/ 10 ML|Tricare|TRICARE EAST REGION|0.92||||1.50||| J2704|ERX|0636|PROPOFOL 1000MG/100ML|UTMB|UTMB CORRECTIONAL MANAGED CARE|1.75||||||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Medicare|MEDICARE ACUTE|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Texas Workforce Commission|DIS DETER SERV (DDS)|0.92||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Texas Workforce Commission|DIS DETER SERV (DDS)|1.50||||0.92||| J2704|ERX|0636|PROPOFOL 200MG/20ML|PHCS|MULTIPLAN PHCS OTHER|||||0.92||| J2704|ERX|0636|PROPOFOL 1000MG/100ML|Medicare|MEDICARE ACUTE|1.75||||1.75||| J2704|ERX|0636|PROPOFOL 100 MG/ 10 ML|Medicare|MEDICARE ACUTE|1.50||||1.50||| J2704|ERX|0636|PROPOFOL 100 MG/ 10 ML|NON CONTRACTED|COMMERCIAL OTHER 1|1.75||||1.50||| J2704|ERX|0636|PROPOFOL 200MG/20ML|NON CONTRACTED|COMMERCIAL OTHER 1|0.92||||0.92||| J2710|ERX|0636||Tricare|TRICARE EAST REGION|||||1.77||| J2710|ERX|0250||United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.77||| J2710|ERX|0636||Managed Medicare|HEALTHSPRING MA|||||1.77||| J2710|ERX|0636||United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.77||| J2710|ERX|0636||Humana Medicare Advantage|HUMANA MA|||||1.77||| J2710|ERX|0250||Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.77||| J2710|ERX|0250||Managed Medicaid|MEDICAID SUPERIOR|||||1.77||| J2710|ERX|0250||Managed Medicaid|MEDICAID AMERIGROUP|||||1.77||| J2710|ERX|0636||Medicare|MEDICARE ACUTE|||||1.77||| J2710|ERX|0636||Managed Medicaid|MEDICAID SUPERIOR|||||1.77||| J2710|ERX|0250||Medicare|MEDICARE ACUTE|||||1.77||| J2710|ERX|0636||Managed Medicaid|MEDICAID AMERIGROUP|||||1.77||| J2710|ERX|0636||Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.77||| J2710|ERX|0250||United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.77||| J2710|ERX|0636||Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.77||| J2710|ERX|0636||Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.77||| J2710|ERX|0250||Aetna|AETNA PPO|||||1.77||| J2710|ERX|0636||Aetna|AETNA PPO|||||1.77||| J2710|ERX|0250||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.77||| J2710|ERX|0636||Blue Cross HMO Specialty|BCBSTX HMO|||||1.77||| J2710|ERX|0636||Blue Cross PPO Specialty|BCBSTX PPO|||||1.77||| J2710|ERX|0250||Blue Cross HMO Specialty|BCBSTX HMO|||||1.77||| J2710|ERX|0636||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.77||| J2710|ERX|0250||Cigna|CIGNA|||||1.77||| J2710|ERX|0250||Humana Medicare Advantage|HUMANA MA|||||1.77||| J2710|ERX|0250||Blue Cross PPO Specialty|BCBSTX PPO|||||1.77||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Blue Cross PPO Specialty|BCBSTX PPO|1,389.50||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Aenta Medicare Advantage|AETNA MEDICARE MA|1,389.50||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Blue Cross HMO Specialty|BCBSTX HMO|1,389.50||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Aetna|AETNA PPO|1,389.50||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1,389.50||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Managed Medicaid|MEDICAID SUPERIOR|1,389.50||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1,389.50||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Managed Medicaid|MEDICAID AMERIGROUP|1,389.50||||||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1,389.50||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Veterans Affairs|VETERANS ADMINISTRATION|1,389.50||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Medicaid|MEDICAID|1,389.50||||||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Managed Medicare|HEALTHSPRING MA|1,389.50||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Medicare|MEDICARE ACUTE|1,389.50||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Medicare|MEDICARE PART B ONLY IP|1,389.50||||||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Managed Medicare|BCBS MEDICARE PPO MA|||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1,389.50||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Tricare|TRICARE EAST REGION|||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Medicaid|HENDERSON COUNTY INDIGENT|1,389.50||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Aetna|AETNA OTHER|||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,389.50||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,389.50||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|United Medicare Advantage|UHC AARP MCR HMO MA|||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|1,389.50||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Humana Medicare Advantage|HUMANA MA|1,389.50||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Cigna|CIGNA OTHER|||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Cigna|CIGNA|||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Veterans Affairs|VETERANS ADMINISTRATION|1,389.50||||||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|United Healthcare|UNITED HEALTHCARE|||||1,389.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|United Healthcare|UNITED HEALTHCARE|1,389.50||||1,389.50||| J2790|ERX|0636|HYPERRHO IMMUNE GLOBULIN|NON CONTRACTED|COMMERCIAL OTHER 1|||||388.25||| J2790|ERX|0636|HYPERRHO IMMUNE GLOBULIN|Medicaid|MEDICAID|388.25||||388.25||| J2790|ERX|0636|HYPERRHO IMMUNE GLOBULIN|United Healthcare|UNITED HEALTHCARE|||||388.25||| J2790|ERX|0636|HYPERRHO IMMUNE GLOBULIN|Medicaid|MEDICAID HMO|388.25||||388.25||| J2790|ERX|0636|HYPERRHO IMMUNE GLOBULIN|United Healthcare|UNITED HEALTHCARE|388.25||||||| J2790|ERX|0636|HYPERRHO IMMUNE GLOBULIN|Cigna|CIGNA|||||388.25||| J2790|ERX|0636|HYPERRHO IMMUNE GLOBULIN|Cigna|CIGNA|388.25||||||| J2790|ERX|0636|HYPERRHO IMMUNE GLOBULIN|Cigna|CIGNA OTHER|388.25||||||| J2790|ERX|0636|HYPERRHO IMMUNE GLOBULIN|Managed Medicaid|MEDICAID SUPERIOR|388.25||||388.25||| J2790|ERX|0636|HYPERRHO IMMUNE GLOBULIN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|388.25||||||| J2790|ERX|0636|HYPERRHO IMMUNE GLOBULIN|Managed Medicaid|MEDICAID AMERIGROUP|388.25||||||| J2790|ERX|0636|HYPERRHO IMMUNE GLOBULIN|Aetna|AETNA OTHER|||||388.25||| J2790|ERX|0636|HYPERRHO IMMUNE GLOBULIN|Blue Cross HMO Specialty|BCBSTX HMO|||||388.25||| J2790|ERX|0636|HYPERRHO IMMUNE GLOBULIN|Blue Cross PPO Specialty|BCBSTX PPO|388.25||||388.25||| J2790|ERX|0636|HYPERRHO IMMUNE GLOBULIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|388.25||||||| J2800|ERX|0636|METHOCARBAMOL 100MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|||||5.00||| J2800|ERX|0636|METHOCARBAMOL 100MG/1ML|Medicare|MEDICARE ACUTE|5.00||||5.00||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|623.75||||623.75||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||623.75||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|United Healthcare|TML GROUP BENEFITS|||||623.75||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||623.75||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Managed Medicare|HEALTHSPRING MA|||||623.75||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Managed Medicare|BCBS MEDICARE PPO MA|||||623.75||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Tricare|TRICARE EAST REGION|||||623.75||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Medicaid|HENDERSON COUNTY INDIGENT|623.75||||||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||623.75||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Medicare|MEDICARE ACUTE|623.75||||623.75||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Blue Cross HMO Specialty|BCBSTX HMO|||||623.75||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|||||623.75||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||623.75||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||623.75||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Access Direct Platinum|HEALTHFIRST TPA UMR|||||623.75||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||623.75||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Cigna|CIGNA|||||623.75||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||623.75||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Managed Medicaid|MEDICAID SUPERIOR|623.75||||623.75||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Humana Medicare Advantage|HUMANA MA|||||623.75||| J2997|ERX|0636|ALTEPLASE 100MG VIAL|Managed Medicaid|MEDICAID SUPERIOR|||||281.61||| J2997|ERX|0636|ALTEPLASE 100MG VIAL|Managed Medicaid|MEDICAID AMERIGROUP|281.61||||||| J2997|ERX|0636|ALTEPLASE 100MG VIAL|Cigna|CIGNA|||||281.61||| J2997|ERX|0636|ALTEPLASE 100MG VIAL|Humana Medicare Advantage|HUMANA MA|281.61||||281.61||| J2997|ERX|0250|ALTEPLASE 2MG VIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|329.08||||||| J2997|ERX|0636|ALTEPLASE 100MG VIAL|Aetna|AETNA PPO|||||281.61||| J2997|ERX|0636|ALTEPLASE 100MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|||||281.61||| J2997|ERX|0636|ALTEPLASE 100MG VIAL|Tricare|TRICARE FOR LIFE|||||281.61||| J2997|ERX|0250|ALTEPLASE 2MG VIAL|Medicare|MEDICARE ACUTE|329.08||||||| J2997|ERX|0636|ALTEPLASE 100MG VIAL|Medicare|MEDICARE ACUTE|||||281.61||| J2997|ERX|0636|ALTEPLASE 100MG VIAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||281.61||| J2997|ERX|0636|ALTEPLASE 100MG VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||281.61||| J2997|ERX|0636|ALTEPLASE 100MG VIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||281.61||| J3101|ERX|0636|TENECTEPLASE 50MG 1 KIT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||413.02||| J3101|ERX|0636|TENECTEPLASE 50MG 1 