"Procedure"|"Code Type"|"Revenue Code"|"Procedure Description"|"Payer"|"Plan"|"Inpatient Gross Charges"|"Inpatient Expected Reimbursement"|"Inpatient Max Reimbursement"|"Inpatient Minimal Reimbursement"|"Outpatient Gross Charges"|"Outpatient Expected Reimbursement"|"Outpatient Max Reimbursement"|"Outpatient Minimal Reimbursement" 0042T|EAP|0350|CT PERFUSION W/CONTRAST C|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||27.26||| 0042T|EAP|0350|CT PERFUSION W/CONTRAST C|Aenta Medicare Advantage|AETNA MEDICARE MA|||||27.26||| 0042T|EAP|0350|CT PERFUSION W/CONTRAST C|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||27.26||| 0042T|EAP|0350|CT PERFUSION W/CONTRAST C|Medicaid|MEDICAID|||||27.26||| 0042T|EAP|0350|CT PERFUSION W/CONTRAST C|Blue Cross HMO Specialty|BCBSTX HMO|||||27.26||| 0042T|EAP|0350|CT PERFUSION W/CONTRAST C|Medicare|MEDICARE ACUTE|||||27.26||| 0042T|EAP|0350|CT PERFUSION W/CONTRAST C|United Medicare Advantage|UHC MEDICARE GOLD MA|||||27.26||| 0042T|EAP|0350|CT PERFUSION W/CONTRAST C|Humana Medicare Advantage|HUMANA MA|||||27.26||| 0042T|EAP|0350|CT PERFUSION W/CONTRAST C|NON CONTRACTED|COMMERCIAL OTHER 1|27.26||||27.26||| 0042T|EAP|0350|CT PERFUSION W/CONTRAST C|Blue Cross PPO Specialty|BCBSTX PPO|27.26||||27.26||| 0042T|EAP|0350|CT PERFUSION W/CONTRAST C|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||27.26||| 00840|EAP|0964|CRNA LAPAROSCOPIC PROCEDU|Managed Medicaid|MEDICAID SUPERIOR|||||1,037.75||| 00840|EAP|0964|CRNA LAPAROSCOPIC PROCEDU|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,037.75||| 00940|EAP|0964|CRNA VAGINAL PROCEDURES|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||522.25||| 00952|EAP|0964|CRNA HYSTEROSCOPY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||558.50||| 01991|EAP|0370|ANES DX/THER NRV BLK OTH/|United Healthcare|UNITED HEALTHCARE|14.30||||||| 01991|EAP|0370|ANES DX/THER NRV BLK OTH/|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|14.30||||||| 01991|EAP|0370|ANES DX/THER NRV BLK OTH/|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||14.30||| 01991|EAP|0370|ANES DX/THER NRV BLK OTH/|United Medicare Advantage|UHC MEDICARE GOLD MA|||||14.30||| 01991|EAP|0370|ANES DX/THER NRV BLK OTH/|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||14.30||| 01991|EAP|0370|ANES DX/THER NRV BLK OTH/|Cigna|CIGNA|||||14.30||| 100|DRG||SEIZURES W MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|19,651.50|8855.04|8855.04|8855.04|||| 10060|EAP|0450|I&D ABSCESS SIMP/SNGL|United Healthcare|UNITED HEALTHCARE OTHER|||||538.50||| 10060|EAP|0450|I&D ABSCESS SIMP/SNGL|Managed Medicaid|MEDICAID AMERIGROUP|||||538.50||| 10060|EAP|0450|I&D ABSCESS SIMP/SNGL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||538.50||| 10060|EAP|0450|I&D ABSCESS SIMP/SNGL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||538.50||| 10060|EAP|0450|I&D ABSCESS SIMP/SNGL|United Healthcare|UNITED HEALTHCARE|538.50||||||| 10060|EAP|0450|I&D ABSCESS SIMP/SNGL|Workers Compensation|WORKERS COMPENSATION OTHER|||||538.50||| 10060|EAP|0450|I&D ABSCESS SIMP/SNGL|Managed Medicaid|MEDICAID SUPERIOR|||||538.50||| 10060|EAP|0450|I&D ABSCESS SIMP/SNGL|Medicaid|MEDICAID|||||538.50||| 10060|EAP|0450|I&D ABSCESS SIMP/SNGL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||538.50||| 10060|EAP|0450|I&D ABSCESS SIMP/SNGL|Blue Cross PPO Specialty|BCBSTX PPO|||||538.50||| 10060|EAP|0450|I&D ABSCESS SIMP/SNGL|United Healthcare|UNITED HEALTHCARE|||||538.50||| 10060|EAP|0450|I&D ABSCESS SIMP/SNGL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||538.50||| 10060|EAP|0450|I&D ABSCESS SIMP/SNGL|Medicare|MEDICARE ACUTE|538.50||||538.50||| 10060|EAP|0450|I&D ABSCESS SIMP/SNGL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||538.50||| 10080|EAP|0450|I&D PILONIDAL CYST SIMPLE|Blue Cross PPO Specialty|BCBSTX PPO|||||428.50||| 10080|EAP|0450|I&D PILONIDAL CYST SIMPLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||428.50||| 10120|EAP|0450|REM FB SUBQ SIMPLE|Managed Medicaid|MEDICAID AMERIGROUP|||||7.00||| 10120|EAP|0450|REM FB SUBQ SIMPLE|NON CONTRACTED|COMMERCIAL OTHER 1|||||7.00||| 10120|EAP|0450|REM FB SUBQ SIMPLE|Medicaid|MEDICAID|||||7.00||| 10120|EAP|0450|REM FB SUBQ SIMPLE|Blue Cross PPO Specialty|BCBSTX PPO|||||7.00||| 10120|EAP|0450|REM FB SUBQ SIMPLE|Medicare|MEDICARE ACUTE|||||7.00||| 10140|EAP|0450|I&D HEMATOMA SEROMA FLUID|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2,568.75||| 10160|EAP|0450|ASP ABSCESS/HEMA/BUCCA/CY|Blue Cross PPO Specialty|BCBSTX PPO|||||4.15||| 103|DRG||HEADACHES W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|14,434.89|3932.79|3932.79|3932.79|||| 11730|EAP|0450|RMV NAIL PLATE SINGL/SIMP|Managed Medicaid|MEDICAID AMERIGROUP|||||4.61||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Veterans Affairs|VETERANS ADMINISTRATION|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Aetna|AETNA OTHER|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Workers Compensation|WORKERS COMPENSATION OTHER|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Blue Cross HMO Specialty|BCBSTX HMO|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Blue Cross PPO Specialty|BCBSTX PPO|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|United Healthcare|UNITED HEALTHCARE|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Managed Medicaid|MEDICAID AMERIGROUP|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|United Medicare Advantage|UHC MEDICARE GOLD MA|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Medicare|MEDICARE ACUTE|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Humana Medicare Advantage|HUMANA MA|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Managed Medicaid|MEDICAID SUPERIOR|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Cigna|CIGNA|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|United Healthcare|UNITED HEALTHCARE OTHER|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Medicaid|MEDICAID|||||366.50||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|NON CONTRACTED|COMMERCIAL OTHER 1|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Blue Cross PPO Specialty|BCBSTX PPO|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Cigna|CIGNA|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Managed Medicaid|MEDICAID SUPERIOR|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Humana Medicare Advantage|HUMANA MA|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Workers Compensation|WORKERS COMPENSATION OTHER|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Medicaid|MEDICAID|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|United Medicare Advantage|UHC MEDICARE GOLD MA|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Managed Medicaid|MEDICAID AMERIGROUP|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Aetna|AETNA PPO|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|NON CONTRACTED|COMMERCIAL OTHER 2|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Medicare|MEDICARE ACUTE|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|United Healthcare|UNITED HEALTHCARE|||||384.75||| 12004|EAP|0450|RPR LAC SIMPL 7.6-12.5CM|Medicare|MEDICARE ACUTE|||||4.26||| 12004|EAP|0450|RPR LAC SIMPL 7.6-12.5CM|Blue Cross PPO Specialty|BCBSTX OTHER|||||4.26||| 12004|EAP|0450|RPR LAC SIMPL 7.6-12.5CM|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.26||| 12004|EAP|0450|RPR LAC SIMPL 7.6-12.5CM|Medicaid|MEDICAID|||||4.26||| 12004|EAP|0450|RPR LAC SIMPL 7.6-12.5CM|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.26||| 12004|EAP|0450|RPR LAC SIMPL 7.6-12.5CM|Managed Medicaid|MEDICAID AMERIGROUP|||||4.26||| 12005|EAP|0450|RPR LAC SIMPL 12.6-20CM|Humana Medicare Advantage|HUMANA MA|||||474.50||| 12005|EAP|0450|RPR LAC SIMPL 12.6-20CM|United Medicare Advantage|UHC MEDICARE GOLD MA|||||474.50||| 12006|EAP|0450|RPR LAC SIMPL 20.1-30.0CM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||515.25||| 12006|EAP|0450|RPR LAC SIMPL 20.1-30.0CM|United Healthcare|UNITED HEALTHCARE|||||515.25||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|Blue Cross PPO Specialty|BCBSTX PPO|||||376.25||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||376.25||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||376.25||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|Cigna|CIGNA|||||376.25||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|Humana Medicare Advantage|HUMANA MA|||||376.25||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|Medicare|MEDICARE ACUTE|||||376.25||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|Managed Medicaid|MEDICAID SUPERIOR|||||376.25||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||376.25||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|Managed Medicaid|MEDICAID AMERIGROUP|||||376.25||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||376.25||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|United Healthcare|UNITED HEALTHCARE|||||376.25||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|Veterans Affairs|VETERANS ADMINISTRATION|||||376.25||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|Tricare|TRICARE EAST REGION|||||376.25||| 12013|EAP|0450|RPR LAC SIMPL FACE 2.6-5.|Blue Cross PPO Specialty|BCBSTX PPO|||||4.00||| 12013|EAP|0450|RPR LAC SIMPL FACE 2.6-5.|Managed Medicaid|MEDICAID SUPERIOR|||||4.00||| 12013|EAP|0450|RPR LAC SIMPL FACE 2.6-5.|Medicare|MEDICARE ACUTE|||||4.00||| 12013|EAP|0450|RPR LAC SIMPL FACE 2.6-5.|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.00||| 12013|EAP|0450|RPR LAC SIMPL FACE 2.6-5.|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4.00||| 12013|EAP|0450|RPR LAC SIMPL FACE 2.6-5.|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||4.00||| 12013|EAP|0450|RPR LAC SIMPL FACE 2.6-5.|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.00||| 12013|EAP|0450|RPR LAC SIMPL FACE 2.6-5.|Humana Medicare Advantage|HUMANA MA|||||4.00||| 12013|EAP|0450|RPR LAC SIMPL FACE 2.6-5.|Veterans Affairs|VETERANS ADMINISTRATION|||||4.00||| 12013|EAP|0450|RPR LAC SIMPL FACE 2.6-5.|Blue Cross PPO Specialty|BCBSTX OTHER|||||4.00||| 12014|EAP|0450|RPR LAC SIMPL FACE 5.1-7.|Medicare|MEDICARE ACUTE|||||418.50||| 12031|EAP|0450|RPR LAYER CLOSURE 2.5CM O|Workers Compensation|WORKERS COMPENSATION OTHER|||||7.17||| 12032|EAP|0450|RPR LAYER CLOSURE 2.6-7.5|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||6.94||| 12032|EAP|0450|RPR LAYER CLOSURE 2.6-7.5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||6.94||| 12032|EAP|0450|RPR LAYER CLOSURE 2.6-7.5|Blue Cross PPO Specialty|BCBSTX PPO|||||6.94||| 12032|EAP|0450|RPR LAYER CLOSURE 2.6-7.5|Workers Compensation|WORKERS COMPENSATION OTHER|||||6.94||| 12041|EAP|0450|RPR LAYER CLOSURE 2.5CM O|Blue Cross HMO Specialty|BCBSTX HMO|||||451.25||| 12041|EAP|0450|RPR LAYER CLOSURE 2.5CM O|Workers Compensation|WORKERS COMPENSATION OTHER|||||451.25||| 12041|EAP|0450|RPR LAYER CLOSURE 2.5CM O|Medicare|MEDICARE ACUTE|||||451.25||| 12041|EAP|0450|RPR LAYER CLOSURE 2.5CM O|Managed Medicaid|MEDICAID AMERIGROUP|||||451.25||| 12052|EAP|0450|RPR LAYER CLOS FACE 2.6-5|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||474.50||| 122|DRG||ACUTE MAJOR EYE INFECTIONS W/O CC/MCC|Cigna|CIGNA|8,520.30|31.5|31.5|31.5|||| 153|DRG||OTITIS MEDIA & URI W/O MCC|Medicare|MEDICARE ACUTE|15,471.43|4836.63|4836.63|1194.16|||| 153|DRG||OTITIS MEDIA & URI W/O MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|23,390.81|2536.86|4836.63|1194.16|||| 153|DRG||OTITIS MEDIA & URI W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|21,879.25|1194.16|4836.63|1194.16|||| 155|DRG||OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W CC|Medicare|MEDICARE ACUTE|14,606.25|6746.73|6746.73|6746.73|||| 156|DRG||OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W/O CC/MCC|Medicare|MEDICARE ACUTE|11,075.30|5798.5|5798.5|5798.5|||| 158|DRG||DENTAL & ORAL DISEASES W CC|Blue Cross HMO Specialty|BCBSTX HMO|20,019.35|3808.7|3808.7|3808.7|||| 159|DRG||DENTAL & ORAL DISEASES W/O CC/MCC|Medicare|MEDICARE ACUTE|16,287.75|8736.7|8736.7|8736.7|||| 16000|EAP|0450|TX BURN 1ST DEGREE|Blue Cross PPO Specialty|BCBSTX PPO|||||2.36||| 16000|EAP|0450|TX BURN 1ST DEGREE|Managed Medicaid|MEDICAID SUPERIOR|||||2.36||| 16000|EAP|0450|TX BURN 1ST DEGREE|Medicare|MEDICARE ACUTE|||||2.36||| 16000|EAP|0450|TX BURN 1ST DEGREE|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.36||| 16000|EAP|0450|TX BURN 1ST DEGREE|Humana Medicare Advantage|HUMANA MA|||||2.36||| 16000|EAP|0450|TX BURN 1ST DEGREE|Managed Medicaid|MEDICAID AMERIGROUP|||||2.36||| 16020|EAP|0450|DEBRIDE BURN PART THICK <|Managed Medicaid|MEDICAID AMERIGROUP|||||3.33||| 175|DRG||PULMONARY EMBOLISM W MCC OR ACUTE COR PULMONALE|Medicare|MEDICARE ACUTE|211.85|9618.7|9618.7|9618.7|||| 176|DRG||PULMONARY EMBOLISM W/O MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|76,168.55|21522.43|21522.43|21522.43|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|12,393.96|19.63|28593.54|19.63|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|NON CONTRACTED|COMMERCIAL OTHER 2|110.75|110.75|28593.54|19.63|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|26,015.38|98.15|28593.54|19.63|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|59,288.77|14951.8|28593.54|19.63|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|49,936.09|14951.8|28593.54|19.63|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Medicare|MEDICARE ACUTE|32,001.43|9711.3|28593.54|19.63|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Blue Cross PPO Specialty|BCBSTX PPO|31,830.19||||||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|61,679.15|28593.54|28593.54|19.63|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Cigna|CIGNA|29,618.69|6661.13|28593.54|19.63|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Blue Cross HMO Specialty|BCBSTX HMO|9,267.79|1124.99|28593.54|19.63|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|NON CONTRACTED|COMMERCIAL OTHER 1|7,614.13|6140.945|28593.54|19.63|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Humana Medicare Advantage|HUMANA MA|40,986.21|117.78|28593.54|19.63|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Managed Medicaid|MEDICAID SUPERIOR|15,763.75|3574.19|28593.54|19.63|||| 178|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W CC|Humana Medicare Advantage|HUMANA MA|29,057.22|7704.96|9618.7|7704.96|||| 178|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W CC|Medicare|MEDICARE ACUTE|26,145.50|9618.7|9618.7|7704.96|||| 180|DRG||RESPIRATORY NEOPLASMS W MCC|Medicare|MEDICARE ACUTE|32,664.84|107.88|15399.65|107.88|||| 180|DRG||RESPIRATORY NEOPLASMS W MCC|NON CONTRACTED|COMMERCIAL OTHER 1|15,399.65|15399.65|15399.65|107.88|||| 183|DRG||MAJOR CHEST TRAUMA W MCC|Medicare|MEDICARE ACUTE|27,543.26|58.89|58.89|58.89|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|58,696.53|196.13|7694.96|196.13|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Medicare|MEDICARE ACUTE|25,205.50|7694.96|7694.96|196.13|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|21,393.50|17149.25|17149.25|78.52|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Medicare|MEDICARE ACUTE|25,603.90|7722.24|17149.25|78.52|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Managed Medicare|HEALTHSPRING MA|28,396.54|78.52|17149.25|78.52|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Blue Cross PPO Specialty|BCBSTX PPO|19,882.50|5992.79|17149.25|78.52|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|15,214.25|7722.24|17149.25|78.52|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|21,797.05|14318.24|17149.25|78.52|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|25,020.40|4115.825|17149.25|78.52|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Humana Medicare Advantage|HUMANA MA|29,497.04|7770.1|17149.25|78.52|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|33,737.62|9644.7|17149.25|78.52|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|27,465.25|5771.22|17149.25|78.52|||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|Medicare|MEDICARE ACUTE|164.66|39.26|19973.69|39.26|||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|Humana Medicare Advantage|HUMANA MA|29,139.63|8671.91|19973.69|39.26|||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|43,773.88|19973.69|19973.69|39.26|||| 192|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC|Medicare|MEDICARE ACUTE|15,364.50|5798.5|11440.84|19.63|||| 192|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|5,669.71|19.63|11440.84|19.63|||| 192|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|104.61|3482.11|11440.84|19.63|||| 192|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|28,161.70|11440.84|11440.84|19.63|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Humana Medicare Advantage|HUMANA MA|26,370.10|6816.61|20688.25|4750.93|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Medicare|MEDICARE ACUTE|23,548.25|7722.68|20688.25|4750.93|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|210.97|6989.36|20688.25|4750.93|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|26,756.51|6804.98|20688.25|4750.93|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|305.68|20688.25|20688.25|4750.93|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Blue Cross PPO Specialty|BCBSTX PPO|24,885.50|6626.95|20688.25|4750.93|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Blue Cross HMO Specialty|BCBSTX HMO|23,775.75|4750.93|20688.25|4750.93|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|25,458.38|8183.97|20688.25|4750.93|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|30,653.74|12219.5|20688.25|4750.93|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|Medicare|MEDICARE ACUTE|16,980.25|5798.94|35185.2|5798.94|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|Aetna|AETNA OTHER|68,778.85|35185.2|35185.2|5798.94|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|Humana Medicare Advantage|HUMANA MA|24,926.50|9651.2|35185.2|5798.94|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|United Medicare Advantage|UHC MEDICARE GOLD MA|34,927.30|7694.96|35185.2|5798.94|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|13,160.29|3456.66|11640.59|1951.9|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|Medicare|MEDICARE ACUTE|4,789.25|1951.9|11640.59|1951.9|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|32,589.53|11640.59|11640.59|1951.9|||| 196|DRG||INTERSTITIAL LUNG DISEASE W MCC|Humana Medicare Advantage|HUMANA MA|74,324.75|21166.85|21166.85|15726.06|||| 196|DRG||INTERSTITIAL LUNG DISEASE W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|40,043.65|15726.06|21166.85|15726.06|||| 197|DRG||INTERSTITIAL LUNG DISEASE W CC|Medicare|MEDICARE ACUTE|18,588.05|5799.38|5799.38|5799.38|||| 199|DRG||PNEUMOTHORAX W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|17,774.30|1931.54|1931.54|1931.54|||| 202|DRG||BRONCHITIS & ASTHMA W CC/MCC|Managed Medicaid|MEDICAID AMERIGROUP|28,029.83|8549.16|8549.16|4021.75|||| 202|DRG||BRONCHITIS & ASTHMA W CC/MCC|Blue Cross HMO Specialty|BCBSTX HMO|186.09|4021.75|8549.16|4021.75|||| 202|DRG||BRONCHITIS & ASTHMA W CC/MCC|Managed Medicaid|MEDICAID SUPERIOR|20,262.75|8549.16|8549.16|4021.75|||| 206|DRG||OTHER RESPIRATORY SYSTEM DIAGNOSES W/O MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|24,661.84|3077.51|3077.51|3077.51|||| 20610|EAP|0450|ASP JOINT MAJOR|Medicare|MEDICARE ACUTE|||||6.57||| 20610|EAP|0450|ASP JOINT MAJOR|Humana Medicare Advantage|HUMANA MA|6.57||||6.57||| 208|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS|Humana Medicare Advantage|HUMANA MA|33,718.55|3861.88|3861.88|19.63|||| 208|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS|Medicare|MEDICARE ACUTE|20,794.75|19.63|3861.88|19.63|||| 23605|EAP|0450|TX FX PROX HUMERAL HD W M|Cigna|CIGNA|||||1,609.25||| 23650|EAP|0450|TX DISLOC SHLDR W MANIP W|Blue Cross HMO Specialty|BCBSTX HMO|||||5.71||| 23650|EAP|0450|TX DISLOC SHLDR W MANIP W|Blue Cross PPO Specialty|BCBSTX PPO|||||5.71||| 23650|EAP|0450|TX DISLOC SHLDR W MANIP W|Workers Compensation|WORKERS COMPENSATION OTHER|||||5.71||| 23650|EAP|0450|TX DISLOC SHLDR W MANIP W|Medicare|MEDICARE ACUTE|||||5.71||| 23650|EAP|0450|TX DISLOC SHLDR W MANIP W|Humana Medicare Advantage|HUMANA MA|||||5.71||| 23650|EAP|0450|TX DISLOC SHLDR W MANIP W|Managed Medicaid|MEDICAID SUPERIOR|||||5.71||| 24640|EAP|0450|TX RAD HD SUBLUX W MANIP|Managed Medicaid|MEDICAID SUPERIOR|||||3.86||| 24640|EAP|0450|TX RAD HD SUBLUX W MANIP|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3.86||| 24640|EAP|0450|TX RAD HD SUBLUX W MANIP|Managed Medicaid|MEDICAID AMERIGROUP|||||3.86||| 24640|EAP|0450|TX RAD HD SUBLUX W MANIP|Aetna|AETNA PPO|||||3.86||| 24640|EAP|0450|TX RAD HD SUBLUX W MANIP|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.86||| 25565|EAP|0450|TX FX RADIUS ULNA W MANIP|Managed Medicaid|MEDICAID SUPERIOR|||||665.50||| 264|DRG||OTHER CIRCULATORY SYSTEM O.R. PROCEDURES|Medicare|MEDICARE ACUTE|67,448.59|196.3|196.3|196.3|||| 26725|EAP|0450|TX FX FINGER EACH W MANIP|Aetna|AETNA PPO|||||563.75||| 26770|EAP|0450|TX DISLOC FINGER JT W MAN|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.27||| 26770|EAP|0450|TX DISLOC FINGER JT W MAN|Blue Cross PPO Specialty|BCBSTX PPO|||||4.27||| 27810|EAP|0450|TREATMENT OF ANKLE FRACTU|Blue Cross PPO Specialty|BCBSTX PPO|||||366.50||| 27818|EAP|0450|TREATMENT OF ANKLE FRACTU|Blue Cross PPO Specialty|BCBSTX PPO|||||3.93||| 27842|EAP|0450|CLSD TRMT ANKLE DISLOCATI|Humana Medicare Advantage|HUMANA MA|||||2,013.75||| 280|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC|Humana Medicare Advantage|HUMANA MA|27,314.20|58.89|58.89|58.89|||| 281|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC|Humana Medicare Advantage|HUMANA MA|31,197.84|7729.34|7729.34|7729.34|||| 28660|EAP|0450|CLSD TRMT INTERPHALANGEAL|United Healthcare|UNITED HEALTHCARE|||||424.25||| 288|DRG||ACUTE & SUBACUTE ENDOCARDITIS W MCC|Medicare|MEDICARE ACUTE|90,602.07|59457.3|59457.3|59457.3|||| 290|DRG||ACUTE & SUBACUTE ENDOCARDITIS W/O CC/MCC|Medicare|MEDICARE ACUTE|137,958.38|873.67|873.67|873.67|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|25,321.45|4795.01|21768.72|58.89|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|24,783.07|21768.72|21768.72|58.89|||| 291|DRG||HEART FAILURE & SHOCK W MCC|United Healthcare|UNITED HEALTHCARE|79,176.49|13445.89|21768.72|58.89|||| 291|DRG||HEART FAILURE & SHOCK W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|29,414.64|58.89|21768.72|58.89|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Humana Medicare Advantage|HUMANA MA|27,615.39|9693.84|21768.72|58.89|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Medicare|MEDICARE ACUTE|21,522.13|5798.94|21768.72|58.89|||| 29105|EAP|0450|APPLY LONG ARM SPLINT|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||307.50||| 29105|EAP|0450|APPLY LONG ARM SPLINT|United Healthcare|UNITED HEALTHCARE|||||307.50||| 29105|EAP|0450|APPLY LONG ARM SPLINT|Managed Medicaid|MEDICAID AMERIGROUP|||||307.50||| 29105|EAP|0450|APPLY LONG ARM SPLINT|Managed Medicaid|MEDICAID SUPERIOR|||||307.50||| 29105|EAP|0450|APPLY LONG ARM SPLINT|Aetna|AETNA OTHER|||||307.50||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Workers Compensation|WORKERS COMPENSATION OTHER|||||285.50||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Medicare|MEDICARE ACUTE|||||285.50||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Medicaid|MEDICAID TEXAS CHILDRENS|||||285.50||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|NON CONTRACTED|COMMERCIAL OTHER 1|||||285.50||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|United Healthcare|UNITED HEALTHCARE|||||285.50||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Managed Medicaid|MEDICAID AMERIGROUP|||||285.50||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Humana Medicare Advantage|HUMANA MA|||||285.50||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Medicaid|MEDICAID|||||285.50||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Blue Cross PPO Specialty|BCBSTX PPO|||||285.50||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Blue Cross HMO Specialty|BCBSTX HMO|||||285.50||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Managed Medicaid|MEDICAID SUPERIOR|||||285.50||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Cigna|CIGNA|||||285.50||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||285.50||| 292|DRG||HEART FAILURE & SHOCK W CC|Medicare|MEDICARE ACUTE|15,269.14|39.26|39.26|39.26|||| 292|DRG||HEART FAILURE & SHOCK W CC|Humana Medicare Advantage|HUMANA MA|11,858.26|39.26|39.26|39.26|||| 29505|EAP|0450|APPLY LONG LEG SPLINT|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||313.50||| 29505|EAP|0450|APPLY LONG LEG SPLINT|Medicare|MEDICARE ACUTE|||||313.50||| 29505|EAP|0450|APPLY LONG LEG SPLINT|Managed Medicaid|MEDICAID SUPERIOR|||||313.50||| 29515|EAP|0450|APPLY SPLINT LOWER LEG|Medicare|MEDICARE ACUTE|||||291.50||| 29515|EAP|0450|APPLY SPLINT LOWER LEG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||291.50||| 29515|EAP|0450|APPLY SPLINT LOWER LEG|Humana Medicare Advantage|HUMANA MA|||||291.50||| 29515|EAP|0450|APPLY SPLINT LOWER LEG|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||291.50||| 29515|EAP|0450|APPLY SPLINT LOWER LEG|NON CONTRACTED|COMMERCIAL OTHER 1|||||291.50||| 29515|EAP|0450|APPLY SPLINT LOWER LEG|Blue Cross PPO Specialty|BCBSTX PPO|||||291.50||| 29515|EAP|0450|APPLY SPLINT LOWER LEG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||291.50||| 29515|EAP|0450|APPLY SPLINT LOWER LEG|Managed Medicaid|MEDICAID SUPERIOR|||||291.50||| 29515|EAP|0450|APPLY SPLINT LOWER LEG|Medicaid|MEDICAID|||||291.50||| 299|DRG||PERIPHERAL VASCULAR DISORDERS W MCC|Medicare|MEDICARE ACUTE|32,242.11|58.89|58.89|58.89|||| 300|DRG||PERIPHERAL VASCULAR DISORDERS W CC|Medicare|MEDICARE ACUTE|26,757.76|13494.34|13494.34|13494.34|||| 301|DRG||PERIPHERAL VASCULAR DISORDERS W/O CC/MCC|Medicare|MEDICARE ACUTE|390.08|24462.76|24462.76|24462.76|||| 30300|EAP|0450|REM FB INTRANASAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||272.25||| 30300|EAP|0450|REM FB INTRANASAL|Managed Medicaid|MEDICAID AMERIGROUP|||||272.25||| 308|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC|Managed Medicaid|MEDICAID AMERIGROUP|53,681.34|8218.01|8218.01|4819.1|||| 308|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC|Humana Medicare Advantage|HUMANA MA|12,866.63|4819.1|8218.01|4819.1|||| 309|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC|Medicare|MEDICARE ACUTE|14,727.28|4837.07|7174.4|4837.07|||| 309|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC|NON CONTRACTED|COMMERCIAL OTHER 1|7,174.40|7174.4|7174.4|4837.07|||| 30901|EAP|0450|CONTROL NOSE BLEED ANT/SI|Blue Cross PPO Specialty|BCBSTX PPO|||||366.50||| 30901|EAP|0450|CONTROL NOSE BLEED ANT/SI|Humana Medicare Advantage|HUMANA MA|||||366.50||| 310|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC|Medicare|MEDICARE ACUTE|9,110.75|3875.64|3875.64|3875.64|||| 312|DRG||SYNCOPE & COLLAPSE|Medicare|MEDICARE ACUTE|9,662.38|2913.33|2913.33|2913.33|||| 314|DRG||OTHER CIRCULATORY SYSTEM DIAGNOSES W MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|34,421.44|21768.72|21768.72|1951.02|||| 314|DRG||OTHER CIRCULATORY SYSTEM DIAGNOSES W MCC|Medicare|MEDICARE ACUTE|3,646.50|1951.02|21768.72|1951.02|||| 315|DRG||OTHER CIRCULATORY SYSTEM DIAGNOSES W CC|Blue Cross PPO Specialty|BCBSTX PPO|17,662.25|4811.04|4811.04|4811.04|||| 31500|EAP|0450|INTUBATION EMERGENCY|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||7.15||| 31500|EAP|0450|INTUBATION EMERGENCY|United Medicare Advantage|UHC MEDICARE GOLD MA|||||7.15||| 31500|EAP|0450|INTUBATION EMERGENCY|Medicare|MEDICARE ACUTE|||||7.15||| 31500|EAP|0450|INTUBATION EMERGENCY|Blue Cross PPO Specialty|BCBSTX PPO|||||7.15||| 31500|EAP|0450|INTUBATION EMERGENCY|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||7.15||| 31500|EAP|0450|INTUBATION EMERGENCY|Humana Medicare Advantage|HUMANA MA|||||7.15||| 32551|EAP|0450|INSERTION OF CHEST TUBE|United Medicare Advantage|UHC MEDICARE GOLD MA|10.93||||||| 32551|EAP|0450|INSERTION OF CHEST TUBE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||10.93||| 330|DRG||MAJOR SMALL & LARGE BOWEL PROCEDURES W CC|Blue Cross PPO Specialty|BCBSTX PPO|36,122.40|3628.51|3628.51|3628.51|||| 331|DRG||MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|47,471.35|13493.68|13493.68|13493.68|||| 337|DRG||PERITONEAL ADHESIOLYSIS W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|43,679.40|9651.2|9651.2|9651.2|||| 339|DRG||APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC|United Healthcare|UNITED HEALTHCARE OTHER|37,372.55|17145.56|17145.56|13901.88|||| 339|DRG||APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC|Access Direct Platinum|HEALTHFIRST TPA UMR|42,943.90|13901.88|17145.56|13901.88|||| 342|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|27,905.72|22146.27|22146.27|13394.55|||| 342|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC|Tricare|TRICARE EAST REGION|39,315.58|13394.55|22146.27|13394.55|||| 343|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC|Medicaid|MEDICAID TEXAS CHILDRENS|48,482.80|9808.78|9808.78|5462.31|||| 343|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|26,729.90|5462.31|9808.78|5462.31|||| 343|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC|Tricare|TRICARE EAST REGION|25,282.85|8613.69|9808.78|5462.31|||| 343|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC|Medicaid|MEDICAID|32,127.10|9808.78|9808.78|5462.31|||| 345|DRG||MINOR SMALL & LARGE BOWEL PROCEDURES W CC|United Medicare Advantage|UHC MEDICARE GOLD MA|20,750.70|3863.08|3863.08|3863.08|||| 346|DRG||MINOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|19,582.60|6223.81|6223.81|6223.81|||| 36415|EAP|0300|VENIPUNCTURE|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||0.82||| 36415|EAP|0300|VENIPUNCTURE|United Healthcare|UNITED HEALTHCARE|0.82||||19.75||| 36415|EAP|0300|VENIPUNCTURE|United Healthcare|TML GROUP BENEFITS|||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Medicaid|MORRIS COUNTY INDIGENT|||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Medicaid|MEDICAID HMO|||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Medicaid|CAMP COUNTY INDIGENT|||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Medicare|MEDICARE ACUTE|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Medicaid|MEDICAID TEXAS CHILDRENS|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Multiplan|NALC|||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||19.75||| 36415|EAP|0300|VENIPUNCTURE|PHCS|MULTIPLAN PHCS|||||0.66||| 36415|EAP|0300|VENIPUNCTURE|United Healthcare|UNITED HEALTHCARE|0.66||||19.75||| 36415|EAP|0300|VENIPUNCTURE|United Healthcare|GEHA|||||0.66||| 36415|EAP|0300|VENIPUNCTURE|PHCS|HUMANA INSURANCE|||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Tricare|TRICARE EAST REGION|0.82||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Blue Cross HMO Specialty|BCBSTX HMO|0.82||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Medicaid|MEDICAID|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.66||| 36415|EAP|0300|VENIPUNCTURE|PHCS|GROUP AND PENSION|||||19.75||| 36415|EAP|0300|VENIPUNCTURE|PHCS|MERITAIN HEALTH|||||0.82||| 36415|EAP|0300|VENIPUNCTURE|United Healthcare|UNITED HEALTHCARE ERS|||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Tricare|TRICARE FOR LIFE|||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Medicaid|MEDICAID BCBSTX|||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||0.66||| 36415|EAP|0300|VENIPUNCTURE|United Healthcare|UNITED HEALTHCARE OTHER|0.66||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Veterans Affairs|VETERANS ADMINISTRATION|||||0.66||| 36415|EAP|0300|VENIPUNCTURE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||19.75||| 36415|EAP|0300|VENIPUNCTURE|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.66||| 36415|EAP|0300|VENIPUNCTURE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.66||||42.88||| 36415|EAP|0300|VENIPUNCTURE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.66||||0.66||| 36415|EAP|0300|DRUG SCREEN COLLECTION FE|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Veterans Affairs|VETERANS ADMINISTRATION|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Managed Medicaid|MEDICAID SUPERIOR|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.74||| 36415|EAP|0300|VENIPUNCTURE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|NON CONTRACTED|COMMERCIAL OTHER 1|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Managed Medicare|UPSHUR COUNTY SHERIFF DEPT|||||0.82||| 36415|EAP|0300|VENIPUNCTURE|Managed Medicare|BCBS MEDICARE PPO MA|||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Managed Medicaid|MEDICAID AMERIGROUP|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|NON CONTRACTED|ZZZZZ LIABILITY INS OTHER 1|||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Humana Medicare Advantage|HUMANA MA|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Medicare|MEDICARE PART B ONLY IP|0.66||||||| 36415|EAP|0300|VENIPUNCTURE|Blue Cross PPO Specialty|BCBSTX OTHER|||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.82||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Blue Cross PPO Specialty|BCBSTX PPO|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|0.82||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.82||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Aenta Medicare Advantage|AETNA MEDICARE MA|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Aetna|AETNA OTHER|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Managed Medicare|HEALTHSPRING MA|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.66||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Aetna|AETNA PPO|||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Access Direct Platinum|HEALTHFIRST TPA UMR|0.66||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Aetna|MAIL HANDLERS BENEFIT PLAN|||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Cigna|CIGNA|0.66||||0.66||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||669.75||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|United Healthcare|UNITED HEALTHCARE|||||5.15||| 36430|EAP|0450|BLOOD TRANSFUSION|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||923.50||| 36430|EAP|0450|BLOOD TRANSFUSION|Humana Medicare Advantage|HUMANA MA|||||923.50||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|Blue Cross PPO Specialty|BCBSTX PPO|669.75||||10.27||| 36430|EAP|0450|BLOOD TRANSFUSION|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||923.50||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|Aenta Medicare Advantage|AETNA MEDICARE MA|||||669.75||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|Blue Cross PPO Specialty|BCBSTX PPO|669.75||||669.75||| 36430|EAP|0450|BLOOD TRANSFUSION|Aenta Medicare Advantage|AETNA MEDICARE MA|||||923.50||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||669.75||| 36430|EAP|0450|BLOOD TRANSFUSION|Cigna|CIGNA|||||923.50||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|Cigna|CIGNA|||||669.75||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|Managed Medicaid|MEDICAID SUPERIOR|669.75||||669.75||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||669.75||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|669.75||||10.27||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|Humana Medicare Advantage|HUMANA MA|669.75||||669.75||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||669.75||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|United Medicare Advantage|UHC MEDICARE GOLD MA|669.75||||669.75||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|Managed Medicaid|MEDICAID AMERIGROUP|669.75||||669.75||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|Managed Medicare|HEALTHSPRING MA|669.75||||||| 36430|EAP|0450|BLOOD TRANSFUSION|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||923.50||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|669.75||||669.75||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|Medicare|MEDICARE ACUTE|669.75||||669.75||| 36430|EAP|0450|BLOOD TRANSFUSION|Veterans Affairs|VETERANS ADMINISTRATION|||||923.50||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|United Healthcare|UNITED HEALTHCARE|669.75||||10.27||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|NON CONTRACTED|COMMERCIAL OTHER 1|||||669.75||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|Medicare|MEDICARE ACUTE|669.75||||10.27||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||10.27||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|United Healthcare|UNITED HEALTHCARE|||||669.75||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|Tricare|TRICARE EAST REGION|||||669.75||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|Veterans Affairs|VETERANS ADMINISTRATION|||||669.75||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|Medicaid|MEDICAID|||||669.75||| 36430|EAP|0450|BLOOD TRANSFUSION|Medicare|MEDICARE ACUTE|||||923.50||| 36556|EAP|0450|INSERT NON TUNNEL CATH 5|Medicare|MEDICARE ACUTE|||||19.47||| 36556|EAP|0450|INSERT NON TUNNEL CATH 5|Medicaid|MEDICAID|||||19.47||| 36556|EAP|0450|INSERT NON TUNNEL CATH 5|United Medicare Advantage|UHC MEDICARE GOLD MA|||||19.47||| 36556|EAP|0450|INSERT NON TUNNEL CATH 5|Blue Cross PPO Specialty|BCBSTX PPO|||||19.47||| 36569|EAP|0760|INSERT PICC CATH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||29.35||| 36569|EAP|0760|INSERT PICC CATH|Medicare|MEDICARE ACUTE|||||29.35||| 36600|EAP|0300|ARTERIAL PUNCTURE|Managed Medicare|HEALTHSPRING MA|||||2.34||| 36600|EAP|0300|ARTERIAL PUNCTURE|Medicare|MEDICARE ACUTE|||||2.34||| 372|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC|Medicare|MEDICARE ACUTE|22,240.50|7722.24|7722.24|7722.24|||| 375|DRG||DIGESTIVE MALIGNANCY W CC|Medicare|MEDICARE ACUTE|25,282.18|13105.05|13105.05|13105.05|||| 378|DRG||G.I. HEMORRHAGE W CC|Medicare|MEDICARE ACUTE|16,443.40|1923.74|1923.74|1923.74|||| 381|DRG||COMPLICATED PEPTIC ULCER W CC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|46,605.60|9155.82|9155.82|9155.82|||| 389|DRG||G.I. OBSTRUCTION W CC|Blue Cross PPO Specialty|BCBSTX PPO|15,568.63|4243.83|4243.83|58.89|||| 389|DRG||G.I. OBSTRUCTION W CC|Humana Medicare Advantage|HUMANA MA|21,656.45|58.89|4243.83|58.89|||| 390|DRG||G.I. OBSTRUCTION W/O CC/MCC|Medicare|MEDICARE ACUTE|6,299.46|19.63|19.63|19.63|||| 391|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC|Medicare|MEDICARE ACUTE|12,421.55|3875.64|3875.64|3875.64|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|9,365.60|3873.48|11422.5|2692.25|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|15,164.09|2692.25|11422.5|2692.25|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Cigna|CIGNA|30,599.37|5039.62|11422.5|2692.25|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Medicare|MEDICARE ACUTE|9,608.65|3875.64|11422.5|2692.25|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|NON CONTRACTED|COMMERCIAL OTHER 1|32,268.37|11422.5|11422.5|2692.25|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|32,962.70|3801.93|11422.5|2692.25|||| 406|DRG||PANCREAS, LIVER & SHUNT PROCEDURES W CC|Medicare|MEDICARE ACUTE|60,204.14|78.52|78.52|78.52|||| 419|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|32,633.03|10877.6|10877.6|6870.5|||| 419|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC|Medicare|MEDICARE ACUTE|34,736.77|6870.5|10877.6|6870.5|||| 42700|EAP|0450|DRAINAGE OF TONSIL ABSESS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.19||| 432|DRG||CIRRHOSIS & ALCOHOLIC HEPATITIS W MCC|Medicare|MEDICARE ACUTE|61,653.14|176.67|176.67|176.67|||| 43220|EAP|0750|ESOPHAGOSCOPY BALLOON DIL|Medicaid|MEDICAID|||||1,951.50||| 43220|EAP|0750|ESOPHAGOSCOPY BALLOON DIL|Humana Medicare Advantage|HUMANA MA|||||2,536.95||| 43235|EAP|0750|EGD DIAGNOSTIC|Tricare|TRICARE FOR LIFE|||||1,951.50||| 43235|EAP|0750|EGD DIAGNOSTIC|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2,244.23||| 43235|EAP|0750|EGD DIAGNOSTIC|United Healthcare|UNITED HEALTHCARE|||||1,951.50||| 43235|EAP|0750|EGD DIAGNOSTIC|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1,951.50||| 43235|EAP|0750|EGD DIAGNOSTIC|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,951.50||| 43235|EAP|0750|EGD DIAGNOSTIC|Blue Cross HMO Specialty|BCBSTX HMO|||||1,951.50||| 43235|EAP|0750|EGD DIAGNOSTIC|Humana Medicare Advantage|HUMANA MA|||||1,951.50||| 43235|EAP|0750|EGD DIAGNOSTIC|Medicare|MEDICARE ACUTE|1,951.50||||1,951.50||| 43235|EAP|0750|EGD DIAGNOSTIC|Blue Cross PPO Specialty|BCBSTX PPO|||||1,951.50||| 43235|EAP|0750|EGD DIAGNOSTIC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,951.50||| 43235|EAP|0750|EGD DIAGNOSTIC|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2,244.23||| 43235|EAP|0750|EGD DIAGNOSTIC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,951.50||| 43235|EAP|0750|EGD DIAGNOSTIC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2,244.23||| 43239|EAP|0750|EGD BIOPSY|Managed Medicaid|MEDICAID AMERIGROUP|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1,951.50||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Blue Cross PPO Specialty|BCBSTX PPO|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Medicare|MEDICARE ACUTE|1,951.50||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Medicaid|MEDICAID TEXAS CHILDRENS|||||2,536.95||| 43239|EAP|0750|EGD BIOPSY|Aetna|AETNA PPO|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Cigna|CIGNA|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Managed Medicaid|MEDICAID SUPERIOR|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Humana Medicare Advantage|HUMANA MA|||||2,244.23||| 43239|EAP|0750|EGD BIOPSY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2,244.23||| 43239|EAP|0750|EGD BIOPSY|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Aetna|AETNA OTHER|||||2,536.95||| 43239|EAP|0750|EGD BIOPSY|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2,536.95||| 43239|EAP|0750|EGD BIOPSY|United Healthcare|UNITED HEALTHCARE|||||2,536.95||| 43239|EAP|0750|EGD BIOPSY|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Medicaid|MORRIS COUNTY INDIGENT|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Tricare|TRICARE EAST REGION|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2,536.95||| 43239|EAP|0750|EGD BIOPSY|United Healthcare|UNITED HEALTHCARE|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|United Healthcare|UNITED HEALTHCARE OTHER|||||2,244.23||| 43248|EAP|0750|EGD GUIDE WIRE INSERTION|NON CONTRACTED|COMMERCIAL OTHER 1|||||2,244.23||| 43248|EAP|0750|EGD GUIDE WIRE INSERTION|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1,951.50||| 43248|EAP|0750|EGD GUIDE WIRE INSERTION|United Healthcare|UNITED HEALTHCARE|||||1,951.50||| 43248|EAP|0750|EGD GUIDE WIRE INSERTION|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,951.50||| 43248|EAP|0750|EGD GUIDE WIRE INSERTION|Medicare|MEDICARE ACUTE|||||2,536.95||| 43248|EAP|0750|EGD GUIDE WIRE INSERTION|United Healthcare|UNITED HEALTHCARE|||||2,536.95||| 43248|EAP|0750|EGD GUIDE WIRE INSERTION|Medicaid|MORRIS COUNTY INDIGENT|||||1,951.50||| 43248|EAP|0750|EGD GUIDE WIRE INSERTION|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,951.50||| 43248|EAP|0750|EGD GUIDE WIRE INSERTION|Humana Medicare Advantage|HUMANA MA|||||1,951.50||| 43248|EAP|0750|EGD GUIDE WIRE INSERTION|Blue Cross PPO Specialty|BCBSTX PPO|||||2,536.95||| 43255|EAP|0750|EGD CONTROL BLEEDING ANY|Blue Cross PPO Specialty|BCBSTX PPO|||||1,951.50||| 433|DRG||CIRRHOSIS & ALCOHOLIC HEPATITIS W CC|Medicaid|MEDICAID|24,315.75|6255.12|6255.12|58.89|||| 433|DRG||CIRRHOSIS & ALCOHOLIC HEPATITIS W CC|Medicare|MEDICARE ACUTE|34,215.18|58.89|6255.12|58.89|||| 43450|EAP|0750|DILATION OF ESOPHAGUS|Blue Cross PPO Specialty|BCBSTX PPO|||||1,281.75||| 43450|EAP|0750|DILATION OF ESOPHAGUS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,281.75||| 435|DRG||MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W MCC|Humana Medicare Advantage|HUMANA MA|9,747.27|78.52|11262.61|78.52|||| 435|DRG||MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W MCC|NON CONTRACTED|COMMERCIAL OTHER 1|11,262.61|11262.61|11262.61|78.52|||| 43752|EAP|0450|PLCMNT TUBE NASO ORO GAST|Medicare|MEDICARE ACUTE|||||486.50||| 43752|EAP|0450|PLCMNT TUBE NASO ORO GAST|Blue Cross PPO Specialty|BCBSTX PPO|486.50||||||| 43762|EAP|0450|CHANGE GASTROSTOMY TUBE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||695.75||| 43762|EAP|0450|CHANGE GASTROSTOMY TUBE|Medicare|MEDICARE ACUTE|||||695.75||| 43762|EAP|0450|CHANGE GASTROSTOMY TUBE|Managed Medicaid|MEDICAID AMERIGROUP|||||695.75||| 438|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC|Medicare|MEDICARE ACUTE|23,323.93|58.89|58.89|58.89|||| 439|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC|Humana Medicare Advantage|HUMANA MA|19,031.03|5790.72|9119.7|1923.74|||| 439|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC|Tricare|TRICARE EAST REGION|31,425.90|9119.7|9119.7|1923.74|||| 439|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC|Medicare|MEDICARE PART B ONLY IP|6,154.75|1923.74|9119.7|1923.74|||| 441|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|52,717.75|13502.58|13502.58|39.26|||| 441|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|19,849.25|6619.06|13502.58|39.26|||| 441|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W MCC|Medicare|MEDICARE ACUTE|36,692.67|39.26|13502.58|39.26|||| 442|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W CC|United Medicare Advantage|UHC MEDICARE GOLD MA|29,952.80|15726.06|15726.06|3847.48|||| 442|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W CC|Medicare|MEDICARE ACUTE|10,875.25|3847.48|15726.06|3847.48|||| 45330|EAP|0750|SIGMOIDOSCOPY DIAGNOSTIC|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1,138.50||| 45330|EAP|0750|SIGMOIDOSCOPY DIAGNOSTIC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,138.50||| 45330|EAP|0750|SIGMOIDOSCOPY DIAGNOSTIC|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,326.32||| 45330|EAP|0750|SIGMOIDOSCOPY DIAGNOSTIC|Medicare|MEDICARE ACUTE|||||1,138.50||| 45330|EAP|0750|SIGMOIDOSCOPY DIAGNOSTIC|Blue Cross PPO Specialty|BCBSTX PPO|||||1,138.50||| 45330|EAP|0750|SIGMOIDOSCOPY DIAGNOSTIC|Humana Medicare Advantage|HUMANA MA|||||1,138.50||| 45331|EAP|0750|SIGMOIDOSCOPY W BIOPSY|Blue Cross PPO Specialty|BCBSTX PPO|||||1,138.50||| 45338|EAP|0750|SIGMOIDOSCOPY W TUMOR REM|Medicare|MEDICARE ACUTE|||||17.75||| 45338|EAP|0750|SIGMOIDOSCOPY W TUMOR REM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||17.75||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||20.72||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|Aenta Medicare Advantage|AETNA MEDICARE MA|||||20.72||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2,413.83||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|Blue Cross PPO Specialty|BCBSTX PPO|||||2,413.83||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|United Medicare Advantage|UHC MEDICARE GOLD MA|||||20.72||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|United Healthcare|UNITED HEALTHCARE|||||2,413.83||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|Medicare|MEDICARE ACUTE|||||2,413.83||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|Humana Medicare Advantage|HUMANA MA|||||2,413.83||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|Tricare|TRICARE EAST REGION|||||20.72||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2,413.83||| 45380|EAP|0750|COLONOSCOPY W BIOPSY|Cigna|CIGNA|||||20.72||| 45380|EAP|0750|COLONOSCOPY W BIOPSY|Medicare|MEDICARE ACUTE|||||20.72||| 45380|EAP|0750|COLONOSCOPY W BIOPSY|NON CONTRACTED|COMMERCIAL OTHER 1|||||20.72||| 45380|EAP|0750|COLONOSCOPY W BIOPSY|Tricare|TRICARE EAST REGION|||||20.72||| 45380|EAP|0750|COLONOSCOPY W BIOPSY|Blue Cross PPO Specialty|BCBSTX PPO|||||20.72||| 45384|EAP|0750|COLONOSCOPY W LESION REMO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||20.72||| 45384|EAP|0750|COLONOSCOPY W LESION REMO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||20.72||| 45384|EAP|0750|COLONOSCOPY W LESION REMO|Humana Medicare Advantage|HUMANA MA|||||2,413.83||| 45384|EAP|0750|COLONOSCOPY W LESION REMO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2,413.83||| 45384|EAP|0750|COLONOSCOPY W LESION REMO|NON CONTRACTED|COMMERCIAL OTHER 1|||||20.72||| 45384|EAP|0750|COLONOSCOPY W LESION REMO|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||20.72||| 45384|EAP|0750|COLONOSCOPY W LESION REMO|Medicare|MEDICARE ACUTE|||||20.72||| 45384|EAP|0750|COLONOSCOPY W LESION REMO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2,413.83||| 45384|EAP|0750|COLONOSCOPY W LESION REMO|United Healthcare|UNITED HEALTHCARE|||||2,413.83||| 45384|EAP|0750|COLONOSCOPY W LESION REMO|Blue Cross PPO Specialty|BCBSTX PPO|||||20.72||| 45384|EAP|0750|COLONOSCOPY W LESION REMO|Tricare|TRICARE EAST REGION|||||20.72||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|Medicare|MEDICARE ACUTE|||||20.72||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|NON CONTRACTED|COMMERCIAL OTHER 1|||||20.72||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||20.72||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||20.72||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||20.72||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|Managed Medicaid|MEDICAID SUPERIOR|||||2,413.83||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||20.72||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|Humana Medicare Advantage|HUMANA MA|||||20.72||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|Aetna|AETNA PPO|||||20.72||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||20.72||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2,242.92||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||20.72||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|United Healthcare|UNITED HEALTHCARE|||||2,242.92||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|Blue Cross HMO Specialty|BCBSTX HMO|||||20.72||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||20.72||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|Blue Cross PPO Specialty|BCBSTX PPO|||||20.72||| 46040|EAP|0450|I&D PERIRECTAL ABSCESS|Blue Cross PPO Specialty|BCBSTX PPO|||||17.00||| 463|DRG||WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W MCC|Medicare|MEDICARE ACUTE|172,055.75|97878.32|97878.32|97878.32|||| 49082|EAP|0450|ABDOMINAL PARACENTESIS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||9.68||| 49082|EAP|0450|ABDOMINAL PARACENTESIS|Humana Medicare Advantage|HUMANA MA|||||9.68||| 51600|EAP|0320|XR INJ VOIDING CYSTOGRAM|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4.10||| 51700|EAP|0450|IRRIGATION OF BLADDER|Managed Medicare|HEALTHSPRING MA|||||376.25||| 51701|EAP|0450|INSERT BLADDER CATH STRAI|Medicare|MEDICARE ACUTE|212.75||||212.75||| 51701|EAP|0450|INSERT BLADDER CATH STRAI|Medicaid|MEDICAID|212.75||||||| 51701|EAP|0450|INSERT BLADDER CATH STRAI|NON CONTRACTED|COMMERCIAL OTHER 1|212.75||||||| 51701|EAP|0450|INSERT BLADDER CATH STRAI|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||212.75||| 51701|EAP|0450|INSERT BLADDER CATH STRAI|Humana Medicare Advantage|HUMANA MA|212.75||||212.75||| 51701|EAP|0450|INSERT BLADDER CATH STRAI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|212.75||||212.75||| 51701|EAP|0450|INSERT BLADDER CATH STRAI|Managed Medicaid|MEDICAID SUPERIOR|||||212.75||| 51701|EAP|0450|INSERT BLADDER CATH STRAI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||212.75||| 51701|EAP|0450|INSERT BLADDER CATH STRAI|Aetna|AETNA OTHER|||||212.75||| 51701|EAP|0450|INSERT BLADDER CATH STRAI|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||212.75||| 51701|EAP|0450|INSERT BLADDER CATH STRAI|United Medicare Advantage|UHC MEDICARE GOLD MA|||||212.75||| 51701|EAP|0450|INSERT BLADDER CATH STRAI|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||212.75||| 51701|EAP|0450|INSERT BLADDER CATH STRAI|Managed Medicaid|MEDICAID AMERIGROUP|||||212.75||| 51702|EAP|0450|INSERT FOLEY SIMPL|Cigna|CIGNA|||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|Blue Cross PPO Specialty|BCBSTX PPO|||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|Humana Medicare Advantage|HUMANA MA|277.25||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|Managed Medicare|HEALTHSPRING MA|||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|277.25||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|277.25||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|Access Direct Platinum|HEALTHFIRST TPA UMR|||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|Veterans Affairs|VETERANS ADMINISTRATION|||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|277.25||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|Medicare|MEDICARE ACUTE|277.25||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|Medicaid|MEDICAID|||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|United Healthcare|UNITED HEALTHCARE|||||277.25||| 536|DRG||FRACTURES OF HIP & PELVIS W/O MCC|Medicare|MEDICARE ACUTE|23,973.25|9646.86|9646.86|9646.86|||| 539|DRG||OSTEOMYELITIS W MCC|Medicare|MEDICARE ACUTE|51,561.42|18025.01|18025.01|18025.01|||| 540|DRG||OSTEOMYELITIS W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|47,205.38|47082.62|47082.62|47082.62|||| 543|DRG||PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W CC|Medicare|MEDICARE ACUTE|14,194.08|39.26|39.26|39.26|||| 546|DRG||CONNECTIVE TISSUE DISORDERS W CC|United Medicare Advantage|UHC MEDICARE GOLD MA|27,247.25|5794.62|13978.72|5794.62|||| 546|DRG||CONNECTIVE TISSUE DISORDERS W CC|Medicare|MEDICARE ACUTE|20,495.75|13978.72|13978.72|5794.62|||| 550|DRG||SEPTIC ARTHRITIS W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|9,135.50|7694.96|7694.96|7694.96|||| 55100|EAP|0450|DRAINAGE OF SCROTAL TESTI|Medicare|MEDICARE ACUTE|||||1,083.53||| 552|DRG||MEDICAL BACK PROBLEMS W/O MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|22,378.88|14331.52|14331.52|3874.76|||| 552|DRG||MEDICAL BACK PROBLEMS W/O MCC|Medicare|MEDICARE ACUTE|117.96|3874.76|14331.52|3874.76|||| 553|DRG||BONE DISEASES & ARTHROPATHIES W MCC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|116,909.59|10729.11|10729.11|10729.11|||| 558|DRG||TENDONITIS, MYOSITIS & BURSITIS W/O MCC|United Healthcare|UNITED HEALTHCARE|25,465.82|8606.25|8606.25|74.02|||| 558|DRG||TENDONITIS, MYOSITIS & BURSITIS W/O MCC|Medicare|MEDICARE ACUTE|17,640.45|74.02|8606.25|74.02|||| 558|DRG||TENDONITIS, MYOSITIS & BURSITIS W/O MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|13,731.38|3077.51|8606.25|74.02|||| 559|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|27,807.80|12231.38|12231.38|71.32|||| 559|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC|Medicare|MEDICARE ACUTE|22,459.18|71.32|12231.38|71.32|||| 56|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC|Medicare|MEDICARE ACUTE|18,762.50|5799.38|5799.38|5799.38|||| 560|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC|Medicare|MEDICARE ACUTE|34,330.14|231.79|231.79|231.79|||| 561|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC|Medicare|MEDICARE ACUTE|32,056.85|20272.71|20272.71|20272.71|||| 563|DRG||FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W/O MCC|Medicare|MEDICARE ACUTE|24,257.97|58.89|58.89|58.89|||| 56405|EAP|0450|I&D ABSCESS VULVA PERINEA|Medicare|MEDICARE ACUTE|||||741.75||| 56420|EAP|0450|I&D BARTHOLINS GLAND|Blue Cross PPO Specialty|BCBSTX PPO|||||469.50||| 56420|EAP|0450|I&D BARTHOLINS GLAND|Tricare|TRICARE EAST REGION|||||469.50||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|Humana Medicare Advantage|HUMANA MA|2,504.75|19.63|117.78|19.63|||| 57|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC|Medicare|MEDICARE ACUTE|33,888.48|117.78|117.78|19.63|||| 571|DRG||SKIN DEBRIDEMENT W CC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|52,113.52|15004.92|15004.92|15004.92|||| 580|DRG||OTHER SKIN, SUBCUT TISS & BREAST PROC W CC|NON CONTRACTED|COMMERCIAL OTHER 1|39,230.80|8427.41|8833.5|8427.41|||| 580|DRG||OTHER SKIN, SUBCUT TISS & BREAST PROC W CC|Medicare|MEDICARE ACUTE|40,624.53|8833.5|8833.5|8427.41|||| 593|DRG||SKIN ULCERS W CC|Humana Medicare Advantage|HUMANA MA|13,111.75|3849.45|3849.45|3849.45|||| 602|DRG||CELLULITIS W MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|61,340.33|13199.34|13199.34|13199.34|||| 603|DRG||CELLULITIS W/O MCC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|15,873.56|58.89|20309.75|31.5|||| 603|DRG||CELLULITIS W/O MCC|NON CONTRACTED|COMMERCIAL OTHER 1|20,309.75|20309.75|20309.75|31.5|||| 603|DRG||CELLULITIS W/O MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|42,043.26|117.78|20309.75|31.5|||| 603|DRG||CELLULITIS W/O MCC|United Healthcare|UNITED HEALTHCARE|16,407.99|8427.41|20309.75|31.5|||| 603|DRG||CELLULITIS W/O MCC|Medicare|MEDICARE ACUTE|15,002.03|58.89|20309.75|31.5|||| 603|DRG||CELLULITIS W/O MCC|Cigna|CIGNA|215.24|31.5|20309.75|31.5|||| 603|DRG||CELLULITIS W/O MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|110.78|3021.2|20309.75|31.5|||| 603|DRG||CELLULITIS W/O MCC|Humana Medicare Advantage|HUMANA MA|16,509.55|4848.61|20309.75|31.5|||| 603|DRG||CELLULITIS W/O MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|31,004.70|13199.34|20309.75|31.5|||| 603|DRG||CELLULITIS W/O MCC|Managed Medicaid|MEDICAID SUPERIOR|22,874.59|7963.96|20309.75|31.5|||| 603|DRG||CELLULITIS W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|22,721.25|4075.49|20309.75|31.5|||| 62270|EAP|0450|SPINAL TAP DX|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|758.75||||||| 62270|EAP|0450|SPINAL TAP DX|NON CONTRACTED|COMMERCIAL OTHER 1|||||758.75||| 62270|EAP|0450|SPINAL TAP DX|United Healthcare|UNITED HEALTHCARE|||||758.75||| 62270|EAP|0450|SPINAL TAP DX|Managed Medicaid|MEDICAID SUPERIOR|||||758.75||| 638|DRG||DIABETES W CC|Blue Cross PPO Specialty|BCBSTX PPO|34,359.14|4389.78|8430.615|39.26|||| 638|DRG||DIABETES W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|22,105.30|8430.615|8430.615|39.26|||| 638|DRG||DIABETES W CC|Medicaid|MEDICAID|26,645.30|7067.72|8430.615|39.26|||| 638|DRG||DIABETES W CC|Medicare|MEDICARE ACUTE|22,856.78|5863.38|8430.615|39.26|||| 638|DRG||DIABETES W CC|Humana Medicare Advantage|HUMANA MA|12,512.88|39.26|8430.615|39.26|||| 639|DRG||DIABETES W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|28,640.30|3180.35|11237.67|19.63|||| 639|DRG||DIABETES W/O CC/MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|14,255.02|11237.67|11237.67|19.63|||| 639|DRG||DIABETES W/O CC/MCC|Tricare|TRICARE EAST REGION|16,081.50|19.63|11237.67|19.63|||| 639|DRG||DIABETES W/O CC/MCC|Medicaid|MEDICAID|37,255.41|7067.72|11237.67|19.63|||| 640|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W MCC|Humana Medicare Advantage|HUMANA MA|19,627.30|7720.96|7720.96|6989.36|||| 640|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W MCC|Medicare|MEDICARE ACUTE|11,024.25|6989.36|7720.96|6989.36|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Humana Medicare Advantage|HUMANA MA|21,156.55|6870.5|14422.68|3784.31|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|44,556.45|14422.68|14422.68|3784.31|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|16,455.22|3784.31|14422.68|3784.31|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Medicare|MEDICARE ACUTE|10,996.90|3874.76|14422.68|3784.31|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Managed Medicaid|MEDICAID SUPERIOR|24,055.56|9138.65|14422.68|3784.31|||| 644|DRG||ENDOCRINE DISORDERS W CC|Medicare|MEDICARE ACUTE|21,675.50|7722.24|7722.24|137.41|||| 644|DRG||ENDOCRINE DISORDERS W CC|Humana Medicare Advantage|HUMANA MA|35,573.36|137.41|7722.24|137.41|||| 64400|EAP|0450|NJX AA&/STRD TRIGEMINAL N|Blue Cross PPO Specialty|BCBSTX PPO|||||7.07||| 64400|EAP|0450|NJX AA&/STRD TRIGEMINAL N|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||7.07||| 64400|EAP|0450|NJX AA&/STRD TRIGEMINAL N|Medicare|MEDICARE ACUTE|||||7.07||| 64447|EAP|0370|INJ ANES AGENT FEMORAL NE|United Healthcare|UNITED HEALTHCARE|21.43||||||| 64486|EAP|0370|TAP BLOCK UNILATERAL BY I|Cigna|CIGNA|||||77.07||| 64486|EAP|0360||Humana Medicare Advantage|HUMANA MA|77.07||||||| 64486|EAP|0360||Managed Medicaid|MEDICAID SUPERIOR|||||77.07||| 64486|EAP|0360||Blue Cross HMO Specialty|BCBSTX HMO|||||77.07||| 64486|EAP|0370|TAP BLOCK UNILATERAL BY I|Blue Cross PPO Specialty|BCBSTX PPO|||||77.07||| 64486|EAP|0360||Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|77.07||||||| 64486|EAP|0360||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||77.07||| 64486|EAP|0370|TAP BLOCK UNILATERAL BY I|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||77.07||| 64486|EAP|0360||Medicaid|MEDICAID TEXAS CHILDRENS|77.07||||||| 64486|EAP|0360||United Healthcare|UNITED HEALTHCARE|||||77.07||| 64486|EAP|0360||NON CONTRACTED|COMMERCIAL OTHER 1|||||77.07||| 64486|EAP|0360||United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||77.07||| 64486|EAP|0370|TAP BLOCK UNILATERAL BY I|United Medicare Advantage|UHC MEDICARE GOLD MA|||||77.07||| 64486|EAP|0370|TAP BLOCK UNILATERAL BY I|Humana Medicare Advantage|HUMANA MA|||||77.07||| 64486|EAP|0360||United Medicare Advantage|UHC MEDICARE GOLD MA|||||77.07||| 64486|EAP|0360||Medicare|MEDICARE ACUTE|77.07||||77.07||| 64486|EAP|0360||Blue Cross PPO Specialty|BCBSTX PPO|77.07||||77.07||| 64488|EAP|0360||Tricare|TRICARE EAST REGION|106.24||||||| 64488|EAP|0370|TAP BLOCK BILATERAL BY IN|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||106.24||| 64488|EAP|0360||Medicaid|MEDICAID|106.24||||||| 64488|EAP|0370|TAP BLOCK BILATERAL BY IN|Blue Cross PPO Specialty|BCBSTX PPO|||||106.24||| 64488|EAP|0360||Managed Medicaid|MEDICAID AMERIGROUP|||||106.24||| 64488|EAP|0370|TAP BLOCK BILATERAL BY IN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||106.24||| 64488|EAP|0360||Cigna|CIGNA|||||106.24||| 64488|EAP|0370|TAP BLOCK BILATERAL BY IN|Humana Medicare Advantage|HUMANA MA|||||106.24||| 64488|EAP|0360||Humana Medicare Advantage|HUMANA MA|||||106.24||| 64488|EAP|0360||Blue Cross PPO Specialty|BCBSTX PPO|||||106.24||| 64488|EAP|0360||United Healthcare|UNITED HEALTHCARE|||||106.24||| 64493|EAP|0361|INJ PARAVERT F JNT L/S 1|Humana Medicare Advantage|HUMANA MA|||||3,224.48||| 64493|EAP|0361|INJ PARAVERT F JNT L/S 1|Managed Medicaid|MEDICAID SUPERIOR|||||28.79||| 64493|EAP|0361|INJ PARAVERT F JNT L/S 1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3,224.48||| 64493|EAP|0361|INJ PARAVERT F JNT L/S 1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||28.79||| 64493|EAP|0361|INJ PARAVERT F JNT L/S 1|Blue Cross PPO Specialty|BCBSTX PPO|||||3,224.48||| 64493|EAP|0361|INJ PARAVERT F JNT L/S 1|Medicare|MEDICARE ACUTE|||||3,224.48||| 64493|EAP|0361|INJ PARAVERT F JNT L/S 1|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||28.79||| 64493|EAP|0361|INJ PARAVERT F JNT L/S 1|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3,224.48||| 64494|EAP|0361|INJ PARAVERT F JNT L/S 2|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,834.56||| 64494|EAP|0361|INJ PARAVERT F JNT L/S 2|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||16.38||| 64494|EAP|0361|INJ PARAVERT F JNT L/S 2|Medicare|MEDICARE ACUTE|||||1,834.56||| 64494|EAP|0361|INJ PARAVERT F JNT L/S 2|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||16.38||| 64494|EAP|0361|INJ PARAVERT F JNT L/S 2|Blue Cross PPO Specialty|BCBSTX PPO|||||1,834.56||| 64494|EAP|0361|INJ PARAVERT F JNT L/S 2|Humana Medicare Advantage|HUMANA MA|||||1,834.56||| 64494|EAP|0361|INJ PARAVERT F JNT L/S 2|Managed Medicaid|MEDICAID SUPERIOR|||||16.38||| 64494|EAP|0361|INJ PARAVERT F JNT L/S 2|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,834.56||| 64495|EAP|0361|INJ PARAVERT F JNT L/S 3|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||15.07||| 64495|EAP|0361|INJ PARAVERT F JNT L/S 3|Managed Medicaid|MEDICAID SUPERIOR|||||15.07||| 64495|EAP|0361|INJ PARAVERT F JNT L/S 3|Humana Medicare Advantage|HUMANA MA|||||1,687.84||| 64495|EAP|0361|INJ PARAVERT F JNT L/S 3|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||15.07||| 64495|EAP|0361|INJ PARAVERT F JNT L/S 3|Medicare|MEDICARE ACUTE|||||1,687.84||| 64495|EAP|0361|INJ PARAVERT F JNT L/S 3|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,687.84||| 645|DRG||ENDOCRINE DISORDERS W/O CC/MCC|Medicare|MEDICARE ACUTE|10,285.25|3874.76|3874.76|3874.76|||| 64635|EAP|0361|DESTROY LUMB/SAC FACET JT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||44.02||| 64635|EAP|0361|DESTROY LUMB/SAC FACET JT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||44.02||| 64635|EAP|0361|DESTROY LUMB/SAC FACET JT|Medicare|MEDICARE ACUTE|||||44.02||| 64636|EAP|0361|DESTROY L/S FACET JNT ADD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||25.20||| 64636|EAP|0361|DESTROY L/S FACET JNT ADD|Medicare|MEDICARE ACUTE|||||25.20||| 64636|EAP|0361|DESTROY L/S FACET JNT ADD|United Medicare Advantage|UHC MEDICARE GOLD MA|||||25.20||| 64999|EAP|0360|GANGLION INPAR NERVE BLOC|Aenta Medicare Advantage|AETNA MEDICARE MA|||||42.36||| 65|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS|Medicaid|MEDICAID|158,862.80||||||| 65|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS|NON CONTRACTED|COMMERCIAL OTHER 1|45,165.96|12119.92|12119.92|39.26|||| 65|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS|Managed Medicare|HEALTHSPRING MA|18,720.53|39.26|12119.92|39.26|||| 65|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS|Humana Medicare Advantage|HUMANA MA|66,491.97|176.67|12119.92|39.26|||| 65|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS|Blue Cross PPO Specialty|BCBSTX PPO|71,347.62|5191.54|12119.92|39.26|||| 65|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS|Medicare|MEDICARE ACUTE|230.08|8141.71|12119.92|39.26|||| 65205|EAP|0450|RMV FB EXT EYE SUPERFICIA|Blue Cross PPO Specialty|BCBSTX PPO|||||351.90||| 65222|EAP|0450|RMV FB EYE EXT CORNEAL W|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||343.75||| 66|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC|Medicare|MEDICARE ACUTE|175.95|3874.76|6750.79|3874.76|||| 66|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|24,364.65|6750.79|6750.79|3874.76|||| 673|DRG||OTHER KIDNEY & URINARY TRACT PROCEDURES W MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|31,566.04|19905.75|19905.75|19905.75|||| 682|DRG||RENAL FAILURE W MCC|Blue Cross PPO Specialty|BCBSTX PPO|23,149.94|7710.56|7710.56|5771.22|||| 682|DRG||RENAL FAILURE W MCC|Medicare|MEDICARE ACUTE|20,465.32|5771.22|7710.56|5771.22|||| 683|DRG||RENAL FAILURE W CC|Humana Medicare Advantage|HUMANA MA|21,115.21|78.52|15421.4|78.52|||| 683|DRG||RENAL FAILURE W CC|Aenta Medicare Advantage|AETNA MEDICARE MA|29,437.82|7274.64|15421.4|78.52|||| 683|DRG||RENAL FAILURE W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|18,259.75|3215.03|15421.4|78.52|||| 683|DRG||RENAL FAILURE W CC|United Medicare Advantage|UHC MEDICARE GOLD MA|38,970.33|15421.4|15421.4|78.52|||| 683|DRG||RENAL FAILURE W CC|Blue Cross PPO Specialty|BCBSTX PPO|29,815.39|4625.33|15421.4|78.52|||| 683|DRG||RENAL FAILURE W CC|Medicare|MEDICARE ACUTE|11,102.38|3875.64|15421.4|78.52|||| 684|DRG||RENAL FAILURE W/O CC/MCC|Medicare|MEDICARE ACUTE|7,795.71|1937.38|6503.08|19.63|||| 684|DRG||RENAL FAILURE W/O CC/MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|164.92|6503.08|6503.08|19.63|||| 684|DRG||RENAL FAILURE W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|4,529.02|19.63|6503.08|19.63|||| 687|DRG||KIDNEY & URINARY TRACT NEOPLASMS W CC|Medicare|MEDICARE ACUTE|29,175.05|12231.38|12231.38|12231.38|||| 689|DRG||KIDNEY & URINARY TRACT INFECTIONS W MCC|Humana Medicare Advantage|HUMANA MA|40,751.05|9646.86|9646.86|58.89|||| 689|DRG||KIDNEY & URINARY TRACT INFECTIONS W MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|22,312.92|5455.98|9646.86|58.89|||| 689|DRG||KIDNEY & URINARY TRACT INFECTIONS W MCC|Medicare|MEDICARE ACUTE|19,429.43|58.89|9646.86|58.89|||| 69|DRG||TRANSIENT ISCHEMIA W/O THROMBOLYTIC|Tricare|TRICARE EAST REGION|20,333.36|5564.22|5564.22|3852.76|||| 69|DRG||TRANSIENT ISCHEMIA W/O THROMBOLYTIC|Blue Cross PPO Specialty|BCBSTX PPO|23,131.86|3852.76|5564.22|3852.76|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|Humana Medicare Advantage|HUMANA MA|16,557.80|58.89|5787.06|58.89|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|11,713.80|3996.71|5787.06|58.89|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|189.18|5787.06|5787.06|58.89|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|Medicare|MEDICARE ACUTE|11,756.50|5771.22|5787.06|58.89|||| 69200|EAP|0450|RMV FB EXT AUDITORY CANAL|Blue Cross PPO Specialty|BCBSTX PPO|||||2.42||| 69200|EAP|0450|RMV FB EXT AUDITORY CANAL|Managed Medicaid|MEDICAID SUPERIOR|||||2.42||| 69209|EAP|0450|REMOVE IMPACTED EAR WAX|Medicare|MEDICARE ACUTE|||||1.40||| 69209|EAP|0450|REMOVE IMPACTED EAR WAX|Managed Medicaid|MEDICAID SUPERIOR|||||1.40||| 698|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|74,245.33|21363.61|21363.61|58.89|||| 698|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|20,930.20|58.89|21363.61|58.89|||| 70|DRG||NONSPECIFIC CEREBROVASCULAR DISORDERS W MCC|Medicare|MEDICARE ACUTE|12,224.61|58.89|5863.85|58.89|||| 70|DRG||NONSPECIFIC CEREBROVASCULAR DISORDERS W MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|40,119.16|5863.85|5863.85|58.89|||| 70110|EAP|0320|XR MANDIBLE COMPLETE|Humana Medicare Advantage|HUMANA MA|||||3.75||| 70110|EAP|0320|XR MANDIBLE COMPLETE|Managed Medicaid|MEDICAID AMERIGROUP|||||487.50||| 70110|EAP|0320|XR MANDIBLE COMPLETE|Medicare|MEDICARE ACUTE|||||3.75||| 70110|EAP|0320|XR MANDIBLE COMPLETE|United Healthcare|UNITED HEALTHCARE|||||3.75||| 70150|EAP|0320|XR FACIAL BONES COMPLETE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.50||| 70150|EAP|0320|XR FACIAL BONES COMPLETE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.50||| 70150|EAP|0320|XR FACIAL BONES COMPLETE|Blue Cross PPO Specialty|BCBSTX PPO|||||2.50||| 70150|EAP|0320|XR FACIAL BONES COMPLETE|Humana Medicare Advantage|HUMANA MA|||||2.50||| 70150|EAP|0320|XR FACIAL BONES COMPLETE|Medicare|MEDICARE ACUTE|||||2.50||| 70160|EAP|0320|XR NASAL BONES|Managed Medicaid|MEDICAID AMERIGROUP|||||2.50||| 70160|EAP|0320|XR NASAL BONES|Humana Medicare Advantage|HUMANA MA|||||3.25||| 70160|EAP|0320|XR NASAL BONES|Managed Medicaid|MEDICAID SUPERIOR|||||2.50||| 70160|EAP|0320|XR NASAL BONES|Blue Cross PPO Specialty|BCBSTX PPO|||||3.25||| 70160|EAP|0320|XR NASAL BONES|United Healthcare|UNITED HEALTHCARE|||||2.50||| 70210|EAP|0320|XR SINUSES 1 OR 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||2.15||| 70210|EAP|0320|XR SINUSES 1 OR 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 70220|EAP|0320|XR SINUSES 3 OR MORE VIEW|Medicare|MEDICARE ACUTE|||||2.50||| 70220|EAP|0320|XR SINUSES 3 OR MORE VIEW|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.50||| 70220|EAP|0320|XR SINUSES 3 OR MORE VIEW|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.50||| 70220|EAP|0320|XR SINUSES 3 OR MORE VIEW|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.50||| 70220|EAP|0320|XR SINUSES 3 OR MORE VIEW|Tricare|TRICARE EAST REGION|||||2.50||| 70220|EAP|0320|XR SINUSES 3 OR MORE VIEW|Medicaid|MEDICAID|||||2.50||| 70220|EAP|0320|XR SINUSES 3 OR MORE VIEW|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||3.25||| 70220|EAP|0320|XR SINUSES 3 OR MORE VIEW|United Healthcare|UNITED HEALTHCARE|||||2.50||| 70220|EAP|0320|XR SINUSES 3 OR MORE VIEW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.50||| 70220|EAP|0320|XR SINUSES 3 OR MORE VIEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.50||| 70220|EAP|0320|XR SINUSES 3 OR MORE VIEW|Managed Medicaid|MEDICAID AMERIGROUP|||||2.50||| 70220|EAP|0320|XR SINUSES 3 OR MORE VIEW|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||2.50||| 70220|EAP|0320|XR SINUSES 3 OR MORE VIEW|Managed Medicaid|MEDICAID SUPERIOR|||||2.50||| 70220|EAP|0320|XR SINUSES 3 OR MORE VIEW|Blue Cross PPO Specialty|BCBSTX PPO|||||2.50||| 70250|EAP|0320|XR SKULL 1 TO 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||2.15||| 70250|EAP|0320|XR SKULL 1 TO 3 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||279.50||| 70250|EAP|0320|XR SKULL 1 TO 3 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||279.50||| 70250|EAP|0320|XR SKULL 1 TO 3 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||279.50||| 70250|EAP|0320|XR SKULL 1 TO 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||279.50||| 70260|EAP|0320|XR SKULL 4 OR MORE VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||3.25||| 70360|EAP|0320|XR NECK SOFT TISSUE|Blue Cross PPO Specialty|BCBSTX PPO|||||2.15||| 70360|EAP|0320|XR NECK SOFT TISSUE|Managed Medicaid|MEDICAID SUPERIOR|||||2.15||| 70360|EAP|0320|XR NECK SOFT TISSUE|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 70360|EAP|0320|XR NECK SOFT TISSUE|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.15||| 70360|EAP|0320|XR NECK SOFT TISSUE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||247.25||| 70360|EAP|0320|XR NECK SOFT TISSUE|Medicare|MEDICARE ACUTE|||||2.15||| 70360|EAP|0320|XR NECK SOFT TISSUE|Aetna|AETNA OTHER|||||2.15||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|18.85||||18.85||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|14.50||||14.50||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||14.50||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Cigna|CIGNA|||||18.85||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|14.50||||14.50||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Managed Medicare|HEALTHSPRING MA|18.85||||14.50||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|18.85||||14.50||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Aetna|AETNA PPO|||||14.50||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|||||14.50||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|14.50||||14.50||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|14.50||||18.85||| 70450|EAP|0350|CT HEAD W/O CONTRAST|United Healthcare|UNITED HEALTHCARE|||||18.85||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Workers Compensation|WORKERS COMPENSATION OTHER|||||14.50||| 70450|EAP|0350|CT HEAD W/O CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|18.85||||14.50||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Aetna|AETNA OTHER|||||14.50||| 70450|EAP|0350|CT HEAD W/O CONTRAST|United Healthcare|UNITED HEALTHCARE OTHER|||||14.50||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UMR|||||14.50||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|18.85||||18.85||| 70450|EAP|0350|CT HEAD W/O CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||18.85||| 70450|EAP|0350|CT HEAD W/O CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|14.50||||18.85||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|||||18.85||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Humana Medicare Advantage|HUMANA MA|14.50||||14.50||| 70450|EAP|0350|CT HEAD W/O CONTRAST|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||14.50||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Tricare|TRICARE EAST REGION|18.85||||14.50||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|||||18.85||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|||||1,667.50||| 70450|EAP|0350|CT HEAD W/O CONTRAST|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||18.85||| 70450|EAP|0350|CT HEAD W/O CONTRAST|PHCS|HUMANA INSURANCE|||||1,667.50||| 70450|EAP|0350|CT HEAD W/O CONTRAST|PHCS|GROUP AND PENSION|||||14.50||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Medicaid|MEDICAID TEXAS CHILDRENS|||||1,667.50||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Medicaid|MORRIS COUNTY INDIGENT|||||14.50||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Medicaid|MEDICAID|||||18.85||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||14.50||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Medicaid|MEDICAID HMO|||||18.85||| 70450|EAP|0350|CT HEAD W/O CONTRAST|Medicare|MEDICARE ACUTE|18.85||||14.50||| 70450|EAP|0350|CT HEAD W/O CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 1|18.85||||18.85||| 70460|EAP|0350|CT HEAD W CONTRAST|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||17.00||| 70460|EAP|0350|CT HEAD W CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|||||22.10||| 70460|EAP|0350|CT HEAD W CONTRAST|Tricare|TRICARE EAST REGION|||||17.00||| 70470|EAP|0350|CT HEAD W/WO CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|||||26.00||| 70470|EAP|0350|CT HEAD W/WO CONTRAST|Medicare|MEDICARE ACUTE|||||23.00||| 70470|EAP|0350|CT HEAD W/WO CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||20.00||| 70470|EAP|0350|CT HEAD W/WO CONTRAST|Humana Medicare Advantage|HUMANA MA|||||20.00||| 70480|EAP|0350|CT ORBIT SELLA FOSSA OUT-|Medicare|MEDICARE ACUTE|||||14.50||| 70480|EAP|0350|CT ORBIT SELLA FOSSA OUT-|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||18.85||| 70480|EAP|0350|CT ORBIT SELLA FOSSA OUT-|Managed Medicaid|MEDICAID AMERIGROUP|||||14.50||| 70480|EAP|0350|CT ORBIT SELLA FOSSA OUT-|Managed Medicaid|MEDICAID SUPERIOR|||||14.50||| 70486|EAP|0350|CT SINUSES/MAXILLA FACIAL|Aetna|AETNA PPO|||||18.85||| 70486|EAP|0350|CT SINUSES/MAXILLA FACIAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||18.85||| 70486|EAP|0350|CT SINUSES/MAXILLA FACIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,667.50||| 70486|EAP|0350|CT SINUSES/MAXILLA FACIAL|Blue Cross HMO Specialty|BCBSTX HMO|||||18.85||| 70486|EAP|0350|CT SINUSES/MAXILLA FACIAL|Blue Cross PPO Specialty|BCBSTX PPO|||||18.85||| 70486|EAP|0350|CT SINUSES/MAXILLA FACIAL|Managed Medicaid|MEDICAID SUPERIOR|18.85||||18.85||| 70486|EAP|0350|CT SINUSES/MAXILLA FACIAL|Humana Medicare Advantage|HUMANA MA|||||14.50||| 70486|EAP|0350|CT SINUSES/MAXILLA FACIAL|Cigna|CIGNA|||||18.85||| 70486|EAP|0350|CT SINUSES/MAXILLA FACIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|14.50||||14.50||| 70486|EAP|0350|CT SINUSES/MAXILLA FACIAL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||14.50||| 70486|EAP|0350|CT SINUSES/MAXILLA FACIAL|United Healthcare|UNITED HEALTHCARE|||||18.85||| 70486|EAP|0350|CT SINUSES/MAXILLA FACIAL|Medicare|MEDICARE ACUTE|||||18.85||| 70486|EAP|0350|CT SINUSES/MAXILLA FACIAL|Medicaid|MEDICAID|||||14.50||| 70486|EAP|0350|CT SINUSES/MAXILLA FACIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||14.50||| 70486|EAP|0350|CT SINUSES/MAXILLA FACIAL|Veterans Affairs|VETERANS ADMINISTRATION|||||14.50||| 70486|EAP|0350|CT SINUSES/MAXILLA FACIAL|United Healthcare|UNITED HEALTHCARE|||||14.50||| 70486|EAP|0350|CT SINUSES/MAXILLA FACIAL|Managed Medicaid|MEDICAID AMERIGROUP|||||18.85||| 70486|EAP|0350|CT SINUSES/MAXILLA FACIAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||14.50||| 70487|EAP|0350|CT FACIAL W / CONTRAST|Medicare|MEDICARE ACUTE|||||17.00||| 70487|EAP|0350|CT FACIAL W / CONTRAST|United Healthcare|UNITED HEALTHCARE|||||17.00||| 70487|EAP|0350|CT FACIAL W / CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|||||22.10||| 70490|EAP|0350|CT SOFT TISSUE NECK W/O C|Managed Medicaid|MEDICAID SUPERIOR|18.85||||18.85||| 70490|EAP|0350|CT SOFT TISSUE NECK W/O C|Aetna|AETNA OTHER|||||18.85||| 70490|EAP|0350|CT SOFT TISSUE NECK W/O C|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||14.50||| 70490|EAP|0350|CT SOFT TISSUE NECK W/O C|Blue Cross PPO Specialty|BCBSTX PPO|||||18.85||| 70490|EAP|0350|CT SOFT TISSUE NECK W/O C|Medicare|MEDICARE ACUTE|14.50||||14.50||| 70490|EAP|0350|CT SOFT TISSUE NECK W/O C|Managed Medicaid|MEDICAID AMERIGROUP|18.85||||||| 70490|EAP|0350|CT SOFT TISSUE NECK W/O C|Humana Medicare Advantage|HUMANA MA|||||18.85||| 70491|EAP|0350|CT SOFT TISSUE NECK W CON|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||22.10||| 70491|EAP|0350|CT SOFT TISSUE NECK W CON|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||22.10||| 70491|EAP|0350|CT SOFT TISSUE NECK W CON|Blue Cross HMO Specialty|BCBSTX HMO|||||17.00||| 70491|EAP|0350|CT SOFT TISSUE NECK W CON|Medicare|MEDICARE ACUTE|||||19.55||| 70491|EAP|0350|CT SOFT TISSUE NECK W CON|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||17.00||| 70491|EAP|0350|CT SOFT TISSUE NECK W CON|United Medicare Advantage|UHC MEDICARE GOLD MA|||||22.10||| 70491|EAP|0350|CT SOFT TISSUE NECK W CON|Managed Medicaid|MEDICAID SUPERIOR|||||17.00||| 70491|EAP|0350|CT SOFT TISSUE NECK W CON|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||17.00||| 70491|EAP|0350|CT SOFT TISSUE NECK W CON|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||22.10||| 70491|EAP|0350|CT SOFT TISSUE NECK W CON|Humana Medicare Advantage|HUMANA MA|||||17.00||| 70491|EAP|0350|CT SOFT TISSUE NECK W CON|Blue Cross PPO Specialty|BCBSTX PPO|||||17.00||| 70491|EAP|0350|CT SOFT TISSUE NECK W CON|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||17.00||| 70491|EAP|0350|CT SOFT TISSUE NECK W CON|Managed Medicaid|MEDICAID AMERIGROUP|22.10||||22.10||| 70491|EAP|0350|CT SOFT TISSUE NECK W CON|PHCS|HUMANA INSURANCE|||||22.10||| 70492|EAP|0350|CT SOFT TISSUE NECK W/WO|Medicaid|MEDICAID|||||26.00||| 70496|EAP|0351|CTA HEAD WO/W|Medicaid|MEDICAID|||||2,587.50||| 70496|EAP|0351|CTA HEAD WO/W|Blue Cross PPO Specialty|BCBSTX PPO|29.25||||29.25||| 70496|EAP|0351|CTA HEAD WO/W|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||22.50||| 70496|EAP|0351|CTA HEAD WO/W|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||22.50||| 70496|EAP|0351|CTA HEAD WO/W|Humana Medicare Advantage|HUMANA MA|22.50||||29.25||| 70496|EAP|0351|CTA HEAD WO/W|Managed Medicaid|MEDICAID AMERIGROUP|||||29.25||| 70496|EAP|0351|CTA HEAD WO/W|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|22.50||||29.25||| 70496|EAP|0351|CTA HEAD WO/W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||29.25||| 70496|EAP|0351|CTA HEAD WO/W|Blue Cross HMO Specialty|BCBSTX HMO|||||29.25||| 70496|EAP|0351|CTA HEAD WO/W|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||22.50||| 70496|EAP|0351|CTA HEAD WO/W|United Medicare Advantage|UHC MEDICARE GOLD MA|||||29.25||| 70496|EAP|0351|CTA HEAD WO/W|Veterans Affairs|VETERANS ADMINISTRATION|||||29.25||| 70496|EAP|0351|CTA HEAD WO/W|NON CONTRACTED|COMMERCIAL OTHER 1|29.25||||29.25||| 70496|EAP|0351|CTA HEAD WO/W|PHCS|GROUP AND PENSION|||||22.50||| 70496|EAP|0351|CTA HEAD WO/W|Aenta Medicare Advantage|AETNA MEDICARE MA|22.50||||22.50||| 70496|EAP|0351|CTA HEAD WO/W|Medicare|MEDICARE ACUTE|22.50||||22.50||| 70496|EAP|0351|CTA HEAD WO/W|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||22.50||| 70498|EAP|0351|CTA NECK WO/W|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||22.50||| 70498|EAP|0351|CTA NECK WO/W|Medicaid|MEDICAID|||||2,587.50||| 70498|EAP|0351|CTA NECK WO/W|PHCS|GROUP AND PENSION|||||22.50||| 70498|EAP|0351|CTA NECK WO/W|United Medicare Advantage|UHC MEDICARE GOLD MA|||||29.25||| 70498|EAP|0351|CTA NECK WO/W|Veterans Affairs|VETERANS ADMINISTRATION|||||29.25||| 70498|EAP|0351|CTA NECK WO/W|Medicare|MEDICARE ACUTE|22.50||||22.50||| 70498|EAP|0351|CTA NECK WO/W|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||22.50||| 70498|EAP|0351|CTA NECK WO/W|Humana Medicare Advantage|HUMANA MA|22.50||||29.25||| 70498|EAP|0351|CTA NECK WO/W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||29.25||| 70498|EAP|0351|CTA NECK WO/W|NON CONTRACTED|COMMERCIAL OTHER 1|29.25||||29.25||| 70498|EAP|0351|CTA NECK WO/W|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||22.50||| 70498|EAP|0351|CTA NECK WO/W|Blue Cross HMO Specialty|BCBSTX HMO|||||29.25||| 70498|EAP|0351|CTA NECK WO/W|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2,587.50||| 70498|EAP|0351|CTA NECK WO/W|Cigna|CIGNA|||||29.25||| 70498|EAP|0351|CTA NECK WO/W|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|22.50||||29.25||| 70498|EAP|0351|CTA NECK WO/W|Managed Medicaid|MEDICAID AMERIGROUP|||||29.25||| 70498|EAP|0351|CTA NECK WO/W|Blue Cross PPO Specialty|BCBSTX PPO|29.25||||29.25||| 70498|EAP|0351|CTA NECK WO/W|Aenta Medicare Advantage|AETNA MEDICARE MA|22.50||||22.50||| 70544|EAP|0610|MRA HEAD (ANGIOGRPHY)|Blue Cross PPO Specialty|BCBSTX PPO|||||23.00||| 70544|EAP|0610|MRA HEAD (ANGIOGRPHY)|Aenta Medicare Advantage|AETNA MEDICARE MA|||||23.00||| 70544|EAP|0610|MRA HEAD (ANGIOGRPHY)|Humana Medicare Advantage|HUMANA MA|23.00||||23.00||| 70544|EAP|0610|MRA HEAD (ANGIOGRPHY)|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||23.00||| 70544|EAP|0610|MRA HEAD (ANGIOGRPHY)|Medicare|MEDICARE ACUTE|23.00||||23.00||| 70544|EAP|0610|MRA HEAD (ANGIOGRPHY)|United Medicare Advantage|UHC MEDICARE GOLD MA|23.00||||23.00||| 70544|EAP|0610|MRA HEAD (ANGIOGRPHY)|Managed Medicare|HEALTHSPRING MA|23.00||||||| 70544|EAP|0610|MRA HEAD (ANGIOGRPHY)|United Healthcare|UNITED HEALTHCARE|||||23.00||| 70547|EAP|0610|MRA NECK (ANGIOGRAPHY)|United Medicare Advantage|UHC MEDICARE GOLD MA|||||23.00||| 70547|EAP|0610|MRA NECK (ANGIOGRAPHY)|Medicare|MEDICARE ACUTE|23.00||||23.00||| 70547|EAP|0610|MRA NECK (ANGIOGRAPHY)|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||23.00||| 70547|EAP|0610|MRA NECK (ANGIOGRAPHY)|United Healthcare|UNITED HEALTHCARE|||||23.00||| 70547|EAP|0610|MRA NECK (ANGIOGRAPHY)|Aenta Medicare Advantage|AETNA MEDICARE MA|||||23.00||| 70547|EAP|0610|MRA NECK (ANGIOGRAPHY)|Blue Cross PPO Specialty|BCBSTX PPO|23.00||||||| 70547|EAP|0610|MRA NECK (ANGIOGRAPHY)|Humana Medicare Advantage|HUMANA MA|23.00||||23.00||| 70547|EAP|0610|MRA NECK (ANGIOGRAPHY)|Managed Medicare|HEALTHSPRING MA|23.00||||||| 70551|EAP|0610|MRI BRAIN WO CONTRAST|Humana Medicare Advantage|HUMANA MA|23.00||||23.00||| 70551|EAP|0610|MRI BRAIN WO CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||23.00||| 70551|EAP|0610|MRI BRAIN WO CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|||||23.00||| 70551|EAP|0610|MRI BRAIN WO CONTRAST|Managed Medicare|HEALTHSPRING MA|23.00||||||| 70551|EAP|0610|MRI BRAIN WO CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|23.00||||23.00||| 