KIT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||413.02||| J3101|ERX|0636|TENECTEPLASE 50MG 1 KIT|Medicare|MEDICARE ACUTE|||||413.02||| J3101|ERX|0636|TENECTEPLASE 50MG 1 KIT|Blue Cross PPO Specialty|BCBSTX PPO|||||413.02||| J3101|ERX|0636|TENECTEPLASE 50MG 1 KIT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||413.02||| J3101|ERX|0636|TENECTEPLASE 50MG 1 KIT|Humana Medicare Advantage|HUMANA MA|||||413.02||| J3262|ERX|0636|TOCILIZUMAB 400 MG/20 ML|Cigna|CIGNA|19.92||||||| J3262|ERX|0636|TOCILIZUMAB 400 MG/20 ML|Humana Medicare Advantage|HUMANA MA|19.92||||||| J3262|ERX|0636|TOCILIZUMAB 400 MG/20 ML|Blue Cross PPO Specialty|BCBSTX PPO|19.92||||||| J3262|ERX|0636|TOCILIZUMAB 400 MG/20 ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|19.92||||||| J3262|ERX|0636|TOCILIZUMAB 400 MG/20 ML|UTMB|UTMB CORRECTIONAL MANAGED CARE|19.92||||||| J3262|ERX|0636|TOCILIZUMAB 400 MG/20 ML|Medicare|MEDICARE ACUTE|19.92||||||| J3262|ERX|0636|TOCILIZUMAB 400 MG/20 ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|19.92||||||| J3262|ERX|0636|TOCILIZUMAB 400 MG/20 ML|Veterans Affairs|VETERANS ADMINISTRATION|19.92||||||| J3262|ERX|0636|TOCILIZUMAB 400 MG/20 ML|United Medicare Advantage|UHC MEDICARE GOLD MA|19.92||||||| J3380|ERX|0636|VEDOLIZUMAB 300MG VIAL|Medicare|MEDICARE ACUTE|||||70.17||| J3380|ERX|0636|VEDOLIZUMAB 300MG VIAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||70.17||| J3380|ERX|0636|VEDOLIZUMAB 300MG VIAL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||70.17||| J3380|ERX|0636|VEDOLIZUMAB 300MG VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||70.17||| J3489|ERX|0636|ZOLEDRONIC ACID 4MG/5ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2,148.06||||||| J3489|ERX|0636|ZOLEDRONIC ACID 4MG/5ML|Medicaid|MEDICAID|2,148.06||||||| J3489|ERX|0636|ZOLEDRONIC ACID 4MG/5ML|Managed Medicare|HEALTHSPRING MA|2,148.06||||||| J3489|ERX|0636|ZOLEDRONIC ACID 4MG/5ML|Medicare|MEDICARE ACUTE|2,148.06||||||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|1.03||||||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Managed Medicare|BCBS MEDICARE PPO MA|1.03||||||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.03||||||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Managed Medicaid|MEDICAID SUPERIOR|1.24||||1.03||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.03||||1.03||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Managed Medicaid|MEDICAID AMERIGROUP|1.03||||||| J3490|ERX|0258|NA CHLOR 0.9% KCL 40MEQ/1|Managed Medicaid|MEDICAID AMERIGROUP|1.24||||||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.03||||1.03||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Humana Medicare Advantage|HUMANA MA|1.03||||1.03||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Humana Medicare Advantage|HUMANA MA|1.24||||1.03||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Blue Cross HMO Specialty|BCBSTX HMO|1.03||||||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Cigna|CIGNA|1.03||||||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Cigna|CIGNA|||||1.03||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Blue Cross PPO Specialty|BCBSTX PPO|1.03||||1.03||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Blue Cross PPO Specialty|BCBSTX PPO|1.24||||1.03||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.03||||||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Aetna|AETNA PPO|1.03||||||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Aetna|BOON CHAPMAN|1.03||||||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|ChampVA|CHAMPVA CENTER|1.03||||||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Aenta Medicare Advantage|AETNA MEDICARE MA|1.03||||1.03||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.03||||1.03||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Medicare|MEDICARE ACUTE|1.03||||1.03||| J3490|ERX|0258|NA CHLOR 0.9% KCL 40MEQ/1|Medicare|MEDICARE ACUTE|1.24||||1.24||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|NON CONTRACTED|COMMERCIAL OTHER 1|1.03||||||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|United Healthcare|UNITED HEALTHCARE|1.03||||||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|United Healthcare|TML GROUP BENEFITS|1.03||||1.03||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|United Healthcare|UNITED HEALTHCARE OTHER|||||1.03||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Managed Medicaid|MEDICAID SUPERIOR|1.03||||1.03||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Managed Medicare|HEALTHSPRING MA|1.03||||1.03||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|United Healthcare|UMR UNITED MEDICAL RESOURCES|1.03||||||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Medicaid|MOLINA HEALTHCARE OF TEXAS|1.03||||||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Medicaid|MEDICAID|1.03||||||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Medicaid|HENDERSON COUNTY INDIGENT|1.03||||||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.03||||1.03||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|United Medicare Advantage|UHC MEDICARE GOLD MA|1.03||||1.03||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|United Medicare Advantage|UHC AARP MCR HMO MA|1.03||||||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.24||||1.03||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.03||||1.03||| J3490|ERX|0258|NA CHLOR 0.9% KCL 40MEQ/1|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.03||||1.24||| J3490|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Veterans Affairs|VETERANS ADMINISTRATION|1.03||||1.03||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Workers Compensation|UT EMPLOYEE INJURY|265.50||||||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Workers Compensation|WORKERS COMPENSATION OTHER|||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Veterans Affairs|VETERANS ADMINISTRATION|265.50||||||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Veterans Affairs|VETERANS ADMINISTRATION|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|United Medicare Advantage|UHC AARP MCR HMO MA|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|United Medicare Advantage|AARP UHC WEST COMPLETE MA|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Medicaid|MEDICAID TEXAS CHILDRENS|||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Medicaid|MEDICAID HMO|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Medicaid|MEDICAID BCBSTX|||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Medicaid|HENDERSON COUNTY INDIGENT|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Medicaid|COUNTY INDIGENT HEALTH OTHER|265.50||||||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Medicaid|MEDICAID|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Tricare|TRICARE EAST REGION|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Tricare|TRICARE FOR LIFE|||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|UTMB|UTMB CORRECTIONAL MANAGED CARE|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|NON CONTRACTED|COMMERCIAL OTHER 2|||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|PHCS|MULTIPLAN PHCS OTHER|||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|PHCS|HUMANA|||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Medicare|MEDICARE PART B ONLY IP|265.50||||||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|United Healthcare|GOLDEN RULE|||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|United Healthcare|UNITED HEALTHCARE OTHER|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|United Healthcare|UMR UNITED MEDICAL RESOURCES|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|United Healthcare|TML GROUP BENEFITS|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|United Healthcare|GEHA|||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|United Healthcare|UNITED HEALTHCARE|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Medicare|MEDICARE ACUTE|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Texas Workforce Commission|DIS DETER SERV (DDS)|265.50||||||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|NON CONTRACTED|COMMERCIAL OTHER 1|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Access Direct Platinum|HEALTHFIRST TPA UMR|||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Aetna|AETNA OTHER|||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Aetna|BOON CHAPMAN|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Aetna|AETNA PPO|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Aenta Medicare Advantage|AETNA MEDICARE MA|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Blue Cross HMO Specialty|BCBSTX HMO|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Medicaid|MOLINA HEALTHCARE OF TEXAS|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Medicaid|LAW ENFORCEMENT OTHER|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|ChampVA|CHAMPVA CENTER|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Cigna|CIGNA|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Cigna|CIGNA OTHER|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Blue Cross PPO Specialty|BCBSTX OTHER|||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Blue Cross PPO Specialty|BCBSTX PPO|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Humana Medicare Advantage|HUMANA MA|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Managed Medicaid|MEDICAID AMERIGROUP|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|MTC Medical|VAN ZANDT COUNTY INMATE|||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|United Medicare Advantage|UHC MEDICARE GOLD MA|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Workers Compensation|TEXAS MUTUAL INSURANCE|||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Managed Medicaid|MEDICAID SUPERIOR|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Managed Medicaid|MEDICAID UNITED HEALTHCARE|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Managed Medicare|VAN ZANDT COUNTY INMATE|||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Managed Medicare|MA PART B ONLY IP|265.50||||||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Managed Medicare|HEALTHSPRING MA|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Managed Medicare|BCBS MEDICARE PPO MA|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Managed Medicare|WELLCARE CHOICE MA|265.50||||265.50||| J7030|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Managed Medicare|HOSPICE ETMC|265.50||||265.50||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|United Healthcare|GOLDEN RULE|||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|United Healthcare|UMR UNITED MEDICAL RESOURCES|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|United Healthcare|GEHA|||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Medicare|MEDICARE PART B ONLY IP|1.93||||||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Medicare|MEDICARE ACUTE|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|United Healthcare|UNITED HEALTHCARE|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Medicaid|MOLINA HEALTHCARE OF TEXAS|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|United Healthcare|TML GROUP BENEFITS|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Medicaid|MEDICAID HMO|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Medicaid|MEDICAID|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Medicaid|HENDERSON COUNTY INDIGENT|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|United Medicare Advantage|UHC MEDICARE GOLD MA|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|United Medicare Advantage|UHC AARP MCR HMO MA|||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Veterans Affairs|VETERANS ADMINISTRATION|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Managed Medicare|MA PART B ONLY IP|1.93||||||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Managed Medicare|VAN ZANDT COUNTY INMATE|1.93||||||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Managed Medicare|WELLCARE CHOICE MA|||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Managed Medicare|HEALTHSPRING MA|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Managed Medicare|BCBS MEDICARE PPO MA|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Humana Medicare Advantage|HUMANA MA|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Managed Medicaid|MEDICAID SUPERIOR|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Managed Medicaid|MEDICAID AMERIGROUP|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Blue Cross HMO Specialty|BCBSTX HMO|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|ChampVA|CHAMPVA CENTER|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Cigna|CIGNA|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Cigna|CIGNA|||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Blue Cross PPO Specialty|BCBSTX PPO|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|MTC Medical|VAN ZANDT COUNTY INMATE|1.93||||||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Access Direct Platinum|HEALTHFIRST TPA UMR|||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Aetna|AETNA OTHER|||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Aetna|AETNA PPO|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Aenta Medicare Advantage|AETNA MEDICARE MA|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Multiplan|NALC|||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Tricare|TRICARE EAST REGION|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|UTMB|UTMB CORRECTIONAL MANAGED CARE|1.93||||||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|NON CONTRACTED|COMMERCIAL OTHER 1|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|PHCS|MULTIPLAN PHCS OTHER|||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|PHCS|MULTIPLAN PHCS|||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|PHCS|HUMANA|||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|United Healthcare|UNITED HEALTHCARE OTHER|1.93||||1.93||| J7040|ERX|0250|SODIUM CHLORIDE 0.9% 500M|United Healthcare|UNITED HEALTHCARE|||||1.93||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|Veterans Affairs|VETERANS ADMINISTRATION|210.75||||210.75||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|210.75||||210.75||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|United Medicare Advantage|UHC MEDICARE GOLD MA|210.75||||210.75||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|210.75||||210.75||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|Medicaid|MEDICAID|210.75||||||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|Medicaid|HENDERSON COUNTY INDIGENT|210.75||||||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|Medicaid|COUNTY INDIGENT HEALTH OTHER|210.75||||||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|Tricare|TRICARE EAST REGION|210.75||||210.75||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|UTMB|UTMB CORRECTIONAL MANAGED CARE|210.75||||||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|NON CONTRACTED|COMMERCIAL OTHER 1|210.75||||210.75||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||210.75||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|United Healthcare|UNITED HEALTHCARE|210.75||||210.75||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|Medicare|MEDICARE ACUTE|210.75||||210.75||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||210.75||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|Medicaid|MOLINA HEALTHCARE OF TEXAS|210.75||||||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||210.75||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|Aetna|AETNA PPO|210.75||||||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|Aenta Medicare Advantage|AETNA MEDICARE MA|210.75||||210.75||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|210.75||||210.75||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|Medicaid|MEDICAID TEXAS CHILDRENS|||||210.75||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|Blue Cross HMO Specialty|BCBSTX HMO|210.75||||||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|Cigna|CIGNA|210.75||||||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|Cigna|CIGNA OTHER|210.75||||210.75||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|Cigna|CIGNA|||||210.75||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|Blue Cross PPO Specialty|BCBSTX PPO|210.75||||210.75||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|Humana Medicare Advantage|HUMANA MA|210.75||||210.75||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|Managed Medicaid|MEDICAID SUPERIOR|210.75||||210.75||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|210.75||||210.75||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|Managed Medicaid|MEDICAID AMERIGROUP|210.75||||210.75||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|210.75||||210.75||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|210.75||||210.75||| J7050|ERX|0250|SODIUM CHLORIDE 0.9% 250M|Managed Medicare|HEALTHSPRING MA|210.75||||210.75||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|Managed Medicare|HEALTHSPRING MA|1.93||||1.93||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|Managed Medicare|BCBS MEDICARE PPO MA|||||1.93||| J7060|ERX|0258|DEXTROSE 5%-WATER 500ML|Managed Medicaid|MEDICAID SUPERIOR|1.69||||1.69||| J7060|ERX|0258|DEXTROSE 5%-WATER 500ML|Managed Medicaid|MEDICAID AMERIGROUP|1.69||||1.69||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|Humana Medicare Advantage|HUMANA MA|1.93||||1.93||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|Managed Medicaid|MEDICAID SUPERIOR|||||1.93||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.93||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|Managed Medicaid|MEDICAID AMERIGROUP|1.93||||||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1.93||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|Cigna|CIGNA|||||1.93||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|Blue Cross PPO Specialty|BCBSTX PPO|||||1.93||| J7060|ERX|0258|DEXTROSE 5%-WATER 500ML|Blue Cross PPO Specialty|BCBSTX PPO|1.69||||1.69||| J7060|ERX|0258|DEXTROSE 5%-WATER 500ML|Humana Medicare Advantage|HUMANA MA|||||1.69||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.93||||1.93||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|Aetna|AETNA PPO|1.93||||||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.93||| J7060|ERX|0258|DEXTROSE 5%-WATER 500ML|Medicare|MEDICARE ACUTE|1.69||||1.69||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|United Healthcare|UNITED HEALTHCARE OTHER|||||1.93||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.93||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|Medicare|MEDICARE ACUTE|1.93||||1.93||| J7060|ERX|0258|DEXTROSE 5%-WATER 500ML|Medicaid|MEDICAID HMO|1.69||||||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.93||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.93||||1.93||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.93||||1.93||| J7060|ERX|0258|DEXTROSE 