70551|EAP|0610|MRI BRAIN WO CONTRAST|Aetna|AETNA PPO|||||23.00||| 70551|EAP|0610|MRI BRAIN WO CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|||||23.00||| 70551|EAP|0610|MRI BRAIN WO CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|||||23.00||| 70551|EAP|0610|MRI BRAIN WO CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||23.00||| 70551|EAP|0610|MRI BRAIN WO CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||23.00||| 70551|EAP|0610|MRI BRAIN WO CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|||||23.00||| 70551|EAP|0610|MRI BRAIN WO CONTRAST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||23.00||| 70551|EAP|0610|MRI BRAIN WO CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|23.00||||23.00||| 70551|EAP|0610|MRI BRAIN WO CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|||||23.00||| 70551|EAP|0610|MRI BRAIN WO CONTRAST|Medicaid|MEDICAID|||||23.00||| 70551|EAP|0610|MRI BRAIN WO CONTRAST|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||23.00||| 70551|EAP|0610|MRI BRAIN WO CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|23.00||||23.00||| 70551|EAP|0610|MRI BRAIN WO CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|23.00||||23.00||| 70551|EAP|0610|MRI BRAIN WO CONTRAST|United Healthcare|UNITED HEALTHCARE|||||23.00||| 70551|EAP|0610|MRI BRAIN WO CONTRAST|Medicare|MEDICARE ACUTE|23.00||||23.00||| 70551|EAP|0610|MRI BRAIN WO CONTRAST|Tricare|TRICARE EAST REGION|23.00||||23.00||| 70551|EAP|0610|MRI BRAIN WO CONTRAST|Medicaid|MEDICAID BCBSTX|||||23.00||| 70551|EAP|0610|MRI BRAIN WO CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||23.00||| 70551|EAP|0610|MRI BRAIN WO CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 1|23.00||||||| 70551|EAP|0610|MRI BRAIN WO CONTRAST|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||23.00||| 70552|EAP|0610|MRI BRAIN W CONTRAST|Humana Medicare Advantage|HUMANA MA|||||27.00||| 70553|EAP|0610|MRI BRAIN W W/O|Medicare|MEDICARE ACUTE|||||34.00||| 70553|EAP|0610|MRI BRAIN W W/O|Tricare|TRICARE EAST REGION|||||34.00||| 70553|EAP|0610|MRI BRAIN W W/O|United Medicare Advantage|UHC MEDICARE GOLD MA|||||34.00||| 70553|EAP|0610|MRI BRAIN W W/O|United Healthcare|UNITED HEALTHCARE|||||34.00||| 70553|EAP|0610|MRI BRAIN W W/O|Blue Cross HMO Specialty|BCBSTX HMO|||||34.00||| 70553|EAP|0610|MRI BRAIN W W/O|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||34.00||| 70553|EAP|0610|MRI BRAIN W W/O|NON CONTRACTED|COMMERCIAL OTHER 1|||||34.00||| 70553|EAP|0610|MRI BRAIN W W/O|Aetna|AETNA OTHER|||||34.00||| 70553|EAP|0610|MRI BRAIN W W/O|Blue Cross PPO Specialty|BCBSTX PPO|||||34.00||| 70553|EAP|0610|MRI BRAIN W W/O|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||34.00||| 70553|EAP|0610|MRI BRAIN W W/O|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|34.00||||34.00||| 70553|EAP|0610|MRI BRAIN W W/O|Humana Medicare Advantage|HUMANA MA|||||34.00||| 70553|EAP|0610|MRI BRAIN W W/O|Cigna|CIGNA|||||34.00||| 70553|EAP|0610|MRI BRAIN W W/O|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||34.00||| 70553|EAP|0610|MRI BRAIN W W/O|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||34.00||| 70553|EAP|0610|MRI BRAIN W W/O|Aetna|AETNA PPO|||||34.00||| 70553|EAP|0610|MRI BRAIN W W/O|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||34.00||| 71|DRG||NONSPECIFIC CEREBROVASCULAR DISORDERS W CC|Medicare|MEDICARE ACUTE|10,529.50|3847.48|3847.48|58.89|||| 71|DRG||NONSPECIFIC CEREBROVASCULAR DISORDERS W CC|Humana Medicare Advantage|HUMANA MA|11,942.56|58.89|3847.48|58.89|||| 71045|EAP|0324|XR CHEST 1 VIEW|PHCS|MULTIPLAN PHCS|||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|Medicaid|MEDICAID TEXAS CHILDRENS|1.95||||203.16||| 71045|EAP|0324|XR CHEST 1 VIEW|Medicaid|MEDICAID HMO|||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||203.16||| 71045|EAP|0324|XR CHEST 1 VIEW|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|PHCS|MERITAIN HEALTH|||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|Medicaid|MEDICAID|1.95||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|Medicaid|MORRIS COUNTY INDIGENT|||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|NON CONTRACTED|COMMERCIAL OTHER 1|211.31||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|Medicare|MEDICARE ACUTE|211.31||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|211.31||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.95||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|211.31||||203.16||| 71045|EAP|0324|XR CHEST 1 VIEW|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|Aetna|AETNA PPO|||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|Managed Medicare|BCBS MEDICARE PPO MA|||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|PHCS|GROUP AND PENSION|||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|211.31||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|Aetna|AETNA OTHER|||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|Blue Cross HMO Specialty|BCBSTX HMO|1.95||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|Tricare|TRICARE FOR LIFE|||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|Aenta Medicare Advantage|AETNA MEDICARE MA|1.95||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|Managed Medicaid|MEDICAID SUPERIOR|1.95||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|Tricare|TRICARE EAST REGION|211.31||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|211.31||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|Blue Cross PPO Specialty|BCBSTX PPO|211.31||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|Access Direct Platinum|HEALTHFIRST TPA UMR|1.95||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.95||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|PHCS|HUMANA INSURANCE|||||203.16||| 71045|EAP|0324|XR CHEST 1 VIEW|Managed Medicaid|MEDICAID AMERIGROUP|1.95||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|Humana Medicare Advantage|HUMANA MA|1.95||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|Cigna|CIGNA|211.31||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|Managed Medicare|HEALTHSPRING MA|211.31||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|Cigna|CIGNA|1.95||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|Aetna|AETNA QHP HMO|||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|United Healthcare|UNITED HEALTHCARE OTHER|1.95||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|United Healthcare|UNITED HEALTHCARE ERS|||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|United Medicare Advantage|UHC MEDICARE GOLD MA|1.95||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|Veterans Affairs|VETERANS ADMINISTRATION|1.95||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|United Healthcare|TML GROUP BENEFITS|||||203.16||| 71045|EAP|0324|XR CHEST 1 VIEW|United Healthcare|UNITED HEALTHCARE|211.31||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.95||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|United Medicare Advantage|AARP UHC WEST COMPLETE MA|211.31||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|Veterans Affairs|VETERANS ADMINISTRATION|||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|United Healthcare|GEHA|||||211.31||| 71045|EAP|0324|XR CHEST 1 VIEW|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|211.31||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|Workers Compensation|WORKERS COMPENSATION OTHER|||||211.31||| 71046|EAP|0324|XR CHEST 2 VIEWS|Managed Medicare|BCBS MEDICARE PPO MA|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|2.15||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|2.15||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Managed Medicare|WELLCARE CHOICE MA|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Managed Medicare|HEALTHSPRING MA|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.15||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.15||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Aetna|AETNA OTHER|2.15||||223.99||| 71046|EAP|0324|XR CHEST 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|223.99||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|2.15||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||232.98||| 71046|EAP|0324|XR CHEST 2 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|232.98||||232.98||| 71046|EAP|0324|XR CHEST 2 VIEWS|Aetna|AETNA PPO|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||232.98||| 71046|EAP|0324|XR CHEST 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|2.15||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|2.15||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||223.99||| 71046|EAP|0324|XR CHEST 2 VIEWS|Tricare|TRICARE EAST REGION|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Humana Medicare Advantage|HUMANA MA|232.98||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Medicaid|MEDICAID|2.15||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Cigna|CIGNA|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Medicaid|MEDICAID HMO|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Medicare|MEDICARE ACUTE|2.15||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Medicaid|MORRIS COUNTY INDIGENT|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||223.99||| 71046|EAP|0324|XR CHEST 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|2.15||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|United Healthcare|ZZZZZ UNITED HEALTHCARE|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|United Healthcare|TML GROUP BENEFITS|||||232.98||| 71046|EAP|0324|XR CHEST 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.15||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UMR|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|2.15||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||232.98||| 71046|EAP|0324|XR CHEST 2 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|232.98||||232.98||| 71048|EAP|0324|XR CHEST 4 OR MORE VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||3.75||| 71048|EAP|0324|XR CHEST 4 OR MORE VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||406.36||| 71101|EAP|0320|XR RT RIBS MIN 3 W POST C|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3.25||| 71101|EAP|0320|XR RT RIBS MIN 3 W POST C|Veterans Affairs|VETERANS ADMINISTRATION|||||3.25||| 71101|EAP|0320|XR RT RIBS MIN 3 W POST C|United Medicare Advantage|UHC MEDICARE GOLD MA|||||287.50||| 71101|EAP|0320|XR LT RIBS MIN 3 W POST C|United Medicare Advantage|UHC MEDICARE GOLD MA|||||287.50||| 71101|EAP|0320|XR RT RIBS MIN 3 W POST C|United Healthcare|UNITED HEALTHCARE|||||287.50||| 71101|EAP|0320|XR LT RIBS MIN 3 W POST C|United Healthcare|UNITED HEALTHCARE|||||3.25||| 71101|EAP|0320|XR RT RIBS MIN 3 W POST C|Medicaid|MEDICAID TEXAS CHILDRENS|||||287.50||| 71101|EAP|0320|XR LT RIBS MIN 3 W POST C|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.50||| 71101|EAP|0320|XR LT RIBS MIN 3 W POST C|Blue Cross HMO Specialty|BCBSTX HMO|||||287.50||| 71101|EAP|0320|XR RT RIBS MIN 3 W POST C|Cigna|CIGNA|||||3.25||| 71101|EAP|0320|XR RT RIBS MIN 3 W POST C|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.50||| 71101|EAP|0320|XR LT RIBS MIN 3 W POST C|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||287.50||| 71101|EAP|0320|XR RT RIBS MIN 3 W POST C|Managed Medicaid|MEDICAID AMERIGROUP|||||287.50||| 71101|EAP|0320|XR RT RIBS MIN 3 W POST C|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.50||| 71101|EAP|0320|XR RT RIBS MIN 3 W POST C|Managed Medicaid|MEDICAID SUPERIOR|||||3.25||| 71101|EAP|0320|XR LT RIBS MIN 3 W POST C|Humana Medicare Advantage|HUMANA MA|||||3.25||| 71101|EAP|0320|XR LT RIBS MIN 3 W POST C|Managed Medicare|HEALTHSPRING MA|||||3.25||| 71101|EAP|0320|XR LT RIBS MIN 3 W POST C|Blue Cross PPO Specialty|BCBSTX PPO|||||3.25||| 71101|EAP|0320|XR RT RIBS MIN 3 W POST C|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||287.50||| 71101|EAP|0320|XR LT RIBS MIN 3 W POST C|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.50||| 71101|EAP|0320|XR LT RIBS MIN 3 W POST C|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.50||| 71101|EAP|0320|XR LT RIBS MIN 3 W POST C|Managed Medicaid|MEDICAID AMERIGROUP|||||2.50||| 71101|EAP|0320|XR RT RIBS MIN 3 W POST C|Blue Cross PPO Specialty|BCBSTX PPO|||||2.50||| 71101|EAP|0320|XR LT RIBS MIN 3 W POST C|Medicare|MEDICARE ACUTE|2.50||||3.25||| 71101|EAP|0320|XR RT RIBS MIN 3 W POST C|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.50||| 71101|EAP|0320|XR RT RIBS MIN 3 W POST C|Humana Medicare Advantage|HUMANA MA|||||287.50||| 71101|EAP|0320|XR RT RIBS MIN 3 W POST C|Medicare|MEDICARE ACUTE|2.50||||2.50||| 71101|EAP|0320|XR LT RIBS MIN 3 W POST C|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.50||| 71101|EAP|0320|XR LT RIBS MIN 3 W POST C|Managed Medicaid|MEDICAID SUPERIOR|||||287.50||| 71111|EAP|0320|XR RIBS BILATERAL 4 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3.25||| 71111|EAP|0320|XR RIBS BILATERAL 4 VIEWS|Aetna|AETNA PPO|||||2.50||| 71111|EAP|0320|XR RIBS BILATERAL 4 VIEWS|Medicare|MEDICARE ACUTE|||||287.50||| 71111|EAP|0320|XR RIBS BILATERAL 4 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.25||| 71120|EAP|0320|XR STERNUM 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||279.50||| 71120|EAP|0320|XR STERNUM 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||2.15||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|1,667.50||||18.85||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|18.85||||1,667.50||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|18.85||||18.85||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|18.85||||14.50||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UMR|||||18.85||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|||||14.50||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||18.85||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|14.50||||18.85||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1,667.50||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Cigna|CIGNA|||||18.85||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|14.50||||18.85||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Managed Medicare|HEALTHSPRING MA|18.85||||1,667.50||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Cigna|CIGNA|14.50||||||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Aetna|AETNA PPO|||||18.85||| 71250|EAP|0350|CT THORAX W/O CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|14.50||||14.50||| 71250|EAP|0350|CT THORAX W/O CONTRAST|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|14.50||||1,667.50||| 71250|EAP|0350|CT THORAX W/O CONTRAST|United Healthcare|UNITED HEALTHCARE|||||18.85||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|||||1,667.50||| 71250|EAP|0350|CT THORAX W/O CONTRAST|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||14.50||| 71250|EAP|0350|CT THORAX W/O CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|18.85||||||| 71250|EAP|0350|CT THORAX W/O CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|14.50||||1,667.50||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Medicare|MEDICARE ACUTE|1,667.50||||18.85||| 71250|EAP|0350|CT THORAX W/O CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 1|||||18.85||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Medicaid|MEDICAID TEXAS CHILDRENS|||||18.85||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||14.50||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Medicaid|MEDICAID|14.50||||14.50||| 71250|EAP|0350|CT THORAX W/O CONTRAST|United Healthcare|UNITED HEALTHCARE OTHER|||||14.50||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|18.85||||1,667.50||| 71250|EAP|0350|CT THORAX W/O CONTRAST|Humana Medicare Advantage|HUMANA MA|18.85||||18.85||| 71260|EAP|0350|CT THORAX W CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 1|||||22.10||| 71260|EAP|0350|CT THORAX W CONTRAST|NON CONTRACTED|ZZZZZ LIABILITY INS OTHER 1|||||17.00||| 71260|EAP|0350|CT THORAX W CONTRAST|Medicaid|MEDICAID|||||17.00||| 71260|EAP|0350|CT THORAX W CONTRAST|United Healthcare|UNITED HEALTHCARE|||||22.10||| 71260|EAP|0350|CT THORAX W CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|||||17.00||| 71260|EAP|0350|CT THORAX W CONTRAST|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||17.00||| 71260|EAP|0350|CT THORAX W CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||17.00||| 71260|EAP|0350|CT THORAX W CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||17.00||| 71260|EAP|0350|CT THORAX W CONTRAST|Cigna|CIGNA|||||19.55||| 71260|EAP|0350|CT THORAX W CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||19.55||| 71260|EAP|0350|CT THORAX W CONTRAST|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||17.00||| 71260|EAP|0350|CT THORAX W CONTRAST|Medicare|MEDICARE ACUTE|22.10||||22.10||| 71260|EAP|0350|CT THORAX W CONTRAST|Humana Medicare Advantage|HUMANA MA|22.10||||19.55||| 71260|EAP|0350|CT THORAX W CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|||||17.00||| 71260|EAP|0350|CT THORAX W CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||17.00||| 71260|EAP|0350|CT THORAX W CONTRAST|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|22.10||||22.10||| 71260|EAP|0350|CT THORAX W CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|||||17.00||| 71260|EAP|0350|CT THORAX W CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||17.00||| 71260|EAP|0350|CT THORAX W CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|||||17.00||| 71260|EAP|0350|CT THORAX W CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||17.00||| 71260|EAP|0350|CT THORAX W CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|17.00||||19.55||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|29.25||||29.25||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2,587.50||||29.25||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|Blue Cross PPO Specialty|BCBSTX PPO|29.25||||22.50||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|Blue Cross HMO Specialty|BCBSTX HMO|22.50||||29.25||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2,587.50||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|Managed Medicare|HEALTHSPRING MA|||||22.50||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|Cigna|CIGNA|||||29.25||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|Humana Medicare Advantage|HUMANA MA|29.25||||22.50||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2,587.50||||29.25||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|Managed Medicaid|MEDICAID AMERIGROUP|22.50||||22.50||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|29.25||||29.25||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|Cigna|CIGNA|||||22.50||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|United Medicare Advantage|UHC MEDICARE GOLD MA|||||29.25||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||22.50||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|United Healthcare|UNITED HEALTHCARE OTHER|||||22.50||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|Veterans Affairs|VETERANS ADMINISTRATION|||||29.25||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|Veterans Affairs|VETERANS ADMINISTRATION|||||22.50||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|29.25||||||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||29.25||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|United Healthcare|UNITED HEALTHCARE|||||29.25||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|United Healthcare|UNITED HEALTHCARE|||||2,587.50||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|PHCS|HUMANA INSURANCE|||||29.25||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|NON CONTRACTED|COMMERCIAL OTHER 1|||||29.25||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|Medicaid|MEDICAID HMO|||||29.25||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|Medicaid|MEDICAID|||||22.50||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|Medicare|MEDICARE ACUTE|2,587.50||||22.50||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|Tricare|TRICARE EAST REGION|||||22.50||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|Medicaid|MEDICAID TEXAS CHILDRENS|||||29.25||| 71275|EAP|0352|CTA CHEST (NONCORONARY) W|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||22.50||| 72|DRG||NONSPECIFIC CEREBROVASCULAR DISORDERS W/O CC/MCC|Medicare|MEDICARE ACUTE|33,409.73|145.34|145.34|145.34|||| 72040|EAP|0320|XR SPINE CERVICAL 2/3 VIE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||247.25||| 72040|EAP|0320|XR SPINE CERVICAL 2/3 VIE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.15||| 72040|EAP|0320|XR SPINE CERVICAL 2/3 VIE|Managed Medicaid|MEDICAID SUPERIOR|||||279.50||| 72040|EAP|0320|XR SPINE CERVICAL 2/3 VIE|Humana Medicare Advantage|HUMANA MA|||||2.15||| 72040|EAP|0320|XR SPINE CERVICAL 2/3 VIE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.15||| 72040|EAP|0320|XR SPINE CERVICAL 2/3 VIE|Aetna|AETNA PPO|||||279.50||| 72040|EAP|0320|XR SPINE CERVICAL 2/3 VIE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||279.50||| 72040|EAP|0320|XR SPINE CERVICAL 2/3 VIE|Cigna|CIGNA|||||279.50||| 72040|EAP|0320|XR SPINE CERVICAL 2/3 VIE|Blue Cross PPO Specialty|BCBSTX PPO|2.15||||279.50||| 72040|EAP|0320|XR SPINE CERVICAL 2/3 VIE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||2.15||| 72040|EAP|0320|XR SPINE CERVICAL 2/3 VIE|Managed Medicaid|MEDICAID AMERIGROUP|||||279.50||| 72040|EAP|0320|XR SPINE CERVICAL 2/3 VIE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.15||| 72040|EAP|0320|XR SPINE CERVICAL 2/3 VIE|United Healthcare|TML GROUP BENEFITS|||||2.15||| 72040|EAP|0320|XR SPINE CERVICAL 2/3 VIE|United Healthcare|UNITED HEALTHCARE|||||279.50||| 72040|EAP|0320|XR SPINE CERVICAL 2/3 VIE|United Medicare Advantage|UHC MEDICARE GOLD MA|2.15||||279.50||| 72040|EAP|0320|XR SPINE CERVICAL 2/3 VIE|Workers Compensation|WORKERS COMPENSATION OTHER|||||247.25||| 72040|EAP|0320|XR SPINE CERVICAL 2/3 VIE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||279.50||| 72040|EAP|0320|XR SPINE CERVICAL 2/3 VIE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.15||| 72040|EAP|0320|XR SPINE CERVICAL 2/3 VIE|United Healthcare|UNITED HEALTHCARE OTHER|||||2.15||| 72040|EAP|0320|XR SPINE CERVICAL 2/3 VIE|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.15||| 72040|EAP|0320|XR SPINE CERVICAL 2/3 VIE|Tricare|TRICARE EAST REGION|||||2.15||| 72040|EAP|0320|XR SPINE CERVICAL 2/3 VIE|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.15||| 72040|EAP|0320|XR SPINE CERVICAL 2/3 VIE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.15||| 72040|EAP|0320|XR SPINE CERVICAL 2/3 VIE|Medicare|MEDICARE ACUTE|||||2.15||| 72040|EAP|0320|XR SPINE CERVICAL 2/3 VIE|Medicaid|MEDICAID|||||2.15||| 72052|EAP|0320|XR SPINE CERVICAL COMPLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||487.50||| 72052|EAP|0320|XR SPINE CERVICAL COMPLET|Medicare|MEDICARE ACUTE|||||487.50||| 72052|EAP|0320|XR SPINE CERVICAL COMPLET|Tricare|TRICARE EAST REGION|||||3.75||| 72052|EAP|0320|XR SPINE CERVICAL COMPLET|Medicaid|MEDICAID|||||487.50||| 72052|EAP|0320|XR SPINE CERVICAL COMPLET|United Healthcare|UNITED HEALTHCARE OTHER|||||3.75||| 72052|EAP|0320|XR SPINE CERVICAL COMPLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3.75||| 72052|EAP|0320|XR SPINE CERVICAL COMPLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||487.50||| 72052|EAP|0320|XR SPINE CERVICAL COMPLET|United Healthcare|UNITED HEALTHCARE|||||3.75||| 72052|EAP|0320|XR SPINE CERVICAL COMPLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||3.75||| 72052|EAP|0320|XR SPINE CERVICAL COMPLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||487.50||| 72052|EAP|0320|XR SPINE CERVICAL COMPLET|Aetna|AETNA OTHER|||||487.50||| 72052|EAP|0320|XR SPINE CERVICAL COMPLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||431.25||| 72052|EAP|0320|XR SPINE CERVICAL COMPLET|Blue Cross PPO Specialty|BCBSTX PPO|||||3.75||| 72052|EAP|0320|XR SPINE CERVICAL COMPLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||487.50||| 72052|EAP|0320|XR SPINE CERVICAL COMPLET|Managed Medicaid|MEDICAID AMERIGROUP|||||487.50||| 72052|EAP|0320|XR SPINE CERVICAL COMPLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.75||| 72052|EAP|0320|XR SPINE CERVICAL COMPLET|Humana Medicare Advantage|HUMANA MA|||||3.75||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||2.15||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||2.15||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||247.25||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|Managed Medicare|HEALTHSPRING MA|||||279.50||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||247.25||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||247.25||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||279.50||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||279.50||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||279.50||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||279.50||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|Medicare|MEDICARE ACUTE|||||2.15||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|2.15||||279.50||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|Cigna|CIGNA|||||247.25||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||2.15||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||247.25||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.15||| 72082|EAP|0320|XR ENTIRE SPINE 2 OR 3 VI|Medicare|MEDICARE ACUTE|||||2.15||| 72082|EAP|0320|XR ENTIRE SPINE 2 OR 3 VI|Aetna|AETNA PPO|||||2.15||| 72082|EAP|0320|XR ENTIRE SPINE 2 OR 3 VI|Cigna|CIGNA|||||279.50||| 72082|EAP|0320|XR ENTIRE SPINE 2 OR 3 VI|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.15||| 72082|EAP|0320|XR ENTIRE SPINE 2 OR 3 VI|Blue Cross PPO Specialty|BCBSTX PPO|||||247.25||| 72082|EAP|0320|XR ENTIRE SPINE 2 OR 3 VI|Managed Medicaid|MEDICAID SUPERIOR|||||279.50||| 72082|EAP|0320|XR ENTIRE SPINE 2 OR 3 VI|Tricare|TRICARE EAST REGION|||||2.15||| 72082|EAP|0320|XR ENTIRE SPINE 2 OR 3 VI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.15||| 72082|EAP|0320|XR ENTIRE SPINE 2 OR 3 VI|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 72082|EAP|0320|XR ENTIRE SPINE 2 OR 3 VI|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||279.50||| 72083|EAP|0320|XR ENTIRE SPINE 4 OR 5 VI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.25||| 72083|EAP|0320|XR ENTIRE SPINE 4 OR 5 VI|Managed Medicaid|MEDICAID SUPERIOR|||||3.25||| 72083|EAP|0320|XR ENTIRE SPINE 4 OR 5 VI|Humana Medicare Advantage|HUMANA MA|||||2.50||| 72083|EAP|0320|XR ENTIRE SPINE 4 OR 5 VI|Managed Medicaid|MEDICAID AMERIGROUP|||||287.50||| 72083|EAP|0320|XR ENTIRE SPINE 4 OR 5 VI|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.25||| 72083|EAP|0320|XR ENTIRE SPINE 4 OR 5 VI|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.50||| 72083|EAP|0320|XR ENTIRE SPINE 4 OR 5 VI|Blue Cross PPO Specialty|BCBSTX PPO|||||2.50||| 72083|EAP|0320|XR ENTIRE SPINE 4 OR 5 VI|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.50||| 72083|EAP|0320|XR ENTIRE SPINE 4 OR 5 VI|Tricare|TRICARE EAST REGION|||||287.50||| 72083|EAP|0320|XR ENTIRE SPINE 4 OR 5 VI|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.50||| 72083|EAP|0320|XR ENTIRE SPINE 4 OR 5 VI|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||3.25||| 72083|EAP|0320|XR ENTIRE SPINE 4 OR 5 VI|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.50||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|NON CONTRACTED|CAMP COUNTY SHERIFF OFFICE|||||279.50||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|NON CONTRACTED|COMMERCIAL OTHER 1|||||279.50||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|PHCS|GROUP AND PENSION|||||2.15||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.15||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||247.25||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|Tricare|TRICARE EAST REGION|||||2.15||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|Medicaid|MEDICAID|||||279.50||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|Medicare|MEDICARE ACUTE|||||2.15||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.15||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||247.25||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|United Healthcare|UNITED HEALTHCARE|||||2.15||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|United Healthcare|UNITED HEALTHCARE OTHER|||||2.15||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|United Medicare Advantage|UHC MEDICARE GOLD MA|2.15||||279.50||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||279.50||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|Aetna|AETNA PPO|||||279.50||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|Cigna|CIGNA|||||2.15||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|Cigna|CIGNA|||||247.25||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|Workers Compensation|WORKERS COMPENSATION OTHER|||||279.50||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|Blue Cross PPO Specialty|BCBSTX PPO|||||279.50||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.15||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||279.50||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||2.15||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|Blue Cross HMO Specialty|BCBSTX HMO|||||2.15||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|Managed Medicare|HEALTHSPRING MA|||||279.50||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||279.50||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|Managed Medicaid|MEDICAID SUPERIOR|||||279.50||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||279.50||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|Humana Medicare Advantage|HUMANA MA|||||2.15||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|Managed Medicaid|MEDICAID AMERIGROUP|||||279.50||| 72100|EAP|0320|XR SPINE LUMBOSACRAL 2 OR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||279.50||| 72110|EAP|0320|XR SPINE LUMBOSACRAL COMP|Managed Medicaid|MEDICAID SUPERIOR|||||3.75||| 72110|EAP|0320|XR SPINE LUMBOSACRAL COMP|Cigna|CIGNA|||||3.75||| 72110|EAP|0320|XR SPINE LUMBOSACRAL COMP|Medicare|MEDICARE ACUTE|||||3.75||| 72110|EAP|0320|XR SPINE LUMBOSACRAL COMP|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||487.50||| 72110|EAP|0320|XR SPINE LUMBOSACRAL COMP|Blue Cross PPO Specialty|BCBSTX PPO|||||431.25||| 72110|EAP|0320|XR SPINE LUMBOSACRAL COMP|Cigna|CIGNA|||||487.50||| 72110|EAP|0320|XR SPINE LUMBOSACRAL COMP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||487.50||| 72110|EAP|0320|XR SPINE LUMBOSACRAL COMP|United Medicare Advantage|UHC MEDICARE GOLD MA|||||487.50||| 72110|EAP|0320|XR SPINE LUMBOSACRAL COMP|Humana Medicare Advantage|HUMANA MA|||||3.75||| 72114|EAP|0320|XR SPINE LUMBOSACRAL COMP|Tricare|TRICARE EAST REGION|||||3.75||| 72114|EAP|0320|XR SPINE LUMBOSACRAL COMP|NON CONTRACTED|COMMERCIAL OTHER 1|||||487.50||| 72114|EAP|0320|XR SPINE LUMBOSACRAL COMP|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||3.75||| 72114|EAP|0320|XR SPINE LUMBOSACRAL COMP|Medicaid|MEDICAID|||||487.50||| 72114|EAP|0320|XR SPINE LUMBOSACRAL COMP|United Healthcare|UNITED HEALTHCARE|||||431.25||| 72114|EAP|0320|XR SPINE LUMBOSACRAL COMP|United Healthcare|UNITED HEALTHCARE|||||487.50||| 72114|EAP|0320|XR SPINE LUMBOSACRAL COMP|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.75||| 72114|EAP|0320|XR SPINE LUMBOSACRAL COMP|Medicaid|MORRIS COUNTY INDIGENT|||||487.50||| 72114|EAP|0320|XR SPINE LUMBOSACRAL COMP|Medicare|MEDICARE ACUTE|||||3.75||| 72114|EAP|0320|XR SPINE LUMBOSACRAL COMP|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||487.50||| 72114|EAP|0320|XR SPINE LUMBOSACRAL COMP|Blue Cross HMO Specialty|BCBSTX HMO|||||3.75||| 72114|EAP|0320|XR SPINE LUMBOSACRAL COMP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||487.50||| 72114|EAP|0320|XR SPINE LUMBOSACRAL COMP|Cigna|CIGNA|||||431.25||| 72114|EAP|0320|XR SPINE LUMBOSACRAL COMP|Cigna|CIGNA|||||487.50||| 72114|EAP|0320|XR SPINE LUMBOSACRAL COMP|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||487.50||| 72114|EAP|0320|XR SPINE LUMBOSACRAL COMP|Blue Cross PPO Specialty|BCBSTX PPO|||||487.50||| 72114|EAP|0320|XR SPINE LUMBOSACRAL COMP|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3.75||| 72114|EAP|0320|XR SPINE LUMBOSACRAL COMP|Managed Medicaid|MEDICAID AMERIGROUP|||||487.50||| 72114|EAP|0320|XR SPINE LUMBOSACRAL COMP|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||487.50||| 72114|EAP|0320|XR SPINE LUMBOSACRAL COMP|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.75||| 72114|EAP|0320|XR SPINE LUMBOSACRAL COMP|Humana Medicare Advantage|HUMANA MA|||||487.50||| 72114|EAP|0320|XR SPINE LUMBOSACRAL COMP|Managed Medicaid|MEDICAID SUPERIOR|||||431.25||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|Humana Medicare Advantage|HUMANA MA|||||18.85||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|Cigna|CIGNA|||||1,667.50||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|Cigna|CIGNA|||||14.50||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1,667.50||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|Managed Medicaid|MEDICAID AMERIGROUP|||||1,667.50||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|Access Direct Platinum|HEALTHFIRST TPA UMR|||||14.50||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|Blue Cross PPO Specialty|BCBSTX PPO|||||1,667.50||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||18.85||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|18.85||||14.50||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|Blue Cross HMO Specialty|BCBSTX HMO|||||1,667.50||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|Managed Medicaid|MEDICAID SUPERIOR|||||18.85||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1,667.50||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,667.50||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||18.85||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|Veterans Affairs|VETERANS ADMINISTRATION|||||14.50||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||18.85||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|Workers Compensation|WORKERS COMPENSATION OTHER|||||18.85||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|United Medicare Advantage|UHC MEDICARE GOLD MA|14.50||||14.50||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|United Healthcare|UNITED HEALTHCARE|||||18.85||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|United Healthcare|TML GROUP BENEFITS|||||14.50||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|Medicaid|MEDICAID|14.50||||18.85||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|PHCS|GROUP AND PENSION|||||14.50||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|NON CONTRACTED|COMMERCIAL OTHER 1|||||14.50||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|Medicare|MEDICARE ACUTE|18.85||||1,667.50||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|PHCS|HUMANA INSURANCE|||||14.50||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|Tricare|TRICARE EAST REGION|||||14.50||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||14.50||| 72125|EAP|0350|CT SPINE CERVICAL W/O CON|Medicaid|MEDICAID TEXAS CHILDRENS|||||14.50||| 72128|EAP|0350|CT SPINE THORACIC W/0 CON|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||18.85||| 72128|EAP|0350|CT SPINE THORACIC W/0 CON|Medicaid|MEDICAID|14.50||||||| 72128|EAP|0350|CT SPINE THORACIC W/0 CON|United Healthcare|UNITED HEALTHCARE|||||14.50||| 72128|EAP|0350|CT SPINE THORACIC W/0 CON|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||18.85||| 72128|EAP|0350|CT SPINE THORACIC W/0 CON|Blue Cross PPO Specialty|BCBSTX PPO|||||14.50||| 72128|EAP|0350|CT SPINE THORACIC W/0 CON|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,667.50||| 72128|EAP|0350|CT SPINE THORACIC W/0 CON|Humana Medicare Advantage|HUMANA MA|||||18.85||| 72128|EAP|0350|CT SPINE THORACIC W/0 CON|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,667.50||| 72128|EAP|0350|CT SPINE THORACIC W/0 CON|Medicare|MEDICARE ACUTE|14.50||||18.85||| 72128|EAP|0350|CT SPINE THORACIC W/0 CON|Managed Medicaid|MEDICAID SUPERIOR|||||18.85||| 72128|EAP|0350|CT SPINE THORACIC W/0 CON|NON CONTRACTED|COMMERCIAL OTHER 1|||||18.85||| 72128|EAP|0350|CT SPINE THORACIC W/0 CON|Managed Medicaid|MEDICAID AMERIGROUP|||||14.50||| 72129|EAP|0350|CT SPINE THORACIC W CONTR|Blue Cross PPO Specialty|BCBSTX PPO|||||22.10||| 72131|EAP|0350|CT SPINE LUMBAR W/O CONTR|United Healthcare|UNITED HEALTHCARE|||||14.50||| 72131|EAP|0350|CT SPINE LUMBAR W/O CONTR|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||18.85||| 72131|EAP|0350|CT SPINE LUMBAR W/O CONTR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||18.85||| 72131|EAP|0350|CT SPINE LUMBAR W/O CONTR|United Healthcare|UNITED HEALTHCARE|||||1,667.50||| 72131|EAP|0350|CT SPINE LUMBAR W/O CONTR|Veterans Affairs|VETERANS ADMINISTRATION|||||18.85||| 72131|EAP|0350|CT SPINE LUMBAR W/O CONTR|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||14.50||| 72131|EAP|0350|CT SPINE LUMBAR W/O CONTR|Workers Compensation|WORKERS COMPENSATION OTHER|||||18.85||| 72131|EAP|0350|CT SPINE LUMBAR W/O CONTR|Medicare|MEDICARE ACUTE|18.85||||18.85||| 72131|EAP|0350|CT SPINE LUMBAR W/O CONTR|PHCS|HUMANA INSURANCE|||||18.85||| 72131|EAP|0350|CT SPINE LUMBAR W/O CONTR|Medicaid|MEDICAID TEXAS CHILDRENS|||||18.85||| 72131|EAP|0350|CT SPINE LUMBAR W/O CONTR|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||18.85||| 72131|EAP|0350|CT SPINE LUMBAR W/O CONTR|NON CONTRACTED|COMMERCIAL OTHER 1|||||14.50||| 72131|EAP|0350|CT SPINE LUMBAR W/O CONTR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|18.85||||14.50||| 72131|EAP|0350|CT SPINE LUMBAR W/O CONTR|Managed Medicaid|MEDICAID SUPERIOR|||||18.85||| 72131|EAP|0350|CT SPINE LUMBAR W/O CONTR|Humana Medicare Advantage|HUMANA MA|||||18.85||| 72131|EAP|0350|CT SPINE LUMBAR W/O CONTR|Managed Medicaid|MEDICAID AMERIGROUP|||||14.50||| 72131|EAP|0350|CT SPINE LUMBAR W/O CONTR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|14.50||||18.85||| 72131|EAP|0350|CT SPINE LUMBAR W/O CONTR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,667.50||| 72131|EAP|0350|CT SPINE LUMBAR W/O CONTR|Blue Cross PPO Specialty|BCBSTX PPO|||||14.50||| 72131|EAP|0350|CT SPINE LUMBAR W/O CONTR|Aetna|AETNA PPO|||||18.85||| 72132|EAP|0350|CT SPINE LUMBAR W/ CONTRA|Blue Cross PPO Specialty|BCBSTX PPO|||||22.10||| 72132|EAP|0350|CT SPINE LUMBAR W/ CONTRA|NON CONTRACTED|COMMERCIAL OTHER 1|||||22.10||| 72132|EAP|0350|CT SPINE LUMBAR W/ CONTRA|Humana Medicare Advantage|HUMANA MA|||||22.10||| 72132|EAP|0350|CT SPINE LUMBAR W/ CONTRA|Medicare|MEDICARE ACUTE|||||17.00||| 72141|EAP|0610|MRI CERVICAL SPINE WO|United Healthcare|UNITED HEALTHCARE|||||23.00||| 72141|EAP|0610|MRI CERVICAL SPINE WO|Workers Compensation|WORKERS COMPENSATION OTHER|||||23.00||| 72141|EAP|0610|MRI CERVICAL SPINE WO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||23.00||| 72141|EAP|0610|MRI CERVICAL SPINE WO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||23.00||| 72141|EAP|0610|MRI CERVICAL SPINE WO|Medicaid|MORRIS COUNTY INDIGENT|||||23.00||| 72141|EAP|0610|MRI CERVICAL SPINE WO|Tricare|TRICARE EAST REGION|||||23.00||| 72141|EAP|0610|MRI CERVICAL SPINE WO|Medicare|MEDICARE ACUTE|23.00||||23.00||| 72141|EAP|0610|MRI CERVICAL SPINE WO|NON CONTRACTED|COMMERCIAL OTHER 1|||||23.00||| 72141|EAP|0610|MRI CERVICAL SPINE WO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||23.00||| 72141|EAP|0610|MRI CERVICAL SPINE WO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||23.00||| 72141|EAP|0610|MRI CERVICAL SPINE WO|Humana Medicare Advantage|HUMANA MA|||||23.00||| 72141|EAP|0610|MRI CERVICAL SPINE WO|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||23.00||| 72141|EAP|0610|MRI CERVICAL SPINE WO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||23.00||| 72141|EAP|0610|MRI CERVICAL SPINE WO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||23.00||| 72141|EAP|0610|MRI CERVICAL SPINE WO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||23.00||| 72141|EAP|0610|MRI CERVICAL SPINE WO|Blue Cross PPO Specialty|BCBSTX PPO|||||23.00||| 72141|EAP|0610|MRI CERVICAL SPINE WO|Aetna|AETNA PPO|||||23.00||| 72141|EAP|0610|MRI CERVICAL SPINE WO|Aetna|AETNA OTHER|||||23.00||| 72141|EAP|0610|MRI CERVICAL SPINE WO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||23.00||| 72141|EAP|0610|MRI CERVICAL SPINE WO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||23.00||| 72146|EAP|0610|MRI THORACIC SPINE|Blue Cross PPO Specialty|BCBSTX PPO|||||23.00||| 72146|EAP|0610|MRI THORACIC SPINE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||23.00||| 72146|EAP|0610|MRI THORACIC SPINE|Blue Cross HMO Specialty|BCBSTX HMO|||||23.00||| 72146|EAP|0610|MRI THORACIC SPINE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||23.00||| 72146|EAP|0610|MRI THORACIC SPINE|Humana Medicare Advantage|HUMANA MA|||||23.00||| 72146|EAP|0610|MRI THORACIC SPINE|Managed Medicare|BCBS MEDICARE PPO MA|||||23.00||| 72146|EAP|0610|MRI THORACIC SPINE|Medicare|MEDICARE ACUTE|23.00||||23.00||| 72146|EAP|0610|MRI THORACIC SPINE|NON CONTRACTED|COMMERCIAL OTHER 1|||||23.00||| 72146|EAP|0610|MRI THORACIC SPINE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||23.00||| 72146|EAP|0610|MRI THORACIC SPINE|United Healthcare|UNITED HEALTHCARE|||||23.00||| 72146|EAP|0610|MRI THORACIC SPINE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||23.00||| 72146|EAP|0610|MRI THORACIC SPINE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO CONTR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO CONTR|Workers Compensation|WORKERS COMPENSATION OTHER|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO CONTR|United Healthcare|UNITED HEALTHCARE|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO CONTR|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO CONTR|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO CONTR|United Medicare Advantage|UHC MEDICARE GOLD MA|23.00||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO CONTR|Tricare|TRICARE EAST REGION|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO CONTR|Medicare|MEDICARE ACUTE|23.00||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO CONTR|NON CONTRACTED|COMMERCIAL OTHER 1|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO CONTR|Managed Medicaid|MEDICAID SUPERIOR|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO CONTR|Managed Medicare|BCBS MEDICARE PPO MA|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO CONTR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO CONTR|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO CONTR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO CONTR|Cigna|CIGNA|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO CONTR|Managed Medicare|HEALTHSPRING MA|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO CONTR|Humana Medicare Advantage|HUMANA MA|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO CONTR|Blue Cross HMO Specialty|BCBSTX HMO|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO CONTR|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO CONTR|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO CONTR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|23.00||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO CONTR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO CONTR|Blue Cross PPO Specialty|BCBSTX PPO|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO CONTR|Access Direct Platinum|HEALTHFIRST TPA UMR|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO CONTR|Aetna|AETNA PPO|||||23.00||| 72156|EAP|0610|MRI CERVICAL SPINE W W/O|Humana Medicare Advantage|HUMANA MA|||||34.00||| 72156|EAP|0610|MRI CERVICAL SPINE W W/O|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||34.00||| 72156|EAP|0610|MRI CERVICAL SPINE W W/O|United Medicare Advantage|UHC MEDICARE GOLD MA|34.00||||||| 72156|EAP|0610|MRI CERVICAL SPINE W W/O|Aetna|AETNA PPO|||||34.00||| 72156|EAP|0610|MRI CERVICAL SPINE W W/O|Cigna|CIGNA|||||34.00||| 72157|EAP|0610|MRI THORACIC SPINE W WO|Medicare|MEDICARE ACUTE|34.00||||||| 72158|EAP|0610|MRI LUMBAR SPINE W W/O|Blue Cross PPO Specialty|BCBSTX PPO|||||34.00||| 72158|EAP|0610|MRI LUMBAR SPINE W W/O|United Medicare Advantage|UHC MEDICARE GOLD MA|||||34.00||| 72158|EAP|0610|MRI LUMBAR SPINE W W/O|Medicare|MEDICARE ACUTE|||||34.00||| 72158|EAP|0610|MRI LUMBAR SPINE W W/O|United Healthcare|UNITED HEALTHCARE|||||34.00||| 72158|EAP|0610|MRI LUMBAR SPINE W W/O|Veterans Affairs|VETERANS ADMINISTRATION|||||34.00||| 72158|EAP|0610|MRI LUMBAR SPINE W W/O|Aenta Medicare Advantage|AETNA MEDICARE MA|||||34.00||| 72158|EAP|0610|MRI LUMBAR SPINE W W/O|Humana Medicare Advantage|HUMANA MA|||||34.00||| 72158|EAP|0610|MRI LUMBAR SPINE W W/O|Blue Cross HMO Specialty|BCBSTX HMO|||||34.00||| 72170|EAP|0320|XR PELVIS 1 VIEW|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||253.50||| 72170|EAP|0320|XR PELVIS 1 VIEW|Medicare|MEDICARE ACUTE|1.95||||1.95||| 72170|EAP|0320|XR PELVIS 1 VIEW|Tricare|TRICARE EAST REGION|||||253.50||| 72170|EAP|0320|XR PELVIS 1 VIEW|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.95||| 72170|EAP|0320|XR PELVIS 1 VIEW|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||253.50||| 72170|EAP|0320|XR PELVIS 1 VIEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.95||| 72170|EAP|0320|XR PELVIS 1 VIEW|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.95||| 72170|EAP|0320|XR PELVIS 1 VIEW|Blue Cross PPO Specialty|BCBSTX PPO|||||253.50||| 72170|EAP|0320|XR PELVIS 1 VIEW|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.95||| 72170|EAP|0320|XR PELVIS 1 VIEW|Managed Medicaid|MEDICAID SUPERIOR|||||1.95||| 72170|EAP|0320|XR PELVIS 1 VIEW|Humana Medicare Advantage|HUMANA MA|||||253.50||| 72170|EAP|0320|XR PELVIS 1 VIEW|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.95||| 72191|EAP|0352|CTA PELVIS WO/W|NON CONTRACTED|COMMERCIAL OTHER 1|||||29.25||| 72192|EAP|0350|CT PELVIS W/O CONTRAST|Cigna|CIGNA|||||18.85||| 72192|EAP|0350|CT PELVIS W/O CONTRAST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||14.50||| 72192|EAP|0350|CT PELVIS W/O CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,667.50||| 72192|EAP|0350|CT PELVIS W/O CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||18.85||| 72192|EAP|0350|CT PELVIS W/O CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|||||18.85||| 72192|EAP|0350|CT PELVIS W/O CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||18.85||| 72192|EAP|0350|CT PELVIS W/O CONTRAST|United Healthcare|TML GROUP BENEFITS|||||14.50||| 72192|EAP|0350|CT PELVIS W/O CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|||||18.85||| 72192|EAP|0350|CT PELVIS W/O CONTRAST|Humana Medicare Advantage|HUMANA MA|||||14.50||| 72192|EAP|0350|CT PELVIS W/O CONTRAST|Medicaid|MEDICAID TEXAS CHILDRENS|||||14.50||| 72192|EAP|0350|CT PELVIS W/O CONTRAST|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||18.85||| 72192|EAP|0350|CT PELVIS W/O CONTRAST|Medicare|MEDICARE ACUTE|18.85||||14.50||| 72192|EAP|0350|CT PELVIS W/O CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||14.50||| 72192|EAP|0350|CT PELVIS W/O CONTRAST|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||14.50||| 72192|EAP|0350|CT PELVIS W/O CONTRAST|Workers Compensation|WORKERS COMPENSATION OTHER|||||18.85||| 72192|EAP|0350|CT PELVIS W/O CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|||||18.85||| 72193|EAP|0350|CT PELVIS WITH CONTRAST|Medicare|MEDICARE ACUTE|22.10||||17.00||| 72193|EAP|0350|CT PELVIS WITH CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||22.10||| 72193|EAP|0350|CT PELVIS WITH CONTRAST|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||17.00||| 72193|EAP|0350|CT PELVIS WITH CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|17.00||||||| 72195|EAP|0610|MRI PELVIS WO CONTRAST|Medicare|MEDICARE ACUTE|||||23.00||| 72197|EAP|0610|MRI PELVIS W AND WO|Blue Cross PPO Specialty|BCBSTX PPO|||||34.00||| 72197|EAP|0610|MRI PELVIS W AND WO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||34.00||| 72197|EAP|0610|MRI PELVIS W AND WO|Medicare|MEDICARE ACUTE|||||34.00||| 72200|EAP|0320|XR SACROILIAC JOINTS|Tricare|TRICARE EAST REGION|||||3.25||| 72200|EAP|0320|XR SACROILIAC JOINTS|Medicare|MEDICARE ACUTE|||||2.50||| 72200|EAP|0320|XR SACROILIAC JOINTS|United Healthcare|UNITED HEALTHCARE|||||2.50||| 72200|EAP|0320|XR SACROILIAC JOINTS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.50||| 72200|EAP|0320|XR SACROILIAC JOINTS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.25||| 72220|EAP|0320|XR SACRUM/COCCYX 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||2.15||| 72220|EAP|0320|XR SACRUM/COCCYX 2 VIEWS|Managed Medicare|HEALTHSPRING MA|||||2.15||| 72220|EAP|0320|XR SACRUM/COCCYX 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||279.50||| 72220|EAP|0320|XR SACRUM/COCCYX 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||247.25||| 72220|EAP|0320|XR SACRUM/COCCYX 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||279.50||| 72220|EAP|0320|XR SACRUM/COCCYX 2 VIEWS|Cigna|CIGNA|||||279.50||| 72220|EAP|0320|XR SACRUM/COCCYX 2 VIEWS|Aetna|AETNA QHP HMO|||||279.50||| 72220|EAP|0320|XR SACRUM/COCCYX 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||2.15||| 72220|EAP|0320|XR SACRUM/COCCYX 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||247.25||| 72220|EAP|0320|XR SACRUM/COCCYX 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.15||| 72220|EAP|0320|XR SACRUM/COCCYX 2 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||279.50||| 72220|EAP|0320|XR SACRUM/COCCYX 2 VIEWS|Medicare|MEDICARE ACUTE|||||2.15||| 72220|EAP|0320|XR SACRUM/COCCYX 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.15||| 728|DRG||INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM W/O MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|10,714.72|39.26|39.26|39.26|||| 729|DRG||OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES W CC/MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|18,964.48|58.89|58.89|58.89|||| 73|DRG||CRANIAL & PERIPHERAL NERVE DISORDERS W MCC|United Healthcare|UNITED HEALTHCARE|27,943.75|14143.26|14143.26|14143.26|||| 73000|EAP|0320|XR RT CLAVICLE COMPLETE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.15||| 73000|EAP|0320|XR LT CLAVICLE COMPLETE|Blue Cross HMO Specialty|BCBSTX HMO|||||279.50||| 73000|EAP|0320|XR LT CLAVICLE COMPLETE|Blue Cross PPO Specialty|BCBSTX PPO|||||279.50||| 73000|EAP|0320|XR LT CLAVICLE COMPLETE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.15||| 73000|EAP|0320|XR LT CLAVICLE COMPLETE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.15||| 73000|EAP|0320|XR LT CLAVICLE COMPLETE|Cigna|CIGNA|||||279.50||| 73000|EAP|0320|XR LT CLAVICLE COMPLETE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.15||| 73000|EAP|0320|XR LT CLAVICLE COMPLETE|Managed Medicaid|MEDICAID AMERIGROUP|||||279.50||| 73000|EAP|0320|XR RT CLAVICLE COMPLETE|Humana Medicare Advantage|HUMANA MA|||||279.50||| 73000|EAP|0320|XR LT CLAVICLE COMPLETE|Humana Medicare Advantage|HUMANA MA|||||279.50||| 73000|EAP|0320|XR LT CLAVICLE COMPLETE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||279.50||| 73000|EAP|0320|XR RT CLAVICLE COMPLETE|Medicare|MEDICARE ACUTE|||||2.15||| 73000|EAP|0320|XR LT CLAVICLE COMPLETE|Medicare|MEDICARE ACUTE|||||279.50||| 73010|EAP|0320|XR LT SCAPULA COMPLETE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.15||| 73010|EAP|0320|XR LT SCAPULA COMPLETE|Medicare|MEDICARE ACUTE|||||2.15||| 73010|EAP|0320|XR RT SCAPULA COMPLETE|Humana Medicare Advantage|HUMANA MA|||||487.50||| 73010|EAP|0320|XR LT SCAPULA COMPLETE|Blue Cross PPO Specialty|BCBSTX PPO|||||2.15||| 73020|EAP|0320|XR LT SHOULDER 1 VIEW|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.95||| 73020|EAP|0320|XR LT SHOULDER 1 VIEW|Medicare|MEDICARE ACUTE|||||253.50||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||279.50||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|Aetna|AETNA OTHER|||||247.25||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||279.50||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||2.15||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.15||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|2.15||||247.25||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.15||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UMR|||||279.50||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||279.50||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|Cigna|CIGNA|||||2.15||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|Cigna|CIGNA|||||279.50||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.15||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||279.50||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.15||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||279.50||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|Managed Medicare|HEALTHSPRING MA|||||279.50||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||247.25||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|Medicare|MEDICARE ACUTE|279.50||||2.15||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.15||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|Medicare|MEDICARE ACUTE|279.50||||279.50||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.15||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|PHCS|HUMANA INSURANCE|||||279.50||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2.15||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|Tricare|TRICARE EAST REGION|||||247.25||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|Medicaid|MEDICAID|||||279.50||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||279.50||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||247.25||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|Medicaid|MORRIS COUNTY INDIGENT|||||279.50||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.15||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||279.50||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.15||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||279.50||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|Tricare|TRICARE EAST REGION|||||279.50||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||2.15||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||247.25||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|2.15||||2.15||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||279.50||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||279.50||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||279.50||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||279.50||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||279.50||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.15||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.15||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||247.25||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||2.15||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.15||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.15||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||2.15||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||279.50||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||279.50||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|United Healthcare|TML GROUP BENEFITS|||||2.15||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||2.15||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||279.50||| 73030|EAP|0320|XR RT SHOULDER 2 VIEWS|United Healthcare|TML GROUP BENEFITS|||||2.15||| 73030|EAP|0320|XR LT SHOULDER 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||279.50||| 73060|EAP|0320|XR LT HUMERUS 2 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.15||| 73060|EAP|0320|XR LT HUMERUS 2 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.15||| 73060|EAP|0320|XR LT HUMERUS 2 VIEWS|Medicare|MEDICARE ACUTE|279.50||||247.25||| 73060|EAP|0320|XR RT HUMERUS 2 VIEWS|Medicare|MEDICARE ACUTE|279.50||||247.25||| 73060|EAP|0320|XR LT HUMERUS 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||279.50||| 73060|EAP|0320|XR RT HUMERUS 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||279.50||| 73060|EAP|0320|XR RT HUMERUS 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||247.25||| 73060|EAP|0320|XR LT HUMERUS 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||279.50||| 73060|EAP|0320|XR RT HUMERUS 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.15||| 73060|EAP|0320|XR RT HUMERUS 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||279.50||| 73060|EAP|0320|XR LT HUMERUS 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||279.50||| 73060|EAP|0320|XR LT HUMERUS 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||247.25||| 73060|EAP|0320|XR RT HUMERUS 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||279.50||| 73060|EAP|0320|XR LT HUMERUS 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||279.50||| 73060|EAP|0320|XR RT HUMERUS 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||279.50||| 73060|EAP|0320|XR LT HUMERUS 2 VIEWS|Cigna|CIGNA|||||2.15||| 73070|EAP|0320|XR LT ELBOW 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.15||| 73070|EAP|0320|XR LT ELBOW 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||247.25||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.15||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||247.25||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|Aetna|AETNA PPO|||||279.50||| 73070|EAP|0320|XR LT ELBOW 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.15||| 73070|EAP|0320|XR LT ELBOW 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||2.15||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||279.50||| 73070|EAP|0320|XR LT ELBOW 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||279.50||| 73070|EAP|0320|XR LT ELBOW 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||279.50||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.15||| 73070|EAP|0320|XR LT ELBOW 2 VIEWS|Medicaid|MEDICAID|||||279.50||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||279.50||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||279.50||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||247.25||| 73070|EAP|0320|XR LT ELBOW 2 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.15||| 73070|EAP|0320|XR LT ELBOW 2 VIEWS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||279.50||| 73070|EAP|0320|XR LT ELBOW 2 VIEWS|Medicare|MEDICARE ACUTE|279.50||||279.50||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|Medicare|MEDICARE ACUTE|279.50||||247.25||| 73070|EAP|0320|XR LT ELBOW 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||279.50||| 73070|EAP|0320|XR LT ELBOW 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||279.50||| 73070|EAP|0320|XR LT ELBOW 2 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|279.50||||2.15||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||279.50||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||279.50||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||2.15||| 73070|EAP|0320|XR LT ELBOW 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||279.50||| 73080|EAP|0320|XR RT ELBOW 3 VIEWS OR MO|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.50||| 73080|EAP|0320|XR RT ELBOW 3 VIEWS OR MO|United Healthcare|UNITED HEALTHCARE|||||287.50||| 73080|EAP|0320|XR RT ELBOW 3 VIEWS OR MO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.50||| 73080|EAP|0320|XR RT ELBOW 3 VIEWS OR MO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||287.50||| 73080|EAP|0320|XR LT ELBOW 3 VIEWS OR MO|Veterans Affairs|VETERANS ADMINISTRATION|||||2.50||| 73080|EAP|0320|XR LT ELBOW 3 VIEWS OR MO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.25||| 73080|EAP|0320|XR LT ELBOW 3 VIEWS OR MO|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.50||| 73080|EAP|0320|XR RT ELBOW 3 VIEWS OR MO|Medicare|MEDICARE ACUTE|2.50||||287.50||| 73080|EAP|0320|XR LT ELBOW 3 VIEWS OR MO|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||287.50||| 73080|EAP|0320|XR RT ELBOW 3 VIEWS OR MO|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||3.25||| 73080|EAP|0320|XR LT ELBOW 3 VIEWS OR MO|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.25||| 73080|EAP|0320|XR RT ELBOW 3 VIEWS OR MO|Tricare|TRICARE EAST REGION|||||3.25||| 73080|EAP|0320|XR RT ELBOW 3 VIEWS OR MO|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.25||| 73080|EAP|0320|XR LT ELBOW 3 VIEWS OR MO|Medicare|MEDICARE ACUTE|2.50||||2.50||| 73080|EAP|0320|XR RT ELBOW 3 VIEWS OR MO|Managed Medicaid|MEDICAID SUPERIOR|||||3.25||| 73080|EAP|0320|XR RT ELBOW 3 VIEWS OR MO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.50||| 73080|EAP|0320|XR RT ELBOW 3 VIEWS OR MO|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.50||| 73080|EAP|0320|XR RT ELBOW 3 VIEWS OR MO|Humana Medicare Advantage|HUMANA MA|||||3.25||| 73080|EAP|0320|XR LT ELBOW 3 VIEWS OR MO|Managed Medicaid|MEDICAID AMERIGROUP|||||2.50||| 73080|EAP|0320|XR RT ELBOW 3 VIEWS OR MO|Managed Medicaid|MEDICAID AMERIGROUP|||||3.25||| 73080|EAP|0320|XR LT ELBOW 3 VIEWS OR MO|Humana Medicare Advantage|HUMANA MA|||||3.25||| 73080|EAP|0320|XR LT ELBOW 3 VIEWS OR MO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3.25||| 73080|EAP|0320|XR RT ELBOW 3 VIEWS OR MO|Blue Cross PPO Specialty|BCBSTX PPO|||||2.50||| 73080|EAP|0320|XR LT ELBOW 3 VIEWS OR MO|Blue Cross PPO Specialty|BCBSTX PPO|||||2.50||| 73080|EAP|0320|XR RT ELBOW 3 VIEWS OR MO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.25||| 73080|EAP|0320|XR LT ELBOW 3 VIEWS OR MO|Aetna|AETNA OTHER|||||3.25||| 73080|EAP|0320|XR RT ELBOW 3 VIEWS OR MO|Cigna|CIGNA|||||2.50||| 73080|EAP|0320|XR RT ELBOW 3 VIEWS OR MO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||287.50||| 73080|EAP|0320|XR LT ELBOW 3 VIEWS OR MO|Cigna|CIGNA|||||3.25||| 73080|EAP|0320|XR LT ELBOW 3 VIEWS OR MO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.25||| 73080|EAP|0320|XR LT ELBOW 3 VIEWS OR MO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.25||| 73080|EAP|0320|XR RT ELBOW 3 VIEWS OR MO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.50||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.15||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Cigna|CIGNA|||||2.15||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||2.15||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||279.50||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||279.50||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Humana Medicare Advantage|HUMANA MA|2.15||||279.50||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Cigna|CIGNA|||||2.15||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||279.50||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.15||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||279.50||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||279.50||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||279.50||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||279.50||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||279.50||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.15||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||279.50||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Medicare|MEDICARE ACUTE|279.50||||279.50||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||279.50||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.15||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Medicaid|MEDICAID|||||2.15||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.15||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.15||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||279.50||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Medicare|MEDICARE ACUTE|279.50||||2.15||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2.15||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||279.50||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||247.25||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||247.25||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||2.15||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||279.50||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||279.50||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Medicaid|MEDICAID|||||279.50||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.15||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||279.50||| 73100|EAP|0320|XR RT WRIST 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||279.50||| 73100|EAP|0320|XR RT WRIST 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||279.50||| 73100|EAP|0320|XR LT WRIST 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||279.50||| 73100|EAP|0320|XR LT WRIST 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.15||| 73100|EAP|0320|XR RT WRIST 2 VIEWS|Medicare|MEDICARE ACUTE|||||2.15||| 73100|EAP|0320|XR LT WRIST 2 VIEWS|Medicare|MEDICARE ACUTE|||||279.50||| 73100|EAP|0320|XR RT WRIST 2 VIEWS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2.15||| 73100|EAP|0320|XR LT WRIST 2 VIEWS|Tricare|TRICARE EAST REGION|||||2.15||| 73100|EAP|0320|XR LT WRIST 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||247.25||| 73100|EAP|0320|XR RT WRIST 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||247.25||| 73100|EAP|0320|XR RT WRIST 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||247.25||| 73100|EAP|0320|XR RT WRIST 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||2.15||| 73100|EAP|0320|XR RT WRIST 2 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||279.50||| 73100|EAP|0320|XR LT WRIST 2 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||279.50||| 73100|EAP|0320|XR RT WRIST 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||279.50||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||2.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||287.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||3.25||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UMR|||||2.50||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||287.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||3.25||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.25||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.25||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.50||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Humana Medicare Advantage|HUMANA MA|||||2.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||3.25||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Humana Medicare Advantage|HUMANA MA|||||2.50||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||2.50||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.25||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Tricare|TRICARE EAST REGION|||||2.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||287.50||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Medicaid|MORRIS COUNTY INDIGENT|||||3.25||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||3.25||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3.25||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Medicare|MEDICARE ACUTE|3.25||||3.25||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Medicaid|MEDICAID|||||2.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.50||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.50||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Aetna|AETNA OTHER|||||3.25||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Medicare|MEDICARE ACUTE|3.25||||2.50||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||3.25||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||3.25||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||2.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.50||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3.25||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||287.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Medicaid|MORRIS COUNTY INDIGENT|||||3.25||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||2.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||2.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||3.25||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.50||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||3.25||| 73120|EAP|0320|XR RT HAND 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|2.15||||2.15||| 73120|EAP|0320|XR RT HAND 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||279.50||| 73120|EAP|0320|XR LT HAND 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||279.50||| 73120|EAP|0320|XR RT HAND 2 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.15||| 73120|EAP|0320|XR LT HAND 2 VIEWS|Medicare|MEDICARE ACUTE|2.15||||2.15||| 73120|EAP|0320|XR RT HAND 2 VIEWS|Medicare|MEDICARE ACUTE|2.15||||279.50||| 73120|EAP|0320|XR RT HAND 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||2.15||| 73120|EAP|0320|XR RT HAND 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.15||| 73120|EAP|0320|XR RT HAND 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||2.15||| 73120|EAP|0320|XR LT HAND 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||279.50||| 73120|EAP|0320|XR RT HAND 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73120|EAP|0320|XR LT HAND 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||279.50||| 73120|EAP|0320|XR RT HAND 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.15||| 73120|EAP|0320|XR LT HAND 2 VIEWS|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||279.50||| 73120|EAP|0320|XR RT HAND 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||2.15||| 73120|EAP|0320|XR LT HAND 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||2.15||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.50||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3.25||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||3.25||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||3.25||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Cigna|CIGNA|||||3.25||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||2.50||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.25||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Humana Medicare Advantage|HUMANA MA|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Cigna|CIGNA|||||287.50||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||2.50||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Medicaid|MEDICAID|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||2.50||| 73130|EAP|0320|XR LT HAND 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.50||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Medicare|MEDICARE ACUTE|||||2.50||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Medicaid|MORRIS COUNTY INDIGENT|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||3.25||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||3.25||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.25||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||3.25||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Humana Medicare Advantage|HUMANA MA|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Medicare|MEDICARE ACUTE|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.50||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||3.25||| 73130|EAP|0320|XR RT HAND 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||287.50||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.50||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Tricare|TRICARE EAST REGION|||||3.25||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Medicaid|MEDICAID|||||3.25||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.50||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||3.25||| 73130|EAP|0320|XR LT HAND 3 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||2.50||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||3.25||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||3.25||| 73130|EAP|0320|XR LT HAND 3 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||3.25||| 73130|EAP|0320|XR RT HAND 3 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||287.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.50||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.50||| 73130|EAP|0320|XR LT HAND 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||2.50||| 73140|EAP|0320|XR FINGERS 2 VIEWS LT|Workers Compensation|WORKERS COMPENSATION OTHER|||||247.25||| 73140|EAP|0320|XR FINGERS 2 VIEWS LT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.15||| 73140|EAP|0320|XR FINGERS 2 VIEWS RT|Workers Compensation|WORKERS COMPENSATION OTHER|||||279.50||| 73140|EAP|0320|XR FINGERS 2 VIEWS RT|Medicaid|MEDICAID TEXAS CHILDRENS|||||247.25||| 73140|EAP|0320|XR FINGERS 2 VIEWS LT|Medicaid|MEDICAID|||||279.50||| 73140|EAP|0320|XR FINGERS 2 VIEWS RT|Medicare|MEDICARE ACUTE|||||279.50||| 73140|EAP|0320|XR FINGERS 2 VIEWS LT|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||279.50||| 73140|EAP|0320|XR FINGERS 2 VIEWS LT|Medicare|MEDICARE ACUTE|||||2.15||| 73140|EAP|0320|XR FINGERS 2 VIEWS RT|Tricare|TRICARE EAST REGION|||||279.50||| 73140|EAP|0320|XR FINGERS 2 VIEWS LT|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73140|EAP|0320|XR FINGERS 2 VIEWS RT|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.15||| 73140|EAP|0320|XR FINGERS 2 VIEWS LT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.15||| 73140|EAP|0320|XR FINGERS 2 VIEWS LT|Managed Medicaid|MEDICAID SUPERIOR|||||2.15||| 73140|EAP|0320|XR FINGERS 2 VIEWS LT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.15||| 73140|EAP|0320|XR FINGERS 2 VIEWS LT|Cigna|CIGNA|||||247.25||| 73140|EAP|0320|XR FINGERS 2 VIEWS RT|Veterans Affairs|VETERANS ADMINISTRATION|||||279.50||| 73140|EAP|0320|XR FINGERS 2 VIEWS RT|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73140|EAP|0320|XR FINGERS 2 VIEWS RT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.15||| 73140|EAP|0320|XR FINGERS 2 VIEWS RT|Managed Medicaid|MEDICAID SUPERIOR|||||2.15||| 73140|EAP|0320|XR FINGERS 2 VIEWS LT|Humana Medicare Advantage|HUMANA MA|||||2.15||| 73140|EAP|0320|XR FINGERS 2 VIEWS LT|Blue Cross PPO Specialty|BCBSTX PPO|||||279.50||| 73140|EAP|0320|XR FINGERS 2 VIEWS LT|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.15||| 73140|EAP|0320|XR FINGERS 2 VIEWS RT|Blue Cross PPO Specialty|BCBSTX PPO|||||247.25||| 73140|EAP|0320|XR FINGERS 2 VIEWS LT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.15||| 73140|EAP|0320|XR FINGERS 2 VIEWS RT|Blue Cross HMO Specialty|BCBSTX HMO|||||2.15||| 73140|EAP|0320|XR FINGERS 2 VIEWS RT|Aetna|AETNA PPO|||||279.50||| 73140|EAP|0320|XR FINGERS 2 VIEWS RT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||279.50||| 73140|EAP|0320|XR FINGERS 2 VIEWS RT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||247.25||| 73140|EAP|0320|XR FINGERS 2 VIEWS LT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||279.50||| 73140|EAP|0320|XR FINGERS 2 VIEWS RT|Humana Medicare Advantage|HUMANA MA|||||279.50||| 73200|EAP|0350|CT EXTREM UPPER RT WO CON|Blue Cross PPO Specialty|BCBSTX PPO|||||18.85||| 73200|EAP|0350|CT EXTREM UPPER LT WO CON|Managed Medicaid|MEDICAID AMERIGROUP|||||18.85||| 73200|EAP|0350|CT EXTREM UPPER LT WO CON|Humana Medicare Advantage|HUMANA MA|||||1,667.50||| 73200|EAP|0350|CT EXTREM UPPER RT WO CON|Tricare|TRICARE EAST REGION|||||14.50||| 73200|EAP|0350|CT EXTREM UPPER RT WO CON|Medicare|MEDICARE ACUTE|18.85||||18.85||| 73200|EAP|0350|CT EXTREM UPPER LT WO CON|Medicare|MEDICARE ACUTE|18.85||||14.50||| 73200|EAP|0350|CT EXTREM UPPER LT WO CON|NON CONTRACTED|COMMERCIAL OTHER 1|||||18.85||| 73200|EAP|0350|CT EXTREM UPPER LT WO CON|United Medicare Advantage|UHC MEDICARE GOLD MA|||||14.50||| 73200|EAP|0350|CT EXTREM UPPER RT WO CON|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,667.50||| 73200|EAP|0350|CT EXTREM UPPER RT WO CON|United Healthcare|UNITED HEALTHCARE|||||14.50||| 73201|EAP|0350|CT EXTREM UPPER RT W CONT|Veterans Affairs|VETERANS ADMINISTRATION|22.10||||||| 73201|EAP|0350|CT EXTREM UPPER RT W CONT|Medicare|MEDICARE ACUTE|||||19.55||| 73201|EAP|0350|CT EXTREM UPPER LT W CONT|Medicare|MEDICARE ACUTE|||||17.00||| 73201|EAP|0350|CT EXTREM UPPER RT W CONT|Blue Cross PPO Specialty|BCBSTX PPO|||||17.00||| 73201|EAP|0350|CT EXTREM UPPER RT W CONT|Workers Compensation|WORKERS COMPENSATION OTHER|||||22.10||| 73201|EAP|0350|CT EXTREM UPPER LT W CONT|NON CONTRACTED|COMMERCIAL OTHER 1|17.00||||||| 73201|EAP|0350|CT EXTREM UPPER RT W CONT|NON CONTRACTED|COMMERCIAL OTHER 1|17.00||||||| 73218|EAP|0610|MRI LT UPPER EXTREMITY W/|Blue Cross PPO Specialty|BCBSTX PPO|||||23.00||| 73218|EAP|0610|MRI RT UPPER EXTREMITY W/|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||23.00||| 73218|EAP|0610|MRI LT UPPER EXTREMITY W/|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||23.00||| 73218|EAP|0610|MRI RT UPPER EXTREMITY W/|Blue Cross PPO Specialty|BCBSTX PPO|||||23.00||| 73218|EAP|0610|MRI RT UPPER EXTREMITY W/|Medicare|MEDICARE ACUTE|||||23.00||| 73221|EAP|0610|MRI UPPER EXTREMITY JOINT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||23.00||| 73221|EAP|0610|MRI UPPER EXTREMITY JOINT|United Healthcare|UNITED HEALTHCARE|||||23.00||| 73221|EAP|0610|MRI UPPER EXTREMITY JOINT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||23.00||| 73221|EAP|0610|MRI UPPER EXTREMITY JOINT|NON CONTRACTED|COMMERCIAL OTHER 1|||||23.00||| 73221|EAP|0610|MRI UPPER EXTREMITY JOINT|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||23.00||| 73221|EAP|0610|MRI UPPER EXTREMITY JOINT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||23.00||| 73221|EAP|0610|MRI UPPER EXTREMITY JOINT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||23.00||| 73221|EAP|0610|MRI UPPER EXTREMITY JOINT|Cigna|CIGNA|||||23.00||| 73221|EAP|0610|MRI UPPER EXTREMITY JOINT|Managed Medicare|HEALTHSPRING MA|||||23.00||| 73221|EAP|0610|MRI UPPER EXTREMITY JOINT|Tricare|TRICARE EAST REGION|||||23.00||| 73221|EAP|0610|MRI UPPER EXTREMITY JOINT|Humana Medicare Advantage|HUMANA MA|||||23.00||| 73221|EAP|0610|MRI UPPER EXTREMITY JOINT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||23.00||| 73221|EAP|0610|MRI UPPER EXTREMITY JOINT|Aenta Medicare Advantage|AETNA MEDICARE MA|||||23.00||| 73221|EAP|0610|MRI UPPER EXTREMITY JOINT|Medicare|MEDICARE ACUTE|||||23.00||| 73221|EAP|0610|MRI UPPER EXTREMITY JOINT|Blue Cross PPO Specialty|BCBSTX PPO|||||23.00||| 73221|EAP|0610|MRI UPPER EXTREMITY JOINT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||23.00||| 73221|EAP|0610|MRI UPPER EXTREMITY JOINT|Blue Cross HMO Specialty|BCBSTX HMO|||||23.00||| 73221|EAP|0610|MRI UPPER EXTREMITY JOINT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||23.00||| 73221|EAP|0610|MRI UPPER EXTREMITY JOINT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||23.00||| 73221|EAP|0610|MRI UPPER EXTREMITY JOINT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||23.00||| 73223|EAP|0610|MRI UPPER EXTREMITY W WO|Medicare|MEDICARE ACUTE|34.00||||||| 73501|EAP|0320|XR HIP UNILATERAL 1 VIEW|Managed Medicaid|MEDICAID SUPERIOR|||||253.50||| 73501|EAP|0320|XR HIP UNILATERAL 1 VIEW|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||224.25||| 73501|EAP|0320|XR HIP UNILATERAL 1 VIEW|Managed Medicaid|MEDICAID AMERIGROUP|||||1.95||| 73501|EAP|0320|XR HIP UNILATERAL 1 VIEW|Medicare|MEDICARE ACUTE|||||1.95||| 73502|EAP|0320|XR HIP UNILATERAL 2 OR 3|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||279.50||| 73502|EAP|0320|XR HIP UNILATERAL 2 OR 3|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||279.50||| 73502|EAP|0320|XR HIP UNILATERAL 2 OR 3|Workers Compensation|WORKERS COMPENSATION OTHER|||||247.25||| 73502|EAP|0320|XR HIP UNILATERAL 2 OR 3|NON CONTRACTED|COMMERCIAL OTHER 1|||||247.25||| 73502|EAP|0320|XR HIP UNILATERAL 2 OR 3|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||279.50||| 73502|EAP|0320|XR HIP UNILATERAL 2 OR 3|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.15||| 73502|EAP|0320|XR HIP UNILATERAL 2 OR 3|Medicare|MEDICARE ACUTE|279.50||||2.15||| 73502|EAP|0320|XR HIP UNILATERAL 2 OR 3|Tricare|TRICARE EAST REGION|||||2.15||| 73502|EAP|0320|XR HIP UNILATERAL 2 OR 3|Blue Cross PPO Specialty|BCBSTX PPO|||||279.50||| 73502|EAP|0320|XR HIP UNILATERAL 2 OR 3|Aetna|AETNA OTHER|||||2.15||| 73502|EAP|0320|XR HIP UNILATERAL 2 OR 3|Aenta Medicare Advantage|AETNA MEDICARE MA|||||279.50||| 73502|EAP|0320|XR HIP UNILATERAL 2 OR 3|Blue Cross HMO Specialty|BCBSTX HMO|||||2.15||| 73502|EAP|0320|XR HIP UNILATERAL 2 OR 3|United Healthcare|UNITED HEALTHCARE|||||2.15||| 73502|EAP|0320|XR HIP UNILATERAL 2 OR 3|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||247.25||| 73502|EAP|0320|XR HIP UNILATERAL 2 OR 3|United Medicare Advantage|UHC MEDICARE GOLD MA|2.15||||247.25||| 73502|EAP|0320|XR HIP UNILATERAL 2 OR 3|Managed Medicaid|MEDICAID AMERIGROUP|||||247.25||| 73502|EAP|0320|XR HIP UNILATERAL 2 OR 3|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.15||| 73502|EAP|0320|XR HIP UNILATERAL 2 OR 3|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.15||| 73502|EAP|0320|XR HIP UNILATERAL 2 OR 3|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||247.25||| 73502|EAP|0320|XR HIP UNILATERAL 2 OR 3|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||279.50||| 73502|EAP|0320|XR HIP UNILATERAL 2 OR 3|Cigna|CIGNA|||||279.50||| 73502|EAP|0320|XR HIP UNILATERAL 2 OR 3|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||279.50||| 73502|EAP|0320|XR HIP UNILATERAL 2 OR 3|Managed Medicaid|MEDICAID SUPERIOR|||||2.15||| 73502|EAP|0320|XR HIP UNILATERAL 2 OR 3|Humana Medicare Advantage|HUMANA MA|279.50||||2.15||| 73521|EAP|0320|XR HIPS W/PELVIS BILATERA|Humana Medicare Advantage|HUMANA MA|||||2.15||| 73521|EAP|0320|XR HIPS W/PELVIS BILATERA|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||247.25||| 73521|EAP|0320|XR HIPS W/PELVIS BILATERA|Managed Medicare|HEALTHSPRING MA|||||2.15||| 73521|EAP|0320|XR HIPS W/PELVIS BILATERA|Managed Medicaid|MEDICAID SUPERIOR|||||2.15||| 73521|EAP|0320|XR HIPS W/PELVIS BILATERA|Managed Medicaid|MEDICAID AMERIGROUP|||||279.50||| 73521|EAP|0320|XR HIPS W/PELVIS BILATERA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||279.50||| 73521|EAP|0320|XR HIPS W/PELVIS BILATERA|Blue Cross PPO Specialty|BCBSTX PPO|||||247.25||| 73521|EAP|0320|XR HIPS W/PELVIS BILATERA|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|279.50||||||| 73521|EAP|0320|XR HIPS W/PELVIS BILATERA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||247.25||| 73521|EAP|0320|XR HIPS W/PELVIS BILATERA|Medicare|MEDICARE ACUTE|||||279.50||| 73521|EAP|0320|XR HIPS W/PELVIS BILATERA|United Healthcare|UNITED HEALTHCARE|||||2.15||| 73521|EAP|0320|XR HIPS W/PELVIS BILATERA|United Medicare Advantage|UHC MEDICARE GOLD MA|||||279.50||| 73521|EAP|0320|XR HIPS W/PELVIS BILATERA|Veterans Affairs|VETERANS ADMINISTRATION|||||2.15||| 73522|EAP|0320|XR HIPS W/PELVIS BILAT 3|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.25||| 73522|EAP|0320|XR HIPS W/PELVIS BILAT 3|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.50||| 73522|EAP|0320|XR HIPS W/PELVIS BILAT 3|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.25||| 73522|EAP|0320|XR HIPS W/PELVIS BILAT 3|Blue Cross PPO Specialty|BCBSTX PPO|||||3.25||| 73522|EAP|0320|XR HIPS W/PELVIS BILAT 3|Humana Medicare Advantage|HUMANA MA|||||3.25||| 73522|EAP|0320|XR HIPS W/PELVIS BILAT 3|Managed Medicaid|MEDICAID SUPERIOR|||||287.50||| 73522|EAP|0320|XR HIPS W/PELVIS BILAT 3|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.50||| 73523|EAP|0320|XR HIPS W/PELVIS BILATERA|Blue Cross HMO Specialty|BCBSTX HMO|||||3.75||| 73523|EAP|0320|XR HIPS W/PELVIS BILATERA|Medicare|MEDICARE ACUTE|||||3.75||| 73551|EAP|0320|XR FEMUR 1 VIEW|Managed Medicaid|MEDICAID AMERIGROUP|||||1.95||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.15||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||2.15||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||279.50||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||279.50||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.15||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.15||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|Medicare|MEDICARE ACUTE|2.15||||279.50||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||279.50||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||279.50||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||279.50||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||247.25||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|Cigna|CIGNA|||||2.15||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||2.15||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|Humana Medicare Advantage|HUMANA MA|2.15||||279.50||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||247.25||| 73560|EAP|0320|XR LT KNEE 1 OR 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.15||| 73560|EAP|0320|XR LT KNEE 1 OR 2 VIEWS|Managed Medicare|HEALTHSPRING MA|||||2.15||| 73560|EAP|0320|XR LT KNEE 1 OR 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||279.50||| 73560|EAP|0320|XR LT KNEE 1 OR 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73560|EAP|0320|XR RT KNEE 1 OR 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||2.15||| 73560|EAP|0320|XR LT KNEE 1 OR 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||247.25||| 73560|EAP|0320|XR RT KNEE 1 OR 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||279.50||| 73560|EAP|0320|XR RT KNEE 1 OR 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.15||| 73560|EAP|0320|XR RT KNEE 1 OR 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||279.50||| 73560|EAP|0320|XR LT KNEE 1 OR 2 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.15||| 73560|EAP|0320|XR LT KNEE 1 OR 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||279.50||| 73560|EAP|0320|XR RT KNEE 1 OR 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||279.50||| 73560|EAP|0320|XR RT KNEE 1 OR 2 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||279.50||| 73560|EAP|0320|XR RT KNEE 1 OR 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||279.50||| 73560|EAP|0320|XR LT KNEE 1 OR 2 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|279.50||||2.15||| 73560|EAP|0320|XR LT KNEE 1 OR 2 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||279.50||| 73560|EAP|0320|XR RT KNEE 1 OR 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||279.50||| 73560|EAP|0320|XR RT KNEE 1 OR 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||2.15||| 73560|EAP|0320|XR LT KNEE 1 OR 2 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||279.50||| 73560|EAP|0320|XR RT KNEE 1 OR 2 VIEWS|Aetna|AETNA OTHER|||||2.15||| 73560|EAP|0320|XR RT KNEE 1 OR 2 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|279.50||||279.50||| 73560|EAP|0320|XR LT KNEE 1 OR 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.15||| 73560|EAP|0320|XR LT KNEE 1 OR 2 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.15||| 73560|EAP|0320|XR RT KNEE 1 OR 2 VIEWS|Cigna|CIGNA|||||279.50||| 73560|EAP|0320|XR RT KNEE 1 OR 2 VIEWS|Medicaid|MEDICAID|||||2.15||| 73560|EAP|0320|XR LT KNEE 1 OR 2 VIEWS|PHCS|HUMANA INSURANCE|||||279.50||| 73560|EAP|0320|XR RT KNEE 1 OR 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.15||| 73560|EAP|0320|XR LT KNEE 1 OR 2 VIEWS|Tricare|TRICARE EAST REGION|||||2.15||| 73560|EAP|0320|XR LT KNEE 1 OR 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||2.15||| 73560|EAP|0320|XR RT KNEE 1 OR 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.15||| 73560|EAP|0320|XR RT KNEE 1 OR 2 VIEWS|Medicare|MEDICARE ACUTE|2.15||||2.15||| 73560|EAP|0320|XR RT KNEE 1 OR 2 VIEWS|Tricare|TRICARE EAST REGION|||||2.15||| 73560|EAP|0320|XR LT KNEE 1 OR 2 VIEWS|Aetna|AETNA OTHER|||||279.50||| 73560|EAP|0320|XR LT KNEE 1 OR 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.15||| 73560|EAP|0320|XR LT KNEE 1 OR 2 VIEWS|Medicaid|MEDICAID|||||2.15||| 73560|EAP|0320|XR LT KNEE 1 OR 2 VIEWS|Medicare|MEDICARE ACUTE|2.15||||2.15||| 73560|EAP|0320|XR LT KNEE 1 OR 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||279.50||| 73560|EAP|0320|XR LT KNEE 1 OR 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||247.25||| 73560|EAP|0320|XR LT KNEE 1 OR 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||2.15||| 73560|EAP|0320|XR RT KNEE 1 OR 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||279.50||| 73560|EAP|0320|XR LT KNEE 1 OR 2 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.15||| 73560|EAP|0320|XR RT KNEE 1 OR 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||247.25||| 73560|EAP|0320|XR LT KNEE 1 OR 2 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||2.15||| 73560|EAP|0320|XR RT KNEE 1 OR 2 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||247.25||| 73560|EAP|0320|XR RT KNEE 1 OR 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||279.50||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||3.25||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|Aetna|AETNA PPO|||||2.50||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3.25||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||3.25||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||287.50||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||287.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||287.50||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.25||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Aetna|AETNA PPO|||||2.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||2.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||3.25||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.25||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Humana Medicare Advantage|HUMANA MA|2.50||||2.50||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.25||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||287.50||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||287.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.50||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|Cigna|CIGNA|||||3.25||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Medicaid|MEDICAID|||||3.25||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||287.50||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||3.25||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||287.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Cigna|CIGNA|||||287.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Managed Medicare|HEALTHSPRING MA|||||2.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.25||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|Humana Medicare Advantage|HUMANA MA|2.50||||2.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.25||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.25||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||3.25||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||287.50||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||3.25||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||287.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||3.25||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||287.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||2.50||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||287.50||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||2.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.50||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Medicaid|MORRIS COUNTY INDIGENT|||||3.25||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|Medicare|MEDICARE ACUTE|2.50||||2.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Medicare|MEDICARE ACUTE|2.50||||2.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.25||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.25||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Tricare|TRICARE EAST REGION|||||3.25||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|PHCS|HUMANA INSURANCE|||||2.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.50||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|Medicaid|MEDICAID|||||3.25||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||287.50||| 73562|EAP|0320|XR LT KNEE 3 VIEWS|Medicaid|MORRIS COUNTY INDIGENT|||||2.50||| 73564|EAP|0320|XR RT KNEE 4 OR MORE VIEW|Cigna|CIGNA|||||2.50||| 73564|EAP|0320|XR RT KNEE 4 OR MORE VIEW|Humana Medicare Advantage|HUMANA MA|||||2.50||| 73564|EAP|0320|XR RT KNEE 4 OR MORE VIEW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.25||| 73564|EAP|0320|XR LT KNEE 4 OR MORE VIEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||287.50||| 73564|EAP|0320|XR RT KNEE 4 OR MORE VIEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.50||| 73564|EAP|0320|XR LT KNEE 4 OR MORE VIEW|Blue Cross HMO Specialty|BCBSTX HMO|||||287.50||| 73564|EAP|0320|XR RT KNEE 4 OR MORE VIEW|Blue Cross PPO Specialty|BCBSTX PPO|||||2.50||| 73564|EAP|0320|XR LT KNEE 4 OR MORE VIEW|Blue Cross PPO Specialty|BCBSTX PPO|||||2.50||| 73564|EAP|0320|XR LT KNEE 4 OR MORE VIEW|Medicaid|MEDICAID|||||3.25||| 73564|EAP|0320|XR RT KNEE 4 OR MORE VIEW|Medicare|MEDICARE ACUTE|||||3.25||| 73564|EAP|0320|XR RT KNEE 4 OR MORE VIEW|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.25||| 73564|EAP|0320|XR LT KNEE 4 OR MORE VIEW|Humana Medicare Advantage|HUMANA MA|||||287.50||| 73564|EAP|0320|XR LT KNEE 4 OR MORE VIEW|Medicare|MEDICARE ACUTE|||||3.25||| 73564|EAP|0320|XR RT KNEE 4 OR MORE VIEW|Tricare|TRICARE EAST REGION|||||3.25||| 73564|EAP|0320|XR RT KNEE 4 OR MORE VIEW|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.50||| 73564|EAP|0320|XR LT KNEE 4 OR MORE VIEW|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3.25||| 73564|EAP|0320|XR RT KNEE 4 OR MORE VIEW|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||287.50||| 73564|EAP|0320|XR LT KNEE 4 OR MORE VIEW|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.25||| 73564|EAP|0320|XR RT KNEE 4 OR MORE VIEW|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.25||| 73565|EAP|0320|XR AP BIL STANDING KNEES|United Healthcare|UNITED HEALTHCARE|||||2.15||| 73565|EAP|0320|XR AP BIL STANDING KNEES|United Medicare Advantage|UHC MEDICARE GOLD MA|||||279.50||| 73565|EAP|0320|XR AP BIL STANDING KNEES|Medicaid|MORRIS COUNTY INDIGENT|||||247.25||| 73565|EAP|0320|XR AP BIL STANDING KNEES|Medicare|MEDICARE ACUTE|||||279.50||| 73565|EAP|0320|XR AP BIL STANDING KNEES|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||279.50||| 73565|EAP|0320|XR AP BIL STANDING KNEES|Blue Cross HMO Specialty|BCBSTX HMO|||||279.50||| 73565|EAP|0320|XR AP BIL STANDING KNEES|Blue Cross PPO Specialty|BCBSTX PPO|||||2.15||| 73565|EAP|0320|XR AP BIL STANDING KNEES|Managed Medicaid|MEDICAID AMERIGROUP|||||279.50||| 73565|EAP|0320|XR AP BIL STANDING KNEES|Managed Medicaid|MEDICAID SUPERIOR|||||247.25||| 73565|EAP|0320|XR AP BIL STANDING KNEES|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.15||| 73565|EAP|0320|XR AP BIL STANDING KNEES|Humana Medicare Advantage|HUMANA MA|||||247.25||| 73590|EAP|0320|XR RT TIBIA-FIBULA 2 VIEW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||279.50||| 73590|EAP|0320|XR RT TIBIA-FIBULA 2 VIEW|Managed Medicaid|MEDICAID SUPERIOR|||||2.15||| 73590|EAP|0320|XR LT TIBIA-FIBULA 2 VIEW|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73590|EAP|0320|XR LT TIBIA-FIBULA 2 VIEW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.15||| 73590|EAP|0320|XR LT TIBIA-FIBULA 2 VIEW|Managed Medicaid|MEDICAID SUPERIOR|||||279.50||| 73590|EAP|0320|XR LT TIBIA-FIBULA 2 VIEW|Humana Medicare Advantage|HUMANA MA|||||247.25||| 73590|EAP|0320|XR RT TIBIA-FIBULA 2 VIEW|Humana Medicare Advantage|HUMANA MA|||||2.15||| 73590|EAP|0320|XR RT TIBIA-FIBULA 2 VIEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.15||| 73590|EAP|0320|XR RT TIBIA-FIBULA 2 VIEW|Cigna|CIGNA|||||2.15||| 73590|EAP|0320|XR LT TIBIA-FIBULA 2 VIEW|Blue Cross PPO Specialty|BCBSTX PPO|2.15||||247.25||| 73590|EAP|0320|XR RT TIBIA-FIBULA 2 VIEW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||279.50||| 73590|EAP|0320|XR RT TIBIA-FIBULA 2 VIEW|Blue Cross PPO Specialty|BCBSTX PPO|2.15||||279.50||| 73590|EAP|0320|XR RT TIBIA-FIBULA 2 VIEW|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.15||| 73590|EAP|0320|XR LT TIBIA-FIBULA 2 VIEW|Medicare|MEDICARE ACUTE|2.15||||279.50||| 73590|EAP|0320|XR LT TIBIA-FIBULA 2 VIEW|NON CONTRACTED|COMMERCIAL OTHER 1|||||279.50||| 73590|EAP|0320|XR LT TIBIA-FIBULA 2 VIEW|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.15||| 73590|EAP|0320|XR RT TIBIA-FIBULA 2 VIEW|Tricare|TRICARE FOR LIFE|||||2.15||| 73590|EAP|0320|XR RT TIBIA-FIBULA 2 VIEW|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73590|EAP|0320|XR RT TIBIA-FIBULA 2 VIEW|Medicare|MEDICARE ACUTE|2.15||||2.15||| 73590|EAP|0320|XR LT TIBIA-FIBULA 2 VIEW|Tricare|TRICARE FOR LIFE|||||2.15||| 73590|EAP|0320|XR LT TIBIA-FIBULA 2 VIEW|United Healthcare|GEHA|||||279.50||| 73590|EAP|0320|XR LT TIBIA-FIBULA 2 VIEW|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.15||| 73590|EAP|0320|XR LT TIBIA-FIBULA 2 VIEW|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||279.50||| 73590|EAP|0320|XR LT TIBIA-FIBULA 2 VIEW|United Medicare Advantage|UHC MEDICARE GOLD MA|||||247.25||| 73590|EAP|0320|XR RT TIBIA-FIBULA 2 VIEW|United Medicare Advantage|UHC MEDICARE GOLD MA|||||279.50||| 73590|EAP|0320|XR RT TIBIA-FIBULA 2 VIEW|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||279.50||| 73590|EAP|0320|XR LT TIBIA-FIBULA 2 VIEW|Workers Compensation|WORKERS COMPENSATION OTHER|||||279.50||| 73600|EAP|0320|XR RT ANKLE 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||279.50||| 73600|EAP|0320|XR LT ANKLE 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.15||| 73600|EAP|0320|XR LT ANKLE 2 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.15||| 73600|EAP|0320|XR RT ANKLE 2 VIEWS|Medicare|MEDICARE ACUTE|279.50||||2.15||| 73600|EAP|0320|XR RT ANKLE 2 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.15||| 73600|EAP|0320|XR LT ANKLE 2 VIEWS|Medicare|MEDICARE ACUTE|279.50||||2.15||| 73600|EAP|0320|XR RT ANKLE 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||279.50||| 73600|EAP|0320|XR LT ANKLE 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||279.50||| 73600|EAP|0320|XR RT ANKLE 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||279.50||| 73600|EAP|0320|XR LT ANKLE 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||247.25||| 73600|EAP|0320|XR RT ANKLE 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UMR|||||2.15||| 73600|EAP|0320|XR LT ANKLE 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UMR|||||2.15||| 73600|EAP|0320|XR LT ANKLE 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||279.50||| 73600|EAP|0320|XR RT ANKLE 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||2.15||| 73600|EAP|0320|XR RT ANKLE 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73600|EAP|0320|XR LT ANKLE 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||279.50||| 73600|EAP|0320|XR RT ANKLE 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||2.15||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|Managed Medicaid|MEDICAID AMERIGROUP|||||2.50||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|Managed Medicare|HEALTHSPRING MA|||||3.25||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.25||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|Cigna|CIGNA|||||3.25||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|Managed Medicaid|MEDICAID AMERIGROUP|||||2.50||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|Managed Medicaid|MEDICAID SUPERIOR|||||2.50||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.50||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.50||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|Humana Medicare Advantage|HUMANA MA|2.50||||2.50||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|Managed Medicare|BCBS MEDICARE PPO MA|||||2.50||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|Managed Medicare|WELLCARE CHOICE MA|||||2.50||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||3.25||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|Humana Medicare Advantage|HUMANA MA|2.50||||2.50||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.25||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|Blue Cross PPO Specialty|BCBSTX PPO|||||3.25||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.50||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|Aetna|AETNA OTHER|||||3.25||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.50||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|Blue Cross HMO Specialty|BCBSTX HMO|||||2.50||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.50||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.25||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|Access Direct Platinum|HEALTHFIRST TPA UMR|||||2.50||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|Blue Cross PPO Specialty|BCBSTX PPO|||||3.25||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|Aetna|AETNA PPO|||||2.50||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||287.50||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3.25||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.50||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.50||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|Medicaid|MEDICAID HMO|||||3.25||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||287.50||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|Medicaid|MEDICAID|||||3.25||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|Cigna|CIGNA|||||2.50||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|Cigna|CIGNA|||||2.50||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|Medicaid|MEDICAID TEXAS CHILDRENS|||||3.25||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|NON CONTRACTED|COMMERCIAL OTHER 1|||||287.50||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|Medicare|MEDICARE ACUTE|||||2.50||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|Medicaid|MEDICAID|||||2.50||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|Tricare|TRICARE EAST REGION|||||2.50||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|Medicare|MEDICARE ACUTE|||||3.25||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|Medicaid|MEDICAID TEXAS CHILDRENS|||||3.25||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|PHCS|HUMANA INSURANCE|||||2.50||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|Managed Medicaid|MEDICAID SUPERIOR|||||3.25||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|NON CONTRACTED|COMMERCIAL OTHER 1|||||287.50||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|Tricare|TRICARE EAST REGION|||||287.50||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||3.25||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|United Healthcare|UNITED HEALTHCARE OTHER|||||2.50||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.50||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|United Healthcare|UNITED HEALTHCARE|||||2.50||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.50||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.25||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.50||| 73610|EAP|0320|XR RT ANKLE COMPLETE 3 VW|Veterans Affairs|VETERANS ADMINISTRATION|||||3.25||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|Workers Compensation|WORKERS COMPENSATION OTHER|||||3.25||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|United Healthcare|UNITED HEALTHCARE|||||2.50||| 73610|EAP|0320|XR LT ANKLE COMPLETE 3 VW|United Healthcare|UNITED HEALTHCARE|||||3.25||| 73620|EAP|0320|XR LT FOOT 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||2.15||| 73620|EAP|0320|XR LT FOOT 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.15||| 73620|EAP|0320|XR RT FOOT 2 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.15||| 73620|EAP|0320|XR LT FOOT 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||279.50||| 73620|EAP|0320|XR LT FOOT 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||279.50||| 73620|EAP|0320|XR LT FOOT 2 VIEWS|Medicare|MEDICARE ACUTE|||||247.25||| 73620|EAP|0320|XR RT FOOT 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||279.50||| 73620|EAP|0320|XR RT FOOT 2 VIEWS|Medicare|MEDICARE ACUTE|||||279.50||| 73620|EAP|0320|XR RT FOOT 2 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||279.50||| 73620|EAP|0320|XR RT FOOT 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||247.25||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Cigna|CIGNA|||||287.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.50||| 73630|EAP|0320|XR LT FOOT 3 VIEWS|Cigna|CIGNA|||||3.25||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||2.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.25||||3.25||| 73630|EAP|0320|XR LT FOOT 3 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.25||||3.25||| 73630|EAP|0320|XR LT FOOT 3 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||287.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.25||| 73630|EAP|0320|XR LT FOOT 3 VIEWS|Humana Medicare Advantage|HUMANA MA|2.50||||3.25||| 73630|EAP|0320|XR LT FOOT 3 VIEWS|Managed Medicare|WELLCARE CHOICE MA|||||2.50||| 73630|EAP|0320|XR LT FOOT 3 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3.25||| 73630|EAP|0320|XR LT FOOT 3 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.25||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|3.25||||3.25||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||2.50||| 73630|EAP|0320|XR LT FOOT 3 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.25||| 73630|EAP|0320|XR LT FOOT 3 VIEWS|Aetna|AETNA OTHER|||||3.25||| 73630|EAP|0320|XR LT FOOT 3 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||3.25||| 73630|EAP|0320|XR LT FOOT 3 VIEWS|Medicare|MEDICARE ACUTE|3.25||||2.50||| 73630|EAP|0320|XR LT FOOT 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.25||| 73630|EAP|0320|XR LT FOOT 3 VIEWS|Tricare|TRICARE EAST REGION|||||3.25||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||287.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3.25||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Tricare|TRICARE EAST REGION|||||3.25||| 73630|EAP|0320|XR LT FOOT 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||2.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Humana Medicare Advantage|HUMANA MA|287.50||||3.25||| 73630|EAP|0320|XR LT FOOT 3 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3.25||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Medicare|MEDICARE ACUTE|3.25||||2.50||| 73630|EAP|0320|XR LT FOOT 3 VIEWS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||3.25||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|PHCS|HUMANA INSURANCE|||||2.50||| 73630|EAP|0320|XR LT FOOT 3 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||2.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Medicaid|MEDICAID|||||3.25||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||287.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|United Healthcare|UNITED HEALTHCARE|3.25||||287.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||287.50||| 73630|EAP|0320|XR LT FOOT 3 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||2.50||| 73630|EAP|0320|XR LT FOOT 3 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||3.25||| 73630|EAP|0320|XR LT FOOT 3 VIEWS|United Healthcare|UNITED HEALTHCARE|3.25||||3.25||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||3.25||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||3.25||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.25||| 73630|EAP|0320|XR LT FOOT 3 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.25||| 73630|EAP|0320|XR LT FOOT 3 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.50||| 73630|EAP|0320|XR LT FOOT 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||2.50||| 73630|EAP|0320|XR LT FOOT 3 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|United Healthcare|TML GROUP BENEFITS|||||2.50||| 73650|EAP|0320|XR RT OS CALCIS - HEEL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.15||| 73650|EAP|0320|XR RT OS CALCIS - HEEL|United Healthcare|UNITED HEALTHCARE|||||279.50||| 73650|EAP|0320|XR LT OS CALCIS - HEEL|NON CONTRACTED|COMMERCIAL OTHER 1|||||279.50||| 73650|EAP|0320|XR LT OS CALCIS - HEEL|Medicare|MEDICARE ACUTE|2.15||||247.25||| 73650|EAP|0320|XR RT OS CALCIS - HEEL|NON CONTRACTED|COMMERCIAL OTHER 1|||||279.50||| 73650|EAP|0320|XR RT OS CALCIS - HEEL|Medicare|MEDICARE ACUTE|2.15||||2.15||| 73650|EAP|0320|XR RT OS CALCIS - HEEL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.15||| 73650|EAP|0320|XR RT OS CALCIS - HEEL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||279.50||| 73650|EAP|0320|XR LT OS CALCIS - HEEL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||279.50||| 73650|EAP|0320|XR RT OS CALCIS - HEEL|Blue Cross HMO Specialty|BCBSTX HMO|||||279.50||| 73650|EAP|0320|XR RT OS CALCIS - HEEL|Blue Cross PPO Specialty|BCBSTX PPO|||||279.50||| 73650|EAP|0320|XR LT OS CALCIS - HEEL|Blue Cross PPO Specialty|BCBSTX PPO|||||279.50||| 73650|EAP|0320|XR LT OS CALCIS - HEEL|Humana Medicare Advantage|HUMANA MA|||||279.50||| 73650|EAP|0320|XR RT OS CALCIS - HEEL|Managed Medicaid|MEDICAID AMERIGROUP|||||247.25||| 73660|EAP|0320|XR TOE 2 VIEWS RT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|279.50||||279.50||| 73660|EAP|0320|XR TOE 2 VIEWS RT|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73660|EAP|0320|XR TOE 2 VIEWS RT|Humana Medicare Advantage|HUMANA MA|||||2.15||| 73660|EAP|0320|XR TOE 2 VIEWS LT|Cigna|CIGNA|||||279.50||| 73660|EAP|0320|XR TOE 2 VIEWS LT|Managed Medicaid|MEDICAID SUPERIOR|||||2.15||| 73660|EAP|0320|XR TOE 2 VIEWS LT|Managed Medicaid|MEDICAID AMERIGROUP|||||279.50||| 73660|EAP|0320|XR TOE 2 VIEWS RT|Blue Cross PPO Specialty|BCBSTX PPO|||||279.50||| 73660|EAP|0320|XR TOE 2 VIEWS RT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||279.50||| 73660|EAP|0320|XR TOE 2 VIEWS RT|Medicare|MEDICARE ACUTE|||||2.15||| 73660|EAP|0320|XR TOE 2 VIEWS RT|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.15||| 73660|EAP|0320|XR TOE 2 VIEWS LT|Medicare|MEDICARE ACUTE|||||2.15||| 73660|EAP|0320|XR TOE 2 VIEWS LT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||247.25||| 73660|EAP|0320|XR TOE 2 VIEWS RT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.15||| 73660|EAP|0320|XR TOE 2 VIEWS LT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.15||| 73700|EAP|0350|CT EXTRE LOW LT WO CONT|Workers Compensation|WORKERS COMPENSATION OTHER|||||14.50||| 73700|EAP|0350|CT EXTREM LOW RT WO CONT|United Healthcare|UNITED HEALTHCARE|18.85||||||| 73700|EAP|0350|CT EXTRE LOW LT WO CONT|United Medicare Advantage|UHC MEDICARE GOLD MA|18.85||||1,667.50||| 73700|EAP|0350|CT EXTREM LOW RT WO CONT|United Medicare Advantage|UHC MEDICARE GOLD MA|18.85||||1,667.50||| 73700|EAP|0350|CT EXTRE LOW LT WO CONT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||18.85||| 73700|EAP|0350|CT EXTREM LOW RT WO CONT|Medicare|MEDICARE ACUTE|1,667.50||||18.85||| 73700|EAP|0350|CT EXTREM LOW RT WO CONT|NON CONTRACTED|COMMERCIAL OTHER 1|||||18.85||| 73700|EAP|0350|CT EXTRE LOW LT WO CONT|PHCS|HUMANA INSURANCE|||||18.85||| 73700|EAP|0350|CT EXTRE LOW LT WO CONT|Medicare|MEDICARE ACUTE|1,667.50||||1,667.50||| 73700|EAP|0350|CT EXTRE LOW LT WO CONT|Blue Cross PPO Specialty|BCBSTX PPO|||||18.85||| 73700|EAP|0350|CT EXTREM LOW RT WO CONT|Blue Cross PPO Specialty|BCBSTX PPO|||||18.85||| 73700|EAP|0350|CT EXTRE LOW LT WO CONT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|18.85||||||| 73700|EAP|0350|CT EXTRE LOW LT WO CONT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||14.50||| 73700|EAP|0350|CT EXTREM LOW RT WO CONT|Blue Cross HMO Specialty|BCBSTX HMO|||||14.50||| 73700|EAP|0350|CT EXTREM LOW RT WO CONT|Humana Medicare Advantage|HUMANA MA|18.85||||14.50||| 73700|EAP|0350|CT EXTRE LOW LT WO CONT|Humana Medicare Advantage|HUMANA MA|14.50||||14.50||| 73700|EAP|0350|CT EXTREM LOW RT WO CONT|Cigna|CIGNA|||||14.50||| 73700|EAP|0350|CT EXTREM LOW RT WO CONT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|18.85||||||| 73700|EAP|0350|CT EXTREM LOW RT WO CONT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||18.85||| 73700|EAP|0350|CT EXTRE LOW LT WO CONT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|14.50||||||| 73701|EAP|0350|CT EXTREM LOW LT W CONT|Humana Medicare Advantage|HUMANA MA|17.00||||||| 73701|EAP|0350|CT EXTREM LOW LT W CONT|Blue Cross PPO Specialty|BCBSTX PPO|22.10||||||| 73701|EAP|0350|CT EXTREM LOW RT W CONT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|17.00||||||| 73701|EAP|0350|CT EXTREM LOW LT W CONT|Medicare|MEDICARE ACUTE|22.10||||22.10||| 73718|EAP|0610|MRI LOWER EXTREMITY LT WO|United Healthcare|TML GROUP BENEFITS|||||23.00||| 73718|EAP|0610|MRI LOWER EXTREMITY RT WO|Medicare|MEDICARE ACUTE|||||23.00||| 73718|EAP|0610|MRI LOWER EXTREMITY LT WO|Aetna|AETNA PPO|||||23.00||| 73718|EAP|0610|MRI LOWER EXTREMITY RT WO|Aetna|AETNA OTHER|||||23.00||| 73718|EAP|0610|MRI LOWER EXTREMITY RT WO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||23.00||| 73718|EAP|0610|MRI LOWER EXTREMITY LT WO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|23.00||||||| 73718|EAP|0610|MRI LOWER EXTREMITY RT WO|Managed Medicaid|MEDICAID AMERIGROUP|||||23.00||| 73718|EAP|0610|MRI LOWER EXTREMITY LT WO|Humana Medicare Advantage|HUMANA MA|||||23.00||| 73718|EAP|0610|MRI LOWER EXTREMITY LT WO|Cigna|CIGNA|23.00||||||| 73718|EAP|0610|MRI LOWER EXTREMITY RT WO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|23.00||||||| 73720|EAP|0610|MRI LOWER EXTREMITY W/WO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|34.00||||||| 73720|EAP|0610|MRI LOWER EXTREMITY W/WO|Humana Medicare Advantage|HUMANA MA|34.00||||||| 73720|EAP|0610|MRI LOWER EXTREMITY W/WO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|34.00||||||| 73721|EAP|0610|MRI LOWER EXT JOINT WO RT|Medicare|MEDICARE ACUTE|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO RT|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO RT|Medicaid|MEDICAID|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO LT|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO LT|Medicare|MEDICARE ACUTE|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO RT|Medicaid|MORRIS COUNTY INDIGENT|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO LT|Medicaid|MORRIS COUNTY INDIGENT|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO RT|Tricare|TRICARE EAST REGION|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO LT|Tricare|TRICARE EAST REGION|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO LT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO RT|United Healthcare|UNITED HEALTHCARE|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO LT|United Healthcare|UNITED HEALTHCARE|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO LT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO RT|Workers Compensation|WORKERS COMPENSATION OTHER|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO RT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO RT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO LT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO LT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO RT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO LT|Blue Cross HMO Specialty|BCBSTX HMO|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO LT|Aenta Medicare Advantage|AETNA MEDICARE MA|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO RT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO RT|Blue Cross PPO Specialty|BCBSTX PPO|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO LT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO LT|Blue Cross PPO Specialty|BCBSTX PPO|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO RT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO RT|PHCS|HUMANA INSURANCE|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO RT|Blue Cross HMO Specialty|BCBSTX HMO|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO RT|Cigna|CIGNA|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO RT|Humana Medicare Advantage|HUMANA MA|23.00||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO LT|Cigna|CIGNA|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO RT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO LT|Managed Medicaid|MEDICAID SUPERIOR|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO LT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO LT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO RT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||23.00||| 73721|EAP|0610|MRI LOWER EXT JOINT WO LT|Humana Medicare Advantage|HUMANA MA|23.00||||23.00||| 73723|EAP|0610|MRI LOWER EXTREMITY W WO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||34.00||| 73723|EAP|0610|MRI LOWER EXTREMITY W WO|Medicare|MEDICARE ACUTE|34.00||||||| 74|DRG||CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|25,453.46|1225.41|1225.41|1225.41|||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||253.50||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|United Healthcare|UNITED HEALTHCARE|||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||253.50||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|United Healthcare|TML GROUP BENEFITS|||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Workers Compensation|WORKERS COMPENSATION OTHER|||||253.50||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Tricare|TRICARE EAST REGION|||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Medicare|MEDICARE ACUTE|253.50||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Medicaid|MEDICAID HMO|||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Medicaid|MEDICAID TEXAS CHILDRENS|||||253.50||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Medicaid|MEDICAID|||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|NON CONTRACTED|COMMERCIAL OTHER 1|||||253.50||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Cigna|CIGNA|||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Managed Medicaid|MEDICAID AMERIGROUP|||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|United Medicare Advantage|UHC MEDICARE GOLD MA|1.95||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Managed Medicaid|MEDICAID SUPERIOR|||||253.50||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Humana Medicare Advantage|HUMANA MA|1.95||||253.50||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Aenta Medicare Advantage|AETNA MEDICARE MA|||||253.50||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Blue Cross HMO Specialty|BCBSTX HMO|||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||224.25||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Blue Cross PPO Specialty|BCBSTX PPO|||||253.50||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.15||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||2.15||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.15||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||247.25||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||279.50||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|Cigna|CIGNA|||||2.15||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|Medicare|MEDICARE ACUTE|||||2.15||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|Tricare|TRICARE EAST REGION|||||2.15||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.15||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||2.15||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||279.50||| 74022|EAP|0320|XR ABDOMEN 3 VWS W PA CHE|Veterans Affairs|VETERANS ADMINISTRATION|||||3.25||| 74022|EAP|0320|XR ABDOMEN 3 VWS W PA CHE|United Healthcare|UNITED HEALTHCARE|2.50||||||| 74022|EAP|0320|XR ABDOMEN 3 VWS W PA CHE|United Healthcare|UNITED HEALTHCARE|||||3.25||| 74022|EAP|0320|XR ABDOMEN 3 VWS W PA CHE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.50||| 74022|EAP|0320|XR ABDOMEN 3 VWS W PA CHE|Tricare|TRICARE EAST REGION|||||2.50||| 74022|EAP|0320|XR ABDOMEN 3 VWS W PA CHE|Medicare|MEDICARE ACUTE|2.50||||2.50||| 74022|EAP|0320|XR ABDOMEN 3 VWS W PA CHE|Humana Medicare Advantage|HUMANA MA|||||287.50||| 74022|EAP|0320|XR ABDOMEN 3 VWS W PA CHE|Managed Medicaid|MEDICAID SUPERIOR|||||3.25||| 74022|EAP|0320|XR ABDOMEN 3 VWS W PA CHE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.50||| 74022|EAP|0320|XR ABDOMEN 3 VWS W PA CHE|Managed Medicaid|MEDICAID AMERIGROUP|||||3.25||| 74022|EAP|0320|XR ABDOMEN 3 VWS W PA CHE|Aetna|AETNA OTHER|||||2.50||| 74022|EAP|0320|XR ABDOMEN 3 VWS W PA CHE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.50||| 74022|EAP|0320|XR ABDOMEN 3 VWS W PA CHE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||3.25||| 74022|EAP|0320|XR ABDOMEN 3 VWS W PA CHE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3.25||| 74022|EAP|0320|XR ABDOMEN 3 VWS W PA CHE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.25||| 74022|EAP|0320|XR ABDOMEN 3 VWS W PA CHE|Blue Cross PPO Specialty|BCBSTX PPO|||||287.50||| 74150|EAP|0350|CT ABDOMEN W/O CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|||||14.50||| 74150|EAP|0350|CT ABDOMEN W/O CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||18.85||| 74150|EAP|0350|CT ABDOMEN W/O CONTRAST|Humana Medicare Advantage|HUMANA MA|||||14.50||| 74150|EAP|0350|CT ABDOMEN W/O CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|||||18.85||| 74150|EAP|0350|CT ABDOMEN W/O CONTRAST|Medicare|MEDICARE ACUTE|14.50||||18.85||| 74150|EAP|0350|CT ABDOMEN W/O CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||18.85||| 74160|EAP|0350|CT ABDOMEN W CONTRAST|United Healthcare|UNITED HEALTHCARE|||||17.00||| 74160|EAP|0350|CT ABDOMEN W CONTRAST|United Healthcare|UNITED HEALTHCARE OTHER|||||22.10||| 74160|EAP|0350|CT ABDOMEN W CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||17.00||| 74160|EAP|0350|CT ABDOMEN W CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|||||22.10||| 74160|EAP|0350|CT ABDOMEN W CONTRAST|Medicaid|MEDICAID|||||17.00||| 74160|EAP|0350|CT ABDOMEN W CONTRAST|Medicare|MEDICARE ACUTE|22.10||||19.55||| 74160|EAP|0350|CT ABDOMEN W CONTRAST|Humana Medicare Advantage|HUMANA MA|||||22.10||| 74160|EAP|0350|CT ABDOMEN W CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|||||17.00||| 74160|EAP|0350|CT ABDOMEN W CONTRAST|Cigna|CIGNA|22.10||||||| 74160|EAP|0350|CT ABDOMEN W CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|||||19.55||| 74160|EAP|0350|CT ABDOMEN W CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||22.10||| 74170|EAP|0350|CT ABDOMEN W/WO CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||26.00||| 74170|EAP|0350|CT ABDOMEN W/WO CONTRAST|Medicare|MEDICARE ACUTE|||||20.00||| 74170|EAP|0350|CT ABDOMEN W/WO CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 1|||||20.00||| 74174|EAP|0352|CTA ABDOMEN/PELVIS|United Medicare Advantage|UHC MEDICARE GOLD MA|22.50||||||| 74174|EAP|0352|CTA ABDOMEN/PELVIS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|29.25||||||| 74174|EAP|0352|CTA ABDOMEN/PELVIS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||22.50||| 74174|EAP|0352|CTA ABDOMEN/PELVIS|Medicare|MEDICARE ACUTE|||||29.25||| 74174|EAP|0352|CTA ABDOMEN/PELVIS|Humana Medicare Advantage|HUMANA MA|||||22.50||| 74174|EAP|0352|CTA ABDOMEN/PELVIS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||29.25||| 74174|EAP|0352|CTA ABDOMEN/PELVIS|Blue Cross HMO Specialty|BCBSTX HMO|||||22.50||| 74174|EAP|0352|CTA ABDOMEN/PELVIS|Blue Cross PPO Specialty|BCBSTX PPO|||||29.25||| 74175|EAP|0352|CTA ABDOMEN WO/W|Humana Medicare Advantage|HUMANA MA|||||29.25||| 74175|EAP|0352|CTA ABDOMEN WO/W|Managed Medicaid|MEDICAID AMERIGROUP|22.50||||||| 74175|EAP|0352|CTA ABDOMEN WO/W|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||22.50||| 74175|EAP|0352|CTA ABDOMEN WO/W|Medicare|MEDICARE ACUTE|||||22.50||| 74175|EAP|0352|CTA ABDOMEN WO/W|United Medicare Advantage|UHC MEDICARE GOLD MA|||||22.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|United Healthcare|UNITED HEALTHCARE OTHER|||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|United Healthcare|UNITED HEALTHCARE|14.50||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|United Healthcare|UNITED HEALTHCARE|||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|United Healthcare|TML GROUP BENEFITS|||||18.85||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||18.85||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Veterans Affairs|VETERANS ADMINISTRATION|||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|United Medicare Advantage|UHC MEDICARE GOLD MA|1,667.50||||18.85||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||18.85||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Tricare|TRICARE EAST REGION|1,667.50||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,667.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||18.85||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Medicaid|MORRIS COUNTY INDIGENT|||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Tricare|TRICARE FOR LIFE|||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Medicaid|MEDICAID|14.50||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Medicaid|MEDICAID TEXAS CHILDRENS|||||18.85||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|18.85||||18.85||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Medicare|MEDICARE ACUTE|18.85||||18.85||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Aetna|AETNA PPO|||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||18.85||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Blue Cross PPO Specialty|BCBSTX PPO|14.50||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Aenta Medicare Advantage|AETNA MEDICARE MA|18.85||||18.85||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Blue Cross PPO Specialty|BCBSTX OTHER|||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|14.50||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Aetna|AETNA OTHER|||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Blue Cross HMO Specialty|BCBSTX HMO|||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Cigna|CIGNA|14.50||||||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Managed Medicare|BCBS MEDICARE PPO MA|||||18.85||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Managed Medicaid|MEDICAID SUPERIOR|14.50||||18.85||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Managed Medicaid|MEDICAID AMERIGROUP|14.50||||18.85||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1,667.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Managed Medicare|HEALTHSPRING MA|||||1,667.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Managed Medicaid|MEDICAID UNITED HEALTHCARE|14.50||||18.85||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Humana Medicare Advantage|HUMANA MA|14.50||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Cigna|CIGNA|18.85||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS W/OUT C|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|14.50||||18.85||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Cigna|CIGNA|||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Cigna|CIGNA|17.00||||||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|19.55||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Managed Medicare|HEALTHSPRING MA|||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Access Direct Platinum|HEALTHFIRST TPA UMR|||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Blue Cross HMO Specialty|BCBSTX HMO|||||22.10||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Aetna|AETNA OTHER|||||22.10||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|22.10||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|17.00||||22.10||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|22.10||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Blue Cross PPO Specialty|BCBSTX PPO|17.00||||22.10||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Medicaid|MEDICAID TEXAS CHILDRENS|17.00||||22.10||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|PHCS|HUMANA INSURANCE|||||22.10||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Humana Medicare Advantage|HUMANA MA|19.55||||22.10||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Medicaid|MORRIS COUNTY INDIGENT|||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||22.10||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Medicare|MEDICARE ACUTE|17.00||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Managed Medicaid|MEDICAID SUPERIOR|22.10||||22.10||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|NON CONTRACTED|COMMERCIAL OTHER 1|19.55||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Tricare|TRICARE EAST REGION|22.10||||22.10||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Managed Medicaid|MEDICAID AMERIGROUP|17.00||||22.10||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Medicaid|MEDICAID|||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|United Healthcare|UNITED HEALTHCARE OTHER|17.00||||19.55||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||22.10||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|United Healthcare|UNITED HEALTHCARE|||||22.10||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|United Healthcare|TML GROUP BENEFITS|||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Veterans Affairs|VETERANS ADMINISTRATION|17.00||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Workers Compensation|WORKERS COMPENSATION OTHER|||||22.10||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|17.00||||22.10||| 74178|EAP|0350|CT ABDOMEN/PELVIS W & WO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||26.00||| 74178|EAP|0350|CT ABDOMEN/PELVIS W & WO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||26.00||| 74178|EAP|0350|CT ABDOMEN/PELVIS W & WO|Medicare|MEDICARE ACUTE|||||20.00||| 74178|EAP|0350|CT ABDOMEN/PELVIS W & WO|Blue Cross PPO Specialty|BCBSTX PPO|||||26.00||| 74178|EAP|0350|CT ABDOMEN/PELVIS W & WO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||20.00||| 74178|EAP|0350|CT ABDOMEN/PELVIS W & WO|Blue Cross HMO Specialty|BCBSTX HMO|||||26.00||| 74178|EAP|0350|CT ABDOMEN/PELVIS W & WO|Access Direct Platinum|HEALTHFIRST TPA UMR|||||20.00||| 74178|EAP|0350|CT ABDOMEN/PELVIS W & WO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||20.00||| 74178|EAP|0350|CT ABDOMEN/PELVIS W & WO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||20.00||| 74178|EAP|0350|CT ABDOMEN/PELVIS W & WO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||26.00||| 74178|EAP|0350|CT ABDOMEN/PELVIS W & WO|Managed Medicaid|MEDICAID SUPERIOR|||||20.00||| 74178|EAP|0350|CT ABDOMEN/PELVIS W & WO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||26.00||| 74178|EAP|0350|CT ABDOMEN/PELVIS W & WO|Humana Medicare Advantage|HUMANA MA|||||23.00||| 74181|EAP|0610|MRI ABDOMEN WO|Humana Medicare Advantage|HUMANA MA|||||27.00||| 74181|EAP|0610|MRI ABDOMEN WO|Blue Cross PPO Specialty|BCBSTX PPO|||||27.00||| 74181|EAP|0610|MRI ABDOMEN WO|NON CONTRACTED|COMMERCIAL OTHER 1|||||27.00||| 74181|EAP|0610|MRI ABDOMEN WO|Medicare|MEDICARE ACUTE|27.00||||27.00||| 74181|EAP|0610|MRI ABDOMEN WO|Tricare|TRICARE EAST REGION|27.00||||||| 74181|EAP|0610|MRI ABDOMEN WO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||27.00||| 74183|EAP|0610|MRI ABDOMEN W WO|United Medicare Advantage|UHC MEDICARE GOLD MA|34.00||||34.00||| 74183|EAP|0610|MRI ABDOMEN W WO|Medicare|MEDICARE ACUTE|34.00||||34.00||| 74183|EAP|0610|MRI ABDOMEN W WO|NON CONTRACTED|COMMERCIAL OTHER 1|||||34.00||| 74183|EAP|0610|MRI ABDOMEN W WO|Blue Cross PPO Specialty|BCBSTX PPO|34.00||||34.00||| 74183|EAP|0610|MRI ABDOMEN W WO|Humana Medicare Advantage|HUMANA MA|||||34.00||| 74250|EAP|0320|XR SMALL BOWEL SERIES|Humana Medicare Advantage|HUMANA MA|487.50||||||| 74250|EAP|0320|XR SMALL BOWEL SERIES|Blue Cross PPO Specialty|BCBSTX PPO|487.50||||||| 74250|EAP|0320|XR SMALL BOWEL SERIES|Medicare|MEDICARE ACUTE|487.50||||3.75||| 74455|EAP|0320|XR CYSTOGRAM VOIDING|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||3.75||| 747|DRG||VAGINA, CERVIX & VULVA PROCEDURES W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|37,070.85|4822.62|4822.62|4822.62|||| 75635|EAP|0352|CTA ABDO AORTA BILAT ILIO|Medicare|MEDICARE ACUTE|||||22.50||| 75635|EAP|0352|CTA ABDO AORTA BILAT ILIO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||22.50||| 75635|EAP|0352|CTA ABDO AORTA BILAT ILIO|Humana Medicare Advantage|HUMANA MA|||||22.50||| 75635|EAP|0352|CTA ABDO AORTA BILAT ILIO|Blue Cross PPO Specialty|BCBSTX PPO|||||22.50||| 75635|EAP|0352|CTA ABDO AORTA BILAT ILIO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||22.50||| 75635|EAP|0352|CTA ABDO AORTA BILAT ILIO|Blue Cross HMO Specialty|BCBSTX HMO|||||22.50||| 758|DRG||INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W CC|Humana Medicare Advantage|HUMANA MA|26,602.50|7720.96|7720.96|7720.96|||| 76010|EAP|0320|XR INFANT CHILD FOREIGN B|Aetna|AETNA OTHER|||||1.95||| 76536|EAP|0402|US SOFT TISSUE/THYROID|United Healthcare|UNITED HEALTHCARE|||||708.50||| 76536|EAP|0402|US SOFT TISSUE/THYROID|United Healthcare|UNITED HEALTHCARE|||||5.45||| 76536|EAP|0402|US SOFT TISSUE/THYROID|United Medicare Advantage|UHC MEDICARE GOLD MA|||||5.45||| 76536|EAP|0402|US SOFT TISSUE/THYROID|Tricare|TRICARE EAST REGION|||||5.45||| 76536|EAP|0402|US SOFT TISSUE/THYROID|Medicaid|MORRIS COUNTY INDIGENT|||||5.45||| 76536|EAP|0402|US SOFT TISSUE/THYROID|NON CONTRACTED|COMMERCIAL OTHER 1|||||626.75||| 76536|EAP|0402|US SOFT TISSUE/THYROID|Medicare|MEDICARE ACUTE|||||5.45||| 76536|EAP|0402|US SOFT TISSUE/THYROID|Humana Medicare Advantage|HUMANA MA|||||5.45||| 76536|EAP|0402|US SOFT TISSUE/THYROID|Managed Medicaid|MEDICAID AMERIGROUP|||||5.45||| 76536|EAP|0402|US SOFT TISSUE/THYROID|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||708.50||| 76536|EAP|0402|US SOFT TISSUE/THYROID|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||5.45||| 76536|EAP|0402|US SOFT TISSUE/THYROID|Managed Medicaid|MEDICAID SUPERIOR|||||5.45||| 76536|EAP|0402|US SOFT TISSUE/THYROID|Cigna|CIGNA|||||708.50||| 76536|EAP|0402|US SOFT TISSUE/THYROID|Blue Cross HMO Specialty|BCBSTX HMO|||||708.50||| 76536|EAP|0402|US SOFT TISSUE/THYROID|Blue Cross PPO Specialty|BCBSTX PPO|||||5.45||| 76536|EAP|0402|US SOFT TISSUE/THYROID|Aetna|AETNA OTHER|||||5.45||| 76536|EAP|0402|US SOFT TISSUE/THYROID|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||5.45||| 76536|EAP|0402|US SOFT TISSUE/THYROID|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||5.45||| 76536|EAP|0402|US SOFT TISSUE/THYROID|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||708.50||| 76536|EAP|0402|US SOFT TISSUE/THYROID|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||708.50||| 76536|EAP|0402|US SOFT TISSUE/THYROID|Aetna|AETNA PPO|||||626.75||| 76604|EAP|0402|US CHEST B SCAN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.36||| 76604|EAP|0402|US CHEST B SCAN|Blue Cross PPO Specialty|BCBSTX PPO|||||4.36||| 76604|EAP|0402|US CHEST B SCAN|Humana Medicare Advantage|HUMANA MA|||||4.36||| 76604|EAP|0402|US CHEST B SCAN|Cigna|CIGNA|||||566.80||| 76700|EAP|0402|US ABDOMEN COMPLETE|Medicaid|MEDICAID TEXAS CHILDRENS|||||7.61||| 76700|EAP|0402|US ABDOMEN COMPLETE|Tricare|TRICARE EAST REGION|989.30||||7.61||| 76700|EAP|0402|US ABDOMEN COMPLETE|Medicare|MEDICARE ACUTE|989.30||||7.61||| 76700|EAP|0402|US ABDOMEN COMPLETE|Medicaid|MEDICAID|||||989.30||| 76700|EAP|0402|US ABDOMEN COMPLETE|United Healthcare|UNITED HEALTHCARE|989.30||||7.61||| 76700|EAP|0402|US ABDOMEN COMPLETE|Veterans Affairs|VETERANS ADMINISTRATION|||||989.30||| 76700|EAP|0402|US ABDOMEN COMPLETE|United Healthcare|UNITED HEALTHCARE OTHER|||||7.61||| 76700|EAP|0402|US ABDOMEN COMPLETE|United Healthcare|TML GROUP BENEFITS|||||7.61||| 76700|EAP|0402|US ABDOMEN COMPLETE|United Healthcare|UNITED HEALTHCARE|||||7.61||| 76700|EAP|0402|US ABDOMEN COMPLETE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||875.15||| 76700|EAP|0402|US ABDOMEN COMPLETE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|7.61||||||| 76700|EAP|0402|US ABDOMEN COMPLETE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|989.30||||||| 76700|EAP|0402|US ABDOMEN COMPLETE|United Healthcare|GEHA|||||7.61||| 76700|EAP|0402|US ABDOMEN COMPLETE|United Medicare Advantage|UHC MEDICARE GOLD MA|7.61||||7.61||| 76700|EAP|0402|US ABDOMEN COMPLETE|Managed Medicaid|MEDICAID AMERIGROUP|||||7.61||| 76700|EAP|0402|US ABDOMEN COMPLETE|Cigna|CIGNA|||||989.30||| 76700|EAP|0402|US ABDOMEN COMPLETE|Cigna|CIGNA|||||7.61||| 76700|EAP|0402|US ABDOMEN COMPLETE|Managed Medicaid|MEDICAID SUPERIOR|||||989.30||| 76700|EAP|0402|US ABDOMEN COMPLETE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||875.15||| 76700|EAP|0402|US ABDOMEN COMPLETE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|7.61||||7.61||| 76700|EAP|0402|US ABDOMEN COMPLETE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||875.15||| 76700|EAP|0402|US ABDOMEN COMPLETE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|989.30||||875.15||| 76700|EAP|0402|US ABDOMEN COMPLETE|Managed Medicare|HEALTHSPRING MA|||||7.61||| 76700|EAP|0402|US ABDOMEN COMPLETE|NON CONTRACTED|COMMERCIAL OTHER 1|||||7.61||| 76700|EAP|0402|US ABDOMEN COMPLETE|Humana Medicare Advantage|HUMANA MA|989.30||||7.61||| 76700|EAP|0402|US ABDOMEN COMPLETE|Blue Cross PPO Specialty|BCBSTX PPO|||||989.30||| 76700|EAP|0402|US ABDOMEN COMPLETE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.61||||989.30||| 76700|EAP|0402|US ABDOMEN COMPLETE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||989.30||| 76700|EAP|0402|US ABDOMEN COMPLETE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||7.61||| 76700|EAP|0402|US ABDOMEN COMPLETE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||7.61||| 76700|EAP|0402|US ABDOMEN COMPLETE|Blue Cross HMO Specialty|BCBSTX HMO|||||7.61||| 76700|EAP|0402|US ABDOMEN COMPLETE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||7.61||| 76700|EAP|0402|US ABDOMEN COMPLETE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|989.30||||989.30||| 76700|EAP|0402|US ABDOMEN COMPLETE|Aetna|AETNA PPO|||||7.61||| 76705|EAP|0402|US ABDOMEN LIMITED|Aenta Medicare Advantage|AETNA MEDICARE MA|||||5.74||| 76705|EAP|0402|US ABDOMEN LIMITED|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|660.10||||5.74||| 76705|EAP|0402|US ABDOMEN LIMITED|Blue Cross HMO Specialty|BCBSTX HMO|||||660.10||| 76705|EAP|0402|US ABDOMEN LIMITED|Blue Cross PPO Specialty|BCBSTX PPO|746.20||||746.20||| 76705|EAP|0402|US ABDOMEN LIMITED|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||5.74||| 76705|EAP|0402|US ABDOMEN LIMITED|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||746.20||| 76705|EAP|0402|US ABDOMEN LIMITED|Cigna|CIGNA|||||660.10||| 76705|EAP|0402|US ABDOMEN LIMITED|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||5.74||| 76705|EAP|0402|US ABDOMEN LIMITED|Managed Medicaid|MEDICAID SUPERIOR|||||746.20||| 76705|EAP|0402|US ABDOMEN LIMITED|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||746.20||| 76705|EAP|0402|US ABDOMEN LIMITED|Humana Medicare Advantage|HUMANA MA|660.10||||5.74||| 76705|EAP|0402|US ABDOMEN LIMITED|Managed Medicaid|MEDICAID AMERIGROUP|||||5.74||| 76705|EAP|0402|US ABDOMEN LIMITED|United Medicare Advantage|UHC MEDICARE GOLD MA|||||5.74||| 76705|EAP|0402|US ABDOMEN LIMITED|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||746.20||| 76705|EAP|0402|US ABDOMEN LIMITED|United Healthcare|UNITED HEALTHCARE|746.20||||5.74||| 76705|EAP|0402|US ABDOMEN LIMITED|Medicare|MEDICARE ACUTE|660.10||||5.74||| 76705|EAP|0402|US ABDOMEN LIMITED|Tricare|TRICARE EAST REGION|||||746.20||| 76705|EAP|0402|US ABDOMEN LIMITED|Medicaid|MEDICAID HMO|||||5.74||| 76705|EAP|0402|US ABDOMEN LIMITED|NON CONTRACTED|COMMERCIAL OTHER 1|||||5.74||| 76706|EAP|0402|US EXAM AAA SCREEN|Medicare|MEDICARE ACUTE|||||5.20||| 76706|EAP|0402|US EXAM AAA SCREEN|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.00||| 76706|EAP|0402|US EXAM AAA SCREEN|Humana Medicare Advantage|HUMANA MA|||||4.60||| 76706|EAP|0402|US EXAM AAA SCREEN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.00||| 76706|EAP|0402|US EXAM AAA SCREEN|Blue Cross HMO Specialty|BCBSTX HMO|||||5.20||| 76706|EAP|0402|US EXAM AAA SCREEN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.00||| 76770|EAP|0402|US RENAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||727.95||| 76770|EAP|0402|US RENAL|Blue Cross PPO Specialty|BCBSTX PPO|822.90||||6.33||| 76770|EAP|0402|US RENAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|822.90||||822.90||| 76770|EAP|0402|US RENAL|Managed Medicare|HEALTHSPRING MA|||||6.33||| 76770|EAP|0402|US RENAL|Managed Medicaid|MEDICAID SUPERIOR|822.90||||6.33||| 76770|EAP|0402|US RENAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||6.33||| 76770|EAP|0402|US RENAL|Cigna|CIGNA|||||6.33||| 76770|EAP|0402|US RENAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||6.33||| 76770|EAP|0402|US RENAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||6.33||| 76770|EAP|0402|US RENAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||6.33||| 76770|EAP|0402|US RENAL|Humana Medicare Advantage|HUMANA MA|822.90||||822.90||| 76770|EAP|0402|US RENAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||6.33||| 76770|EAP|0402|US RENAL|United Medicare Advantage|UHC MEDICARE GOLD MA|822.90||||822.90||| 76770|EAP|0402|US RENAL|United Healthcare|UNITED HEALTHCARE|||||6.33||| 76770|EAP|0402|US RENAL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|6.33||||6.33||| 76770|EAP|0402|US RENAL|United Healthcare|UNITED HEALTHCARE OTHER|||||822.90||| 76770|EAP|0402|US RENAL|Medicaid|MORRIS COUNTY INDIGENT|||||6.33||| 76770|EAP|0402|US RENAL|Medicaid|MEDICAID TEXAS CHILDRENS|||||6.33||| 76770|EAP|0402|US RENAL|Medicare|MEDICARE ACUTE|6.33||||6.33||| 76770|EAP|0402|US RENAL|Tricare|TRICARE EAST REGION|||||6.33||| 76770|EAP|0402|US RENAL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||6.33||| 76775|EAP|0402|US RETROPERITONEAL LIMITE|PHCS|HUMANA INSURANCE|||||678.60||| 76775|EAP|0402|US RETROPERITONEAL LIMITE|Medicare|MEDICARE ACUTE|||||678.60||| 76775|EAP|0402|US RETROPERITONEAL LIMITE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||5.22||| 76775|EAP|0402|US RETROPERITONEAL LIMITE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||5.22||| 76775|EAP|0402|US RETROPERITONEAL LIMITE|Humana Medicare Advantage|HUMANA MA|||||5.22||| 76775|EAP|0402|US RETROPERITONEAL LIMITE|Managed Medicaid|MEDICAID SUPERIOR|||||678.60||| 76775|EAP|0402|US RETROPERITONEAL LIMITE|Managed Medicaid|MEDICAID AMERIGROUP|5.22||||||| 76775|EAP|0402|US RETROPERITONEAL LIMITE|Managed Medicare|BCBS MEDICARE PPO MA|||||678.60||| 76775|EAP|0402|US RETROPERITONEAL LIMITE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||678.60||| 76801|EAP|0402|US OB 1ST TRIMESTER|Blue Cross PPO Specialty|BCBSTX PPO|||||6.89||| 76801|EAP|0402|US OB 1ST TRIMESTER|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||5.30||| 76801|EAP|0402|US OB 1ST TRIMESTER|Managed Medicaid|MEDICAID AMERIGROUP|||||5.30||| 76801|EAP|0402|US OB 1ST TRIMESTER|Managed Medicaid|MEDICAID SUPERIOR|||||6.89||| 76801|EAP|0402|US OB 1ST TRIMESTER|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||5.30||| 76801|EAP|0402|US OB 1ST TRIMESTER|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||5.30||| 76801|EAP|0402|US OB 1ST TRIMESTER|Medicaid|MEDICAID|||||5.30||| 76801|EAP|0402|US OB 1ST TRIMESTER|NON CONTRACTED|COMMERCIAL OTHER 1|||||5.30||| 76805|EAP|0402|US PREGNANCY COMPLETE|Medicaid|MEDICAID|||||841.10||| 76805|EAP|0402|US PREGNANCY COMPLETE|Managed Medicaid|MEDICAID SUPERIOR|||||744.05||| 76805|EAP|0402|US PREGNANCY COMPLETE|Blue Cross PPO Specialty|BCBSTX PPO|||||744.05||| 76817|EAP|0402|US OB TRANSVAGINAL|Managed Medicaid|MEDICAID SUPERIOR|||||4.64||| 76817|EAP|0402|US OB TRANSVAGINAL|Medicaid|MEDICAID|||||603.20||| 76830|EAP|0402|US TRANSVAGINAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||5.42||| 76830|EAP|0402|US TRANSVAGINAL|United Healthcare|UNITED HEALTHCARE OTHER|||||5.42||| 76830|EAP|0402|US TRANSVAGINAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||5.42||| 76830|EAP|0402|US TRANSVAGINAL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||704.60||| 76830|EAP|0402|US TRANSVAGINAL|United Healthcare|TML GROUP BENEFITS|||||5.42||| 76830|EAP|0402|US TRANSVAGINAL|United Healthcare|UNITED HEALTHCARE|||||704.60||| 76830|EAP|0402|US TRANSVAGINAL|Medicaid|MORRIS COUNTY INDIGENT|||||5.42||| 76830|EAP|0402|US TRANSVAGINAL|Medicare|MEDICARE ACUTE|||||5.42||| 76830|EAP|0402|US TRANSVAGINAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||5.42||| 76830|EAP|0402|US TRANSVAGINAL|United Healthcare|UNITED HEALTHCARE|||||623.30||| 76830|EAP|0402|US TRANSVAGINAL|Medicaid|MEDICAID|||||704.60||| 76830|EAP|0402|US TRANSVAGINAL|Tricare|TRICARE EAST REGION|||||704.60||| 76830|EAP|0402|US TRANSVAGINAL|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||5.42||| 76830|EAP|0402|US TRANSVAGINAL|Aetna|AETNA PPO|||||704.60||| 76830|EAP|0402|US TRANSVAGINAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||704.60||| 76830|EAP|0402|US TRANSVAGINAL|Blue Cross HMO Specialty|BCBSTX HMO|||||5.42||| 76830|EAP|0402|US TRANSVAGINAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||5.42||| 76830|EAP|0402|US TRANSVAGINAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||704.60||| 76830|EAP|0402|US TRANSVAGINAL|Blue Cross PPO Specialty|BCBSTX PPO|||||5.42||| 76830|EAP|0402|US TRANSVAGINAL|Cigna|CIGNA|||||704.60||| 76830|EAP|0402|US TRANSVAGINAL|Managed Medicaid|MEDICAID AMERIGROUP|||||704.60||| 76830|EAP|0402|US TRANSVAGINAL|Cigna|CIGNA|||||5.42||| 76830|EAP|0402|US TRANSVAGINAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||704.60||| 76830|EAP|0402|US TRANSVAGINAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||623.30||| 76830|EAP|0402|US TRANSVAGINAL|Humana Medicare Advantage|HUMANA MA|||||5.42||| 76830|EAP|0402|US TRANSVAGINAL|Managed Medicare|UPSHUR COUNTY SHERIFF DEPT|||||5.42||| 76830|EAP|0402|US TRANSVAGINAL|Managed Medicaid|MEDICAID SUPERIOR|||||5.42||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||839.80||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|Managed Medicaid|MEDICAID AMERIGROUP|||||839.80||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|Managed Medicaid|MEDICAID SUPERIOR|839.80||||6.46||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|Cigna|CIGNA|||||839.80||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|Humana Medicare Advantage|HUMANA MA|||||6.46||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||839.80||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|Cigna|CIGNA|||||6.46||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||6.46||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|Blue Cross PPO Specialty|BCBSTX PPO|||||6.46||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|Blue Cross HMO Specialty|BCBSTX HMO|||||6.46||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||839.80||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||6.46||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|Aetna|AETNA PPO|||||839.80||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|Medicare|MEDICARE ACUTE|||||6.46||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|Managed Medicare|UPSHUR COUNTY SHERIFF DEPT|||||6.46||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|Medicaid|MEDICAID|||||839.80||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|Tricare|TRICARE EAST REGION|||||839.80||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|NON CONTRACTED|COMMERCIAL OTHER 1|||||6.46||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|Medicaid|MORRIS COUNTY INDIGENT|||||6.46||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|Medicaid|MEDICAID TEXAS CHILDRENS|6.46||||6.46||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||6.46||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||742.90||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||839.80||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||6.46||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|United Healthcare|TML GROUP BENEFITS|||||6.46||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|United Healthcare|UNITED HEALTHCARE|||||839.80||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|United Healthcare|UNITED HEALTHCARE|||||6.46||| 76856|EAP|0402|US PELVIC NON OB COMPLETE|United Healthcare|UNITED HEALTHCARE OTHER|||||742.90||| 76857|EAP|0402|US PELVIC NON OB LIMITED|United Medicare Advantage|UHC MEDICARE GOLD MA|||||514.80||| 76857|EAP|0402|US PELVIC NON OB LIMITED|Medicare|MEDICARE ACUTE|||||3.96||| 76857|EAP|0402|US PELVIC NON OB LIMITED|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||514.80||| 76857|EAP|0402|US PELVIC NON OB LIMITED|Blue Cross PPO Specialty|BCBSTX PPO|||||514.80||| 76857|EAP|0402|US PELVIC NON OB LIMITED|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.96||| 76857|EAP|0402|US PELVIC NON OB LIMITED|Managed Medicaid|MEDICAID SUPERIOR|||||3.96||| 76857|EAP|0402|US PELVIC NON OB LIMITED|Humana Medicare Advantage|HUMANA MA|||||514.80||| 76870|EAP|0402|US TESTICULAR|Managed Medicaid|MEDICAID AMERIGROUP|||||761.80||| 76870|EAP|0402|US TESTICULAR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||761.80||| 76870|EAP|0402|US TESTICULAR|Managed Medicaid|MEDICAID SUPERIOR|||||761.80||| 76870|EAP|0402|US TESTICULAR|Cigna|CIGNA|||||761.80||| 76870|EAP|0402|US TESTICULAR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||673.90||| 76870|EAP|0402|US TESTICULAR|Humana Medicare Advantage|HUMANA MA|||||5.86||| 76870|EAP|0402|US TESTICULAR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||5.86||| 76870|EAP|0402|US TESTICULAR|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||761.80||| 76870|EAP|0402|US TESTICULAR|Blue Cross PPO Specialty|BCBSTX PPO|5.86||||761.80||| 76870|EAP|0402|US TESTICULAR|Medicaid|MEDICAID|||||5.86||| 76870|EAP|0402|US TESTICULAR|Medicare|MEDICARE ACUTE|||||5.86||| 76870|EAP|0402|US TESTICULAR|Workers Compensation|WORKERS COMPENSATION OTHER|||||761.80||| 76870|EAP|0402|US TESTICULAR|United Medicare Advantage|UHC MEDICARE GOLD MA|761.80||||761.80||| 76870|EAP|0402|US TESTICULAR|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||761.80||| 76881|EAP|0402|US EXTREMITY NON VASCULAR|Medicare|MEDICARE ACUTE|630.50||||557.75||| 76881|EAP|0402|US EXTREMITY NON VASCULAR|Blue Cross PPO Specialty|BCBSTX PPO|||||630.50||| 76881|EAP|0402|US EXTREMITY NON VASCULAR|Blue Cross HMO Specialty|BCBSTX HMO|||||557.75||| 76881|EAP|0402|US EXTREMITY NON VASCULAR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||630.50||| 76881|EAP|0402|US EXTREMITY NON VASCULAR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||557.75||| 76881|EAP|0402|US EXTREMITY NON VASCULAR|Managed Medicaid|MEDICAID AMERIGROUP|||||630.50||| 76881|EAP|0402|US EXTREMITY NON VASCULAR|Managed Medicaid|MEDICAID SUPERIOR|4.85||||630.50||| 76881|EAP|0402|US EXTREMITY NON VASCULAR|Humana Medicare Advantage|HUMANA MA|630.50||||630.50||| 76881|EAP|0402|US EXTREMITY NON VASCULAR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||557.75||| 77072|EAP|0320|XR BONE AGE STUDY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.25||| 77072|EAP|0320|XR BONE AGE STUDY|Managed Medicaid|MEDICAID AMERIGROUP|||||3.25||| 77072|EAP|0320|XR BONE AGE STUDY|Managed Medicaid|MEDICAID SUPERIOR|||||3.25||| 77075|EAP|0320|XR SKELETAL SURVEY COMPLE|Medicare|MEDICARE ACUTE|||||487.50||| 77075|EAP|0320|XR SKELETAL SURVEY COMPLE|Managed Medicaid|MEDICAID SUPERIOR|||||3.75||| 78226|EAP|0341|HEPATOBILIARY IMAGING W/O|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||9.95||| 78227|EAP|0340|NM HIDA SCAN|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||5.20||| 78227|EAP|0340|NM HIDA SCAN|United Medicare Advantage|UHC MEDICARE GOLD MA|||||5.20||| 78227|EAP|0340|NM HIDA SCAN|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||6.76||| 78227|EAP|0340|NM HIDA SCAN|Medicaid|MEDICAID|||||5.20||| 78227|EAP|0340|NM HIDA SCAN|Tricare|TRICARE EAST REGION|6.76||||||| 78227|EAP|0340|NM HIDA SCAN|Medicare|MEDICARE ACUTE|||||5.98||| 78227|EAP|0340|NM HIDA SCAN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||6.76||| 78227|EAP|0340|NM HIDA SCAN|Managed Medicaid|MEDICAID SUPERIOR|||||6.76||| 78227|EAP|0340|NM HIDA SCAN|Cigna|CIGNA|||||5.20||| 78227|EAP|0340|NM HIDA SCAN|Humana Medicare Advantage|HUMANA MA|||||5.20||| 78227|EAP|0340|NM HIDA SCAN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.20||||6.76||| 78227|EAP|0340|NM HIDA SCAN|Blue Cross PPO Specialty|BCBSTX PPO|||||5.98||| 78227|EAP|0340|NM HIDA SCAN|Blue Cross HMO Specialty|BCBSTX HMO|||||5.20||| 78227|EAP|0340|NM HIDA SCAN|Aetna|AETNA PPO|||||5.20||| 78227|EAP|0340|NM HIDA SCAN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||6.76||| 78264|EAP|0340|NM GASTRIC EMPTYING SCAN|Blue Cross PPO Specialty|BCBSTX PPO|||||16.25||| 78264|EAP|0340|NM GASTRIC EMPTYING SCAN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||16.25||| 78264|EAP|0340|NM GASTRIC EMPTYING SCAN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||16.25||| 78264|EAP|0340|NM GASTRIC EMPTYING SCAN|Humana Medicare Advantage|HUMANA MA|||||12.50||| 78264|EAP|0340|NM GASTRIC EMPTYING SCAN|Medicare|MEDICARE ACUTE|12.50||||12.50||| 78264|EAP|0340|NM GASTRIC EMPTYING SCAN|United Medicare Advantage|UHC MEDICARE GOLD MA|||||16.25||| 78306|EAP|0340|NM BONE SCAN-WHOLE BODY|United Medicare Advantage|UHC MEDICARE GOLD MA|14.00||||||| 78306|EAP|0340|NM BONE SCAN-WHOLE BODY|Medicare|MEDICARE ACUTE|||||18.20||| 78306|EAP|0340|NM BONE SCAN-WHOLE BODY|Humana Medicare Advantage|HUMANA MA|||||18.20||| 78306|EAP|0340|NM BONE SCAN-WHOLE BODY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||14.00||| 78306|EAP|0340|NM BONE SCAN-WHOLE BODY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||14.00||| 78306|EAP|0340|NM BONE SCAN-WHOLE BODY|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||18.20||| 78451|EAP|0340|NM MYOCARDIAL PERF SINGLE|Medicare|MEDICARE ACUTE|||||22.00||| 78451|EAP|0340|NM MYOCARDIAL PERF SINGLE|NON CONTRACTED|COMMERCIAL OTHER 1|||||22.00||| 78452|EAP|0341|NM MYOCARDIAL PERF MULTI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||41.47||| 78452|EAP|0341|NM MYOCARDIAL PERF MULTI|Aenta Medicare Advantage|AETNA MEDICARE MA|||||31.90||| 78452|EAP|0341|NM MYOCARDIAL PERF MULTI|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||41.47||| 78452|EAP|0341|NM MYOCARDIAL PERF MULTI|Aetna|AETNA PPO|||||31.90||| 78452|EAP|0341|NM MYOCARDIAL PERF MULTI|Blue Cross PPO Specialty|BCBSTX PPO|||||41.47||| 78452|EAP|0341|NM MYOCARDIAL PERF MULTI|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||41.47||| 78452|EAP|0341|NM MYOCARDIAL PERF MULTI|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3,668.50||| 78452|EAP|0341|NM MYOCARDIAL PERF MULTI|Cigna|CIGNA|||||31.90||| 78452|EAP|0341|NM MYOCARDIAL PERF MULTI|Blue Cross HMO Specialty|BCBSTX HMO|||||41.47||| 78452|EAP|0341|NM MYOCARDIAL PERF MULTI|Managed Medicare|HEALTHSPRING MA|||||41.47||| 78452|EAP|0341|NM MYOCARDIAL PERF MULTI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||41.47||| 78452|EAP|0341|NM MYOCARDIAL PERF MULTI|Humana Medicare Advantage|HUMANA MA|||||41.47||| 78452|EAP|0341|NM MYOCARDIAL PERF MULTI|United Medicare Advantage|UHC MEDICARE GOLD MA|||||41.47||| 78452|EAP|0341|NM MYOCARDIAL PERF MULTI|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||31.90||| 78452|EAP|0341|NM MYOCARDIAL PERF MULTI|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||31.90||| 78452|EAP|0341|NM MYOCARDIAL PERF MULTI|United Healthcare|UNITED HEALTHCARE|||||3,668.50||| 78452|EAP|0341|NM MYOCARDIAL PERF MULTI|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3,668.50||| 78452|EAP|0341|NM MYOCARDIAL PERF MULTI|NON CONTRACTED|COMMERCIAL OTHER 1|||||31.90||| 78452|EAP|0341|NM MYOCARDIAL PERF MULTI|Medicare|MEDICARE ACUTE|||||31.90||| 78452|EAP|0341|NM MYOCARDIAL PERF MULTI|Tricare|TRICARE EAST REGION|||||3,668.50||| 78452|EAP|0341|NM MYOCARDIAL PERF MULTI|Medicaid|MORRIS COUNTY INDIGENT|||||31.90||| 78580|EAP|0340|NM LUNG PERFUSION SCAN|Medicare|MEDICARE ACUTE|13.13||||||| 78580|EAP|0340|NM LUNG PERFUSION SCAN|Humana Medicare Advantage|HUMANA MA|13.13||||||| 78580|EAP|0340|NM LUNG PERFUSION SCAN|Blue Cross PPO Specialty|BCBSTX PPO|||||13.13||| 78582|EAP|0340|NM PULM VENT AND PERFUSIO|Blue Cross PPO Specialty|BCBSTX PPO|10.92||||||| 78582|EAP|0340|NM PULM VENT AND PERFUSIO|Humana Medicare Advantage|HUMANA MA|10.92||||10.92||| 78582|EAP|0340|NM PULM VENT AND PERFUSIO|Medicare|MEDICARE ACUTE|9.66||||||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.72||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Veterans Affairs|VETERANS ADMINISTRATION|2.72||||353.60||| 80048|EAP|0301|BASIC METABOLIC PROFILE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|353.60||||||| 80048|EAP|0301|BASIC METABOLIC PROFILE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.72||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.72||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|United Healthcare|TML GROUP BENEFITS|||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|NON CONTRACTED|COMMERCIAL OTHER 1|2.72||||2.72||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Medicaid|MEDICAID|353.60||||2.72||| 80048|EAP|0301|BASIC METABOLIC PROFILE|United Healthcare|UNITED HEALTHCARE|2.72||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|United Healthcare|UNITED HEALTHCARE|353.60||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|PHCS|MERITAIN HEALTH|||||353.60||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Tricare|TRICARE FOR LIFE|||||2.72||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Medicaid|MEDICAID TEXAS CHILDRENS|2.72||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||353.60||| 80048|EAP|0301|BASIC METABOLIC PROFILE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Medicaid|MORRIS COUNTY INDIGENT|||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|United Healthcare|UNITED HEALTHCARE OTHER|2.72||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Medicare|MEDICARE PART B ONLY IP|2.72||||||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Medicare|MEDICARE ACUTE|2.72||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||353.60||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Tricare|TRICARE EAST REGION|353.60||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|PHCS|GROUP AND PENSION|||||2.72||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Managed Medicaid|MEDICAID SUPERIOR|312.80||||2.72||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Managed Medicaid|MEDICAID AMERIGROUP|353.60||||2.72||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Managed Medicare|HEALTHSPRING MA|312.80||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|353.60||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|PHCS|HUMANA INSURANCE|||||2.72||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.72||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Humana Medicare Advantage|HUMANA MA|312.80||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|United Medicare Advantage|UHC MEDICARE GOLD MA|2.72||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.72||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Cigna|CIGNA|2.72||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Blue Cross HMO Specialty|BCBSTX HMO|353.60||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Cigna|CIGNA|||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Access Direct Platinum|HEALTHFIRST TPA UMR|2.72||||176.88||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Aetna|AETNA PPO|||||312.80||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|353.60||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Aetna|AETNA OTHER|2.72||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Blue Cross PPO Specialty|BCBSTX PPO|353.60||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|353.60||||176.88||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Aenta Medicare Advantage|AETNA MEDICARE MA|2.72||||81.75||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.72||| 80048|EAP|0301|BASIC METABOLIC PROFILE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||353.60||| 80051|EAP|0301|ELECTROLYTES|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||67.