5%-WATER 500ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.69||||||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|Veterans Affairs|VETERANS ADMINISTRATION|||||1.93||| J7070|ERX|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Veterans Affairs|VETERANS ADMINISTRATION|1.03||||1.03||| J7070|ERX|0258|DEXTROSE 5%-WATER 1000ML|Veterans Affairs|VETERANS ADMINISTRATION|2.59||||244.50||| J7070|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|Veterans Affairs|VETERANS ADMINISTRATION|2.59||||2.59||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.59||||2.59||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.59||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|88.75||||2.59||| J7070|ERX|0250|DEX 5%-1/2NS KCL 20 MEQ 1|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.03||||1.03||| J7070|ERX|0250|DEX 5%-1/2NS KCL 20 MEQ 1|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.03||||1.03||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.59||||2.59||| J7070|ERX|0258|DEXTROSE 5%-WATER 1000ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.59||||244.50||| J7070|ERX|0258|DEXTROSE 5%-WATER 1000ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|244.50||||2.59||| J7070|ERX|0258|DEXTROSE 5%-LR 1000ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.59||||2.59||| J7070|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.59||||2.59||| J7070|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.59||||2.59||| J7070|ERX|0258|DEXTROSE 5%-WATER 1000ML|United Medicare Advantage|UHC AARP MCR HMO MA|244.50||||||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.59||| J7070|ERX|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Medicaid|MEDICAID|1.03||||1.03||| J7070|ERX|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Medicaid|HENDERSON COUNTY INDIGENT|||||1.03||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|Medicaid|MEDICAID|2.59||||2.59||| J7070|ERX|0258|DEXTROSE 5%-WATER 1000ML|Medicaid|MEDICAID|244.50||||2.59||| J7070|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.59||| J7070|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|2.59||||2.59||| J7070|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|Medicaid|MEDICAID|2.59||||2.59||| J7070|ERX|0250|DEX 5%-1/2NS KCL 40 MEQ 1|Tricare|TRICARE EAST REGION|1.03||||88.75||| J7070|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|Tricare|TRICARE EAST REGION|2.59||||2.59||| J7070|ERX|0258|DEXTROSE 5%-WATER 1000ML|Medicare|MEDICARE ACUTE|244.50||||244.50||| J7070|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|Medicare|MEDICARE ACUTE|2.59||||2.59||| J7070|ERX|0258|DEXTROSE 5%-WATER 1000ML|NON CONTRACTED|COMMERCIAL OTHER 1|244.50||||2.59||| J7070|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|NON CONTRACTED|COMMERCIAL OTHER 1|2.59||||2.59||| J7070|ERX|0258|DEXTROSE 5%-LR 1000ML|NON CONTRACTED|COMMERCIAL OTHER 1|2.59||||2.59||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|United Healthcare|UNITED HEALTHCARE|2.59||||||| J7070|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|United Healthcare|UNITED HEALTHCARE|||||2.59||| J7070|ERX|0258|DEXTROSE 5%-LR 1000ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|2.59||||||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|Medicare|MEDICARE ACUTE|88.75||||2.59||| J7070|ERX|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Medicare|MEDICARE PART B ONLY IP|1.03||||||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|Medicare|MEDICARE ACUTE|2.59||||2.59||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.59||| J7070|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.59||||||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|Aetna|BOON CHAPMAN|2.59||||||| J7070|ERX|0258|DEXTROSE 5%-LR 1000ML|Aetna|AETNA PPO|244.50||||2.59||| J7070|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|Aetna|AETNA OTHER|||||2.59||| J7070|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|Aetna|AETNA PPO|2.59||||2.59||| J7070|ERX|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Aenta Medicare Advantage|AETNA MEDICARE MA|1.03||||1.03||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|Aenta Medicare Advantage|AETNA MEDICARE MA|2.59||||1.03||| J7070|ERX|0258|DEXTROSE 5%-LR 1000ML|Aenta Medicare Advantage|AETNA MEDICARE MA|2.59||||||| J7070|ERX|0258|DEXTROSE 5%-WATER 1000ML|Aenta Medicare Advantage|AETNA MEDICARE MA|244.50||||||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|Aetna|AETNA PPO|||||2.59||| J7070|ERX|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.03||||1.03||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.59||||2.59||| J7070|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.59||||2.59||| J7070|ERX|0258|DEXTROSE 5%-LR 1000ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.59||||2.59||| J7070|ERX|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Medicare|MEDICARE ACUTE|1.03||||1.03||| J7070|ERX|0258|DEXTROSE 5%-WATER 1000ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|244.50||||244.50||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|Blue Cross HMO Specialty|BCBSTX HMO|2.59||||2.59||| J7070|ERX|0258|DEXTROSE 5%-LR 1000ML|Blue Cross HMO Specialty|BCBSTX HMO|2.59||||2.59||| J7070|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|Blue Cross HMO Specialty|BCBSTX HMO|2.59||||2.59||| J7070|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|United Healthcare|UNITED HEALTHCARE|2.59||||||| J7070|ERX|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Cigna|CIGNA|||||1.03||| J7070|ERX|0258|DEXTROSE 5%-LR 1000ML|Cigna|CIGNA|||||2.59||| J7070|ERX|0258|DEXTROSE 5%-LR 1000ML|Cigna|CIGNA|2.59||||2.59||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|Blue Cross PPO Specialty|BCBSTX PPO|2.59||||2.59||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|Blue Cross PPO Specialty|BCBSTX PPO|88.75||||2.59||| J7070|ERX|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Blue Cross PPO Specialty|BCBSTX PPO|1.03||||1.03||| J7070|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|Blue Cross PPO Specialty|BCBSTX PPO|2.59||||2.59||| J7070|ERX|0258|DEXTROSE 5%-LR 1000ML|Blue Cross PPO Specialty|BCBSTX PPO|2.59||||2.59||| J7070|ERX|0258|DEXTROSE 5%-LR 1000ML|Medicare|MEDICARE ACUTE|2.59||||2.59||| J7070|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|Medicaid|HENDERSON COUNTY INDIGENT|2.59||||||| J7070|ERX|0258|DEXTROSE 5%-WATER 1000ML|Blue Cross PPO Specialty|BCBSTX PPO|244.50||||2.59||| J7070|ERX|0250|DEX 5%-1/2NS KCL 40 MEQ 1|Humana Medicare Advantage|HUMANA MA|88.75||||88.75||| J7070|ERX|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Humana Medicare Advantage|HUMANA MA|1.03||||1.03||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|Humana Medicare Advantage|HUMANA MA|2.59||||2.59||| J7070|ERX|0258|DEXTROSE 5%-LR 1000ML|Medicaid|MEDICAID|2.59||||2.59||| J7070|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|Humana Medicare Advantage|HUMANA MA|2.59||||2.59||| J7070|ERX|0258|DEXTROSE 5%-WATER 1000ML|Humana Medicare Advantage|HUMANA MA|244.50||||244.50||| J7070|ERX|0258|DEXTROSE 5%-LR 1000ML|Humana Medicare Advantage|HUMANA MA|2.59||||2.59||| J7070|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.59||||2.59||| J7070|ERX|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.03||||1.03||| J7070|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|Managed Medicaid|MEDICAID AMERIGROUP|2.59||||2.59||| J7070|ERX|0258|DEXTROSE 5%-WATER 1000ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|244.50||||244.50||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.59||||1.03||| J7070|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|United Medicare Advantage|UHC MEDICARE GOLD MA|2.59||||2.59||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.59||||1.03||| J7070|ERX|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Managed Medicaid|MEDICAID AMERIGROUP|1.03||||1.03||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|Managed Medicaid|MEDICAID AMERIGROUP|2.59||||2.59||| J7070|ERX|0250|DEX 5%-1/2NS KCL 40 MEQ 1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|88.75||||1.03||| J7070|ERX|0258|DEXTROSE 5%-WATER 1000ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|244.50||||244.50||| J7070|ERX|0250|DEX 5%-1/2NS KCL 20 MEQ 1|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.03||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|2.59||||2.59||| J7070|ERX|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.03||||||| J7070|ERX|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Managed Medicare|HEALTHSPRING MA|2.59||||1.03||| J7070|ERX|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Managed Medicare|BCBS MEDICARE PPO MA|1.03||||||| J7070|ERX|0258|DEXTROSE 5%-WATER 1000ML|Managed Medicare|HEALTHSPRING MA|2.59||||244.50||| J7070|ERX|0258|DEXTROSE 5%-WATER 1000ML|Managed Medicare|BCBS MEDICARE PPO MA|2.59||||244.50||| J7070|ERX|0258|DEXTROSE 5%-LR 1000ML|Managed Medicare|WELLCARE CHOICE MA|2.59||||||| J7070|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|Managed Medicare|HEALTHSPRING MA|2.59||||2.59||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|Managed Medicaid|MEDICAID SUPERIOR|2.59||||2.59||| J7070|ERX|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.03||||1.03||| J7070|ERX|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Managed Medicaid|MEDICAID SUPERIOR|1.03||||1.03||| J7070|ERX|0258|DEXTROSE 5%-WATER 