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Multiplan|NALC|||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|NON CONTRACTED|ZZZZZ LIABILITY INS OTHER 1|||||441.68||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|United Healthcare|GEHA|||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Medicaid|MEDICAID HMO|||||390.72||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|NON CONTRACTED|COMMERCIAL OTHER 1|441.68||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|PHCS|GROUP AND PENSION|||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|NON CONTRACTED|COMMERCIAL OTHER 2|||||441.68||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|PHCS|MULTIPLAN PHCS|||||441.68||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Tricare|TRICARE EAST REGION|441.68||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||390.72||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Tricare|TRICARE FOR LIFE|||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|United Healthcare|UNITED HEALTHCARE ERS|||||441.68||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Medicaid|MORRIS COUNTY INDIGENT|||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Medicaid|MEDICAID|339.75||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|United Healthcare|UNITED HEALTHCARE|441.68||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Medicaid|CAMP COUNTY INDIGENT|||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Medicaid|MEDICAID TEXAS CHILDRENS|339.75||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|United Healthcare|UNITED HEALTHCARE OTHER|339.75||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|United Healthcare|TML GROUP BENEFITS|||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|United Medicare Advantage|UHC MEDICARE GOLD MA|441.68||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|441.68||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|339.75||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Workers Compensation|WORKERS COMPENSATION OTHER|||||441.68||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|PHCS|MERITAIN HEALTH|||||441.68||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Medicare|MEDICARE ACUTE|441.68||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Veterans Affairs|VETERANS ADMINISTRATION|||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Veterans Affairs|VETERANS ADMINISTRATION|339.75||||441.68||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Cigna|CIGNA|441.68||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Medicaid|MEDICAID BCBSTX|||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||390.72||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Blue Cross HMO Specialty|BCBSTX HMO|441.68||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Aetna|AETNA OTHER|339.75||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Aenta Medicare Advantage|AETNA MEDICARE MA|441.68||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Aetna|MAIL HANDLERS BENEFIT PLAN|||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|PHCS|HUMANA INSURANCE|||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Aetna|AETNA PPO|||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|441.68||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|441.68||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|339.75||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Access Direct Platinum|HEALTHFIRST TPA UMR|339.75||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Blue Cross PPO Specialty|BCBSTX OTHER|||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Medicare|MEDICARE PART B ONLY IP|339.75||||||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|United Healthcare|UNITED HEALTHCARE|339.75||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|441.68||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Cigna|CIGNA|339.75||||441.68||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Blue Cross PPO Specialty|BCBSTX PPO|441.68||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Managed Medicaid|MEDICAID UNITED HEALTHCARE|339.75||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Managed Medicare|BCBS MEDICARE PPO MA|||||390.72||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Managed Medicare|HEALTHSPRING MA|390.72||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Managed Medicaid|MEDICAID AMERIGROUP|339.75||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Managed Medicaid|MEDICAID SUPERIOR|441.68||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Humana Medicare Advantage|HUMANA MA|441.68||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|441.68||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.02||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Managed Medicaid|MEDICAID SUPERIOR|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Humana Medicare Advantage|HUMANA MA|559.65||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Managed Medicare|BCBS MEDICARE PPO MA|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Managed Medicaid|MEDICAID AMERIGROUP|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Aenta Medicare Advantage|AETNA MEDICARE MA|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|559.65||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|559.65||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Blue Cross HMO Specialty|BCBSTX HMO|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Aetna|AETNA PPO|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|559.65||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Cigna|CIGNA|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Access Direct Platinum|HEALTHFIRST TPA UMR|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Aetna|AETNA OTHER|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|United Medicare Advantage|UHC MEDICARE GOLD MA|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|430.50||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Blue Cross PPO Specialty|BCBSTX PPO|559.65||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Tricare|TRICARE EAST REGION|559.65||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Multiplan|NALC|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|United Healthcare|TML GROUP BENEFITS|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|PHCS|HUMANA INSURANCE|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Managed Medicare|HEALTHSPRING MA|559.65||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Medicaid|MEDICAID|495.08||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Medicaid|MORRIS COUNTY INDIGENT|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|NON CONTRACTED|COMMERCIAL OTHER 1|559.65||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Medicare|MEDICARE ACUTE|430.50||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|United Healthcare|GEHA|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|United Healthcare|UNITED HEALTHCARE|430.50||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|PHCS|GROUP AND PENSION|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Tricare|TRICARE FOR LIFE|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Medicare|MEDICARE PART B ONLY IP|430.50||||||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Medicaid|MEDICAID TEXAS CHILDRENS|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|United Healthcare|UNITED HEALTHCARE OTHER|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||129.25||| 80061|EAP|0301|CARDIAC RISK PANEL (LIPID|United Healthcare|UNITED HEALTHCARE|559.65||||129.25||| 80069|EAP|0301|RENAL FUNCTION PANEL|Medicaid|MORRIS COUNTY INDIGENT|||||83.75||| 80069|EAP|0301|RENAL FUNCTION PANEL|Medicare|MEDICARE ACUTE|||||83.75||| 80069|EAP|0301|RENAL FUNCTION PANEL|Tricare|TRICARE EAST REGION|||||83.75||| 80069|EAP|0301|RENAL FUNCTION PANEL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||83.75||| 80069|EAP|0301|RENAL FUNCTION PANEL|United Healthcare|UNITED HEALTHCARE|||||83.75||| 80069|EAP|0301|RENAL FUNCTION PANEL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||83.75||| 80069|EAP|0301|RENAL FUNCTION PANEL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||83.75||| 80069|EAP|0301|RENAL FUNCTION PANEL|Cigna|CIGNA|||||83.75||| 80069|EAP|0301|RENAL FUNCTION PANEL|Blue Cross PPO Specialty|BCBSTX PPO|||||83.75||| 80069|EAP|0301|RENAL FUNCTION PANEL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||83.75||| 80069|EAP|0301|RENAL FUNCTION PANEL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||83.75||| 80069|EAP|0301|RENAL FUNCTION PANEL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||83.75||| 80069|EAP|0301|RENAL FUNCTION PANEL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||83.75||| 80069|EAP|0301|RENAL FUNCTION PANEL|Managed Medicaid|MEDICAID AMERIGROUP|||||83.75||| 80069|EAP|0301|RENAL FUNCTION PANEL|Humana Medicare Advantage|HUMANA MA|||||83.75||| 80069|EAP|0301|RENAL FUNCTION PANEL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||83.75||| 80069|EAP|0301|RENAL FUNCTION PANEL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||83.75||| 80074|EAP|0301|HEPATITIS COMPLETE|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.77||| 80076|EAP|0301|LIVER SERIES|Managed Medicaid|MEDICAID UNITED HEALTHCARE|262.50||||78.75||| 80076|EAP|0301|LIVER SERIES|Managed Medicaid|MEDICAID SUPERIOR|262.50||||78.75||| 80076|EAP|0301|LIVER SERIES|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|341.25||||78.75||| 80076|EAP|0301|LIVER SERIES|Humana Medicare Advantage|HUMANA MA|262.50||||78.75||| 80076|EAP|0301|LIVER SERIES|Managed Medicaid|MEDICAID AMERIGROUP|||||78.75||| 80076|EAP|0301|LIVER SERIES|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||78.75||| 80076|EAP|0301|LIVER SERIES|Blue Cross HMO Specialty|BCBSTX HMO|||||78.75||| 80076|EAP|0301|LIVER SERIES|Cigna|CIGNA|||||78.75||| 80076|EAP|0301|LIVER SERIES|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||78.75||| 80076|EAP|0301|LIVER SERIES|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||78.75||| 80076|EAP|0301|LIVER SERIES|Blue Cross PPO Specialty|BCBSTX PPO|||||78.75||| 80076|EAP|0301|LIVER SERIES|Aenta Medicare Advantage|AETNA MEDICARE MA|||||78.75||| 80076|EAP|0301|LIVER SERIES|Aetna|AETNA PPO|||||78.75||| 80076|EAP|0301|LIVER SERIES|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||78.75||| 80076|EAP|0301|LIVER SERIES|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||262.50||| 80076|EAP|0301|LIVER SERIES|United Medicare Advantage|UHC MEDICARE GOLD MA|||||78.75||| 80076|EAP|0301|LIVER SERIES|NON CONTRACTED|COMMERCIAL OTHER 1|||||78.75||| 80076|EAP|0301|LIVER SERIES|Tricare|TRICARE EAST REGION|||||78.75||| 80076|EAP|0301|LIVER SERIES|United Healthcare|UNITED HEALTHCARE OTHER|||||78.75||| 80076|EAP|0301|LIVER SERIES|Medicare|MEDICARE ACUTE|341.25||||78.75||| 80076|EAP|0301|LIVER SERIES|Medicaid|MEDICAID TEXAS CHILDRENS|||||78.75||| 80076|EAP|0301|LIVER SERIES|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||78.75||| 80076|EAP|0301|LIVER SERIES|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||78.75||| 80076|EAP|0301|LIVER SERIES|United Healthcare|UNITED HEALTHCARE|||||78.75||| 80156|EAP|0301|TEGRETOL CARBAMAZEPH|Medicare|MEDICARE ACUTE|||||140.50||| 80156|EAP|0301|TEGRETOL CARBAMAZEPH|Blue Cross PPO Specialty|BCBSTX PPO|||||140.50||| 80156|EAP|0301|TEGRETOL CARBAMAZEPH|Humana Medicare Advantage|HUMANA MA|||||140.50||| 80158|EAP|0301|CYCLOSPORIN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||158.25||| 80158|EAP|0301|CYCLOSPORIN|Humana Medicare Advantage|HUMANA MA|||||158.25||| 80158|EAP|0301|CYCLOSPORIN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||158.25||| 80158|EAP|0301|CYCLOSPORIN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||158.25||| 80158|EAP|0301|CYCLOSPORIN|Medicare|MEDICARE ACUTE|||||158.25||| 80158|EAP|0301|CYCLOSPORIN|United Healthcare|UNITED HEALTHCARE|||||158.25||| 80162|EAP|0301|DIGOXIN|United Medicare Advantage|UHC MEDICARE GOLD MA|426.50||||1.28||| 80162|EAP|0301|DIGOXIN|Medicare|MEDICARE ACUTE|426.50||||1.28||| 80162|EAP|0301|DIGOXIN|Cigna|CIGNA|||||426.50||| 80162|EAP|0301|DIGOXIN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|426.50||||||| 80162|EAP|0301|DIGOXIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.28||| 80162|EAP|0301|DIGOXIN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|426.50||||277.25||| 80162|EAP|0301|DIGOXIN|Humana Medicare Advantage|HUMANA MA|426.50||||1.28||| 80164|EAP|0301|DEPAKENE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||130.75||| 80164|EAP|0301|DEPAKENE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.83||| 80164|EAP|0301|DEPAKENE|Managed Medicaid|MEDICAID SUPERIOR|||||2.83||| 80164|EAP|0301|DEPAKENE|Humana Medicare Advantage|HUMANA MA|||||130.75||| 80164|EAP|0301|DEPAKENE|Blue Cross HMO Specialty|BCBSTX HMO|||||130.75||| 80164|EAP|0301|DEPAKENE|Blue Cross PPO Specialty|BCBSTX PPO|||||130.75||| 80164|EAP|0301|DEPAKENE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||130.75||| 80164|EAP|0301|DEPAKENE|United Healthcare|UNITED HEALTHCARE|||||130.75||| 80164|EAP|0301|DEPAKENE|Medicaid|MEDICAID|||||2.83||| 80164|EAP|0301|DEPAKENE|Medicare|MEDICARE ACUTE|435.25||||130.75||| 80164|EAP|0301|DEPAKENE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||130.75||| 80164|EAP|0301|DEPAKENE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||130.75||| 80170|EAP|0301|GENTAMICIN TROUGH|Managed Medicaid|MEDICAID SUPERIOR|526.50||||||| 80170|EAP|0301|GENTAMICIN PEAK|Managed Medicaid|MEDICAID SUPERIOR|526.50||||||| 80171|EAP|0301|NEURONTIN|Medicare|MEDICARE ACUTE|||||1.32||| 80171|EAP|0301|NEURONTIN|Humana Medicare Advantage|HUMANA MA|||||1.32||| 80175|EAP|0300|LAMOTRIGINE|Blue Cross PPO Specialty|BCBSTX PPO|||||158.25||| 80175|EAP|0300|LAMOTRIGINE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||158.25||| 80175|EAP|0300|LAMOTRIGINE|Medicare|MEDICARE ACUTE|||||158.25||| 80178|EAP|0301|LITHIUM|Medicaid|MEDICAID|||||63.75||| 80178|EAP|0301|LITHIUM|Medicaid|MEDICAID TEXAS CHILDRENS|||||63.75||| 80178|EAP|0301|LITHIUM|United Healthcare|UNITED HEALTHCARE|||||212.25||| 80178|EAP|0301|LITHIUM|Medicare|MEDICARE ACUTE|||||63.75||| 80178|EAP|0301|LITHIUM|United Medicare Advantage|UHC MEDICARE GOLD MA|||||63.75||| 80178|EAP|0301|LITHIUM|Managed Medicaid|MEDICAID SUPERIOR|||||63.75||| 80178|EAP|0301|LITHIUM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||63.75||| 80178|EAP|0301|LITHIUM|Humana Medicare Advantage|HUMANA MA|||||63.75||| 80184|EAP|0301|PHENOBARB|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||110.50||| 80184|EAP|0301|PHENOBARB|Medicare|MEDICARE ACUTE|||||110.50||| 80185|EAP|0301|DILANTIN|Blue Cross PPO Specialty|BCBSTX PPO|4.26||||2.77||| 80185|EAP|0301|DILANTIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.26||| 80185|EAP|0301|DILANTIN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.28||| 80185|EAP|0301|DILANTIN|Humana Medicare Advantage|HUMANA MA|||||1.28||| 80185|EAP|0301|DILANTIN|Managed Medicaid|MEDICAID SUPERIOR|||||4.26||| 80185|EAP|0301|DILANTIN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.28||| 80185|EAP|0301|DILANTIN|Medicare|MEDICARE ACUTE|||||4.26||| 80185|EAP|0301|DILANTIN|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.26||| 80185|EAP|0301|DILANTIN|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.28||| 80197|EAP|0301|PROGRAFF (TACRO)|Medicare|MEDICARE ACUTE|||||132.25||| 80197|EAP|0301|PROGRAFF (TACRO)|Managed Medicaid|MEDICAID AMERIGROUP|||||132.25||| 80197|EAP|0301|PROGRAFF (TACRO)|Humana Medicare Advantage|HUMANA MA|||||132.25||| 80197|EAP|0301|PROGRAFF (TACRO)|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||132.25||| 80198|EAP|0301|THEOPHYLLINE LEVEL|Medicare|MEDICARE ACUTE|||||136.50||| 80200|EAP|0301|TOBRAMYCIN PEAK|Blue Cross PPO Specialty|BCBSTX PPO|517.75||||||| 80201|EAP|0301|TOPIRAMATE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.18||| 80201|EAP|0301|TOPIRAMATE|Blue Cross PPO Specialty|BCBSTX PPO|||||35.40||| 80202|EAP|0301|VANCOMYCIN TROUGH|United Medicare Advantage|UHC MEDICARE GOLD MA|435.25||||||| 80202|EAP|0301|VANCOMYCIN TROUGH|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|435.25||||||| 80202|EAP|0301|VANCOMYCIN TROUGH|United Healthcare|UNITED HEALTHCARE|435.25||||||| 80202|EAP|0301|VANCOMYCIN TROUGH|United Healthcare|UNITED HEALTHCARE OTHER|435.25||||||| 80202|EAP|0301|VANCOMYCIN TROUGH|Medicare|MEDICARE PART B ONLY IP|435.25||||||| 80202|EAP|0301|VANCOMYCIN RANDOM|Medicare|MEDICARE ACUTE|435.25||||435.25||| 80202|EAP|0301|VANCOMYCIN TROUGH|Medicare|MEDICARE ACUTE|435.25||||130.75||| 80202|EAP|0301|VANCOMYCIN TROUGH|NON CONTRACTED|COMMERCIAL OTHER 1|435.25||||||| 80202|EAP|0301|VANCOMYCIN TROUGH|Cigna|CIGNA|435.25||||||| 80202|EAP|0301|VANCOMYCIN TROUGH|Blue Cross PPO Specialty|BCBSTX PPO|435.25||||435.25||| 80202|EAP|0301|VANCOMYCIN TROUGH|Aetna|AETNA OTHER|435.25||||||| 80202|EAP|0301|VANCOMYCIN TROUGH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|435.25||||||| 80202|EAP|0301|VANCOMYCIN TROUGH|Aenta Medicare Advantage|AETNA MEDICARE MA|435.25||||130.75||| 80202|EAP|0301|VANCOMYCIN TROUGH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||130.75||| 80202|EAP|0301|VANCOMYCIN TROUGH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|435.25||||||| 80202|EAP|0301|VANCOMYCIN TROUGH|Humana Medicare Advantage|HUMANA MA|435.25||||130.75||| 80202|EAP|0301|VANCOMYCIN TROUGH|Managed Medicaid|MEDICAID SUPERIOR|435.25||||||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Managed Medicare|HEALTHSPRING MA|442.50||||442.50||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|442.50||||575.25||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Managed Medicaid|MEDICAID SUPERIOR|575.25||||442.50||| 80307|EAP|0300|DRUG ABUSE PANEL III|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||132.75||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|442.50||||442.50||| 80307|EAP|0301|ACETAMINOPHEN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|6.50||||8.45||| 80307|EAP|0301|ACETAMINOPHEN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|6.50||||6.50||| 80307|EAP|0300|DRUG ABUSE PANEL III|Humana Medicare Advantage|HUMANA MA|||||132.75||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Humana Medicare Advantage|HUMANA MA|575.25||||442.50||| 80307|EAP|0301|ACETAMINOPHEN|Managed Medicare|HEALTHSPRING MA|442.50||||6.50||| 80307|EAP|0301|ACETAMINOPHEN|Managed Medicaid|MEDICAID AMERIGROUP|6.50||||8.45||| 80307|EAP|0301|ACETAMINOPHEN|Managed Medicaid|MEDICAID SUPERIOR|575.25||||6.50||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Aenta Medicare Advantage|AETNA MEDICARE MA|||||575.25||| 80307|EAP|0301|ACETAMINOPHEN|Blue Cross HMO Specialty|BCBSTX HMO|||||6.50||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Blue Cross HMO Specialty|BCBSTX HMO|||||442.50||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Cigna|CIGNA|||||575.25||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Aetna|AETNA PPO|||||442.50||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Aetna|AETNA OTHER|||||575.25||| 80307|EAP|0301|ACETAMINOPHEN|Aetna|AETNA PPO|||||6.50||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||442.50||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|8.45||||442.50||| 80307|EAP|0301|ACETAMINOPHEN|Aetna|AETNA OTHER|||||8.45||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|508.88||||442.50||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Blue Cross PPO Specialty|BCBSTX OTHER|||||442.50||| 80307|EAP|0301|ACETAMINOPHEN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||6.50||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||442.50||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Access Direct Platinum|HEALTHFIRST TPA UMR|||||132.75||| 80307|EAP|0300|DRUG ABUSE PANEL III|Blue Cross PPO Specialty|BCBSTX PPO|||||132.75||| 80307|EAP|0301|ACETAMINOPHEN|Blue Cross PPO Specialty|BCBSTX PPO|575.25||||747.50||| 80307|EAP|0301|ACETAMINOPHEN|Blue Cross PPO Specialty|BCBSTX OTHER|||||6.50||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Blue Cross PPO Specialty|BCBSTX PPO|575.25||||442.50||| 80307|EAP|0301|ACETAMINOPHEN|Medicaid|MEDICAID TEXAS CHILDRENS|||||8.45||| 80307|EAP|0301|DRUG SCREEN RAPID ST|NON CONTRACTED|COMMERCIAL OTHER 1|575.25||||442.50||| 80307|EAP|0300|DRUG ABUSE PANEL III|NON CONTRACTED|COMMERCIAL OTHER 1|||||132.75||| 80307|EAP|0301|DRUG SCREEN RAPID ST|United Healthcare|UNITED HEALTHCARE|||||575.25||| 80307|EAP|0301|DRUG SCREEN RAPID ST|United Healthcare|UNITED HEALTHCARE|||||508.88||| 80307|EAP|0301|ACETAMINOPHEN|United Healthcare|TML GROUP BENEFITS|||||8.45||| 80307|EAP|0301|ACETAMINOPHEN|NON CONTRACTED|COMMERCIAL OTHER 1|575.25||||747.50||| 80307|EAP|0301|DRUG SCREEN RAPID ST|NON CONTRACTED|CAMP COUNTY SHERIFF OFFICE|||||132.75||| 80307|EAP|0301|ACETAMINOPHEN|Cigna|CIGNA|||||8.45||| 80307|EAP|0301|DRUG SCREEN RAPID ST|United Healthcare|UNITED HEALTHCARE OTHER|||||287.63||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Medicare|MEDICARE ACUTE|575.25||||442.50||| 80307|EAP|0301|ACETAMINOPHEN|Medicare|MEDICARE ACUTE|8.45||||8.45||| 80307|EAP|0301|ACETAMINOPHEN|United Healthcare|UNITED HEALTHCARE|||||747.50||| 80307|EAP|0301|ACETAMINOPHEN|Aenta Medicare Advantage|AETNA MEDICARE MA|||||8.45||| 80307|EAP|0300|DRUG ABUSE PANEL III|United Healthcare|UNITED HEALTHCARE|||||132.75||| 80307|EAP|0301|ACETAMINOPHEN|Medicaid|MEDICAID|442.50||||747.50||| 80307|EAP|0301|ACETAMINOPHEN|United Healthcare|UNITED HEALTHCARE OTHER|||||6.50||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||508.88||| 80307|EAP|0301|ACETAMINOPHEN|Humana Medicare Advantage|HUMANA MA|6.50||||8.45||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Medicaid|MEDICAID|442.50||||575.25||| 80307|EAP|0301|ACETAMINOPHEN|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||6.50||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||508.88||| 80307|EAP|0300|DRUG ABUSE PANEL III|Medicare|MEDICARE ACUTE|||||132.75||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Tricare|TRICARE EAST REGION|575.25||||442.50||| 80307|EAP|0301|DRUG SCREEN RAPID ST|United Healthcare|TML GROUP BENEFITS|||||575.25||| 80307|EAP|0301|DRUG SCREEN RAPID ST|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||442.50||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Medicaid|MEDICAID TEXAS CHILDRENS|||||575.25||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Managed Medicaid|MEDICAID AMERIGROUP|442.50||||575.25||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Medicaid|MEDICAID HMO|||||442.50||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Veterans Affairs|VETERANS ADMINISTRATION|||||575.25||| 80307|EAP|0301|ACETAMINOPHEN|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|442.50||||8.45||| 80307|EAP|0301|DRUG SCREEN RAPID ST|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|442.50||||575.25||| 80307|EAP|0301|DRUG SCREEN RAPID ST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||575.25||| 80307|EAP|0301|DRUG SCREEN RAPID ST|United Medicare Advantage|UHC MEDICARE GOLD MA|442.50||||508.88||| 80307|EAP|0301|DRUG SCREEN RAPID ST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||508.88||| 80307|EAP|0301|ACETAMINOPHEN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||8.45||| 80307|EAP|0301|ACETAMINOPHEN|United Medicare Advantage|UHC MEDICARE GOLD MA|442.50||||6.50||| 80307|EAP|0301|DRUG SCREEN RAPID ST|Workers Compensation|WORKERS COMPENSATION OTHER|||||575.25||| 80307|EAP|0301|ACETAMINOPHEN|Veterans Affairs|VETERANS ADMINISTRATION|||||8.45||| 80320|EAP|0301|ALCOHOL-ETHANOL|Veterans Affairs|VETERANS ADMINISTRATION|||||451.43||| 80320|EAP|0301|ALCOHOL-ETHANOL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||451.43||| 80320|EAP|0301|ALCOHOL-ETHANOL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||347.25||| 80320|EAP|0301|ALCOHOL-ETHANOL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||451.43||| 80320|EAP|0301|ALCOHOL-ETHANOL|Workers Compensation|WORKERS COMPENSATION OTHER|||||451.43||| 80320|EAP|0301|ALCOHOL-ETHANOL|Medicare|MEDICARE ACUTE|399.34||||347.25||| 80320|EAP|0301|ALCOHOL-ETHANOL|PHCS|HUMANA INSURANCE|||||347.25||| 80320|EAP|0301|ALCOHOL-ETHANOL|Medicaid|MEDICAID|399.34||||399.34||| 80320|EAP|0301|ALCOHOL-ETHANOL|United Healthcare|UNITED HEALTHCARE|||||399.34||| 80320|EAP|0301|ALCOHOL-ETHANOL|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||347.25||| 80320|EAP|0301|ALCOHOL-ETHANOL|Medicaid|MEDICAID TEXAS CHILDRENS|||||451.43||| 80320|EAP|0301|ALCOHOL-ETHANOL|United Healthcare|TML GROUP BENEFITS|||||451.43||| 80320|EAP|0301|ALCOHOL-ETHANOL|NON CONTRACTED|COMMERCIAL OTHER 1|||||399.34||| 80320|EAP|0301|ALCOHOL-ETHANOL|United Healthcare|UNITED HEALTHCARE OTHER|||||347.25||| 80320|EAP|0301|ALCOHOL-ETHANOL|Blue Cross PPO Specialty|BCBSTX PPO|||||451.43||| 80320|EAP|0301|ALCOHOL-ETHANOL|Blue Cross HMO Specialty|BCBSTX HMO|||||347.25||| 80320|EAP|0301|ALCOHOL-ETHANOL|Aetna|AETNA OTHER|||||451.43||| 80320|EAP|0301|ALCOHOL-ETHANOL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||451.43||| 80320|EAP|0301|ALCOHOL-ETHANOL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||451.43||| 80320|EAP|0301|ALCOHOL-ETHANOL|Cigna|CIGNA|||||451.43||| 80320|EAP|0301|ALCOHOL-ETHANOL|Cigna|CIGNA|||||347.25||| 80320|EAP|0301|ALCOHOL-ETHANOL|Blue Cross PPO Specialty|BCBSTX OTHER|||||347.25||| 80320|EAP|0301|ALCOHOL-ETHANOL|Aetna|AETNA PPO|||||347.25||| 80320|EAP|0301|ALCOHOL-ETHANOL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|451.43||||451.43||| 80320|EAP|0301|ALCOHOL-ETHANOL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||347.25||| 80320|EAP|0301|ALCOHOL-ETHANOL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|347.25||||451.43||| 80320|EAP|0301|ALCOHOL-ETHANOL|Managed Medicaid|MEDICAID SUPERIOR|451.43||||347.25||| 80320|EAP|0301|ALCOHOL-ETHANOL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|347.25||||347.25||| 80320|EAP|0301|ALCOHOL-ETHANOL|Managed Medicaid|MEDICAID AMERIGROUP|347.25||||451.43||| 80320|EAP|0301|ALCOHOL-ETHANOL|Humana Medicare Advantage|HUMANA MA|||||451.43||| 80320|EAP|0301|ALCOHOL-ETHANOL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||451.43||| 80320|EAP|0301|ALCOHOL-ETHANOL|Managed Medicare|HEALTHSPRING MA|347.25||||347.25||| 80324|EAP|0301|DRUG SCREEN AMPHETAMINES|Medicare|MEDICARE ACUTE|||||1.32||| 80324|EAP|0301|DRUG SCREEN AMPHETAMINES|United Healthcare|UNITED HEALTHCARE|||||1.32||| 80329|EAP|0301|SALICYLATES|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.28||||296.40||| 80329|EAP|0301|SALICYLATES|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.28||||2.28||| 80329|EAP|0301|SALICYLATES|Humana Medicare Advantage|HUMANA MA|||||296.40||| 80329|EAP|0301|SALICYLATES|Managed Medicaid|MEDICAID AMERIGROUP|2.28||||296.40||| 80329|EAP|0301|SALICYLATES|Managed Medicare|HEALTHSPRING MA|||||2.28||| 80329|EAP|0301|SALICYLATES|Cigna|CIGNA|||||296.40||| 80329|EAP|0301|SALICYLATES|Aetna|AETNA OTHER|||||296.40||| 80329|EAP|0301|SALICYLATES|Blue Cross HMO Specialty|BCBSTX HMO|||||2.28||| 80329|EAP|0301|SALICYLATES|Aetna|AETNA PPO|||||2.28||| 80329|EAP|0301|SALICYLATES|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.28||| 80329|EAP|0301|SALICYLATES|Blue Cross PPO Specialty|BCBSTX PPO|||||262.20||| 80329|EAP|0301|SALICYLATES|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.28||| 80329|EAP|0301|SALICYLATES|Aenta Medicare Advantage|AETNA MEDICARE MA|||||296.40||| 80329|EAP|0301|SALICYLATES|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|296.40||||||| 80329|EAP|0301|SALICYLATES|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.28||| 80329|EAP|0301|SALICYLATES|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||296.40||| 80329|EAP|0301|SALICYLATES|Managed Medicaid|MEDICAID SUPERIOR|||||2.28||| 80329|EAP|0301|SALICYLATES|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||296.40||| 80329|EAP|0301|SALICYLATES|Veterans Affairs|VETERANS ADMINISTRATION|||||296.40||| 80329|EAP|0301|SALICYLATES|Medicaid|MEDICAID|||||262.20||| 80329|EAP|0301|SALICYLATES|NON CONTRACTED|COMMERCIAL OTHER 1|||||262.20||| 80329|EAP|0301|SALICYLATES|United Healthcare|TML GROUP BENEFITS|||||296.40||| 80329|EAP|0301|SALICYLATES|Medicare|MEDICARE ACUTE|296.40||||296.40||| 80329|EAP|0301|SALICYLATES|United Healthcare|UNITED HEALTHCARE|||||262.20||| 80329|EAP|0301|SALICYLATES|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2.28||| 80329|EAP|0301|SALICYLATES|Medicaid|MEDICAID TEXAS CHILDRENS|||||296.40||| 80329|EAP|0301|SALICYLATES|United Healthcare|UNITED HEALTHCARE OTHER|||||2.28||| 80329|EAP|0301|SALICYLATES|United Healthcare|UNITED HEALTHCARE|||||296.40||| 80332|EAP|0301|TRILEPTAL|Medicare|MEDICARE ACUTE|||||464.29||| 80332|EAP|0301|TRILEPTAL|Tricare|TRICARE EAST REGION|||||174.25||| 80332|EAP|0301|TRILEPTAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||174.25||| 80332|EAP|0301|TRILEPTAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||174.25||| 80332|EAP|0301|TRILEPTAL|Humana Medicare Advantage|HUMANA MA|||||174.25||| 80346|EAP|0301|QUANTITATIVE ASSAY DRUG|Managed Medicaid|MEDICAID AMERIGROUP|||||442.50||| 80346|EAP|0301|QUANTITATIVE ASSAY DRUG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||575.25||| 80346|EAP|0301|QUANTITATIVE ASSAY DRUG|Humana Medicare Advantage|HUMANA MA|||||1.32||| 80346|EAP|0301|QUANTITATIVE ASSAY DRUG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.32||| 80346|EAP|0301|QUANTITATIVE ASSAY DRUG|Blue Cross PPO Specialty|BCBSTX PPO|||||1.32||| 80346|EAP|0301|QUANTITATIVE ASSAY DRUG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.32||| 80346|EAP|0301|QUANTITATIVE ASSAY DRUG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||287.25||| 80346|EAP|0301|QUANTITATIVE ASSAY DRUG|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.32||| 80346|EAP|0301|QUANTITATIVE ASSAY DRUG|Medicare|MEDICARE ACUTE|442.50||||1.32||| 80349|EAP|0301|DRUG SCREEN CANNABINOIDS|Medicare|MEDICARE ACUTE|||||1.32||| 80349|EAP|0301|DRUG SCREEN CANNABINOIDS|United Healthcare|UNITED HEALTHCARE|||||1.32||| 80349|EAP|0301|DRUG SCREEN CANNABINOIDS|Humana Medicare Advantage|HUMANA MA|||||1.32||| 80353|EAP|0301|COCAINE LEVEL|Medicare|MEDICARE ACUTE|||||1.32||| 80359|EAP|0301|METHYLENECLIOXYAMPLETAMIN|United Healthcare|UNITED HEALTHCARE|||||1.32||| 80359|EAP|0301|METHYLENECLIOXYAMPLETAMIN|Medicare|MEDICARE ACUTE|||||1.32||| 808|DRG||MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W MCC|Blue Cross PPO Specialty|BCBSTX PPO|44,258.75|9464.81|9464.81|78.52|||| 808|DRG||MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W MCC|Medicare|MEDICARE ACUTE|28,489.39|78.52|9464.81|78.52|||| 809|DRG||MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|37,107.56|3311.64|3311.64|3311.64|||| 81001|EAP|0307|URINE CHEM & MICRO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.17||||58.50||| 81001|EAP|0307|URINE CHEM & MICRO|United Medicare Advantage|UHC MEDICARE GOLD MA|0.90||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|United Healthcare|UNITED HEALTHCARE OTHER|0.90||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|United Healthcare|UNITED HEALTHCARE|0.90||||1.17||| 81001|EAP|0307|URINE CHEM & MICRO|Veterans Affairs|VETERANS ADMINISTRATION|||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|United Healthcare|TML GROUP BENEFITS|||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|United Healthcare|GEHA|||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|0.90||||0.27||| 81001|EAP|0307|URINE CHEM & MICRO|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.17||| 81001|EAP|0307|URINE CHEM & MICRO|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|Medicaid|MORRIS COUNTY INDIGENT|||||58.50||| 81001|EAP|0307|URINE CHEM & MICRO|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|Medicaid|MEDICAID TEXAS CHILDRENS|0.90||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|Medicaid|MEDICAID HMO|||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|Medicaid|MEDICAID|0.90||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|NON CONTRACTED|COMMERCIAL OTHER 1|1.17||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|PHCS|GROUP AND PENSION|||||58.50||| 81001|EAP|0307|URINE CHEM & MICRO|Tricare|TRICARE FOR LIFE|||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|PHCS|HUMANA INSURANCE|||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|Tricare|TRICARE EAST REGION|1.17||||0.27||| 81001|EAP|0307|URINE CHEM & MICRO|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|Medicaid|MEDICAID BCBSTX|||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|Medicare|MEDICARE ACUTE|1.17||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|Managed Medicaid|MEDICAID AMERIGROUP|0.90||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|Managed Medicare|HEALTHSPRING MA|1.17||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.90||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|Humana Medicare Advantage|HUMANA MA|0.90||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.90||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|Managed Medicare|BCBS MEDICARE PPO MA|||||103.50||| 81001|EAP|0307|URINE CHEM & MICRO|Managed Medicaid|MEDICAID SUPERIOR|1.17||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|United Healthcare|UNITED HEALTHCARE|||||0.27||| 81001|EAP|0307|URINE CHEM & MICRO|Veterans Affairs|VETERANS ADMINISTRATION|0.90||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||58.50||| 81001|EAP|0307|URINE CHEM & MICRO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|103.50||||0.27||| 81001|EAP|0307|URINE CHEM & MICRO|Aetna|AETNA PPO|||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|Aenta Medicare Advantage|AETNA MEDICARE MA|1.17||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.27||| 81001|EAP|0307|URINE CHEM & MICRO|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||103.50||| 81001|EAP|0307|URINE CHEM & MICRO|Blue Cross HMO Specialty|BCBSTX HMO|1.17||||0.27||| 81001|EAP|0307|URINE CHEM & MICRO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.17||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||1.17||| 81001|EAP|0307|URINE CHEM & MICRO|Cigna|CIGNA|0.90||||1.17||| 81001|EAP|0307|URINE CHEM & MICRO|Blue Cross PPO Specialty|BCBSTX PPO|0.90||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|Aetna|AETNA OTHER|||||103.50||| 81001|EAP|0307|URINE CHEM & MICRO|Blue Cross PPO Specialty|BCBSTX OTHER|||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|Cigna|CIGNA|103.50||||0.90||| 81001|EAP|0307|URINE CHEM & MICRO|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1.17||| 81001|EAP|0307|URINE CHEM & MICRO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.17||||0.27||| 81001|EAP|0307|URINE CHEM & MICRO|Access Direct Platinum|HEALTHFIRST TPA UMR|||||0.27||| 81002|EAP|0307|URINALYSIS W/O SCOPE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||24.75||| 81002|EAP|0307|URINALYSIS W/O SCOPE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||24.75||| 81002|EAP|0307|URINALYSIS W/O SCOPE|Managed Medicaid|MEDICAID SUPERIOR|||||24.75||| 81002|EAP|0307|URINALYSIS W/O SCOPE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||24.75||| 81002|EAP|0307|URINALYSIS W/O SCOPE|Managed Medicaid|MEDICAID AMERIGROUP|||||24.75||| 81002|EAP|0307|URINALYSIS W/O SCOPE|Humana Medicare Advantage|HUMANA MA|||||24.75||| 81002|EAP|0307|URINALYSIS W/O SCOPE|Medicaid|MEDICAID|||||24.75||| 81002|EAP|0300|UA DIP STICK|Medicare|MEDICARE ACUTE|||||0.30||| 81002|EAP|0307|URINALYSIS W/O SCOPE|Medicare|MEDICARE ACUTE|||||24.75||| 81002|EAP|0307|URINALYSIS W/O SCOPE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||24.75||| 81003|EAP|0300|URINALYSIS BY REAGENT STR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||21.75||| 81003|EAP|0300|URINALYSIS BY REAGENT STR|Medicare|MEDICARE ACUTE|||||21.75||| 81003|EAP|0300|URINALYSIS BY REAGENT STR|United Healthcare|UNITED HEALTHCARE|||||21.75||| 81003|EAP|0300|URINALYSIS BY REAGENT STR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||93.93||| 81003|EAP|0300|URINALYSIS BY REAGENT STR|Humana Medicare Advantage|HUMANA MA|72.25||||21.75||| 81003|EAP|0300|URINALYSIS BY REAGENT STR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||21.75||| 81003|EAP|0300|URINALYSIS BY REAGENT STR|Blue Cross PPO Specialty|BCBSTX PPO|72.25||||21.75||| 81003|EAP|0300|URINALYSIS BY REAGENT STR|Blue Cross PPO Specialty|BCBSTX OTHER|||||21.75||| 81025|EAP|0300|PREGNANCY TEST URINE RHC|Blue Cross PPO Specialty|BCBSTX PPO|||||0.59||| 81025|EAP|0300|PREGNANCY TEST URINE RHC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.59||| 81025|EAP|0300|PREGNANCY TEST URINE RHC|Managed Medicaid|MEDICAID SUPERIOR|||||0.59||| 81025|EAP|0300|PREGNANCY TEST URINE RHC|Medicaid|MEDICAID|||||0.59||| 81025|EAP|0300|PREGNANCY TEST URINE RHC|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.59||| 81025|EAP|0300|PREGNANCY TEST URINE RHC|Medicare|MEDICARE ACUTE|||||0.59||| 81050|EAP|0307|URINE VOLUME MEASUREMENT|United Medicare Advantage|UHC MEDICARE GOLD MA|125.13||||||| 81050|EAP|0307|URINE VOLUME MEASUREMENT|Tricare|TRICARE EAST REGION|||||37.75||| 81050|EAP|0307|URINE VOLUME MEASUREMENT|Medicare|MEDICARE ACUTE|||||37.75||| 81050|EAP|0307|URINE VOLUME MEASUREMENT|Humana Medicare Advantage|HUMANA MA|||||37.75||| 81050|EAP|0307|URINE VOLUME MEASUREMENT|Managed Medicaid|MEDICAID AMERIGROUP|||||37.75||| 81050|EAP|0307|URINE VOLUME MEASUREMENT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||37.75||| 81050|EAP|0307|URINE VOLUME MEASUREMENT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||37.75||| 811|DRG||RED BLOOD CELL DISORDERS W MCC|Medicare|MEDICARE ACUTE|36,181.07|58.89|58.89|58.89|||| 812|DRG||RED BLOOD CELL DISORDERS W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|28,287.90|4445.15|4445.15|1957.45|||| 812|DRG||RED BLOOD CELL DISORDERS W/O MCC|Humana Medicare Advantage|HUMANA MA|138.18|3860.48|4445.15|1957.45|||| 812|DRG||RED BLOOD CELL DISORDERS W/O MCC|Medicare|MEDICARE ACUTE|9,970.38|1957.45|4445.15|1957.45|||| 81240|EAP|0300|PROTHROMBIN GENE MUTATION|Medicare|MEDICARE ACUTE|425.10||||98.25||| 81241|EAP|0300|FACTOR V LEIDEN|Medicare|MEDICARE ACUTE|648.70||||98.25||| 82009|EAP|0301|ACETONE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.40||||140.22||| 82009|EAP|0301|ACETONE|Managed Medicaid|MEDICAID AMERIGROUP|||||1.40||| 82009|EAP|0301|ACETONE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.40||||140.44||| 82009|EAP|0301|ACETONE|Managed Medicaid|MEDICAID SUPERIOR|||||140.22||| 82009|EAP|0301|ACETONE|Cigna|CIGNA|||||1.40||| 82009|EAP|0301|ACETONE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.40||| 82009|EAP|0301|ACETONE|Humana Medicare Advantage|HUMANA MA|||||1.40||| 82009|EAP|0301|ACETONE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.40||| 82009|EAP|0301|ACETONE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.40||| 82009|EAP|0301|ACETONE|Blue Cross PPO Specialty|BCBSTX PPO|1.40||||1.40||| 82009|EAP|0301|ACETONE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.40||| 82009|EAP|0301|ACETONE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.40||| 82009|EAP|0301|ACETONE|Veterans Affairs|VETERANS ADMINISTRATION|||||140.44||| 82009|EAP|0301|ACETONE|Medicaid|MEDICAID|1.40||||140.44||| 82009|EAP|0301|ACETONE|United Healthcare|UNITED HEALTHCARE|||||1.40||| 82009|EAP|0301|ACETONE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||1.40||| 82009|EAP|0301|ACETONE|Medicaid|MORRIS COUNTY INDIGENT|||||140.44||| 82009|EAP|0301|ACETONE|Medicare|MEDICARE ACUTE|||||1.40||| 82009|EAP|0301|ACETONE|Tricare|TRICARE EAST REGION|140.44||||||| 82009|EAP|0301|ACETONE|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.40||| 82040|EAP|0301|ALBUMIN SERUM|Medicare|MEDICARE ACUTE|1.59||||47.75||| 82040|EAP|0301|ALBUMIN SERUM|United Medicare Advantage|UHC MEDICARE GOLD MA|1.59||||||| 82040|EAP|0301|ALBUMIN SERUM|Blue Cross HMO Specialty|BCBSTX HMO|||||47.75||| 82040|EAP|0301|ALBUMIN SERUM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||47.75||| 82040|EAP|0301|ALBUMIN SERUM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||47.75||| 82040|EAP|0301|ALBUMIN SERUM|Humana Medicare Advantage|HUMANA MA|||||47.75||| 82040|EAP|0301|ALBUMIN SERUM|Managed Medicaid|MEDICAID AMERIGROUP|||||47.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Managed Medicaid|MEDICAID AMERIGROUP|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Managed Medicaid|MEDICAID SUPERIOR|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Managed Medicare|BCBS MEDICARE PPO MA|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Managed Medicare|HEALTHSPRING MA|179.31||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|179.31||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Blue Cross HMO Specialty|BCBSTX HMO|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Cigna|CIGNA|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Blue Cross PPO Specialty|BCBSTX PPO|179.31||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|179.31||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Veterans Affairs|VETERANS ADMINISTRATION|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Humana Medicare Advantage|HUMANA MA|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Medicaid|MEDICAID|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Medicaid|CAMP COUNTY INDIGENT|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Multiplan|NALC|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Medicare|MEDICARE ACUTE|179.31||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Medicaid|MORRIS COUNTY INDIGENT|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|NON CONTRACTED|COMMERCIAL OTHER 1|179.31||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|United Healthcare|UNITED HEALTHCARE OTHER|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|PHCS|HUMANA INSURANCE|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Tricare|TRICARE EAST REGION|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|United Healthcare|TML GROUP BENEFITS|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|United Healthcare|UNITED HEALTHCARE|||||53.75||| 82043|EAP|0301|MICRO ALBUMIN URINE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||53.75||| 82085|EAP|0301|ALDOLASE|Medicare|MEDICARE ACUTE|312.73||||93.50||| 82085|EAP|0301|ALDOLASE|United Healthcare|UNITED HEALTHCARE|312.73||||||| 82085|EAP|0301|ALDOLASE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||93.50||| 82085|EAP|0301|ALDOLASE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||93.50||| 82085|EAP|0301|ALDOLASE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||93.50||| 82085|EAP|0301|ALDOLASE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|311.75||||||| 82085|EAP|0301|ALDOLASE|Humana Medicare Advantage|HUMANA MA|||||93.50||| 82088|EAP|0301|ALDOSTERONE|Blue Cross PPO Specialty|BCBSTX PPO|||||392.75||| 82088|EAP|0301|ALDOSTERONE|Medicare|MEDICARE ACUTE|11.21||||||| 82103|EAP|0301|ALPHA 1 ANTITRYPSIN TOTAL|Medicare|MEDICARE ACUTE|||||129.50||| 82103|EAP|0301|ALPHA 1 ANTITRYPSIN TOTAL|United Healthcare|UNITED HEALTHCARE|||||129.50||| 82103|EAP|0301|ALPHA 1 ANTITRYPSIN TOTAL|Blue Cross PPO Specialty|BCBSTX PPO|432.85||||||| 82103|EAP|0301|ALPHA 1 ANTITRYPSIN TOTAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||129.50||| 82105|EAP|0301|ALPHA FETO PROTEIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||161.75||| 82105|EAP|0301|ALPHA FETO PROTEIN|Humana Medicare Advantage|HUMANA MA|||||161.75||| 82105|EAP|0301|ALPHA FETO PROTEIN|Managed Medicaid|MEDICAID AMERIGROUP|||||161.75||| 82105|EAP|0301|ALPHA FETO PROTEIN|Blue Cross PPO Specialty|BCBSTX PPO|540.44||||161.75||| 82105|EAP|0301|ALPHA FETO PROTEIN|Blue Cross HMO Specialty|BCBSTX HMO|||||161.75||| 82105|EAP|0301|ALPHA FETO PROTEIN|Aenta Medicare Advantage|AETNA MEDICARE MA|||||161.75||| 82105|EAP|0301|ALPHA FETO PROTEIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||161.75||| 82105|EAP|0301|ALPHA FETO PROTEIN|United Medicare Advantage|UHC MEDICARE GOLD MA|540.44||||161.75||| 82105|EAP|0301|ALPHA FETO PROTEIN|United Healthcare|UNITED HEALTHCARE|||||161.75||| 82105|EAP|0301|ALPHA FETO PROTEIN|Tricare|TRICARE EAST REGION|||||161.75||| 82105|EAP|0301|ALPHA FETO PROTEIN|Medicare|MEDICARE ACUTE|||||161.75||| 82131|EAP|0301|HOMOCYSTEINE|Medicare|MEDICARE ACUTE|||||162.75||| 82131|EAP|0301|HOMOCYSTEINE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||162.75||| 82131|EAP|0301|HOMOCYSTEINE|Blue Cross PPO Specialty|BCBSTX PPO|||||162.75||| 82140|EAP|0301|AMMONIA BLOOD|Managed Medicaid|MEDICAID AMERIGROUP|||||140.50||| 82140|EAP|0301|AMMONIA BLOOD|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|468.25||||469.72||| 82140|EAP|0301|AMMONIA BLOOD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|468.25||||468.25||| 82140|EAP|0301|AMMONIA BLOOD|Humana Medicare Advantage|HUMANA MA|468.99||||469.72||| 82140|EAP|0301|AMMONIA BLOOD|Blue Cross PPO Specialty|BCBSTX PPO|||||468.25||| 82140|EAP|0301|AMMONIA BLOOD|Aenta Medicare Advantage|AETNA MEDICARE MA|||||469.72||| 82140|EAP|0301|AMMONIA BLOOD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|468.25||||468.25||| 82140|EAP|0301|AMMONIA BLOOD|Blue Cross HMO Specialty|BCBSTX HMO|||||468.25||| 82140|EAP|0301|AMMONIA BLOOD|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|469.72||||||| 82140|EAP|0301|AMMONIA BLOOD|United Medicare Advantage|UHC MEDICARE GOLD MA|468.25||||468.25||| 82140|EAP|0301|AMMONIA BLOOD|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|468.25||||||| 82140|EAP|0301|AMMONIA BLOOD|Medicare|MEDICARE ACUTE|469.72||||468.25||| 82140|EAP|0301|AMMONIA BLOOD|Medicaid|MEDICAID|||||468.25||| 82140|EAP|0301|AMMONIA BLOOD|Medicaid|MEDICAID TEXAS CHILDRENS|||||140.50||| 82140|EAP|0301|AMMONIA BLOOD|Medicaid|MEDICAID HMO|||||140.50||| 82140|EAP|0301|AMMONIA BLOOD|NON CONTRACTED|COMMERCIAL OTHER 1|||||469.72||| 82140|EAP|0301|AMMONIA BLOOD|United Healthcare|UNITED HEALTHCARE OTHER|||||468.25||| 82150|EAP|0301|AMYLASE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||208.65||| 82150|EAP|0301|AMYLASE|United Healthcare|UNITED HEALTHCARE|208.65||||2.08||| 82150|EAP|0301|AMYLASE|Medicare|MEDICARE ACUTE|2.08||||2.08||| 82150|EAP|0301|AMYLASE|United Healthcare|UNITED HEALTHCARE|2.08||||2.08||| 82150|EAP|0301|AMYLASE|Medicare|MEDICARE PART B ONLY IP|2.08||||||| 82150|EAP|0301|AMYLASE|NON CONTRACTED|COMMERCIAL OTHER 1|208.65||||2.08||| 82150|EAP|0301|AMYLASE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||208.65||| 82150|EAP|0301|AMYLASE|Tricare|TRICARE EAST REGION|208.65||||208.65||| 82150|EAP|0301|AMYLASE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.08||| 82150|EAP|0301|AMYLASE|United Healthcare|UNITED HEALTHCARE OTHER|||||2.08||| 82150|EAP|0301|AMYLASE|Medicaid|MEDICAID BCBSTX|||||2.08||| 82150|EAP|0301|AMYLASE|Medicaid|MEDICAID|208.33||||2.08||| 82150|EAP|0301|AMYLASE|Veterans Affairs|VETERANS ADMINISTRATION|2.08||||2.08||| 82150|EAP|0301|AMYLASE|Medicaid|MEDICAID TEXAS CHILDRENS|||||208.65||| 82150|EAP|0301|AMYLASE|United Medicare Advantage|UHC MEDICARE GOLD MA|208.65||||2.08||| 82150|EAP|0301|AMYLASE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.08||| 82150|EAP|0301|AMYLASE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.08||||208.33||| 82150|EAP|0301|AMYLASE|Veterans Affairs|VETERANS ADMINISTRATION|||||2.08||| 82150|EAP|0301|AMYLASE|United Healthcare|TML GROUP BENEFITS|||||2.08||| 82150|EAP|0301|AMYLASE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||135.58||| 82150|EAP|0301|AMYLASE|Aetna|AETNA OTHER|||||208.33||| 82150|EAP|0301|AMYLASE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.08||| 82150|EAP|0301|AMYLASE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|208.65||||2.08||| 82150|EAP|0301|AMYLASE|Blue Cross HMO Specialty|BCBSTX HMO|||||135.25||| 82150|EAP|0301|AMYLASE|Aetna|AETNA PPO|||||2.08||| 82150|EAP|0301|AMYLASE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|208.33||||2.08||| 82150|EAP|0301|AMYLASE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|208.33||||2.08||| 82150|EAP|0301|AMYLASE|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||2.08||| 82150|EAP|0301|AMYLASE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||208.33||| 82150|EAP|0301|AMYLASE|Cigna|CIGNA|208.33||||2.08||| 82150|EAP|0301|AMYLASE|Blue Cross PPO Specialty|BCBSTX PPO|2.08||||2.08||| 82150|EAP|0301|AMYLASE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.08||||208.65||| 82150|EAP|0301|AMYLASE|Managed Medicaid|MEDICAID AMERIGROUP|2.08||||208.65||| 82150|EAP|0301|AMYLASE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.08||| 82150|EAP|0301|AMYLASE|Humana Medicare Advantage|HUMANA MA|2.08||||2.08||| 82150|EAP|0301|AMYLASE|Managed Medicaid|MEDICAID SUPERIOR|208.65||||2.08||| 82150|EAP|0301|AMYLASE|Managed Medicare|HEALTHSPRING MA|||||2.08||| 82150|EAP|0301|AMYLASE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.08||| 82164|EAP|0301|ACE ANGIOTENSIN CONVERTIN|Humana Medicare Advantage|HUMANA MA|||||140.75||| 82164|EAP|0301|ACE ANGIOTENSIN CONVERTIN|Blue Cross PPO Specialty|BCBSTX PPO|||||140.75||| 82164|EAP|0301|ACE ANGIOTENSIN CONVERTIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||140.75||| 82164|EAP|0301|ACE ANGIOTENSIN CONVERTIN|United Medicare Advantage|UHC MEDICARE GOLD MA|||||140.75||| 82164|EAP|0301|ACE ANGIOTENSIN CONVERTIN|Medicare|MEDICARE ACUTE|||||140.75||| 82247|EAP|0301|BILIRUBIN TOTAL|Medicare|MEDICARE ACUTE|||||48.50||| 82247|EAP|0301|BILIRUBIN TOTAL|PHCS|HUMANA INSURANCE|||||48.50||| 82247|EAP|0301|BILIRUBIN TOTAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||48.50||| 82247|EAP|0301|BILIRUBIN TOTAL|Blue Cross HMO Specialty|BCBSTX HMO|||||48.50||| 82247|EAP|0301|BILIRUBIN TOTAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||48.50||| 82247|EAP|0301|BILIRUBIN TOTAL|Blue Cross PPO Specialty|BCBSTX PPO|||||48.50||| 82247|EAP|0301|BILIRUBIN TOTAL|Humana Medicare Advantage|HUMANA MA|161.76||||||| 82247|EAP|0301|BILIRUBIN TOTAL|Managed Medicaid|MEDICAID SUPERIOR|||||48.50||| 82247|EAP|0301|BILIRUBIN TOTAL|Managed Medicaid|MEDICAID AMERIGROUP|||||48.50||| 82248|EAP|0301|BILIRUBIN DIRECT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||161.25||| 82248|EAP|0301|BILIRUBIN DIRECT|Managed Medicaid|MEDICAID SUPERIOR|||||48.50||| 82248|EAP|0301|BILIRUBIN DIRECT|Humana Medicare Advantage|HUMANA MA|||||48.50||| 82248|EAP|0301|BILIRUBIN DIRECT|Managed Medicaid|MEDICAID AMERIGROUP|||||48.50||| 82248|EAP|0301|BILIRUBIN DIRECT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||48.50||| 82248|EAP|0301|BILIRUBIN DIRECT|Blue Cross PPO Specialty|BCBSTX PPO|161.76||||48.50||| 82248|EAP|0301|BILIRUBIN DIRECT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||48.50||| 82248|EAP|0301|BILIRUBIN DIRECT|Medicare|MEDICARE ACUTE|161.25||||48.50||| 82248|EAP|0301|BILIRUBIN DIRECT|PHCS|HUMANA INSURANCE|||||48.50||| 82248|EAP|0301|BILIRUBIN DIRECT|NON CONTRACTED|COMMERCIAL OTHER 1|||||48.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|Veterans Affairs|VETERANS ADMINISTRATION|104.50||||104.83||| 82270|EAP|0301|OCCULT BLOOD STOOL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|United Medicare Advantage|UHC MEDICARE GOLD MA|104.67||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|Medicaid|MEDICAID|||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|NON CONTRACTED|COMMERCIAL OTHER 1|104.83||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|PHCS|MULTIPLAN PHCS|||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|United Healthcare|UNITED HEALTHCARE|104.83||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|Medicare|MEDICARE PART B ONLY IP|104.50||||||| 82270|EAP|0301|OCCULT BLOOD STOOL|Medicare|MEDICARE ACUTE|104.83||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|Tricare|TRICARE EAST REGION|||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|United Healthcare|UNITED HEALTHCARE|||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|United Healthcare|UNITED HEALTHCARE OTHER|||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|Aenta Medicare Advantage|AETNA MEDICARE MA|104.83||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|Cigna|CIGNA|||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|104.83||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|Aetna|AETNA PPO|||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|104.83||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|Blue Cross PPO Specialty|BCBSTX PPO|104.50||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|104.50||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|Blue Cross HMO Specialty|BCBSTX HMO|||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|104.50||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|Managed Medicaid|MEDICAID SUPERIOR|104.83||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|Humana Medicare Advantage|HUMANA MA|104.83||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|104.83||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|Managed Medicaid|MEDICAID AMERIGROUP|104.50||||31.50||| 82270|EAP|0301|OCCULT BLOOD STOOL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||31.50||| 82271|EAP|0301|OCCULT BLOOD OTHER SOURCE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||104.83||| 82271|EAP|0301|OCCULT BLOOD OTHER SOURCE|Managed Medicaid|MEDICAID SUPERIOR|||||104.50||| 82271|EAP|0301|OCCULT BLOOD OTHER SOURCE|Medicare|MEDICARE ACUTE|104.83||||104.50||| 82271|EAP|0301|OCCULT BLOOD OTHER SOURCE|United Medicare Advantage|UHC MEDICARE GOLD MA|104.50||||104.83||| 82271|EAP|0301|OCCULT BLOOD OTHER SOURCE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||104.50||| 82306|EAP|0300|VITAMIN D 25 OH|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Multiplan|NALC|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Medicaid|MORRIS COUNTY INDIGENT|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|United Healthcare|UNITED HEALTHCARE|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Tricare|TRICARE EAST REGION|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|United Healthcare|UNITED HEALTHCARE OTHER|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|United Healthcare|TML GROUP BENEFITS|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Medicare|MEDICARE ACUTE|875.48||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|PHCS|HUMANA INSURANCE|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Medicaid|CAMP COUNTY INDIGENT|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Blue Cross HMO Specialty|BCBSTX HMO|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Medicaid|MEDICAID|2.62||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Aetna|AETNA PPO|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Access Direct Platinum|HEALTHFIRST TPA UMR|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Blue Cross PPO Specialty|BCBSTX PPO|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Cigna|CIGNA|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|875.48||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Humana Medicare Advantage|HUMANA MA|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Managed Medicaid|MEDICAID SUPERIOR|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Managed Medicare|HEALTHSPRING MA|||||2.62||| 82306|EAP|0301|VITAMIN D 25 HYDROXY|Managed Medicaid|MEDICAID AMERIGROUP|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Managed Medicaid|MEDICAID AMERIGROUP|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Managed Medicare|BCBS MEDICARE PPO MA|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.62||| 82306|EAP|0300|VITAMIN D 25 OH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.62||| 82310|EAP|0301|CALCIUM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||166.27||| 82310|EAP|0301|CALCIUM|Humana Medicare Advantage|HUMANA MA|||||49.75||| 82310|EAP|0301|CALCIUM|Medicare|MEDICARE ACUTE|165.75||||165.75||| 82310|EAP|0301|CALCIUM|United Medicare Advantage|UHC MEDICARE GOLD MA|||||49.75||| 82330|EAP|0301|CALCIUM IONIZED|United Medicare Advantage|UHC MEDICARE GOLD MA|||||131.75||| 82330|EAP|0301|CALCIUM IONIZED|Medicare|MEDICARE ACUTE|4.39||||4.39||| 82330|EAP|0301|CALCIUM IONIZED|Medicaid|MEDICAID|440.38||||||| 82330|EAP|0301|CALCIUM IONIZED|Blue Cross PPO Specialty|BCBSTX PPO|||||131.75||| 82330|EAP|0301|CALCIUM IONIZED|Blue Cross HMO Specialty|BCBSTX HMO|||||131.75||| 82330|EAP|0301|CALCIUM IONIZED|Humana Medicare Advantage|HUMANA MA|440.38||||||| 82340|EAP|0301|CALCIUM URINE 24 HOURS|Managed Medicaid|MEDICAID AMERIGROUP|||||58.25||| 82365|EAP|0301|STONE ANALYSIS QUALITATIV|Aetna|AETNA OTHER|||||0.90||| 82365|EAP|0301|STONE ANALYSIS QUALITATIV|Humana Medicare Advantage|HUMANA MA|||||0.90||| 82378|EAP|0301|CEA|Medicare|MEDICARE ACUTE|611.41||||1.83||| 82378|EAP|0301|CEA|United Medicare Advantage|UHC MEDICARE GOLD MA|611.41||||1.83||| 82378|EAP|0301|CEA|Managed Medicaid|MEDICAID SUPERIOR|||||1.83||| 82378|EAP|0301|CEA|Humana Medicare Advantage|HUMANA MA|||||1.83||| 82378|EAP|0301|CEA|Blue Cross PPO Specialty|BCBSTX PPO|||||1.83||| 82384|EAP|0301|CATECHOLAMINES SERUM|Blue Cross PPO Specialty|BCBSTX PPO|||||241.50||| 82384|EAP|0301|CATECHOLAMINES SERUM|United Medicare Advantage|UHC MEDICARE GOLD MA|||||241.50||| 82384|EAP|0301|CATECHOLAMINES SERUM|Medicare|MEDICARE ACUTE|8.05||||||| 82390|EAP|0301|CERULOPLASMIN|Medicare|MEDICARE ACUTE|||||103.50||| 82390|EAP|0301|CERULOPLASMIN|United Healthcare|UNITED HEALTHCARE|||||103.50||| 82390|EAP|0301|CERULOPLASMIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||103.50||| 82390|EAP|0301|CERULOPLASMIN|Blue Cross PPO Specialty|BCBSTX PPO|346.08||||||| 82465|EAP|0301|CHOLESTROL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.42||| 82465|EAP|0301|CHOLESTROL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.42||| 82465|EAP|0301|CHOLESTROL|United Medicare Advantage|UHC MEDICARE GOLD MA|140.44||||||| 82465|EAP|0301|CHOLESTROL|Medicare|MEDICARE ACUTE|||||0.42||| 82533|EAP|0301|CORTISOL TOTAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||157.25||| 82533|EAP|0301|CORTISOL TOTAL|Medicare|MEDICARE ACUTE|523.75||||157.25||| 82533|EAP|0301|CORTISOL TOTAL|United Healthcare|UNITED HEALTHCARE|||||340.50||| 82533|EAP|0301|CORTISOL TOTAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||157.25||| 82533|EAP|0301|CORTISOL TOTAL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||157.25||| 82533|EAP|0301|CORTISOL TOTAL|Humana Medicare Advantage|HUMANA MA|525.39||||||| 82533|EAP|0301|CORTISOL TOTAL|Managed Medicare|HEALTHSPRING MA|||||157.25||| 82533|EAP|0301|CORTISOL TOTAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||157.25||| 82550|EAP|0301|CPK|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||62.75||| 82550|EAP|0301|CPK|Aenta Medicare Advantage|AETNA MEDICARE MA|209.91||||209.25||| 82550|EAP|0301|CPK|Blue Cross PPO Specialty|BCBSTX OTHER|||||209.91||| 82550|EAP|0301|CPK|Aetna|AETNA PPO|||||209.25||| 82550|EAP|0301|CPK|Blue Cross PPO Specialty|BCBSTX PPO|209.91||||209.25||| 82550|EAP|0301|CPK|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|209.91||||209.91||| 82550|EAP|0301|CPK|Cigna|CIGNA|||||209.91||| 82550|EAP|0301|CPK|Blue Cross HMO Specialty|BCBSTX HMO|209.91||||209.91||| 82550|EAP|0301|CPK|Aetna|AETNA OTHER|||||209.58||| 82550|EAP|0301|CPK|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|209.58||||209.25||| 82550|EAP|0301|CPK|Managed Medicaid|MEDICAID UNITED HEALTHCARE|209.25||||209.91||| 82550|EAP|0301|CPK|Managed Medicaid|MEDICAID SUPERIOR|||||1.36||| 82550|EAP|0301|CPK|Managed Medicaid|MEDICAID AMERIGROUP|209.25||||209.25||| 82550|EAP|0301|CPK|Humana Medicare Advantage|HUMANA MA|209.91||||209.25||| 82550|EAP|0301|CPK|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|209.91||||209.91||| 82550|EAP|0301|CPK|Veterans Affairs|VETERANS ADMINISTRATION|209.91||||209.91||| 82550|EAP|0301|CPK|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|209.91||||||| 82550|EAP|0301|CPK|Managed Medicare|HEALTHSPRING MA|209.91||||209.25||| 82550|EAP|0301|CPK|Cigna|CIGNA|209.91||||209.25||| 82550|EAP|0301|CPK|United Medicare Advantage|UHC MEDICARE GOLD MA|209.25||||209.25||| 82550|EAP|0301|CPK|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||209.25||| 82550|EAP|0301|CPK|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||209.25||| 82550|EAP|0301|CPK|Workers Compensation|WORKERS COMPENSATION OTHER|||||209.91||| 82550|EAP|0301|CPK|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|209.91||||62.75||| 82550|EAP|0301|CPK|United Healthcare|UNITED HEALTHCARE|209.91||||||| 82550|EAP|0301|CPK|Medicaid|MORRIS COUNTY INDIGENT|||||209.25||| 82550|EAP|0301|CPK|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||209.91||| 82550|EAP|0301|CPK|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||209.25||| 82550|EAP|0301|CPK|Medicaid|MEDICAID HMO|||||209.91||| 82550|EAP|0301|CPK|Medicaid|MEDICAID|209.25||||209.91||| 82550|EAP|0301|CPK|United Healthcare|TML GROUP BENEFITS|||||209.91||| 82550|EAP|0301|CPK|NON CONTRACTED|COMMERCIAL OTHER 1|209.91||||209.25||| 82550|EAP|0301|CPK|PHCS|HUMANA INSURANCE|||||209.25||| 82550|EAP|0301|CPK|Tricare|TRICARE EAST REGION|||||209.25||| 82550|EAP|0301|CPK|PHCS|GROUP AND PENSION|||||209.25||| 82550|EAP|0301|CPK|Medicare|MEDICARE ACUTE|209.25||||209.25||| 82550|EAP|0301|CPK|United Healthcare|UNITED HEALTHCARE|209.91||||209.25||| 82550|EAP|0301|CPK|United Healthcare|GEHA|||||209.25||| 82552|EAP|0301|CPK ISOENZYMES|Medicare|MEDICARE ACUTE|||||129.25||| 82553|EAP|0301|CPK-MB|Managed Medicaid|MEDICAID AMERIGROUP|197.50||||197.81||| 82553|EAP|0301|CPK-MB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|197.50||||198.12||| 82553|EAP|0301|CPK-MB|Humana Medicare Advantage|HUMANA MA|197.50||||197.50||| 82553|EAP|0301|CPK-MB|Managed Medicare|HEALTHSPRING MA|198.12||||197.50||| 82553|EAP|0301|CPK-MB|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|198.12||||197.50||| 82553|EAP|0301|CPK-MB|Blue Cross PPO Specialty|BCBSTX PPO|198.12||||197.50||| 82553|EAP|0301|CPK-MB|Aetna|AETNA PPO|||||197.50||| 82553|EAP|0301|CPK-MB|Aetna|AETNA OTHER|||||197.50||| 82553|EAP|0301|CPK-MB|Cigna|CIGNA|||||198.12||| 82553|EAP|0301|CPK-MB|Aenta Medicare Advantage|AETNA MEDICARE MA|198.12||||197.50||| 82553|EAP|0301|CPK-MB|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||197.50||| 82553|EAP|0301|CPK-MB|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||198.12||| 82553|EAP|0301|CPK-MB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|197.50||||197.50||| 82553|EAP|0301|CPK-MB|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|198.12||||||| 82553|EAP|0301|CPK-MB|Veterans Affairs|VETERANS ADMINISTRATION|||||198.12||| 82553|EAP|0301|CPK-MB|Blue Cross HMO Specialty|BCBSTX HMO|||||198.12||| 82553|EAP|0301|CPK-MB|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|198.12||||||| 82553|EAP|0301|CPK-MB|United Medicare Advantage|UHC MEDICARE GOLD MA|197.50||||198.12||| 82553|EAP|0301|CPK-MB|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||197.50||| 82553|EAP|0301|CPK-MB|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||197.50||| 82553|EAP|0301|CPK-MB|Workers Compensation|WORKERS COMPENSATION OTHER|||||198.12||| 82553|EAP|0301|CPK-MB|Medicaid|MORRIS COUNTY INDIGENT|||||197.50||| 82553|EAP|0301|CPK-MB|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||198.12||| 82553|EAP|0301|CPK-MB|Medicaid|MEDICAID|197.50||||197.81||| 82553|EAP|0301|CPK-MB|Tricare|TRICARE EAST REGION|||||128.38||| 82553|EAP|0301|CPK-MB|NON CONTRACTED|COMMERCIAL OTHER 1|||||197.50||| 82553|EAP|0301|CPK-MB|Medicare|MEDICARE ACUTE|197.50||||197.50||| 82553|EAP|0301|CPK-MB|Medicaid|MEDICAID HMO|||||198.12||| 82553|EAP|0301|CPK-MB|United Healthcare|TML GROUP BENEFITS|||||59.25||| 82553|EAP|0301|CPK-MB|United Healthcare|UNITED HEALTHCARE|198.12||||59.25||| 82553|EAP|0301|CPK-MB|United Healthcare|GEHA|||||197.50||| 82553|EAP|0301|CPK-MB|United Healthcare|UNITED HEALTHCARE|||||197.50||| 82553|EAP|0301|CPK-MB|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||197.50||| 82565|EAP|0301|CREATININE SERUM|United Healthcare|UNITED HEALTHCARE|||||49.50||| 82565|EAP|0301|CREATININE SERUM|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||49.50||| 82565|EAP|0301|CREATININE SERUM|Medicare|MEDICARE ACUTE|164.50||||49.50||| 82565|EAP|0301|CREATININE SERUM|NON CONTRACTED|COMMERCIAL OTHER 1|164.50||||49.50||| 82565|EAP|0301|CREATININE SERUM|Tricare|TRICARE EAST REGION|||||49.50||| 82565|EAP|0301|CREATININE SERUM|United Healthcare|UNITED HEALTHCARE OTHER|||||49.50||| 82565|EAP|0301|CREATININE SERUM|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||49.50||| 82565|EAP|0301|CREATININE SERUM|United Medicare Advantage|UHC MEDICARE GOLD MA|||||49.50||| 82565|EAP|0301|CREATININE SERUM|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||49.50||| 82565|EAP|0301|CREATININE SERUM|Veterans Affairs|VETERANS ADMINISTRATION|||||49.50||| 82565|EAP|0301|CREATININE SERUM|Workers Compensation|WORKERS COMPENSATION OTHER|||||164.50||| 82565|EAP|0301|CREATININE SERUM|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||49.50||| 82565|EAP|0301|CREATININE SERUM|Aenta Medicare Advantage|AETNA MEDICARE MA|||||49.50||| 82565|EAP|0301|CREATININE SERUM|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||49.50||| 82565|EAP|0301|CREATININE SERUM|Blue Cross HMO Specialty|BCBSTX HMO|||||49.50||| 82565|EAP|0301|CREATININE SERUM|Access Direct Platinum|HEALTHFIRST TPA UMR|||||49.50||| 82565|EAP|0301|CREATININE SERUM|PHCS|HUMANA INSURANCE|||||49.50||| 82565|EAP|0301|CREATININE SERUM|Medicaid|MEDICAID|||||164.76||| 82565|EAP|0301|CREATININE SERUM|Cigna|CIGNA|||||49.50||| 82565|EAP|0301|CREATININE SERUM|Blue Cross PPO Specialty|BCBSTX PPO|||||49.50||| 82565|EAP|0301|CREATININE SERUM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||49.50||| 82565|EAP|0301|CREATININE SERUM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||49.50||| 82565|EAP|0301|CREATININE SERUM|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||49.50||| 82565|EAP|0301|CREATININE SERUM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|164.50||||49.50||| 82565|EAP|0301|CREATININE SERUM|Managed Medicaid|MEDICAID SUPERIOR|||||1.07||| 82565|EAP|0301|CREATININE SERUM|Managed Medicaid|MEDICAID AMERIGROUP|||||49.50||| 82565|EAP|0301|CREATININE SERUM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||49.50||| 82565|EAP|0301|CREATININE SERUM|Humana Medicare Advantage|HUMANA MA|||||49.50||| 82570|EAP|0301|CREATININE URINE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.50||| 82570|EAP|0301|CREATININE URINE|Managed Medicaid|MEDICAID SUPERIOR|166.25||||0.50||| 82570|EAP|0301|CREATININE URINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|166.25||||0.50||| 82570|EAP|0301|CREATININE URINE|Humana Medicare Advantage|HUMANA MA|166.77||||0.50||| 82570|EAP|0301|CREATININE URINE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|166.25||||0.50||| 82570|EAP|0301|CREATININE URINE|Managed Medicare|HEALTHSPRING MA|166.25||||0.50||| 82570|EAP|0301|CREATININE URINE|Aenta Medicare Advantage|AETNA MEDICARE MA|166.77||||0.50||| 82570|EAP|0301|CREATININE URINE|Blue Cross HMO Specialty|BCBSTX HMO|||||0.50||| 82570|EAP|0301|CREATININE URINE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||0.50||| 82570|EAP|0301|CREATININE URINE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.50||| 82570|EAP|0301|CREATININE URINE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|166.77||||0.50||| 82570|EAP|0301|CREATININE URINE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|166.77||||0.50||| 82570|EAP|0301|CREATININE URINE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.50||| 82570|EAP|0301|CREATININE URINE|Cigna|CIGNA|||||0.50||| 82570|EAP|0301|CREATININE URINE|Veterans Affairs|VETERANS ADMINISTRATION|||||0.50||| 82570|EAP|0301|CREATININE URINE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|166.77||||0.50||| 82570|EAP|0301|CREATININE URINE|United Medicare Advantage|UHC MEDICARE GOLD MA|166.77||||0.50||| 82570|EAP|0301|CREATININE URINE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|166.51||||0.50||| 82570|EAP|0301|CREATININE URINE|Blue Cross PPO Specialty|BCBSTX PPO|166.77||||0.50||| 82570|EAP|0301|CREATININE URINE|Managed Medicaid|MEDICAID AMERIGROUP|||||0.50||| 82570|EAP|0301|CREATININE URINE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.50||| 82570|EAP|0301|CREATININE URINE|Multiplan|NALC|||||0.50||| 82570|EAP|0301|CREATININE URINE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.50||| 82570|EAP|0301|CREATININE URINE|Medicaid|MORRIS COUNTY INDIGENT|||||0.50||| 82570|EAP|0301|CREATININE URINE|Medicaid|MEDICAID|||||0.50||| 82570|EAP|0301|CREATININE URINE|Medicaid|CAMP COUNTY INDIGENT|||||0.50||| 82570|EAP|0301|CREATININE URINE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.50||| 82570|EAP|0301|CREATININE URINE|United Healthcare|UNITED HEALTHCARE OTHER|||||0.50||| 82570|EAP|0301|CREATININE URINE|Medicare|MEDICARE ACUTE|166.77||||0.50||| 82570|EAP|0301|CREATININE URINE|Tricare|TRICARE EAST REGION|166.77||||0.50||| 82570|EAP|0301|CREATININE URINE|NON CONTRACTED|COMMERCIAL OTHER 1|166.77||||0.50||| 82570|EAP|0301|CREATININE URINE|United Healthcare|UNITED HEALTHCARE|166.77||||0.50||| 82570|EAP|0301|CREATININE URINE|United Healthcare|UNITED HEALTHCARE|166.25||||0.50||| 82570|EAP|0301|CREATININE URINE|United Healthcare|TML GROUP BENEFITS|||||0.50||| 82575|EAP|0301|CREATININE CLEARANCE|Medicare|MEDICARE ACUTE|||||0.91||| 82575|EAP|0301|CREATININE CLEARANCE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.91||| 82575|EAP|0301|CREATININE CLEARANCE|Humana Medicare Advantage|HUMANA MA|||||0.91||| 82575|EAP|0301|CREATININE CLEARANCE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.91||| 82595|EAP|0301|CRYOGLOBULIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||62.50||| 82607|EAP|0301|B12 LEVEL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|485.77||||145.25||| 82607|EAP|0301|B12 LEVEL|United Medicare Advantage|UHC MEDICARE GOLD MA|485.01||||145.25||| 82607|EAP|0301|B12 LEVEL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||145.25||| 82607|EAP|0301|B12 LEVEL|Medicaid|MEDICAID|484.25||||145.25||| 82607|EAP|0301|B12 LEVEL|PHCS|GROUP AND PENSION|||||145.25||| 82607|EAP|0301|B12 LEVEL|United Healthcare|TML GROUP BENEFITS|||||145.25||| 82607|EAP|0301|B12 LEVEL|NON CONTRACTED|COMMERCIAL OTHER 1|485.77||||145.25||| 82607|EAP|0301|B12 LEVEL|PHCS|MULTIPLAN PHCS|||||145.25||| 82607|EAP|0301|B12 LEVEL|Tricare|TRICARE EAST REGION|||||145.25||| 82607|EAP|0301|B12 LEVEL|Multiplan|NALC|||||145.25||| 82607|EAP|0301|B12 LEVEL|Medicare|MEDICARE ACUTE|485.77||||145.25||| 82607|EAP|0301|B12 LEVEL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||145.25||| 82607|EAP|0301|B12 LEVEL|United Healthcare|UNITED HEALTHCARE|485.77||||145.25||| 82607|EAP|0301|B12 LEVEL|United Healthcare|UNITED HEALTHCARE OTHER|||||145.25||| 82607|EAP|0301|B12 LEVEL|United Healthcare|UNITED HEALTHCARE|||||145.25||| 82607|EAP|0301|B12 LEVEL|PHCS|HUMANA INSURANCE|||||145.25||| 82607|EAP|0301|B12 LEVEL|Aenta Medicare Advantage|AETNA MEDICARE MA|485.77||||145.25||| 82607|EAP|0301|B12 LEVEL|Blue Cross PPO Specialty|BCBSTX OTHER|||||145.25||| 82607|EAP|0301|B12 LEVEL|Medicaid|MORRIS COUNTY INDIGENT|||||145.25||| 82607|EAP|0301|B12 LEVEL|Cigna|CIGNA|||||145.25||| 82607|EAP|0301|B12 LEVEL|Blue Cross PPO Specialty|BCBSTX PPO|485.01||||145.25||| 82607|EAP|0301|B12 LEVEL|Blue Cross HMO Specialty|BCBSTX HMO|||||145.25||| 82607|EAP|0301|B12 LEVEL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|485.77||||145.25||| 82607|EAP|0301|B12 LEVEL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||145.25||| 82607|EAP|0301|B12 LEVEL|Access Direct Platinum|HEALTHFIRST TPA UMR|||||145.25||| 82607|EAP|0301|B12 LEVEL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|485.01||||145.25||| 82607|EAP|0301|B12 LEVEL|Cigna|CIGNA|484.25||||145.25||| 82607|EAP|0301|B12 LEVEL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||145.25||| 82607|EAP|0301|B12 LEVEL|Managed Medicare|HEALTHSPRING MA|484.25||||145.25||| 82607|EAP|0301|B12 LEVEL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|484.25||||145.25||| 82607|EAP|0301|B12 LEVEL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|485.77||||145.25||| 82607|EAP|0301|B12 LEVEL|Managed Medicaid|MEDICAID SUPERIOR|484.25||||145.25||| 82607|EAP|0301|B12 LEVEL|Managed Medicaid|MEDICAID AMERIGROUP|||||145.25||| 82607|EAP|0301|B12 LEVEL|Humana Medicare Advantage|HUMANA MA|485.77||||145.25||| 82607|EAP|0301|B12 LEVEL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||145.25||| 82626|EAP|0301|DHEA|Medicare|MEDICARE ACUTE|||||243.50||| 82627|EAP|0300|DEHYDROEPIANDROSTERONE|Managed Medicaid|MEDICAID AMERIGROUP|||||1.83||| 82627|EAP|0300|DEHYDROEPIANDROSTERONE|Managed Medicaid|MEDICAID SUPERIOR|||||1.83||| 82627|EAP|0300|DEHYDROEPIANDROSTERONE|Blue Cross HMO Specialty|BCBSTX HMO|||||1.83||| 82627|EAP|0300|DEHYDROEPIANDROSTERONE|Blue Cross PPO Specialty|BCBSTX PPO|||||1.83||| 82627|EAP|0300|DEHYDROEPIANDROSTERONE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.83||| 82627|EAP|0300|DEHYDROEPIANDROSTERONE|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.83||| 82627|EAP|0300|DEHYDROEPIANDROSTERONE|Tricare|TRICARE EAST REGION|||||1.83||| 82627|EAP|0300|DEHYDROEPIANDROSTERONE|Medicare|MEDICARE ACUTE|||||1.83||| 82652|EAP|0301|VITAMIN D|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.71||| 82652|EAP|0301|VITAMIN D|Medicare|MEDICARE ACUTE|||||3.71||| 82652|EAP|0301|VITAMIN D|Aetna|AETNA PPO|||||3.71||| 82652|EAP|0301|VITAMIN D|Blue Cross HMO Specialty|BCBSTX HMO|||||3.71||| 82652|EAP|0301|VITAMIN D|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.71||| 82652|EAP|0301|VITAMIN D|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.71||| 82652|EAP|0301|VITAMIN D|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1,113.75||||3.71||| 82652|EAP|0301|VITAMIN D|Humana Medicare Advantage|HUMANA MA|||||3.71||| 82670|EAP|0301|ESTRADIOL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||269.25||| 82670|EAP|0301|ESTRADIOL|Managed Medicaid|MEDICAID AMERIGROUP|||||269.25||| 82670|EAP|0301|ESTRADIOL|Managed Medicaid|MEDICAID SUPERIOR|||||269.25||| 82670|EAP|0301|ESTRADIOL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||269.25||| 82670|EAP|0301|ESTRADIOL|Managed Medicare|HEALTHSPRING MA|||||269.25||| 82670|EAP|0301|ESTRADIOL|Blue Cross PPO Specialty|BCBSTX PPO|||||269.25||| 82670|EAP|0301|ESTRADIOL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||269.25||| 82670|EAP|0301|ESTRADIOL|Cigna|CIGNA|||||269.25||| 82670|EAP|0301|ESTRADIOL|Humana Medicare Advantage|HUMANA MA|||||269.25||| 82670|EAP|0301|ESTRADIOL|Blue Cross HMO Specialty|BCBSTX HMO|||||269.25||| 82670|EAP|0301|ESTRADIOL|Access Direct Platinum|HEALTHFIRST TPA UMR|||||269.25||| 82670|EAP|0301|ESTRADIOL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||269.25||| 82670|EAP|0301|ESTRADIOL|Medicaid|MEDICAID TEXAS CHILDRENS|||||269.25||| 82670|EAP|0301|ESTRADIOL|Tricare|TRICARE EAST REGION|||||269.25||| 82670|EAP|0301|ESTRADIOL|Medicare|MEDICARE ACUTE|||||269.25||| 82670|EAP|0301|ESTRADIOL|NON CONTRACTED|COMMERCIAL OTHER 1|||||269.25||| 82670|EAP|0301|ESTRADIOL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||269.25||| 82670|EAP|0301|ESTRADIOL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||269.25||| 82670|EAP|0301|ESTRADIOL|United Healthcare|UNITED HEALTHCARE|||||269.25||| 82670|EAP|0301|ESTRADIOL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||269.25||| 82671|EAP|0301|ESTROGEN TOTAL SERUM|Medicare|MEDICARE ACUTE|||||84.50||| 82705|EAP|0301|FECAL FATS|Blue Cross PPO Specialty|BCBSTX PPO|||||0.49||| 82728|EAP|0301|FERRITIN|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||131.25||| 82728|EAP|0301|FERRITIN|United Medicare Advantage|UHC MEDICARE GOLD MA|438.19||||131.25||| 82728|EAP|0301|FERRITIN|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||131.25||| 82728|EAP|0301|FERRITIN|Medicaid|MORRIS COUNTY INDIGENT|||||131.25||| 82728|EAP|0301|FERRITIN|Medicaid|MEDICAID|437.50||||284.38||| 82728|EAP|0301|FERRITIN|United Healthcare|TML GROUP BENEFITS|||||131.25||| 82728|EAP|0301|FERRITIN|United Healthcare|UNITED HEALTHCARE|438.87||||131.25||| 82728|EAP|0301|FERRITIN|Medicaid|MEDICAID TEXAS CHILDRENS|||||131.25||| 82728|EAP|0301|FERRITIN|United Healthcare|UNITED HEALTHCARE|||||131.25||| 82728|EAP|0301|FERRITIN|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||131.25||| 82728|EAP|0301|FERRITIN|Tricare|TRICARE EAST REGION|||||131.25||| 82728|EAP|0301|FERRITIN|Medicare|MEDICARE ACUTE|438.87||||131.25||| 82728|EAP|0301|FERRITIN|United Healthcare|UNITED HEALTHCARE OTHER|||||131.25||| 82728|EAP|0301|FERRITIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|437.50||||131.25||| 82728|EAP|0301|FERRITIN|Managed Medicaid|MEDICAID SUPERIOR|437.50||||131.25||| 82728|EAP|0301|FERRITIN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|438.87||||131.25||| 82728|EAP|0301|FERRITIN|NON CONTRACTED|COMMERCIAL OTHER 1|438.87||||131.25||| 82728|EAP|0301|FERRITIN|PHCS|MULTIPLAN PHCS|||||131.25||| 82728|EAP|0301|FERRITIN|Humana Medicare Advantage|HUMANA MA|438.87||||131.25||| 82728|EAP|0301|FERRITIN|Managed Medicaid|MEDICAID AMERIGROUP|437.50||||131.25||| 82728|EAP|0301|FERRITIN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||131.25||| 82728|EAP|0301|FERRITIN|Managed Medicare|HEALTHSPRING MA|437.50||||131.25||| 82728|EAP|0301|FERRITIN|Aenta Medicare Advantage|AETNA MEDICARE MA|438.87||||131.25||| 82728|EAP|0301|FERRITIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|438.19||||131.25||| 82728|EAP|0301|FERRITIN|Blue Cross PPO Specialty|BCBSTX PPO|438.87||||131.25||| 82728|EAP|0301|FERRITIN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|438.87||||131.25||| 82728|EAP|0301|FERRITIN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|438.87||||131.25||| 82728|EAP|0301|FERRITIN|Access Direct Platinum|HEALTHFIRST TPA UMR|||||131.25||| 82728|EAP|0301|FERRITIN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|438.87||||131.25||| 82728|EAP|0301|FERRITIN|Blue Cross HMO Specialty|BCBSTX HMO|438.87||||131.25||| 82728|EAP|0301|FERRITIN|Cigna|CIGNA|||||131.25||| 82746|EAP|0301|FOLIC ACID|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|473.73||||141.75||| 82746|EAP|0301|FOLIC ACID|Aenta Medicare Advantage|AETNA MEDICARE MA|||||141.75||| 82746|EAP|0301|FOLIC ACID|Blue Cross HMO Specialty|BCBSTX HMO|||||141.75||| 82746|EAP|0301|FOLIC ACID|Blue Cross PPO Specialty|BCBSTX PPO|||||141.75||| 82746|EAP|0301|FOLIC ACID|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||141.75||| 82746|EAP|0301|FOLIC ACID|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||141.75||| 82746|EAP|0301|FOLIC ACID|Managed Medicaid|MEDICAID SUPERIOR|||||141.75||| 82746|EAP|0301|FOLIC ACID|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|472.25||||||| 82746|EAP|0301|FOLIC ACID|Humana Medicare Advantage|HUMANA MA|473.73||||141.75||| 82746|EAP|0301|FOLIC ACID|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||141.75||| 82746|EAP|0301|FOLIC ACID|Cigna|CIGNA|||||141.75||| 82746|EAP|0301|FOLIC ACID|Managed Medicaid|MEDICAID AMERIGROUP|||||141.75||| 82746|EAP|0301|FOLIC ACID|NON CONTRACTED|COMMERCIAL OTHER 1|||||141.75||| 82746|EAP|0301|FOLIC ACID|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||141.75||| 82746|EAP|0301|FOLIC ACID|Medicaid|MORRIS COUNTY INDIGENT|||||141.75||| 82746|EAP|0301|FOLIC ACID|Medicaid|MEDICAID|||||141.75||| 82746|EAP|0301|FOLIC ACID|Tricare|TRICARE EAST REGION|||||141.75||| 82746|EAP|0301|FOLIC ACID|Medicare|MEDICARE ACUTE|472.25||||141.75||| 82746|EAP|0301|FOLIC ACID|United Healthcare|UNITED HEALTHCARE OTHER|||||141.75||| 82746|EAP|0301|FOLIC ACID|United Healthcare|UNITED HEALTHCARE|||||141.75||| 82746|EAP|0301|FOLIC ACID|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||141.75||| 82746|EAP|0301|FOLIC ACID|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||141.75||| 82746|EAP|0301|FOLIC ACID|United Medicare Advantage|UHC MEDICARE GOLD MA|472.25||||141.75||| 82747|EAP|0300|RBC FOLATE|United Medicare Advantage|UHC MEDICARE GOLD MA|506.38||||||| 82747|EAP|0300|RBC FOLATE|Medicare|MEDICARE ACUTE|506.38||||||| 82747|EAP|0300|RBC FOLATE|Humana Medicare Advantage|HUMANA MA|506.38||||||| 82784|EAP|0300|IMMUNOGLOBULIN IGA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||89.75||| 82784|EAP|0300|IMMUNOGLOBULIN IGG IGA IG|Blue Cross PPO Specialty|BCBSTX PPO|||||0.77||| 82784|EAP|0300|IMMUNOGLOBULIN IGG IGA IG|Managed Medicaid|MEDICAID SUPERIOR|2.55||||||| 82784|EAP|0301|GAMMA IGM|Humana Medicare Advantage|HUMANA MA|298.75||||||| 82784|EAP|0300|IMMUNOGLOBULIN IGG IGA IG|Humana Medicare Advantage|HUMANA MA|298.75||||0.77||| 82784|EAP|0300|IMMUNOGLOBULIN IGG IGA IG|Medicare|MEDICARE ACUTE|||||0.77||| 82784|EAP|0300|IMMUNOGLOBULIN IGA|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||89.75||| 82784|EAP|0301|GAMMA IGM|Medicare|MEDICARE ACUTE|||||89.75||| 82784|EAP|0300|IMMUNOGLOBULIN IGA|Medicare|MEDICARE ACUTE|||||89.75||| 82784|EAP|0301|GAMMA IGM|United Medicare Advantage|UHC MEDICARE GOLD MA|||||89.75||| 82785|EAP|0301|IGE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||158.75||| 82785|EAP|0301|IGE|Medicare|MEDICARE ACUTE|||||158.75||| 82785|EAP|0301|IGE|United Healthcare|UNITED HEALTHCARE|||||158.75||| 82785|EAP|0301|IGE|United Healthcare|TML GROUP BENEFITS|||||158.75||| 82785|EAP|0301|IGE|Managed Medicaid|MEDICAID SUPERIOR|||||158.75||| 82785|EAP|0301|IGE|Humana Medicare Advantage|HUMANA MA|||||158.75||| 82785|EAP|0301|IGE|Managed Medicaid|MEDICAID AMERIGROUP|||||158.75||| 82785|EAP|0301|IGE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||158.75||| 82785|EAP|0301|IGE|Blue Cross PPO Specialty|BCBSTX PPO|||||158.75||| 82785|EAP|0301|IGE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||158.75||| 82785|EAP|0301|IGE|Cigna|CIGNA|||||158.75||| 82803|EAP|0301|ARTERIAL BLOOD GAS|Aenta Medicare Advantage|AETNA MEDICARE MA|583.07||||583.07||| 82803|EAP|0301|ARTERIAL BLOOD GAS|Blue Cross PPO Specialty|BCBSTX PPO|583.07||||583.07||| 82803|EAP|0301|ARTERIAL BLOOD GAS|Blue Cross HMO Specialty|BCBSTX HMO|582.16||||583.07||| 82803|EAP|0301|ARTERIAL BLOOD GAS|Aetna|AETNA OTHER|||||583.07||| 82803|EAP|0301|ARTERIAL BLOOD GAS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|581.25||||583.07||| 82803|EAP|0301|ARTERIAL BLOOD GAS|Cigna|CIGNA|||||583.07||| 82803|EAP|0301|ARTERIAL BLOOD GAS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||581.25||| 82803|EAP|0301|ARTERIAL BLOOD GAS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|581.25||||583.07||| 82803|EAP|0301|ARTERIAL BLOOD GAS|Managed Medicaid|MEDICAID AMERIGROUP|581.25||||581.25||| 82803|EAP|0301|ARTERIAL BLOOD GAS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|581.25||||583.07||| 82803|EAP|0301|ARTERIAL BLOOD GAS|Managed Medicaid|MEDICAID SUPERIOR|581.25||||582.16||| 82803|EAP|0301|ARTERIAL BLOOD GAS|Humana Medicare Advantage|HUMANA MA|581.25||||583.07||| 82803|EAP|0301|ARTERIAL BLOOD GAS|Managed Medicare|HEALTHSPRING MA|583.07||||581.25||| 82803|EAP|0301|ARTERIAL BLOOD GAS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|583.07||||583.07||| 82803|EAP|0301|ARTERIAL BLOOD GAS|Cigna|CIGNA|583.07||||583.07||| 82803|EAP|0301|ARTERIAL BLOOD GAS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|583.07||||||| 82803|EAP|0301|ARTERIAL BLOOD GAS|United Medicare Advantage|UHC MEDICARE GOLD MA|581.25||||583.07||| 82803|EAP|0301|ARTERIAL BLOOD GAS|Workers Compensation|WORKERS COMPENSATION OTHER|||||583.07||| 82803|EAP|0301|ARTERIAL BLOOD GAS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|583.07||||||| 82803|EAP|0301|ARTERIAL BLOOD GAS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|583.07||||||| 82803|EAP|0301|ARTERIAL BLOOD GAS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|581.25||||583.07||| 82803|EAP|0301|ARTERIAL BLOOD GAS|Veterans Affairs|VETERANS ADMINISTRATION|||||583.07||| 82803|EAP|0301|ARTERIAL BLOOD GAS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||583.07||| 82803|EAP|0301|ARTERIAL BLOOD GAS|Medicaid|MORRIS COUNTY INDIGENT|||||583.07||| 82803|EAP|0301|ARTERIAL BLOOD GAS|Medicaid|MEDICAID|583.07||||583.07||| 82803|EAP|0301|ARTERIAL BLOOD GAS|NON CONTRACTED|COMMERCIAL OTHER 1|583.07||||583.07||| 82803|EAP|0301|ARTERIAL BLOOD GAS|Medicare|MEDICARE ACUTE|581.25||||583.07||| 82803|EAP|0301|ARTERIAL BLOOD GAS|Tricare|TRICARE EAST REGION|583.07||||581.25||| 82803|EAP|0301|ARTERIAL BLOOD GAS|United Healthcare|UNITED HEALTHCARE|583.07||||583.07||| 82803|EAP|0301|ARTERIAL BLOOD GAS|United Healthcare|TML GROUP BENEFITS|||||583.07||| 82803|EAP|0301|ARTERIAL BLOOD GAS|United Healthcare|UNITED HEALTHCARE|||||582.16||| 82945|EAP|0301|GLUCOSE CSF|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.26||| 82945|EAP|0301|GLUCOSE CSF|United Healthcare|UNITED HEALTHCARE|||||126.39||| 82945|EAP|0301|GLUCOSE CSF|Managed Medicaid|MEDICAID SUPERIOR|||||126.20||| 82945|EAP|0301|GLUCOSE CSF|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.38||| 82945|EAP|0301|GLUCOSE CSF|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.38||| 82945|EAP|0301|GLUCOSE CSF|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|126.39||||||| 82947|EAP|0301|GLUCOSE|Blue Cross PPO Specialty|BCBSTX PPO|1.26||||1.26||| 82947|EAP|0301|GLUCOSE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|126.39||||||| 82947|EAP|0301|GLUCOSE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.26||||0.38||| 82947|EAP|0301|GLUCOSE|Cigna|CIGNA|||||0.38||| 82947|EAP|0301|GLUCOSE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.26||||82.20||| 82947|EAP|0301|GLUCOSE|Humana Medicare Advantage|HUMANA MA|126.39||||1.26||| 82947|EAP|0301|GLUCOSE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.26||| 82947|EAP|0301|GLUCOSE|Medicare|MEDICARE ACUTE|126.39||||1.26||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|53.75||||53.92||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|53.92||||53.92||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|United Medicare Advantage|UHC MEDICARE GOLD MA|53.75||||53.75||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|United Medicare Advantage|AARP UHC WEST COMPLETE MA|53.92||||53.92||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Workers Compensation|WORKERS COMPENSATION OTHER|||||53.75||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||53.92||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Medicaid|MORRIS COUNTY INDIGENT|||||53.92||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Medicaid|MEDICAID|53.92||||53.75||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||53.75||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|NON CONTRACTED|COMMERCIAL OTHER 1|53.92||||53.92||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||53.75||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Tricare|TRICARE EAST REGION|53.92||||53.75||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|PHCS|MERITAIN HEALTH|||||53.92||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Medicare|MEDICARE ACUTE|53.92||||53.75||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Medicare|MEDICARE PART B ONLY IP|53.75||||||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|United Healthcare|UNITED HEALTHCARE|53.75||||53.92||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|United Healthcare|UNITED HEALTHCARE OTHER|53.75||||53.92||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|United Healthcare|UNITED HEALTHCARE|53.92||||53.84||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Medicaid|MEDICAID TEXAS CHILDRENS|||||53.92||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||53.75||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Managed Medicaid|MEDICAID SUPERIOR|||||53.92||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Managed Medicaid|MEDICAID UNITED HEALTHCARE|53.75||||53.92||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Managed Medicaid|MEDICAID AMERIGROUP|||||53.75||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Veterans Affairs|VETERANS ADMINISTRATION|||||53.92||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Humana Medicare Advantage|HUMANA MA|53.92||||53.75||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|53.92||||53.75||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Managed Medicare|HEALTHSPRING MA|53.92||||53.75||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|53.75||||53.75||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Aetna|AETNA PPO|||||53.75||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Aetna|AETNA OTHER|||||53.84||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Blue Cross PPO Specialty|BCBSTX PPO|53.92||||53.75||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Blue Cross HMO Specialty|BCBSTX HMO|||||53.75||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Aenta Medicare Advantage|AETNA MEDICARE MA|53.75||||53.75||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|53.92||||53.75||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Access Direct Platinum|HEALTHFIRST TPA UMR|53.75||||53.75||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Cigna|CIGNA|||||53.92||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|53.92||||53.92||| 82948|EAP|0301|GLUCOSE BLOOD STRIP(GTS)|Cigna|CIGNA|53.75||||||| 82951|EAP|0301|GLUCOSE TOLERANCE|Blue Cross PPO Specialty|BCBSTX PPO|||||124.25||| 82951|EAP|0301|GLUCOSE TOLERANCE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||124.25||| 82951|EAP|0301|GLUCOSE TOLERANCE|NON CONTRACTED|COMMERCIAL OTHER 1|||||124.25||| 82951|EAP|0301|GLUCOSE TOLERANCE|United Healthcare|UNITED HEALTHCARE|||||124.25||| 82952|EAP|0301|GLUCOSE|NON CONTRACTED|COMMERCIAL OTHER 1|||||37.75||| 82952|EAP|0301|GLUCOSE|United Healthcare|UNITED HEALTHCARE|||||37.75||| 82952|EAP|0301|GLUCOSE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||37.75||| 82952|EAP|0301|GLUCOSE|Blue Cross PPO Specialty|BCBSTX PPO|||||37.75||| 82955|EAP|0301|G-6PD|Medicare|MEDICARE ACUTE|||||72.10||| 82977|EAP|0301|GAMMA GT|Blue Cross PPO Specialty|BCBSTX PPO|||||69.50||| 82977|EAP|0301|GAMMA GT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||69.50||| 82977|EAP|0301|GAMMA GT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||69.50||| 82977|EAP|0301|GAMMA GT|Blue Cross HMO Specialty|BCBSTX HMO|||||69.50||| 82977|EAP|0301|GAMMA GT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||69.50||| 82977|EAP|0301|GAMMA GT|Managed Medicaid|MEDICAID SUPERIOR|||||69.50||| 82977|EAP|0301|GAMMA GT|Humana Medicare Advantage|HUMANA MA|||||69.50||| 82977|EAP|0301|GAMMA GT|Cigna|CIGNA|||||69.50||| 82977|EAP|0301|GAMMA GT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||69.50||| 82977|EAP|0301|GAMMA GT|Managed Medicaid|MEDICAID AMERIGROUP|||||69.50||| 82977|EAP|0301|GAMMA GT|United Medicare Advantage|UHC MEDICARE GOLD MA|231.97||||69.50||| 82977|EAP|0301|GAMMA GT|United Healthcare|UNITED HEALTHCARE|||||69.50||| 82977|EAP|0301|GAMMA GT|NON CONTRACTED|COMMERCIAL OTHER 1|||||69.50||| 82977|EAP|0301|GAMMA GT|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||69.50||| 82977|EAP|0301|GAMMA GT|Medicaid|MEDICAID HMO|||||69.50||| 82977|EAP|0301|GAMMA GT|Medicaid|MEDICAID|||||69.50||| 82977|EAP|0301|GAMMA GT|Tricare|TRICARE EAST REGION|||||69.50||| 82977|EAP|0301|GAMMA GT|Medicare|MEDICARE ACUTE|231.97||||69.50||| 82977|EAP|0301|GAMMA GT|United Healthcare|UNITED HEALTHCARE OTHER|||||69.50||| 83001|EAP|0301|FSH|Medicaid|MEDICAID|598.87||||||| 83001|EAP|0301|FSH|NON CONTRACTED|COMMERCIAL OTHER 1|||||179.25||| 83001|EAP|0301|FSH|Tricare|TRICARE EAST REGION|||||179.25||| 83001|EAP|0301|FSH|Medicaid|MEDICAID TEXAS CHILDRENS|||||179.25||| 83001|EAP|0301|FSH|Medicare|MEDICARE ACUTE|||||179.25||| 83001|EAP|0301|FSH|United Healthcare|UNITED HEALTHCARE|||||179.25||| 83001|EAP|0301|FSH|Managed Medicaid|MEDICAID SUPERIOR|||||179.25||| 83001|EAP|0301|FSH|Managed Medicaid|MEDICAID AMERIGROUP|||||179.25||| 83001|EAP|0301|FSH|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||179.25||| 83001|EAP|0301|FSH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||179.25||| 83001|EAP|0301|FSH|Access Direct Platinum|HEALTHFIRST TPA UMR|||||179.25||| 83001|EAP|0301|FSH|Cigna|CIGNA|||||179.25||| 83001|EAP|0301|FSH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||179.25||| 83001|EAP|0301|FSH|Blue Cross PPO Specialty|BCBSTX PPO|||||179.25||| 83001|EAP|0301|FSH|Blue Cross HMO Specialty|BCBSTX HMO|||||179.25||| 83001|EAP|0301|FSH|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||179.25||| 83001|EAP|0301|FSH|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||179.25||| 83001|EAP|0301|FSH|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||179.25||| 83001|EAP|0301|FSH|United Healthcare|UNITED HEALTHCARE OTHER|||||179.25||| 83002|EAP|0301|LUTENIZING HORMONE|Blue Cross PPO Specialty|BCBSTX PPO|||||178.50||| 83002|EAP|0301|LUTENIZING HORMONE|Managed Medicaid|MEDICAID SUPERIOR|||||178.50||| 83002|EAP|0301|LUTENIZING HORMONE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||178.50||| 83002|EAP|0301|LUTENIZING HORMONE|Blue Cross HMO Specialty|BCBSTX HMO|||||178.50||| 83002|EAP|0301|LUTENIZING HORMONE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||178.50||| 83002|EAP|0301|LUTENIZING HORMONE|Medicare|MEDICARE ACUTE|||||178.50||| 83002|EAP|0301|LUTENIZING HORMONE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||178.50||| 83002|EAP|0301|LUTENIZING HORMONE|United Healthcare|UNITED HEALTHCARE|||||178.50||| 83002|EAP|0301|LUTENIZING HORMONE|Medicaid|MEDICAID|596.86||||||| 83002|EAP|0301|LUTENIZING HORMONE|Tricare|TRICARE EAST REGION|||||178.50||| 83002|EAP|0301|LUTENIZING HORMONE|Managed Medicaid|MEDICAID AMERIGROUP|||||178.50||| 83002|EAP|0301|LUTENIZING HORMONE|Medicaid|MEDICAID TEXAS CHILDRENS|||||178.50||| 83002|EAP|0301|LUTENIZING HORMONE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||178.50||| 83013|EAP|0301|H PYLORI BREATH|Managed Medicaid|MEDICAID AMERIGROUP|||||649.25||| 83013|EAP|0301|H PYLORI BREATH|Blue Cross HMO Specialty|BCBSTX HMO|||||649.25||| 83013|EAP|0301|H PYLORI BREATH|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||649.25||| 83013|EAP|0301|H PYLORI BREATH|Medicare|MEDICARE ACUTE|||||649.25||| 83013|EAP|0301|H PYLORI BREATH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||649.25||| 83013|EAP|0301|H PYLORI BREATH|United Healthcare|GEHA|||||649.25||| 83013|EAP|0301|H PYLORI BREATH|Aetna|AETNA PPO|||||649.25||| 83013|EAP|0301|H PYLORI BREATH|Medicaid|MORRIS COUNTY INDIGENT|||||649.25||| 83013|EAP|0301|H PYLORI BREATH|Cigna|CIGNA|||||649.25||| 83013|EAP|0301|H PYLORI BREATH|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||649.25||| 83013|EAP|0301|H PYLORI BREATH|NON CONTRACTED|COMMERCIAL OTHER 1|||||649.25||| 83013|EAP|0301|H PYLORI BREATH|Blue Cross PPO Specialty|BCBSTX PPO|||||649.25||| 83013|EAP|0301|H PYLORI BREATH|United Medicare Advantage|UHC MEDICARE GOLD MA|||||649.25||| 83013|EAP|0301|H PYLORI BREATH|Medicaid|MEDICAID|||||649.25||| 83013|EAP|0301|H PYLORI BREATH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||649.25||| 83013|EAP|0301|H PYLORI BREATH|Humana Medicare Advantage|HUMANA MA|||||649.25||| 83013|EAP|0301|H PYLORI BREATH|United Healthcare|UNITED HEALTHCARE|||||649.25||| 83013|EAP|0301|H PYLORI BREATH|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||649.25||| 83013|EAP|0301|H PYLORI BREATH|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||649.25||| 83013|EAP|0301|H PYLORI BREATH|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||649.25||| 83013|EAP|0301|H PYLORI BREATH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||649.25||| 83020|EAP|0301|HEMOGLOBIN ELECTRO|Medicare|MEDICARE ACUTE|413.50||||||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Blue Cross PPO Specialty|BCBSTX OTHER|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|312.73||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Veterans Affairs|VETERANS ADMINISTRATION|312.73||||203.12||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Multiplan|NALC|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||312.73||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|United Medicare Advantage|UHC MEDICARE GOLD MA|312.73||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Medicaid|CAMP COUNTY INDIGENT|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Medicaid|MORRIS COUNTY INDIGENT|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Humana Medicare Advantage|HUMANA MA|312.24||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|United Healthcare|UNITED HEALTHCARE OTHER|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Aenta Medicare Advantage|AETNA MEDICARE MA|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Medicare|MEDICARE ACUTE|311.75||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|NON CONTRACTED|COMMERCIAL OTHER 1|312.73||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|United Healthcare|UNITED HEALTHCARE|312.73||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Cigna|CIGNA|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Medicaid|MEDICAID|311.75||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Tricare|TRICARE EAST REGION|312.73||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Cigna|CIGNA|311.75||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Tricare|TRICARE FOR LIFE|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Blue Cross PPO Specialty|BCBSTX PPO|312.73||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Medicaid|MEDICAID HMO|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Medicaid|MEDICAID TEXAS CHILDRENS|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Access Direct Platinum|HEALTHFIRST TPA UMR|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|United Healthcare|TML GROUP