1000ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.59||||244.50||| J7070|ERX|0258|DEXTROSE 5%-WATER 1000ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.59||||244.50||| J7070|ERX|0258|DEXTROSE 5%-WATER 1000ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|244.50||||244.50||| J7070|ERX|0258|DEXTROSE 5%-LR 1000ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.59||||244.50||| J7070|ERX|0258|DEXTROSE 5%-LR 1000ML|Managed Medicaid|MEDICAID SUPERIOR|2.59||||2.59||| J7070|ERX|0258|DEXTROSE 5%-LR 1000ML|Managed Medicaid|MEDICAID AMERIGROUP|2.59||||2.59||| J7070|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|Managed Medicaid|MEDICAID SUPERIOR|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Managed Medicare|WELLCARE CHOICE MA|||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Managed Medicare|VAN ZANDT COUNTY INMATE|||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Managed Medicare|MA PART B ONLY IP|2.59||||||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Managed Medicare|HEALTHSPRING MA|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Managed Medicaid|MEDICAID SUPERIOR|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Managed Medicaid|MEDICAID AMERIGROUP|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Humana Medicare Advantage|HUMANA MA|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Blue Cross HMO Specialty|BCBSTX HMO|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|ChampVA|CHAMPVA CENTER|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Cigna|CIGNA OTHER|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Blue Cross PPO Specialty|BCBSTX PPO|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Access Direct Platinum|HEALTHFIRST TPA UMR|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Aetna|AETNA PPO|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Aetna|AETNA OTHER|||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Aenta Medicare Advantage|AETNA MEDICARE MA|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Multiplan|NALC|||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Cigna|CIGNA|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Tricare|TRICARE EAST REGION|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|NON CONTRACTED|COMMERCIAL OTHER 1|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|PHCS|MULTIPLAN PHCS OTHER|||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|PHCS|HUMANA|2.59||||||| J7120|ERX|0250|LACTATED RINGERS 1000ML|MTC Medical|VAN ZANDT COUNTY INMATE|||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|United Healthcare|UNITED HEALTHCARE|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|United Healthcare|TML GROUP BENEFITS|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|United Healthcare|UNITED HEALTHCARE OTHER|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|United Healthcare|GEHA|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Medicare|MEDICARE PART B ONLY IP|2.59||||||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Texas Workforce Commission|DIS DETER SERV (DDS)|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Medicare|MEDICARE ACUTE|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Managed Medicare|OTHER INSTITUTIONS|||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Medicaid|MEDICAID HMO|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Medicaid|MEDICAID|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Managed Medicare|BCBS MEDICARE PPO MA|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Medicaid|HENDERSON COUNTY INDIGENT|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|United Medicare Advantage|UHC MEDICARE GOLD MA|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|United Medicare Advantage|UHC AARP WELLMED HMO MA|||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|United Medicare Advantage|UHC AARP MCR HMO MA|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Veterans Affairs|VETERANS ADMINISTRATION|2.59||||2.59||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Veterans Affairs|VETERANS ADMINISTRATION|2.59||||||| J7682|ERX|0636|TOBRAMYCIN 300 MG/5 ML NE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|553.71||||||| J7682|ERX|0636|TOBRAMYCIN 300 MG/5 ML NE|Medicare|MEDICARE ACUTE|553.71||||||| L1830|EAP|0270||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.51||| L1830|EAP|0270||Blue Cross HMO Specialty|BCBSTX HMO|||||2.51||| L1830|EAP|0270||Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2.51||| L1830|EAP|0270||Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.51||| L1830|EAP|0270||Blue Cross PPO Specialty|BCBSTX PPO|||||2.51||| L1830|EAP|0270||Humana Medicare Advantage|HUMANA MA|||||2.51||| L1830|EAP|0270||Managed Medicaid|MEDICAID AMERIGROUP|||||2.51||| L1830|EAP|0270||Managed Medicare|HEALTHSPRING MA|||||2.51||| L1830|EAP|0270||Tricare|TRICARE EAST REGION|||||2.51||| L1830|EAP|0270||Tricare|TRICARE FOR LIFE|||||2.51||| L1830|EAP|0270||Medicare|MEDICARE ACUTE|||||2.51||| L1830|EAP|0270||United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.51||| L1830|EAP|0270||United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.51||| L3650|EAP|0270||United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.61||| L3650|EAP|0270||Medicare|MEDICARE ACUTE|||||1.61||| L3650|EAP|0270||Managed Medicare|HEALTHSPRING MA|||||1.61||| L3650|EAP|0270||Humana Medicare Advantage|HUMANA MA|||||1.61||| L3650|EAP|0270||Blue Cross HMO Specialty|BCBSTX HMO|||||1.61||| L3650|EAP|0270||Blue Cross PPO Specialty|BCBSTX PPO|||||1.61||| L3650|EAP|0270||Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.61||| L3650|EAP|0270||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.61||| P9012|EAP|0387|CRYOPRECIPITATE (BLOOD PR|Blue Cross PPO Specialty|BCBSTX PPO|133.75||||||| P9016|EAP|0381|LEUKOCYTE (LRBC)|Medicaid|HENDERSON COUNTY INDIGENT|959.25||||||| P9016|EAP|0381|LEUKOCYTE (LRBC)|Medicaid|MEDICAID|959.25||||959.25||| P9016|EAP|0381|LEUKOCYTE (LRBC)|Medicaid|MOLINA HEALTHCARE OF TEXAS|959.25||||||| P9016|EAP|0390|BLOOD PROCESSING CHG|Medicaid|MEDICAID|3.44||||3.44||| P9016|EAP|0390|BLOOD PROCESSING CHG|Medicaid|MEDICAID HMO|3.44||||||| P9016|EAP|0390|BLOOD PROCESSING CHG|Medicaid|MOLINA HEALTHCARE OF TEXAS|3.44||||||| P9016|EAP|0390|BLOOD PROCESSING CHG|Tricare|TRICARE EAST REGION|3.44||||||| P9016|EAP|0381|LEUKOCYTE (LRBC)|UTMB|UTMB CORRECTIONAL MANAGED CARE|959.25||||||| P9016|EAP|0390|BLOOD PROCESSING CHG|UTMB|UTMB CORRECTIONAL MANAGED CARE|3.44||||||| P9016|EAP|0381|LEUKOCYTE (LRBC)|Medicare|MEDICARE ACUTE|959.25||||959.25||| P9016|EAP|0390|BLOOD PROCESSING CHG|Medicare|MEDICARE ACUTE|3.44||||3.44||| P9016|EAP|0391||Medicare|MEDICARE ACUTE|||||1,356.76||| P9016|EAP|0381|LEUKOCYTE (LRBC)|NON CONTRACTED|COMMERCIAL OTHER 1|959.25||||||| P9016|EAP|0381|LEUKOCYTE (LRBC)|Veterans Affairs|VETERANS ADMINISTRATION|959.25||||959.25||| P9016|EAP|0390|BLOOD PROCESSING CHG|Veterans Affairs|VETERANS ADMINISTRATION|3.44||||3.44||| P9016|EAP|0381|LEUKOCYTE (LRBC)|United Healthcare|UNITED HEALTHCARE OTHER|||||959.25||| P9016|EAP|0381|LEUKOCYTE (LRBC)|United Healthcare|UNITED HEALTHCARE|||||959.25||| P9016|EAP|0381|LEUKOCYTE (LRBC)|United Healthcare|UMR UNITED MEDICAL RESOURCES|959.25||||||| P9016|EAP|0381|LEUKOCYTE (LRBC)|United Healthcare|TML GROUP BENEFITS|959.25||||||| P9016|EAP|0390|BLOOD PROCESSING CHG|United Healthcare|UNITED HEALTHCARE|3.44||||||| P9016|EAP|0390|BLOOD PROCESSING CHG|United Healthcare|UNITED HEALTHCARE|||||3.44||| P9016|EAP|0390|BLOOD PROCESSING CHG|United Healthcare|UMR UNITED MEDICAL RESOURCES|3.44||||||| P9016|EAP|0390|BLOOD PROCESSING CHG|United Healthcare|TML GROUP BENEFITS|3.44||||||| P9016|EAP|0381|LEUKOCYTE (LRBC)|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|959.25||||959.25||| P9016|EAP|0381|LEUKOCYTE (LRBC)|United Medicare Advantage|UHC MEDICARE GOLD MA|959.25||||959.25||| P9016|EAP|0381|LEUKOCYTE (LRBC)|United Medicare Advantage|UHC AARP MCR HMO MA|||||959.25||| P9016|EAP|0390|BLOOD PROCESSING CHG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3.44||||3.44||| P9016|EAP|0390|BLOOD PROCESSING CHG|United Medicare Advantage|UHC MEDICARE GOLD MA|3.44||||3.44||| P9016|EAP|0390|BLOOD PROCESSING CHG|United Medicare Advantage|UHC AARP MCR HMO MA|||||3.44||| P9016|EAP|0390|BLOOD PROCESSING CHG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3.44||||3.44||| P9016|EAP|0381|LEUKOCYTE (LRBC)|Cigna|CIGNA|959.25||||959.25||| P9016|EAP|0390|BLOOD PROCESSING CHG|Cigna|CIGNA|3.44||||3.44||| P9016|EAP|0381|LEUKOCYTE (LRBC)|Humana Medicare Advantage|HUMANA MA|959.25||||959.25||| P9016|EAP|0381|LEUKOCYTE (LRBC)|United Medicare Advantage|AARP UHC WEST COMPLETE MA|959.25||||959.25||| P9016|EAP|0390|BLOOD PROCESSING CHG|Humana Medicare Advantage|HUMANA MA|3.44||||3.44||| P9016|EAP|0381|LEUKOCYTE (LRBC)|Managed Medicaid|MEDICAID UNITED HEALTHCARE|959.25||||959.25||| P9016|EAP|0381|LEUKOCYTE (LRBC)|Managed Medicaid|MEDICAID SUPERIOR|959.25||||959.25||| P9016|EAP|0381|LEUKOCYTE (LRBC)|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|959.25||||959.25||| P9016|EAP|0381|LEUKOCYTE (LRBC)|Managed Medicaid|MEDICAID AMERIGROUP|959.25||||959.25||| P9016|EAP|0390|BLOOD PROCESSING CHG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.44||||3.44||| P9016|EAP|0390|BLOOD PROCESSING CHG|Managed Medicaid|MEDICAID SUPERIOR|3.44||||3.44||| P9016|EAP|0390|BLOOD PROCESSING CHG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|3.44||||3.44||| P9016|EAP|0390|BLOOD PROCESSING CHG|United Healthcare|UNITED HEALTHCARE OTHER|||||3.44||| P9016|EAP|0381|LEUKOCYTE (LRBC)|United Healthcare|UNITED HEALTHCARE|959.25||||||| P9016|EAP|0390|BLOOD PROCESSING CHG|Managed Medicaid|MEDICAID AMERIGROUP|3.44||||3.44||| P9016|EAP|0381|LEUKOCYTE (LRBC)|Managed Medicare|HOSPICE ETMC|||||959.25||| P9016|EAP|0381|LEUKOCYTE (LRBC)|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||959.25||| P9016|EAP|0381|LEUKOCYTE (LRBC)|Managed Medicare|HEALTHSPRING MA|959.25||||959.25||| P9016|EAP|0390|BLOOD PROCESSING CHG|NON CONTRACTED|COMMERCIAL OTHER 1|3.44||||||| P9016|EAP|0381|LEUKOCYTE (LRBC)|Managed Medicare|BCBS MEDICARE PPO MA|959.25||||||| P9016|EAP|0390|BLOOD PROCESSING CHG|Managed Medicare|HOSPICE ETMC|||||3.44||| P9016|EAP|0390|BLOOD PROCESSING CHG|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||3.44||| P9016|EAP|0390|BLOOD PROCESSING CHG|Managed Medicare|HEALTHSPRING MA|3.44||||3.44||| P9016|EAP|0390|BLOOD PROCESSING CHG|Managed Medicare|BCBS MEDICARE PPO MA|3.44||||||| P9016|EAP|0381|LEUKOCYTE (LRBC)|Aenta Medicare Advantage|AETNA MEDICARE MA|959.25||||959.25||| P9016|EAP|0390|BLOOD PROCESSING CHG|Aenta Medicare Advantage|AETNA MEDICARE MA|3.44||||3.44||| P9016|EAP|0381|LEUKOCYTE (LRBC)|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|959.25||||||| P9016|EAP|0381|LEUKOCYTE (LRBC)|Tricare|TRICARE EAST REGION|959.25||||||| P9016|EAP|0390|BLOOD PROCESSING CHG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|3.44||||||| P9016|EAP|0381|LEUKOCYTE (LRBC)|Aetna|AETNA OTHER|||||959.25||| P9016|EAP|0381|LEUKOCYTE (LRBC)|Aetna|AETNA PPO|959.25||||959.25||| P9016|EAP|0390|BLOOD PROCESSING CHG|Aetna|AETNA PPO|3.44||||3.44||| P9016|EAP|0390|BLOOD PROCESSING CHG|Medicaid|HENDERSON COUNTY INDIGENT|3.44||||||| P9016|EAP|0381|LEUKOCYTE (LRBC)|Medicaid|MEDICAID HMO|959.25||||||| P9016|EAP|0390|BLOOD PROCESSING CHG|Aetna|AETNA OTHER|||||3.44||| P9016|EAP|0381|LEUKOCYTE (LRBC)|Blue Cross PPO Specialty|BCBSTX PPO|959.25||||959.25||| P9016|EAP|0390|BLOOD PROCESSING CHG|Blue Cross PPO Specialty|BCBSTX PPO|3.44||||3.44||| P9016|EAP|0381|LEUKOCYTE (LRBC)|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||959.25||| P9016|EAP|0390|BLOOD PROCESSING CHG|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||3.44||| P9016|EAP|0381|LEUKOCYTE (LRBC)|ChampVA|CHAMPVA CENTER|959.25||||||| P9016|EAP|0390|BLOOD PROCESSING CHG|ChampVA|CHAMPVA CENTER|3.44||||||| P9016|EAP|0381|LEUKOCYTE (LRBC)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|959.25||||959.25||| P9016|EAP|0390|BLOOD PROCESSING CHG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.44||||3.44||| P9016|EAP|0381|LEUKOCYTE (LRBC)|Blue Cross HMO Specialty|BCBSTX HMO|959.25||||959.25||| P9016|EAP|0390|BLOOD PROCESSING CHG|Blue Cross HMO Specialty|BCBSTX HMO|3.44||||3.44||| P9017|EAP|0383||Humana Medicare Advantage|HUMANA MA|551.25||||551.25||| P9017|EAP|0383||United Medicare Advantage|UHC MEDICARE GOLD MA|||||551.25||| P9017|EAP|0383||Medicare|MEDICARE ACUTE|||||551.25||| P9034|EAP|0384|PLATELET PHERESIS|Medicaid|HENDERSON COUNTY INDIGENT|2,156.25||||||| P9034|EAP|0384|PLATELET PHERESIS|Medicare|MEDICARE ACUTE|2,156.25||||2,156.25||| P9034|EAP|0384|PLATELET PHERESIS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2,156.25||||2,156.25||| P9034|EAP|0384|PLATELET PHERESIS|Blue Cross PPO Specialty|BCBSTX PPO|2,156.25||||2,156.25||| P9034|EAP|0384|PLATELET PHERESIS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2,156.25||||2,156.25||| P9034|EAP|0384|PLATELET PHERESIS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2,156.25||||2,156.25||| P9034|EAP|0384|PLATELET PHERESIS|Managed Medicaid|MEDICAID SUPERIOR|2,156.25||||||| P9034|EAP|0384|PLATELET PHERESIS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2,156.25||||||| P9034|EAP|0384|PLATELET PHERESIS|Managed Medicare|HEALTHSPRING MA|2,156.25||||||| P9034|EAP|0384|PLATELET PHERESIS|Humana Medicare Advantage|HUMANA MA|2,156.25||||||| P9045|ERX|0250|ALBUMIN 5% 12.5 G 250ML|Humana Medicare Advantage|HUMANA MA|821.75||||||| P9045|ERX|0250|ALBUMIN 5% 12.5 G 250ML|Medicare|MEDICARE ACUTE|821.75||||821.75||| P9047|ERX|0636|ALBUMIN 25%, 25G/100ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1,155.63||||1,155.63||| P9047|ERX|0636|ALBUMIN 25%, 25G/100ML|United Medicare Advantage|UHC AARP MCR HMO MA|1,155.63||||||| P9047|ERX|0636|ALBUMIN 25%, 25G/100ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,155.63||||||| P9047|ERX|0636|ALBUMIN 25%, 25G/100ML|United Healthcare|UNITED HEALTHCARE|1,155.63||||||| P9047|ERX|0636|ALBUMIN 25%, 25G/100ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|1,155.63||||||| P9047|ERX|0636|ALBUMIN 25%, 25G/100ML|Medicaid|MEDICAID|1,155.63||||||| P9047|ERX|0636|ALBUMIN 25%, 25G/100ML|Managed Medicare|HEALTHSPRING MA|1,155.63||||1,155.63||| P9047|ERX|0636|ALBUMIN 25%, 25G/100ML|Managed Medicare|BCBS MEDICARE PPO MA|1,155.63||||||| P9047|ERX|0636|ALBUMIN 25%, 25G/100ML|United Medicare Advantage|UHC MEDICARE GOLD MA|1,155.63||||||| P9047|ERX|0636|ALBUMIN 25%, 25G/100ML|Medicare|MEDICARE ACUTE|1,155.63||||1,155.63||| P9047|ERX|0636|ALBUMIN 25%, 25G/100ML|Aenta Medicare Advantage|AETNA MEDICARE MA|1,155.63||||||| P9047|ERX|0636|ALBUMIN 25%, 25G/100ML|Aetna|AETNA PPO|1,155.63||||||| P9047|ERX|0636|ALBUMIN 25%, 25G/100ML|Blue Cross HMO Specialty|BCBSTX HMO|1,155.63||||||| P9047|ERX|0636|ALBUMIN 25%, 25G/100ML|Blue Cross PPO Specialty|BCBSTX PPO|1,155.63||||1,155.63||| P9047|ERX|0636|ALBUMIN 25%, 25G/100ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,155.63||||1,155.63||| P9047|ERX|0636|ALBUMIN 25%, 25G/100ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1,155.63||||||| P9047|ERX|0636|ALBUMIN 25%, 25G/100ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1,155.63||||||| P9047|ERX|0636|ALBUMIN 25%, 25G/100ML|Humana Medicare Advantage|HUMANA MA|1,155.63||||||| P9612|EAP|0278|CATH FOR URINE SPEC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.65||| P9612|EAP|0278|CATH FOR URINE SPEC|Managed Medicaid|MEDICAID SUPERIOR|||||0.65||| P9612|EAP|0278|CATH FOR URINE SPEC|Medicare|MEDICARE ACUTE|0.65||||0.65||| P9612|EAP|0278|CATH FOR URINE SPEC|United Healthcare|UNITED HEALTHCARE|||||0.65||| P9612|EAP|0278|CATH FOR URINE SPEC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.65||| Q2009|ERX|0636|FOSPHENYTOIN 500MG/10ML V|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1.16||| Q2009|ERX|0636|FOSPHENYTOIN 1000 MG/100|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.16||||2.25||| Q2009|ERX|0636|FOSPHENYTOIN 500MG/10ML V|United Healthcare|UNITED HEALTHCARE|||||1.16||| Q2009|ERX|0636|FOSPHENYTOIN 500 MG/100 M|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.16||||1.16||| Q2009|ERX|0636|FOSPHENYTOIN 500MG/10ML V|Medicare|MEDICARE ACUTE|1.16||||1.16||| Q2009|ERX|0636|FOSPHENYTOIN 100MG/2ML VI|Medicare|MEDICARE ACUTE|33.60||||1.16||| Q2009|ERX|0636|FOSPHENYTOIN 500MG/10ML V|Medicare|MEDICARE ACUTE|2.25||||1.16||| Q2009|ERX|0636|FOSPHENYTOIN 500MG/10ML V|Blue Cross PPO Specialty|BCBSTX PPO|||||1.16||| Q2009|ERX|0636|FOSPHENYTOIN 500MG/10ML V|Humana Medicare Advantage|HUMANA MA|||||1.16||| Q2009|ERX|0636|FOSPHENYTOIN 1000 MG/100|Humana Medicare Advantage|HUMANA MA|||||2.25||| Q2009|ERX|0636|FOSPHENYTOIN 500MG/10ML V|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.16||| Q2009|ERX|0636|FOSPHENYTOIN 500 MG/100 M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.16||| Q2009|ERX|0636|FOSPHENYTOIN 1000 MG/100|Managed Medicaid|MEDICAID SUPERIOR|||||2.25||| Q2009|ERX|0636|FOSPHENYTOIN 1000 MG/100|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.25||||||| Q2037|ERX|0636||Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.45||||0.45||| Q2037|ERX|0636||Managed Medicaid|MEDICAID SUPERIOR|0.45||||||| Q2037|ERX|0636||Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.45||||||| Q2037|ERX|0636||Cigna|CIGNA|0.45||||0.45||| Q2037|ERX|0636||Cigna|CIGNA OTHER|0.45||||||| Q2037|ERX|0636||Humana Medicare Advantage|HUMANA MA|0.45||||0.45||| Q2037|ERX|0636||Aetna|AETNA PPO|0.45||||0.45||| Q2037|ERX|0636||Blue Cross HMO Specialty|BCBSTX HMO|0.45||||0.45||| Q2037|ERX|0636||Blue Cross PPO Specialty|BCBSTX PPO|0.45||||0.45||| Q2037|ERX|0636||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.45||||0.45||| Q2037|ERX|0636||Tricare|TRICARE EAST REGION|0.45||||||| Q2037|ERX|0636||NON CONTRACTED|COMMERCIAL OTHER 1|0.45||||||| Q2037|ERX|0636||Medicare|MEDICARE ACUTE|0.45||||0.45||| Q2037|ERX|0636||Aenta Medicare Advantage|AETNA MEDICARE MA|0.45||||||| Q2037|ERX|0636||Managed Medicaid|MEDICAID AMERIGROUP|0.45||||||| Q2037|ERX|0636||Medicaid|MOLINA HEALTHCARE OF TEXAS|0.45||||||| Q2037|ERX|0636||Medicaid|MEDICAID HMO|0.45||||||| Q2037|ERX|0636||Medicaid|MEDICAID|0.45||||0.45||| Q2037|ERX|0636||Medicaid|HENDERSON COUNTY INDIGENT|0.45||||||| Q2037|ERX|0636||Managed Medicare|HENDERSON CNTY INMATE INDIGENT|0.45||||||| Q2037|ERX|0636||Managed Medicare|HEALTHSPRING MA|0.45||||0.45||| Q2037|ERX|0636||Managed Medicare|BCBS MEDICARE PPO MA|||||0.45||| Q2037|ERX|0636||United Healthcare|UNITED HEALTHCARE|0.45||||0.45||| Q2037|ERX|0636||Veterans Affairs|VETERANS ADMINISTRATION|0.45||||||| Q2037|ERX|0636||United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.45||||0.45||| Q2037|ERX|0636||United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.45||| Q2037|ERX|0636||United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.45||||0.45||| Q5104|ERX|0636|RENFLEXIS 100 MG VIAL|Medicare|MEDICARE