BENEFITS|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|312.73||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|312.73||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Blue Cross HMO Specialty|BCBSTX HMO|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|312.73||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Managed Medicare|HEALTHSPRING MA|312.73||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Aetna|AETNA PPO|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|311.75||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|PHCS|GROUP AND PENSION|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|312.24||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|United Healthcare|GEHA|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|PHCS|HUMANA INSURANCE|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Managed Medicaid|MEDICAID SUPERIOR|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Managed Medicaid|MEDICAID AMERIGROUP|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||93.50||| 83036|EAP|0301|GLYCO-HEMOGLOBIN|United Healthcare|UNITED HEALTHCARE|311.75||||93.50||| 83491|EAP|0301|HYDROCORTICOSLERD-17|Blue Cross PPO Specialty|BCBSTX PPO|||||147.90||| 83516|EAP|0300|ACETYLCHOLINE BLOCKING|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||130.25||| 83516|EAP|0301|MITOCHONDRIAL AB|Medicare|MEDICARE ACUTE|||||111.25||| 83516|EAP|0300|ACETYLCHOLINE BLOCKING|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||130.25||| 83516|EAP|0300|ACETYLCHOLINE BLOCKING|Medicaid|MEDICAID|435.36||||||| 83516|EAP|0300|ACETYLCHOLINE BLOCKING|Tricare|TRICARE EAST REGION|||||130.25||| 83516|EAP|0301|MITOCHONDRIAL AB|United Medicare Advantage|UHC MEDICARE GOLD MA|||||111.25||| 83516|EAP|0300|ACETYLCHOLINE BLOCKING|Managed Medicaid|MEDICAID AMERIGROUP|||||130.25||| 83516|EAP|0301|MITOCHONDRIAL AB|Blue Cross PPO Specialty|BCBSTX PPO|371.91||||111.25||| 83516|EAP|0301|MITOCHONDRIAL AB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||111.25||| 83516|EAP|0300|ACETYLCHOLINE BLOCKING|Managed Medicaid|MEDICAID SUPERIOR|||||130.25||| 83516|EAP|0300|ACETYLCHOLINE BLOCKING|United Healthcare|UNITED HEALTHCARE|||||130.25||| 83516|EAP|0300|ACETYLCHOLINE BLOCKING|Humana Medicare Advantage|HUMANA MA|||||130.25||| 83516|EAP|0300|ACETYLCHOLINE BLOCKING|Medicare|MEDICARE ACUTE|||||130.25||| 83516|EAP|0300|ACETYLCHOLINE BLOCKING|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||130.25||| 83516|EAP|0300|ACETYLCHOLINE BLOCKING|United Medicare Advantage|UHC MEDICARE GOLD MA|||||130.25||| 83516|EAP|0300|ACETYLCHOLINE BLOCKING|Blue Cross PPO Specialty|BCBSTX OTHER|||||130.25||| 83516|EAP|0301|MITOCHONDRIAL AB|United Healthcare|UNITED HEALTHCARE|||||111.25||| 83516|EAP|0300|ACETYLCHOLINE BLOCKING|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.34||||||| 83516|EAP|0300|ACETYLCHOLINE BLOCKING|Blue Cross PPO Specialty|BCBSTX PPO|435.36||||130.25||| 83525|EAP|0301|INSULIN TOTAL|Cigna|CIGNA|||||110.25||| 83525|EAP|0301|INSULIN TOTAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||110.25||| 83525|EAP|0301|INSULIN TOTAL|Managed Medicaid|MEDICAID SUPERIOR|||||110.25||| 83525|EAP|0301|INSULIN TOTAL|Tricare|TRICARE EAST REGION|||||110.25||| 83525|EAP|0301|INSULIN TOTAL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||367.25||| 83525|EAP|0301|INSULIN TOTAL|Blue Cross PPO Specialty|BCBSTX PPO|||||110.25||| 83525|EAP|0301|INSULIN TOTAL|Medicare|MEDICARE ACUTE|367.25||||110.25||| 83525|EAP|0301|INSULIN TOTAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||110.25||| 83525|EAP|0301|INSULIN TOTAL|United Healthcare|UNITED HEALTHCARE|||||110.25||| 83525|EAP|0301|INSULIN TOTAL|Humana Medicare Advantage|HUMANA MA|||||110.25||| 83525|EAP|0301|INSULIN TOTAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|367.25||||110.25||| 83525|EAP|0301|INSULIN TOTAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||110.25||| 83525|EAP|0301|INSULIN TOTAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||110.25||| 83540|EAP|0301|IRON SERUM|Managed Medicaid|MEDICAID SUPERIOR|2.08||||||| 83540|EAP|0301|IRON SERUM|Managed Medicaid|MEDICAID AMERIGROUP|||||62.50||| 83540|EAP|0301|IRON SERUM|Blue Cross PPO Specialty|BCBSTX PPO|||||62.50||| 83540|EAP|0301|IRON SERUM|Humana Medicare Advantage|HUMANA MA|||||62.50||| 83540|EAP|0301|IRON SERUM|Medicare|MEDICARE ACUTE|2.08||||62.50||| 83550|EAP|0301|IRON BIND CAPACITY|Medicaid|MORRIS COUNTY INDIGENT|||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|United Healthcare|UNITED HEALTHCARE|281.88||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|United Healthcare|UNITED HEALTHCARE|||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|Medicare|MEDICARE ACUTE|281.88||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|United Healthcare|UNITED HEALTHCARE OTHER|||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|Managed Medicare|HEALTHSPRING MA|2.81||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|Cigna|CIGNA|||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|PHCS|MULTIPLAN PHCS|||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|Aenta Medicare Advantage|AETNA MEDICARE MA|281.44||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|Access Direct Platinum|HEALTHFIRST TPA UMR|||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|Blue Cross PPO Specialty|BCBSTX PPO|281.44||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|281.88||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|United Medicare Advantage|UHC MEDICARE GOLD MA|281.44||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|Tricare|TRICARE EAST REGION|||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|281.88||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|Humana Medicare Advantage|HUMANA MA|281.88||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|United Healthcare|TML GROUP BENEFITS|||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|Medicaid|MEDICAID|2.81||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|Managed Medicaid|MEDICAID AMERIGROUP|||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|NON CONTRACTED|COMMERCIAL OTHER 1|281.88||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|Medicaid|MEDICAID TEXAS CHILDRENS|||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.81||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.81||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|Blue Cross HMO Specialty|BCBSTX HMO|||||84.50||| 83550|EAP|0301|IRON BIND CAPACITY|Managed Medicaid|MEDICAID SUPERIOR|||||84.50||| 83605|EAP|0301|LACTIC ACID|NON CONTRACTED|COMMERCIAL OTHER 1|344.07||||344.07||| 83605|EAP|0301|LACTIC ACID|Medicaid|MEDICAID|3.43||||344.07||| 83605|EAP|0301|LACTIC ACID|Medicare|MEDICARE ACUTE|3.43||||3.43||| 83605|EAP|0301|LACTIC ACID|Tricare|TRICARE EAST REGION|344.07||||||| 83605|EAP|0301|LACTIC ACID|Medicare|MEDICARE PART B ONLY IP|3.43||||||| 83605|EAP|0301|LACTIC ACID|Veterans Affairs|VETERANS ADMINISTRATION|3.43||||344.07||| 83605|EAP|0301|LACTIC ACID|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||344.07||| 83605|EAP|0301|LACTIC ACID|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3.43||| 83605|EAP|0301|LACTIC ACID|Blue Cross HMO Specialty|BCBSTX HMO|3.43||||3.43||| 83605|EAP|0301|LACTIC ACID|Managed Medicaid|MEDICAID UNITED HEALTHCARE|343.54||||344.07||| 83605|EAP|0301|LACTIC ACID|Managed Medicaid|MEDICAID AMERIGROUP|344.07||||3.43||| 83605|EAP|0301|LACTIC ACID|Humana Medicare Advantage|HUMANA MA|344.07||||344.07||| 83605|EAP|0301|LACTIC ACID|Medicaid|MORRIS COUNTY INDIGENT|||||343.54||| 83605|EAP|0301|LACTIC ACID|Aenta Medicare Advantage|AETNA MEDICARE MA|344.07||||3.43||| 83605|EAP|0301|LACTIC ACID|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|3.43||||344.07||| 83605|EAP|0301|LACTIC ACID|Managed Medicaid|MEDICAID SUPERIOR|344.07||||3.43||| 83605|EAP|0301|LACTIC ACID|United Healthcare|UNITED HEALTHCARE|||||3.43||| 83605|EAP|0301|LACTIC ACID|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||343.54||| 83605|EAP|0301|LACTIC ACID|United Healthcare|TML GROUP BENEFITS|||||343.54||| 83605|EAP|0301|LACTIC ACID|Veterans Affairs|VETERANS ADMINISTRATION|||||3.43||| 83605|EAP|0301|LACTIC ACID|United Medicare Advantage|UHC MEDICARE GOLD MA|3.43||||3.43||| 83605|EAP|0301|LACTIC ACID|Workers Compensation|WORKERS COMPENSATION OTHER|||||344.07||| 83605|EAP|0301|LACTIC ACID|Managed Medicare|BCBS MEDICARE PPO MA|||||344.07||| 83605|EAP|0301|LACTIC ACID|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||344.07||| 83605|EAP|0301|LACTIC ACID|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|343.54||||344.07||| 83605|EAP|0301|LACTIC ACID|Managed Medicare|HEALTHSPRING MA|||||3.43||| 83605|EAP|0301|LACTIC ACID|PHCS|HUMANA INSURANCE|||||3.43||| 83605|EAP|0301|LACTIC ACID|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|343.54||||3.43||| 83605|EAP|0301|LACTIC ACID|Aetna|AETNA OTHER|||||344.07||| 83605|EAP|0301|LACTIC ACID|United Healthcare|UNITED HEALTHCARE OTHER|3.43||||343.54||| 83605|EAP|0301|LACTIC ACID|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|344.07||||344.07||| 83605|EAP|0301|LACTIC ACID|United Healthcare|UNITED HEALTHCARE|344.07||||344.07||| 83605|EAP|0301|LACTIC ACID|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||344.07||| 83605|EAP|0301|LACTIC ACID|Blue Cross PPO Specialty|BCBSTX OTHER|||||344.07||| 83605|EAP|0301|LACTIC ACID|Aetna|AETNA PPO|||||3.43||| 83605|EAP|0301|LACTIC ACID|Cigna|CIGNA|344.07||||344.07||| 83605|EAP|0301|LACTIC ACID|Blue Cross PPO Specialty|BCBSTX PPO|3.43||||344.07||| 83605|EAP|0301|LACTIC ACID|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|344.07||||||| 83605|EAP|0301|LACTIC ACID|Cigna|CIGNA|3.43||||344.07||| 83605|EAP|0301|LACTIC ACID|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|3.43||||344.07||| 83605|EAP|0301|LACTIC ACID|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|3.43||||3.43||| 83615|EAP|0301|LDH|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|194.36||||||| 83615|EAP|0301|LDH|Cigna|CIGNA|||||58.25||| 83615|EAP|0301|LDH|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|194.36||||||| 83615|EAP|0301|LDH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|193.75||||194.06||| 83615|EAP|0301|LDH|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|194.36||||||| 83615|EAP|0301|LDH|Aetna|MAIL HANDLERS BENEFIT PLAN|||||58.25||| 83615|EAP|0301|LDH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|194.06||||194.36||| 83615|EAP|0301|LDH|Aenta Medicare Advantage|AETNA MEDICARE MA|194.36||||193.75||| 83615|EAP|0301|LDH|Cigna|CIGNA|194.36||||194.36||| 83615|EAP|0301|LDH|Managed Medicaid|MEDICAID SUPERIOR|194.36||||126.31||| 83615|EAP|0301|LDH|Blue Cross HMO Specialty|BCBSTX HMO|194.36||||126.31||| 83615|EAP|0301|LDH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|194.36||||194.36||| 83615|EAP|0301|LDH|Humana Medicare Advantage|HUMANA MA|194.36||||193.75||| 83615|EAP|0301|LDH|Veterans Affairs|VETERANS ADMINISTRATION|193.75||||194.06||| 83615|EAP|0301|LDH|Managed Medicaid|MEDICAID AMERIGROUP|||||1.26||| 83615|EAP|0301|LDH|United Healthcare|UNITED HEALTHCARE|||||194.36||| 83615|EAP|0301|LDH|Blue Cross PPO Specialty|BCBSTX PPO|194.36||||193.75||| 83615|EAP|0301|LDH|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||193.75||| 83615|EAP|0301|LDH|Managed Medicare|HEALTHSPRING MA|||||193.75||| 83615|EAP|0301|LDH|United Medicare Advantage|UHC MEDICARE GOLD MA|194.36||||193.75||| 83615|EAP|0301|LDH|Medicaid|MEDICAID|||||194.06||| 83615|EAP|0301|LDH|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||194.36||| 83615|EAP|0301|LDH|Aetna|AETNA OTHER|||||194.36||| 83615|EAP|0301|LDH|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|193.75||||194.06||| 83615|EAP|0301|LDH|Medicare|MEDICARE ACUTE|194.36||||193.75||| 83615|EAP|0301|LDH|United Healthcare|UNITED HEALTHCARE OTHER|||||194.36||| 83615|EAP|0301|LDH|NON CONTRACTED|COMMERCIAL OTHER 1|194.36||||194.36||| 83630|EAP|0300|LACTOFERRIN FECAL|Blue Cross HMO Specialty|BCBSTX HMO|||||1.62||| 83630|EAP|0300|LACTOFERRIN FECAL|Medicare|MEDICARE ACUTE|||||1.62||| 83630|EAP|0300|LACTOFERRIN FECAL|Humana Medicare Advantage|HUMANA MA|||||1.62||| 83630|EAP|0300|LACTOFERRIN FECAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.62||| 83630|EAP|0300|LACTOFERRIN FECAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.62||| 83655|EAP|0301|LEAD LEVEL|Blue Cross PPO Specialty|BCBSTX PPO|||||116.75||| 83655|EAP|0301|LEAD LEVEL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||116.75||| 83655|EAP|0301|LEAD LEVEL|Cigna|CIGNA|||||116.75||| 83655|EAP|0301|LEAD LEVEL|Medicaid|MEDICAID TEXAS CHILDRENS|||||116.75||| 83655|EAP|0301|LEAD LEVEL|Managed Medicaid|MEDICAID SUPERIOR|||||116.75||| 83655|EAP|0301|LEAD LEVEL|Medicaid|MEDICAID|||||116.75||| 83655|EAP|0301|LEAD LEVEL|Managed Medicaid|MEDICAID AMERIGROUP|||||116.75||| 83655|EAP|0301|LEAD LEVEL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||116.75||| 83655|EAP|0301|LEAD LEVEL|Tricare|TRICARE EAST REGION|||||116.75||| 83690|EAP|0301|LIPASE|United Healthcare|UNITED HEALTHCARE|221.25||||221.25||| 83690|EAP|0301|LIPASE|Aetna|AETNA PPO|||||221.25||| 83690|EAP|0301|LIPASE|United Healthcare|UNITED HEALTHCARE|221.94||||221.25||| 83690|EAP|0301|LIPASE|Managed Medicaid|MEDICAID SUPERIOR|221.94||||221.25||| 83690|EAP|0301|LIPASE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|221.25||||221.25||| 83690|EAP|0301|LIPASE|Managed Medicare|HEALTHSPRING MA|||||221.25||| 83690|EAP|0301|LIPASE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||144.22||| 83690|EAP|0301|LIPASE|Medicaid|MEDICAID BCBSTX|||||221.25||| 83690|EAP|0301|LIPASE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|221.60||||221.60||| 83690|EAP|0301|LIPASE|Blue Cross PPO Specialty|BCBSTX OTHER|||||221.25||| 83690|EAP|0301|LIPASE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|221.25||||221.25||| 83690|EAP|0301|LIPASE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||221.94||| 83690|EAP|0301|LIPASE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|221.94||||221.25||| 83690|EAP|0301|LIPASE|Managed Medicaid|MEDICAID AMERIGROUP|221.25||||221.94||| 83690|EAP|0301|LIPASE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||221.25||| 83690|EAP|0301|LIPASE|Humana Medicare Advantage|HUMANA MA|221.60||||221.25||| 83690|EAP|0301|LIPASE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|221.94||||221.60||| 83690|EAP|0301|LIPASE|Blue Cross PPO Specialty|BCBSTX PPO|221.60||||221.25||| 83690|EAP|0301|LIPASE|Cigna|CIGNA|221.60||||221.25||| 83690|EAP|0301|LIPASE|Aetna|AETNA OTHER|||||221.25||| 83690|EAP|0301|LIPASE|Blue Cross HMO Specialty|BCBSTX HMO|||||221.25||| 83690|EAP|0301|LIPASE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|221.60||||221.25||| 83690|EAP|0301|LIPASE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||221.25||| 83690|EAP|0301|LIPASE|Medicare|MEDICARE PART B ONLY IP|221.25||||||| 83690|EAP|0301|LIPASE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||221.25||| 83690|EAP|0301|LIPASE|Medicaid|MEDICAID TEXAS CHILDRENS|221.25||||221.94||| 83690|EAP|0301|LIPASE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|221.25||||221.25||| 83690|EAP|0301|LIPASE|NON CONTRACTED|COMMERCIAL OTHER 1|221.94||||221.25||| 83690|EAP|0301|LIPASE|United Healthcare|TML GROUP BENEFITS|||||221.25||| 83690|EAP|0301|LIPASE|Medicare|MEDICARE ACUTE|221.25||||221.25||| 83690|EAP|0301|LIPASE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||221.94||| 83690|EAP|0301|LIPASE|Veterans Affairs|VETERANS ADMINISTRATION|||||221.25||| 83690|EAP|0301|LIPASE|United Medicare Advantage|UHC MEDICARE GOLD MA|221.94||||221.25||| 83690|EAP|0301|LIPASE|Veterans Affairs|VETERANS ADMINISTRATION|221.25||||221.25||| 83690|EAP|0301|LIPASE|Medicaid|MEDICAID|221.60||||221.25||| 83690|EAP|0301|LIPASE|Tricare|TRICARE EAST REGION|221.94||||221.94||| 83690|EAP|0301|LIPASE|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||221.25||| 83690|EAP|0301|LIPASE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||221.25||| 83690|EAP|0301|LIPASE|Medicaid|MORRIS COUNTY INDIGENT|||||221.25||| 83690|EAP|0301|LIPASE|Tricare|TRICARE FOR LIFE|||||221.25||| 83690|EAP|0301|LIPASE|United Healthcare|UNITED HEALTHCARE OTHER|||||66.50||| 83735|EAP|0301|MAGNESIUM SERUM|Aenta Medicare Advantage|AETNA MEDICARE MA|215.25||||215.25||| 83735|EAP|0301|MAGNESIUM SERUM|Blue Cross HMO Specialty|BCBSTX HMO|215.59||||215.92||| 83735|EAP|0301|MAGNESIUM SERUM|Aetna|AETNA OTHER|||||215.59||| 83735|EAP|0301|MAGNESIUM SERUM|Blue Cross PPO Specialty|BCBSTX PPO|215.92||||215.25||| 83735|EAP|0301|MAGNESIUM SERUM|Cigna|CIGNA|215.25||||215.92||| 83735|EAP|0301|MAGNESIUM SERUM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|215.92||||215.25||| 83735|EAP|0301|MAGNESIUM SERUM|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||215.92||| 83735|EAP|0301|MAGNESIUM SERUM|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||215.92||| 83735|EAP|0301|MAGNESIUM SERUM|Managed Medicare|BCBS MEDICARE PPO MA|||||215.92||| 83735|EAP|0301|MAGNESIUM SERUM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|215.25||||215.92||| 83735|EAP|0301|MAGNESIUM SERUM|Cigna|CIGNA|215.92||||215.25||| 83735|EAP|0301|MAGNESIUM SERUM|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||215.59||| 83735|EAP|0301|MAGNESIUM SERUM|Aetna|AETNA PPO|||||1.40||| 83735|EAP|0301|MAGNESIUM SERUM|PHCS|MERITAIN HEALTH|||||215.92||| 83735|EAP|0301|MAGNESIUM SERUM|United Healthcare|GEHA|||||215.92||| 83735|EAP|0301|MAGNESIUM SERUM|Managed Medicare|HEALTHSPRING MA|215.92||||215.59||| 83735|EAP|0301|MAGNESIUM SERUM|Humana Medicare Advantage|HUMANA MA|215.92||||215.25||| 83735|EAP|0301|MAGNESIUM SERUM|Access Direct Platinum|HEALTHFIRST TPA UMR|||||1.40||| 83735|EAP|0301|MAGNESIUM SERUM|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||215.92||| 83735|EAP|0301|MAGNESIUM SERUM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|215.92||||215.25||| 83735|EAP|0301|MAGNESIUM SERUM|Managed Medicaid|MEDICAID AMERIGROUP|215.25||||215.25||| 83735|EAP|0301|MAGNESIUM SERUM|Managed Medicaid|MEDICAID SUPERIOR|215.92||||215.92||| 83735|EAP|0301|MAGNESIUM SERUM|United Healthcare|UNITED HEALTHCARE|215.25||||215.92||| 83735|EAP|0301|MAGNESIUM SERUM|NON CONTRACTED|COMMERCIAL OTHER 1|215.92||||215.92||| 83735|EAP|0301|MAGNESIUM SERUM|Medicaid|MEDICAID TEXAS CHILDRENS|||||215.92||| 83735|EAP|0301|MAGNESIUM SERUM|Medicaid|MORRIS COUNTY INDIGENT|||||1.40||| 83735|EAP|0301|MAGNESIUM SERUM|Tricare|TRICARE EAST REGION|215.92||||215.59||| 83735|EAP|0301|MAGNESIUM SERUM|PHCS|HUMANA INSURANCE|||||215.25||| 83735|EAP|0301|MAGNESIUM SERUM|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||215.25||| 83735|EAP|0301|MAGNESIUM SERUM|Medicaid|MEDICAID|215.25||||215.25||| 83735|EAP|0301|MAGNESIUM SERUM|United Healthcare|UNITED HEALTHCARE OTHER|215.25||||215.92||| 83735|EAP|0301|MAGNESIUM SERUM|Medicare|MEDICARE ACUTE|215.92||||215.25||| 83735|EAP|0301|MAGNESIUM SERUM|United Healthcare|UNITED HEALTHCARE ERS|||||215.92||| 83735|EAP|0301|MAGNESIUM SERUM|United Healthcare|UNITED HEALTHCARE|215.92||||215.25||| 83735|EAP|0301|MAGNESIUM SERUM|Blue Cross PPO Specialty|BCBSTX OTHER|||||215.25||| 83735|EAP|0301|MAGNESIUM SERUM|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||215.59||| 83735|EAP|0301|MAGNESIUM SERUM|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|215.92||||1.40||| 83735|EAP|0301|MAGNESIUM SERUM|United Medicare Advantage|UHC MEDICARE GOLD MA|215.25||||215.25||| 83735|EAP|0301|MAGNESIUM SERUM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|215.92||||215.25||| 83735|EAP|0301|MAGNESIUM SERUM|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|215.25||||215.25||| 83735|EAP|0301|MAGNESIUM SERUM|Veterans Affairs|VETERANS ADMINISTRATION|||||215.25||| 83735|EAP|0301|MAGNESIUM SERUM|Veterans Affairs|VETERANS ADMINISTRATION|215.25||||215.92||| 83735|EAP|0301|MAGNESIUM SERUM|Medicaid|MEDICAID HMO|||||215.59||| 83735|EAP|0301|MAGNESIUM SERUM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||215.25||| 83735|EAP|0301|MAGNESIUM SERUM|PHCS|MULTIPLAN PHCS|||||215.92||| 83735|EAP|0301|MAGNESIUM SERUM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|215.92||||215.59||| 83835|EAP|0301|METANEPHRINES FRACT|Blue Cross PPO Specialty|BCBSTX PPO|||||163.25||| 83835|EAP|0301|METANEPHRINES|United Healthcare|UNITED HEALTHCARE|||||163.25||| 83835|EAP|0301|METANEPHRINES|Blue Cross PPO Specialty|BCBSTX PPO|||||163.25||| 83835|EAP|0301|METANEPHRINES|United Medicare Advantage|UHC MEDICARE GOLD MA|||||163.25||| 83835|EAP|0301|METANEPHRINES|Medicare|MEDICARE ACUTE|544.25||||||| 83835|EAP|0301|METANEPHRINES FRACT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||163.25||| 83874|EAP|0301|MYOGLOBIN|United Healthcare|UNITED HEALTHCARE|||||124.50||| 83874|EAP|0301|MYOGLOBIN|Cigna|CIGNA|||||124.50||| 83874|EAP|0301|MYOGLOBIN|Blue Cross PPO Specialty|BCBSTX PPO|416.30||||124.50||| 83874|EAP|0301|MYOGLOBIN|Medicare|MEDICARE ACUTE|||||124.50||| 83880|EAP|0301|BNP|Veterans Affairs|VETERANS ADMINISTRATION|||||1,102.44||| 83880|EAP|0301|BNP|United Healthcare|GEHA|||||1,102.44||| 83880|EAP|0301|BNP|Workers Compensation|WORKERS COMPENSATION OTHER|||||1,102.44||| 83880|EAP|0301|BNP|NON CONTRACTED|COMMERCIAL OTHER 1|1,102.44||||1,102.44||| 83880|EAP|0301|BNP|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||10.99||| 83880|EAP|0301|BNP|United Medicare Advantage|UHC MEDICARE GOLD MA|10.99||||1,100.72||| 83880|EAP|0301|BNP|Medicaid|MEDICAID TEXAS CHILDRENS|||||1,102.44||| 83880|EAP|0301|BNP|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1,102.44||| 83880|EAP|0301|BNP|Veterans Affairs|VETERANS ADMINISTRATION|||||10.99||| 83880|EAP|0301|BNP|United Healthcare|UNITED HEALTHCARE|1,102.44||||1,102.44||| 83880|EAP|0301|BNP|Medicare|MEDICARE ACUTE|1,102.44||||10.99||| 83880|EAP|0301|BNP|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||10.99||| 83880|EAP|0301|BNP|Managed Medicaid|MEDICAID AMERIGROUP|10.99||||10.99||| 83880|EAP|0301|BNP|Tricare|TRICARE EAST REGION|||||10.99||| 83880|EAP|0301|BNP|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1,102.44||||1,102.44||| 83880|EAP|0301|BNP|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1,102.44||||10.99||| 83880|EAP|0301|BNP|Aenta Medicare Advantage|AETNA MEDICARE MA|10.99||||10.99||| 83880|EAP|0301|BNP|Managed Medicare|HEALTHSPRING MA|1,102.44||||10.99||| 83880|EAP|0301|BNP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,102.44||||1,100.72||| 83880|EAP|0301|BNP|Medicaid|MEDICAID|10.99||||10.99||| 83880|EAP|0301|BNP|Aetna|AETNA PPO|||||10.99||| 83880|EAP|0301|BNP|Blue Cross PPO Specialty|BCBSTX OTHER|||||10.99||| 83880|EAP|0301|BNP|United Healthcare|UNITED HEALTHCARE ERS|||||1,102.44||| 83880|EAP|0301|BNP|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1,102.44||||10.99||| 83880|EAP|0301|BNP|Managed Medicare|BCBS MEDICARE PPO MA|||||1,102.44||| 83880|EAP|0301|BNP|Cigna|CIGNA|||||714.85||| 83880|EAP|0301|BNP|Blue Cross HMO Specialty|BCBSTX HMO|1,102.44||||1,102.44||| 83880|EAP|0301|BNP|United Healthcare|UNITED HEALTHCARE|||||1,102.44||| 83880|EAP|0301|BNP|Managed Medicaid|MEDICAID SUPERIOR|||||1,102.44||| 83880|EAP|0301|BNP|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||713.13||| 83880|EAP|0301|BNP|Humana Medicare Advantage|HUMANA MA|1,102.44||||10.99||| 83880|EAP|0301|BNP|United Healthcare|TML GROUP BENEFITS|||||1,102.44||| 83880|EAP|0301|BNP|Blue Cross PPO Specialty|BCBSTX PPO|1,102.44||||1,100.72||| 83880|EAP|0301|BNP|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1,102.44||| 83880|EAP|0301|BNP|Cigna|CIGNA|1,102.44||||1,102.44||| 83880|EAP|0301|BNP|Aetna|AETNA OTHER|||||1,102.44||| 83880|EAP|0301|BNP|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1,102.44||||||| 83880|EAP|0301|BNP|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1,102.44||||1,100.72||| 83880|EAP|0301|BNP|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||10.99||| 83880|EAP|0301|BNP|Medicaid|MORRIS COUNTY INDIGENT|||||1,102.44||| 83880|EAP|0301|BNP|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1,100.72||||1,102.44||| 83921|EAP|0301|METHYLAMALONIC ACID SERUM|Medicare|MEDICARE ACUTE|5.29||||158.75||| 83930|EAP|0301|OSMOLALITY SERUM|Humana Medicare Advantage|HUMANA MA|||||47.50||| 83930|EAP|0301|OSMOLALITY SERUM|Blue Cross PPO Specialty|BCBSTX PPO|||||47.50||| 83930|EAP|0301|OSMOLALITY SERUM|Medicare|MEDICARE ACUTE|158.25||||47.50||| 83935|EAP|0301|OSMOLALITY URINE|United Medicare Advantage|UHC MEDICARE GOLD MA|158.75||||||| 83935|EAP|0301|OSMOLALITY URINE|Managed Medicare|HEALTHSPRING MA|158.25||||||| 83935|EAP|0301|OSMOLALITY URINE|Aenta Medicare Advantage|AETNA MEDICARE MA|158.75||||||| 83935|EAP|0301|OSMOLALITY URINE|Humana Medicare Advantage|HUMANA MA|158.75||||158.25||| 83935|EAP|0301|OSMOLALITY URINE|Blue Cross PPO Specialty|BCBSTX PPO|158.75||||158.25||| 83935|EAP|0301|OSMOLALITY URINE|Medicare|MEDICARE ACUTE|158.25||||158.50||| 83970|EAP|0301|PARATHYROID HORMONE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.98||| 83970|EAP|0301|PARATHYROID HORMONE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||3.98||| 83970|EAP|0301|PARATHYROID HORMONE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1,122.50||||3.98||| 83970|EAP|0301|PARATHYROID HORMONE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||3.98||| 83970|EAP|0301|PARATHYROID HORMONE|Blue Cross PPO Specialty|BCBSTX PPO|||||3.98||| 83970|EAP|0301|PARATHYROID HORMONE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.98||| 83970|EAP|0301|PARATHYROID HORMONE|Blue Cross HMO Specialty|BCBSTX HMO|||||3.98||| 83970|EAP|0301|PARATHYROID HORMONE|Cigna|CIGNA|||||3.98||| 83970|EAP|0301|PARATHYROID HORMONE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.98||| 83970|EAP|0301|PARATHYROID HORMONE|Medicaid|MORRIS COUNTY INDIGENT|||||3.98||| 83970|EAP|0301|PARATHYROID HORMONE|Humana Medicare Advantage|HUMANA MA|||||3.98||| 83970|EAP|0301|PARATHYROID HORMONE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3.98||| 83970|EAP|0301|PARATHYROID HORMONE|Managed Medicaid|MEDICAID AMERIGROUP|||||3.98||| 83970|EAP|0301|PARATHYROID HORMONE|United Healthcare|UNITED HEALTHCARE|||||3.98||| 83970|EAP|0301|PARATHYROID HORMONE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3.98||| 83970|EAP|0301|PARATHYROID HORMONE|Medicare|MEDICARE ACUTE|1,126.02||||3.98||| 83970|EAP|0301|PARATHYROID HORMONE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.98||| 84075|EAP|0301|ALKALINE PHOSPHATASE|Blue Cross HMO Specialty|BCBSTX HMO|||||0.50||| 84100|EAP|0301|PHOSPHORUS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|152.98||||||| 84100|EAP|0301|PHOSPHORUS|United Medicare Advantage|UHC MEDICARE GOLD MA|152.50||||45.75||| 84100|EAP|0301|PHOSPHORUS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||45.75||| 84100|EAP|0301|PHOSPHORUS|United Healthcare|UNITED HEALTHCARE|152.98||||45.75||| 84100|EAP|0301|PHOSPHORUS|Medicaid|MEDICAID|||||45.75||| 84100|EAP|0301|PHOSPHORUS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||45.75||| 84100|EAP|0301|PHOSPHORUS|Medicaid|MORRIS COUNTY INDIGENT|||||45.75||| 84100|EAP|0301|PHOSPHORUS|Access Direct Platinum|HEALTHFIRST TPA UMR|||||45.75||| 84100|EAP|0301|PHOSPHORUS|Humana Medicare Advantage|HUMANA MA|||||45.75||| 84100|EAP|0301|PHOSPHORUS|Managed Medicaid|MEDICAID SUPERIOR|||||45.75||| 84100|EAP|0301|PHOSPHORUS|Managed Medicaid|MEDICAID AMERIGROUP|||||45.75||| 84100|EAP|0301|PHOSPHORUS|Aetna|AETNA PPO|||||45.75||| 84100|EAP|0301|PHOSPHORUS|United Healthcare|UNITED HEALTHCARE|||||45.75||| 84100|EAP|0301|PHOSPHORUS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||45.75||| 84100|EAP|0301|PHOSPHORUS|Blue Cross PPO Specialty|BCBSTX PPO|||||152.50||| 84100|EAP|0301|PHOSPHORUS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||45.75||| 84100|EAP|0301|PHOSPHORUS|Medicare|MEDICARE ACUTE|152.50||||45.75||| 84132|EAP|0301|POTASSIUM K SERUM|Aenta Medicare Advantage|AETNA MEDICARE MA|147.50||||95.88||| 84132|EAP|0301|POTASSIUM K SERUM|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|147.96||||||| 84132|EAP|0301|POTASSIUM K SERUM|Blue Cross PPO Specialty|BCBSTX PPO|147.96||||147.50||| 84132|EAP|0301|POTASSIUM K SERUM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|147.50||||147.96||| 84132|EAP|0301|POTASSIUM K SERUM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|147.73||||147.96||| 84132|EAP|0301|POTASSIUM K SERUM|Managed Medicaid|MEDICAID SUPERIOR|147.96||||147.50||| 84132|EAP|0301|POTASSIUM K SERUM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|147.96||||||| 84132|EAP|0301|POTASSIUM K SERUM|NON CONTRACTED|COMMERCIAL OTHER 1|||||147.96||| 84132|EAP|0301|POTASSIUM K SERUM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|147.50||||147.96||| 84132|EAP|0301|POTASSIUM K SERUM|Humana Medicare Advantage|HUMANA MA|147.96||||147.50||| 84132|EAP|0301|POTASSIUM K SERUM|Tricare|TRICARE EAST REGION|147.96||||||| 84132|EAP|0301|POTASSIUM K SERUM|Medicaid|MEDICAID|147.50||||147.96||| 84132|EAP|0301|POTASSIUM K SERUM|United Healthcare|UNITED HEALTHCARE|147.96||||||| 84132|EAP|0301|POTASSIUM K SERUM|Veterans Affairs|VETERANS ADMINISTRATION|147.50||||||| 84132|EAP|0301|POTASSIUM K SERUM|United Medicare Advantage|UHC MEDICARE GOLD MA|147.50||||147.73||| 84132|EAP|0301|POTASSIUM K SERUM|United Healthcare|UNITED HEALTHCARE OTHER|147.50||||||| 84132|EAP|0301|POTASSIUM K SERUM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|147.96||||||| 84132|EAP|0301|POTASSIUM K SERUM|United Healthcare|UNITED HEALTHCARE|147.50||||||| 84132|EAP|0301|POTASSIUM K SERUM|Medicare|MEDICARE ACUTE|147.73||||147.50||| 84132|EAP|0301|POTASSIUM K SERUM|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|147.50||||147.50||| 84133|EAP|0301|POTASSIUM K URINE|Medicare|MEDICARE ACUTE|138.47||||||| 84134|EAP|0301|PREALBUMIN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|271.43||||||| 84134|EAP|0301|PREALBUMIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|271.85||||81.50||| 84134|EAP|0301|PREALBUMIN|Humana Medicare Advantage|HUMANA MA|271.43||||81.50||| 84134|EAP|0301|PREALBUMIN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||81.50||| 84134|EAP|0301|PREALBUMIN|Managed Medicare|HEALTHSPRING MA|2.71||||||| 84134|EAP|0301|PREALBUMIN|Medicare|MEDICARE ACUTE|271.85||||81.50||| 84134|EAP|0301|PREALBUMIN|Aetna|AETNA PPO|||||81.50||| 84134|EAP|0301|PREALBUMIN|Blue Cross HMO Specialty|BCBSTX HMO|||||81.50||| 84134|EAP|0301|PREALBUMIN|United Medicare Advantage|UHC MEDICARE GOLD MA|2.71||||81.50||| 84144|EAP|0301|PROGESTERONE|Medicare|MEDICARE ACUTE|||||201.25||| 84144|EAP|0301|PROGESTERONE|Managed Medicaid|MEDICAID SUPERIOR|||||201.25||| 84144|EAP|0301|PROGESTERONE|Blue Cross PPO Specialty|BCBSTX PPO|||||201.25||| 84144|EAP|0301|PROGESTERONE|United Healthcare|UNITED HEALTHCARE|||||201.25||| 84144|EAP|0301|PROGESTERONE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||201.25||| 84146|EAP|0301|PROLACTIN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||186.75||| 84146|EAP|0301|PROLACTIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||186.75||| 84146|EAP|0301|PROLACTIN|Managed Medicaid|MEDICAID SUPERIOR|||||186.75||| 84146|EAP|0301|PROLACTIN|Humana Medicare Advantage|HUMANA MA|||||186.75||| 84146|EAP|0301|PROLACTIN|Blue Cross HMO Specialty|BCBSTX HMO|||||186.75||| 84146|EAP|0301|PROLACTIN|Managed Medicaid|MEDICAID AMERIGROUP|||||405.60||| 84146|EAP|0301|PROLACTIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||186.75||| 84146|EAP|0301|PROLACTIN|Tricare|TRICARE EAST REGION|||||186.75||| 84146|EAP|0301|PROLACTIN|Medicare|MEDICARE ACUTE|||||186.75||| 84146|EAP|0301|PROLACTIN|Medicaid|MEDICAID TEXAS CHILDRENS|||||186.75||| 84146|EAP|0301|PROLACTIN|Blue Cross PPO Specialty|BCBSTX PPO|||||186.75||| 84146|EAP|0301|PROLACTIN|United Medicare Advantage|UHC MEDICARE GOLD MA|||||186.75||| 84146|EAP|0301|PROLACTIN|United Healthcare|UNITED HEALTHCARE|||||186.75||| 84153|EAP|0301|PSA|United Healthcare|TML GROUP BENEFITS|||||177.25||| 84153|EAP|0301|PSA|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||177.25||| 84153|EAP|0301|PSA|United Medicare Advantage|UHC MEDICARE GOLD MA|590.75||||177.25||| 84153|EAP|0301|PSA|United Healthcare|GEHA|||||177.25||| 84153|EAP|0301|PSA|NON CONTRACTED|COMMERCIAL OTHER 1|||||177.25||| 84153|EAP|0301|PSA|Medicaid|MORRIS COUNTY INDIGENT|||||177.25||| 84153|EAP|0301|PSA|Tricare|TRICARE EAST REGION|||||177.25||| 84153|EAP|0301|PSA|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||177.25||| 84153|EAP|0301|PSA|United Healthcare|UNITED HEALTHCARE OTHER|||||177.25||| 84153|EAP|0301|PSA|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||177.25||| 84153|EAP|0301|PSA|Multiplan|NALC|||||177.25||| 84153|EAP|0301|PSA|United Healthcare|UNITED HEALTHCARE|||||177.25||| 84153|EAP|0301|PSA|Medicaid|MEDICAID|||||177.25||| 84153|EAP|0301|PSA|Access Direct Platinum|HEALTHFIRST TPA UMR|||||177.25||| 84153|EAP|0301|PSA|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||177.25||| 84153|EAP|0301|PSA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||177.25||| 84153|EAP|0301|PSA|Aenta Medicare Advantage|AETNA MEDICARE MA|592.60||||177.25||| 84153|EAP|0301|PSA|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||177.25||| 84153|EAP|0301|PSA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|590.75||||177.25||| 84153|EAP|0301|PSA|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||177.25||| 84153|EAP|0301|PSA|Managed Medicare|HEALTHSPRING MA|590.75||||177.25||| 84153|EAP|0301|PSA|Blue Cross PPO Specialty|BCBSTX PPO|3.84||||177.25||| 84153|EAP|0301|PSA|Blue Cross HMO Specialty|BCBSTX HMO|||||177.25||| 84153|EAP|0301|PSA|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||177.25||| 84153|EAP|0301|PSA|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||177.25||| 84153|EAP|0301|PSA|Medicare|MEDICARE ACUTE|591.68||||177.25||| 84153|EAP|0301|PSA|Humana Medicare Advantage|HUMANA MA|592.60||||177.25||| 84153|EAP|0301|PSA|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||177.25||| 84153|EAP|0301|PSA|Cigna|CIGNA|||||177.25||| 84154|EAP|0300|FREE PSA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||5.37||| 84154|EAP|0300|FREE PSA|United Medicare Advantage|UHC MEDICARE GOLD MA|5.37||||1.61||| 84154|EAP|0300|FREE PSA|Managed Medicare|HEALTHSPRING MA|5.37||||||| 84154|EAP|0300|FREE PSA|Blue Cross PPO Specialty|BCBSTX PPO|||||1.61||| 84154|EAP|0300|FREE PSA|Medicare|MEDICARE ACUTE|5.37||||1.61||| 84154|EAP|0300|FREE PSA|Humana Medicare Advantage|HUMANA MA|538.68||||1.61||| 84155|EAP|0301|PROTEIN TOTAL SERUM|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|118.12||||||| 84155|EAP|0301|PROTEIN TOTAL SERUM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|117.75||||||| 84155|EAP|0301|PROTEIN TOTAL SERUM|United Medicare Advantage|UHC MEDICARE GOLD MA|117.94||||35.25||| 84155|EAP|0301|PROTEIN TOTAL SERUM|Managed Medicaid|MEDICAID AMERIGROUP|||||35.25||| 84155|EAP|0301|PROTEIN TOTAL SERUM|Cigna|CIGNA|||||35.25||| 84155|EAP|0301|PROTEIN TOTAL SERUM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|117.75||||35.25||| 84155|EAP|0301|PROTEIN TOTAL SERUM|Managed Medicaid|MEDICAID SUPERIOR|117.75||||||| 84155|EAP|0301|PROTEIN TOTAL SERUM|Humana Medicare Advantage|HUMANA MA|117.75||||35.25||| 84155|EAP|0301|PROTEIN TOTAL SERUM|Blue Cross PPO Specialty|BCBSTX PPO|117.75||||35.25||| 84155|EAP|0301|PROTEIN TOTAL SERUM|Medicare|MEDICARE ACUTE|118.12||||35.25||| 84155|EAP|0301|PROTEIN TOTAL SERUM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||35.25||| 84155|EAP|0301|PROTEIN TOTAL SERUM|United Healthcare|UNITED HEALTHCARE|||||35.25||| 84155|EAP|0301|PROTEIN TOTAL SERUM|United Healthcare|UNITED HEALTHCARE|118.12||||35.25||| 84156|EAP|0301|PROTEIN URINE RANDOM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|117.75||||35.25||| 84156|EAP|0301|PROTEIN URINE RANDOM|Managed Medicaid|MEDICAID SUPERIOR|117.75||||||| 84156|EAP|0301|PROTEIN URINE RANDOM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|117.75||||35.25||| 84156|EAP|0301|PROTEIN URINE RANDOM|Humana Medicare Advantage|HUMANA MA|118.12||||35.25||| 84156|EAP|0301|PROTEIN 24 HOUR URINE|Humana Medicare Advantage|HUMANA MA|118.12||||35.25||| 84156|EAP|0301|PROTEIN URINE RANDOM|Managed Medicaid|MEDICAID AMERIGROUP|||||35.25||| 84156|EAP|0301|PROTEIN URINE RANDOM|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||35.25||| 84156|EAP|0301|PROTEIN URINE RANDOM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||35.25||| 84156|EAP|0301|PROTEIN URINE RANDOM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|118.12||||35.25||| 84156|EAP|0301|PROTEIN URINE RANDOM|Aenta Medicare Advantage|AETNA MEDICARE MA|118.12||||35.25||| 84156|EAP|0301|PROTEIN URINE RANDOM|Blue Cross PPO Specialty|BCBSTX PPO|118.12||||35.25||| 84156|EAP|0301|PROTEIN URINE RANDOM|Blue Cross HMO Specialty|BCBSTX HMO|||||35.25||| 84156|EAP|0301|PROTEIN URINE RANDOM|Cigna|CIGNA|||||35.25||| 84156|EAP|0301|PROTEIN URINE RANDOM|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|118.12||||||| 84156|EAP|0301|PROTEIN URINE RANDOM|Managed Medicare|HEALTHSPRING MA|118.12||||||| 84156|EAP|0301|PROTEIN URINE RANDOM|Medicare|MEDICARE ACUTE|118.12||||35.25||| 84156|EAP|0301|PROTEIN 24 HOUR URINE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|118.12||||35.25||| 84156|EAP|0301|PROTEIN URINE RANDOM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|118.12||||35.25||| 84156|EAP|0301|PROTEIN 24 HOUR URINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|117.75||||35.25||| 84156|EAP|0301|PROTEIN URINE RANDOM|United Medicare Advantage|UHC MEDICARE GOLD MA|117.94||||35.25||| 84156|EAP|0301|PROTEIN URINE RANDOM|United Medicare Advantage|UHC MEDICARE GOLD MA|117.12||||35.25||| 84156|EAP|0301|PROTEIN URINE RANDOM|Veterans Affairs|VETERANS ADMINISTRATION|||||35.25||| 84156|EAP|0301|PROTEIN 24 HOUR URINE|Medicare|MEDICARE ACUTE|118.12||||35.25||| 84156|EAP|0301|PROTEIN URINE RANDOM|NON CONTRACTED|COMMERCIAL OTHER 1|118.12||||||| 84156|EAP|0301|PROTEIN URINE RANDOM|Medicaid|MORRIS COUNTY INDIGENT|||||35.25||| 84156|EAP|0301|PROTEIN 24 HOUR URINE|Tricare|TRICARE EAST REGION|||||35.25||| 84156|EAP|0301|PROTEIN URINE RANDOM|Tricare|TRICARE EAST REGION|||||76.50||| 84156|EAP|0301|PROTEIN URINE RANDOM|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|117.94||||35.25||| 84156|EAP|0301|PROTEIN URINE RANDOM|United Healthcare|UNITED HEALTHCARE|117.75||||35.25||| 84156|EAP|0301|PROTEIN URINE RANDOM|United Healthcare|UNITED HEALTHCARE|118.12||||35.25||| 84157|EAP|0301|PROTEIN TOTAL CSF|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.86||| 84157|EAP|0301|PROTEIN TOTAL CSF|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|100.31||||||| 84157|EAP|0301|PROTEIN TOTAL CSF|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.86||| 84157|EAP|0301|PROTEIN TOTAL CSF|United Healthcare|UNITED HEALTHCARE|||||100.31||| 84157|EAP|0301|PROTEIN TOTAL CSF|Medicare|MEDICARE ACUTE|||||1.00||| 84157|EAP|0301|PROTEIN TOTAL CSF|United Medicare Advantage|UHC MEDICARE GOLD MA|100.31||||||| 84157|EAP|0301|PROTEIN TOTAL CSF|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.00||| 84157|EAP|0301|PROTEIN TOTAL CSF|Managed Medicaid|MEDICAID SUPERIOR|||||100.16||| 84157|EAP|0301|PROTEIN TOTAL CSF|Humana Medicare Advantage|HUMANA MA|||||1.00||| 84165|EAP|0301|PROTEIN ELECTROPHORETIC F|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||103.50||| 84165|EAP|0301|PROTEIN ELECTROPHORETIC F|Managed Medicaid|MEDICAID AMERIGROUP|||||103.50||| 84165|EAP|0301|PROTEIN ELECTROPHORETIC F|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|3.45||||||| 84165|EAP|0301|PROTEIN ELECTROPHORETIC F|Humana Medicare Advantage|HUMANA MA|3.45||||103.50||| 84165|EAP|0301|PROTEIN ELECTROPHORETIC F|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|346.08||||||| 84165|EAP|0301|PROTEIN ELECTROPHORETIC F|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.45||||103.50||| 84165|EAP|0301|PROTEIN ELECTROPHORETIC F|Blue Cross PPO Specialty|BCBSTX PPO|3.45||||103.50||| 84165|EAP|0301|PROTEIN ELECTROPHORETIC F|United Medicare Advantage|UHC MEDICARE GOLD MA|3.45||||103.50||| 84165|EAP|0301|PROTEIN ELECTROPHORETIC F|United Healthcare|UNITED HEALTHCARE|||||103.50||| 84165|EAP|0301|PROTEIN ELECTROPHORETIC F|United Healthcare|UNITED HEALTHCARE|346.08||||103.50||| 84165|EAP|0301|PROTEIN ELECTROPHORETIC F|Medicare|MEDICARE ACUTE|346.08||||103.50||| 84165|EAP|0301|PROTEIN ELECTROPHORETIC F|Managed Medicaid|MEDICAID SUPERIOR|3.45||||||| 84165|EAP|0301|PROTEIN ELECTROPHORETIC F|Cigna|CIGNA|||||103.50||| 84166|EAP|0301|URINE PROTEIN ELECTRO|Medicare|MEDICARE ACUTE|574.80||||1.72||| 84166|EAP|0301|URINE PROTEIN ELECTRO|United Healthcare|UNITED HEALTHCARE|574.80||||||| 84166|EAP|0301|URINE PROTEIN ELECTRO|Managed Medicaid|MEDICAID SUPERIOR|5.73||||||| 84166|EAP|0301|URINE PROTEIN ELECTRO|United Medicare Advantage|UHC MEDICARE GOLD MA|5.73||||1.72||| 84166|EAP|0301|URINE PROTEIN ELECTRO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|5.73||||||| 84166|EAP|0301|URINE PROTEIN ELECTRO|Humana Medicare Advantage|HUMANA MA|574.80||||||| 84166|EAP|0301|URINE PROTEIN ELECTRO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.72||| 84166|EAP|0301|URINE PROTEIN ELECTRO|Blue Cross PPO Specialty|BCBSTX PPO|5.73||||1.72||| 84207|EAP|0300|VITAMIN B6|NON CONTRACTED|COMMERCIAL OTHER 1|||||241.50||| 84207|EAP|0300|VITAMIN B6|United Medicare Advantage|UHC MEDICARE GOLD MA|||||241.50||| 84207|EAP|0300|VITAMIN B6|Blue Cross HMO Specialty|BCBSTX HMO|||||241.50||| 84244|EAP|0301|RENIN PLASMA|Blue Cross PPO Specialty|BCBSTX PPO|||||2.12||| 84244|EAP|0301|RENIN PLASMA|Medicare|MEDICARE ACUTE|706.75||||||| 843|DRG||OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W MCC|NON CONTRACTED|COMMERCIAL OTHER 1|7,087.75|7087.75|7087.75|7087.75|||| 84300|EAP|0301|SODIUM URINE|Managed Medicare|HEALTHSPRING MA|156.25||||||| 84300|EAP|0301|SODIUM URINE|Aenta Medicare Advantage|AETNA MEDICARE MA|156.74||||||| 84300|EAP|0301|SODIUM URINE|Blue Cross PPO Specialty|BCBSTX PPO|156.74||||0.47||| 84300|EAP|0301|SODIUM URINE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|156.50||||||| 84300|EAP|0301|SODIUM URINE|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.47||| 84300|EAP|0301|SODIUM URINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|156.25||||||| 84300|EAP|0301|SODIUM URINE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|156.25||||||| 84300|EAP|0301|SODIUM URINE|Humana Medicare Advantage|HUMANA MA|156.74||||156.25||| 84300|EAP|0301|SODIUM URINE|Medicare|MEDICARE ACUTE|156.74||||0.47||| 84300|EAP|0301|SODIUM URINE|United Medicare Advantage|UHC MEDICARE GOLD MA|156.74||||||| 84300|EAP|0301|SODIUM URINE|Tricare|TRICARE EAST REGION|156.74||||156.25||| 84315|EAP|0301|SPEC GRAVITY FLUID|Blue Cross PPO Specialty|BCBSTX PPO|||||0.48||| 844|DRG||OTHER MYELOPROLIF DIS OR POORLY DIFF NEOPL DIAG W CC|Humana Medicare Advantage|HUMANA MA|60.69|3847.48|3847.48|3847.48|||| 84402|EAP|0301|TESTOSTERONE FREE|United Healthcare|UNITED HEALTHCARE|||||245.50||| 84402|EAP|0301|TESTOSTERONE FREE|Tricare|TRICARE EAST REGION|||||245.50||| 84402|EAP|0301|TESTOSTERONE FREE|Medicare|MEDICARE ACUTE|||||245.50||| 84402|EAP|0301|TESTOSTERONE FREE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||245.50||| 84402|EAP|0301|TESTOSTERONE FREE|United Healthcare|TML GROUP BENEFITS|||||245.50||| 84402|EAP|0301|TESTOSTERONE FREE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||245.50||| 84402|EAP|0301|TESTOSTERONE FREE|Cigna|CIGNA|||||245.50||| 84402|EAP|0301|TESTOSTERONE FREE|NON CONTRACTED|COMMERCIAL OTHER 1|||||245.50||| 84402|EAP|0301|TESTOSTERONE FREE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||245.50||| 84402|EAP|0301|TESTOSTERONE FREE|Blue Cross HMO Specialty|BCBSTX HMO|||||245.50||| 84402|EAP|0301|TESTOSTERONE FREE|Aetna|AETNA PPO|||||245.50||| 84402|EAP|0301|TESTOSTERONE FREE|Humana Medicare Advantage|HUMANA MA|||||245.50||| 84402|EAP|0301|TESTOSTERONE FREE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||245.50||| 84402|EAP|0301|TESTOSTERONE FREE|Blue Cross PPO Specialty|BCBSTX PPO|||||245.50||| 84402|EAP|0301|TESTOSTERONE FREE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||245.50||| 84402|EAP|0301|TESTOSTERONE FREE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||245.50||| 84402|EAP|0301|TESTOSTERONE FREE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||245.50||| 84402|EAP|0301|TESTOSTERONE FREE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||245.50||| 84402|EAP|0301|TESTOSTERONE FREE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||245.50||| 84402|EAP|0301|TESTOSTERONE FREE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||245.50||| 84403|EAP|0301|TESTOSTERONE TOTAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.49||| 84403|EAP|0301|TESTOSTERONE TOTAL|Managed Medicaid|MEDICAID SUPERIOR|||||2.49||| 84403|EAP|0301|TESTOSTERONE TOTAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.49||| 84403|EAP|0301|TESTOSTERONE TOTAL|Managed Medicaid|MEDICAID AMERIGROUP|||||2.49||| 84403|EAP|0301|TESTOSTERONE TOTAL|Humana Medicare Advantage|HUMANA MA|||||2.49||| 84403|EAP|0301|TESTOSTERONE TOTAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.49||| 84403|EAP|0301|TESTOSTERONE TOTAL|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.49||| 84403|EAP|0301|TESTOSTERONE TOTAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.49||| 84403|EAP|0301|TESTOSTERONE TOTAL|Aetna|AETNA PPO|||||2.49||| 84403|EAP|0301|TESTOSTERONE TOTAL|Blue Cross PPO Specialty|BCBSTX PPO|||||2.49||| 84403|EAP|0301|TESTOSTERONE TOTAL|Cigna|CIGNA|||||2.49||| 84403|EAP|0301|TESTOSTERONE TOTAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.49||| 84403|EAP|0301|TESTOSTERONE TOTAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.49||| 84403|EAP|0301|TESTOSTERONE TOTAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.49||| 84403|EAP|0301|TESTOSTERONE TOTAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.49||| 84403|EAP|0301|TESTOSTERONE TOTAL|United Healthcare|GEHA|||||2.49||| 84403|EAP|0301|TESTOSTERONE TOTAL|Access Direct Platinum|HEALTHFIRST TPA UMR|||||2.49||| 84403|EAP|0301|TESTOSTERONE TOTAL|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.49||| 84403|EAP|0301|TESTOSTERONE TOTAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.49||| 84403|EAP|0301|TESTOSTERONE TOTAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.49||| 84403|EAP|0301|TESTOSTERONE TOTAL|Medicare|MEDICARE ACUTE|||||2.49||| 84403|EAP|0301|TESTOSTERONE TOTAL|United Healthcare|TML GROUP BENEFITS|||||2.49||| 84403|EAP|0301|TESTOSTERONE TOTAL|Tricare|TRICARE EAST REGION|||||2.49||| 84403|EAP|0301|TESTOSTERONE TOTAL|Blue Cross HMO Specialty|BCBSTX HMO|||||2.49||| 84403|EAP|0301|TESTOSTERONE TOTAL|United Healthcare|UNITED HEALTHCARE|||||2.49||| 84425|EAP|0301|THIAMINE VITAMIN B1 LEVEL|Cigna|CIGNA|||||0.58||| 84425|EAP|0301|THIAMINE VITAMIN B1 LEVEL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.93||||||| 84425|EAP|0301|THIAMINE VITAMIN B1 LEVEL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.58||| 84425|EAP|0301|THIAMINE VITAMIN B1 LEVEL|Blue Cross HMO Specialty|BCBSTX HMO|||||0.58||| 84432|EAP|0301|THYROGLOBULIN|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||81.75||| 84432|EAP|0301|THYROGLOBULIN|Managed Medicaid|MEDICAID SUPERIOR|||||81.75||| 84432|EAP|0301|THYROGLOBULIN|Blue Cross PPO Specialty|BCBSTX PPO|||||81.75||| 84436|EAP|0301|T4|Blue Cross HMO Specialty|BCBSTX HMO|||||66.25||| 84436|EAP|0301|T4|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||66.25||| 84436|EAP|0301|T4|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||66.25||| 84436|EAP|0301|T4|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||66.25||| 84436|EAP|0301|T4|Access Direct Platinum|HEALTHFIRST TPA UMR|||||66.25||| 84436|EAP|0301|T4|Aetna|AETNA PPO|||||66.25||| 84436|EAP|0301|T4|Cigna|CIGNA|||||66.25||| 84436|EAP|0301|T4|Managed Medicaid|MEDICAID AMERIGROUP|||||66.25||| 84436|EAP|0301|T4|United Medicare Advantage|UHC MEDICARE GOLD MA|220.75||||66.25||| 84436|EAP|0301|T4|Aenta Medicare Advantage|AETNA MEDICARE MA|||||66.25||| 84436|EAP|0301|T4|Medicaid|MEDICAID HMO|||||66.25||| 84436|EAP|0301|T4|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||66.25||| 84436|EAP|0301|T4|Blue Cross PPO Specialty|BCBSTX PPO|||||66.25||| 84436|EAP|0301|T4|NON CONTRACTED|COMMERCIAL OTHER 1|||||66.25||| 84436|EAP|0301|T4|Medicaid|MEDICAID TEXAS CHILDRENS|||||66.25||| 84436|EAP|0301|T4|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||66.25||| 84436|EAP|0301|T4|Humana Medicare Advantage|HUMANA MA|221.44||||66.25||| 84436|EAP|0301|T4|Managed Medicaid|MEDICAID SUPERIOR|||||66.25||| 84436|EAP|0301|T4|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||66.25||| 84436|EAP|0301|T4|Medicare|MEDICARE ACUTE|220.75||||66.25||| 84436|EAP|0301|T4|Tricare|TRICARE EAST REGION|||||66.25||| 84436|EAP|0301|T4|Medicaid|MEDICAID|221.44||||66.25||| 84436|EAP|0301|T4|United Healthcare|UNITED HEALTHCARE|||||66.25||| 84436|EAP|0301|T4|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|220.75||||66.25||| 84436|EAP|0301|T4|United Healthcare|UNITED HEALTHCARE OTHER|||||66.25||| 84439|EAP|0301|T4 FREE|Medicaid|MORRIS COUNTY INDIGENT|||||0.87||| 84439|EAP|0301|T4 FREE|Medicare|MEDICARE ACUTE|289.75||||0.87||| 84439|EAP|0301|T4 FREE|United Healthcare|UNITED HEALTHCARE OTHER|||||0.87||| 84439|EAP|0301|T4 FREE|United Healthcare|GEHA|||||0.87||| 84439|EAP|0301|T4 FREE|PHCS|HUMANA INSURANCE|||||0.87||| 84439|EAP|0301|T4 FREE|Tricare|TRICARE EAST REGION|289.75||||0.87||| 84439|EAP|0301|T4 FREE|Medicaid|MEDICAID TEXAS CHILDRENS|||||0.87||| 84439|EAP|0301|T4 FREE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.87||| 84439|EAP|0301|T4 FREE|United Healthcare|TML GROUP BENEFITS|||||0.87||| 84439|EAP|0301|T4 FREE|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.87||| 84439|EAP|0301|T4 FREE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|289.75||||0.87||| 84439|EAP|0301|T4 FREE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.87||| 84439|EAP|0301|T4 FREE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.87||| 84439|EAP|0301|T4 FREE|United Medicare Advantage|UHC MEDICARE GOLD MA|290.21||||0.87||| 84439|EAP|0301|T4 FREE|Managed Medicaid|MEDICAID SUPERIOR|||||0.87||| 84439|EAP|0301|T4 FREE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.87||| 84439|EAP|0301|T4 FREE|Cigna|CIGNA|||||0.87||| 84439|EAP|0301|T4 FREE|Aetna|AETNA PPO|||||0.87||| 84439|EAP|0301|T4 FREE|Blue Cross HMO Specialty|BCBSTX HMO|||||0.87||| 84439|EAP|0301|T4 FREE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|290.66||||0.87||| 84439|EAP|0301|T4 FREE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.87||| 84439|EAP|0301|T4 FREE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.87||| 84439|EAP|0301|T4 FREE|Aetna|AETNA OTHER|||||0.87||| 84439|EAP|0301|T4 FREE|Medicaid|MEDICAID|188.38||||0.87||| 84439|EAP|0301|T4 FREE|United Healthcare|UNITED HEALTHCARE|290.66||||0.87||| 84439|EAP|0301|T4 FREE|Humana Medicare Advantage|HUMANA MA|290.66||||0.87||| 84439|EAP|0301|T4 FREE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.87||| 84439|EAP|0301|T4 FREE|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||0.87||| 84439|EAP|0301|T4 FREE|Blue Cross PPO Specialty|BCBSTX PPO|290.66||||0.87||| 84439|EAP|0301|T4 FREE|Managed Medicare|HEALTHSPRING MA|289.75||||0.87||| 84439|EAP|0301|T4 FREE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.87||| 84439|EAP|0301|T4 FREE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.87||| 84439|EAP|0301|T4 FREE|Managed Medicaid|MEDICAID AMERIGROUP|289.75||||0.87||| 84439|EAP|0301|T4 FREE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||0.87||| 84439|EAP|0301|T4 FREE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.87||| 84439|EAP|0301|T4 FREE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.87||| 84439|EAP|0301|T4 FREE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.87||| 84439|EAP|0301|T4 FREE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.87||| 84439|EAP|0301|T4 FREE|Multiplan|NALC|||||0.87||| 84439|EAP|0301|T4 FREE|Medicaid|MEDICAID HMO|||||0.87||| 84443|EAP|0301|TSH|Aetna|AETNA OTHER|||||1.62||| 84443|EAP|0301|TSH|Aetna|AETNA PPO|||||1.62||| 84443|EAP|0301|TSH|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|541.44||||1.62||| 84443|EAP|0301|TSH|Aenta Medicare Advantage|AETNA MEDICARE MA|541.44||||1.62||| 84443|EAP|0301|TSH|Blue Cross PPO Specialty|BCBSTX PPO|540.60||||1.62||| 84443|EAP|0301|TSH|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||1.62||| 84443|EAP|0301|TSH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|540.60||||1.62||| 84443|EAP|0301|TSH|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1.62||| 84443|EAP|0301|TSH|Access Direct Platinum|HEALTHFIRST TPA UMR|||||1.62||| 84443|EAP|0301|TSH|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.62||| 84443|EAP|0301|TSH|Cigna|CIGNA|||||1.62||| 84443|EAP|0301|TSH|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|541.44||||1.62||| 84443|EAP|0301|TSH|Blue Cross HMO Specialty|BCBSTX HMO|||||1.62||| 84443|EAP|0301|TSH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|539.75||||1.62||| 84443|EAP|0301|TSH|Managed Medicaid|MEDICAID SUPERIOR|539.75||||1.62||| 84443|EAP|0301|TSH|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||1.62||| 84443|EAP|0301|TSH|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.62||| 84443|EAP|0301|TSH|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|541.44||||1.62||| 84443|EAP|0301|TSH|Managed Medicare|HEALTHSPRING MA|539.75||||1.62||| 84443|EAP|0301|TSH|United Medicare Advantage|UHC MEDICARE GOLD MA|541.44||||1.62||| 84443|EAP|0301|TSH|Managed Medicare|BCBS MEDICARE PPO MA|||||1.62||| 84443|EAP|0301|TSH|Humana Medicare Advantage|HUMANA MA|541.44||||1.62||| 84443|EAP|0301|TSH|Multiplan|NALC|||||1.62||| 84443|EAP|0301|TSH|Medicare|MEDICARE ACUTE|539.75||||1.62||| 84443|EAP|0301|TSH|Medicaid|MEDICAID|539.75||||1.62||| 84443|EAP|0301|TSH|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|541.44||||1.62||| 84443|EAP|0301|TSH|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.62||| 84443|EAP|0301|TSH|Tricare|TRICARE EAST REGION|539.75||||1.62||| 84443|EAP|0301|TSH|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.62||| 84443|EAP|0301|TSH|Veterans Affairs|VETERANS ADMINISTRATION|||||540.60||| 84443|EAP|0301|TSH|Managed Medicaid|MEDICAID AMERIGROUP|539.75||||1.62||| 84443|EAP|0301|TSH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|540.60||||1.62||| 84443|EAP|0301|TSH|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.62||| 84443|EAP|0301|TSH|Medicaid|MORRIS COUNTY INDIGENT|||||1.62||| 84443|EAP|0301|TSH|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.62||| 84443|EAP|0301|TSH|PHCS|GROUP AND PENSION|||||1.62||| 84443|EAP|0301|TSH|United Healthcare|UNITED HEALTHCARE OTHER|||||1.62||| 84443|EAP|0301|TSH|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.62||| 84443|EAP|0301|TSH|United Healthcare|GEHA|||||1.62||| 84443|EAP|0301|TSH|United Healthcare|TML GROUP BENEFITS|||||1.62||| 84443|EAP|0301|TSH|PHCS|HUMANA INSURANCE|||||1.62||| 84443|EAP|0301|TSH|Medicaid|MEDICAID HMO|||||1.62||| 84443|EAP|0301|TSH|United Healthcare|UNITED HEALTHCARE|541.44||||1.62||| 84445|EAP|0301|TSI|Blue Cross PPO Specialty|BCBSTX PPO|||||4.90||| 84445|EAP|0301|TSI|Managed Medicaid|MEDICAID SUPERIOR|||||4.90||| 84445|EAP|0301|TSI|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||4.90||| 84446|EAP|0301|VITAMINE E LEVEL|Blue Cross PPO Specialty|BCBSTX PPO|||||136.75||| 84450|EAP|0301|TRANSAMINASE OT SGOT|United Healthcare|UNITED HEALTHCARE OTHER|||||0.50||| 84450|EAP|0301|TRANSAMINASE OT SGOT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.50||| 84450|EAP|0301|TRANSAMINASE OT SGOT|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.50||| 84450|EAP|0301|TRANSAMINASE OT SGOT|PHCS|GROUP AND PENSION|||||0.50||| 84450|EAP|0301|TRANSAMINASE OT SGOT|Medicare|MEDICARE ACUTE|||||0.50||| 84450|EAP|0301|TRANSAMINASE OT SGOT|Tricare|TRICARE EAST REGION|||||0.50||| 84450|EAP|0301|TRANSAMINASE OT SGOT|Managed Medicaid|MEDICAID AMERIGROUP|||||0.50||| 84450|EAP|0301|TRANSAMINASE OT SGOT|United Healthcare|UNITED HEALTHCARE|||||0.50||| 84450|EAP|0301|TRANSAMINASE OT SGOT|Humana Medicare Advantage|HUMANA MA|166.52||||0.50||| 84450|EAP|0301|TRANSAMINASE OT SGOT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.50||| 84450|EAP|0301|TRANSAMINASE OT SGOT|Blue Cross PPO Specialty|BCBSTX PPO|||||0.50||| 84450|EAP|0301|TRANSAMINASE OT SGOT|Blue Cross HMO Specialty|BCBSTX HMO|||||0.50||| 84450|EAP|0301|TRANSAMINASE OT SGOT|Managed Medicaid|MEDICAID SUPERIOR|||||0.50||| 84460|EAP|0301|TRANSAMINASE PT SGPT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.51||| 84460|EAP|0301|TRANSAMINASE PT SGPT|Blue Cross HMO Specialty|BCBSTX HMO|||||0.51||| 84460|EAP|0301|TRANSAMINASE PT SGPT|Blue Cross PPO Specialty|BCBSTX PPO|||||0.51||| 84460|EAP|0301|TRANSAMINASE PT SGPT|Managed Medicaid|MEDICAID AMERIGROUP|||||0.51||| 84460|EAP|0301|TRANSAMINASE PT SGPT|Managed Medicaid|MEDICAID SUPERIOR|||||0.51||| 84460|EAP|0301|TRANSAMINASE PT SGPT|Humana Medicare Advantage|HUMANA MA|170.53||||0.51||| 84460|EAP|0301|TRANSAMINASE PT SGPT|Medicare|MEDICARE ACUTE|||||0.51||| 84460|EAP|0301|TRANSAMINASE PT SGPT|United Healthcare|UNITED HEALTHCARE|||||0.51||| 84460|EAP|0301|TRANSAMINASE PT SGPT|Tricare|TRICARE EAST REGION|||||0.51||| 84460|EAP|0301|TRANSAMINASE PT SGPT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.51||| 84460|EAP|0301|TRANSAMINASE PT SGPT|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.51||| 84460|EAP|0301|TRANSAMINASE PT SGPT|United Healthcare|UNITED HEALTHCARE OTHER|||||0.51||| 84460|EAP|0301|TRANSAMINASE PT SGPT|PHCS|GROUP AND PENSION|||||0.51||| 84466|EAP|0300|ASSAY OF TRANSFERRIN|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||75.25||| 84466|EAP|0300|ASSAY OF TRANSFERRIN|Medicaid|MEDICAID TEXAS CHILDRENS|||||75.25||| 84466|EAP|0300|ASSAY OF TRANSFERRIN|NON CONTRACTED|COMMERCIAL OTHER 1|||||75.25||| 84466|EAP|0300|ASSAY OF TRANSFERRIN|Tricare|TRICARE EAST REGION|||||75.25||| 84466|EAP|0300|ASSAY OF TRANSFERRIN|Blue Cross PPO Specialty|BCBSTX PPO|||||75.25||| 84466|EAP|0300|ASSAY OF TRANSFERRIN|Managed Medicaid|MEDICAID AMERIGROUP|||||75.25||| 84466|EAP|0300|ASSAY OF TRANSFERRIN|Humana Medicare Advantage|HUMANA MA|||||112.88||| 84466|EAP|0300|ASSAY OF TRANSFERRIN|United Healthcare|UNITED HEALTHCARE|||||75.25||| 84466|EAP|0300|ASSAY OF TRANSFERRIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||75.25||| 84466|EAP|0300|ASSAY OF TRANSFERRIN|Medicare|MEDICARE ACUTE|150.50||||75.25||| 84466|EAP|0300|ASSAY OF TRANSFERRIN|Managed Medicaid|MEDICAID SUPERIOR|150.50||||75.25||| 84478|EAP|0301|TRIGLYCERIDES|Aetna|AETNA PPO|||||55.50||| 84478|EAP|0301|TRIGLYCERIDES|Blue Cross PPO Specialty|BCBSTX PPO|||||185.33||| 84479|EAP|0301|T3|United Medicare Advantage|UHC MEDICARE GOLD MA|2.08||||62.50||| 84479|EAP|0301|T3|Medicare|MEDICARE ACUTE|2.08||||62.50||| 84479|EAP|0301|T3|Medicaid|MEDICAID TEXAS CHILDRENS|||||62.50||| 84479|EAP|0301|T3|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||62.50||| 84479|EAP|0301|T3|Medicaid|MEDICAID HMO|||||62.50||| 84479|EAP|0301|T3|Tricare|TRICARE EAST REGION|||||62.50||| 84479|EAP|0301|T3|United Healthcare|UNITED HEALTHCARE|||||62.50||| 84479|EAP|0301|T3|United Healthcare|UNITED HEALTHCARE OTHER|||||62.50||| 84479|EAP|0301|T3|Medicaid|MEDICAID|2.08||||62.50||| 84479|EAP|0301|T3|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||62.50||| 84479|EAP|0301|T3|NON CONTRACTED|COMMERCIAL OTHER 1|||||62.50||| 84479|EAP|0301|T3|Humana Medicare Advantage|HUMANA MA|208.65||||62.50||| 84479|EAP|0301|T3|Managed Medicaid|MEDICAID SUPERIOR|||||62.50||| 84479|EAP|0301|T3|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.08||||62.50||| 84479|EAP|0301|T3|Access Direct Platinum|HEALTHFIRST TPA UMR|||||62.50||| 84479|EAP|0301|T3|Managed Medicaid|MEDICAID AMERIGROUP|||||62.50||| 84479|EAP|0301|T3|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||62.50||| 84479|EAP|0301|T3|Blue Cross HMO Specialty|BCBSTX HMO|||||62.50||| 84479|EAP|0301|T3|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||62.50||| 84479|EAP|0301|T3|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||62.50||| 84479|EAP|0301|T3|Cigna|CIGNA|||||62.50||| 84479|EAP|0301|T3|Blue Cross PPO Specialty|BCBSTX PPO|||||62.50||| 84480|EAP|0301|TT3|Managed Medicaid|MEDICAID AMERIGROUP|||||136.75||| 84480|EAP|0301|TT3|Managed Medicaid|MEDICAID SUPERIOR|||||136.75||| 84480|EAP|0301|TT3|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||136.75||| 84480|EAP|0301|TT3|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||387.21||| 84480|EAP|0301|TT3|Aenta Medicare Advantage|AETNA MEDICARE MA|||||136.75||| 84480|EAP|0301|TT3|Blue Cross PPO Specialty|BCBSTX PPO|||||136.75||| 84480|EAP|0301|TT3|Humana Medicare Advantage|HUMANA MA|||||136.75||| 84480|EAP|0301|TT3|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||136.75||| 84480|EAP|0301|TT3|United Healthcare|UNITED HEALTHCARE|||||136.75||| 84480|EAP|0301|TT3|NON CONTRACTED|COMMERCIAL OTHER 1|||||136.75||| 84480|EAP|0301|TT3|United Healthcare|UNITED HEALTHCARE OTHER|||||136.75||| 84480|EAP|0301|TT3|Tricare|TRICARE EAST REGION|||||136.75||| 84480|EAP|0301|TT3|Medicaid|MEDICAID TEXAS CHILDRENS|||||136.75||| 84480|EAP|0301|TT3|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||136.75||| 84480|EAP|0301|TT3|Medicaid|MEDICAID|||||136.75||| 84480|EAP|0301|TT3|Medicare|MEDICARE ACUTE|||||136.75||| 84481|EAP|0301|T3 FREE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||163.25||| 84481|EAP|0301|T3 FREE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||163.25||| 84481|EAP|0301|T3 FREE|NON CONTRACTED|COMMERCIAL OTHER 1|||||163.25||| 84481|EAP|0301|T3 FREE|Medicaid|MEDICAID TEXAS CHILDRENS|||||163.25||| 84481|EAP|0301|T3 FREE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||163.25||| 84481|EAP|0301|T3 FREE|Medicaid|MEDICAID HMO|||||163.25||| 84481|EAP|0301|T3 FREE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||163.25||| 84481|EAP|0301|T3 FREE|Tricare|TRICARE EAST REGION|||||163.25||| 84481|EAP|0301|T3 FREE|Medicare|MEDICARE ACUTE|||||163.25||| 84481|EAP|0301|T3 FREE|United Healthcare|GEHA|||||163.25||| 84481|EAP|0301|T3 FREE|United Healthcare|UNITED HEALTHCARE OTHER|||||163.25||| 84481|EAP|0301|T3 FREE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||163.25||| 84481|EAP|0301|T3 FREE|United Healthcare|UNITED HEALTHCARE|||||163.25||| 84481|EAP|0301|T3 FREE|Medicaid|MEDICAID|544.25||||163.25||| 84481|EAP|0301|T3 FREE|Managed Medicaid|MEDICAID SUPERIOR|||||163.25||| 84481|EAP|0301|T3 FREE|Managed Medicaid|MEDICAID AMERIGROUP|||||163.25||| 84481|EAP|0301|T3 FREE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||163.25||| 84481|EAP|0301|T3 FREE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||163.25||| 84481|EAP|0301|T3 FREE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||163.25||| 84481|EAP|0301|T3 FREE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||163.25||| 84481|EAP|0301|T3 FREE|Cigna|CIGNA|||||163.25||| 84481|EAP|0301|T3 FREE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||163.25||| 84481|EAP|0301|T3 FREE|Aetna|AETNA PPO|||||163.25||| 84481|EAP|0301|T3 FREE|Blue Cross PPO Specialty|BCBSTX PPO|||||163.25||| 84481|EAP|0301|T3 FREE|Blue Cross HMO Specialty|BCBSTX HMO|||||163.25||| 84481|EAP|0301|T3 FREE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||163.25||| 84481|EAP|0301|T3 FREE|Humana Medicare Advantage|HUMANA MA|545.96||||163.25||| 84481|EAP|0301|T3 FREE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||163.25||| 84481|EAP|0301|T3 FREE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||163.25||| 84484|EAP|0300|TROPONIN I|Humana Medicare Advantage|HUMANA MA|268.84||||2.68||| 84484|EAP|0300|TROPONIN I|Aenta Medicare Advantage|AETNA MEDICARE MA|268.84||||2.68||| 84484|EAP|0300|TROPONIN I|Access Direct Platinum|HEALTHFIRST TPA UMR|||||2.68||| 84484|EAP|0300|TROPONIN I|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|268.84||||2.68||| 84484|EAP|0300|TROPONIN I|Aetna|AETNA PPO|||||2.68||| 84484|EAP|0300|TROPONIN I|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.68||| 84484|EAP|0300|TROPONIN I|Blue Cross HMO Specialty|BCBSTX HMO|268.84||||268.84||| 84484|EAP|0300|TROPONIN I|Cigna|CIGNA|||||268.84||| 84484|EAP|0300|TROPONIN I|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|268.42||||2.68||| 84484|EAP|0300|TROPONIN I|Aetna|AETNA OTHER|||||268.42||| 84484|EAP|0300|TROPONIN I|Cigna|CIGNA|268.42||||2.68||| 84484|EAP|0300|TROPONIN I|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|268.84||||268.84||| 84484|EAP|0300|TROPONIN I|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||2.68||| 84484|EAP|0300|TROPONIN I|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||268.84||| 84484|EAP|0300|TROPONIN I|Medicaid|MORRIS COUNTY INDIGENT|||||268.42||| 84484|EAP|0300|TROPONIN I|Managed Medicaid|MEDICAID SUPERIOR|268.84||||268.84||| 84484|EAP|0300|TROPONIN I|Managed Medicare|BCBS MEDICARE PPO MA|||||268.42||| 84484|EAP|0300|TROPONIN I|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||268.84||| 84484|EAP|0300|TROPONIN I|United Healthcare|GEHA|||||268.42||| 84484|EAP|0300|TROPONIN I|Managed Medicare|HEALTHSPRING MA|268.84||||2.68||| 84484|EAP|0300|TROPONIN I|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|268.84||||268.84||| 84484|EAP|0300|TROPONIN I|United Healthcare|UNITED HEALTHCARE|2.68||||268.84||| 84484|EAP|0300|TROPONIN I|Medicaid|MEDICAID TEXAS CHILDRENS|||||268.84||| 84484|EAP|0300|TROPONIN I|Managed Medicaid|MEDICAID AMERIGROUP|2.68||||2.68||| 84484|EAP|0300|TROPONIN I|Medicaid|MEDICAID HMO|||||268.84||| 84484|EAP|0300|TROPONIN I|NON CONTRACTED|COMMERCIAL OTHER 1|268.84||||268.84||| 84484|EAP|0300|TROPONIN I|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||268.84||| 84484|EAP|0300|TROPONIN I|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||268.84||| 84484|EAP|0300|TROPONIN I|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.68||||268.84||| 84484|EAP|0300|TROPONIN I|Medicaid|MEDICAID|2.68||||2.68||| 84484|EAP|0300|TROPONIN I|PHCS|HUMANA INSURANCE|||||268.42||| 84484|EAP|0300|TROPONIN I|PHCS|MERITAIN HEALTH|||||268.84||| 84484|EAP|0300|TROPONIN I|United Healthcare|UNITED HEALTHCARE ERS|||||268.84||| 84484|EAP|0300|TROPONIN I|Tricare|TRICARE EAST REGION|268.84||||2.68||| 84484|EAP|0300|TROPONIN I|Medicare|MEDICARE ACUTE|2.68||||2.68||| 84484|EAP|0300|TROPONIN I|PHCS|MULTIPLAN PHCS|||||268.84||| 84484|EAP|0300|TROPONIN I|Blue Cross PPO Specialty|BCBSTX PPO|268.84||||2.68||| 84484|EAP|0300|TROPONIN I|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|268.84||||268.84||| 84484|EAP|0300|TROPONIN I|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.68||| 84484|EAP|0300|TROPONIN I|United Healthcare|UNITED HEALTHCARE OTHER|||||268.42||| 84484|EAP|0300|TROPONIN I|Veterans Affairs|VETERANS ADMINISTRATION|2.68||||268.84||| 84484|EAP|0300|TROPONIN I|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|268.84||||2.68||| 84484|EAP|0300|TROPONIN I|Tricare|TRICARE FOR LIFE|||||2.68||| 84484|EAP|0300|TROPONIN I|United Healthcare|TML GROUP BENEFITS|||||176.67||| 84484|EAP|0300|TROPONIN I|United Healthcare|UNITED HEALTHCARE|268.84||||268.84||| 84484|EAP|0300|TROPONIN I|Veterans Affairs|VETERANS ADMINISTRATION|||||2.68||| 84484|EAP|0300|TROPONIN I|United Medicare Advantage|UHC MEDICARE GOLD MA|2.68||||268.84||| 84484|EAP|0300|TROPONIN I|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.68||||2.68||| 84484|EAP|0300|TROPONIN I|Workers Compensation|WORKERS COMPENSATION OTHER|||||268.84||| 84484|EAP|0300|TROPONIN I|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.68||| 84520|EAP|0301|UREA NITROGEN BUN|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.38||| 84520|EAP|0301|UREA NITROGEN BUN|Workers Compensation|WORKERS COMPENSATION OTHER|||||126.75||| 84520|EAP|0301|UREA NITROGEN BUN|Veterans Affairs|VETERANS ADMINISTRATION|||||0.38||| 84520|EAP|0301|UREA NITROGEN BUN|Medicare|MEDICARE ACUTE|126.75||||0.38||| 84520|EAP|0301|UREA NITROGEN BUN|Tricare|TRICARE EAST REGION|||||0.38||| 84520|EAP|0301|UREA NITROGEN BUN|Medicaid|MEDICAID|||||126.95||| 84520|EAP|0301|UREA NITROGEN BUN|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.38||| 84520|EAP|0301|UREA NITROGEN BUN|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.38||| 84520|EAP|0301|UREA NITROGEN BUN|United Healthcare|UNITED HEALTHCARE|||||0.38||| 84520|EAP|0301|UREA NITROGEN BUN|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.38||| 84520|EAP|0301|UREA NITROGEN BUN|Managed Medicaid|MEDICAID SUPERIOR|||||82.38||| 84520|EAP|0301|UREA NITROGEN BUN|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.38||| 84520|EAP|0301|UREA NITROGEN BUN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.38||| 84520|EAP|0301|UREA NITROGEN BUN|PHCS|HUMANA INSURANCE|||||0.38||| 84520|EAP|0301|UREA NITROGEN BUN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.38||| 84520|EAP|0301|UREA NITROGEN BUN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.38||| 84520|EAP|0301|UREA NITROGEN BUN|Managed Medicaid|MEDICAID AMERIGROUP|||||0.38||| 84520|EAP|0301|UREA NITROGEN BUN|Humana Medicare Advantage|HUMANA MA|||||0.38||| 84520|EAP|0301|UREA NITROGEN BUN|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.38||| 84520|EAP|0301|UREA NITROGEN BUN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.38||| 84520|EAP|0301|UREA NITROGEN BUN|Blue Cross HMO Specialty|BCBSTX HMO|||||0.38||| 84520|EAP|0301|UREA NITROGEN BUN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.38||| 84520|EAP|0301|UREA NITROGEN BUN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.38||| 84520|EAP|0301|UREA NITROGEN BUN|Access Direct Platinum|HEALTHFIRST TPA UMR|||||0.38||| 84520|EAP|0301|UREA NITROGEN BUN|Blue Cross PPO Specialty|BCBSTX PPO|||||0.38||| 84520|EAP|0301|UREA NITROGEN BUN|Cigna|CIGNA|||||0.38||| 84520|EAP|0301|UREA NITROGEN BUN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.38||| 84550|EAP|0301|URIC ACID BLOOD|Cigna|CIGNA|||||43.50||| 84550|EAP|0301|URIC ACID BLOOD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.45||||43.50||| 84550|EAP|0301|URIC ACID BLOOD|Blue Cross HMO Specialty|BCBSTX HMO|||||43.50||| 84550|EAP|0301|URIC ACID BLOOD|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||43.50||| 84550|EAP|0301|URIC ACID BLOOD|Aenta Medicare Advantage|AETNA MEDICARE MA|145.45||||43.50||| 84550|EAP|0301|URIC ACID BLOOD|Blue Cross PPO Specialty|BCBSTX PPO|||||43.50||| 84550|EAP|0301|URIC ACID BLOOD|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|145.45||||43.50||| 84550|EAP|0301|URIC ACID BLOOD|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||43.50||| 84550|EAP|0301|URIC ACID BLOOD|Managed Medicaid|MEDICAID AMERIGROUP|||||43.50||| 84550|EAP|0301|URIC ACID BLOOD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||43.50||| 84550|EAP|0301|URIC ACID BLOOD|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||43.50||| 84550|EAP|0301|URIC ACID BLOOD|Managed Medicaid|MEDICAID SUPERIOR|||||43.50||| 84550|EAP|0301|URIC ACID BLOOD|Humana Medicare Advantage|HUMANA MA|145.45||||43.50||| 84550|EAP|0301|URIC ACID BLOOD|Managed Medicare|HEALTHSPRING MA|1.45||||43.50||| 84550|EAP|0301|URIC ACID BLOOD|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||43.50||| 84550|EAP|0301|URIC ACID BLOOD|United Healthcare|UNITED HEALTHCARE|||||43.50||| 84550|EAP|0301|URIC ACID BLOOD|Medicare|MEDICARE ACUTE|145.45||||43.50||| 84550|EAP|0301|URIC ACID BLOOD|Tricare|TRICARE EAST REGION|||||43.50||| 84550|EAP|0301|URIC ACID BLOOD|United Healthcare|UNITED HEALTHCARE|145.45||||94.25||| 84550|EAP|0301|URIC ACID BLOOD|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||43.50||| 84550|EAP|0301|URIC ACID BLOOD|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||43.50||| 84550|EAP|0301|URIC ACID BLOOD|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||43.50||| 84550|EAP|0301|URIC ACID BLOOD|United Medicare Advantage|UHC MEDICARE GOLD MA|1.45||||43.50||| 84550|EAP|0301|URIC ACID BLOOD|NON CONTRACTED|COMMERCIAL OTHER 1|||||43.50||| 84550|EAP|0301|URIC ACID BLOOD|United Healthcare|TML GROUP BENEFITS|||||43.50||| 84550|EAP|0301|URIC ACID BLOOD|Medicaid|MEDICAID|||||43.50||| 84550|EAP|0301|URIC ACID BLOOD|Veterans Affairs|VETERANS ADMINISTRATION|||||145.23||| 84550|EAP|0301|URIC ACID BLOOD|Medicaid|MORRIS COUNTY INDIGENT|||||43.50||| 84585|EAP|0301|VMA|Medicare|MEDICARE ACUTE|||||149.50||| 84630|EAP|0301|ZINC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||109.75||| 84630|EAP|0301|ZINC|Managed Medicaid|MEDICAID SUPERIOR|||||109.75||| 84630|EAP|0301|ZINC|Humana Medicare Advantage|HUMANA MA|||||109.75||| 84630|EAP|0301|ZINC|United Medicare Advantage|UHC MEDICARE GOLD MA|||||109.75||| 84630|EAP|0301|ZINC|Blue Cross HMO Specialty|BCBSTX HMO|||||109.75||| 84681|EAP|0301|C PEPTIDE|United Healthcare|UNITED HEALTHCARE|||||200.50||| 84681|EAP|0301|C PEPTIDE|Medicaid|MEDICAID|670.34||||||| 84681|EAP|0301|C PEPTIDE|Medicare|MEDICARE ACUTE|668.25||||200.50||| 84681|EAP|0301|C PEPTIDE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||670.34||| 84681|EAP|0301|C PEPTIDE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||200.50||| 84681|EAP|0301|C PEPTIDE|Blue Cross PPO Specialty|BCBSTX PPO|||||200.50||| 84681|EAP|0301|C PEPTIDE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||200.50||| 84702|EAP|0301|BETA HCG|Cigna|CIGNA|||||84.25||| 84702|EAP|0301|BETA HCG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||84.25||| 84702|EAP|0301|BETA HCG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||84.25||| 84702|EAP|0301|BETA HCG|Aenta Medicare Advantage|AETNA MEDICARE MA|||||84.25||| 84702|EAP|0301|BETA HCG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||84.25||| 84702|EAP|0301|BETA HCG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||84.25||| 84702|EAP|0301|BETA HCG|United Healthcare|UNITED HEALTHCARE OTHER|||||182.82||| 84702|EAP|0301|BETA HCG|NON CONTRACTED|COMMERCIAL OTHER 1|||||280.50||| 84702|EAP|0301|BETA HCG|Managed Medicaid|MEDICAID SUPERIOR|||||280.50||| 84702|EAP|0301|BETA HCG|Blue Cross PPO Specialty|BCBSTX PPO|||||84.25||| 84702|EAP|0301|BETA HCG|Medicare|MEDICARE ACUTE|||||84.25||| 84702|EAP|0301|BETA HCG|Tricare|TRICARE EAST REGION|||||84.25||| 84702|EAP|0301|BETA HCG|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||281.38||| 84702|EAP|0301|BETA HCG|United Healthcare|TML GROUP BENEFITS|||||84.25||| 84702|EAP|0301|BETA HCG|Managed Medicaid|MEDICAID AMERIGROUP|||||280.50||| 84702|EAP|0301|BETA HCG|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||84.25||| 84702|EAP|0301|BETA HCG|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||281.38||| 84702|EAP|0301|BETA HCG|Medicaid|MEDICAID TEXAS CHILDRENS|||||84.25||| 84702|EAP|0301|BETA HCG|Medicaid|MEDICAID|||||280.50||| 84702|EAP|0301|BETA HCG|United Healthcare|UNITED HEALTHCARE|||||84.25||| 84703|EAP|0301|PREGNANCY TEST SERUM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||72.50||| 84703|EAP|0301|PREGNANCY TEST URINE|Blue Cross PPO Specialty|BCBSTX PPO|241.25||||241.25||| 84703|EAP|0301|PREGNANCY TEST URINE|Blue Cross PPO Specialty|BCBSTX OTHER|||||241.25||| 84703|EAP|0301|PREGNANCY TEST URINE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||242.01||| 84703|EAP|0301|PREGNANCY TEST SERUM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||241.25||| 84703|EAP|0301|PREGNANCY TEST URINE|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||242.01||| 84703|EAP|0301|PREGNANCY TEST SERUM|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||241.63||| 84703|EAP|0301|PREGNANCY TEST SERUM|Blue Cross PPO Specialty|BCBSTX OTHER|||||241.25||| 84703|EAP|0301|PREGNANCY TEST URINE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||241.25||| 84703|EAP|0301|PREGNANCY TEST SERUM|Cigna|CIGNA|||||242.01||| 84703|EAP|0301|PREGNANCY TEST URINE|Cigna|CIGNA|||||241.25||| 84703|EAP|0301|PREGNANCY TEST URINE|Cigna|CIGNA|||||242.01||| 84703|EAP|0301|PREGNANCY TEST URINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||242.01||| 84703|EAP|0301|PREGNANCY TEST SERUM|Managed Medicaid|MEDICAID AMERIGROUP|||||242.01||| 84703|EAP|0301|PREGNANCY TEST URINE|Managed Medicaid|MEDICAID SUPERIOR|241.63||||241.25||| 84703|EAP|0301|PREGNANCY TEST URINE|Managed Medicaid|MEDICAID AMERIGROUP|||||241.25||| 84703|EAP|0301|PREGNANCY TEST URINE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||241.25||| 84703|EAP|0301|PREGNANCY TEST SERUM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||242.01||| 84703|EAP|0301|PREGNANCY TEST SERUM|Blue Cross PPO Specialty|BCBSTX PPO|241.25||||241.25||| 84703|EAP|0301|PREGNANCY TEST URINE|Humana Medicare Advantage|HUMANA MA|||||241.25||| 84703|EAP|0301|PREGNANCY TEST SERUM|Humana Medicare Advantage|HUMANA MA|||||242.01||| 84703|EAP|0301|PREGNANCY TEST SERUM|Managed Medicaid|MEDICAID SUPERIOR|241.63||||241.25||| 84703|EAP|0301|PREGNANCY TEST SERUM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||242.01||| 84703|EAP|0301|PREGNANCY TEST URINE|Veterans Affairs|VETERANS ADMINISTRATION|||||241.25||| 84703|EAP|0301|PREGNANCY TEST URINE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||242.01||| 84703|EAP|0301|PREGNANCY TEST URINE|Workers Compensation|WORKERS COMPENSATION OTHER|||||241.25||| 84703|EAP|0301|PREGNANCY TEST URINE|Medicare|MEDICARE ACUTE|||||241.25||| 84703|EAP|0301|PREGNANCY TEST URINE|Medicaid|MEDICAID|241.63||||241.25||| 84703|EAP|0301|PREGNANCY TEST SERUM|Medicaid|MEDICAID|241.63||||242.01||| 84703|EAP|0301|PREGNANCY TEST SERUM|NON CONTRACTED|COMMERCIAL OTHER 1|||||242.01||| 84703|EAP|0301|PREGNANCY TEST SERUM|United Healthcare|UNITED HEALTHCARE|||||156.88||| 84703|EAP|0301|PREGNANCY TEST URINE|Medicaid|MEDICAID HMO|||||241.25||| 84703|EAP|0301|PREGNANCY TEST URINE|PHCS|HUMANA INSURANCE|||||241.25||| 84703|EAP|0301|PREGNANCY TEST SERUM|United Healthcare|UNITED HEALTHCARE OTHER|||||157.26||| 84703|EAP|0301|PREGNANCY TEST SERUM|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||241.25||| 84703|EAP|0301|PREGNANCY TEST URINE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||242.01||| 84703|EAP|0301|PREGNANCY TEST URINE|United Healthcare|GEHA|||||241.25||| 84703|EAP|0301|PREGNANCY TEST SERUM|Medicaid|MEDICAID TEXAS CHILDRENS|241.25||||242.01||| 84703|EAP|0301|PREGNANCY TEST URINE|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||241.25||| 84703|EAP|0301|PREGNANCY TEST URINE|United Healthcare|UNITED HEALTHCARE|||||241.63||| 84703|EAP|0301|PREGNANCY TEST SERUM|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||241.63||| 84703|EAP|0301|PREGNANCY TEST URINE|Medicaid|MORRIS COUNTY INDIGENT|||||241.25||| 84703|EAP|0301|PREGNANCY TEST URINE|Medicaid|MEDICAID TEXAS CHILDRENS|241.25||||241.25||| 84703|EAP|0301|PREGNANCY TEST URINE|Tricare|TRICARE EAST REGION|||||242.01||| 84703|EAP|0301|PREGNANCY TEST URINE|NON CONTRACTED|COMMERCIAL OTHER 1|||||241.25||| 84703|EAP|0301|PREGNANCY TEST SERUM|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||242.01||| 84703|EAP|0301|PREGNANCY TEST SERUM|United Healthcare|UNITED HEALTHCARE|||||241.25||| 84703|EAP|0301|PREGNANCY TEST SERUM|Tricare|TRICARE EAST REGION|||||242.01||| 84703|EAP|0301|PREGNANCY TEST URINE|United Healthcare|UNITED HEALTHCARE OTHER|||||241.63||| 84703|EAP|0301|PREGNANCY TEST URINE|United Healthcare|UNITED HEALTHCARE|||||241.25||| 84703|EAP|0301|PREGNANCY TEST URINE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||242.01||| 84703|EAP|0301|PREGNANCY TEST URINE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||241.25||| 84703|EAP|0301|PREGNANCY TEST URINE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||241.25||| 84703|EAP|0301|PREGNANCY TEST URINE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|242.01||||241.25||| 84703|EAP|0301|PREGNANCY TEST SERUM|Blue Cross HMO Specialty|BCBSTX HMO|242.01||||241.25||| 84703|EAP|0301|PREGNANCY TEST URINE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||242.01||| 84703|EAP|0301|PREGNANCY TEST SERUM|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|242.01||||72.50||| 84703|EAP|0301|PREGNANCY TEST URINE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||241.25||| 84703|EAP|0301|PREGNANCY TEST URINE|Aetna|AETNA PPO|||||241.25||| 84703|EAP|0301|PREGNANCY TEST URINE|Blue Cross HMO Specialty|BCBSTX HMO|242.01||||241.25||| 84703|EAP|0301|PREGNANCY TEST URINE|Aetna|AETNA OTHER|||||242.01||| 84703|EAP|0301|PREGNANCY TEST SERUM|Aetna|AETNA PPO|||||241.25||| 85007|EAP|0305|MANUAL CELL COUNT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|71.88||||110.50||| 85007|EAP|0305|MANUAL CELL COUNT|Managed Medicaid|MEDICAID SUPERIOR|110.50||||110.50||| 85007|EAP|0305|MANUAL CELL COUNT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|110.50||||33.25||| 85007|EAP|0305|MANUAL CELL COUNT|Humana Medicare Advantage|HUMANA MA|110.50||||110.50||| 85007|EAP|0305|MANUAL CELL COUNT|Managed Medicare|HEALTHSPRING MA|||||110.50||| 85007|EAP|0305|MANUAL CELL COUNT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||33.25||| 85007|EAP|0305|MANUAL CELL COUNT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|110.50||||110.50||| 85007|EAP|0305|MANUAL CELL COUNT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|110.50||||110.50||| 85007|EAP|0305|MANUAL CELL COUNT|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|110.50||||110.50||| 85007|EAP|0305|MANUAL CELL COUNT|Access Direct Platinum|HEALTHFIRST TPA UMR|||||33.25||| 85007|EAP|0305|MANUAL CELL COUNT|Aetna|AETNA PPO|||||71.88||| 85007|EAP|0305|MANUAL CELL COUNT|Aetna|AETNA OTHER|||||110.50||| 85007|EAP|0305|MANUAL CELL COUNT|Cigna|CIGNA|110.50||||||| 85007|EAP|0305|MANUAL CELL COUNT|Cigna|CIGNA|110.50||||110.50||| 85007|EAP|0305|MANUAL CELL COUNT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|110.50||||33.25||| 85007|EAP|0305|MANUAL CELL COUNT|Aenta Medicare Advantage|AETNA MEDICARE MA|110.50||||110.50||| 85007|EAP|0305|MANUAL CELL COUNT|Tricare|TRICARE EAST REGION|110.50||||33.25||| 85007|EAP|0305|MANUAL CELL COUNT|Blue Cross HMO Specialty|BCBSTX HMO|||||110.50||| 85007|EAP|0305|MANUAL CELL COUNT|Medicaid|MEDICAID|110.50||||110.50||| 85007|EAP|0305|MANUAL CELL COUNT|Blue Cross PPO Specialty|BCBSTX PPO|110.50||||110.50||| 85007|EAP|0305|MANUAL CELL COUNT|NON CONTRACTED|COMMERCIAL OTHER 1|110.50||||110.50||| 85007|EAP|0305|MANUAL CELL COUNT|Medicaid|MEDICAID TEXAS CHILDRENS|||||33.25||| 85007|EAP|0305|MANUAL CELL COUNT|Managed Medicaid|MEDICAID AMERIGROUP|110.50||||33.25||| 85007|EAP|0305|MANUAL CELL COUNT|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||110.50||| 85007|EAP|0305|MANUAL CELL COUNT|Medicare|MEDICARE PART B ONLY IP|110.50||||||| 85007|EAP|0305|MANUAL CELL COUNT|Tricare|TRICARE FOR LIFE|||||110.50||| 85007|EAP|0305|MANUAL CELL COUNT|Medicare|MEDICARE ACUTE|110.50||||110.50||| 85007|EAP|0305|MANUAL CELL COUNT|Veterans Affairs|VETERANS ADMINISTRATION|||||110.50||| 85007|EAP|0305|MANUAL CELL COUNT|United Medicare Advantage|UHC MEDICARE GOLD MA|110.50||||110.50||| 85007|EAP|0305|MANUAL CELL COUNT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||33.25||| 85007|EAP|0305|MANUAL CELL COUNT|United Healthcare|UNITED HEALTHCARE|||||110.50||| 85007|EAP|0305|MANUAL CELL COUNT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|110.50||||71.88||| 85007|EAP|0305|MANUAL CELL COUNT|United Healthcare|UNITED HEALTHCARE|||||33.25||| 85007|EAP|0305|MANUAL CELL COUNT|United Healthcare|UNITED HEALTHCARE OTHER|110.50||||33.25||| 85007|EAP|0305|MANUAL CELL COUNT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|110.50||||110.50||| 85007|EAP|0305|MANUAL CELL COUNT|Veterans Affairs|VETERANS ADMINISTRATION|110.50||||110.50||| 85014|EAP|0305|HEMATOCRIT|United Healthcare|UNITED HEALTHCARE|0.76||||||| 85014|EAP|0305|HEMATOCRIT|Tricare|TRICARE EAST REGION|||||49.50||| 85014|EAP|0305|HEMATOCRIT|Medicare|MEDICARE ACUTE|0.76||||0.76||| 85014|EAP|0305|HEMATOCRIT|Aetna|AETNA PPO|||||0.76||| 85014|EAP|0305|HEMATOCRIT|Blue Cross HMO Specialty|BCBSTX HMO|||||0.76||| 85014|EAP|0305|HEMATOCRIT|Blue Cross PPO Specialty|BCBSTX PPO|0.76||||0.76||| 85014|EAP|0305|HEMATOCRIT|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.76||| 85014|EAP|0305|HEMATOCRIT|Managed Medicaid|MEDICAID AMERIGROUP|||||0.76||| 85014|EAP|0305|HEMATOCRIT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.76||| 85014|EAP|0305|HEMATOCRIT|Humana Medicare Advantage|HUMANA MA|0.76||||0.76||| 85014|EAP|0305|HEMATOCRIT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.76||| 85014|EAP|0305|HEMATOCRIT|Managed Medicaid|MEDICAID SUPERIOR|0.76||||0.76||| 85014|EAP|0305|HEMATOCRIT|Managed Medicare|HEALTHSPRING MA|0.76||||||| 85014|EAP|0305|HEMATOCRIT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.76||| 85014|EAP|0305|HEMATOCRIT|Medicaid|MEDICAID|||||0.76||| 85014|EAP|0305|HEMATOCRIT|Medicaid|MORRIS COUNTY INDIGENT|||||0.76||| 85014|EAP|0305|HEMATOCRIT|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.76||| 85014|EAP|0305|HEMATOCRIT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.76||| 85014|EAP|0305|HEMATOCRIT|United Medicare Advantage|UHC MEDICARE GOLD MA|0.76||||0.76||| 85014|EAP|0305|HEMATOCRIT|United Healthcare|UNITED HEALTHCARE|||||0.76||| 85014|EAP|0305|HEMATOCRIT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.76||| 85018|EAP|0305|HEMOGLOBIN|Managed Medicaid|MEDICAID AMERIGROUP|||||49.50||| 85018|EAP|0305|HEMOGLOBIN|Managed Medicaid|MEDICAID SUPERIOR|0.76||||0.23||| 85018|EAP|0305|HEMOGLOBIN|Humana Medicare Advantage|HUMANA MA|0.76||||0.76||| 85018|EAP|0305|HEMOGLOBIN|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.76||| 85018|EAP|0305|HEMOGLOBIN|Blue Cross HMO Specialty|BCBSTX HMO|||||0.76||| 85018|EAP|0305|HEMOGLOBIN|Aetna|AETNA PPO|||||0.76||| 85018|EAP|0305|HEMOGLOBIN|Blue Cross PPO Specialty|BCBSTX PPO|0.76||||0.76||| 85018|EAP|0305|HEMOGLOBIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.76||| 85018|EAP|0305|HEMOGLOBIN|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.76||| 85018|EAP|0305|HEMOGLOBIN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.76||| 