ACUTE|||||286.28||| Q5106|ERX|0636|RETACRIT 40000 UNIT/1ML (|Humana Medicare Advantage|HUMANA MA|47.43||||47.43||| Q5106|ERX|0636|RETACRIT 10000 UNIT/1ML (|Humana Medicare Advantage|HUMANA MA|47.43||||47.43||| Q5106|ERX|0636|RETACRIT 40000 UNIT/1ML (|United Medicare Advantage|UHC MEDICARE GOLD MA|47.43||||||| Q5106|ERX|0636|RETACRIT 10000 UNIT/1ML (|United Medicare Advantage|AARP UHC WEST COMPLETE MA|47.43||||||| Q5106|ERX|0636|RETACRIT 10000 UNIT/1ML (|Managed Medicare|HEALTHSPRING MA|47.43||||||| Q5106|ERX|0636|RETACRIT 40000 UNIT/1ML (|Medicare|MEDICARE ACUTE|47.43||||||| Q5106|ERX|0636|RETACRIT 10000 UNIT/1ML (|Medicare|MEDICARE ACUTE|47.43||||||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Medicare|MEDICARE ACUTE|4.35||||4.35||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Texas Workforce Commission|DIS DETER SERV (DDS)|||||4.35||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Medicaid|MOLINA HEALTHCARE OF TEXAS|4.35||||||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Medicaid|HENDERSON COUNTY INDIGENT|||||4.35||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|4.35||||||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Managed Medicare|HEALTHSPRING MA|4.35||||4.35||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Managed Medicare|BCBS MEDICARE PPO MA|4.35||||||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.35||||||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|United Healthcare|TML GROUP BENEFITS|4.35||||||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Veterans Affairs|VETERANS ADMINISTRATION|4.35||||||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.35||||4.35||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|4.35||||4.35||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.35||||4.35||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Blue Cross HMO Specialty|BCBSTX HMO|||||4.35||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Medicaid|MEDICAID|4.35||||||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Medicare|MEDICARE PART B ONLY IP|4.35||||||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Blue Cross PPO Specialty|BCBSTX PPO|4.35||||4.35||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.35||||4.35||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|4.35||||4.35||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.35||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Aetna|AETNA PPO|4.35||||||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.35||||4.35||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Managed Medicaid|MEDICAID SUPERIOR|4.35||||4.35||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.35||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Humana Medicare Advantage|HUMANA MA|4.35||||4.35||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|Humana Medicare Advantage|HUMANA MA|2.75||||2.75||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.75||||378.13||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|Managed Medicare|WELLCARE CHOICE MA|2.75||||||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.75||||2.75||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|Managed Medicaid|MEDICAID SUPERIOR|2.75||||2.75||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|Managed Medicaid|MEDICAID AMERIGROUP|||||2.75||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||753.50||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.75||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|Aetna|AETNA PPO|||||2.75||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|Aenta Medicare Advantage|AETNA MEDICARE MA|2.75||||2.75||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.75||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|Blue Cross HMO Specialty|BCBSTX HMO|||||2.75||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|Cigna|CIGNA|||||2.75||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|Cigna|CIGNA OTHER|||||2.75||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|Managed Medicare|HEALTHSPRING MA|||||2.75||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|Blue Cross PPO Specialty|BCBSTX PPO|||||2.75||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|Veterans Affairs|VETERANS ADMINISTRATION|2.75||||2.75||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.75||||2.75||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|United Medicare Advantage|UHC MEDICARE GOLD MA|2.75||||2.75||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.75||||2.75||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2.75||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|Medicaid|MEDICAID|||||2.75||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|Medicare|MEDICARE ACUTE|2.75||||2.75||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.75||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|United Healthcare|UNITED HEALTHCARE|||||2.75||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.75||| Q9965|EAP|0255|ISOVUE 300% 150ML SYRINGE|United Healthcare|TML GROUP BENEFITS|||||753.50||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Multiplan|UNION PACIFIC RAILROAD|||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Medicare|MEDICARE PART B ONLY IP|2.75||||||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Tricare|TRICARE EAST REGION|499.75||||499.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Tricare|TRICARE FOR LIFE|||||499.75||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Tricare|TRICARE FOR LIFE|||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|UTMB|UTMB CORRECTIONAL MANAGED CARE|||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|NON CONTRACTED|COMMERCIAL OTHER 1|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|PHCS|HUMANA|||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|United Healthcare|ZZZZZ UNITED HEALTHCARE|||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|United Healthcare|UNITED HEALTHCARE|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|United Healthcare|UNITED HEALTHCARE|||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|United Healthcare|UMR UNITED MEDICAL RESOURCES|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|United Healthcare|TML GROUP BENEFITS|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|United Healthcare|GOLDEN RULE|||||251.25||| Q9967|EAP|0636|LOW OSM CONTRAST 370MG/ML|Medicare|MEDICARE ACUTE|0.01||||0.01||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Medicare|MEDICARE ACUTE|2.51||||2.51||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Texas Workforce Commission|DIS DETER SERV (DDS)|||||2.75||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.51||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Medicaid|MOLINA HEALTHCARE OF TEXAS|2.75||||||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.51||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Medicaid|MEDICAID|126.88||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Medicaid|MEDICAID HMO|||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Medicaid|MEDICAID|251.25||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Medicaid|COUNTY INDIGENT HEALTH OTHER|2.75||||||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Medicaid|LAW ENFORCEMENT OTHER|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Medicaid|HENDERSON COUNTY INDIGENT|499.75||||499.75||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|126.88||||126.88||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|||||2.75||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Managed Medicare|BCBS MEDICARE PPO MA|2.51||||||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|United Healthcare|UNITED HEALTHCARE OTHER|||||2.51||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|United Healthcare|UNITED HEALTHCARE|||||2.51||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|United Healthcare|UMR UNITED MEDICAL RESOURCES|2.75||||2.75||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|United Healthcare|TML GROUP BENEFITS|2.51||||||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|United Healthcare|GOLDEN RULE|||||2.51||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|United Medicare Advantage|UHC MEDICARE GOLD MA|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|United Medicare Advantage|UHC AARP MCR HMO MA|||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.75||||2.75||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Veterans Affairs|VETERANS ADMINISTRATION|2.51||||2.51||| Q9967|EAP|0636|LOW OSM CONTRAST 370MG/ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.01||||2.75||| Q9967|EAP|0636|LOW OSM CONTRAST 370MG/ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.01||||2.51||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.51||||2.75||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|United Medicare Advantage|UHC MEDICARE GOLD MA|2.51||||2.51||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|United Medicare Advantage|UHC AARP MCR HMO MA|||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Workers Compensation|UT EMPLOYEE INJURY|2.75||||||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Veterans Affairs|VETERANS ADMINISTRATION|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Veterans Affairs|VETERANS ADMINISTRATION|||||2.75||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Blue Cross HMO Specialty|BCBSTX HMO|||||2.51||| Q9967|EAP|0636|LOW OSM CONTRAST 370MG/ML|Blue Cross PPO Specialty|BCBSTX PPO|0.01||||2.51||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.51||||2.75||| Q9967|EAP|0636|LOW OSM CONTRAST 370MG/ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.01||||2.75||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Blue Cross PPO Specialty|BCBSTX PPO|2.51||||2.51||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Blue Cross HMO Specialty|BCBSTX HMO|2.75||||2.75||| Q9967|EAP|0636|LOW OSM CONTRAST 370MG/ML|Veterans Affairs|VETERANS ADMINISTRATION|0.01||||2.51||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|251.25||||2.75||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|ChampVA|CHAMPVA CENTER|||||2.75||| Q9967|EAP|0636|LOW OSM CONTRAST 370MG/ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.01||||2.51||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.51||||2.51||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Cigna|CIGNA|2.75||||2.75||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|United Healthcare|UNITED HEALTHCARE|||||126.88||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Cigna|CIGNA OTHER|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Cigna|CIGNA|499.75||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Blue Cross PPO Specialty|BCBSTX PPO|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.75||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Managed Medicare|HEALTHSPRING MA|2.75||||2.51||| Q9967|EAP|0636|LOW OSM CONTRAST 370MG/ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.01||||2.51||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Aenta Medicare Advantage|AETNA MEDICARE MA|126.88||||2.51||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Access Direct Platinum|HEALTHFIRST TPA UMR|||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Medicaid|MOLINA HEALTHCARE OF TEXAS|251.25||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Access Direct Platinum|HEALTHFIRST TPA TYLER ISD|||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|499.75||||499.75||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.75||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.51||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Access Direct Platinum|HEALTHFIRST TPA UMR|||||126.88||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.51||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Aetna|BOON CHAPMAN|2.75||||2.75||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Medicaid|MEDICAID HMO|2.51||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Aetna|AETNA PPO|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Aetna|AETNA OTHER|||||2.75||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Aetna|AETNA PPO|2.51||||126.88||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Aetna|AETNA OTHER|||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Aenta Medicare Advantage|AETNA MEDICARE MA|499.75||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Managed Medicaid|MEDICAID AMERIGROUP|251.25||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.75||||2.75||| Q9967|EAP|0636|LOW OSM CONTRAST 370MG/ML|Medicaid|HENDERSON COUNTY INDIGENT|2.51||||0.01||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|United Healthcare|UNITED HEALTHCARE OTHER|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Managed Medicaid|MEDICAID SUPERIOR|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Managed Medicare|VAN ZANDT COUNTY INMATE|2.75||||||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.75||||2.75||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.51||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Managed Medicare|MA PART B ONLY IP|2.75||||||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Managed Medicare|HEALTHSPRING MA|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Managed Medicare|BCBS MEDICARE PPO MA|2.75||||2.75||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Tricare|TRICARE EAST REGION|2.51||||2.51||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Medicare|MEDICARE ACUTE|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Managed Medicare|OTHER INSTITUTIONS|||||251.25||| Q9967|EAP|0636|LOW OSM CONTRAST 370MG/ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.01||||2.51||| Q9967|EAP|0636|LOW OSM CONTRAST 370MG/ML|Managed Medicaid|MEDICAID AMERIGROUP|0.01||||2.51||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Managed Medicaid|MEDICAID UNITED HEALTHCARE|126.88||||2.51||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Managed Medicaid|MEDICAID SUPERIOR|2.51||||2.51||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|126.88||||2.51||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Managed Medicaid|MEDICAID AMERIGROUP|2.51||||2.51||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|Humana Medicare Advantage|HUMANA MA|2.75||||2.75||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Cigna|CIGNA OTHER|2.51||||||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Cigna|CIGNA|||||2.51||| Q9967|EAP|0636|LOW OSM CONTRAST 370MG/ML|Humana Medicare Advantage|HUMANA MA|0.01||||2.51||| Q9967|EAP|0636|ISOVUE 300MG/ML 50ML PER|Humana Medicare Advantage|HUMANA MA|2.51||||2.51||| Q9967|EAP|0255|ISOVUE 300MG/ML 100ML PER|MTC Medical|VAN ZANDT COUNTY INMATE|2.75||||||| U0001|EAP|0300|COVID - 19PCR|Humana Medicare Advantage|HUMANA MA|1.80||||1.80||| U0001|EAP|0300|COVID - 19PCR|Managed Medicaid|MEDICAID SUPERIOR|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Managed Medicaid|MEDICAID AMERIGROUP|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Managed Medicare|HEALTHSPRING MA|1.80||||||| U0001|EAP|0300|COVID - 19PCR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.80||||1.80||| U0001|EAP|0300|COVID - 19PCR|Blue Cross PPO Specialty|BCBSTX PPO|1.80||||1.80||| U0001|EAP|0300|COVID - 19PCR|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Blue Cross HMO Specialty|BCBSTX HMO|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Cigna|CIGNA|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.80||||1.80||| U0001|EAP|0300|COVID - 19PCR|Veterans Affairs|VETERANS ADMINISTRATION|||||1.80||| U0001|EAP|0300|COVID - 19PCR|United Healthcare|UNITED HEALTHCARE|||||1.80||| U0001|EAP|0300|COVID - 19PCR|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.80||||1.80||| U0001|EAP|0300|COVID - 19PCR|United Medicare Advantage|UHC MEDICARE GOLD MA|1.80||||||| U0001|EAP|0300|COVID - 19PCR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.80||||1.80||| U0001|EAP|0300|COVID - 19PCR|Medicaid|MEDICAID|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Medicare|MEDICARE PART B ONLY IP|1.80||||||| U0001|EAP|0300|COVID - 19PCR|Medicare|MEDICARE ACUTE|1.80||||1.80||| U0001|EAP|0300|COVID - 19PCR|Tricare|TRICARE EAST REGION|||||1.80||| U0001|EAP|0300|COVID - 19PCR|NON CONTRACTED|COMMERCIAL OTHER 1|1.80||||1.80||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Medicare|MEDICARE ACUTE|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Tricare|TRICARE EAST REGION|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|NON CONTRACTED|COMMERCIAL OTHER 1|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Medicaid|MOLINA HEALTHCARE OF TEXAS|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Medicaid|MEDICAID PCCM|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Medicaid|MEDICAID|||||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|United Healthcare|UNITED HEALTHCARE|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|United Healthcare|UMR UNITED MEDICAL RESOURCES|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|United Healthcare|TML GROUP BENEFITS|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|United Medicare Advantage|UHC MEDICARE GOLD MA|1.54||||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|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Veterans Affairs|VETERANS ADMINISTRATION|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Workers Compensation|UT EMPLOYEE INJURY|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Blue Cross PPO Specialty|BCBSTX PPO|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Blue Cross PPO Specialty|BCBSTX OTHER|||||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|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|ChampVA|CHAMPVA CENTER|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Blue Cross HMO Specialty|BCBSTX HMO|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Cigna|CIGNA OTHER|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Medicaid|MEDICAID HMO|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Medicaid|HENDERSON COUNTY INDIGENT|1.54||||||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Cigna|CIGNA|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Aetna|AETNA PPO|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Aetna|AETNA OTHER|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Aenta Medicare Advantage|AETNA MEDICARE MA|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Managed Medicaid|MEDICAID SUPERIOR|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Managed Medicaid|MEDICAID AMERIGROUP|1.54||||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|Managed Medicare|HENDERSON CNTY INMATE INDIGENT|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Managed Medicare|HEALTHSPRING MA|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Managed Medicare|BCBS MEDICARE PPO MA|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Humana Medicare Advantage|HUMANA MA|1.54||||1.54|||