85018|EAP|0305|HEMOGLOBIN|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.23||| 85018|EAP|0305|HEMOGLOBIN|Tricare|TRICARE EAST REGION|||||0.23||| 85018|EAP|0305|HEMOGLOBIN|Managed Medicare|HEALTHSPRING MA|0.76||||||| 85018|EAP|0305|HEMOGLOBIN|Medicaid|MEDICAID TEXAS CHILDRENS|||||0.23||| 85018|EAP|0305|HEMOGLOBIN|Medicaid|MEDICAID|||||49.50||| 85018|EAP|0305|HEMOGLOBIN|Medicaid|MORRIS COUNTY INDIGENT|||||0.76||| 85018|EAP|0305|HEMOGLOBIN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.76||| 85018|EAP|0305|HEMOGLOBIN|Medicare|MEDICARE ACUTE|0.76||||0.76||| 85018|EAP|0305|HEMOGLOBIN|United Healthcare|UNITED HEALTHCARE|||||0.76||| 85018|EAP|0305|HEMOGLOBIN|United Healthcare|UNITED HEALTHCARE|0.76||||||| 85018|EAP|0305|HEMOGLOBIN|Cigna|CIGNA|||||0.23||| 85018|EAP|0305|HEMOGLOBIN|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.76||| 85018|EAP|0305|HEMOGLOBIN|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.76||| 85018|EAP|0305|HEMOGLOBIN|United Medicare Advantage|UHC MEDICARE GOLD MA|0.76||||0.76||| 85025|EAP|0305|CBC W AUTO DIFF|United Healthcare|UNITED HEALTHCARE OTHER|249.75||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|United Healthcare|UNITED HEALTHCARE ERS|||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|United Medicare Advantage|UHC MEDICARE GOLD MA|249.75||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|249.75||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|249.75||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|United Medicare Advantage|AARP UHC WEST COMPLETE MA|249.75||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|Veterans Affairs|VETERANS ADMINISTRATION|249.75||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|United Healthcare|GEHA|||||162.38||| 85025|EAP|0305|CBC W AUTO DIFF|Workers Compensation|WORKERS COMPENSATION OTHER|||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|Multiplan|NALC|||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|NON CONTRACTED|COMMERCIAL OTHER 1|249.75||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|NON CONTRACTED|COMMERCIAL OTHER 2|||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|PHCS|MULTIPLAN PHCS|||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|PHCS|HUMANA INSURANCE|||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|Medicare|MEDICARE ACUTE|249.75||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|Medicaid|MEDICAID HMO|||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|Tricare|TRICARE EAST REGION|249.75||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|Medicaid|MEDICAID TEXAS CHILDRENS|249.75||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|Tricare|TRICARE FOR LIFE|||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|Medicare|MEDICARE PART B ONLY IP|249.75||||||| 85025|EAP|0305|CBC W AUTO DIFF|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|Medicaid|MEDICAID BCBSTX|||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|Medicaid|MEDICAID|249.75||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|NON CONTRACTED|ZZZZZ LIABILITY INS OTHER 1|||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|PHCS|GROUP AND PENSION|||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|PHCS|MERITAIN HEALTH|||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|Medicaid|MORRIS COUNTY INDIGENT|||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|249.75||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|249.75||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|Aenta Medicare Advantage|AETNA MEDICARE MA|249.75||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|Blue Cross PPO Specialty|BCBSTX OTHER|||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|Aetna|AETNA PPO|||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|Cigna|CIGNA|249.75||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|Aetna|AETNA OTHER|249.75||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|Blue Cross PPO Specialty|BCBSTX PPO|249.75||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|249.75||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|United Healthcare|TML GROUP BENEFITS|||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|Veterans Affairs|VETERANS ADMINISTRATION|||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|United Healthcare|UNITED HEALTHCARE|249.75||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|Managed Medicaid|MEDICAID UNITED HEALTHCARE|249.75||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|Managed Medicaid|MEDICAID AMERIGROUP|249.75||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|Humana Medicare Advantage|HUMANA MA|249.75||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|Access Direct Platinum|HEALTHFIRST TPA UMR|249.75||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|249.75||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|Managed Medicaid|MEDICAID SUPERIOR|249.75||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|249.75||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|Managed Medicare|BCBS MEDICARE PPO MA|||||249.75||| 85025|EAP|0305|CBC W AUTO DIFF|Managed Medicare|HEALTHSPRING MA|249.75||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|Blue Cross HMO Specialty|BCBSTX HMO|249.75||||0.75||| 85025|EAP|0305|CBC W AUTO DIFF|Aetna|MAIL HANDLERS BENEFIT PLAN|||||0.75||| 85027|EAP|0305|CBC W/O AUTO DIFF|Managed Medicaid|MEDICAID SUPERIOR|1.76||||1.76||| 85027|EAP|0305|CBC W/O AUTO DIFF|Managed Medicaid|MEDICAID AMERIGROUP|1.76||||0.75||| 85027|EAP|0305|CBC W/O AUTO DIFF|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.76||||0.75||| 85027|EAP|0305|CBC W/O AUTO DIFF|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.76||||1.76||| 85027|EAP|0305|CBC W/O AUTO DIFF|Humana Medicare Advantage|HUMANA MA|1.76||||1.76||| 85027|EAP|0305|CBC W/O AUTO DIFF|Managed Medicare|HEALTHSPRING MA|1.76||||1.76||| 85027|EAP|0305|CBC W/O AUTO DIFF|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.76||||1.76||| 85027|EAP|0305|CBC W/O AUTO DIFF|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.76||||1.76||| 85027|EAP|0305|CBC W/O AUTO DIFF|Blue Cross HMO Specialty|BCBSTX HMO|||||1.76||| 85027|EAP|0305|CBC W/O AUTO DIFF|Blue Cross PPO Specialty|BCBSTX PPO|1.76||||1.76||| 85027|EAP|0305|CBC W/O AUTO DIFF|Aetna|AETNA PPO|||||0.75||| 85027|EAP|0305|CBC W/O AUTO DIFF|Cigna|CIGNA|1.76||||125.50||| 85027|EAP|0305|CBC W/O AUTO DIFF|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.76||||125.50||| 85027|EAP|0305|CBC W/O AUTO DIFF|Access Direct Platinum|HEALTHFIRST TPA UMR|1.76||||0.75||| 85027|EAP|0305|CBC W/O AUTO DIFF|Cigna|CIGNA|1.76||||1.76||| 85027|EAP|0305|CBC W/O AUTO DIFF|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.76||||125.50||| 85027|EAP|0305|CBC W/O AUTO DIFF|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.76||| 85027|EAP|0305|CBC W/O AUTO DIFF|Tricare|TRICARE EAST REGION|1.76||||0.75||| 85027|EAP|0305|CBC W/O AUTO DIFF|Aetna|AETNA OTHER|||||1.76||| 85027|EAP|0305|CBC W/O AUTO DIFF|Aenta Medicare Advantage|AETNA MEDICARE MA|1.76||||1.76||| 85027|EAP|0305|CBC W/O AUTO DIFF|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.75||| 85027|EAP|0305|CBC W/O AUTO DIFF|Medicaid|MEDICAID|1.76||||1.76||| 85027|EAP|0305|CBC W/O AUTO DIFF|NON CONTRACTED|COMMERCIAL OTHER 1|1.76||||1.76||| 85027|EAP|0305|CBC W/O AUTO DIFF|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.76||| 85027|EAP|0305|CBC W/O AUTO DIFF|Tricare|TRICARE FOR LIFE|||||1.76||| 85027|EAP|0305|CBC W/O AUTO DIFF|Medicare|MEDICARE ACUTE|1.76||||1.76||| 85027|EAP|0305|CBC W/O AUTO DIFF|Medicare|MEDICARE PART B ONLY IP|1.76||||||| 85027|EAP|0305|CBC W/O AUTO DIFF|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.76||| 85027|EAP|0305|CBC W/O AUTO DIFF|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.76||||125.50||| 85027|EAP|0305|CBC W/O AUTO DIFF|United Medicare Advantage|UHC MEDICARE GOLD MA|1.76||||1.76||| 85027|EAP|0305|CBC W/O AUTO DIFF|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.76||||1.76||| 85027|EAP|0305|CBC W/O AUTO DIFF|Veterans Affairs|VETERANS ADMINISTRATION|1.76||||1.76||| 85027|EAP|0305|CBC W/O AUTO DIFF|United Healthcare|UNITED HEALTHCARE OTHER|1.76||||125.50||| 85027|EAP|0305|CBC W/O AUTO DIFF|United Healthcare|UNITED HEALTHCARE|||||1.76||| 85027|EAP|0305|CBC W/O AUTO DIFF|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||125.50||| 85027|EAP|0305|CBC W/O AUTO DIFF|Veterans Affairs|VETERANS ADMINISTRATION|||||1.76||| 85027|EAP|0305|CBC W/O AUTO DIFF|United Healthcare|UNITED HEALTHCARE|1.76||||0.75||| 85032|EAP|0305|PLATELET COUNT|Medicare|MEDICARE ACUTE|||||1.39||| 85045|EAP|0305|RETICULOCYTE COUNT|Blue Cross PPO Specialty|BCBSTX PPO|113.40||||0.34||| 85045|EAP|0305|RETICULOCYTE COUNT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.34||| 85045|EAP|0305|RETICULOCYTE COUNT|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.34||| 85045|EAP|0305|RETICULOCYTE COUNT|Access Direct Platinum|HEALTHFIRST TPA UMR|||||0.34||| 85045|EAP|0305|RETICULOCYTE COUNT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.34||| 85045|EAP|0305|RETICULOCYTE COUNT|Blue Cross HMO Specialty|BCBSTX HMO|||||0.34||| 85045|EAP|0305|RETICULOCYTE COUNT|Aenta Medicare Advantage|AETNA MEDICARE MA|113.40||||73.70||| 85045|EAP|0305|RETICULOCYTE COUNT|Cigna|CIGNA|||||0.34||| 85045|EAP|0305|RETICULOCYTE COUNT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.34||| 85045|EAP|0305|RETICULOCYTE COUNT|Managed Medicaid|MEDICAID AMERIGROUP|||||0.34||| 85045|EAP|0305|RETICULOCYTE COUNT|Managed Medicaid|MEDICAID SUPERIOR|||||0.34||| 85045|EAP|0305|RETICULOCYTE COUNT|Humana Medicare Advantage|HUMANA MA|113.40||||0.34||| 85045|EAP|0305|RETICULOCYTE COUNT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|113.40||||0.34||| 85045|EAP|0305|RETICULOCYTE COUNT|Managed Medicare|HEALTHSPRING MA|113.40||||||| 85045|EAP|0305|RETICULOCYTE COUNT|United Healthcare|UNITED HEALTHCARE OTHER|||||0.34||| 85045|EAP|0305|RETICULOCYTE COUNT|United Healthcare|TML GROUP BENEFITS|||||0.34||| 85045|EAP|0305|RETICULOCYTE COUNT|United Healthcare|UNITED HEALTHCARE|||||0.34||| 85045|EAP|0305|RETICULOCYTE COUNT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|113.40||||0.34||| 85045|EAP|0305|RETICULOCYTE COUNT|United Medicare Advantage|UHC MEDICARE GOLD MA|113.40||||0.34||| 85045|EAP|0305|RETICULOCYTE COUNT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.34||| 85045|EAP|0305|RETICULOCYTE COUNT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.34||| 85045|EAP|0305|RETICULOCYTE COUNT|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.34||| 85045|EAP|0305|RETICULOCYTE COUNT|United Healthcare|UNITED HEALTHCARE|113.40||||0.34||| 85045|EAP|0305|RETICULOCYTE COUNT|Tricare|TRICARE EAST REGION|||||0.34||| 85045|EAP|0305|RETICULOCYTE COUNT|Medicare|MEDICARE ACUTE|113.40||||0.34||| 85045|EAP|0305|RETICULOCYTE COUNT|Medicaid|MEDICAID|||||0.34||| 85045|EAP|0305|RETICULOCYTE COUNT|Medicaid|MORRIS COUNTY INDIGENT|||||0.34||| 85045|EAP|0305|RETICULOCYTE COUNT|Medicaid|MEDICAID TEXAS CHILDRENS|||||0.34||| 85060|EAP|0300|PATHOLOGIST SMEAR REVIEW|Medicare|MEDICARE ACUTE|1.10||||0.33||| 85060|EAP|0300|PATHOLOGIST SMEAR REVIEW|United Medicare Advantage|UHC MEDICARE GOLD MA|1.10||||0.33||| 85060|EAP|0300|PATHOLOGIST SMEAR REVIEW|Managed Medicaid|MEDICAID SUPERIOR|1.10||||0.33||| 85060|EAP|0300|PATHOLOGIST SMEAR REVIEW|Humana Medicare Advantage|HUMANA MA|1.10||||||| 85060|EAP|0300|PATHOLOGIST SMEAR REVIEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.33||| 85060|EAP|0300|PATHOLOGIST SMEAR REVIEW|Blue Cross PPO Specialty|BCBSTX PPO|1.10||||||| 85240|EAP|0300|CLOTTING FACTOR VIII|Blue Cross PPO Specialty|BCBSTX PPO|||||0.62||| 85240|EAP|0300|CLOTTING FACTOR VIII|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.62||| 85240|EAP|0300|CLOTTING FACTOR VIII|Managed Medicaid|MEDICAID SUPERIOR|||||0.62||| 85240|EAP|0300|CLOTTING FACTOR VIII|Medicare|MEDICARE ACUTE|||||0.62||| 85245|EAP|0300|RISTOCETIN|Medicare|MEDICARE ACUTE|||||0.79||| 85245|EAP|0300|RISTOCETIN|Managed Medicaid|MEDICAID SUPERIOR|||||0.79||| 85245|EAP|0300|RISTOCETIN|Blue Cross PPO Specialty|BCBSTX PPO|||||0.79||| 85245|EAP|0300|RISTOCETIN|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.79||| 85246|EAP|0300|CLOT FACTOR 8 ANTIGEN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||67.44||| 85246|EAP|0300|CLOT FACTOR 8 ANTIGEN|Blue Cross PPO Specialty|BCBSTX PPO|||||67.44||| 85246|EAP|0300|CLOT FACTOR 8 ANTIGEN|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||67.44||| 85246|EAP|0300|CLOT FACTOR 8 ANTIGEN|Managed Medicaid|MEDICAID SUPERIOR|||||67.44||| 85246|EAP|0300|CLOT FACTOR 8 ANTIGEN|Medicare|MEDICARE ACUTE|||||67.44||| 85291|EAP|0305|FACTOR VIII|Managed Medicaid|MEDICAID SUPERIOR|||||196.75||| 853|DRG||INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC|Medicare|MEDICARE ACUTE|30,315.75|39.26|851.1|39.26|||| 853|DRG||INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC|Cigna|CIGNA|26,112.15|851.1|851.1|39.26|||| 85303|EAP|0305|PROTEIN C ACTIVITY|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||133.25||| 85379|EAP|0305|D-DIMER|Veterans Affairs|VETERANS ADMINISTRATION|||||151.25||| 85379|EAP|0305|D-DIMER|United Healthcare|UNITED HEALTHCARE|||||151.25||| 85379|EAP|0305|D-DIMER|Workers Compensation|WORKERS COMPENSATION OTHER|||||151.25||| 85379|EAP|0305|D-DIMER|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|151.25||||||| 85379|EAP|0305|D-DIMER|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||151.25||| 85379|EAP|0305|D-DIMER|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||151.25||| 85379|EAP|0305|D-DIMER|NON CONTRACTED|COMMERCIAL OTHER 1|151.25||||151.25||| 85379|EAP|0305|D-DIMER|Tricare|TRICARE EAST REGION|||||45.40||| 85379|EAP|0305|D-DIMER|Medicare|MEDICARE ACUTE|151.25||||151.25||| 85379|EAP|0305|D-DIMER|Medicaid|MEDICAID|151.25||||151.25||| 85379|EAP|0305|D-DIMER|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||151.25||| 85379|EAP|0305|D-DIMER|United Medicare Advantage|UHC MEDICARE GOLD MA|||||151.25||| 85379|EAP|0305|D-DIMER|Managed Medicaid|MEDICAID UNITED HEALTHCARE|151.25||||151.25||| 85379|EAP|0305|D-DIMER|Managed Medicaid|MEDICAID SUPERIOR|||||151.25||| 85379|EAP|0305|D-DIMER|Managed Medicaid|MEDICAID AMERIGROUP|151.25||||151.25||| 85379|EAP|0305|D-DIMER|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|151.25||||151.25||| 85379|EAP|0305|D-DIMER|Humana Medicare Advantage|HUMANA MA|151.25||||151.25||| 85379|EAP|0305|D-DIMER|Managed Medicare|BCBS MEDICARE PPO MA|||||151.25||| 85379|EAP|0305|D-DIMER|Managed Medicare|HEALTHSPRING MA|||||151.25||| 85379|EAP|0305|D-DIMER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|151.25||||151.25||| 85379|EAP|0305|D-DIMER|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|151.25||||151.25||| 85379|EAP|0305|D-DIMER|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|151.25||||||| 85379|EAP|0305|D-DIMER|Access Direct Platinum|HEALTHFIRST TPA UMR|||||151.25||| 85379|EAP|0305|D-DIMER|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|151.25||||||| 85379|EAP|0305|D-DIMER|Aenta Medicare Advantage|AETNA MEDICARE MA|151.25||||151.25||| 85379|EAP|0305|D-DIMER|Blue Cross HMO Specialty|BCBSTX HMO|151.25||||151.25||| 85379|EAP|0305|D-DIMER|Blue Cross PPO Specialty|BCBSTX PPO|151.25||||151.25||| 85379|EAP|0305|D-DIMER|Aetna|AETNA OTHER|||||151.25||| 85379|EAP|0305|D-DIMER|Cigna|CIGNA|151.25||||151.25||| 85379|EAP|0305|D-DIMER|Aetna|AETNA PPO|||||151.25||| 85384|EAP|0305|FIBRINOGEN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|272.75||||||| 85384|EAP|0305|FIBRINOGEN|Aenta Medicare Advantage|AETNA MEDICARE MA|272.75||||||| 85384|EAP|0305|FIBRINOGEN|Blue Cross PPO Specialty|BCBSTX PPO|272.75||||272.75||| 85384|EAP|0305|FIBRINOGEN|Blue Cross HMO Specialty|BCBSTX HMO|||||272.75||| 85384|EAP|0305|FIBRINOGEN|Managed Medicaid|MEDICAID SUPERIOR|||||272.75||| 85384|EAP|0305|FIBRINOGEN|Humana Medicare Advantage|HUMANA MA|||||272.75||| 85384|EAP|0305|FIBRINOGEN|Medicare|MEDICARE ACUTE|||||272.75||| 85384|EAP|0305|FIBRINOGEN|Workers Compensation|WORKERS COMPENSATION OTHER|||||272.75||| 854|DRG||INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC|Blue Cross PPO Specialty|BCBSTX PPO|30,213.75|11086.69|11086.69|11086.69|||| 85610|EAP|0305|PROTHROMBIN TIME|Workers Compensation|WORKERS COMPENSATION OTHER|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|United Healthcare|UNITED HEALTHCARE OTHER|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|United Healthcare|TML GROUP BENEFITS|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|United Healthcare|UNITED HEALTHCARE|126.25||||126.25||| 85610|EAP|0305|OC PROTHROMBIN TIME|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||21.25||| 85610|EAP|0305|OC PROTHROMBIN TIME|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|126.25||||21.25||| 85610|EAP|0305|PROTHROMBIN TIME|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|United Healthcare|UNITED HEALTHCARE|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|United Healthcare|GEHA|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|United Medicare Advantage|UHC MEDICARE GOLD MA|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Veterans Affairs|VETERANS ADMINISTRATION|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Veterans Affairs|VETERANS ADMINISTRATION|126.25||||126.25||| 85610|EAP|0305|OC PROTHROMBIN TIME|United Medicare Advantage|UHC MEDICARE GOLD MA|126.25||||21.25||| 85610|EAP|0305|PROTHROMBIN TIME|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|PHCS|HUMANA INSURANCE|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|PHCS|MULTIPLAN PHCS|||||126.25||| 85610|EAP|0305|OC PROTHROMBIN TIME|Tricare|TRICARE EAST REGION|126.25||||21.25||| 85610|EAP|0305|PROTHROMBIN TIME|Medicaid|MEDICAID|126.25||||126.25||| 85610|EAP|0305|OC PROTHROMBIN TIME|Medicare|MEDICARE ACUTE|126.25||||21.25||| 85610|EAP|0305|PROTHROMBIN TIME|Tricare|TRICARE FOR LIFE|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Medicare|MEDICARE ACUTE|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Medicaid|MEDICAID HMO|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Managed Medicare|HEALTHSPRING MA|126.25||||126.25||| 85610|EAP|0305|OC PROTHROMBIN TIME|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||21.25||| 85610|EAP|0305|PROTHROMBIN TIME|Managed Medicaid|MEDICAID UNITED HEALTHCARE|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Medicaid|MEDICAID TEXAS CHILDRENS|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Tricare|TRICARE EAST REGION|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Humana Medicare Advantage|HUMANA MA|126.25||||126.25||| 85610|EAP|0305|OC PROTHROMBIN TIME|Medicaid|MORRIS COUNTY INDIGENT|||||21.25||| 85610|EAP|0305|OC PROTHROMBIN TIME|Humana Medicare Advantage|HUMANA MA|126.25||||21.25||| 85610|EAP|0305|PROTHROMBIN TIME|Medicaid|MORRIS COUNTY INDIGENT|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|PHCS|MERITAIN HEALTH|||||126.25||| 85610|EAP|0305|OC PROTHROMBIN TIME|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|126.25||||21.25||| 85610|EAP|0305|PROTHROMBIN TIME|NON CONTRACTED|COMMERCIAL OTHER 1|126.25||||126.25||| 85610|EAP|0305|OC PROTHROMBIN TIME|Managed Medicaid|MEDICAID UNITED HEALTHCARE|126.25||||21.25||| 85610|EAP|0305|PROTHROMBIN TIME|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Managed Medicare|UPSHUR COUNTY SHERIFF DEPT|||||0.38||| 85610|EAP|0305|PROTHROMBIN TIME|Managed Medicaid|MEDICAID AMERIGROUP|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Managed Medicare|BCBS MEDICARE PPO MA|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Managed Medicaid|MEDICAID SUPERIOR|126.25||||126.25||| 85610|EAP|0305|OC PROTHROMBIN TIME|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|126.25||||21.25||| 85610|EAP|0305|OC PROTHROMBIN TIME|Blue Cross PPO Specialty|BCBSTX PPO|126.25||||21.25||| 85610|EAP|0305|PROTHROMBIN TIME|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Access Direct Platinum|HEALTHFIRST TPA UMR|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|126.25||||||| 85610|EAP|0305|OC PROTHROMBIN TIME|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|126.25||||21.25||| 85610|EAP|0305|OC PROTHROMBIN TIME|United Healthcare|UNITED HEALTHCARE|||||21.25||| 85610|EAP|0305|PROTHROMBIN TIME|Aenta Medicare Advantage|AETNA MEDICARE MA|126.25||||126.25||| 85610|EAP|0305|OC PROTHROMBIN TIME|Aenta Medicare Advantage|AETNA MEDICARE MA|126.25||||21.25||| 85610|EAP|0305|PROTHROMBIN TIME|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Blue Cross HMO Specialty|BCBSTX HMO|||||126.25||| 85610|EAP|0305|OC PROTHROMBIN TIME|Blue Cross HMO Specialty|BCBSTX HMO|||||21.25||| 85610|EAP|0305|PROTHROMBIN TIME|Blue Cross PPO Specialty|BCBSTX PPO|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Cigna|CIGNA|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Cigna|CIGNA|||||126.25||| 85610|EAP|0305|OC PROTHROMBIN TIME|Cigna|CIGNA|126.25||||21.25||| 85610|EAP|0305|PROTHROMBIN TIME|Aetna|AETNA OTHER|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Aetna|AETNA PPO|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Blue Cross PPO Specialty|BCBSTX OTHER|||||126.25||| 85613|EAP|0305|LUPUS ANTICOAGULENT ASSAY|Managed Medicaid|MEDICAID AMERIGROUP|||||67.50||| 85613|EAP|0305|LUPUS ANTICOAGULENT ASSAY|Tricare|TRICARE EAST REGION|||||67.50||| 85613|EAP|0305|LUPUS ANTICOAGULENT ASSAY|United Healthcare|UNITED HEALTHCARE|||||67.50||| 85613|EAP|0305|LUPUS ANTICOAGULENT ASSAY|Medicare|MEDICARE ACUTE|||||67.50||| 85613|EAP|0305|LUPUS ANTICOAGULENT ASSAY|United Medicare Advantage|UHC MEDICARE GOLD MA|224.50||||||| 85613|EAP|0305|LUPUS ANTICOAGULENT ASSAY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||67.50||| 85651|EAP|0305|SEDIMENTATION RATE|Managed Medicaid|MEDICAID AMERIGROUP|||||34.25||| 85652|EAP|0305|SED RATE AUTOMATED|United Medicare Advantage|UHC MEDICARE GOLD MA|86.75||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|United Healthcare|TML GROUP BENEFITS|||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|United Healthcare|UNITED HEALTHCARE OTHER|||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|United Healthcare|UNITED HEALTHCARE|86.75||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|Veterans Affairs|VETERANS ADMINISTRATION|86.75||||||| 85652|EAP|0305|SED RATE AUTOMATED|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|Medicare|MEDICARE ACUTE|86.75||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|Medicaid|MORRIS COUNTY INDIGENT|||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|Medicaid|MEDICAID TEXAS CHILDRENS|||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|Tricare|TRICARE EAST REGION|||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|Medicaid|MEDICAID|||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|86.75||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|Cigna|CIGNA|||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|86.75||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|Aetna|AETNA PPO|||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|Aetna|AETNA OTHER|||||86.75||| 85652|EAP|0305|SED RATE AUTOMATED|Blue Cross PPO Specialty|BCBSTX PPO|86.75||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|Managed Medicaid|MEDICAID AMERIGROUP|86.75||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|86.75||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|Managed Medicaid|MEDICAID SUPERIOR|86.75||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|Managed Medicaid|MEDICAID UNITED HEALTHCARE|86.75||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|Managed Medicare|HEALTHSPRING MA|||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|Humana Medicare Advantage|HUMANA MA|86.75||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|86.75||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.26||| 85652|EAP|0305|SED RATE AUTOMATED|Blue Cross HMO Specialty|BCBSTX HMO|||||0.26||| 85660|EAP|0305|SICKLE CELL STUDY|Blue Cross PPO Specialty|BCBSTX PPO|||||53.25||| 85730|EAP|0305|PTT|NON CONTRACTED|COMMERCIAL OTHER 1|192.75||||192.75||| 85730|EAP|0305|PTT|Tricare|TRICARE FOR LIFE|||||192.75||| 85730|EAP|0305|PTT|PHCS|MERITAIN HEALTH|||||192.75||| 85730|EAP|0305|PTT|PHCS|MULTIPLAN PHCS|||||192.75||| 85730|EAP|0305|PTT|PHCS|HUMANA INSURANCE|||||192.75||| 85730|EAP|0305|PTT|Medicare|MEDICARE ACUTE|192.75||||192.75||| 85730|EAP|0305|PTT|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||192.75||| 85730|EAP|0305|PTT|Medicaid|MORRIS COUNTY INDIGENT|||||192.75||| 85730|EAP|0305|PTT|Medicaid|MEDICAID TEXAS CHILDRENS|||||192.75||| 85730|EAP|0305|PTT|Medicaid|MEDICAID HMO|||||192.75||| 85730|EAP|0305|PTT|Medicaid|MEDICAID|192.75||||192.75||| 85730|EAP|0305|PTT|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||192.75||| 85730|EAP|0305|PTT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||192.75||| 85730|EAP|0305|PTT|United Medicare Advantage|UHC MEDICARE GOLD MA|192.75||||192.75||| 85730|EAP|0305|PTT|Veterans Affairs|VETERANS ADMINISTRATION|192.75||||192.75||| 85730|EAP|0305|PTT|United Healthcare|UNITED HEALTHCARE OTHER|||||192.75||| 85730|EAP|0305|PTT|Workers Compensation|WORKERS COMPENSATION OTHER|||||192.75||| 85730|EAP|0305|PTT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|192.75||||192.75||| 85730|EAP|0305|PTT|United Healthcare|UNITED HEALTHCARE|192.75||||192.75||| 85730|EAP|0305|PTT|United Healthcare|UNITED HEALTHCARE|||||192.75||| 85730|EAP|0305|PTT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||192.75||| 85730|EAP|0305|PTT|Veterans Affairs|VETERANS ADMINISTRATION|||||192.75||| 85730|EAP|0305|PTT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|192.75||||192.75||| 85730|EAP|0305|PTT|Managed Medicare|BCBS MEDICARE PPO MA|||||192.75||| 85730|EAP|0305|PTT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|192.75||||192.75||| 85730|EAP|0305|PTT|Managed Medicare|HEALTHSPRING MA|192.75||||192.75||| 85730|EAP|0305|PTT|Managed Medicaid|MEDICAID AMERIGROUP|192.75||||192.75||| 85730|EAP|0305|PTT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|192.75||||192.75||| 85730|EAP|0305|PTT|Managed Medicaid|MEDICAID SUPERIOR|192.75||||192.75||| 85730|EAP|0305|PTT|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||192.75||| 85730|EAP|0305|PTT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|192.75||||192.75||| 85730|EAP|0305|PTT|Humana Medicare Advantage|HUMANA MA|192.75||||192.75||| 85730|EAP|0305|PTT|Access Direct Platinum|HEALTHFIRST TPA UMR|||||192.75||| 85730|EAP|0305|PTT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|192.75||||192.75||| 85730|EAP|0305|PTT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|192.75||||192.75||| 85730|EAP|0305|PTT|Tricare|TRICARE EAST REGION|192.75||||192.75||| 85730|EAP|0305|PTT|Aenta Medicare Advantage|AETNA MEDICARE MA|192.75||||192.75||| 85730|EAP|0305|PTT|Blue Cross HMO Specialty|BCBSTX HMO|||||192.75||| 85730|EAP|0305|PTT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||192.75||| 85730|EAP|0305|PTT|Cigna|CIGNA|||||192.75||| 85730|EAP|0305|PTT|Aetna|AETNA PPO|||||192.75||| 85730|EAP|0305|PTT|Aetna|AETNA OTHER|||||192.75||| 85730|EAP|0305|PTT|Blue Cross PPO Specialty|BCBSTX PPO|192.75||||192.75||| 85730|EAP|0305|PTT|Blue Cross PPO Specialty|BCBSTX OTHER|||||192.75||| 85730|EAP|0305|PTT|Cigna|CIGNA|192.75||||192.75||| 85730|EAP|0305|PTT|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||192.75||| 85730|EAP|0305|PTT|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||192.75||| 86038|EAP|0302|ANA TITER|Blue Cross PPO Specialty|BCBSTX PPO|3.29||||107.75||| 86038|EAP|0302|ANA TITER|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||107.75||| 86038|EAP|0302|ANA TITER|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||107.75||| 86038|EAP|0302|ANA TITER|Aenta Medicare Advantage|AETNA MEDICARE MA|||||107.75||| 86038|EAP|0302|ANA TITER|Blue Cross HMO Specialty|BCBSTX HMO|||||107.75||| 86038|EAP|0302|ANA TITER|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||107.75||| 86038|EAP|0302|ANA TITER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.29||||107.75||| 86038|EAP|0302|ANA TITER|Cigna|CIGNA|||||107.75||| 86038|EAP|0302|ANA TITER|Managed Medicaid|MEDICAID SUPERIOR|||||107.75||| 86038|EAP|0302|ANA TITER|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.29||||107.75||| 86038|EAP|0302|ANA TITER|Managed Medicaid|MEDICAID AMERIGROUP|3.29||||107.75||| 86038|EAP|0302|ANA TITER|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||107.75||| 86038|EAP|0302|ANA TITER|Humana Medicare Advantage|HUMANA MA|378.35||||107.75||| 86038|EAP|0302|ANA TITER|Managed Medicare|HEALTHSPRING MA|||||107.75||| 86038|EAP|0302|ANA TITER|United Medicare Advantage|UHC MEDICARE GOLD MA|3.29||||107.75||| 86038|EAP|0302|ANA TITER|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|3.29||||107.75||| 86038|EAP|0302|ANA TITER|NON CONTRACTED|COMMERCIAL OTHER 1|||||107.75||| 86038|EAP|0302|ANA TITER|United Healthcare|UNITED HEALTHCARE OTHER|||||107.75||| 86038|EAP|0302|ANA TITER|Medicare|MEDICARE ACUTE|427.70||||107.75||| 86038|EAP|0302|ANA TITER|Tricare|TRICARE EAST REGION|||||107.75||| 86038|EAP|0302|ANA TITER|Medicaid|MORRIS COUNTY INDIGENT|||||107.75||| 86038|EAP|0302|ANA TITER|Medicaid|MEDICAID|||||107.75||| 86038|EAP|0302|ANA TITER|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||107.75||| 86038|EAP|0302|ANA TITER|United Healthcare|UNITED HEALTHCARE|427.70||||107.75||| 86038|EAP|0302|ANA TITER|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||107.75||| 86038|EAP|0302|ANA TITER|United Healthcare|TML GROUP BENEFITS|||||107.75||| 86038|EAP|0302|ANA TITER|United Healthcare|UNITED HEALTHCARE|||||107.75||| 86060|EAP|0302|ASO TITER|NON CONTRACTED|COMMERCIAL OTHER 1|||||70.50||| 86060|EAP|0302|ASO TITER|United Healthcare|UNITED HEALTHCARE|||||70.50||| 86060|EAP|0302|ASO TITER|Medicare|MEDICARE ACUTE|||||70.50||| 86060|EAP|0302|ASO TITER|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||70.50||| 86060|EAP|0302|ASO TITER|United Medicare Advantage|UHC MEDICARE GOLD MA|||||70.50||| 86060|EAP|0302|ASO TITER|Managed Medicare|HEALTHSPRING MA|||||70.50||| 86060|EAP|0302|ASO TITER|Managed Medicaid|MEDICAID SUPERIOR|||||70.50||| 86060|EAP|0302|ASO TITER|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||70.50||| 86060|EAP|0302|ASO TITER|Blue Cross HMO Specialty|BCBSTX HMO|||||70.50||| 86060|EAP|0302|ASO TITER|Cigna|CIGNA|||||70.50||| 86060|EAP|0302|ASO TITER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||70.50||| 86060|EAP|0302|ASO TITER|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||70.50||| 86060|EAP|0302|ASO TITER|Tricare|TRICARE EAST REGION|||||70.50||| 86060|EAP|0302|ASO TITER|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||70.50||| 86060|EAP|0302|ASO TITER|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||70.50||| 86060|EAP|0302|ASO TITER|Aenta Medicare Advantage|AETNA MEDICARE MA|||||70.50||| 86060|EAP|0302|ASO TITER|Managed Medicaid|MEDICAID AMERIGROUP|||||70.50||| 86060|EAP|0302|ASO TITER|Humana Medicare Advantage|HUMANA MA|||||70.50||| 86060|EAP|0302|ASO TITER|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||70.50||| 86060|EAP|0302|ASO TITER|Blue Cross PPO Specialty|BCBSTX PPO|||||70.50||| 86140|EAP|0302|CRP QUAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|216.13||||0.50||| 86140|EAP|0302|CRP QUAL|Cigna|CIGNA|216.13||||0.50||| 86140|EAP|0302|CRP QUAL|Blue Cross HMO Specialty|BCBSTX HMO|||||0.50||| 86140|EAP|0302|CRP QUAL|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.50||| 86140|EAP|0302|CRP QUAL|Cigna|CIGNA|||||216.13||| 86140|EAP|0302|CRP QUAL|Blue Cross PPO Specialty|BCBSTX PPO|216.13||||0.50||| 86140|EAP|0302|CRP QUAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.50||| 86140|EAP|0302|CRP QUAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.50||| 86140|EAP|0302|CRP QUAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|216.13||||0.50||| 86140|EAP|0302|CRP QUAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|216.13||||0.50||| 86140|EAP|0302|CRP QUAL|Aetna|AETNA PPO|||||0.50||| 86140|EAP|0302|CRP QUAL|Managed Medicaid|MEDICAID AMERIGROUP|166.25||||0.50||| 86140|EAP|0302|CRP QUAL|Managed Medicaid|MEDICAID SUPERIOR|216.13||||0.50||| 86140|EAP|0302|CRP QUAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|166.25||||0.50||| 86140|EAP|0302|CRP QUAL|Humana Medicare Advantage|HUMANA MA|166.25||||0.50||| 86140|EAP|0302|CRP QUAL|Managed Medicare|HEALTHSPRING MA|||||0.50||| 86140|EAP|0302|CRP QUAL|Workers Compensation|WORKERS COMPENSATION OTHER|||||216.13||| 86140|EAP|0302|CRP QUAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.50||| 86140|EAP|0302|CRP QUAL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.50||| 86140|EAP|0302|CRP QUAL|Veterans Affairs|VETERANS ADMINISTRATION|||||216.13||| 86140|EAP|0302|CRP QUAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.50||| 86140|EAP|0302|CRP QUAL|Medicare|MEDICARE ACUTE|166.25||||0.50||| 86140|EAP|0302|CRP QUAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.50||| 86140|EAP|0302|CRP QUAL|United Healthcare|TML GROUP BENEFITS|||||216.13||| 86140|EAP|0302|CRP QUAL|Medicaid|MEDICAID|||||191.19||| 86140|EAP|0302|CRP QUAL|United Healthcare|UNITED HEALTHCARE|166.25||||0.50||| 86140|EAP|0302|CRP QUAL|Tricare|TRICARE EAST REGION|||||0.50||| 86141|EAP|0302|CRP HIGH SENSATIVITY|NON CONTRACTED|COMMERCIAL OTHER 1|540.80||||1.25||| 86141|EAP|0302|CRP HIGH SENSATIVITY|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.25||| 86141|EAP|0302|CRP HIGH SENSATIVITY|Tricare|TRICARE EAST REGION|||||332.90||| 86141|EAP|0302|CRP HIGH SENSATIVITY|Medicare|MEDICARE ACUTE|540.80||||1.25||| 86141|EAP|0302|CRP HIGH SENSATIVITY|Medicaid|MEDICAID|||||332.90||| 86141|EAP|0302|CRP HIGH SENSATIVITY|United Healthcare|UNITED HEALTHCARE|540.80||||1.25||| 86141|EAP|0302|CRP HIGH SENSATIVITY|Veterans Affairs|VETERANS ADMINISTRATION|540.80||||540.80||| 86141|EAP|0302|CRP HIGH SENSATIVITY|United Medicare Advantage|UHC MEDICARE GOLD MA|4.16||||1.25||| 86141|EAP|0302|CRP HIGH SENSATIVITY|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|478.40||||1.25||| 86141|EAP|0302|CRP HIGH SENSATIVITY|Managed Medicaid|MEDICAID AMERIGROUP|540.80||||1.25||| 86141|EAP|0302|CRP HIGH SENSATIVITY|Managed Medicaid|MEDICAID SUPERIOR|4.16||||1.25||| 86141|EAP|0302|CRP HIGH SENSATIVITY|United Healthcare|TML GROUP BENEFITS|||||1.25||| 86141|EAP|0302|CRP HIGH SENSATIVITY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|478.40||||1.25||| 86141|EAP|0302|CRP HIGH SENSATIVITY|United Healthcare|UNITED HEALTHCARE OTHER|4.16||||1.25||| 86141|EAP|0302|CRP HIGH SENSATIVITY|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|540.80||||||| 86141|EAP|0302|CRP HIGH SENSATIVITY|Humana Medicare Advantage|HUMANA MA|540.80||||1.25||| 86141|EAP|0302|CRP HIGH SENSATIVITY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|540.80||||4.16||| 86141|EAP|0302|CRP HIGH SENSATIVITY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|540.80||||1.25||| 86141|EAP|0302|CRP HIGH SENSATIVITY|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|540.80||||||| 86141|EAP|0302|CRP HIGH SENSATIVITY|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|540.80||||||| 86141|EAP|0302|CRP HIGH SENSATIVITY|Aenta Medicare Advantage|AETNA MEDICARE MA|540.80||||1.25||| 86141|EAP|0302|CRP HIGH SENSATIVITY|Cigna|CIGNA|4.16||||||| 86141|EAP|0302|CRP HIGH SENSATIVITY|Aetna|AETNA OTHER|||||4.16||| 86141|EAP|0302|CRP HIGH SENSATIVITY|Blue Cross HMO Specialty|BCBSTX HMO|||||1.25||| 86141|EAP|0302|CRP HIGH SENSATIVITY|Cigna|CIGNA|540.80||||1.25||| 86141|EAP|0302|CRP HIGH SENSATIVITY|Blue Cross PPO Specialty|BCBSTX PPO|540.80||||1.25||| 86141|EAP|0302|CRP HIGH SENSATIVITY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|478.40||||1.25||| 86147|EAP|0302|CARDIOLPIN AB IGG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||75.75||| 86147|EAP|0302|CARDIOLIPIN AB IGM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||326.63||| 86157|EAP|0302|MYCOPLASMA PNEUMONIAE AB|United Medicare Advantage|UHC MEDICARE GOLD MA|2.59||||336.70||| 86157|EAP|0302|MYCOPLASMA PNEUMONIAE AB|NON CONTRACTED|COMMERCIAL OTHER 1|||||77.75||| 86157|EAP|0302|MYCOPLASMA PNEUMONIAE AB|Medicare|MEDICARE ACUTE|2.59||||168.38||| 86157|EAP|0302|MYCOPLASMA PNEUMONIAE AB|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||77.75||| 86157|EAP|0302|MYCOPLASMA PNEUMONIAE AB|Medicaid|MEDICAID|||||77.75||| 86157|EAP|0302|MYCOPLASMA PNEUMONIAE AB|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||77.75||| 86157|EAP|0302|MYCOPLASMA PNEUMONIAE AB|Managed Medicaid|MEDICAID SUPERIOR|2.59||||77.75||| 86157|EAP|0302|MYCOPLASMA PNEUMONIAE AB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||77.75||| 86157|EAP|0302|MYCOPLASMA PNEUMONIAE AB|Humana Medicare Advantage|HUMANA MA|2.59||||2.59||| 86157|EAP|0302|MYCOPLASMA PNEUMONIAE AB|Managed Medicaid|MEDICAID AMERIGROUP|2.59||||77.75||| 86157|EAP|0302|MYCOPLASMA PNEUMONIAE AB|Aetna|AETNA OTHER|2.59||||||| 86157|EAP|0302|MYCOPLASMA PNEUMONIAE AB|Blue Cross PPO Specialty|BCBSTX PPO|||||77.75||| 86157|EAP|0302|MYCOPLASMA PNEUMONIAE AB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||77.75||| 86160|EAP|0302|COMPLEMENT AG EACH|Blue Cross PPO Specialty|BCBSTX PPO|||||115.75||| 86160|EAP|0302|C4|Blue Cross PPO Specialty|BCBSTX PPO|||||115.75||| 86160|EAP|0302|C4|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||115.75||| 86160|EAP|0302|C4|Managed Medicaid|MEDICAID AMERIGROUP|||||115.75||| 86160|EAP|0302|C4|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||115.75||| 86160|EAP|0302|COMPLEMENT AG EACH|Managed Medicaid|MEDICAID AMERIGROUP|||||115.75||| 86160|EAP|0302|C4|Medicare|MEDICARE ACUTE|385.75||||115.75||| 86160|EAP|0302|COMPLEMENT AG EACH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||115.75||| 86160|EAP|0302|COMPLEMENT AG EACH|Medicare|MEDICARE ACUTE|501.48||||115.75||| 86160|EAP|0302|COMPLEMENT AG EACH|Humana Medicare Advantage|HUMANA MA|||||115.75||| 86160|EAP|0302|C4|Tricare|TRICARE EAST REGION|||||115.75||| 86160|EAP|0302|COMPLEMENT AG EACH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||115.75||| 86160|EAP|0302|COMPLEMENT AG EACH|Tricare|TRICARE EAST REGION|||||115.75||| 86160|EAP|0302|C4|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||115.75||| 86160|EAP|0302|COMPLEMENT AG EACH|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||115.75||| 86160|EAP|0302|COMPLEMENT AG EACH|United Healthcare|UNITED HEALTHCARE|||||115.75||| 86160|EAP|0302|C4|Humana Medicare Advantage|HUMANA MA|||||115.75||| 86160|EAP|0302|C4|United Healthcare|UNITED HEALTHCARE|||||115.75||| 86160|EAP|0302|C4|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||115.75||| 86160|EAP|0302|COMPLEMENT AG EACH|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||115.75||| 86160|EAP|0302|COMPLEMENT AG EACH|United Medicare Advantage|UHC MEDICARE GOLD MA|||||115.75||| 86160|EAP|0302|C4|United Medicare Advantage|UHC MEDICARE GOLD MA|||||115.75||| 86162|EAP|0302|CH50|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.81||| 86162|EAP|0302|CH50|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.81||| 86200|EAP|0300|CYCLIC CITRULLINATED PEPT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 86200|EAP|0300|CYCLIC CITRULLINATED PEPT|Humana Medicare Advantage|HUMANA MA|540.80||||||| 86200|EAP|0300|CYCLIC CITRULLINATED PEPT|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 86200|EAP|0300|CYCLIC CITRULLINATED PEPT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.25||| 86200|EAP|0300|CYCLIC CITRULLINATED PEPT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 86200|EAP|0300|CYCLIC CITRULLINATED PEPT|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 86200|EAP|0300|CYCLIC CITRULLINATED PEPT|United Medicare Advantage|UHC MEDICARE GOLD MA|4.16||||1.25||| 86200|EAP|0300|CYCLIC CITRULLINATED PEPT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.25||| 86200|EAP|0300|CYCLIC CITRULLINATED PEPT|United Healthcare|UNITED HEALTHCARE|||||1.25||| 86200|EAP|0300|CYCLIC CITRULLINATED PEPT|Medicare|MEDICARE ACUTE|||||1.25||| 86200|EAP|0300|CYCLIC CITRULLINATED PEPT|Medicaid|MORRIS COUNTY INDIGENT|||||1.25||| 86225|EAP|0300|DNA DOUBLE STRANDED|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||132.50||| 86225|EAP|0300|DNA DOUBLE STRANDED|Medicaid|MORRIS COUNTY INDIGENT|||||132.50||| 86225|EAP|0300|DNA DOUBLE STRANDED|Medicare|MEDICARE ACUTE|573.63||||132.50||| 86225|EAP|0300|DNA DOUBLE STRANDED|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||132.50||| 86225|EAP|0300|DNA DOUBLE STRANDED|Aenta Medicare Advantage|AETNA MEDICARE MA|||||132.50||| 86225|EAP|0300|DNA DOUBLE STRANDED|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||132.50||| 86225|EAP|0300|DNA DOUBLE STRANDED|Blue Cross PPO Specialty|BCBSTX PPO|||||132.50||| 86225|EAP|0300|DNA DOUBLE STRANDED|Managed Medicaid|MEDICAID AMERIGROUP|441.25||||132.50||| 86225|EAP|0300|DNA DOUBLE STRANDED|Humana Medicare Advantage|HUMANA MA|||||132.50||| 86235|EAP|0302|ANTI CCP AB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.89||||||| 86235|EAP|0302|ANTI CCP AB|Humana Medicare Advantage|HUMANA MA|||||172.75||| 86235|EAP|0302|ANTI CCP AB|Managed Medicaid|MEDICAID AMERIGROUP|||||172.75||| 86235|EAP|0301|CENTROMERE AB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||111.25||| 86235|EAP|0302|ANTI CCP AB|Cigna|CIGNA|||||172.75||| 86235|EAP|0302|SMOOTH MUSCLE AB TITER|Blue Cross PPO Specialty|BCBSTX PPO|748.80||||748.80||| 86235|EAP|0302|ANTI CCP AB|Blue Cross PPO Specialty|BCBSTX PPO|748.80||||172.75||| 86235|EAP|0301|CENTROMERE AB|Blue Cross PPO Specialty|BCBSTX PPO|||||111.25||| 86235|EAP|0302|SMOOTH MUSCLE AB TITER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||748.80||| 86235|EAP|0302|SCLERODERMA AB|Blue Cross PPO Specialty|BCBSTX PPO|748.80||||172.75||| 86235|EAP|0302|SCLERODERMA AB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||172.75||| 86235|EAP|0302|SCLERODERMA AB|Managed Medicaid|MEDICAID AMERIGROUP|||||172.75||| 86235|EAP|0302|ANTI CCP AB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||172.75||| 86235|EAP|0302|ANTI CCP AB|United Medicare Advantage|UHC MEDICARE GOLD MA|4.89||||||| 86235|EAP|0302|SCLERODERMA AB|Medicare|MEDICARE ACUTE|635.70||||172.75||| 86235|EAP|0302|SMOOTH MUSCLE AB TITER|United Healthcare|UNITED HEALTHCARE|635.70||||748.80||| 86235|EAP|0301|CENTROMERE AB|Medicare|MEDICARE ACUTE|370.75||||||| 86235|EAP|0302|ANTI CCP AB|Medicare|MEDICARE ACUTE|635.70||||172.75||| 86235|EAP|0302|SMOOTH MUSCLE AB TITER|Medicare|MEDICARE ACUTE|635.70||||662.40||| 86255|EAP|0302|ANTI NEUTROPHILIC CYTOPLA|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|387.25||||||| 86255|EAP|0302|ANTI NEUTROPHILIC CYTOPLA|Medicare|MEDICARE ACUTE|||||116.25||| 86255|EAP|0302|ANTI NEUTROPHILIC CYTOPLA|United Healthcare|UNITED HEALTHCARE|||||116.25||| 86255|EAP|0302|ANTI NEUTROPHILIC CYTOPLA|United Medicare Advantage|UHC MEDICARE GOLD MA|||||116.25||| 86255|EAP|0302|ANTI NEUTROPHILIC CYTOPLA|Blue Cross PPO Specialty|BCBSTX PPO|387.25||||||| 86255|EAP|0302|ANTI NEUTROPHILIC CYTOPLA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||116.25||| 86255|EAP|0302|ANTI NEUTROPHILIC CYTOPLA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||116.25||| 86256|EAP|0302|SMITH ANTIBODY TITER|Managed Medicaid|MEDICAID AMERIGROUP|||||116.25||| 86256|EAP|0302|SMITH ANTIBODY TITER|Humana Medicare Advantage|HUMANA MA|||||116.25||| 86256|EAP|0302|SMITH ANTIBODY TITER|Blue Cross PPO Specialty|BCBSTX PPO|||||116.25||| 86256|EAP|0302|SMITH ANTIBODY TITER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||116.25||| 86256|EAP|0302|SMITH ANTIBODY TITER|Medicare|MEDICARE ACUTE|503.43||||116.25||| 86301|EAP|0302|CA 19-9 SERUM|Humana Medicare Advantage|HUMANA MA|||||200.50||| 86301|EAP|0302|CA 19-9 SERUM|United Medicare Advantage|UHC MEDICARE GOLD MA|||||434.38||| 86301|EAP|0302|CA 19-9 SERUM|Medicare|MEDICARE ACUTE|||||200.50||| 86304|EAP|0302|CA 125|Humana Medicare Advantage|HUMANA MA|868.73||||200.50||| 86304|EAP|0302|CA 125|Medicare|MEDICARE ACUTE|||||200.50||| 86304|EAP|0302|CA 125|United Healthcare|UNITED HEALTHCARE|||||200.50||| 86304|EAP|0302|CA 125|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||668.25||| 86304|EAP|0302|CA 125|United Healthcare|TML GROUP BENEFITS|||||200.50||| 86304|EAP|0302|CA 125|Tricare|TRICARE EAST REGION|||||200.50||| 86304|EAP|0302|CA 125|NON CONTRACTED|COMMERCIAL OTHER 1|||||868.73||| 86304|EAP|0302|CA 125|Blue Cross PPO Specialty|BCBSTX PPO|||||200.50||| 86308|EAP|0302|MONO TEST|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.50||| 86308|EAP|0302|MONO TEST|Blue Cross HMO Specialty|BCBSTX HMO|216.13||||||| 86308|EAP|0302|MONO TEST|Managed Medicaid|MEDICAID AMERIGROUP|0.50||||||| 86308|EAP|0302|MONO TEST|Managed Medicaid|MEDICAID SUPERIOR|||||0.50||| 86308|EAP|0302|MONO TEST|Blue Cross PPO Specialty|BCBSTX PPO|||||0.50||| 86308|EAP|0302|MONO TEST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||166.25||| 86308|EAP|0302|MONO TEST|Tricare|TRICARE EAST REGION|||||166.25||| 86308|EAP|0302|MONO TEST|NON CONTRACTED|COMMERCIAL OTHER 1|||||166.25||| 86308|EAP|0302|MONO TEST|Medicare|MEDICARE ACUTE|||||216.13||| 86317|EAP|0300|IMMUNOASSAY INFECTIOUS AG|Tricare|TRICARE EAST REGION|||||1.23||| 86334|EAP|0302|IMMUNOELECTROPHORESIS SER|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|933.08||||||| 86334|EAP|0302|IMMUNOELECTROPHORESIS SER|Blue Cross PPO Specialty|BCBSTX PPO|717.75||||215.50||| 86334|EAP|0302|IMMUNOELECTROPHORESIS SER|Cigna|CIGNA|||||215.50||| 86334|EAP|0302|IMMUNOELECTROPHORESIS SER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|717.75||||215.50||| 86334|EAP|0302|IMMUNOELECTROPHORESIS SER|Managed Medicaid|MEDICAID AMERIGROUP|||||215.50||| 86334|EAP|0302|IMMUNOELECTROPHORESIS SER|Humana Medicare Advantage|HUMANA MA|933.08||||215.50||| 86334|EAP|0302|IMMUNOELECTROPHORESIS SER|United Medicare Advantage|UHC MEDICARE GOLD MA|||||215.50||| 86334|EAP|0302|IMMUNOELECTROPHORESIS SER|Medicare|MEDICARE ACUTE|825.42||||215.50||| 86334|EAP|0302|IMMUNOELECTROPHORESIS SER|United Healthcare|UNITED HEALTHCARE|933.08||||215.50||| 86334|EAP|0302|IMMUNOELECTROPHORESIS SER|United Healthcare|UNITED HEALTHCARE|||||215.50||| 86335|EAP|0302|IMMUNOELECTROPHORESIS URI|Medicare|MEDICARE ACUTE|1,225.58||||282.75||| 86335|EAP|0302|IMMUNOELECTROPHORESIS URI|United Healthcare|UNITED HEALTHCARE|1,225.58||||||| 86335|EAP|0302|IMMUNOELECTROPHORESIS URI|United Healthcare|UNITED HEALTHCARE|||||282.75||| 86335|EAP|0302|IMMUNOELECTROPHORESIS URI|United Medicare Advantage|UHC MEDICARE GOLD MA|||||282.75||| 86335|EAP|0302|IMMUNOELECTROPHORESIS URI|Humana Medicare Advantage|HUMANA MA|1,225.58||||282.75||| 86335|EAP|0302|IMMUNOELECTROPHORESIS URI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||282.75||| 86335|EAP|0302|IMMUNOELECTROPHORESIS URI|Blue Cross PPO Specialty|BCBSTX PPO|942.75||||||| 86340|EAP|0302|INTRINISIC FACTOR BLOCKIN|Blue Cross PPO Specialty|BCBSTX PPO|484.25||||||| 86340|EAP|0302|INTRINISIC FACTOR BLOCKIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|484.25||||||| 86341|EAP|0302|ISLET CELL AB|Managed Medicaid|MEDICAID AMERIGROUP|||||50.80||| 86376|EAP|0302|MICROSOMAL ANTIBODIES|NON CONTRACTED|COMMERCIAL OTHER 1|||||140.25||| 86376|EAP|0302|MICROSOMAL ANTIBODIES|Tricare|TRICARE EAST REGION|||||140.25||| 86376|EAP|0302|MICROSOMAL ANTIBODIES|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||140.25||| 86376|EAP|0302|MICROSOMAL ANTIBODIES|Medicaid|MEDICAID TEXAS CHILDRENS|||||140.25||| 86376|EAP|0302|MICROSOMAL ANTIBODIES|Medicare|MEDICARE ACUTE|||||140.25||| 86376|EAP|0302|MICROSOMAL ANTIBODIES|United Healthcare|UNITED HEALTHCARE|||||140.25||| 86376|EAP|0302|MICROSOMAL ANTIBODIES|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||140.25||| 86376|EAP|0302|MICROSOMAL ANTIBODIES|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||140.25||| 86376|EAP|0302|MICROSOMAL ANTIBODIES|Blue Cross PPO Specialty|BCBSTX PPO|||||140.25||| 86376|EAP|0302|MICROSOMAL ANTIBODIES|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||140.25||| 86376|EAP|0302|MICROSOMAL ANTIBODIES|Managed Medicaid|MEDICAID SUPERIOR|||||140.25||| 86376|EAP|0302|MICROSOMAL ANTIBODIES|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||140.25||| 86430|EAP|0302|RA TEST|Managed Medicare|HEALTHSPRING MA|||||54.75||| 86430|EAP|0302|RA TEST|Managed Medicaid|MEDICAID AMERIGROUP|||||54.75||| 86430|EAP|0302|RA TEST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||54.75||| 86430|EAP|0302|RA TEST|Managed Medicaid|MEDICAID SUPERIOR|||||54.75||| 86430|EAP|0302|RA TEST|Humana Medicare Advantage|HUMANA MA|237.25||||54.75||| 86430|EAP|0302|RA TEST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||54.75||| 86430|EAP|0302|RA TEST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|237.25||||54.75||| 86430|EAP|0302|RA TEST|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||54.75||| 86430|EAP|0302|RA TEST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||54.75||| 86430|EAP|0302|RA TEST|Aenta Medicare Advantage|AETNA MEDICARE MA|||||54.75||| 86430|EAP|0302|RA TEST|Blue Cross HMO Specialty|BCBSTX HMO|||||54.75||| 86430|EAP|0302|RA TEST|Blue Cross PPO Specialty|BCBSTX PPO|||||54.75||| 86430|EAP|0302|RA TEST|Cigna|CIGNA|||||54.75||| 86430|EAP|0302|RA TEST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|182.50||||54.75||| 86430|EAP|0302|RA TEST|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||54.75||| 86430|EAP|0302|RA TEST|United Medicare Advantage|UHC MEDICARE GOLD MA|182.50||||54.75||| 86430|EAP|0302|RA TEST|United Healthcare|TML GROUP BENEFITS|||||54.75||| 86430|EAP|0302|RA TEST|NON CONTRACTED|COMMERCIAL OTHER 1|||||54.75||| 86430|EAP|0302|RA TEST|Medicare|MEDICARE ACUTE|237.25||||54.75||| 86430|EAP|0302|RA TEST|Medicaid|MEDICAID|||||54.75||| 86430|EAP|0302|RA TEST|Medicaid|MORRIS COUNTY INDIGENT|||||54.75||| 86430|EAP|0302|RA TEST|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||54.75||| 86430|EAP|0302|RA TEST|United Healthcare|UNITED HEALTHCARE OTHER|||||54.75||| 86430|EAP|0302|RA TEST|United Healthcare|UNITED HEALTHCARE|||||54.75||| 86430|EAP|0302|RA TEST|Tricare|TRICARE EAST REGION|||||54.75||| 86430|EAP|0302|RA TEST|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||54.75||| 86480|EAP|0300|QUANTIFERON TB|NON CONTRACTED|COMMERCIAL OTHER 1|||||5.10||| 86480|EAP|0300|QUANTIFERON TB|United Healthcare|UNITED HEALTHCARE|||||5.10||| 86480|EAP|0300|QUANTIFERON TB|United Medicare Advantage|UHC MEDICARE GOLD MA|||||5.10||| 86480|EAP|0300|QUANTIFERON TB|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||5.10||| 86480|EAP|0300|QUANTIFERON TB|Blue Cross PPO Specialty|BCBSTX PPO|||||5.10||| 86480|EAP|0300|QUANTIFERON TB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||5.10||| 86480|EAP|0300|QUANTIFERON TB|Managed Medicaid|MEDICAID SUPERIOR|||||5.10||| 86480|EAP|0300|QUANTIFERON TB|Medicare|MEDICARE ACUTE|||||5.10||| 86480|EAP|0300|QUANTIFERON TB|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||5.10||| 86480|EAP|0300|QUANTIFERON TB|Humana Medicare Advantage|HUMANA MA|||||5.10||| 86592|EAP|0302|RPR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||41.25||| 86592|EAP|0302|RPR|Managed Medicaid|MEDICAID SUPERIOR|||||41.25||| 86592|EAP|0302|RPR|Humana Medicare Advantage|HUMANA MA|||||41.25||| 86592|EAP|0302|RPR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||41.25||| 86592|EAP|0302|RPR|Managed Medicaid|MEDICAID AMERIGROUP|||||41.25||| 86592|EAP|0302|RPR|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||41.25||| 86592|EAP|0302|RPR|Blue Cross HMO Specialty|BCBSTX HMO|||||41.25||| 86592|EAP|0302|RPR|Blue Cross PPO Specialty|BCBSTX PPO|||||41.25||| 86592|EAP|0302|RPR|Cigna|CIGNA|||||41.25||| 86592|EAP|0302|RPR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||41.25||| 86592|EAP|0302|RPR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||41.25||| 86592|EAP|0302|RPR|Veterans Affairs|VETERANS ADMINISTRATION|178.10||||||| 86592|EAP|0302|RPR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||41.25||| 86592|EAP|0302|RPR|NON CONTRACTED|COMMERCIAL OTHER 1|||||41.25||| 86592|EAP|0302|RPR|Medicaid|MEDICAID|||||41.25||| 86592|EAP|0302|RPR|Medicaid|MEDICAID TEXAS CHILDRENS|||||41.25||| 86592|EAP|0302|RPR|Tricare|TRICARE EAST REGION|||||41.25||| 86592|EAP|0302|RPR|United Healthcare|UNITED HEALTHCARE|||||41.25||| 86592|EAP|0302|RPR|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||41.25||| 86592|EAP|0302|RPR|Medicare|MEDICARE ACUTE|||||41.25||| 86618|EAP|0302|LYMES DISEASE TITER|United Healthcare|UNITED HEALTHCARE|||||164.25||| 86618|EAP|0302|LYMES DISEASE TITER|United Medicare Advantage|UHC MEDICARE GOLD MA|||||164.25||| 86618|EAP|0302|LYMES DISEASE TITER|Blue Cross HMO Specialty|BCBSTX HMO|||||164.25||| 86618|EAP|0302|LYMES DISEASE TITER|Blue Cross PPO Specialty|BCBSTX PPO|||||164.25||| 86618|EAP|0302|LYMES DISEASE TITER|Cigna|CIGNA|||||164.25||| 86618|EAP|0302|LYMES DISEASE TITER|Managed Medicare|HEALTHSPRING MA|||||164.25||| 86618|EAP|0302|LYMES DISEASE TITER|Managed Medicaid|MEDICAID AMERIGROUP|||||164.25||| 86618|EAP|0302|LYMES DISEASE TITER|Humana Medicare Advantage|HUMANA MA|||||437.84||| 86664|EAP|0302|EPSTEIN BARR NUCLEAR ANTI|Managed Medicaid|MEDICAID AMERIGROUP|||||147.50||| 86664|EAP|0302|EPSTEIN BARR NUCLEAR ANTI|Managed Medicaid|MEDICAID SUPERIOR|||||147.50||| 86664|EAP|0302|EPSTEIN BARR NUCLEAR ANTI|Blue Cross PPO Specialty|BCBSTX PPO|||||147.50||| 86664|EAP|0302|EPSTEIN BARR NUCLEAR ANTI|United Healthcare|UNITED HEALTHCARE|||||147.50||| 86665|EAP|0302|EBV VCA IGM|NON CONTRACTED|COMMERCIAL OTHER 1|||||174.75||| 86665|EAP|0302|EPSTEIN-BARR VIRUS IGG|NON CONTRACTED|COMMERCIAL OTHER 1|||||174.75||| 86665|EAP|0302|EPSTEIN-BARR VIRUS IGG|Blue Cross PPO Specialty|BCBSTX PPO|||||174.75||| 86665|EAP|0302|EPSTEIN-BARR VIRUS IGG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|582.50||||174.75||| 86665|EAP|0302|EBV VCA IGM|Blue Cross PPO Specialty|BCBSTX PPO|||||174.75||| 86665|EAP|0302|EBV VCA IGM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|582.50||||174.75||| 86688|EAP|0302|HIV AB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||96.25||| 86688|EAP|0302|HIV AB|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||96.25||| 86688|EAP|0302|HIV AB|Humana Medicare Advantage|HUMANA MA|||||96.25||| 86688|EAP|0302|HIV AB|Managed Medicaid|MEDICAID SUPERIOR|416.65||||96.25||| 86688|EAP|0302|HIV AB|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||96.25||| 86688|EAP|0302|HIV AB|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||96.25||| 86688|EAP|0302|HIV AB|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||96.25||| 86688|EAP|0302|HIV AB|Blue Cross HMO Specialty|BCBSTX HMO|416.65||||96.25||| 86688|EAP|0302|HIV AB|Cigna|CIGNA|||||96.25||| 86688|EAP|0302|HIV AB|Blue Cross PPO Specialty|BCBSTX PPO|||||96.25||| 86688|EAP|0302|HIV AB|Managed Medicaid|MEDICAID AMERIGROUP|||||96.25||| 86688|EAP|0302|HIV AB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|320.50||||96.25||| 86688|EAP|0302|HIV AB|Veterans Affairs|VETERANS ADMINISTRATION|416.65||||||| 86688|EAP|0302|HIV AB|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||96.25||| 86688|EAP|0302|HIV AB|United Medicare Advantage|UHC MEDICARE GOLD MA|||||96.25||| 86688|EAP|0302|HIV AB|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||96.25||| 86688|EAP|0302|HIV AB|Medicaid|MEDICAID|||||96.25||| 86688|EAP|0302|HIV AB|Tricare|TRICARE EAST REGION|||||96.25||| 86688|EAP|0302|HIV AB|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||96.25||| 86688|EAP|0302|HIV AB|NON CONTRACTED|COMMERCIAL OTHER 1|||||96.25||| 86688|EAP|0302|HIV AB|United Healthcare|UNITED HEALTHCARE|||||96.25||| 86688|EAP|0302|HIV AB|Medicare|MEDICARE ACUTE|368.58||||96.25||| 86688|EAP|0302|HIV AB|Medicaid|MEDICAID TEXAS CHILDRENS|||||96.25||| 86688|EAP|0302|HIV AB|United Healthcare|TML GROUP BENEFITS|||||96.25||| 86694|EAP|0302|HERPES SIMPLIX NON SPECIF|NON CONTRACTED|COMMERCIAL OTHER 1|||||138.75||| 86694|EAP|0302|HERPES SIMPLIX NON SPECIF|Medicaid|MEDICAID TEXAS CHILDRENS|||||138.75||| 86694|EAP|0302|HERPES SIMPLIX NON SPECIF|Cigna|CIGNA|||||138.75||| 86694|EAP|0302|HERPES SIMPLIX NON SPECIF|Blue Cross PPO Specialty|BCBSTX PPO|||||138.75||| 86694|EAP|0302|HERPES SIMPLIX NON SPECIF|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||138.75||| 86694|EAP|0302|HERPES SIMPLIX NON SPECIF|Managed Medicaid|MEDICAID AMERIGROUP|||||138.75||| 86695|EAP|0302|HERPES SIMPLEX TYPE 1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.27||| 86695|EAP|0302|HERPES SIMPLEX TYPE 1|Blue Cross PPO Specialty|BCBSTX PPO|||||1.27||| 86695|EAP|0302|HERPES SIMPLEX TYPE 1|Cigna|CIGNA|||||1.27||| 86695|EAP|0302|HERPES SIMPLEX TYPE 1|Managed Medicaid|MEDICAID AMERIGROUP|||||1.27||| 86695|EAP|0302|HERPES SIMPLEX TYPE 1|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.27||| 86695|EAP|0302|HERPES SIMPLEX TYPE 1|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.27||| 86696|EAP|0302|HERPES SIMPLIX TYPE 2|NON CONTRACTED|COMMERCIAL OTHER 1|||||186.50||| 86696|EAP|0302|HERPES SIMPLIX TYPE 2|Medicaid|MEDICAID TEXAS CHILDRENS|||||186.50||| 86696|EAP|0302|HERPES SIMPLIX TYPE 2|Blue Cross PPO Specialty|BCBSTX PPO|||||186.50||| 86696|EAP|0302|HERPES SIMPLIX TYPE 2|Cigna|CIGNA|||||186.50||| 86696|EAP|0302|HERPES SIMPLIX TYPE 2|Managed Medicaid|MEDICAID AMERIGROUP|||||186.50||| 86696|EAP|0302|HERPES SIMPLIX TYPE 2|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||186.50||| 86704|EAP|0302|HEPATITIS B CORE AB|Managed Medicaid|MEDICAID SUPERIOR|||||116.25||| 86704|EAP|0302|HEPATITIS B CORE AB|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||116.25||| 86704|EAP|0302|HEPATITIS B CORE AB|Humana Medicare Advantage|HUMANA MA|387.25||||116.25||| 86704|EAP|0302|HEPATITIS B CORE AB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|503.43||||116.25||| 86704|EAP|0302|HEPATITIS B CORE AB|Managed Medicare|HEALTHSPRING MA|||||116.25||| 86704|EAP|0302|HEPATITIS B CORE AB|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|503.43||||116.25||| 86704|EAP|0302|HEPATITIS B CORE AB|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||116.25||| 86704|EAP|0302|HEPATITIS B CORE AB|Cigna|CIGNA|||||116.25||| 86704|EAP|0302|HEPATITIS B CORE AB|Blue Cross HMO Specialty|BCBSTX HMO|||||116.25||| 86704|EAP|0302|HEPATITIS B CORE AB|Blue Cross PPO Specialty|BCBSTX PPO|387.25||||116.25||| 86704|EAP|0302|HEPATITIS B CORE AB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|387.25||||116.25||| 86704|EAP|0302|HEPATITIS B CORE AB|Managed Medicaid|MEDICAID AMERIGROUP|387.25||||116.25||| 86704|EAP|0302|HEPATITIS B CORE AB|United Medicare Advantage|UHC MEDICARE GOLD MA|387.25||||116.25||| 86704|EAP|0302|HEPATITIS B CORE AB|NON CONTRACTED|COMMERCIAL OTHER 1|||||116.25||| 86704|EAP|0302|HEPATITIS B CORE AB|United Healthcare|UNITED HEALTHCARE|503.43||||116.25||| 86704|EAP|0302|HEPATITIS B CORE AB|United Healthcare|UNITED HEALTHCARE|387.25||||116.25||| 86704|EAP|0302|HEPATITIS B CORE AB|Medicaid|MEDICAID TEXAS CHILDRENS|||||116.25||| 86704|EAP|0302|HEPATITIS B CORE AB|Tricare|TRICARE EAST REGION|||||116.25||| 86704|EAP|0302|HEPATITIS B CORE AB|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||116.25||| 86704|EAP|0302|HEPATITIS B CORE AB|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||116.25||| 86704|EAP|0302|HEPATITIS B CORE AB|Medicaid|MEDICAID|387.25||||116.25||| 86704|EAP|0302|HEPATITIS B CORE AB|Medicare|MEDICARE ACUTE|387.25||||116.25||| 86704|EAP|0302|HEPATITIS B CORE AB|United Healthcare|UNITED HEALTHCARE OTHER|||||116.25||| 86706|EAP|0302|HEP B SURFACE AB QUANTATI|NON CONTRACTED|COMMERCIAL OTHER 1|||||103.50||| 86706|EAP|0302|HEPATITIS B SURF AB|NON CONTRACTED|COMMERCIAL OTHER 1|||||103.50||| 86706|EAP|0302|HEP B SURFACE AB QUANTATI|United Healthcare|UNITED HEALTHCARE OTHER|||||103.50||| 86706|EAP|0302|HEPATITIS B SURF AB|Tricare|TRICARE EAST REGION|||||103.50||| 86706|EAP|0302|HEP B SURFACE AB QUANTATI|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||103.50||| 86706|EAP|0302|HEPATITIS B SURF AB|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||103.50||| 86706|EAP|0302|HEP B SURFACE AB QUANTATI|United Healthcare|UNITED HEALTHCARE|448.50||||103.50||| 86706|EAP|0302|HEP B SURFACE AB QUANTATI|Tricare|TRICARE EAST REGION|||||103.50||| 86706|EAP|0302|HEPATITIS B SURF AB|Medicare|MEDICARE ACUTE|3.45||||103.50||| 86706|EAP|0302|HEP B SURFACE AB QUANTATI|Medicaid|MEDICAID|3.45||||103.50||| 86706|EAP|0302|HEP B SURFACE AB QUANTATI|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||103.50||| 86706|EAP|0302|HEPATITIS B SURF AB|United Healthcare|UNITED HEALTHCARE|448.50||||103.50||| 86706|EAP|0302|HEPATITIS B SURF AB|United Medicare Advantage|UHC MEDICARE GOLD MA|448.50||||103.50||| 86706|EAP|0302|HEP B SURFACE AB QUANTATI|Medicare|MEDICARE ACUTE|3.45||||103.50||| 86706|EAP|0302|HEP B SURFACE AB QUANTATI|United Medicare Advantage|UHC MEDICARE GOLD MA|448.50||||103.50||| 86706|EAP|0302|HEP B SURFACE AB QUANTATI|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|448.50||||103.50||| 86706|EAP|0302|HEP B SURFACE AB QUANTATI|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||103.50||| 86706|EAP|0302|HEPATITIS B SURF AB|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||103.50||| 86706|EAP|0302|HEP B SURFACE AB QUANTATI|Blue Cross HMO Specialty|BCBSTX HMO|||||103.50||| 86706|EAP|0302|HEPATITIS B SURF AB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.45||||103.50||| 86706|EAP|0302|HEPATITIS B SURF AB|Blue Cross PPO Specialty|BCBSTX PPO|448.50||||103.50||| 86706|EAP|0302|HEP B SURFACE AB QUANTATI|Blue Cross PPO Specialty|BCBSTX PPO|448.50||||103.50||| 86706|EAP|0302|HEP B SURFACE AB QUANTATI|Medicaid|MEDICAID TEXAS CHILDRENS|||||103.50||| 86706|EAP|0302|HEPATITIS B SURF AB|Cigna|CIGNA|||||103.50||| 86706|EAP|0302|HEP B SURFACE AB QUANTATI|Cigna|CIGNA|||||103.50||| 86706|EAP|0302|HEP B SURFACE AB QUANTATI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.45||||103.50||| 86706|EAP|0302|HEPATITIS B SURF AB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|448.50||||103.50||| 86706|EAP|0302|HEPATITIS B SURF AB|United Healthcare|UNITED HEALTHCARE OTHER|||||103.50||| 86706|EAP|0302|HEP B SURFACE AB QUANTATI|Managed Medicaid|MEDICAID SUPERIOR|||||103.50||| 86706|EAP|0302|HEP B SURFACE AB QUANTATI|Managed Medicaid|MEDICAID AMERIGROUP|3.45||||103.50||| 86706|EAP|0302|HEP B SURFACE AB QUANTATI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|448.50||||103.50||| 86706|EAP|0302|HEPATITIS B SURF AB|Humana Medicare Advantage|HUMANA MA|448.50||||103.50||| 86706|EAP|0302|HEP B SURFACE AB QUANTATI|Managed Medicare|HEALTHSPRING MA|||||103.50||| 86706|EAP|0302|HEPATITIS B SURF AB|Managed Medicare|HEALTHSPRING MA|||||103.50||| 86706|EAP|0302|HEP B SURFACE AB QUANTATI|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||103.50||| 86706|EAP|0302|HEP B SURFACE AB QUANTATI|Humana Medicare Advantage|HUMANA MA|3.45||||103.50||| 86707|EAP|0302|HEPATITIS BE ANTIBODY|Medicare|MEDICARE ACUTE|||||111.50||| 86707|EAP|0302|HEPATITIS BE ANTIBODY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||111.50||| 86708|EAP|0302|HEPATITIS A AB|United Medicare Advantage|UHC MEDICARE GOLD MA|517.40||||119.50||| 86708|EAP|0302|HEPATITIS A AB|United Healthcare|UNITED HEALTHCARE|517.40||||119.50||| 86708|EAP|0302|HEPATITIS A AB|NON CONTRACTED|COMMERCIAL OTHER 1|||||119.50||| 86708|EAP|0302|HEPATITIS A AB|Tricare|TRICARE EAST REGION|||||119.50||| 86708|EAP|0302|HEPATITIS A AB|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||119.50||| 86708|EAP|0302|HEPATITIS A AB|Medicaid|MEDICAID TEXAS CHILDRENS|||||119.50||| 86708|EAP|0302|HEPATITIS A AB|Medicaid|MEDICAID|3.98||||119.50||| 86708|EAP|0302|HEPATITIS A AB|Medicare|MEDICARE ACUTE|457.70||||119.50||| 86708|EAP|0302|HEPATITIS A AB|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||119.50||| 86708|EAP|0302|HEPATITIS A AB|United Healthcare|UNITED HEALTHCARE OTHER|||||119.50||| 86708|EAP|0302|HEPATITIS A AB|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|517.40||||119.50||| 86708|EAP|0302|HEPATITIS A AB|Cigna|CIGNA|||||119.50||| 86708|EAP|0302|HEPATITIS A AB|Blue Cross PPO Specialty|BCBSTX PPO|517.40||||119.50||| 86708|EAP|0302|HEPATITIS A AB|Blue Cross HMO Specialty|BCBSTX HMO|||||119.50||| 86708|EAP|0302|HEPATITIS A AB|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||119.50||| 86708|EAP|0302|HEPATITIS A AB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.98||||119.50||| 86708|EAP|0302|HEPATITIS A AB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|517.40||||119.50||| 86708|EAP|0302|HEPATITIS A AB|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||119.50||| 86708|EAP|0302|HEPATITIS A AB|Managed Medicaid|MEDICAID SUPERIOR|||||119.50||| 86708|EAP|0302|HEPATITIS A AB|Managed Medicaid|MEDICAID AMERIGROUP|3.98||||119.50||| 86708|EAP|0302|HEPATITIS A AB|Humana Medicare Advantage|HUMANA MA|3.98||||119.50||| 86708|EAP|0302|HEPATITIS A AB|Managed Medicare|HEALTHSPRING MA|||||119.50||| 86710|EAP|0302|FLU A & B|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||130.75||| 86710|EAP|0302|FLU A & B|Medicare|MEDICARE ACUTE|||||130.75||| 86735|EAP|0300|MUMPS|NON CONTRACTED|COMMERCIAL OTHER 1|||||112.25||| 86735|EAP|0300|MUMPS|Tricare|TRICARE EAST REGION|||||112.25||| 86735|EAP|0300|MUMPS|United Healthcare|UNITED HEALTHCARE OTHER|||||112.25||| 86735|EAP|0300|MUMPS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||112.25||| 86735|EAP|0300|MUMPS|Blue Cross PPO Specialty|BCBSTX PPO|||||112.25||| 86747|EAP|0302|PARVOVIRUS IGM/IGG|Humana Medicare Advantage|HUMANA MA|||||1.45||| 86762|EAP|0302|RUBELLA|NON CONTRACTED|COMMERCIAL OTHER 1|||||138.75||| 86762|EAP|0302|RUBELLA|Tricare|TRICARE EAST REGION|||||138.75||| 86762|EAP|0302|RUBELLA|United Healthcare|UNITED HEALTHCARE OTHER|||||138.75||| 86762|EAP|0302|RUBELLA|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||138.75||| 86762|EAP|0302|RUBELLA|Blue Cross PPO Specialty|BCBSTX PPO|||||138.75||| 86762|EAP|0302|RUBELLA|Cigna|CIGNA|||||138.75||| 86769|EAP|0300|SARS-COV-2 COVID-19 ANTIB|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||84.26||| 86769|EAP|0300|SARS/COVID-19,IGG/IGM/IGA|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||84.26||| 86777|EAP|0302|TOXOPLASMA IGG|Blue Cross PPO Specialty|BCBSTX PPO|||||138.80||| 86778|EAP|0302|TOXOPLASMA IGM|Blue Cross PPO Specialty|BCBSTX PPO|||||1.23||| 86787|EAP|0302|VARICELLA-ZOSTER|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.79||| 86787|EAP|0302|VARICELLA-ZOSTER|Tricare|TRICARE EAST REGION|||||0.79||| 86787|EAP|0302|VARICELLA-ZOSTER|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.79||| 86787|EAP|0302|VARICELLA-ZOSTER|United Healthcare|UNITED HEALTHCARE|||||0.79||| 86787|EAP|0302|VARICELLA-ZOSTER|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.79||| 86787|EAP|0302|VARICELLA-ZOSTER|United Healthcare|UNITED HEALTHCARE OTHER|||||0.79||| 86787|EAP|0302|VARICELLA-ZOSTER|Managed Medicaid|MEDICAID AMERIGROUP|||||0.79||| 86787|EAP|0302|VARICELLA-ZOSTER|Cigna|CIGNA|||||0.79||| 86787|EAP|0302|VARICELLA-ZOSTER|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.79||| 86787|EAP|0302|VARICELLA-ZOSTER|Blue Cross PPO Specialty|BCBSTX PPO|||||0.79||| 86787|EAP|0302|VARICELLA-ZOSTER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.79||| 86800|EAP|0302|THYROGLOBULIN ANTIBODY|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||153.25||| 86800|EAP|0302|THYROGLOBULIN ANTIBODY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||153.25||| 86800|EAP|0302|THYROGLOBULIN ANTIBODY|Blue Cross PPO Specialty|BCBSTX PPO|||||153.25||| 86800|EAP|0302|THYROGLOBULIN ANTIBODY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||153.25||| 86800|EAP|0302|THYROGLOBULIN ANTIBODY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||153.25||| 86800|EAP|0302|THYROGLOBULIN ANTIBODY|Managed Medicaid|MEDICAID SUPERIOR|||||153.25||| 86800|EAP|0302|THYROGLOBULIN ANTIBODY|United Healthcare|UNITED HEALTHCARE|||||153.25||| 86800|EAP|0302|THYROGLOBULIN ANTIBODY|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||153.25||| 86800|EAP|0302|THYROGLOBULIN ANTIBODY|NON CONTRACTED|COMMERCIAL OTHER 1|||||153.25||| 86800|EAP|0302|THYROGLOBULIN ANTIBODY|Tricare|TRICARE EAST REGION|||||153.25||| 86800|EAP|0302|THYROGLOBULIN ANTIBODY|Medicare|MEDICARE ACUTE|||||153.25||| 86800|EAP|0302|THYROGLOBULIN ANTIBODY|Medicaid|MEDICAID TEXAS CHILDRENS|||||153.25||| 86803|EAP|0302|HEPATITIS C AB|NON CONTRACTED|COMMERCIAL OTHER 1|||||137.50||| 86803|EAP|0302|HEPATITIS C AB|PHCS|HUMANA INSURANCE|||||137.50||| 86803|EAP|0302|HEPATITIS C AB|Medicaid|MEDICAID TEXAS CHILDRENS|||||137.50||| 86803|EAP|0302|HEPATITIS C AB|Medicaid|MEDICAID|458.50||||137.50||| 86803|EAP|0302|HEPATITIS C AB|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||137.50||| 86803|EAP|0302|HEPATITIS C AB|Medicare|MEDICARE ACUTE|527.28||||137.50||| 86803|EAP|0302|HEPATITIS C AB|Veterans Affairs|VETERANS ADMINISTRATION|596.05||||||| 86803|EAP|0302|HEPATITIS C AB|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||137.50||| 86803|EAP|0302|HEPATITIS C AB|United Medicare Advantage|UHC MEDICARE GOLD MA|596.05||||137.50||| 86803|EAP|0302|HEPATITIS C AB|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||137.50||| 86803|EAP|0302|HEPATITIS C AB|United Healthcare|UNITED HEALTHCARE|596.05||||137.50||| 86803|EAP|0302|HEPATITIS C AB|United Healthcare|TML GROUP BENEFITS|||||137.50||| 86803|EAP|0302|HEPATITIS C AB|United Healthcare|UNITED HEALTHCARE OTHER|||||137.50||| 86803|EAP|0302|HEPATITIS C AB|Managed Medicare|HEALTHSPRING MA|||||137.50||| 86803|EAP|0302|HEPATITIS C AB|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||137.50||| 86803|EAP|0302|HEPATITIS C AB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|596.05||||137.50||| 86803|EAP|0302|HEPATITIS C AB|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||137.50||| 86803|EAP|0302|HEPATITIS C AB|Humana Medicare Advantage|HUMANA MA|527.28||||137.50||| 86803|EAP|0302|HEPATITIS C AB|Tricare|TRICARE EAST REGION|||||137.50||| 86803|EAP|0302|HEPATITIS C AB|Medicaid|MORRIS COUNTY INDIGENT|||||137.50||| 86803|EAP|0302|HEPATITIS C AB|Managed Medicaid|MEDICAID SUPERIOR|||||137.50||| 86803|EAP|0302|HEPATITIS C AB|Managed Medicaid|MEDICAID AMERIGROUP|458.50||||137.50||| 86803|EAP|0302|HEPATITIS C AB|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||137.50||| 86803|EAP|0302|HEPATITIS C AB|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||137.50||| 86803|EAP|0302|HEPATITIS C AB|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|596.05||||137.50||| 86803|EAP|0302|HEPATITIS C AB|Aenta Medicare Advantage|AETNA MEDICARE MA|||||137.50||| 86803|EAP|0302|HEPATITIS C AB|Blue Cross HMO Specialty|BCBSTX HMO|||||137.50||| 86803|EAP|0302|HEPATITIS C AB|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||137.50||| 86803|EAP|0302|HEPATITIS C AB|Blue Cross PPO Specialty|BCBSTX PPO|527.28||||137.50||| 86803|EAP|0302|HEPATITIS C AB|Cigna|CIGNA|||||137.50||| 86803|EAP|0302|HEPATITIS C AB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|458.50||||137.50||| 86812|EAP|0302|HLA TYPING|Blue Cross PPO Specialty|BCBSTX PPO|||||248.75||| 86812|EAP|0302|HLA TYPING|Medicare|MEDICARE ACUTE|||||248.75||| 86812|EAP|0302|HLA TYPING|Tricare|TRICARE EAST REGION|||||248.75||| 86812|EAP|0302|HLA TYPING|NON CONTRACTED|COMMERCIAL OTHER 1|1,077.70||||||| 86812|EAP|0302|HLA TYPING|Managed Medicaid|MEDICAID AMERIGROUP|||||248.75||| 86850|EAP|0302|ANTIBODY SCREEN|Veterans Affairs|VETERANS ADMINISTRATION|||||189.48||| 86850|EAP|0302|ANTIBODY SCREEN|Veterans Affairs|VETERANS ADMINISTRATION|||||145.75||| 86850|EAP|0302|ANTIBODY SCREEN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||145.75||| 86850|EAP|0302|ANTIBODY SCREEN|United Medicare Advantage|UHC MEDICARE GOLD MA|189.48||||145.75||| 86850|EAP|0302|ANTIBODY SCREEN|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||145.75||| 86850|EAP|0302|ANTIBODY SCREEN|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||145.75||| 86850|EAP|0302|ANTIBODY SCREEN|Medicaid|MORRIS COUNTY INDIGENT|||||145.75||| 86850|EAP|0302|ANTIBODY SCREEN|NON CONTRACTED|COMMERCIAL OTHER 1|||||189.48||| 86850|EAP|0302|ANTIBODY SCREEN|Medicaid|MEDICAID|145.75||||145.75||| 86850|EAP|0302|ANTIBODY SCREEN|Tricare|TRICARE EAST REGION|145.75||||189.48||| 86850|EAP|0302|ANTIBODY SCREEN|Medicare|MEDICARE ACUTE|189.48||||189.48||| 86850|EAP|0302|ANTIBODY SCREEN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||189.48||| 86850|EAP|0302|ANTIBODY SCREEN|United Healthcare|UNITED HEALTHCARE|189.48||||145.75||| 86850|EAP|0302|ANTIBODY SCREEN|Managed Medicaid|MEDICAID SUPERIOR|145.75||||145.75||| 86850|EAP|0302|ANTIBODY SCREEN|Managed Medicaid|MEDICAID AMERIGROUP|145.75||||189.48||| 86850|EAP|0302|ANTIBODY SCREEN|Humana Medicare Advantage|HUMANA MA|145.75||||145.75||| 86850|EAP|0302|ANTIBODY SCREEN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||189.48||| 86850|EAP|0302|ANTIBODY SCREEN|United Healthcare|UNITED HEALTHCARE|||||167.62||| 86850|EAP|0302|ANTIBODY SCREEN|Managed Medicare|HEALTHSPRING MA|145.75||||||| 86850|EAP|0302|ANTIBODY SCREEN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|189.48||||145.75||| 86850|EAP|0302|ANTIBODY SCREEN|Access Direct Platinum|HEALTHFIRST TPA UMR|145.75||||||| 86850|EAP|0302|ANTIBODY SCREEN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||167.62||| 86850|EAP|0302|ANTIBODY SCREEN|Aenta Medicare Advantage|AETNA MEDICARE MA|||||189.48||| 86850|EAP|0302|ANTIBODY SCREEN|Blue Cross HMO Specialty|BCBSTX HMO|||||167.62||| 86850|EAP|0302|ANTIBODY SCREEN|Aetna|AETNA PPO|||||189.48||| 86850|EAP|0302|ANTIBODY SCREEN|Blue Cross PPO Specialty|BCBSTX PPO|145.75||||145.75||| 86850|EAP|0302|ANTIBODY SCREEN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|145.75||||189.48||| 86850|EAP|0302|ANTIBODY SCREEN|Cigna|CIGNA|||||145.75||| 86850|EAP|0302|ANTIBODY SCREEN|Cigna|CIGNA|||||189.48||| 86900|EAP|0300|BLOOD TYPE ABO|Humana Medicare Advantage|HUMANA MA|95.75||||95.75||| 86900|EAP|0300|BLOOD TYPE ABO|Managed Medicare|HEALTHSPRING MA|95.75||||||| 86900|EAP|0300|BLOOD TYPE ABO|Managed Medicaid|MEDICAID AMERIGROUP|95.75||||124.48||| 86900|EAP|0300|BLOOD TYPE ABO|Managed Medicaid|MEDICAID SUPERIOR|95.75||||95.75||| 86900|EAP|0300|BLOOD TYPE ABO|NON CONTRACTED|COMMERCIAL OTHER 1|||||95.75||| 86900|EAP|0300|BLOOD TYPE ABO|Medicaid|MEDICAID|95.75||||95.75||| 86900|EAP|0300|BLOOD TYPE ABO|Medicaid|MORRIS COUNTY INDIGENT|||||95.75||| 86900|EAP|0300|BLOOD TYPE ABO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||124.48||| 86900|EAP|0300|BLOOD TYPE ABO|Medicare|MEDICARE ACUTE|124.48||||95.75||| 86900|EAP|0300|BLOOD TYPE ABO|Tricare|TRICARE EAST REGION|95.75||||124.48||| 86900|EAP|0300|BLOOD TYPE ABO|United Healthcare|UNITED HEALTHCARE|124.48||||95.75||| 86900|EAP|0300|BLOOD TYPE ABO|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||95.75||| 86900|EAP|0300|BLOOD TYPE ABO|United Healthcare|UNITED HEALTHCARE|||||95.75||| 86900|EAP|0300|BLOOD TYPE ABO|Veterans Affairs|VETERANS ADMINISTRATION|||||124.48||| 86900|EAP|0300|BLOOD TYPE ABO|United Medicare Advantage|UHC MEDICARE GOLD MA|124.48||||95.75||| 86900|EAP|0300|BLOOD TYPE ABO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||95.75||| 86900|EAP|0300|BLOOD TYPE ABO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||95.75||| 86900|EAP|0300|BLOOD TYPE ABO|Veterans Affairs|VETERANS ADMINISTRATION|||||95.75||| 86900|EAP|0300|BLOOD TYPE ABO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||124.48||| 86900|EAP|0300|BLOOD TYPE ABO|Access Direct Platinum|HEALTHFIRST TPA UMR|95.75||||||| 86900|EAP|0300|BLOOD TYPE ABO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|124.48||||95.75||| 86900|EAP|0300|BLOOD TYPE ABO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||95.75||| 86900|EAP|0300|BLOOD TYPE ABO|Blue Cross PPO Specialty|BCBSTX PPO|95.75||||95.75||| 86900|EAP|0300|BLOOD TYPE ABO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|95.75||||95.75||| 86900|EAP|0300|BLOOD TYPE ABO|Cigna|CIGNA|||||95.75||| 86900|EAP|0300|BLOOD TYPE ABO|Aetna|AETNA PPO|||||124.48||| 86900|EAP|0300|BLOOD TYPE ABO|Cigna|CIGNA|||||124.48||| 86900|EAP|0300|BLOOD TYPE ABO|Blue Cross HMO Specialty|BCBSTX HMO|||||110.12||| 86900|EAP|0300|BLOOD TYPE ABO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||124.48||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|Veterans Affairs|VETERANS ADMINISTRATION|||||95.75||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||95.75||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|United Medicare Advantage|UHC MEDICARE GOLD MA|124.48||||95.75||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||95.75||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|NON CONTRACTED|COMMERCIAL OTHER 1|||||95.75||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|Medicaid|MORRIS COUNTY INDIGENT|||||95.75||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|Medicaid|MEDICAID|95.75||||95.75||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|Medicare|MEDICARE ACUTE|124.48||||124.48||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|United Healthcare|UNITED HEALTHCARE|124.48||||110.12||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|United Healthcare|UNITED HEALTHCARE|||||95.75||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|Tricare|TRICARE EAST REGION|95.75||||124.48||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||95.75||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||124.48||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||124.48||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|Managed Medicaid|MEDICAID AMERIGROUP|95.75||||95.75||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|Managed Medicaid|MEDICAID SUPERIOR|95.75||||95.75||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|Humana Medicare Advantage|HUMANA MA|95.75||||95.75||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|Veterans Affairs|VETERANS ADMINISTRATION|||||124.48||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|Managed Medicare|HEALTHSPRING MA|95.75||||||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|Aenta Medicare Advantage|AETNA MEDICARE MA|||||124.48||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|Blue Cross HMO Specialty|BCBSTX HMO|||||110.12||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|124.48||||95.75||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|Access Direct Platinum|HEALTHFIRST TPA UMR|95.75||||||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||95.75||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|Blue Cross PPO Specialty|BCBSTX PPO|95.75||||95.75||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|Cigna|CIGNA|||||95.75||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|95.75||||110.12||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|Aetna|AETNA PPO|||||124.48||| 86901|EAP|0300|BLOOD TYPE RH FACTOR|Cigna|CIGNA|||||124.48||| 86922|EAP|0300|COOMBS X MATCH|Aenta Medicare Advantage|AETNA MEDICARE MA|||||216.78||| 86922|EAP|0300|COOMBS X MATCH|Blue Cross PPO Specialty|BCBSTX PPO|166.75||||216.78||| 86922|EAP|0300|COOMBS X MATCH|Cigna|CIGNA|||||166.75||| 86922|EAP|0300|COOMBS X MATCH|Managed Medicaid|MEDICAID AMERIGROUP|||||216.78||| 86922|EAP|0300|COOMBS X MATCH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||166.75||| 86922|EAP|0300|COOMBS X MATCH|Humana Medicare Advantage|HUMANA MA|166.75||||166.75||| 86922|EAP|0300|COOMBS X MATCH|Managed Medicaid|MEDICAID SUPERIOR|166.75||||166.75||| 86922|EAP|0300|COOMBS X MATCH|Managed Medicare|HEALTHSPRING MA|166.75||||||| 86922|EAP|0300|COOMBS X MATCH|NON CONTRACTED|COMMERCIAL OTHER 1|||||216.78||| 86922|EAP|0300|COOMBS X MATCH|Medicaid|MEDICAID|166.75||||166.75||| 86922|EAP|0300|COOMBS X MATCH|Medicare|MEDICARE ACUTE|216.78||||216.78||| 86922|EAP|0300|COOMBS X MATCH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||166.75||| 86922|EAP|0300|COOMBS X MATCH|Tricare|TRICARE EAST REGION|||||216.78||| 86922|EAP|0300|COOMBS X MATCH|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||166.75||| 86922|EAP|0300|COOMBS X MATCH|United Healthcare|UNITED HEALTHCARE|216.78||||166.75||| 86922|EAP|0300|COOMBS X MATCH|Veterans Affairs|VETERANS ADMINISTRATION|||||216.78||| 86922|EAP|0300|COOMBS X MATCH|United Medicare Advantage|UHC MEDICARE GOLD MA|166.75||||166.75||| 86922|EAP|0300|COOMBS X MATCH|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||166.75||| 86922|EAP|0300|COOMBS X MATCH|Veterans Affairs|VETERANS ADMINISTRATION|||||166.75||| 86922|EAP|0300|COOMBS X MATCH|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||166.75||| 87040|EAP|0306|BLOOD CULTURE|Veterans Affairs|VETERANS ADMINISTRATION|331.50||||331.50||| 87040|EAP|0306|BLOOD CULTURE|Workers Compensation|WORKERS COMPENSATION OTHER|||||331.50||| 87040|EAP|0306|BLOOD CULTURE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|331.50||||331.50||| 87040|EAP|0306|BLOOD CULTURE|United Medicare Advantage|UHC MEDICARE GOLD MA|331.50||||331.50||| 87040|EAP|0306|BLOOD CULTURE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||331.50||| 87040|EAP|0306|BLOOD CULTURE|United Healthcare|UNITED HEALTHCARE OTHER|331.50||||331.50||| 87040|EAP|0306|BLOOD CULTURE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||331.50||| 87040|EAP|0306|BLOOD CULTURE|United Healthcare|TML GROUP BENEFITS|||||331.50||| 87040|EAP|0306|BLOOD CULTURE|United Healthcare|UNITED HEALTHCARE|331.50||||331.50||| 87040|EAP|0306|BLOOD CULTURE|NON CONTRACTED|COMMERCIAL OTHER 1|331.50||||331.50||| 87040|EAP|0306|BLOOD CULTURE|Tricare|TRICARE EAST REGION|331.50||||331.50||| 87040|EAP|0306|BLOOD CULTURE|Medicare|MEDICARE ACUTE|331.50||||331.50||| 87040|EAP|0306|BLOOD CULTURE|Medicaid|MORRIS COUNTY INDIGENT|||||331.50||| 87040|EAP|0306|BLOOD CULTURE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||331.50||| 87040|EAP|0306|BLOOD CULTURE|Medicaid|MEDICAID TEXAS CHILDRENS|331.50||||331.50||| 87040|EAP|0306|BLOOD CULTURE|Medicaid|MEDICAID|331.50||||331.50||| 87040|EAP|0306|BLOOD CULTURE|United Healthcare|UNITED HEALTHCARE|||||331.50||| 87040|EAP|0306|BLOOD CULTURE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||331.50||| 87040|EAP|0306|BLOOD CULTURE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|331.50||||331.50||| 87040|EAP|0306|BLOOD CULTURE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|331.50||||331.50||| 87040|EAP|0306|BLOOD CULTURE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|331.50||||331.50||| 87040|EAP|0306|BLOOD CULTURE|Managed Medicaid|MEDICAID SUPERIOR|331.50||||331.50||| 87040|EAP|0306|BLOOD CULTURE|Humana Medicare Advantage|HUMANA MA|331.50||||331.50||| 87040|EAP|0306|BLOOD CULTURE|Managed Medicaid|MEDICAID AMERIGROUP|215.50||||331.50||| 87040|EAP|0306|BLOOD CULTURE|Veterans Affairs|VETERANS ADMINISTRATION|||||331.50||| 87040|EAP|0306|BLOOD CULTURE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||331.50||| 87040|EAP|0306|BLOOD CULTURE|Managed Medicare|HEALTHSPRING MA|||||331.50||| 87040|EAP|0306|BLOOD CULTURE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|331.50||||331.50||| 87040|EAP|0306|BLOOD CULTURE|Aenta Medicare Advantage|AETNA MEDICARE MA|331.50||||331.50||| 87040|EAP|0306|BLOOD CULTURE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|331.50||||331.50||| 87040|EAP|0306|BLOOD CULTURE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|331.50||||||| 87040|EAP|0306|BLOOD CULTURE|Blue Cross HMO Specialty|BCBSTX HMO|331.50||||331.50||| 87040|EAP|0306|BLOOD CULTURE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|331.50||||331.50||| 87040|EAP|0306|BLOOD CULTURE|Aetna|AETNA PPO|||||331.50||| 87040|EAP|0306|BLOOD CULTURE|Aetna|AETNA OTHER|331.50||||331.50||| 87040|EAP|0306|BLOOD CULTURE|Blue Cross PPO Specialty|BCBSTX PPO|331.50||||331.50||| 87040|EAP|0306|BLOOD CULTURE|Cigna|CIGNA|331.50||||331.50||| 87045|EAP|0306|STOOL CULTURE|Aenta Medicare Advantage|AETNA MEDICARE MA|2.57||||0.91||| 87045|EAP|0306|STOOL CULTURE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.91||| 87045|EAP|0306|STOOL CULTURE|Blue Cross HMO Specialty|BCBSTX HMO|||||0.91||| 87045|EAP|0306|STOOL CULTURE|Blue Cross PPO Specialty|BCBSTX PPO|2.57||||0.91||| 87045|EAP|0306|STOOL CULTURE|Aetna|AETNA PPO|||||0.91||| 87045|EAP|0306|STOOL CULTURE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|2.57||||0.91||| 87045|EAP|0306|STOOL CULTURE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.91||| 87045|EAP|0306|STOOL CULTURE|Managed Medicaid|MEDICAID AMERIGROUP|||||0.91||| 87045|EAP|0306|STOOL CULTURE|Managed Medicaid|MEDICAID SUPERIOR|2.57||||0.91||| 87045|EAP|0306|STOOL CULTURE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.91||| 87045|EAP|0306|STOOL CULTURE|Humana Medicare Advantage|HUMANA MA|2.57||||0.91||| 87045|EAP|0306|STOOL CULTURE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.91||| 87045|EAP|0306|STOOL CULTURE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.57||||0.91||| 87045|EAP|0306|STOOL CULTURE|NON CONTRACTED|COMMERCIAL OTHER 1|2.57||||0.91||| 87045|EAP|0306|STOOL CULTURE|Medicare|MEDICARE PART B ONLY IP|2.57||||||| 87045|EAP|0306|STOOL CULTURE|Medicare|MEDICARE ACUTE|2.57||||0.91||| 87045|EAP|0306|STOOL CULTURE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.91||| 87045|EAP|0306|STOOL CULTURE|Medicaid|MEDICAID|||||0.91||| 87045|EAP|0306|STOOL CULTURE|Veterans Affairs|VETERANS ADMINISTRATION|2.57||||||| 87045|EAP|0306|STOOL CULTURE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.91||| 87045|EAP|0306|STOOL CULTURE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.91||| 87045|EAP|0306|STOOL CULTURE|United Healthcare|UNITED HEALTHCARE OTHER|||||2.57||| 87045|EAP|0306|STOOL CULTURE|United Healthcare|UNITED HEALTHCARE|||||0.91||| 8707|EAP|0306||United Healthcare|UNITED HEALTHCARE OTHER|||||0.78||| 8707|EAP|0306||Medicaid|MEDICAID|||||1.49||| 8707|EAP|0306||Medicaid|MEDICAID TEXAS CHILDRENS|||||0.78||| 8707|EAP|0306||Managed Medicaid|MEDICAID SUPERIOR|||||0.78||| 8707|EAP|0306||Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.78||| 8707|EAP|0306||Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.78||| 8707|EAP|0306||Managed Medicaid|MEDICAID AMERIGROUP|||||0.78||| 87070|EAP|0306|WOUND CULTURE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||276.50||| 87070|EAP|0306|THROAT CULTURE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.83||| 87070|EAP|0306|BODY FLUID CULTURE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.83||| 87070|EAP|0306|BODY FLUID CULTURE|Blue Cross PPO Specialty|BCBSTX PPO|276.50||||276.50||| 87070|EAP|0306|THROAT CULTURE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.83||| 87070|EAP|0306|THROAT CULTURE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||0.83||| 87070|EAP|0306|THROAT CULTURE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|276.50||||0.83||| 87070|EAP|0306|CULTURE SPUTUM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.83||| 87070|EAP|0306|THROAT CULTURE|Blue Cross HMO Specialty|BCBSTX HMO|276.50||||0.83||| 87070|EAP|0306|CULTURE SPUTUM|Cigna|CIGNA|276.50||||||| 87070|EAP|0306|CULTURE SPUTUM|Blue Cross PPO Specialty|BCBSTX PPO|276.50||||179.75||| 87070|EAP|0306|WOUND CULTURE|Blue Cross PPO Specialty|BCBSTX PPO|276.50||||0.83||| 87070|EAP|0306|THROAT CULTURE|Blue Cross PPO Specialty|BCBSTX PPO|276.50||||0.83||| 87070|EAP|0306|THROAT CULTURE|Cigna|CIGNA|276.50||||0.83||| 87070|EAP|0306|WOUND CULTURE|Cigna|CIGNA|276.50||||0.83||| 87070|EAP|0306|THROAT CULTURE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|276.50||||0.83||| 87070|EAP|0306|WOUND CULTURE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|179.75||||0.83||| 87070|EAP|0306||Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|276.50||||0.78||| 87070|EAP|0306|BODY FLUID CULTURE|Managed Medicaid|MEDICAID SUPERIOR|||||276.50||| 87070|EAP|0306|THROAT CULTURE|Managed Medicaid|MEDICAID AMERIGROUP|||||0.83||| 87070|EAP|0306|CULTURE SPUTUM|Managed Medicaid|MEDICAID SUPERIOR|||||0.83||| 87070|EAP|0306|THROAT CULTURE|Managed Medicaid|MEDICAID SUPERIOR|||||0.83||| 87070|EAP|0306|CULTURE SPUTUM|Managed Medicaid|MEDICAID AMERIGROUP|||||0.83||| 87070|EAP|0306|BODY FLUID CULTURE|Humana Medicare Advantage|HUMANA MA|276.50||||276.50||| 87070|EAP|0306|THROAT CULTURE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|179.75||||0.83||| 87070|EAP|0306|CULTURE SPUTUM|Humana Medicare Advantage|HUMANA MA|276.50||||276.50||| 87070|EAP|0306|WOUND CULTURE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|276.50||||0.83||| 87070|EAP|0306|THROAT CULTURE|Managed Medicare|BCBS MEDICARE PPO MA|||||0.83||| 87070|EAP|0306|CULTURE SPUTUM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|179.75||||276.50||| 87070|EAP|0306|CULTURE SPUTUM|Managed Medicare|HEALTHSPRING MA|276.50||||0.83||| 87070|EAP|0306|WOUND CULTURE|Humana Medicare Advantage|HUMANA MA|276.50||||0.83||| 87070|EAP|0306|WOUND CULTURE|Managed Medicaid|MEDICAID AMERIGROUP|||||179.75||| 87070|EAP|0306|WOUND CULTURE|NON CONTRACTED|COMMERCIAL OTHER 1|276.50||||0.83||| 87070|EAP|0306|WOUND CULTURE|Managed Medicaid|MEDICAID SUPERIOR|||||0.83||| 87070|EAP|0306|CULTURE SPUTUM|NON CONTRACTED|COMMERCIAL OTHER 1|276.50||||276.50||| 87070|EAP|0306|BODY FLUID CULTURE|NON CONTRACTED|COMMERCIAL OTHER 1|276.50||||276.50||| 87070|EAP|0306|THROAT CULTURE|NON CONTRACTED|COMMERCIAL OTHER 1|276.50||||0.83||| 87070|EAP|0306|THROAT CULTURE|Tricare|TRICARE EAST REGION|||||0.83||| 87070|EAP|0306|WOUND CULTURE|Managed Medicare|HEALTHSPRING MA|276.50||||276.50||| 87070|EAP|0306|CULTURE SPUTUM|Medicare|MEDICARE ACUTE|276.50||||0.83||| 87070|EAP|0306|WOUND CULTURE|Medicare|MEDICARE ACUTE|276.50||||0.83||| 87070|EAP|0306|BODY FLUID CULTURE|Medicare|MEDICARE ACUTE|276.50||||276.50||| 87070|EAP|0306|THROAT CULTURE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.83||| 87070|EAP|0306|THROAT CULTURE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.83||| 87070|EAP|0306|THROAT CULTURE|Medicaid|MEDICAID TEXAS CHILDRENS|||||0.83||| 87070|EAP|0306|THROAT CULTURE|Medicaid|MEDICAID|||||0.83||| 87070|EAP|0306|CULTURE SPUTUM|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.83||| 87070|EAP|0306|WOUND CULTURE|Blue Cross HMO Specialty|BCBSTX HMO|276.50||||0.83||| 87070|EAP|0306|THROAT CULTURE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|276.50||||0.83||| 87070|EAP|0306|WOUND CULTURE|Medicaid|MEDICAID|||||276.50||| 87070|EAP|0306|BODY FLUID CULTURE|United Healthcare|UNITED HEALTHCARE|276.50||||276.50||| 87070|EAP|0306|THROAT CULTURE|United Healthcare|UNITED HEALTHCARE OTHER|||||0.83||| 87070|EAP|0306|THROAT CULTURE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.83||| 87070|EAP|0306|CULTURE SPUTUM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||276.50||| 87070|EAP|0306|THROAT CULTURE|United Healthcare|UNITED HEALTHCARE|276.50||||0.83||| 87070|EAP|0306|WOUND CULTURE|United Healthcare|UNITED HEALTHCARE|276.50||||179.75||| 87070|EAP|0306|WOUND CULTURE|United Healthcare|UNITED HEALTHCARE|||||179.75||| 87070|EAP|0306|CULTURE SPUTUM|United Healthcare|UNITED HEALTHCARE|||||0.83||| 87070|EAP|0306|CULTURE SPUTUM|United Healthcare|TML GROUP BENEFITS|||||276.50||| 87070|EAP|0306|CULTURE SPUTUM|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|276.50||||||| 87070|EAP|0306|WOUND CULTURE|United Medicare Advantage|UHC MEDICARE GOLD MA|276.50||||0.83||| 87070|EAP|0306|THROAT CULTURE|United Medicare Advantage|UHC MEDICARE GOLD MA|276.50||||0.83||| 87070|EAP|0306|CULTURE SPUTUM|United Medicare Advantage|UHC MEDICARE GOLD MA|276.50||||276.50||| 87070|EAP|0306|CULTURE SPUTUM|Veterans Affairs|VETERANS ADMINISTRATION|||||276.50||| 87070|EAP|0306|THROAT CULTURE|United Healthcare|TML GROUP BENEFITS|||||0.83||| 87070|EAP|0306|THROAT CULTURE|United Healthcare|UNITED HEALTHCARE|||||0.83||| 87070|EAP|0306|WOUND CULTURE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.83||| 87076|EAP|0300|ANAEROBIC ID|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.66||| 87076|EAP|0300|ANAEROBIC ID|Medicare|MEDICARE ACUTE|||||0.66||| 87076|EAP|0300|ANAEROBIC ID|United Healthcare|UNITED HEALTHCARE|||||0.66||| 87076|EAP|0300|ANAEROBIC ID|Humana Medicare Advantage|HUMANA MA|||||2.20||| 87076|EAP|0300|ANAEROBIC ID|Blue Cross PPO Specialty|BCBSTX PPO|2.20||||||| 87077|EAP|0306|AEROBIC ID|Aenta Medicare Advantage|AETNA MEDICARE MA|2.20||||2.20||| 87077|EAP|0306|AEROBIC ID|Access Direct Platinum|HEALTHFIRST TPA UMR|||||0.78||| 87077|EAP|0306|AEROBIC ID|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.20||||0.78||| 87077|EAP|0306|AEROBIC ID|Blue Cross HMO Specialty|BCBSTX HMO|||||0.78||| 87077|EAP|0306|AEROBIC ID|Cigna|CIGNA|2.20||||0.78||| 87077|EAP|0306|AEROBIC ID|Aetna|AETNA OTHER|2.20||||2.20||| 87077|EAP|0306|AEROBIC ID|Blue Cross PPO Specialty|BCBSTX PPO|2.20||||0.78||| 87077|EAP|0306|AEROBIC ID|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2.20||| 87077|EAP|0306|AEROBIC ID|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.78||| 87077|EAP|0306|AEROBIC ID|Managed Medicare|HEALTHSPRING MA|2.20||||2.20||| 87077|EAP|0306|AEROBIC ID|Managed Medicaid|MEDICAID SUPERIOR|2.20||||0.78||| 87077|EAP|0306|AEROBIC ID|Managed Medicaid|MEDICAID AMERIGROUP|2.20||||0.78||| 87077|EAP|0306|AEROBIC ID|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.20||||2.20||| 87077|EAP|0306|AEROBIC ID|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.49||||2.20||| 87077|EAP|0306|AEROBIC ID|Humana Medicare Advantage|HUMANA MA|2.20||||0.78||| 87077|EAP|0306|AEROBIC ID|NON CONTRACTED|COMMERCIAL OTHER 1|2.20||||0.78||| 87077|EAP|0306|AEROBIC ID|PHCS|GROUP AND PENSION|||||0.78||| 87077|EAP|0306|AEROBIC ID|PHCS|HUMANA INSURANCE|||||0.78||| 87077|EAP|0306|AEROBIC ID|Tricare|TRICARE FOR LIFE|||||2.20||| 87077|EAP|0306|AEROBIC ID|Medicare|MEDICARE ACUTE|2.20||||0.78||| 87077|EAP|0306|AEROBIC ID|Tricare|TRICARE EAST REGION|2.20||||0.78||| 87077|EAP|0306|AEROBIC ID|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.78||| 87077|EAP|0306|AEROBIC ID|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.78||| 87077|EAP|0306|AEROBIC ID|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.78||| 87077|EAP|0306|AEROBIC ID|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.20||| 87077|EAP|0306|AEROBIC ID|Medicaid|MEDICAID HMO|||||2.20||| 87077|EAP|0306|AEROBIC ID|Medicaid|MEDICAID|2.20||||2.20||| 87077|EAP|0306|AEROBIC ID|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.78||| 87077|EAP|0306|AEROBIC ID|Veterans Affairs|VETERANS ADMINISTRATION|2.20||||2.20||| 87077|EAP|0306|AEROBIC ID|United Healthcare|UNITED HEALTHCARE OTHER|||||0.78||| 87077|EAP|0306|AEROBIC ID|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.78||| 87077|EAP|0306|AEROBIC ID|United Healthcare|GEHA|||||0.78||| 87077|EAP|0306|AEROBIC ID|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.78||| 87077|EAP|0306|AEROBIC ID|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.20||||0.78||| 87077|EAP|0306|AEROBIC ID|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.78||| 87077|EAP|0306|AEROBIC ID|United Healthcare|UNITED HEALTHCARE|2.20||||0.78||| 87077|EAP|0306|AEROBIC ID|United Medicare Advantage|UHC MEDICARE GOLD MA|2.20||||0.78||| 87081|EAP|0306|GC CULTURE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.64||| 87081|EAP|0306|GC CULTURE|Managed Medicaid|MEDICAID SUPERIOR|||||0.64||| 87081|EAP|0306|GC CULTURE|Blue Cross HMO Specialty|BCBSTX HMO|213.25||||||| 87081|EAP|0306|CULTURE STREP|Blue Cross HMO Specialty|BCBSTX HMO|213.25||||||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|259.50||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||259.50||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|259.50||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Access Direct Platinum|HEALTHFIRST TPA UMR|||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|259.50||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Cigna|CIGNA|259.50||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Cigna|CIGNA|259.50||||259.50||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Blue Cross HMO Specialty|BCBSTX HMO|259.50||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Blue Cross PPO Specialty|BCBSTX OTHER|||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Aetna|AETNA PPO|||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Aetna|AETNA OTHER|||||259.50||| 87086|EAP|0306|URINE CULTURE COLONY COUN|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|259.50||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|259.50||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Managed Medicaid|MEDICAID AMERIGROUP|0.78||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Managed Medicare|HEALTHSPRING MA|259.50||||259.50||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Managed Medicaid|MEDICAID SUPERIOR|259.50||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Humana Medicare Advantage|HUMANA MA|259.50||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|NON CONTRACTED|COMMERCIAL OTHER 1|259.50||||259.50||| 87086|EAP|0306|URINE CULTURE COLONY COUN|PHCS|GROUP AND PENSION|||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|PHCS|HUMANA INSURANCE|||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Tricare|TRICARE FOR LIFE|||||259.50||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Tricare|TRICARE EAST REGION|259.50||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Medicare|MEDICARE ACUTE|259.50||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Medicaid|MEDICAID TEXAS CHILDRENS|259.50||||259.50||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Blue Cross PPO Specialty|BCBSTX PPO|259.50||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||259.50||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Medicaid|MORRIS COUNTY INDIGENT|||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Medicaid|MEDICAID HMO|||||259.50||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Medicaid|MEDICAID|259.50||||259.50||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Aenta Medicare Advantage|AETNA MEDICARE MA|259.50||||259.50||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Veterans Affairs|VETERANS ADMINISTRATION|259.50||||259.50||| 87086|EAP|0306|URINE CULTURE COLONY COUN|Veterans Affairs|VETERANS ADMINISTRATION|||||259.50||| 87086|EAP|0306|URINE CULTURE COLONY COUN|United Healthcare|TML GROUP BENEFITS|||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|United Healthcare|UNITED HEALTHCARE OTHER|||||259.50||| 87086|EAP|0306|URINE CULTURE COLONY COUN|United Healthcare|UNITED HEALTHCARE|259.50||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||259.50||| 87086|EAP|0306|URINE CULTURE COLONY COUN|United Healthcare|GEHA|||||168.75||| 87086|EAP|0306|URINE CULTURE COLONY COUN|United Healthcare|UNITED HEALTHCARE|||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|259.50||||168.75||| 87086|EAP|0306|URINE CULTURE COLONY COUN|United Medicare Advantage|UHC MEDICARE GOLD MA|259.50||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|259.50||||0.78||| 87086|EAP|0306|URINE CULTURE COLONY COUN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.78||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|48,096.25|13494.34|15862.09|157.04|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|40,204.93|14264.65|15862.09|157.04|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|NON CONTRACTED|COMMERCIAL OTHER 1|2,655.07|2655.065|15862.09|157.04|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Medicare|MEDICARE ACUTE|50,201.25|157.04|15862.09|157.04|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|32,280.44|14564.13|15862.09|157.04|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Managed Medicaid|MEDICAID SUPERIOR|44,923.27|15862.09|15862.09|157.04|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Humana Medicare Advantage|HUMANA MA|33,524.50|9618.7|15862.09|157.04|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|42,434.75|9093.3|15862.09|157.04|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Blue Cross PPO Specialty|BCBSTX PPO|29,119.51|9343.26|15862.09|157.04|||| 87102|EAP|0306|FUNGUS CULTURE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.81||| 87102|EAP|0306|FUNGUS CULTURE|Managed Medicaid|MEDICAID SUPERIOR|||||0.81||| 87102|EAP|0306|FUNGUS CULTURE|Medicare|MEDICARE ACUTE|||||0.81||| 87116|EAP|0306|ACID FAST CULTURE|Medicare|MEDICARE ACUTE|||||104.25||| 87116|EAP|0306|ACID FAST CULTURE|Managed Medicaid|MEDICAID SUPERIOR|||||104.25||| 87116|EAP|0306|ACID FAST CULTURE|Managed Medicaid|MEDICAID AMERIGROUP|||||104.25||| 87116|EAP|0306|ACID FAST CULTURE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||104.25||| 87177|EAP|0306|OVA PARASITES STOOL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||84.50||| 87177|EAP|0306|OVA PARASITES STOOL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||84.50||| 87177|EAP|0306|OVA PARASITES STOOL|Blue Cross HMO Specialty|BCBSTX HMO|||||84.50||| 87177|EAP|0306|OVA PARASITES STOOL|Aetna|AETNA PPO|||||84.50||| 87177|EAP|0306|OVA PARASITES STOOL|Blue Cross PPO Specialty|BCBSTX PPO|||||84.50||| 87177|EAP|0306|OVA PARASITES STOOL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||84.50||| 87177|EAP|0306|OVA PARASITES STOOL|Managed Medicaid|MEDICAID AMERIGROUP|||||84.50||| 87177|EAP|0306|OVA PARASITES STOOL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||84.50||| 87177|EAP|0306|OVA PARASITES STOOL|Managed Medicaid|MEDICAID SUPERIOR|||||84.50||| 87177|EAP|0306|OVA PARASITES STOOL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||84.50||| 87177|EAP|0306|OVA PARASITES STOOL|Humana Medicare Advantage|HUMANA MA|||||84.50||| 87177|EAP|0306|OVA PARASITES STOOL|United Healthcare|UNITED HEALTHCARE|||||84.50||| 87177|EAP|0306|OVA PARASITES STOOL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||84.50||| 87177|EAP|0306|OVA PARASITES STOOL|Medicaid|MEDICAID|||||84.50||| 87177|EAP|0306|OVA PARASITES STOOL|NON CONTRACTED|COMMERCIAL OTHER 1|||||84.50||| 87177|EAP|0306|OVA PARASITES STOOL|Tricare|TRICARE EAST REGION|||||84.50||| 87177|EAP|0306|OVA PARASITES STOOL|Medicare|MEDICARE ACUTE|||||84.50||| 87177|EAP|0306|OVA PARASITES STOOL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||84.50||| 87184|EAP|0300|KB SENSITIVITY|Medicare|MEDICARE ACUTE|||||58.70||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|180.63||||277.75||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|277.75||||180.63||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Managed Medicaid|MEDICAID SUPERIOR|277.75||||83.50||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Humana Medicare Advantage|HUMANA MA|277.75||||83.50||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Managed Medicaid|MEDICAID AMERIGROUP|277.75||||180.63||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Managed Medicare|HEALTHSPRING MA|277.75||||83.50||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Blue Cross HMO Specialty|BCBSTX HMO|||||83.50||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Aenta Medicare Advantage|AETNA MEDICARE MA|277.75||||277.75||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||83.50||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Access Direct Platinum|HEALTHFIRST TPA UMR|||||83.50||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Aetna|AETNA OTHER|277.75||||277.75||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Blue Cross PPO Specialty|BCBSTX PPO|277.75||||83.50||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||277.75||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||83.50||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Cigna|CIGNA|277.75||||83.50||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Veterans Affairs|VETERANS ADMINISTRATION|277.75||||277.75||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|277.75||||83.50||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|United Medicare Advantage|UHC MEDICARE GOLD MA|277.75||||83.50||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|United Healthcare|UNITED HEALTHCARE OTHER|||||83.50||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|United Healthcare|UNITED HEALTHCARE|277.75||||83.50||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||83.50||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||83.50||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|United Healthcare|GEHA|||||83.50||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||83.50||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|277.75||||83.50||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||83.50||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||83.50||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||83.50||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Medicaid|MEDICAID TEXAS CHILDRENS|||||180.63||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Medicaid|MEDICAID HMO|||||277.75||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Medicaid|MEDICAID|277.75||||277.75||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|NON CONTRACTED|COMMERCIAL OTHER 1|277.75||||180.63||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|PHCS|HUMANA INSURANCE|||||83.50||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|PHCS|GROUP AND PENSION|||||83.50||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Tricare|TRICARE FOR LIFE|||||277.75||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Tricare|TRICARE EAST REGION|277.75||||83.50||| 87186|EAP|0306|MIC SENSITIVITY PER ORGAN|Medicare|MEDICARE ACUTE|277.75||||83.50||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Tricare|TRICARE EAST REGION|21,852.63|7445.04|25487.22|1459.57|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Medicare|MEDICARE ACUTE|21,212.37|7722.24|25487.22|1459.57|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Medicare|MEDICARE PART B ONLY IP|40,046.05|2006.05|25487.22|1459.57|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Veterans Affairs|VETERANS ADMINISTRATION|35,809.28|7723.12|25487.22|1459.57|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|22,043.43|12862.43|25487.22|1459.57|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|48,168.55|13492.18|25487.22|1459.57|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|45,005.72|9012.7|25487.22|1459.57|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|60,914.40|8312.905|25487.22|1459.57|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|28,278.99|10002.63|25487.22|1459.57|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|39,510.32|9012.7|25487.22|1459.57|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|26,181.35|1459.57|25487.22|1459.57|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|55,870.91|25487.22|25487.22|1459.57|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|35,769.55|15862.09|25487.22|1459.57|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Managed Medicaid|MEDICAID SUPERIOR|45,887.82|15862.09|25487.22|1459.57|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Humana Medicare Advantage|HUMANA MA|18,783.35|6820.46|25487.22|1459.57|||| 87205|EAP|0306|GRAM STAIN SMEAR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.37||||1.37||| 87205|EAP|0306|GRAM STAIN SMEAR|Managed Medicaid|MEDICAID AMERIGROUP|41.25||||1.37||| 87205|EAP|0306|GRAM STAIN SMEAR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.37||| 87205|EAP|0306|GRAM STAIN SMEAR|Humana Medicare Advantage|HUMANA MA|||||1.37||| 87205|EAP|0306|GRAM STAIN SMEAR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.37||| 87205|EAP|0306|GRAM STAIN SMEAR|Aenta Medicare Advantage|AETNA MEDICARE MA|1.37||||1.37||| 87205|EAP|0306|GRAM STAIN SMEAR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.37||||||| 87205|EAP|0306|GRAM STAIN SMEAR|Aetna|AETNA OTHER|1.37||||||| 87205|EAP|0306|GRAM STAIN SMEAR|Blue Cross PPO Specialty|BCBSTX PPO|1.37||||1.37||| 87205|EAP|0306|GRAM STAIN SMEAR|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.37||||||| 87205|EAP|0306|GRAM STAIN SMEAR|Veterans Affairs|VETERANS ADMINISTRATION|1.37||||||| 87205|EAP|0306|GRAM STAIN SMEAR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.37||| 87205|EAP|0306|GRAM STAIN SMEAR|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.37||| 87205|EAP|0306|GRAM STAIN SMEAR|Medicare|MEDICARE ACUTE|1.37||||1.37||| 87209|EAP|0300|SMEAR COMPLEX STAIN|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.47||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Medicaid|MEDICAID|||||1.47||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.47||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Tricare|TRICARE EAST REGION|||||1.47||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Medicare|MEDICARE ACUTE|||||1.47||| 87209|EAP|0300|SMEAR COMPLEX STAIN|United Healthcare|UNITED HEALTHCARE|||||1.47||| 87209|EAP|0300|SMEAR COMPLEX STAIN|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.47||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.47||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Aetna|AETNA PPO|||||1.47||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.47||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.47||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Blue Cross PPO Specialty|BCBSTX PPO|||||1.47||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Blue Cross HMO Specialty|BCBSTX HMO|||||1.47||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.47||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Managed Medicaid|MEDICAID SUPERIOR|||||1.47||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.47||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Humana Medicare Advantage|HUMANA MA|||||1.47||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Managed Medicaid|MEDICAID AMERIGROUP|||||1.47||| 87210|EAP|0306|WET MOUNT|Managed Medicaid|MEDICAID AMERIGROUP|||||41.25||| 87210|EAP|0306|WET MOUNT|Managed Medicaid|MEDICAID SUPERIOR|||||41.25||| 87210|EAP|0306|KOH|Managed Medicaid|MEDICAID SUPERIOR|||||1.37||| 87210|EAP|0306|KOH|Managed Medicaid|MEDICAID AMERIGROUP|||||41.25||| 87210|EAP|0306|WET MOUNT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||41.25||| 87210|EAP|0306|KOH|Cigna|CIGNA|||||41.25||| 87210|EAP|0306|WET MOUNT|Blue Cross PPO Specialty|BCBSTX PPO|||||41.25||| 87210|EAP|0306|WET MOUNT|Cigna|CIGNA|||||41.25||| 87210|EAP|0306|WET MOUNT|United Healthcare|UNITED HEALTHCARE|||||41.25||| 87210|EAP|0306|WET MOUNT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||41.25||| 87210|EAP|0306|WET MOUNT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||41.25||| 87210|EAP|0306|WET MOUNT|NON CONTRACTED|COMMERCIAL OTHER 1|||||41.25||| 87210|EAP|0306|WET MOUNT|Tricare|TRICARE EAST REGION|||||41.25||| 87210|EAP|0306|WET MOUNT|Medicare|MEDICARE ACUTE|||||41.25||| 87210|EAP|0306|INDIA INK PREP|Medicare|MEDICARE ACUTE|||||41.25||| 87252|EAP|0306|HERPES CULTURE|Medicare|MEDICARE ACUTE|||||251.25||| 87252|EAP|0306|HERPES CULTURE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||251.25||| 87252|EAP|0306|HERPES CULTURE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||251.25||| 87252|EAP|0306|HERPES CULTURE|Blue Cross PPO Specialty|BCBSTX PPO|||||251.25||| 87252|EAP|0306|HERPES CULTURE|Cigna|CIGNA|||||837.25||| 87252|EAP|0306|HERPES CULTURE|Managed Medicaid|MEDICAID AMERIGROUP|||||251.25||| 87324|EAP|0306|C DIFFICILE TOXIN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|634.25||||190.25||| 87324|EAP|0306|C DIFFICILE TOXIN|Humana Medicare Advantage|HUMANA MA|634.25||||190.25||| 87324|EAP|0306|C DIFFICILE TOXIN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||412.25||| 87324|EAP|0306|C DIFFICILE TOXIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||190.25||| 87324|EAP|0306|C DIFFICILE TOXIN|Aenta Medicare Advantage|AETNA MEDICARE MA|634.25||||190.25||| 87324|EAP|0306|C DIFFICILE TOXIN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||190.25||| 87324|EAP|0306|C DIFFICILE TOXIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|634.25||||190.25||| 87324|EAP|0306|C DIFFICILE TOXIN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||190.25||| 87324|EAP|0306|C DIFFICILE TOXIN|Blue Cross HMO Specialty|BCBSTX HMO|||||190.25||| 87324|EAP|0306|C DIFFICILE TOXIN|Aetna|AETNA PPO|||||190.25||| 87324|EAP|0306|C DIFFICILE TOXIN|Blue Cross PPO Specialty|BCBSTX PPO|||||190.25||| 87324|EAP|0306|C DIFFICILE TOXIN|Veterans Affairs|VETERANS ADMINISTRATION|634.25||||||| 87324|EAP|0306|C DIFFICILE TOXIN|United Medicare Advantage|UHC MEDICARE GOLD MA|634.25||||190.25||| 87324|EAP|0306|C DIFFICILE TOXIN|United Healthcare|UNITED HEALTHCARE OTHER|||||634.25||| 87324|EAP|0306|C DIFFICILE TOXIN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|634.25||||190.25||| 87324|EAP|0306|C DIFFICILE TOXIN|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||190.25||| 87324|EAP|0306|C DIFFICILE TOXIN|NON CONTRACTED|COMMERCIAL OTHER 1|634.25||||190.25||| 87324|EAP|0306|C DIFFICILE TOXIN|Tricare|TRICARE EAST REGION|||||190.25||| 87324|EAP|0306|C DIFFICILE TOXIN|Medicare|MEDICARE ACUTE|634.25||||190.25||| 87328|EAP|0300|CRYPTOSPRIDIUM AG|Medicare|MEDICARE ACUTE|350.40||||350.40||| 87328|EAP|0300|CRYPTOSPRIDIUM AG|NON CONTRACTED|COMMERCIAL OTHER 1|350.40||||||| 87328|EAP|0300|CRYPTOSPRIDIUM AG|Medicaid|MEDICAID|||||350.40||| 87328|EAP|0300|CRYPTOSPRIDIUM AG|Medicare|MEDICARE PART B ONLY IP|350.40||||||| 87328|EAP|0300|CRYPTOSPRIDIUM AG|United Healthcare|UNITED HEALTHCARE OTHER|||||350.40||| 87328|EAP|0300|CRYPTOSPRIDIUM AG|Veterans Affairs|VETERANS ADMINISTRATION|350.40||||||| 87328|EAP|0300|CRYPTOSPRIDIUM AG|Aenta Medicare Advantage|AETNA MEDICARE MA|350.40||||||| 87328|EAP|0300|CRYPTOSPRIDIUM AG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|350.40||||||| 87328|EAP|0300|CRYPTOSPRIDIUM AG|Blue Cross PPO Specialty|BCBSTX PPO|350.40||||350.40||| 87328|EAP|0300|CRYPTOSPRIDIUM AG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|350.40||||||| 87328|EAP|0300|CRYPTOSPRIDIUM AG|Managed Medicaid|MEDICAID SUPERIOR|350.40||||350.40||| 87328|EAP|0300|CRYPTOSPRIDIUM AG|Humana Medicare Advantage|HUMANA MA|350.40||||||| 87328|EAP|0300|CRYPTOSPRIDIUM AG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||350.40||| 87329|EAP|0300|GIARDIA AG IA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.96||||||| 87329|EAP|0300|GIARDIA AG IA|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.96||| 87329|EAP|0300|GIARDIA AG IA|Managed Medicaid|MEDICAID SUPERIOR|2.96||||2.96||| 87329|EAP|0300|GIARDIA AG IA|Humana Medicare Advantage|HUMANA MA|2.96||||||| 87329|EAP|0300|GIARDIA AG IA|Aenta Medicare Advantage|AETNA MEDICARE MA|2.96||||||| 87329|EAP|0300|GIARDIA AG IA|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|2.96||||||| 87329|EAP|0300|GIARDIA AG IA|Blue Cross PPO Specialty|BCBSTX PPO|2.96||||2.96||| 87329|EAP|0300|GIARDIA AG IA|Veterans Affairs|VETERANS ADMINISTRATION|2.96||||||| 87329|EAP|0300|GIARDIA AG IA|Medicare|MEDICARE ACUTE|2.96||||2.96||| 87329|EAP|0300|GIARDIA AG IA|NON CONTRACTED|COMMERCIAL OTHER 1|2.96||||||| 87329|EAP|0300|GIARDIA AG IA|Medicaid|MEDICAID|||||2.96||| 87329|EAP|0300|GIARDIA AG IA|United Healthcare|UNITED HEALTHCARE OTHER|||||2.96||| 87329|EAP|0300|GIARDIA AG IA|Medicare|MEDICARE PART B ONLY IP|2.96||||||| 87337|EAP|0300|ENTAMOEB HIST GROUP AG IA|NON CONTRACTED|COMMERCIAL OTHER 1|2.96||||||| 87337|EAP|0300|ENTAMOEB HIST GROUP AG IA|Medicaid|MEDICAID|||||2.96||| 87337|EAP|0300|ENTAMOEB HIST GROUP AG IA|Medicare|MEDICARE PART B ONLY IP|2.96||||||| 87337|EAP|0300|ENTAMOEB HIST GROUP AG IA|Medicare|MEDICARE ACUTE|2.96||||2.96||| 87337|EAP|0300|ENTAMOEB HIST GROUP AG IA|United Healthcare|UNITED HEALTHCARE OTHER|||||2.96||| 87337|EAP|0300|ENTAMOEB HIST GROUP AG IA|Veterans Affairs|VETERANS ADMINISTRATION|2.96||||||| 87337|EAP|0300|ENTAMOEB HIST GROUP AG IA|Aenta Medicare Advantage|AETNA MEDICARE MA|2.96||||||| 87337|EAP|0300|ENTAMOEB HIST GROUP AG IA|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|2.96||||||| 87337|EAP|0300|ENTAMOEB HIST GROUP AG IA|Blue Cross PPO Specialty|BCBSTX PPO|2.96||||2.96||| 87337|EAP|0300|ENTAMOEB HIST GROUP AG IA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.96||||||| 87337|EAP|0300|ENTAMOEB HIST GROUP AG IA|Managed Medicaid|MEDICAID SUPERIOR|2.96||||2.96||| 87337|EAP|0300|ENTAMOEB HIST GROUP AG IA|Humana Medicare Advantage|HUMANA MA|2.96||||||| 87337|EAP|0300|ENTAMOEB HIST GROUP AG IA|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.96||| 87338|EAP|0306|H PYLORI STOOL ANTIGEN|Managed Medicaid|MEDICAID SUPERIOR|||||122.20||| 87338|EAP|0306|H PYLORI STOOL ANTIGEN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||122.20||| 87338|EAP|0306|H PYLORI STOOL ANTIGEN|Humana Medicare Advantage|HUMANA MA|||||122.20||| 87338|EAP|0306|H PYLORI STOOL ANTIGEN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||122.20||| 87338|EAP|0306|H PYLORI STOOL ANTIGEN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||122.20||| 87338|EAP|0306|H PYLORI STOOL ANTIGEN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||122.20||| 87338|EAP|0306|H PYLORI STOOL ANTIGEN|Blue Cross PPO Specialty|BCBSTX PPO|||||122.20||| 87338|EAP|0306|H PYLORI STOOL ANTIGEN|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||122.20||| 87338|EAP|0306|H PYLORI STOOL ANTIGEN|Medicaid|MEDICAID|||||122.20||| 87338|EAP|0306|H PYLORI STOOL ANTIGEN|Tricare|TRICARE EAST REGION|||||122.20||| 87338|EAP|0306|H PYLORI STOOL ANTIGEN|Medicare|MEDICARE ACUTE|||||122.20||| 87339|EAP|0302|H PYLORI ANTIBODY SERUM|NON CONTRACTED|COMMERCIAL OTHER 1|||||339.80||| 87340|EAP|0306|HEPATITIS BE AB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|331.75||||99.50||| 87340|EAP|0306|HEPATITIS BE AB|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|331.75||||99.50||| 87340|EAP|0306|HEPATITIS BE AB|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||99.50||| 87340|EAP|0306|HEPATITIS BE AB|Blue Cross PPO Specialty|BCBSTX PPO|331.75||||99.50||| 87340|EAP|0306|HEPATITIS BE AB|Blue Cross HMO Specialty|BCBSTX HMO|||||99.50||| 87340|EAP|0306|HEPATITIS BE AB|Cigna|CIGNA|||||99.50||| 87340|EAP|0306|HEPATITIS BE AB|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||99.50||| 87340|EAP|0306|HEPATITIS BE AB|Managed Medicaid|MEDICAID SUPERIOR|||||99.50||| 87340|EAP|0306|HEPATITIS BE AB|Managed Medicaid|MEDICAID AMERIGROUP|331.75||||99.50||| 87340|EAP|0306|HEPATITIS BE AB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|331.75||||99.50||| 87340|EAP|0306|HEPATITIS BE AB|Humana Medicare Advantage|HUMANA MA|331.75||||99.50||| 87340|EAP|0306|HEPATITIS BE AB|Managed Medicare|HEALTHSPRING MA|||||99.50||| 87340|EAP|0306|HEPATITIS BE AB|United Healthcare|UNITED HEALTHCARE OTHER|||||99.50||| 87340|EAP|0306|HEPATITIS BE AB|United Healthcare|UNITED HEALTHCARE|331.75||||99.50||| 87340|EAP|0306|HEPATITIS BE AB|United Medicare Advantage|UHC MEDICARE GOLD MA|331.75||||99.50||| 87340|EAP|0306|HEPATITIS BE AB|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||99.50||| 87340|EAP|0306|HEPATITIS BE AB|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||99.50||| 87340|EAP|0306|HEPATITIS BE AB|Medicaid|MEDICAID TEXAS CHILDRENS|||||99.50||| 87340|EAP|0306|HEPATITIS BE AB|Medicaid|MEDICAID|331.75||||99.50||| 87340|EAP|0306|HEPATITIS BE AB|NON CONTRACTED|COMMERCIAL OTHER 1|||||99.50||| 87340|EAP|0306|HEPATITIS BE AB|Tricare|TRICARE EAST REGION|||||99.50||| 87340|EAP|0306|HEPATITIS BE AB|Medicare|MEDICARE ACUTE|331.75||||99.50||| 87350|EAP|0306|HEPATITIS BE AG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||111.25||| 87350|EAP|0306|HEPATITIS BE AG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||111.25||| 87420|EAP|0306|RSV|Medicaid|MEDICAID HMO|||||385.50||| 87420|EAP|0306|RSV|Medicaid|MEDICAID|||||385.50||| 87420|EAP|0306|RSV|Tricare|TRICARE EAST REGION|||||385.50||| 87420|EAP|0306|RSV|Medicare|MEDICARE ACUTE|||||385.50||| 87420|EAP|0306|RSV|United Healthcare|UNITED HEALTHCARE|||||385.50||| 87420|EAP|0306|RSV|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||385.50||| 87420|EAP|0306|RSV|Cigna|CIGNA|385.50||||385.50||| 87420|EAP|0306|RSV|Medicaid|MEDICAID TEXAS CHILDRENS|||||385.50||| 87420|EAP|0306|RSV|Blue Cross PPO Specialty|BCBSTX PPO|385.50||||385.50||| 87420|EAP|0306|RSV|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||385.50||| 87420|EAP|0306|RSV|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||385.50||| 87420|EAP|0306|RSV|Blue Cross PPO Specialty|BCBSTX OTHER|||||385.50||| 87420|EAP|0306|RSV|Aetna|AETNA PPO|||||385.50||| 87420|EAP|0306|RSV|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||385.50||| 87420|EAP|0306|RSV|Managed Medicaid|MEDICAID SUPERIOR|385.50||||385.50||| 87420|EAP|0306|RSV|Managed Medicaid|MEDICAID AMERIGROUP|385.50||||385.50||| 87425|EAP|0302|ROTAVIRUS ANTIGEN|Managed Medicaid|MEDICAID SUPERIOR|||||54.10||| 87449|EAP|0306|GIARDIA AG|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.02||| 87449|EAP|0306|GIARDIA AG|Medicare|MEDICARE ACUTE|||||1.02||| 87449|EAP|0306|GIARDIA AG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.02||| 87449|EAP|0306|GIARDIA AG|Humana Medicare Advantage|HUMANA MA|||||1.02||| 87490|EAP|0306|CHLAMYDIA BY DNA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||193.25||| 87490|EAP|0306|CHLAMYDIA BY DNA|Managed Medicaid|MEDICAID SUPERIOR|||||418.63||| 87490|EAP|0306|CHLAMYDIA BY DNA|Managed Medicaid|MEDICAID AMERIGROUP|||||193.25||| 87490|EAP|0306|CHLAMYDIA BY DNA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||193.25||| 87490|EAP|0306|CHLAMYDIA BY DNA|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||193.25||| 87490|EAP|0306|CHLAMYDIA BY DNA|Blue Cross PPO Specialty|BCBSTX PPO|||||193.25||| 87490|EAP|0306|CHLAMYDIA BY DNA|Aetna|AETNA PPO|||||193.25||| 87490|EAP|0306|CHLAMYDIA BY DNA|Cigna|CIGNA|||||193.25||| 87490|EAP|0306|CHLAMYDIA BY DNA|United Medicare Advantage|UHC MEDICARE GOLD MA|||||193.25||| 87490|EAP|0306|CHLAMYDIA BY DNA|United Healthcare|UNITED HEALTHCARE|||||193.25||| 87490|EAP|0306|CHLAMYDIA BY DNA|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||193.25||| 87490|EAP|0306|CHLAMYDIA BY DNA|Tricare|TRICARE EAST REGION|||||193.25||| 87490|EAP|0306|CHLAMYDIA BY DNA|Medicare|MEDICARE ACUTE|||||193.25||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.70||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.70||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.70||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|Medicaid|MEDICAID HMO|||||9.00||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|Medicaid|MEDICAID|||||2.70||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|PHCS|GROUP AND PENSION|||||2.70||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.70||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|Medicare|MEDICARE ACUTE|||||2.70||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|United Healthcare|UNITED HEALTHCARE|||||2.70||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|Tricare|TRICARE EAST REGION|||||2.70||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|United Healthcare|TML GROUP BENEFITS|||||2.70||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|United Healthcare|UNITED HEALTHCARE OTHER|||||2.70||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.70||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.70||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.70||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|Blue Cross HMO Specialty|BCBSTX HMO|9.00||||2.70||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.70||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|Aetna|AETNA OTHER|||||9.00||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|Blue Cross PPO Specialty|BCBSTX PPO|9.00||||2.70||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.70||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.70||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|Aetna|AETNA PPO|||||2.70||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|Cigna|CIGNA|||||2.70||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|Managed Medicaid|MEDICAID SUPERIOR|||||2.70||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.70||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.70||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|Managed Medicaid|MEDICAID AMERIGROUP|||||2.70||| 87491|EAP|0300|CHLAMYDIA AMPLIFIED URINE|Humana Medicare Advantage|HUMANA MA|||||2.70||| 87493|EAP|0300|C DIFF BY PCR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||286.60||| 87493|EAP|0300|C DIFF BY PCR|Aenta Medicare Advantage|AETNA MEDICARE MA|||||286.60||| 87493|EAP|0300|C DIFF BY PCR|Blue Cross PPO Specialty|BCBSTX PPO|||||286.60||| 87493|EAP|0300|C DIFF BY PCR|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||286.60||| 87493|EAP|0300|C DIFF BY PCR|Medicare|MEDICARE ACUTE|955.20||||620.90||| 87493|EAP|0300|C DIFF BY PCR|Tricare|TRICARE EAST REGION|||||286.60||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Veterans Affairs|VETERANS ADMINISTRATION|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|United Medicare Advantage|UHC MEDICARE GOLD MA|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Veterans Affairs|VETERANS ADMINISTRATION|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Medicare|MEDICARE ACUTE|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|NON CONTRACTED|COMMERCIAL OTHER 1|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Medicaid|MORRIS COUNTY INDIGENT|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Medicaid|MEDICAID TEXAS CHILDRENS|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Medicaid|MEDICAID HMO|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Medicaid|MEDICAID|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Tricare|TRICARE FOR LIFE|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Tricare|TRICARE EAST REGION|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|United Healthcare|UNITED HEALTHCARE|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|United Healthcare|UNITED HEALTHCARE OTHER|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|United Healthcare|UNITED HEALTHCARE|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|PHCS|GROUP AND PENSION|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Aenta Medicare Advantage|AETNA MEDICARE MA|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Aetna|AETNA PPO|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Blue Cross HMO Specialty|BCBSTX HMO|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1,042.75||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|13.90||||||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Blue Cross PPO Specialty|BCBSTX PPO|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Blue Cross PPO Specialty|BCBSTX OTHER|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Cigna|CIGNA|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Aetna|AETNA OTHER|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Managed Medicaid|MEDICAID SUPERIOR|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Managed Medicare|HEALTHSPRING MA|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Managed Medicaid|MEDICAID AMERIGROUP|1,042.75||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Humana Medicare Advantage|HUMANA MA|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Managed Medicare|BCBS MEDICARE PPO MA|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||13.90||| 87516|EAP|0306|HEPATITIS B AMPLIFIED PRO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||177.80||| 87516|EAP|0306|HEPATITIS B AMPLIFIED PRO|Medicare|MEDICARE ACUTE|||||177.80||| 87521|EAP|0306|HEPATITIS C RNA BY PCR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||338.25||| 87521|EAP|0306|HEPATITIS C RNA BY PCR|United Healthcare|UNITED HEALTHCARE|||||338.25||| 87521|EAP|0306|HEPATITIS C RNA BY PCR|Medicaid|MEDICAID|||||338.25||| 87521|EAP|0306|HEPATITIS C RNA BY PCR|NON CONTRACTED|COMMERCIAL OTHER 1|||||338.25||| 87521|EAP|0306|HEPATITIS C RNA BY PCR|Medicare|MEDICARE ACUTE|||||338.25||| 87521|EAP|0306|HEPATITIS C RNA BY PCR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||338.25||| 87521|EAP|0306|HEPATITIS C RNA BY PCR|Blue Cross PPO Specialty|BCBSTX PPO|||||338.25||| 87521|EAP|0306|HEPATITIS C RNA BY PCR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||338.25||| 87521|EAP|0306|HEPATITIS C RNA BY PCR|Humana Medicare Advantage|HUMANA MA|1,102.75||||338.25||| 87521|EAP|0306|HEPATITIS C RNA BY PCR|Managed Medicare|HEALTHSPRING MA|||||338.25||| 87521|EAP|0306|HEPATITIS C RNA BY PCR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||338.25||| 87538|EAP|0306|HIV VIRAL LOAD|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||181.50||| 87590|EAP|0306|GC BY DNA|Tricare|TRICARE EAST REGION|||||193.25||| 87590|EAP|0306|GC BY DNA|Medicare|MEDICARE ACUTE|||||193.25||| 87590|EAP|0306|GC BY DNA|United Medicare Advantage|UHC MEDICARE GOLD MA|||||193.25||| 87590|EAP|0306|GC BY DNA|United Healthcare|UNITED HEALTHCARE|||||193.25||| 87590|EAP|0306|GC BY DNA|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||193.25||| 87590|EAP|0306|GC BY DNA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||193.25||| 87590|EAP|0306|GC BY DNA|Cigna|CIGNA|||||193.25||| 87590|EAP|0306|GC BY DNA|Blue Cross PPO Specialty|BCBSTX PPO|||||193.25||| 87590|EAP|0306|GC BY DNA|Aetna|AETNA PPO|||||193.25||| 87590|EAP|0306|GC BY DNA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||193.25||| 87590|EAP|0306|GC BY DNA|Managed Medicaid|MEDICAID SUPERIOR|||||418.63||| 87590|EAP|0306|GC BY DNA|Managed Medicaid|MEDICAID AMERIGROUP|||||193.25||| 87591|EAP|0300|GC AMPLIFIED URINE|Managed Medicaid|MEDICAID SUPERIOR|1,005.40||||301.50||| 87591|EAP|0300|GC AMPLIFIED URINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||301.50||| 87591|EAP|0300|GC AMPLIFIED URINE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,005.40||| 87591|EAP|0300|GC AMPLIFIED URINE|Managed Medicaid|MEDICAID AMERIGROUP|||||301.50||| 87591|EAP|0300|GC AMPLIFIED URINE|Blue Cross HMO Specialty|BCBSTX HMO|1,005.40||||301.50||| 87591|EAP|0300|GC AMPLIFIED URINE|Aetna|AETNA OTHER|||||1,005.40||| 87591|EAP|0300|GC AMPLIFIED URINE|Blue Cross PPO Specialty|BCBSTX PPO|1,005.40||||301.50||| 87591|EAP|0300|GC AMPLIFIED URINE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||301.50||| 87591|EAP|0300|GC AMPLIFIED URINE|Aetna|AETNA PPO|||||301.50||| 87591|EAP|0300|GC AMPLIFIED URINE|Blue Cross PPO Specialty|BCBSTX OTHER|||||301.50||| 87591|EAP|0300|GC AMPLIFIED URINE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||301.50||| 87591|EAP|0300|GC AMPLIFIED URINE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||301.50||| 87591|EAP|0300|GC AMPLIFIED URINE|Cigna|CIGNA|||||301.50||| 87591|EAP|0300|GC AMPLIFIED URINE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||301.50||| 87591|EAP|0300|GC AMPLIFIED URINE|Humana Medicare Advantage|HUMANA MA|||||301.50||| 87591|EAP|0300|GC AMPLIFIED URINE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||301.50||| 87591|EAP|0300|GC AMPLIFIED URINE|Medicaid|MEDICAID TEXAS CHILDRENS|||||301.50||| 87591|EAP|0300|GC AMPLIFIED URINE|NON CONTRACTED|COMMERCIAL OTHER 1|||||301.50||| 87591|EAP|0300|GC AMPLIFIED URINE|PHCS|GROUP AND PENSION|||||301.50||| 87591|EAP|0300|GC AMPLIFIED URINE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||301.50||| 87591|EAP|0300|GC AMPLIFIED URINE|Medicaid|MEDICAID HMO|||||1,005.40||| 87591|EAP|0300|GC AMPLIFIED URINE|Tricare|TRICARE EAST REGION|||||301.50||| 87591|EAP|0300|GC AMPLIFIED URINE|United Healthcare|UNITED HEALTHCARE|||||301.50||| 87591|EAP|0300|GC AMPLIFIED URINE|Medicare|MEDICARE ACUTE|||||301.50||| 87591|EAP|0300|GC AMPLIFIED URINE|Medicaid|MEDICAID|||||301.50||| 87591|EAP|0300|GC AMPLIFIED URINE|United Healthcare|TML GROUP BENEFITS|||||301.50||| 87591|EAP|0300|GC AMPLIFIED URINE|United Healthcare|UNITED HEALTHCARE OTHER|||||301.50||| 87591|EAP|0300|GC AMPLIFIED URINE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||301.50||| 87801|EAP|0306|BORDATELLA PERTUSSIS PCR|United Healthcare|UNITED HEALTHCARE|||||338.25||| 87801|EAP|0306|BORDATELLA PERTUSSIS PCR|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1,102.75||||||| 87801|EAP|0306|BORDATELLA PERTUSSIS PCR|Managed Medicaid|MEDICAID SUPERIOR|||||338.25||| 87804|EAP|0300|FLU LAB TEST RHC|Medicare|MEDICARE ACUTE|||||0.64||| 87807|EAP|0300|RSV|Managed Medicaid|MEDICAID SUPERIOR|||||0.80||| 87807|EAP|0300|RSV|Managed Medicaid|MEDICAID AMERIGROUP|||||0.80||| 87807|EAP|0300|RSV|Medicaid|MEDICAID|||||0.80||| 87880|EAP|0306|STREP ID|Veterans Affairs|VETERANS ADMINISTRATION|||||339.80||| 87880|EAP|0306|STREP ID|United Medicare Advantage|UHC MEDICARE GOLD MA|||||339.80||| 87880|EAP|0306|STREP ID|United Healthcare|UNITED HEALTHCARE|||||339.80||| 87880|EAP|0306|STREP ID|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||339.80||| 87880|EAP|0306|STREP ID|United Healthcare|UNITED HEALTHCARE OTHER|||||339.80||| 87880|EAP|0306|STREP ID|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||339.80||| 87880|EAP|0306|STREP ID|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||339.80||| 87880|EAP|0306|STREP ID|Medicaid|MEDICAID TEXAS CHILDRENS|||||339.80||| 87880|EAP|0306|STREP ID|Medicaid|MEDICAID HMO|||||339.80||| 87880|EAP|0306|STREP ID|NON CONTRACTED|COMMERCIAL OTHER 1|||||339.80||| 87880|EAP|0300|STREP RHC|Medicaid|MEDICAID|||||0.57||| 87880|EAP|0306|STREP ID|Tricare|TRICARE FOR LIFE|||||339.80||| 87880|EAP|0306|STREP ID|Tricare|TRICARE EAST REGION|||||339.80||| 87880|EAP|0306|STREP ID|Medicare|MEDICARE ACUTE|339.80||||339.80||| 87880|EAP|0306|STREP ID|Medicaid|MEDICAID|||||339.80||| 87880|EAP|0306|STREP ID|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||339.80||| 87880|EAP|0306|STREP ID|Blue Cross PPO Specialty|BCBSTX OTHER|||||339.80||| 87880|EAP|0306|STREP ID|Aenta Medicare Advantage|AETNA MEDICARE MA|||||339.80||| 87880|EAP|0306|STREP ID|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||339.80||| 87880|EAP|0306|STREP ID|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||339.80||| 87880|EAP|0306|STREP ID|Access Direct Platinum|HEALTHFIRST TPA UMR|||||339.80||| 87880|EAP|0306|STREP ID|Medicaid|MORRIS COUNTY INDIGENT|||||339.80||| 87880|EAP|0306|STREP ID|Blue Cross HMO Specialty|BCBSTX HMO|339.80||||339.80||| 87880|EAP|0306|STREP ID|Aetna|AETNA QHP HMO|||||339.80||| 87880|EAP|0306|STREP ID|Aetna|AETNA PPO|||||339.80||| 87880|EAP|0306|STREP ID|Aetna|AETNA OTHER|||||339.80||| 87880|EAP|0306|STREP ID|Blue Cross PPO Specialty|BCBSTX PPO|339.80||||339.80||| 87880|EAP|0306|STREP ID|Cigna|CIGNA|||||339.80||| 87880|EAP|0306|STREP ID|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||339.80||| 87880|EAP|0306|STREP ID|Humana Medicare Advantage|HUMANA MA|||||339.80||| 87880|EAP|0306|STREP ID|Managed Medicaid|MEDICAID AMERIGROUP|101.90||||339.80||| 87880|EAP|0306|STREP ID|Managed Medicaid|MEDICAID UNITED HEALTHCARE|339.80||||339.80||| 87880|EAP|0306|STREP ID|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||339.80||| 87880|EAP|0306|STREP ID|Managed Medicaid|MEDICAID SUPERIOR|339.80||||339.80||| 87880|EAP|0306|STREP ID|Managed Medicare|HEALTHSPRING MA|||||339.80||| 87880|EAP|0306|STREP ID|Managed Medicare|BCBS MEDICARE PPO MA|||||339.80||| 87899|EAP|0300|URINE LEGIONELLA AG|Humana Medicare Advantage|HUMANA MA|385.50||||385.50||| 87899|EAP|0300|URINE LEGIONELLA AG|Aenta Medicare Advantage|AETNA MEDICARE MA|385.50||||||| 87899|EAP|0300|URINE LEGIONELLA AG|Blue Cross PPO Specialty|BCBSTX PPO|385.50||||||| 87899|EAP|0300|URINE LEGIONELLA AG|Medicare|MEDICARE ACUTE|385.50||||||| 87899|EAP|0300|URINE LEGIONELLA AG|United Medicare Advantage|UHC MEDICARE GOLD MA|385.50||||||| 880|DRG||ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION|Medicare|MEDICARE ACUTE|15,720.25|1951.9|1951.9|1951.9|||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Cigna|CIGNA|||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Blue Cross HMO Specialty|BCBSTX HMO|||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|736.80||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Access Direct Platinum|HEALTHFIRST TPA UMR|736.80||||||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|736.80||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Aetna|AETNA PPO|||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Managed Medicaid|MEDICAID UNITED HEALTHCARE|736.80||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|736.80||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Blue Cross PPO Specialty|BCBSTX PPO|736.80||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Managed Medicaid|MEDICAID SUPERIOR|||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Humana Medicare Advantage|HUMANA MA|736.80||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Managed Medicaid|MEDICAID AMERIGROUP|||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|United Medicare Advantage|UHC MEDICARE GOLD MA|||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|NON CONTRACTED|COMMERCIAL OTHER 1|||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Tricare|TRICARE EAST REGION|736.80||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Medicaid|MEDICAID TEXAS CHILDRENS|736.80||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Medicaid|MEDICAID|736.80||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Medicare|MEDICARE ACUTE|736.80||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|United Healthcare|UNITED HEALTHCARE|736.80||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|United Healthcare|UNITED HEALTHCARE OTHER|736.80||||||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|United Healthcare|UNITED HEALTHCARE|||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|NON CONTRACTED|COMMERCIAL OTHER 1|||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Tricare|TRICARE EAST REGION|||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Medicaid|MEDICAID TEXAS CHILDRENS|||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|United Healthcare|UNITED HEALTHCARE|736.80||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|United Healthcare|UNITED HEALTHCARE|||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|United Healthcare|UNITED HEALTHCARE OTHER|||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|United Medicare Advantage|UHC MEDICARE GOLD MA|||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Managed Medicaid|MEDICAID SUPERIOR|736.80||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Humana Medicare Advantage|HUMANA MA|||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|736.80||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Medicare|MEDICARE ACUTE|736.80||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Medicaid|MORRIS COUNTY INDIGENT|||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Managed Medicaid|MEDICAID AMERIGROUP|||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Aenta Medicare Advantage|AETNA MEDICARE MA|||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Blue Cross HMO Specialty|BCBSTX HMO|||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Aetna|AETNA PPO|||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Aetna|AETNA OTHER|||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Blue Cross PPO Specialty|BCBSTX PPO|736.80||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Cigna|CIGNA|||||736.80||| 88307|EAP|0300|GROSS AND MICROSCOPIC LEV|Blue Cross PPO Specialty|BCBSTX PPO|||||11.54||| 88307|EAP|0300|GROSS AND MICROSCOPIC LEV|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||11.54||| 88307|EAP|0300|GROSS AND MICROSCOPIC LEV|United Healthcare|UNITED HEALTHCARE|11.54||||||| 88342|EAP|0300|IMMUNOHISTOCHEMISTRY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||736.80||| 884|DRG||ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY|Medicare|MEDICARE ACUTE|25,451.30|7722.24|7722.24|7722.24|||| 89|DRG||CONCUSSION W CC|Medicare|MEDICARE ACUTE|31,215.15|7722.24|7722.24|7722.24|||| 89051|EAP|0300|CELL COUNT WITH DIFF BODY|Aenta Medicare Advantage|AETNA MEDICARE MA|||||53.25||| 89051|EAP|0300|CELL COUNT DIFF CSF|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.77||||||| 89051|EAP|0300|CELL COUNT WITH DIFF BODY|Blue Cross PPO Specialty|BCBSTX PPO|||||1.77||| 89051|EAP|0300|CELL COUNT WITH DIFF BODY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||53.25||| 89051|EAP|0300|CELL COUNT WITH DIFF BODY|Humana Medicare Advantage|HUMANA MA|1.77||||1.77||| 89051|EAP|0300|CELL COUNT DIFF CSF|Managed Medicaid|MEDICAID SUPERIOR|||||1.77||| 89051|EAP|0300|CELL COUNT WITH DIFF BODY|United Medicare Advantage|UHC MEDICARE GOLD MA|1.77||||||| 89051|EAP|0300|CELL COUNT WITH DIFF BODY|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.77||| 89051|EAP|0300|CELL COUNT DIFF CSF|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.77||| 89051|EAP|0300|BODY FLUID CELL COUNT|Medicare|MEDICARE ACUTE|||||115.13||| 89051|EAP|0300|CELL COUNT WITH DIFF BODY|Medicare|MEDICARE ACUTE|||||1.77||| 89051|EAP|0300|CELL COUNT DIFF CSF|United Healthcare|UNITED HEALTHCARE|||||1.77||| 89055|EAP|0300|LEUKOCYTE COUNT FECAL|Medicare|MEDICARE ACUTE|147.25||||147.25||| 89055|EAP|0300|LEUKOCYTE COUNT FECAL|NON CONTRACTED|COMMERCIAL OTHER 1|147.25||||147.25||| 89055|EAP|0300|LEUKOCYTE COUNT FECAL|Tricare|TRICARE EAST REGION|||||147.25||| 89055|EAP|0300|LEUKOCYTE COUNT FECAL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||147.25||| 89055|EAP|0300|LEUKOCYTE COUNT FECAL|Medicaid|MEDICAID|||||147.25||| 89055|EAP|0300|LEUKOCYTE COUNT FECAL|United Healthcare|UNITED HEALTHCARE OTHER|||||147.25||| 89055|EAP|0300|LEUKOCYTE COUNT FECAL|United Healthcare|UNITED HEALTHCARE|||||147.25||| 89055|EAP|0300|LEUKOCYTE COUNT FECAL|Veterans Affairs|VETERANS ADMINISTRATION|147.25||||||| 89055|EAP|0300|LEUKOCYTE COUNT FECAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||147.25||| 89055|EAP|0300|LEUKOCYTE COUNT FECAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|147.25||||147.25||| 89055|EAP|0300|LEUKOCYTE COUNT FECAL|Medicare|MEDICARE PART B ONLY IP|147.25||||||| 89055|EAP|0300|LEUKOCYTE COUNT FECAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||147.25||| 89055|EAP|0300|LEUKOCYTE COUNT FECAL|Managed Medicaid|MEDICAID AMERIGROUP|||||147.25||| 89055|EAP|0300|LEUKOCYTE COUNT FECAL|Managed Medicaid|MEDICAID SUPERIOR|147.25||||147.25||| 89055|EAP|0300|LEUKOCYTE COUNT FECAL|Humana Medicare Advantage|HUMANA MA|147.25||||147.25||| 89055|EAP|0300|LEUKOCYTE COUNT FECAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||147.25||| 89055|EAP|0300|LEUKOCYTE COUNT FECAL|Aenta Medicare Advantage|AETNA MEDICARE MA|147.25||||||| 89055|EAP|0300|LEUKOCYTE COUNT FECAL|Blue Cross HMO Specialty|BCBSTX HMO|||||147.25||| 89055|EAP|0300|LEUKOCYTE COUNT FECAL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|147.25||||147.25||| 89055|EAP|0300|LEUKOCYTE COUNT FECAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||147.25||| 89055|EAP|0300|LEUKOCYTE COUNT FECAL|Aetna|AETNA PPO|||||147.25||| 89055|EAP|0300|LEUKOCYTE COUNT FECAL|Blue Cross PPO Specialty|BCBSTX PPO|147.25||||147.25||| 89055|EAP|0300|LEUKOCYTE COUNT FECAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|147.25||||147.25||| 89060|EAP|0300|BODY FLUID CRYSTALS|Blue Cross PPO Specialty|BCBSTX PPO|||||58.50||| 89060|EAP|0300|BODY FLUID CRYSTALS|Medicare|MEDICARE ACUTE|||||58.50||| 89190|EAP|0300|EOSINOPHIL COUNT|Medicare|MEDICARE ACUTE|||||152.50||| 89190|EAP|0300|EOSINOPHIL COUNT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||152.50||| 897|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|15,729.25|2354.79|17341.82|19.63|||| 897|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC|Humana Medicare Advantage|HUMANA MA|10,602.04|19.63|17341.82|19.63|||| 897|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC|Managed Medicare|HEALTHSPRING MA|44,176.90|17341.82|17341.82|19.63|||| 897|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC|Medicare|MEDICARE ACUTE|14,016.13|3875.64|17341.82|19.63|||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||90.75||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|United Healthcare|UNITED HEALTHCARE|||||117.98||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Workers Compensation|WORKERS COMPENSATION OTHER|||||90.75||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||117.98||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||90.75||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Medicare|MEDICARE ACUTE|||||117.98||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|NON CONTRACTED|COMMERCIAL OTHER 1|||||104.37||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||117.98||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Medicaid|MEDICAID|||||117.98||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Blue Cross PPO Specialty|BCBSTX PPO|||||117.98||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Veterans Affairs|VETERANS ADMINISTRATION|||||104.37||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||117.98||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Blue Cross PPO Specialty|BCBSTX OTHER|||||90.75||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|United Healthcare|UNITED HEALTHCARE OTHER|||||90.75||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Aetna|AETNA OTHER|||||117.98||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Blue Cross HMO Specialty|BCBSTX HMO|||||90.75||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||117.98||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|117.98||||104.37||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Cigna|CIGNA|||||90.75||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Humana Medicare Advantage|HUMANA MA|||||117.98||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||117.98||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||117.98||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Managed Medicaid|MEDICAID AMERIGROUP|||||117.98||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||104.37||| 90471|EAP|0771|IMM ADMIN ONE VACCINE|Managed Medicaid|MEDICAID SUPERIOR|||||90.75||| 90686|ERX|0250|INFLUENZA VACCINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|100.35||||||| 90686|ERX|0250|INFLUENZA VACCINE|Humana Medicare Advantage|HUMANA MA|||||100.35||| 90686|ERX|0250|INFLUENZA VACCINE|Medicare|MEDICARE ACUTE|||||100.35||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|United Healthcare|UNITED HEALTHCARE OTHER|||||195.84||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|Workers Compensation|WORKERS COMPENSATION OTHER|||||195.84||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|United Healthcare|UNITED HEALTHCARE|||||195.84||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||195.84||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||195.84||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||195.84||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|Medicare|MEDICARE ACUTE|||||195.84||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||195.84||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||195.84||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|NON CONTRACTED|COMMERCIAL OTHER 1|||||195.84||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|Medicaid|MEDICAID|||||195.84||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||195.84||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|Veterans Affairs|VETERANS ADMINISTRATION|||||195.84||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|Blue Cross HMO Specialty|BCBSTX HMO|||||195.84||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|Blue Cross PPO Specialty|BCBSTX PPO|||||195.84||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|Aetna|AETNA OTHER|||||195.84||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||195.84||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|195.84||||195.84||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|Blue Cross PPO Specialty|BCBSTX OTHER|||||195.84||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|Humana Medicare Advantage|HUMANA MA|||||195.84||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||195.84||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||195.84||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||195.84||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|Cigna|CIGNA|||||195.84||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|Managed Medicaid|MEDICAID SUPERIOR|||||195.84||| 90714|ERX|0636|TETANUS-DIPTHE TOX (ADULT|Managed Medicaid|MEDICAID AMERIGROUP|||||195.84||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Managed Medicaid|MEDICAID UNITED HEALTHCARE|278.25||||||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Humana Medicare Advantage|HUMANA MA|278.25||||278.25||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|278.25||||278.25||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|278.25||||278.25||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||278.25||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Blue Cross PPO Specialty|BCBSTX PPO|278.25||||278.25||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Medicare|MEDICARE ACUTE|278.25||||278.25||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Tricare|TRICARE EAST REGION|278.25||||||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|United Medicare Advantage|UHC MEDICARE GOLD MA|278.25||||278.25||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|United Medicare Advantage|AARP UHC WEST COMPLETE MA|278.25||||||| 917|DRG||POISONING & TOXIC EFFECTS OF DRUGS W MCC|Medicare|MEDICARE ACUTE|14,596.75|5799.38|5799.38|5799.38|||| 92|DRG||OTHER DISORDERS OF NERVOUS SYSTEM W CC|United Medicare Advantage|UHC MEDICARE GOLD MA|34,563.30|13492.18|13492.18|13492.18|||| 92507|EAP|0440|SLP SPEECH THX 45 MIN|Humana Medicare Advantage|HUMANA MA|5.40||||||| 92507|EAP|0440|SLP SPEECH THX 30 MIN|Medicaid|MEDICAID|4.18||||||| 92507|EAP|0440|SLP SPEECH THX 15MIN|Medicaid|MEDICAID|218.75||||||| 92507|EAP|0440|SLP SPEECH THX 45 MIN|United Medicare Advantage|UHC MEDICARE GOLD MA|5.40||||||| 92507|EAP|0440|SLP SPEECH THX 30 MIN|United Medicare Advantage|UHC MEDICARE GOLD MA|4.18||||||| 92522|EAP|0444|SLP EVALUATION OF SPEECH|Medicare|MEDICARE ACUTE|5.08||||||| 92522|EAP|0444|SLP EVALUATION OF SPEECH|NON CONTRACTED|COMMERCIAL OTHER 1|5.08||||||| 92522|EAP|0444|SLP EVALUATION OF SPEECH|Medicaid|MEDICAID|5.08||||||| 92522|EAP|0444|SLP EVALUATION OF SPEECH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||5.08||| 92522|EAP|0444|SLP EVALUATION OF SPEECH|Humana Medicare Advantage|HUMANA MA|5.08||||5.08||| 92526|EAP|0441|SLP TREAT OF SWALLOW DYSF|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|282.75||||||| 92526|EAP|0441|SLP TREAT OF SWALLOW DYSF|Medicare|MEDICARE ACUTE|282.75||||||| 92526|EAP|0441|SLP TREAT OF SWALLOW DYSF|Medicaid|MEDICAID|282.75||||||| 92610|EAP|0444|SLP EVAL SWALLOW FUNC ORA|Blue Cross PPO Specialty|BCBSTX PPO|||||4.18||| 92610|EAP|0444|SLP EVAL SWALLOW FUNC ORA|Humana Medicare Advantage|HUMANA MA|4.18||||||| 92610|EAP|0444|SLP EVAL SWALLOW FUNC ORA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.18||||||| 92610|EAP|0444|SLP EVAL SWALLOW FUNC ORA|Medicare|MEDICARE ACUTE|4.18||||||| 92610|EAP|0444|SLP EVAL SWALLOW FUNC ORA|Medicaid|MEDICAID|4.18||||||| 92610|EAP|0444|SLP EVAL SWALLOW FUNC ORA|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.18||||||| 92610|EAP|0444|SLP EVAL SWALLOW FUNC ORA|United Medicare Advantage|UHC MEDICARE GOLD MA|4.18||||||| 92950|EAP|0450|CPR|United Healthcare|UNITED HEALTHCARE|||||946.91||| 92950|EAP|0410|CPR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||891.08||| 92950|EAP|0450|CPR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||897.46||| 92950|EAP|0410|CPR|Medicare|MEDICARE ACUTE|||||7.98||| 92950|EAP|0450|CPR|Medicare|MEDICARE ACUTE|||||8.48||| 92950|EAP|0410|CPR|Medicaid|MEDICAID|||||891.08||| 92950|EAP|0450|CPR|Medicaid|MEDICAID|||||946.91||| 92950|EAP|0410|CPR|United Healthcare|UNITED HEALTHCARE|||||891.08||| 92950|EAP|0450|CPR|Humana Medicare Advantage|HUMANA MA|||||897.46||| 92950|EAP|0410|CPR|Humana Medicare Advantage|HUMANA MA|7.98||||844.54||| 92950|EAP|0410|CPR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||7.98||| 92950|EAP|0450|CPR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||8.48||| 92950|EAP|0410|CPR|Blue Cross PPO Specialty|BCBSTX PPO|||||7.98||| 92950|EAP|0450|CPR|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||8.48||| 92950|EAP|0450|CPR|Blue Cross PPO Specialty|BCBSTX PPO|||||8.48||| 92977|EAP|0450|THROMBOLYSIS CORONARY INF|Blue Cross PPO Specialty|BCBSTX PPO|||||923.25||| 92977|EAP|0450|THROMBOLYSIS CORONARY INF|NON CONTRACTED|COMMERCIAL OTHER 1|||||923.25||| 92977|EAP|0450|THROMBOLYSIS CORONARY INF|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,030.93||| 93005|EAP|0730|EKG|Veterans Affairs|VETERANS ADMINISTRATION|2.25||||292.50||| 93005|EAP|0730|EKG|Veterans Affairs|VETERANS ADMINISTRATION|||||2.25||| 93005|EAP|0730|EKG|United Healthcare|UNITED HEALTHCARE|292.50||||292.50||| 93005|EAP|0730|EKG|United Healthcare|UNITED HEALTHCARE|2.25||||292.50||| 93005|EAP|0730|EKG|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.25||| 93005|EAP|0730|EKG|United Healthcare|UNITED HEALTHCARE OTHER|2.25||||258.75||| 93005|EAP|0730|EKG|United Healthcare|GEHA|||||292.50||| 93005|EAP|0730|EKG|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.25||||2.25||| 93005|EAP|0730|EKG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|292.50||||258.75||| 93005|EAP|0730|EKG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.25||| 93005|EAP|0730|EKG|United Medicare Advantage|UHC MEDICARE GOLD MA|2.25||||292.50||| 93005|EAP|0730|EKG|Medicare|MEDICARE ACUTE|2.25||||2.25||| 93005|EAP|0730|ECG-12 LEAD|Medicare|MEDICARE ACUTE|2.25||||160.25||| 93005|EAP|0730|EKG|NON CONTRACTED|COMMERCIAL OTHER 1|292.50||||2.25||| 93005|EAP|0730|EKG|NON CONTRACTED|ZZZZZ LIABILITY INS OTHER 1|||||292.50||| 93005|EAP|0730|EKG|PHCS|MERITAIN HEALTH|||||292.50||| 93005|EAP|0730|EKG|PHCS|HUMANA INSURANCE|||||258.75||| 93005|EAP|0730|EKG|PHCS|GROUP AND PENSION|||||2.25||| 93005|EAP|0730|EKG|Medicaid|MORRIS COUNTY INDIGENT|||||292.50||| 93005|EAP|0730|EKG|Tricare|TRICARE FOR LIFE|||||2.25||| 93005|EAP|0730|EKG|Tricare|TRICARE EAST REGION|292.50||||258.75||| 93005|EAP|0730|EKG|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||292.50||| 93005|EAP|0730|EKG|Medicaid|MEDICAID TEXAS CHILDRENS|||||292.50||| 93005|EAP|0730|EKG|Medicaid|MEDICAID HMO|||||292.50||| 93005|EAP|0730|EKG|Medicaid|MEDICAID|2.25||||2.25||| 93005|EAP|0730|EKG|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||2.25||| 93005|EAP|0730|EKG|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.25||| 93005|EAP|0730|EKG|Humana Medicare Advantage|HUMANA MA|2.25||||2.25||| 93005|EAP|0730|ECG-12 LEAD|Cigna|CIGNA|292.50||||160.25||| 93005|EAP|0730|EKG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|292.50||||2.25||| 93005|EAP|0730|EKG|PHCS|MULTIPLAN PHCS|||||292.50||| 93005|EAP|0730|EKG|Managed Medicare|BCBS MEDICARE PPO MA|||||258.75||| 93005|EAP|0730|EKG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|258.75||||2.25||| 93005|EAP|0730|EKG|United Healthcare|UNITED HEALTHCARE ERS|||||292.50||| 93005|EAP|0730|EKG|Cigna|CIGNA|292.50||||2.25||| 93005|EAP|0730|EKG|Cigna|CIGNA|2.25||||292.50||| 93005|EAP|0730|EKG|United Healthcare|TML GROUP BENEFITS|||||292.50||| 93005|EAP|0730|EKG|Managed Medicare|HEALTHSPRING MA|292.50||||258.75||| 93005|EAP|0730|EKG|Managed Medicaid|MEDICAID SUPERIOR|292.50||||292.50||| 93005|EAP|0730|EKG|Managed Medicaid|MEDICAID AMERIGROUP|2.25||||292.50||| 93005|EAP|0730|EKG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||292.50||| 93005|EAP|0730|EKG|Workers Compensation|WORKERS COMPENSATION OTHER|||||292.50||| 93005|EAP|0730|EKG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.25||||292.50||| 93005|EAP|0730|EKG|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.25||| 93005|EAP|0730|EKG|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2.25||| 93005|EAP|0730|EKG|Aenta Medicare Advantage|AETNA MEDICARE MA|292.50||||2.25||| 93005|EAP|0730|EKG|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||2.25||| 93005|EAP|0730|EKG|Aetna|AETNA PPO|||||2.25||| 93005|EAP|0730|EKG|Aetna|AETNA OTHER|||||292.50||| 93005|EAP|0730|EKG|Blue Cross HMO Specialty|BCBSTX HMO|2.25||||292.50||| 93005|EAP|0730|EKG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|292.50||||292.50||| 93005|EAP|0730|EKG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|292.50||||2.25||| 93005|EAP|0730|EKG|Access Direct Platinum|HEALTHFIRST TPA UMR|2.25||||2.25||| 93005|EAP|0730|EKG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.25||| 93005|EAP|0730|EKG|Blue Cross PPO Specialty|BCBSTX PPO|292.50||||2.25||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,188.20||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Blue Cross PPO Specialty|BCBSTX PPO|||||1,188.20||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Aenta Medicare Advantage|AETNA MEDICARE MA|||||9.14||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Blue Cross HMO Specialty|BCBSTX HMO|||||1,188.20||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1,051.10||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||9.14||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,051.10||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1,188.20||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Managed Medicaid|MEDICAID SUPERIOR|||||1,188.20||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Managed Medicaid|MEDICAID AMERIGROUP|||||1,188.20||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Aetna|AETNA PPO|||||9.14||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Cigna|CIGNA|||||1,188.20||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Humana Medicare Advantage|HUMANA MA|||||1,188.20||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,188.20||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Managed Medicare|HEALTHSPRING MA|||||1,188.20||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Medicare|MEDICARE ACUTE|||||9.14||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|NON CONTRACTED|COMMERCIAL OTHER 1|||||9.14||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Tricare|TRICARE EAST REGION|||||1,051.10||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Medicaid|MORRIS COUNTY INDIGENT|||||9.14||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|United Healthcare|UNITED HEALTHCARE|||||1,051.10||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|United Healthcare|UNITED HEALTHCARE|||||1,188.20||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||9.14||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||9.14||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1,051.10||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,188.20||| 93225|EAP|0731|HOLTER MONITER HOOKUP FEE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||5.85||| 93225|EAP|0731|HOLTER MONITER HOOKUP FEE|Medicare|MEDICARE ACUTE|||||4.50||| 93225|EAP|0731|HOLTER MONITER HOOKUP FEE|Humana Medicare Advantage|HUMANA MA|||||517.50||| 93225|EAP|0731|HOLTER MONITER HOOKUP FEE|Managed Medicaid|MEDICAID SUPERIOR|||||5.85||| 93225|EAP|0731|HOLTER MONITER HOOKUP FEE|Cigna|CIGNA|||||4.50||| 93225|EAP|0731|HOLTER MONITER HOOKUP FEE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||5.85||| 93225|EAP|0731|HOLTER MONITER HOOKUP FEE|Blue Cross HMO Specialty|BCBSTX HMO|||||4.50||| 93225|EAP|0731|HOLTER MONITER HOOKUP FEE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||5.85||| 93225|EAP|0731|HOLTER MONITER HOOKUP FEE|Blue Cross PPO Specialty|BCBSTX PPO|||||5.85||| 93270|EAP|0730|CARDIAC EVENT MONITOR HOO|United Healthcare|UNITED HEALTHCARE|||||87.75||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2,185.30||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2,185.30||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Aenta Medicare Advantage|AETNA MEDICARE MA|1,933.15||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Blue Cross PPO Specialty|BCBSTX PPO|2,185.30||||2,185.30||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Aetna|AETNA PPO|||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Aetna|AETNA OTHER|||||27.68||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2,185.30||||2,185.30||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Blue Cross PPO Specialty|BCBSTX PPO|2,185.30||||27.68||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Managed Medicare|HEALTHSPRING MA|2,185.30||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1,933.15||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Managed Medicaid|MEDICAID SUPERIOR|||||1,933.15||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|3,598.40||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Humana Medicare Advantage|HUMANA MA|16.81||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1,933.15||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2,185.30||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Managed Medicaid|MEDICAID AMERIGROUP|16.81||||1,933.15||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Cigna|CIGNA|||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Medicare|MEDICARE PART B ONLY IP|16.81||||||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Medicare|MEDICARE ACUTE|27.68||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Medicare|MEDICARE ACUTE|16.81||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|NON CONTRACTED|COMMERCIAL OTHER 1|2,185.30||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Tricare|TRICARE FOR LIFE|||||2,185.30||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Tricare|TRICARE EAST REGION|2,185.30||||1,933.15||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Medicaid|MORRIS COUNTY INDIGENT|||||1,933.15||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Medicaid|MEDICAID|||||2,185.30||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Blue Cross HMO Specialty|BCBSTX HMO|||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2,185.30||||27.68||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Veterans Affairs|VETERANS ADMINISTRATION|16.81||||||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Veterans Affairs|VETERANS ADMINISTRATION|||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|United Healthcare|TML GROUP BENEFITS|||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|United Healthcare|UNITED HEALTHCARE|16.81||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|United Healthcare|UNITED HEALTHCARE|||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1,933.15||||2,185.30||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1,933.15||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2,185.30||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1,933.15||||27.68||| 93308|EAP|0483|US ECHO TRANSTHORACIC LIM|United Healthcare|UNITED HEALTHCARE|790.40||||6.08||| 93308|EAP|0483|US ECHO TRANSTHORACIC LIM|Medicare|MEDICARE ACUTE|790.40||||||| 93308|EAP|0483|US ECHO TRANSTHORACIC LIM|Humana Medicare Advantage|HUMANA MA|790.40||||6.08||| 93308|EAP|0483|US ECHO TRANSTHORACIC LIM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||790.40||| 93351|EAP|0483|US ECHO STRESS|Blue Cross HMO Specialty|BCBSTX HMO|||||16.60||| 93351|EAP|0483|US ECHO STRESS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||21.58||| 93351|EAP|0483|US ECHO STRESS|Blue Cross PPO Specialty|BCBSTX PPO|||||16.60||| 93351|EAP|0483|US ECHO STRESS|Humana Medicare Advantage|HUMANA MA|||||16.60||| 93351|EAP|0483|US ECHO STRESS|Medicare|MEDICARE ACUTE|||||16.60||| 93880|EAP|0921|US CAROTID BILATERAL|United Healthcare|UNITED HEALTHCARE|11.70||||||| 93880|EAP|0921|US CAROTID BILATERAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||9.00||| 93880|EAP|0921|US CAROTID BILATERAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||11.70||| 93880|EAP|0921|US CAROTID BILATERAL|Medicare|MEDICARE ACUTE|9.00||||9.00||| 93880|EAP|0921|US CAROTID BILATERAL|Medicare|MEDICARE PART B ONLY IP|9.00||||||| 93880|EAP|0921|US CAROTID BILATERAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||9.00||| 93880|EAP|0921|US CAROTID BILATERAL|Tricare|TRICARE EAST REGION|11.70||||9.00||| 93880|EAP|0921|US CAROTID BILATERAL|Medicaid|MORRIS COUNTY INDIGENT|||||9.00||| 93880|EAP|0921|US CAROTID BILATERAL|Medicaid|MEDICAID|||||11.70||| 93880|EAP|0921|US CAROTID BILATERAL|Humana Medicare Advantage|HUMANA MA|9.00||||9.00||| 93880|EAP|0921|US CAROTID BILATERAL|Managed Medicare|HEALTHSPRING MA|11.70||||9.00||| 93880|EAP|0921|US CAROTID BILATERAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||9.00||| 93880|EAP|0921|US CAROTID BILATERAL|Blue Cross HMO Specialty|BCBSTX HMO|||||9.00||| 93880|EAP|0921|US CAROTID BILATERAL|Blue Cross PPO Specialty|BCBSTX PPO|11.70||||11.70||| 93880|EAP|0921|US CAROTID BILATERAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|11.70||||11.70||| 93880|EAP|0921|US CAROTID BILATERAL|Aetna|AETNA PPO|||||9.00||| 93880|EAP|0921|US CAROTID BILATERAL|Aetna|AETNA OTHER|||||9.00||| 93922|EAP|0921|US ANKLE BRACHIAL INDICES|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.08||| 93922|EAP|0921|US ANKLE BRACHIAL INDICES|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.08||| 93922|EAP|0921|US ANKLE BRACHIAL INDICES|Blue Cross PPO Specialty|BCBSTX PPO|||||4.08||| 93922|EAP|0921|US ANKLE BRACHIAL INDICES|Aetna|AETNA PPO|||||4.08||| 93922|EAP|0921|US ANKLE BRACHIAL INDICES|Humana Medicare Advantage|HUMANA MA|||||530.40||| 93922|EAP|0921|US ANKLE BRACHIAL INDICES|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.08||| 93922|EAP|0921|US ANKLE BRACHIAL INDICES|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.08||| 93922|EAP|0921|US ANKLE BRACHIAL INDICES|Medicare|MEDICARE ACUTE|||||4.08||| 93922|EAP|0921|US ANKLE BRACHIAL INDICES|NON CONTRACTED|COMMERCIAL OTHER 1|||||530.40||| 93922|EAP|0921|US ANKLE BRACHIAL INDICES|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.08||| 93922|EAP|0921|US ANKLE BRACHIAL INDICES|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||530.40||| 93924|EAP|0402|US ARTERIAL STUDY LOWER E|United Medicare Advantage|UHC MEDICARE GOLD MA|||||6.73||| 93924|EAP|0402|US ARTERIAL STUDY LOWER E|Medicare|MEDICARE ACUTE|||||6.73||| 93924|EAP|0402|US ARTERIAL STUDY LOWER E|Cigna|CIGNA|||||6.73||| 93925|EAP|0921|US DUPLEX ART L/E BILATER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||8.56||| 93925|EAP|0921|US DUPLEX ART L/E BILATER|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1,112.80||| 93925|EAP|0921|US DUPLEX ART L/E BILATER|Aetna|AETNA PPO|||||8.56||| 93925|EAP|0921|US DUPLEX ART L/E BILATER|Aetna|AETNA OTHER|||||8.56||| 93925|EAP|0921|US DUPLEX ART L/E BILATER|Blue Cross PPO Specialty|BCBSTX PPO|8.56||||8.56||| 93925|EAP|0921|US DUPLEX ART L/E BILATER|Humana Medicare Advantage|HUMANA MA|||||1,112.80||| 93925|EAP|0921|US DUPLEX ART L/E BILATER|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,112.80||| 93925|EAP|0921|US DUPLEX ART L/E BILATER|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1,112.80||||8.56||| 93925|EAP|0921|US DUPLEX ART L/E BILATER|Medicare|MEDICARE ACUTE|||||8.56||| 93925|EAP|0921|US DUPLEX ART L/E BILATER|United Healthcare|UNITED HEALTHCARE|1,112.80||||||| 93925|EAP|0921|US DUPLEX ART L/E BILATER|United Healthcare|UNITED HEALTHCARE|||||1,112.80||| 93925|EAP|0921|US DUPLEX ART L/E BILATER|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,112.80||| 93926|EAP|0921|US DUPLEX ART LOW EXT UNI|United Healthcare|UNITED HEALTHCARE|||||5.99||| 93926|EAP|0921|DUP-SCAN LXTR ART/ARTL BP|United Medicare Advantage|UHC MEDICARE GOLD MA|||||778.70||| 93926|EAP|0921|US DUPLEX ART LOW EXT UNI|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||778.70||| 93926|EAP|0921|US DUPLEX ART LOW EXT UNI|United Medicare Advantage|UHC MEDICARE GOLD MA|||||778.70||| 93926|EAP|0921|US DUPLEX ART LOW EXT UNI|United Medicare Advantage|UHC MEDICARE GOLD MA|||||5.99||| 93926|EAP|0921|US DUPLEX ART LOW EXT UNI|Medicare|MEDICARE ACUTE|688.85||||778.70||| 93926|EAP|0921|US DUPLEX ART LOW EXT UNI|Medicare|MEDICARE ACUTE|688.85||||5.99||| 93926|EAP|0921|DUP-SCAN LXTR ART/ARTL BP|Medicare|MEDICARE ACUTE|688.85||||778.70||| 93926|EAP|0921|US DUPLEX ART LOW EXT UNI|Humana Medicare Advantage|HUMANA MA|||||5.99||| 93926|EAP|0921|US DUPLEX ART LOW EXT UNI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||5.99||| 93926|EAP|0921|US DUPLEX ART LOW EXT UNI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||778.70||| 93926|EAP|0921|US DUPLEX ART LOW EXT UNI|Blue Cross PPO Specialty|BCBSTX PPO|||||778.70||| 93926|EAP|0921|US DUPLEX ART LOW EXT UNI|Blue Cross PPO Specialty|BCBSTX PPO|||||5.99||| 93930|EAP|0921|US DUPLEX ART U/E BILATER|Humana Medicare Advantage|HUMANA MA|||||8.54||| 93931|EAP|0921|US DUPLEX ART UP EXT UNIL|Medicare|MEDICARE ACUTE|662.40||||748.80||| 93931|EAP|0921|US DUPLEX ART UP EXT UNIL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||748.80||| 93931|EAP|0921|US DUPLEX ART UP EXT UNIL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||5.76||| 93970|EAP|0921|US VENOUS U/L BILATERAL|Blue Cross PPO Specialty|BCBSTX PPO|1,083.30||||9.42||| 93970|EAP|0921|US VENOUS U/L BILATERAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1,083.30||| 93970|EAP|0921|US VENOUS U/L BILATERAL|Blue Cross HMO Specialty|BCBSTX HMO|||||1,224.60||| 93970|EAP|0921|US VENOUS U/L BILATERAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||9.42||| 93970|EAP|0921|US VENOUS U/L BILATERAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1,224.60||||||| 93970|EAP|0921|US VENOUS U/L BILATERAL|Humana Medicare Advantage|HUMANA MA|1,224.60||||9.42||| 93970|EAP|0921|US VENOUS U/L BILATERAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|9.42||||9.42||| 93970|EAP|0921|US VENOUS U/L BILATERAL|Managed Medicaid|MEDICAID SUPERIOR|||||1,224.60||| 93970|EAP|0921|US VENOUS U/L BILATERAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||9.42||| 93970|EAP|0921|US VENOUS U/L BILATERAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||9.42||| 93970|EAP|0921|US VENOUS U/L BILATERAL|United Healthcare|UNITED HEALTHCARE|||||9.42||| 93970|EAP|0921|US VENOUS U/L BILATERAL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1,224.60||| 93970|EAP|0921|US VENOUS U/L BILATERAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1,224.60||||||| 93970|EAP|0921|US VENOUS U/L BILATERAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||9.42||| 93970|EAP|0921|US VENOUS U/L BILATERAL|Medicare|MEDICARE ACUTE|9.42||||1,224.60||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT R|Medicare|MEDICARE ACUTE|839.80||||742.90||| 93971|EAP|0921|US VENOUS U/L LTD|Medicare|MEDICARE ACUTE|839.80||||839.80||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT L|NON CONTRACTED|COMMERCIAL OTHER 1|||||839.80||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT R|NON CONTRACTED|COMMERCIAL OTHER 1|||||839.80||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT R|Tricare|TRICARE EAST REGION|||||742.90||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT R|United Healthcare|UNITED HEALTHCARE|839.80||||||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT L|United Healthcare|UNITED HEALTHCARE|||||742.90||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT R|United Medicare Advantage|UHC MEDICARE GOLD MA|839.80||||6.46||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT L|United Medicare Advantage|UHC MEDICARE GOLD MA|839.80||||839.80||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT R|Veterans Affairs|VETERANS ADMINISTRATION|6.46||||839.80||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT L|Veterans Affairs|VETERANS ADMINISTRATION|6.46||||742.90||| 93971|EAP|0921|US VENOUS U/L LTD|NON CONTRACTED|COMMERCIAL OTHER 1|||||6.46||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT L|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||742.90||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT R|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||6.46||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT R|Cigna|CIGNA|6.46||||6.46||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT L|Cigna|CIGNA|6.46||||6.46||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT L|Medicare|MEDICARE ACUTE|6.46||||6.46||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT R|Humana Medicare Advantage|HUMANA MA|839.80||||742.90||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT L|Humana Medicare Advantage|HUMANA MA|839.80||||6.46||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT L|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|742.90||||6.46||| 93971|EAP|0921|US VENOUS U/L LTD|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|742.90||||839.80||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT L|Managed Medicare|HEALTHSPRING MA|||||839.80||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT R|Managed Medicare|HEALTHSPRING MA|||||742.90||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT L|Managed Medicaid|MEDICAID UNITED HEALTHCARE|6.46||||839.80||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT R|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||742.90||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT L|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||742.90||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT R|Blue Cross PPO Specialty|BCBSTX PPO|||||839.80||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT L|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||6.46||| 93971|EAP|0921|US VENOUS UP/LOW UNILAT L|Blue Cross PPO Specialty|BCBSTX PPO|||||839.80||| 93975|EAP|0921|US ARTER & VEN DOP OF ORG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,021.20||| 93975|EAP|0921|US ARTER & VEN DOP OF ORG|Blue Cross HMO Specialty|BCBSTX HMO|||||8.88||| 93975|EAP|0921|US ARTER & VEN DOP OF ORG|Blue Cross PPO Specialty|BCBSTX PPO|8.88||||1,154.40||| 93975|EAP|0921|US ARTER & VEN DOP OF ORG|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1,154.40||| 93975|EAP|0921|US ARTER & VEN DOP OF ORG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1,154.40||| 93975|EAP|0921|US ARTER & VEN DOP OF ORG|Cigna|CIGNA|||||1,154.40||| 93975|EAP|0921|US ARTER & VEN DOP OF ORG|Humana Medicare Advantage|HUMANA MA|||||8.88||| 93975|EAP|0921|US ARTER & VEN DOP OF ORG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,154.40||| 93975|EAP|0921|US ARTER & VEN DOP OF ORG|Managed Medicaid|MEDICAID SUPERIOR|||||1,154.40||| 93975|EAP|0921|US ARTER & VEN DOP OF ORG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||8.88||| 93975|EAP|0921|US ARTER & VEN DOP OF ORG|Managed Medicaid|MEDICAID AMERIGROUP|||||1,154.40||| 93975|EAP|0921|US ARTER & VEN DOP OF ORG|United Healthcare|UNITED HEALTHCARE|||||8.88||| 93975|EAP|0921|US ARTER & VEN DOP OF ORG|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1,021.20||| 93975|EAP|0921|US ARTER & VEN DOP OF ORG|Workers Compensation|WORKERS COMPENSATION OTHER|||||1,154.40||| 93975|EAP|0921|US ARTER & VEN DOP OF ORG|United Medicare Advantage|UHC MEDICARE GOLD MA|1,154.40||||1,154.40||| 93975|EAP|0921|US ARTER & VEN DOP OF ORG|Medicare|MEDICARE ACUTE|||||8.88||| 93975|EAP|0921|US ARTER & VEN DOP OF ORG|Tricare|TRICARE EAST REGION|||||1,154.40||| 93975|EAP|0921|US ARTER & VEN DOP OF ORG|Medicaid|MEDICAID|||||8.88||| 93976|EAP|0921|US ARTER & VEN DOP OF ORG|Medicare|MEDICARE ACUTE|||||6.44||| 93976|EAP|0921|US ARTER & VEN DOP OF ORG|Humana Medicare Advantage|HUMANA MA|||||6.44||| 94002|EAP|0410|VENTILATION ASSIST/MGT FI|Humana Medicare Advantage|HUMANA MA|1,216.25||||||| 94002|EAP|0410|VENTILATION ASSIST/MGT FI|United Medicare Advantage|UHC MEDICARE GOLD MA|1,216.25||||||| 94002|EAP|0410|VENTILATION ASSIST/MGT FI|Medicare|MEDICARE ACUTE|1,216.25||||||| 94003|EAP|0410|VENTILATION ASSIST/MGT SU|Medicare|MEDICARE ACUTE|1,010.25||||876.75||| 94003|EAP|0410|CPAP/BIPAP SUBSEQ DAY|Medicare|MEDICARE ACUTE|876.75||||876.75||| 94003|EAP|0410|CPAP/BIPAP SUBSEQ DAY|NON CONTRACTED|COMMERCIAL OTHER 1|876.75||||||| 94003|EAP|0410|CPAP/BIPAP SUBSEQ DAY|United Healthcare|UNITED HEALTHCARE|876.75||||||| 94003|EAP|0410|CPAP/BIPAP SUBSEQ DAY|United Medicare Advantage|UHC MEDICARE GOLD MA|876.75||||||| 94003|EAP|0410|CPAP/BIPAP SUBSEQ DAY|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|876.75||||||| 94003|EAP|0410|CPAP/BIPAP SUBSEQ DAY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|876.75||||||| 94003|EAP|0410|CPAP/BIPAP SUBSEQ DAY|Blue Cross HMO Specialty|BCBSTX HMO|876.75||||||| 94003|EAP|0410|CPAP/BIPAP SUBSEQ DAY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|876.75||||||| 94003|EAP|0410|CPAP/BIPAP SUBSEQ DAY|Blue Cross PPO Specialty|BCBSTX PPO|876.75||||||| 94003|EAP|0410|CPAP/BIPAP SUBSEQ DAY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|876.75||||||| 94003|EAP|0410|CPAP/BIPAP SUBSEQ DAY|Humana Medicare Advantage|HUMANA MA|876.75||||876.75||| 94010|EAP|0410|INCENTIVE SPIROMETER|Cigna|CIGNA|1.36||||||| 94010|EAP|0410|INCENTIVE SPIROMETER|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.36||| 94010|EAP|0410|INCENTIVE SPIROMETER|Managed Medicaid|MEDICAID SUPERIOR|1.36||||||| 94010|EAP|0460|BREATHING CAPACITY TEST|Managed Medicaid|MEDICAID AMERIGROUP|||||2.62||| 94010|EAP|0410|INCENTIVE SPIROMETER|Humana Medicare Advantage|HUMANA MA|1.36||||1.36||| 94010|EAP|0410|INCENTIVE SPIROMETER|Cigna|CIGNA|1.36||||1.36||| 94010|EAP|0460|BREATHING CAPACITY TEST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.62||| 94010|EAP|0410|INCENTIVE SPIROMETER|Aenta Medicare Advantage|AETNA MEDICARE MA|1.36||||||| 94010|EAP|0410|INCENTIVE SPIROMETER|Blue Cross HMO Specialty|BCBSTX HMO|176.80||||1.36||| 94010|EAP|0410|INCENTIVE SPIROMETER|Access Direct Platinum|HEALTHFIRST TPA UMR|1.36||||||| 94010|EAP|0410|INCENTIVE SPIROMETER|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.36||||||| 94010|EAP|0410|INCENTIVE SPIROMETER|Aetna|AETNA OTHER|1.36||||||| 94010|EAP|0410|INCENTIVE SPIROMETER|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.36||||||| 94010|EAP|0460|BREATHING CAPACITY TEST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||340.60||| 94010|EAP|0410|INCENTIVE SPIROMETER|Blue Cross PPO Specialty|BCBSTX PPO|1.36||||||| 94010|EAP|0460|BREATHING CAPACITY TEST|Blue Cross PPO Specialty|BCBSTX PPO|||||2.62||| 94010|EAP|0410|INCENTIVE SPIROMETER|United Healthcare|UNITED HEALTHCARE OTHER|1.36||||||| 94010|EAP|0410|INCENTIVE SPIROMETER|United Medicare Advantage|UHC MEDICARE GOLD MA|1.36||||||| 94010|EAP|0410|INCENTIVE SPIROMETER|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.36||| 94010|EAP|0410|INCENTIVE SPIROMETER|United Healthcare|UNITED HEALTHCARE|176.80||||1.36||| 94010|EAP|0410|INCENTIVE SPIROMETER|Medicare|MEDICARE ACUTE|1.36||||1.36||| 94010|EAP|0460|BREATHING CAPACITY TEST|Medicare|MEDICARE ACUTE|||||340.60||| 94010|EAP|0410|INCENTIVE SPIROMETER|NON CONTRACTED|COMMERCIAL OTHER 1|176.80||||||| 94010|EAP|0410|INCENTIVE SPIROMETER|Medicaid|MEDICAID TEXAS CHILDRENS|1.36||||||| 94010|EAP|0410|INCENTIVE SPIROMETER|Medicaid|MEDICAID|1.36||||||| 94010|EAP|0460|BREATHING CAPACITY TEST|Medicaid|MEDICAID TEXAS CHILDRENS|||||340.60||| 94010|EAP|0410|INCENTIVE SPIROMETER|Tricare|TRICARE EAST REGION|1.36||||||| 94060|EAP|0460|PULMONARY FUNCTION PRE/PO|Medicare|MEDICARE ACUTE|||||4.76||| 94060|EAP|0460|PULMONARY FUNCTION PRE/PO|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.76||| 94060|EAP|0460|PULMONARY FUNCTION PRE/PO|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4.76||| 94060|EAP|0460|PULMONARY FUNCTION PRE/PO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.76||| 94060|EAP|0460|PULMONARY FUNCTION PRE/PO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||4.76||| 94060|EAP|0460|PULMONARY FUNCTION PRE/PO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||547.40||| 94060|EAP|0460|PULMONARY FUNCTION PRE/PO|Blue Cross PPO Specialty|BCBSTX PPO|||||618.80||| 94060|EAP|0460|PULMONARY FUNCTION PRE/PO|Blue Cross HMO Specialty|BCBSTX HMO|||||618.80||| 94060|EAP|0460|PULMONARY FUNCTION PRE/PO|Aetna|AETNA OTHER|||||4.76||| 94060|EAP|0460|PULMONARY FUNCTION PRE/PO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||618.80||| 94060|EAP|0460|PULMONARY FUNCTION PRE/PO|Humana Medicare Advantage|HUMANA MA|||||547.40||| 94060|EAP|0460|PULMONARY FUNCTION PRE/PO|Managed Medicare|HEALTHSPRING MA|||||4.76||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Managed Medicaid|MEDICAID AMERIGROUP|4.05||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.43||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|Humana Medicare Advantage|HUMANA MA|2.43||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|Managed Medicaid|MEDICAID SUPERIOR|2.43||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.05||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Managed Medicaid|MEDICAID SUPERIOR|4.05||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Managed Medicare|BCBS MEDICARE PPO MA|||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Humana Medicare Advantage|HUMANA MA|4.05||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|Managed Medicaid|MEDICAID AMERIGROUP|2.43||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.05||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.43||||2.43||| 94640|EAP|0410|MDI TREATMENT INITIAL|Humana Medicare Advantage|HUMANA MA|4.97||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Managed Medicare|HEALTHSPRING MA|2.43||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.05||| 94640|EAP|0410|MDI TREATMENT SUBSEQUENT|Humana Medicare Advantage|HUMANA MA|2.43||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.43||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.05||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|Aenta Medicare Advantage|AETNA MEDICARE MA|2.43||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|4.05||||4.05||| 94640|EAP|0410|MDI TREATMENT INITIAL|Blue Cross HMO Specialty|BCBSTX HMO|4.97||||4.05||| 94640|EAP|0410|MDI TREATMENT SUBSEQUENT|Blue Cross HMO Specialty|BCBSTX HMO|4.05||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Blue Cross HMO Specialty|BCBSTX HMO|2.43||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Blue Cross PPO Specialty|BCBSTX OTHER|||||4.05||| 94640|EAP|0410|MDI TREATMENT SUBSEQUENT|Blue Cross PPO Specialty|BCBSTX PPO|4.05||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.43||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.43||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|4.05||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|Aetna|AETNA OTHER|4.05||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|Aetna|AETNA OTHER|2.43||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Aetna|AETNA OTHER|2.43||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|Blue Cross PPO Specialty|BCBSTX PPO|2.43||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Blue Cross PPO Specialty|BCBSTX PPO|2.43||||4.05||| 94640|EAP|0410|MDI TREATMENT INITIAL|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|Veterans Affairs|VETERANS ADMINISTRATION|2.43||||2.43||| 94640|EAP|0410|MDI TREATMENT SUBSEQUENT|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|2.43||||4.05||| 94640|EAP|0410|MDI TREATMENT INITIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|4.97||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|United Healthcare|TML GROUP BENEFITS|||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|United Healthcare|UNITED HEALTHCARE|2.43||||||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|2.43||||4.05||| 94640|EAP|0410|MDI TREATMENT SUBSEQUENT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|United Healthcare|UNITED HEALTHCARE|||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|United Healthcare|UNITED HEALTHCARE|||||4.05||| 94640|EAP|0410|MDI TREATMENT SUBSEQUENT|United Healthcare|UNITED HEALTHCARE|2.43||||||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|Blue Cross HMO Specialty|BCBSTX HMO|2.43||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|United Healthcare|UNITED HEALTHCARE|4.05||||||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.05||| 94640|EAP|0410|MDI TREATMENT INITIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.05||||||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|United Medicare Advantage|UHC MEDICARE GOLD MA|4.05||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|United Medicare Advantage|UHC MEDICARE GOLD MA|2.43||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.43||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.43||||||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|2.43||||4.05||| 94640|EAP|0410|MDI TREATMENT INITIAL|Blue Cross PPO Specialty|BCBSTX PPO|2.43||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|Managed Medicare|HEALTHSPRING MA|2.43||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.43||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.05||||||| 94640|EAP|0410|MDI TREATMENT INITIAL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|4.05||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Veterans Affairs|VETERANS ADMINISTRATION|2.43||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.05||||2.43||| 94640|EAP|0410|MDI TREATMENT INITIAL|Veterans Affairs|VETERANS ADMINISTRATION|2.43||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|Medicare|MEDICARE PART B ONLY IP|2.43||||||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|Medicare|MEDICARE ACUTE|4.05||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|Medicare|MEDICARE ACUTE|2.43||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Medicare|MEDICARE ACUTE|2.43||||4.05||| 94640|EAP|0410|MDI TREATMENT SUBSEQUENT|Medicare|MEDICARE ACUTE|4.05||||2.43||| 94640|EAP|0410|MDI TREATMENT INITIAL|Medicare|MEDICARE ACUTE|4.97||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Medicaid|MORRIS COUNTY INDIGENT|||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.43||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|NON CONTRACTED|COMMERCIAL OTHER 1|2.43||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|NON CONTRACTED|COMMERCIAL OTHER 2|2.43||||||| 94640|EAP|0410|MDI TREATMENT INITIAL|NON CONTRACTED|COMMERCIAL OTHER 1|4.05||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Cigna|CIGNA|||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|NON CONTRACTED|COMMERCIAL OTHER 1|2.43||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|NON CONTRACTED|COMMERCIAL OTHER 1|4.05||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Medicaid|MEDICAID|||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|Tricare|TRICARE EAST REGION|2.43||||2.43||| 94640|EAP|0410|UPDRAFT TREATMENT INITIAL|Tricare|TRICARE EAST REGION|2.43||||4.05||| 94640|EAP|0410|UPDRAFT TREATMENT SUBSEQU|Medicaid|MEDICAID|||||2.43||| 94644|EAP|0410|CONTINUOUS INHAL TRMT 1ST|Medicare|MEDICARE ACUTE|||||135.50||| 94644|EAP|0410|CONTINUOUS INHAL TRMT 1ST|United Medicare Advantage|UHC MEDICARE GOLD MA|135.50||||135.50||| 94644|EAP|0410|CONTINUOUS INHAL TRMT 1ST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||135.50||| 94644|EAP|0410|CONTINUOUS INHAL TRMT 1ST|Blue Cross HMO Specialty|BCBSTX HMO|135.50||||||| 94644|EAP|0410|CONTINUOUS INHAL TRMT 1ST|Blue Cross PPO Specialty|BCBSTX PPO|||||176.15||| 94644|EAP|0410|CONTINUOUS INHAL TRMT 1ST|Humana Medicare Advantage|HUMANA MA|||||135.50||| 94644|EAP|0410|CONTINUOUS INHAL TRMT 1ST|Managed Medicaid|MEDICAID SUPERIOR|||||135.50||| 94644|EAP|0410|CONTINUOUS INHAL TRMT 1ST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||135.50||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|5.30||||||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|Humana Medicare Advantage|HUMANA MA|5.30||||5.30||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|Blue Cross PPO Specialty|BCBSTX PPO|5.30||||||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.30||||||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|Aenta Medicare Advantage|AETNA MEDICARE MA|5.30||||||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|Blue Cross HMO Specialty|BCBSTX HMO|5.30||||||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|5.30||||||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|United Medicare Advantage|UHC MEDICARE GOLD MA|5.30||||5.30||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|5.30||||||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|Medicare|MEDICARE ACUTE|5.30||||5.30||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|NON CONTRACTED|COMMERCIAL OTHER 1|5.30||||||| 94664|EAP|0410|MDI DEMONSTRATION/EVAL|Medicare|MEDICARE ACUTE|4.05||||4.05||| 94664|EAP|0410|MDI DEMONSTRATION/EVAL|Veterans Affairs|VETERANS ADMINISTRATION|||||4.05||| 94664|EAP|0410|MDI DEMONSTRATION/EVAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4.05||| 94664|EAP|0410|MDI DEMONSTRATION/EVAL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||4.05||| 94664|EAP|0410|MDI DEMONSTRATION/EVAL|Blue Cross PPO Specialty|BCBSTX PPO|||||4.05||| 94664|EAP|0410|AEROSOL GEN DEMONST/EVAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|55.50||||||| 94664|EAP|0410|MDI DEMONSTRATION/EVAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.05||||||| 94664|EAP|0410|MDI DEMONSTRATION/EVAL|Humana Medicare Advantage|HUMANA MA|4.05||||||| 94667|EAP|0410|PERCUSSION/PD TREATMENT I|Managed Medicaid|MEDICAID SUPERIOR|1.73||||||| 94667|EAP|0410|FLUTTER VALVE/PEP INITIAL|Humana Medicare Advantage|HUMANA MA|1.73||||||| 94667|EAP|0410|FLUTTER VALVE/PEP INITIAL|Aetna|AETNA OTHER|1.73||||||| 94667|EAP|0410|PERCUSSION/PD TREATMENT I|United Medicare Advantage|UHC MEDICARE GOLD MA|1.73||||||| 94667|EAP|0410|FLUTTER VALVE/PEP INITIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|1.73||||||| 94667|EAP|0410|FLUTTER VALVE/PEP INITIAL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.73||||||| 94667|EAP|0410|FLUTTER VALVE/PEP INITIAL|Medicare|MEDICARE ACUTE|1.73||||||| 94668|EAP|0410|PERCUSSION/PD TREATMENT S|Medicare|MEDICARE ACUTE|102.75||||||| 94668|EAP|0410|FLUTTER VALVE/PEP SUBSEQU|Medicare|MEDICARE ACUTE|102.75||||||| 94668|EAP|0410|FLUTTER VALVE/PEP SUBSEQU|Medicaid|MEDICAID|102.75||||||| 94668|EAP|0410|PERCUSSION/PD TREATMENT S|United Healthcare|UNITED HEALTHCARE|102.75||||||| 94668|EAP|0410|PERCUSSION/PD TREATMENT S|United Medicare Advantage|UHC MEDICARE GOLD MA|102.75||||||| 94668|EAP|0410|PERCUSSION/PD TREATMENT S|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|102.75||||102.75||| 94668|EAP|0410|FLUTTER VALVE/PEP SUBSEQU|United Medicare Advantage|UHC MEDICARE GOLD MA|102.75||||||| 94668|EAP|0410|PERCUSSION/PD TREATMENT S|Managed Medicaid|MEDICAID SUPERIOR|102.75||||||| 94668|EAP|0410|PERCUSSION/PD TREATMENT S|Humana Medicare Advantage|HUMANA MA|102.75||||||| 94668|EAP|0410|FLUTTER VALVE/PEP SUBSEQU|Humana Medicare Advantage|HUMANA MA|102.75||||||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Aenta Medicare Advantage|AETNA MEDICARE MA|106.25||||138.13||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Access Direct Platinum|HEALTHFIRST TPA UMR|106.25||||||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|138.13||||||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|138.13||||||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Aetna|AETNA OTHER|106.25||||106.25||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Blue Cross PPO Specialty|BCBSTX PPO|106.25||||106.25||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Blue Cross HMO Specialty|BCBSTX HMO|106.25||||138.13||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Cigna|CIGNA|106.25||||||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Managed Medicaid|MEDICAID SUPERIOR|106.25||||||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Humana Medicare Advantage|HUMANA MA|138.13||||106.25||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|106.25||||138.13||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Managed Medicaid|MEDICAID AMERIGROUP|106.25||||||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|138.13||||106.25||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Managed Medicare|HEALTHSPRING MA|138.13||||138.13||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Cigna|CIGNA|138.13||||106.25||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|United Healthcare|UNITED HEALTHCARE OTHER|106.25||||||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|United Healthcare|UNITED HEALTHCARE|138.13||||||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|United Healthcare|UNITED HEALTHCARE|||||138.13||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|106.25||||106.25||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|138.13||||||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|United Medicare Advantage|UHC MEDICARE GOLD MA|106.25||||106.25||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|106.25||||106.25||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Veterans Affairs|VETERANS ADMINISTRATION|138.13||||138.13||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|106.25||||106.25||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Medicare|MEDICARE PART B ONLY IP|106.25||||||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Medicare|MEDICARE ACUTE|106.25||||106.25||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Medicaid|MEDICAID|106.25||||106.25||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|NON CONTRACTED|COMMERCIAL OTHER 1|138.13||||138.13||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|NON CONTRACTED|COMMERCIAL OTHER 2|106.25||||||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Medicaid|MEDICAID TEXAS CHILDRENS|106.25||||||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Medicaid|MEDICAID HMO|||||138.13||| 94760|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Tricare|TRICARE EAST REGION|138.13||||106.25||| 94761|EAP|0460|PULSE OXIMETER MULT DETER|Medicare|MEDICARE ACUTE|1.08||||||| 94761|EAP|0460|PULSE OXIMETER MULT DETER|United Medicare Advantage|UHC MEDICARE GOLD MA|1.08||||||| 94761|EAP|0460|PULSE OXIMETER MULT DETER|Managed Medicaid|MEDICAID SUPERIOR|1.08||||||| 94761|EAP|0460|PULSE OXIMETER MULT DETER|Managed Medicare|HEALTHSPRING MA|1.08||||||| 94761|EAP|0460|PULSE OXIMETER MULT DETER|Humana Medicare Advantage|HUMANA MA|1.08||||||| 94761|EAP|0460|PULSE OXIMETER MULT DETER|Blue Cross PPO Specialty|BCBSTX PPO|1.08||||||| 94762|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Blue Cross HMO Specialty|BCBSTX HMO|562.75||||||| 94762|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|731.58||||||| 94762|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Aetna|AETNA OTHER|562.75||||||| 94762|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Blue Cross PPO Specialty|BCBSTX PPO|562.75||||731.58||| 94762|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Managed Medicaid|MEDICAID SUPERIOR|562.75||||562.75||| 94762|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Humana Medicare Advantage|HUMANA MA|562.75||||562.75||| 94762|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Managed Medicaid|MEDICAID AMERIGROUP|562.75||||||| 94762|EAP|0410|MEASURE BLOOD OXYGEN LEVE|United Medicare Advantage|UHC MEDICARE GOLD MA|562.75||||||| 94762|EAP|0410|MEASURE BLOOD OXYGEN LEVE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|562.75||||562.75||| 94762|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Medicare|MEDICARE ACUTE|562.75||||||| 94762|EAP|0410|MEASURE BLOOD OXYGEN LEVE|NON CONTRACTED|COMMERCIAL OTHER 2|562.75||||||| 94762|EAP|0410|MEASURE BLOOD OXYGEN LEVE|Tricare|TRICARE EAST REGION|||||562.75||| 948|DRG||SIGNS & SYMPTOMS W/O MCC|Medicare|MEDICARE ACUTE|14,230.50|8736.7|8736.7|8736.7|||| 949|DRG||AFTERCARE W CC/MCC|Medicare|MEDICARE ACUTE|11,051.09|7042.85|7042.85|7042.85|||| 95|DRG||BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W CC|United Healthcare|UNITED HEALTHCARE|46,702.98|24049.34|24049.34|24049.34|||| 950|DRG||AFTERCARE W/O CC/MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|27,115.38|16599.73|16599.73|16599.73|||| 9500034|ERX|0250|ACETAM-COD 120-12MG/5ML E|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9500034|ERX|0250|ACETAM-COD 120-12MG/5ML E|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| 9500034|ERX|0250|ACETAM-COD 120-12MG/5ML E|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9500034|ERX|0250|ACETAM-COD 120-12MG/5ML E|Humana Medicare Advantage|HUMANA MA|||||1.25||| 9500034|ERX|0250|ACETAM-COD 120-12MG/5ML E|Medicaid|MEDICAID|||||1.25||| 9500034|ERX|0250|ACETAM-COD 120-12MG/5ML E|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9500034|ERX|0250|ACETAM-COD 120-12MG/5ML E|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9500034|ERX|0250|ACETAM-COD 120-12MG/5ML E|Cigna|CIGNA|||||1.25||| 9500034|ERX|0250|ACETAM-COD 120-12MG/5ML E|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9500117|ERX|0250|METOCLOPRAMIDE 5MG/5ML, 1|Medicare|MEDICARE ACUTE|1.25||||||| 9500117|ERX|0250|METOCLOPRAMIDE 5MG/5ML, 1|Medicaid|MEDICAID|1.25||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Blue Cross HMO Specialty|BCBSTX HMO|3.50||||3.50||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.50||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Blue Cross PPO Specialty|BCBSTX PPO|3.50||||3.50||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3.50||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.50||||3.50||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.50||||3.50||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Managed Medicaid|MEDICAID AMERIGROUP|3.50||||3.50||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Cigna|CIGNA|||||3.50||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|3.50||||3.50||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Managed Medicaid|MEDICAID SUPERIOR|3.50||||3.50||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Humana Medicare Advantage|HUMANA MA|3.50||||3.50||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Managed Medicare|HEALTHSPRING MA|||||3.50||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||3.50||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Medicaid|MEDICAID|||||3.50||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||3.50||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||3.50||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|United Medicare Advantage|UHC MEDICARE GOLD MA|3.50||||3.50||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|3.50||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Veterans Affairs|VETERANS ADMINISTRATION|||||3.50||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Medicare|MEDICARE ACUTE|3.50||||3.50||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|NON CONTRACTED|COMMERCIAL OTHER 1|3.50||||3.50||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|PHCS|HUMANA INSURANCE|||||3.50||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|United Healthcare|UNITED HEALTHCARE|||||3.50||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||3.50||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|Medicare|MEDICARE ACUTE|2.25||||2.25||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|NON CONTRACTED|COMMERCIAL OTHER 1|2.25||||||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.25||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|United Medicare Advantage|UHC MEDICARE GOLD MA|2.25||||2.25||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.25||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|Managed Medicaid|MEDICAID SUPERIOR|||||2.25||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.25||||||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|Humana Medicare Advantage|HUMANA MA|2.25||||2.25||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.25||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|Blue Cross HMO Specialty|BCBSTX HMO|2.25||||2.25||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|Blue Cross PPO Specialty|BCBSTX PPO|2.25||||2.25||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|Aenta Medicare Advantage|AETNA MEDICARE MA|2.25||||||| 9500133|ERX|0250|GUAIFEN-CODEINE 100-10MG/|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.25||| 9500141|ERX|0250|GUAI-CODEINE 100-10MG/5ML|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||||| 9500141|ERX|0250|GUAI-CODEINE 100-10MG/5ML|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||||| 9500141|ERX|0250|GUAI-CODEINE 100-10MG/5ML|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9500141|ERX|0250|GUAI-CODEINE 100-10MG/5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9500141|ERX|0250|GUAI-CODEINE 100-10MG/5ML|Medicare|MEDICARE ACUTE|1.25||||||| 9500174|ERX|0250|GLYCERIN SUPP|Humana Medicare Advantage|HUMANA MA|3.50||||||| 9500349|ERX|0250|FLUMAZENIL 0.5MG/5ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.79||| 9500349|ERX|0250|FLUMAZENIL 0.5MG/5ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.79||| 9500349|ERX|0250|FLUMAZENIL 0.5MG/5ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.79||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Managed Medicaid|MEDICAID AMERIGROUP|||||19.25||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||19.25||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Managed Medicaid|MEDICAID SUPERIOR|||||19.25||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Humana Medicare Advantage|HUMANA MA|||||19.25||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Medicaid|MEDICAID|||||19.25||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Medicaid|MEDICAID TEXAS CHILDRENS|||||19.25||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Managed Medicare|HEALTHSPRING MA|||||19.25||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Blue Cross HMO Specialty|BCBSTX HMO|||||19.25||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||19.25||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Blue Cross PPO Specialty|BCBSTX PPO|||||19.25||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||19.25||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||19.25||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|United Medicare Advantage|UHC MEDICARE GOLD MA|||||19.25||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Medicare|MEDICARE ACUTE|||||19.25||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|NON CONTRACTED|COMMERCIAL OTHER 1|||||19.25||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|United Healthcare|GEHA|||||19.25||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Veterans Affairs|VETERANS ADMINISTRATION|1.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||1.25||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||1.25||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Medicaid|MEDICAID|||||1.25||| 9500406|ERX|0250|TRIAMCINOLONE ACET 0.1% ,|Humana Medicare Advantage|HUMANA MA|29.75||||||| 9500406|ERX|0250|TRIAMCINOLONE ACET 0.1% ,|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|29.75||||||| 9500406|ERX|0250|TRIAMCINOLONE ACET 0.1% ,|Medicare|MEDICARE ACUTE|29.75||||||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.25||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.25||||||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Veterans Affairs|VETERANS ADMINISTRATION|||||1.25||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Blue Cross HMO Specialty|BCBSTX HMO|||||1.25||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Cigna|CIGNA|||||1.25||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Medicaid|MEDICAID|||||1.25||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.25||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||1.25||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||1.25||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Managed Medicaid|MEDICAID SUPERIOR|1.25||||1.25||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||1.25||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.25||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Medicaid|MEDICAID|||||1.25||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.25||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.25||||||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Aetna|AETNA PPO|||||1.25||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1.25||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Access Direct Platinum|HEALTHFIRST TPA UMR|1.25||||||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Cigna|CIGNA|||||1.25||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.25||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.25||||1.25||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Veterans Affairs|VETERANS ADMINISTRATION|1.25||||||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.25||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.25||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Tricare|TRICARE EAST REGION|||||1.25||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|United Healthcare|UNITED HEALTHCARE|1.25||||1.25||| 9500463|ERX|0250|HYDROCORTISONE 0.5% CREAM|Medicare|MEDICARE ACUTE|0.22||||||| 9500489|ERX|0250|HYDROCORTISONE 1% CREAM,|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| 9500489|ERX|0250|HYDROCORTISONE 1% CREAM,|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9500612|ERX|0250|ZINC OXIDE 20% OINT, 30 G|Managed Medicaid|MEDICAID SUPERIOR|10.25||||||| 9500620|ERX|0250|ERYTHROMYCIN EYE OINT, 3.|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||104.17||| 9500620|ERX|0250|ERYTHROMYCIN EYE OINT, 3.|United Healthcare|UNITED HEALTHCARE|||||104.17||| 9500620|ERX|0250|ERYTHROMYCIN EYE OINT, 3.|Managed Medicaid|MEDICAID AMERIGROUP|||||104.17||| 9500638|ERX|0250|GENTAMICIN 0.1% CREAM, 15|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9500653|ERX|0250|NYSTATIN-TRIAMCINOLONE 1|Medicare|MEDICARE ACUTE|4.00||||||| 9500737|ERX|0250|POLYCARBOPHIL 625MG TABLE|Veterans Affairs|VETERANS ADMINISTRATION|2.25||||||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Blue Cross HMO Specialty|BCBSTX HMO|||||1.25||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||1.25||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Managed Medicare|BCBS MEDICARE PPO MA|||||1.25||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Managed Medicare|HEALTHSPRING MA|||||1.25||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Medicaid|MEDICAID|1.25||||||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|10.75||||10.75||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|10.75||||10.75||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||10.75||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Medicare|MEDICARE ACUTE|10.75||||10.75||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Tricare|TRICARE EAST REGION|10.75||||||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|10.75||||10.75||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Humana Medicare Advantage|HUMANA MA|10.75||||10.75||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Managed Medicare|HEALTHSPRING MA|10.75||||||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|10.75||||10.75||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|10.75||||||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Cigna|CIGNA|10.75||||||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|10.75||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Aetna|AETNA PPO|||||1.25||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||1.25||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.25||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||1.25||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|1.25||||1.25||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|1.25||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Medicaid|MEDICAID|1.25||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.25||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Medicare|MEDICARE PART B ONLY IP|1.25||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|1.25||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|Tricare|TRICARE EAST REGION|1.25||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.25||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|United Healthcare|UNITED HEALTHCARE|1.25||||1.25||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||||| 9500893|ERX|0250|LISINOPRIL 10MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.25||||||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|10.75||||10.75||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|10.75||||10.75||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Medicare|MEDICARE ACUTE|10.75||||10.75||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|10.75||||||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|United Healthcare|UNITED HEALTHCARE|||||10.75||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|10.75||||||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|10.75||||10.75||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Humana Medicare Advantage|HUMANA MA|10.75||||10.75||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||10.75||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||10.75||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|10.75||||||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9501073|ERX|0250|DIGOXIN 250MCG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9501073|ERX|0250|DIGOXIN 250MCG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9501073|ERX|0250|DIGOXIN 250MCG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||||| 9501115|ERX|0250|CLOBETASOL 0.05% CREAM, 1|Humana Medicare Advantage|HUMANA MA|1.65||||||| 9501115|ERX|0250|CLOBETASOL 0.05% CREAM, 1|Medicare|MEDICARE ACUTE|1.65||||||| 9501206|ERX|0250|SUMATRIPTAN 6MG/0.5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||226.75||| 9501206|ERX|0250|SUMATRIPTAN 6MG/0.5ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||226.75||| 9501206|ERX|0250|SUMATRIPTAN 6MG/0.5ML|Medicare|MEDICARE ACUTE|||||226.75||| 9501206|ERX|0250|SUMATRIPTAN 6MG/0.5ML|PHCS|GROUP AND PENSION|||||226.75||| 9501206|ERX|0250|SUMATRIPTAN 6MG/0.5ML|United Healthcare|UNITED HEALTHCARE|||||226.75||| 9501206|ERX|0250|SUMATRIPTAN 6MG/0.5ML|Blue Cross PPO Specialty|BCBSTX PPO|||||226.75||| 9501206|ERX|0250|SUMATRIPTAN 6MG/0.5ML|Managed Medicaid|MEDICAID AMERIGROUP|||||226.75||| 9501206|ERX|0250|SUMATRIPTAN 6MG/0.5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|226.75||||||| 9501206|ERX|0250|SUMATRIPTAN 6MG/0.5ML|Managed Medicaid|MEDICAID SUPERIOR|||||226.75||| 9501206|ERX|0250|SUMATRIPTAN 6MG/0.5ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||226.75||| 9501206|ERX|0250|SUMATRIPTAN 6MG/0.5ML|Medicaid|MEDICAID|||||226.75||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Humana Medicare Advantage|HUMANA MA|361.25||||361.25||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Aetna|AETNA OTHER|361.25||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Blue Cross PPO Specialty|BCBSTX PPO|361.25||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Aenta Medicare Advantage|AETNA MEDICARE MA|||||361.25||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Medicare|MEDICARE ACUTE|361.25||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|United Healthcare|UNITED HEALTHCARE|||||361.25||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Veterans Affairs|VETERANS ADMINISTRATION|361.25||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|United Medicare Advantage|UHC MEDICARE GOLD MA|||||361.25||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||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||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Veterans Affairs|VETERANS ADMINISTRATION|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Medicare|MEDICARE ACUTE|8.80||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|NON CONTRACTED|COMMERCIAL OTHER 1|||||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|Tricare|TRICARE EAST REGION|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|United Healthcare|UNITED HEALTHCARE|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|||||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|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|8.80||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Aetna|AETNA OTHER|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|Blue Cross PPO Specialty|BCBSTX PPO|8.80||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Cigna|CIGNA|||||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|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|8.80||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Managed Medicaid|MEDICAID AMERIGROUP|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Managed Medicaid|MEDICAID SUPERIOR|||||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|Medicaid|MEDICAID TEXAS CHILDRENS|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Medicaid|MEDICAID|||||8.80||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||8.80||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Managed Medicaid|MEDICAID SUPERIOR|||||271.40||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Humana Medicare Advantage|HUMANA MA|||||271.40||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||271.40||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Aetna|AETNA OTHER|||||271.40||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Blue Cross PPO Specialty|BCBSTX PPO|||||271.40||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Medicare|MEDICARE ACUTE|||||271.40||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||271.40||| 9501412|ERX|0250|DUTASTERIDE 0.5MG CAPSULE|Medicare|MEDICARE ACUTE|10.75||||||| 9501412|ERX|0250|DUTASTERIDE 0.5MG CAPSULE|Humana Medicare Advantage|HUMANA MA|||||10.75||| 9501438|ERX|0250|PHYTONADIONE 5MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|2.45||||||| 9501438|ERX|0250|PHYTONADIONE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|2.45||||2.45||| 9501438|ERX|0250|PHYTONADIONE 5MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.45||||||| 9501438|ERX|0250|PHYTONADIONE 5MG TABLET|Medicare|MEDICARE ACUTE|||||2.45||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|1.25||||||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|1.25||||||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9501479|ERX|0250|SUMATRIPTAN 25MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.13||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.13||| 9501545|ERX|0250|BUPROPION SR 100MG TABLET|Medicaid|MEDICAID|1.25||||1.25||| 9501545|ERX|0250|BUPROPION SR 100MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9501545|ERX|0250|BUPROPION SR 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9501602|ERX|0250|FINASTERIDE 5MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9501602|ERX|0250|FINASTERIDE 5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9501602|ERX|0250|FINASTERIDE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|1.25||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Humana Medicare Advantage|HUMANA MA|||||1.25||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|||||1.25||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.25||| 9501701|ERX|0250|VITAMIN E 400 UNIT CAPSUL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.25||| 9501701|ERX|0250|VITAMIN E 400 UNIT CAPSUL|Medicare|MEDICARE ACUTE|||||1.25||| 9501750|ERX|0250|PREDNISONE 5MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9501750|ERX|0250|PREDNISONE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9501750|ERX|0250|PREDNISONE 5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9501750|ERX|0250|PREDNISONE 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9501750|ERX|0250|PREDNISONE 5MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.25||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UMR|||||1.25||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||1.25||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.25||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.25||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.25||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|1.25||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|United Healthcare|UNITED HEALTHCARE|1.25||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Managed Medicare|HEALTHSPRING MA|||||1.25||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||1.25||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||20.50||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Aetna|AETNA OTHER|20.50||||20.50||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|20.50||||20.50||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|20.50||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|20.50||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Humana Medicare Advantage|HUMANA MA|20.50||||20.50||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|20.50||||20.50||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|20.50||||20.50||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Medicare|MEDICARE ACUTE|20.50||||20.50||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|United Healthcare|UNITED HEALTHCARE|||||20.50||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.25||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Tricare|TRICARE EAST REGION|1.25||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.25||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.25||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Medicare|MEDICARE PART B ONLY IP|1.25||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Aetna|AETNA OTHER|||||1.25||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Aetna|AETNA PPO|||||1.25||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Cigna|CIGNA|||||1.25||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.25||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||1.25||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9501867|ERX|0250|ISOSORBIDE DINITRATE 20MG|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9501867|ERX|0250|ISOSORBIDE DINITRATE 20MG|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9501867|ERX|0250|ISOSORBIDE DINITRATE 20MG|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.25||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|1.25||||1.25||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Medicaid|MORRIS COUNTY INDIGENT|||||1.25||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Medicaid|MEDICAID|1.25||||||| 9501925|ERX|0250|CARBAMAZEPINE 200MG TABLE|Medicaid|MEDICAID|||||1.25||| 9501925|ERX|0250|CARBAMAZEPINE 200MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||||| 9501925|ERX|0250|CARBAMAZEPINE 200MG TABLE|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Medicaid|MEDICAID|1.25||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|1.25||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.25||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||1.25||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|1.25||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Tricare|TRICARE EAST REGION|1.25||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|United Healthcare|UNITED HEALTHCARE|1.25||||1.25||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||1.25||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.25||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.25||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9502022|ERX|0250|ACETAMINOPHEN 120MG SUPP|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.07||| 9502022|ERX|0250|ACETAMINOPHEN 120MG SUPP|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.07||| 9502022|ERX|0250|ACETAMINOPHEN 120MG SUPP|United Healthcare|UNITED HEALTHCARE|||||0.07||| 9502022|ERX|0250|ACETAMINOPHEN 120MG SUPP|Blue Cross HMO Specialty|BCBSTX HMO|||||0.07||| 9502022|ERX|0250|ACETAMINOPHEN 120MG SUPP|Blue Cross PPO Specialty|BCBSTX PPO|||||0.07||| 9502022|ERX|0250|ACETAMINOPHEN 120MG SUPP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.07||| 9502022|ERX|0250|ACETAMINOPHEN 120MG SUPP|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.07||| 9502022|ERX|0250|ACETAMINOPHEN 120MG SUPP|Managed Medicaid|MEDICAID AMERIGROUP|||||0.07||| 9502022|ERX|0250|ACETAMINOPHEN 120MG SUPP|Managed Medicaid|MEDICAID SUPERIOR|0.07||||0.07||| 9502022|ERX|0250|ACETAMINOPHEN 120MG SUPP|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.07||| 9502022|ERX|0250|ACETAMINOPHEN 120MG SUPP|Medicaid|MEDICAID|||||0.07||| 9502022|ERX|0250|ACETAMINOPHEN 120MG SUPP|Medicaid|MEDICAID TEXAS CHILDRENS|||||0.07||| 9502071|ERX|0250|SITAGLIPTIN 100MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|16.25||||||| 9502071|ERX|0250|SITAGLIPTIN 100MG TABLET|Medicare|MEDICARE ACUTE|16.25||||||| 9502097|ERX|0250|PROPRANOLOL 20MG TABLET|Medicaid|MEDICAID|1.25||||||| 9502097|ERX|0250|PROPRANOLOL 20MG TABLET|Aetna|AETNA PPO|||||1.25||| 9502097|ERX|0250|PROPRANOLOL 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||||| 9502097|ERX|0250|PROPRANOLOL 20MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||||| 9502097|ERX|0250|PROPRANOLOL 20MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9502097|ERX|0250|PROPRANOLOL 20MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9502139|ERX|0250|NITROFURANTOIN MACRO 50MG|Medicare|MEDICARE ACUTE|||||1.25||| 9502139|ERX|0250|NITROFURANTOIN MACRO 50MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.02||||||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|Managed Medicaid|MEDICAID SUPERIOR|0.02||||||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|Managed Medicare|HEALTHSPRING MA|0.02||||||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|Humana Medicare Advantage|HUMANA MA|0.02||||0.02||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|Blue Cross PPO Specialty|BCBSTX PPO|0.02||||||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.02||||||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.02||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|United Medicare Advantage|UHC MEDICARE GOLD MA|0.02||||0.02||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|Veterans Affairs|VETERANS ADMINISTRATION|||||0.02||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|Medicare|MEDICARE ACUTE|0.02||||0.02||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|United Healthcare|UNITED HEALTHCARE|0.02||||||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.02||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.25||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Cigna|CIGNA|1.25||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.25||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Medicaid|MEDICAID|1.25||||||| 9502212|ERX|0250|CARBAMIDE PEROXIDE DROP,|Humana Medicare Advantage|HUMANA MA|||||39.75||| 9502212|ERX|0250|CARBAMIDE PEROXIDE DROP,|Medicare|MEDICARE ACUTE|39.75||||||| 9502253|ERX|0250|ACETAMINOPHEN 325MG SUPP|Tricare|TRICARE EAST REGION|||||4.75||| 9502253|ERX|0250|ACETAMINOPHEN 325MG SUPP|United Healthcare|UNITED HEALTHCARE|||||4.75||| 9502253|ERX|0250|ACETAMINOPHEN 325MG SUPP|Blue Cross PPO Specialty|BCBSTX PPO|||||4.75||| 9502253|ERX|0250|ACETAMINOPHEN 325MG SUPP|Managed Medicaid|MEDICAID SUPERIOR|||||4.75||| 9502253|ERX|0250|ACETAMINOPHEN 325MG SUPP|Managed Medicaid|MEDICAID AMERIGROUP|||||4.75||| 9502253|ERX|0250|ACETAMINOPHEN 325MG SUPP|Medicaid|MEDICAID TEXAS CHILDRENS|||||4.75||| 9502253|ERX|0250|ACETAMINOPHEN 325MG SUPP|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||4.75||| 9502253|ERX|0250|ACETAMINOPHEN 325MG SUPP|Medicaid|MEDICAID|||||4.75||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Humana Medicare Advantage|HUMANA MA|||||6.75||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||6.75||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||6.75||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||6.75||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Medicaid|MEDICAID TEXAS CHILDRENS|||||6.75||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|6.75||||6.75||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|6.75||||6.75||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|6.75||||6.75||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Medicare|MEDICARE ACUTE|6.75||||6.75||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|United Healthcare|UNITED HEALTHCARE|||||6.75||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9502287|ERX|0250|BISACODYL 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|1.25||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Medicaid|MEDICAID|1.25||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Veterans Affairs|VETERANS ADMINISTRATION|1.25||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Medicare|MEDICARE ACUTE|1.25||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|NON CONTRACTED|COMMERCIAL OTHER 1|1.25||||||| 9502378|ERX|0250|HYDROXYZINE PAMOATE 25MG|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9502378|ERX|0250|HYDROXYZINE PAMOATE 25MG|Medicaid|MEDICAID|||||1.25||| 9502410|ERX|0250|CHOLESTYRAMINE-SUCROSE 4G|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9502410|ERX|0250|CHOLESTYRAMINE-SUCROSE 4G|Medicare|MEDICARE ACUTE|1.25||||||| 9502451|ERX|0250|LIDOCAINE-EPI 2% SDV 20ML|Medicare|MEDICARE ACUTE|31.64||||22.82||| 9502451|ERX|0250|LIDOCAINE-EPI 2% SDV 20ML|Blue Cross PPO Specialty|BCBSTX PPO|||||0.14||| 9502451|ERX|0250|LIDOCAINE-EPI 2% SDV 20ML|Managed Medicaid|MEDICAID SUPERIOR|||||0.14||| 9502469|ERX|0250|OLANZAPINE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|||||1.25||| 9502469|ERX|0250|OLANZAPINE 5MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9502477|ERX|0250|LIDOCAINE 0.5%PF 50ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||46.75||| 9502493|ERX|0250|LIDOCAINE 2%MDV 50ML|Medicare|MEDICARE ACUTE|||||0.13||| 9502493|ERX|0250|LIDOCAINE 2%MDV 50ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.13||| 9502493|ERX|0250|LIDOCAINE 2%MDV 50ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.13||||||| 9502493|ERX|0250|LIDOCAINE 2%MDV 50ML|Medicaid|MORRIS COUNTY INDIGENT|||||0.13||| 9502493|ERX|0250|LIDOCAINE 2%MDV 50ML|Blue Cross PPO Specialty|BCBSTX PPO|||||0.13||| 9502493|ERX|0250|LIDOCAINE 2%MDV 50ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.13||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Blue Cross HMO Specialty|BCBSTX HMO|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Aetna|AETNA PPO|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Aetna|AETNA OTHER|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Blue Cross PPO Specialty|BCBSTX OTHER|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Blue Cross PPO Specialty|BCBSTX PPO|16.25||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|16.25||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Managed Medicaid|MEDICAID SUPERIOR|16.25||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Managed Medicaid|MEDICAID AMERIGROUP|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|16.25||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Access Direct Platinum|HEALTHFIRST TPA UMR|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Medicaid|MORRIS COUNTY INDIGENT|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Medicaid|MEDICAID HMO|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Humana Medicare Advantage|HUMANA MA|16.25||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Medicaid|MEDICAID|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Cigna|CIGNA|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Managed Medicare|WELLCARE CHOICE MA|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Veterans Affairs|VETERANS ADMINISTRATION|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Medicare|MEDICARE ACUTE|16.25||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|NON CONTRACTED|COMMERCIAL OTHER 1|16.25||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Tricare|TRICARE EAST REGION|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|United Healthcare|UNITED HEALTHCARE|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|United Healthcare|TML GROUP BENEFITS|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|United Healthcare|UNITED HEALTHCARE OTHER|||||16.25||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|United Healthcare|UNITED HEALTHCARE|16.25||||16.25||| 9502519|ERX|0250|LIDOCAINE 4%PF 40MG/ML, 5|Medicare|MEDICARE ACUTE|||||62.75||| 9502519|ERX|0250|LIDOCAINE 4%PF 40MG/ML, 5|Humana Medicare Advantage|HUMANA MA|||||62.75||| 9502519|ERX|0250|LIDOCAINE 4%PF 40MG/ML, 5|Blue Cross PPO Specialty|BCBSTX PPO|||||62.75||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Blue Cross PPO Specialty|BCBSTX PPO|||||0.62||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.62||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.62||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Managed Medicaid|MEDICAID SUPERIOR|||||0.62||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Medicare|MEDICARE ACUTE|0.62||||0.62||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.62||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||10.75||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|United Medicare Advantage|UHC MEDICARE GOLD MA|10.75||||10.75||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|10.75||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Veterans Affairs|VETERANS ADMINISTRATION|10.75||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Medicare|MEDICARE ACUTE|10.75||||10.75||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|United Healthcare|UNITED HEALTHCARE|10.75||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|10.75||||10.75||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Managed Medicaid|MEDICAID AMERIGROUP|||||10.75||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Humana Medicare Advantage|HUMANA MA|10.75||||10.75||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Managed Medicare|HEALTHSPRING MA|10.75||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Medicaid|MEDICAID|||||10.75||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|10.75||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Aenta Medicare Advantage|AETNA MEDICARE MA|10.75||||10.75||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Aetna|AETNA OTHER|||||10.75||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Cigna|CIGNA|10.75||||10.75||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Blue Cross PPO Specialty|BCBSTX PPO|||||10.75||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|Blue Cross PPO Specialty|BCBSTX PPO|||||0.27||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|Managed Medicaid|MEDICAID AMERIGROUP|||||0.27||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|Managed Medicaid|MEDICAID SUPERIOR|0.27||||0.27||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.27||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|Humana Medicare Advantage|HUMANA MA|0.27||||||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|Medicaid|MEDICAID|||||0.27||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|Tricare|TRICARE EAST REGION|||||0.27||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|United Healthcare|UNITED HEALTHCARE|||||0.27||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.27||| 9502725|ERX|0250|LIDOCAINE-PRILOCAINE, 1 K|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.27||| 9502733|ERX|0250|BUDESONIDE NEB 0.25MG/2ML|Medicare|MEDICARE ACUTE|47.75||||||| 9502733|ERX|0250|BUDESONIDE NEB 0.25MG/2ML|Managed Medicaid|MEDICAID SUPERIOR|||||47.75||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|16.25||||16.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Medicare|MEDICARE ACUTE|16.25||||16.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Tricare|TRICARE EAST REGION|||||16.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|United Healthcare|UNITED HEALTHCARE|16.25||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Aetna|AETNA OTHER|||||16.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|16.25||||16.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|16.25||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Managed Medicare|HEALTHSPRING MA|||||16.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|16.25||||16.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Humana Medicare Advantage|HUMANA MA|16.25||||16.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|16.25||||16.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||16.25||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Managed Medicaid|MEDICAID AMERIGROUP|16.25||||||| 9502816|ERX|0250|SIMVASTATIN 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9502816|ERX|0250|SIMVASTATIN 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||||| 9502816|ERX|0250|SIMVASTATIN 10MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.25||| 9502816|ERX|0250|SIMVASTATIN 10MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9502816|ERX|0250|SIMVASTATIN 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9502816|ERX|0250|SIMVASTATIN 10MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||||| 9502816|ERX|0250|SIMVASTATIN 10MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9502824|ERX|0250|PYRIDOSTIGMINE 60MG TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.25||||||| 9502949|ERX|0250|PIPERACILLIN-TAZOBACTAM 2|Managed Medicaid|MEDICAID SUPERIOR|||||43.25||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||16.75||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|Humana Medicare Advantage|HUMANA MA|16.75||||||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||16.75||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|Medicare|MEDICARE ACUTE|16.75||||16.75||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|16.75||||16.75||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|16.75||||||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|16.75||||||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||16.75||| 9502964|ERX|0250|PIPERACILLIN-TAZOBACTAM 3|Tricare|TRICARE EAST REGION|100.50||||||| 9502964|ERX|0250|PIPERACILLIN-TAZOBACTAM 3|Medicare|MEDICARE ACUTE|||||100.50||| 9502964|ERX|0250|PIPERACILLIN-TAZOBACTAM 3|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|100.50||||||| 9502964|ERX|0250|PIPERACILLIN-TAZOBACTAM 3|Aetna|AETNA OTHER|||||100.50||| 9502964|ERX|0250|PIPERACILLIN-TAZOBACTAM 3|Blue Cross PPO Specialty|BCBSTX PPO|100.50||||100.50||| 9502964|ERX|0250|PIPERACILLIN-TAZOBACTAM 3|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||100.50||| 9502964|ERX|0250|PIPERACILLIN-TAZOBACTAM 3|Managed Medicaid|MEDICAID SUPERIOR|||||100.50||| 9502972|ERX|0250|PIPERACILLIN-TAZOBACTAM 4|Medicare|MEDICARE ACUTE|||||0.76||| 9503020|ERX|0250|PROTEIN SUPPLEMENT PACKET|Medicare|MEDICARE ACUTE|0.09||||||| 9503020|ERX|0250|PROTEIN SUPPLEMENT PACKET|Managed Medicare|HEALTHSPRING MA|0.09||||||| 9503046|ERX|0250|SODIUM CHLORIDE 1 G TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.02||| 9503046|ERX|0250|SODIUM CHLORIDE 1 G TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|0.02||||||| 9503046|ERX|0250|SODIUM CHLORIDE 1 G TABLE|Medicare|MEDICARE ACUTE|0.02||||||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|17.25||||||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|17.25||||||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Managed Medicare|HEALTHSPRING MA|17.25||||||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|17.25||||||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||17.25||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|United Healthcare|UNITED HEALTHCARE|||||17.25||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|17.25||||17.25||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|United Healthcare|UNITED HEALTHCARE|17.25||||||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|17.25||||||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|17.25||||||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Medicaid|MEDICAID|17.25||||||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Medicare|MEDICARE ACUTE|17.25||||17.25||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||17.25||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|17.25||||||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|17.25||||17.25||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||17.25||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|Humana Medicare Advantage|HUMANA MA|17.25||||17.25||| 9503053|ERX|0250|LOSARTAN 50MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|17.25||||17.25||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Managed Medicaid|MEDICAID AMERIGROUP|||||3.50||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Medicare|MEDICARE ACUTE|3.50||||3.50||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Managed Medicaid|MEDICAID SUPERIOR|3.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Aenta Medicare Advantage|AETNA MEDICARE MA|3.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Humana Medicare Advantage|HUMANA MA|3.50||||3.50||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Medicaid|MEDICAID|3.50||||3.50||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|3.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|United Healthcare|UNITED HEALTHCARE|||||3.50||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Blue Cross PPO Specialty|BCBSTX PPO|3.50||||3.50||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|3.50||||3.50||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|United Healthcare|UNITED HEALTHCARE|3.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|3.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Aetna|AETNA OTHER|||||3.50||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|United Healthcare|UNITED HEALTHCARE|3.50||||3.50||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Medicaid|MEDICAID|3.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|3.50||||3.50||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Managed Medicaid|MEDICAID AMERIGROUP|||||3.50||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Managed Medicare|HEALTHSPRING MA|3.50||||3.50||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.50||||3.50||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3.50||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Humana Medicare Advantage|HUMANA MA|3.50||||3.50||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Managed Medicaid|MEDICAID SUPERIOR|3.50||||3.50||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||3.50||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.50||||3.50||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Cigna|CIGNA|3.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|3.50||||3.50||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Blue Cross HMO Specialty|BCBSTX HMO|||||3.50||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Medicare|MEDICARE PART B ONLY IP|3.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Veterans Affairs|VETERANS ADMINISTRATION|3.50||||3.50||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Tricare|TRICARE EAST REGION|3.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Medicare|MEDICARE ACUTE|3.50||||3.50||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Aenta Medicare Advantage|AETNA MEDICARE MA|3.50||||3.50||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Blue Cross PPO Specialty|BCBSTX PPO|3.50||||3.50||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.50||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|United Medicare Advantage|UHC MEDICARE GOLD MA|3.50||||3.50||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3.50||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|3.50||||3.50||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|3.50||||3.50||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|United Healthcare|UNITED HEALTHCARE OTHER|3.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|3.50||||3.50||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Medicare|MEDICARE ACUTE|16.25||||||| 9503178|ERX|0250|CEFOXITIN 1 G VIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||72.50||| 9503178|ERX|0250|CEFOXITIN 1 G VIAL|Managed Medicaid|MEDICAID SUPERIOR|72.50||||72.50||| 9503178|ERX|0250|CEFOXITIN 1 G VIAL|Cigna|CIGNA|||||72.50||| 9503178|ERX|0250|CEFOXITIN 1 G VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||72.50||| 9503178|ERX|0250|CEFOXITIN 1 G VIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||72.50||| 9503178|ERX|0250|CEFOXITIN 1 G VIAL|Blue Cross PPO Specialty|BCBSTX PPO|72.50||||72.50||| 9503178|ERX|0250|CEFOXITIN 1 G VIAL|Humana Medicare Advantage|HUMANA MA|72.50||||72.50||| 9503178|ERX|0250|CEFOXITIN 1 G VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||72.50||| 9503178|ERX|0250|CEFOXITIN 1 G VIAL|United Healthcare|UNITED HEALTHCARE|||||72.50||| 9503178|ERX|0250|CEFOXITIN 1 G VIAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||72.50||| 9503202|ERX|0250|NA CHL 0.65% NASAL SPRAY,|United Medicare Advantage|UHC MEDICARE GOLD MA|26.50||||||| 9503202|ERX|0250|NA CHL 0.65% NASAL SPRAY,|Medicare|MEDICARE ACUTE|26.50||||||| 9503202|ERX|0250|NA CHL 0.65% NASAL SPRAY,|Managed Medicaid|MEDICAID AMERIGROUP|||||26.50||| 9503202|ERX|0250|NA CHL 0.65% NASAL SPRAY,|Humana Medicare Advantage|HUMANA MA|26.50||||||| 9503202|ERX|0250|NA CHL 0.65% NASAL SPRAY,|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|26.50||||||| 9503251|ERX|0250|SODIUM CHLORIDE 3% 500ML|Medicare|MEDICARE ACUTE|0.35||||||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.25||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9503475|ERX|0250|DORZOLAMIDE 2% EYE DROP,|Medicare|MEDICARE ACUTE|346.50||||346.50||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.25||||||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9503640|ERX|0250|CEFAZOLIN 1 GM/50ML D5W|Humana Medicare Advantage|HUMANA MA|||||30.50||| 9503780|ERX|0250|TIMOLOL/DORZOLAM DROP,10M|Medicare|MEDICARE ACUTE|679.75||||||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Tricare|TRICARE EAST REGION|1.25||||||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Medicaid|MEDICAID|1.25||||1.25||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.25||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Tricare|TRICARE EAST REGION|||||1.25||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|NON CONTRACTED|COMMERCIAL OTHER 1|1.25||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Medicare|MEDICARE PART B ONLY IP|1.25||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Medicaid|MEDICAID|1.25||||1.25||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||1.25||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|United Healthcare|UNITED HEALTHCARE|1.25||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||1.25||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Tricare|TRICARE EAST REGION|||||1.25||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|NON CONTRACTED|COMMERCIAL OTHER 1|1.25||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|United Healthcare|UNITED HEALTHCARE|1.25||||||| 9503905|ERX|0250|LEVOTHYROXINE 112MCG TABL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9503905|ERX|0250|LEVOTHYROXINE 112MCG TABL|Medicare|MEDICARE ACUTE|1.25||||||| 9503962|ERX|0250|NITROGLYCERIN 0.2MG PATCH|Medicare|MEDICARE ACUTE|||||2.25||| 9503970|ERX|0250|NITROGLYCERIN 0.4MG PATCH|Managed Medicare|HEALTHSPRING MA|||||16.25||| 9503970|ERX|0250|NITROGLYCERIN 0.4MG PATCH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||16.25||| 9503970|ERX|0250|NITROGLYCERIN 0.4MG PATCH|Humana Medicare Advantage|HUMANA MA|16.25||||16.25||| 9503970|ERX|0250|NITROGLYCERIN 0.4MG PATCH|Cigna|CIGNA|||||16.25||| 9503970|ERX|0250|NITROGLYCERIN 0.4MG PATCH|Medicare|MEDICARE ACUTE|||||16.25||| 9504051|ERX|0250|MORPHINE ER 15MG TABLET|Medicare|MEDICARE ACUTE|9.25||||||| 9504127|ERX|0250|ERTAPENEM 1 G VIAL|Blue Cross PPO Specialty|BCBSTX PPO|||||153.25||| 9504127|ERX|0250|ERTAPENEM 1 G VIAL|Humana Medicare Advantage|HUMANA MA|153.25||||||| 9504218|ERX|0250|GENTAMICIN 40MG/ML, 2ML|Managed Medicaid|MEDICAID SUPERIOR|39.75||||||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||25.75||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||25.75||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||25.75||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|Medicare|MEDICARE ACUTE|25.75||||25.75||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Medicare|MEDICARE ACUTE|0.21||||0.21||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Managed Medicaid|MEDICAID AMERIGROUP|||||0.21||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Humana Medicare Advantage|HUMANA MA|||||0.21||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Blue Cross PPO Specialty|BCBSTX PPO|0.21||||0.21||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.21||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Veterans Affairs|VETERANS ADMINISTRATION|||||0.21||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|United Healthcare|UNITED HEALTHCARE|||||0.21||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Managed Medicaid|MEDICAID SUPERIOR|||||0.21||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|Cigna|CIGNA|||||0.21||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.21||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.21||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.12||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Medicare|MEDICARE ACUTE|0.12||||0.12||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|United Healthcare|UNITED HEALTHCARE OTHER|0.12||||0.12||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|United Healthcare|UNITED HEALTHCARE|||||0.12||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.12||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.12||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|0.12||||0.12||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UMR|0.12||||||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|0.12||||0.12||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.12||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|||||0.12||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Humana Medicare Advantage|HUMANA MA|0.12||||0.12||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.12||||0.12||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|United Healthcare|UNITED HEALTHCARE|0.12||||||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.12||| 9504275|ERX|0250|PHENYTOIN 100MG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|||||45.75||| 9504325|ERX|0250|NOREPINEPHRINE 4MG/4ML|Medicare|MEDICARE ACUTE|||||39.75||| 9504325|ERX|0250|NOREPINEPHRINE 4MG/4ML|Veterans Affairs|VETERANS ADMINISTRATION|39.75||||||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|22.25||||22.25||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||22.25||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||22.25||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Tricare|TRICARE EAST REGION|22.25||||||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||22.25||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||22.25||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Cigna|CIGNA|||||22.25||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|22.25||||||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||22.25||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Humana Medicare Advantage|HUMANA MA|||||22.25||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Medicare|MEDICARE ACUTE|||||22.25||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Blue Cross PPO Specialty|BCBSTX PPO|||||22.25||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.25||||2.25||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|United Healthcare|UNITED HEALTHCARE|||||2.25||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Blue Cross HMO Specialty|BCBSTX HMO|||||2.25||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.25||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.25||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.25||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|United Healthcare|UNITED HEALTHCARE|2.25||||2.25||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.25||||2.25||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Blue Cross PPO Specialty|BCBSTX PPO|2.25||||2.25||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Medicare|MEDICARE ACUTE|2.25||||2.25||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.25||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Cigna|CIGNA|||||2.25||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.25||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.25||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Veterans Affairs|VETERANS ADMINISTRATION|2.25||||||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Managed Medicaid|MEDICAID SUPERIOR|2.25||||2.25||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.25||||2.25||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.25||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.25||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Humana Medicare Advantage|HUMANA MA|||||2.25||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Managed Medicaid|MEDICAID AMERIGROUP|||||2.25||| 9504390|ERX|0250|BUPIVACAINE 0.5%PF 10ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||30.50||| 9504390|ERX|0250|BUPIVACAINE 0.5%PF 10ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||30.50||| 9504390|ERX|0250|BUPIVACAINE 0.5%PF 10ML|Managed Medicaid|MEDICAID AMERIGROUP|||||30.50||| 9504390|ERX|0250|BUPIVACAINE 0.5%PF 10ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||30.50||| 9504390|ERX|0250|BUPIVACAINE 0.5%PF 10ML|Managed Medicaid|MEDICAID SUPERIOR|||||30.50||| 9504390|ERX|0250|BUPIVACAINE 0.5%PF 10ML|Humana Medicare Advantage|HUMANA MA|||||30.50||| 9504390|ERX|0250|BUPIVACAINE 0.5%PF 10ML|Medicare|MEDICARE ACUTE|||||30.50||| 9504390|ERX|0250|BUPIVACAINE 0.5%PF 10ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||30.50||| 9504390|ERX|0250|BUPIVACAINE 0.5%PF 10ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||30.50||| 9504390|ERX|0250|BUPIVACAINE 0.5%PF 10ML|Blue Cross HMO Specialty|BCBSTX HMO|||||30.50||| 9504390|ERX|0250|BUPIVACAINE 0.5%PF 10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||30.50||| 9504390|ERX|0250|BUPIVACAINE 0.5%PF 10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||30.50||| 9504390|ERX|0250|BUPIVACAINE 0.5%PF 10ML|Blue Cross PPO Specialty|BCBSTX PPO|||||30.50||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Humana Medicare Advantage|HUMANA MA|||||2.25||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.25||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Managed Medicaid|MEDICAID AMERIGROUP|||||2.25||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|NON CONTRACTED|COMMERCIAL OTHER 1|2.25||||2.25||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|United Healthcare|UNITED HEALTHCARE|2.25||||||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|United Healthcare|UNITED HEALTHCARE OTHER|2.25||||||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Blue Cross PPO Specialty|BCBSTX PPO|||||2.25||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Medicare|MEDICARE ACUTE|||||2.25||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.25||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.25||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.25||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.25||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Cigna|CIGNA|||||2.25||| 9504531|ERX|0250|BUPIVACAINE-EPI 0.25%MDV|Managed Medicaid|MEDICAID AMERIGROUP|||||22.50||| 9504531|ERX|0250|BUPIVACAINE-EPI 0.25%MDV|Managed Medicaid|MEDICAID SUPERIOR|||||22.50||| 9504531|ERX|0250|BUPIVACAINE-EPI 0.25%MDV|Humana Medicare Advantage|HUMANA MA|||||22.50||| 9504531|ERX|0250|BUPIVACAINE-EPI 0.25%MDV|Tricare|TRICARE EAST REGION|||||22.50||| 9504531|ERX|0250|BUPIVACAINE-EPI 0.25%MDV|Medicaid|MEDICAID TEXAS CHILDRENS|||||22.50||| 9504531|ERX|0250|BUPIVACAINE-EPI 0.25%MDV|Blue Cross PPO Specialty|BCBSTX PPO|||||22.50||| 9504531|ERX|0250|BUPIVACAINE-EPI 0.25%MDV|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||22.50||| 9504531|ERX|0250|BUPIVACAINE-EPI 0.25%MDV|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||22.50||| 9504531|ERX|0250|BUPIVACAINE-EPI 0.25%MDV|Medicare|MEDICARE ACUTE|||||22.50||| 9504531|ERX|0250|BUPIVACAINE-EPI 0.25%MDV|NON CONTRACTED|COMMERCIAL OTHER 1|||||22.50||| 9504531|ERX|0250|BUPIVACAINE-EPI 0.25%MDV|United Healthcare|UNITED HEALTHCARE|||||22.50||| 9504531|ERX|0250|BUPIVACAINE-EPI 0.25%MDV|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||22.50||| 9504531|ERX|0250|BUPIVACAINE-EPI 0.25%MDV|United Medicare Advantage|UHC MEDICARE GOLD MA|||||22.50||| 9504531|ERX|0250|BUPIVACAINE-EPI 0.25%MDV|United Healthcare|UNITED HEALTHCARE OTHER|||||22.50||| 9504531|ERX|0250|BUPIVACAINE-EPI 0.25%MDV|Medicaid|MEDICAID|||||22.50||| 9504531|ERX|0250|BUPIVACAINE-EPI 0.25%MDV|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||22.50||| 9504531|ERX|0250|BUPIVACAINE-EPI 0.25%MDV|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||22.50||| 9504531|ERX|0250|BUPIVACAINE-EPI 0.25%MDV|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||22.50||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.48||| 9504630|ERX|0250|KETAMINE 500MG/10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.48||||0.48||| 9504630|ERX|0250|KETAMINE 500MG/10ML|United Healthcare|UNITED HEALTHCARE|0.48||||||| 9504630|ERX|0250|KETAMINE 500MG/10ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.48||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Medicare|MEDICARE ACUTE|||||0.48||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Managed Medicaid|MEDICAID SUPERIOR|||||0.48||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Managed Medicaid|MEDICAID AMERIGROUP|||||0.48||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.48||| 9504630|ERX|0250|KETAMINE 500MG/10ML|Blue Cross PPO Specialty|BCBSTX PPO|||||0.48||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||15.25||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Managed Medicaid|MEDICAID AMERIGROUP|||||15.25||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||15.25||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Medicaid|MEDICAID|15.25||||15.25||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Managed Medicaid|MEDICAID SUPERIOR|||||15.25||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||15.25||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Managed Medicare|BCBS MEDICARE PPO MA|||||15.25||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Blue Cross PPO Specialty|BCBSTX PPO|||||15.25||| 9504648|ERX|0250|LABETALOL 100MG/20ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||15.25||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Humana Medicare Advantage|HUMANA MA|||||15.25||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|15.25||||15.25||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||15.25||| 9504648|ERX|0250|LABETALOL 100MG/20ML|United Healthcare|UNITED HEALTHCARE|||||15.25||| 9504648|ERX|0250|LABETALOL 100MG/20ML|United Medicare Advantage|UHC MEDICARE GOLD MA|15.25||||15.25||| 9504648|ERX|0250|LABETALOL 100MG/20ML|United Healthcare|UNITED HEALTHCARE|15.25||||||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Medicare|MEDICARE ACUTE|15.25||||15.25||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Tricare|TRICARE EAST REGION|15.25||||||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Managed Medicare|HEALTHSPRING MA|||||15.25||| 9504671|ERX|0250|DOBUTAMINE 250MG/250ML D5|Medicare|MEDICARE ACUTE|398.75||||||| 9504671|ERX|0250|DOBUTAMINE 250MG/250ML D5|Humana Medicare Advantage|HUMANA MA|398.75||||||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||11.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Cigna|CIGNA|||||11.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Blue Cross HMO Specialty|BCBSTX HMO|||||11.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||11.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Blue Cross PPO Specialty|BCBSTX PPO|11.75||||11.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||11.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Medicare|MEDICARE ACUTE|11.75||||11.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||11.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||11.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Managed Medicaid|MEDICAID SUPERIOR|||||11.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Access Direct Platinum|HEALTHFIRST TPA UMR|11.75||||||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Tricare|TRICARE EAST REGION|11.75||||||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Medicaid|MEDICAID|11.75||||||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||11.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|United Medicare Advantage|UHC MEDICARE GOLD MA|11.75||||||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|United Healthcare|UNITED HEALTHCARE|||||11.75||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Humana Medicare Advantage|HUMANA MA|||||11.75||| 9504838|ERX|0250|LIDOCAINE 1%MDV 50ML|Medicare|MEDICARE ACUTE|||||14.25||| 9504838|ERX|0250|LIDOCAINE 1%MDV 50ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||14.25||| 9504838|ERX|0250|LIDOCAINE 1%MDV 50ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||14.25||| 9504838|ERX|0250|LIDOCAINE 1%MDV 50ML|Blue Cross PPO Specialty|BCBSTX PPO|14.25||||14.25||| 9504838|ERX|0250|LIDOCAINE 1%MDV 50ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||14.25||| 9504838|ERX|0250|LIDOCAINE 1%MDV 50ML|Humana Medicare Advantage|HUMANA MA|||||14.25||| 9504838|ERX|0250|LIDOCAINE 1%MDV 50ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||14.25||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|Medicare|MEDICARE ACUTE|||||38.25||| 9504846|ERX|0250|LIDOCAINE 1%PF 30ML|Blue Cross PPO Specialty|BCBSTX PPO|38.25||||38.25||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Aetna|AETNA OTHER|0.62||||||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Managed Medicaid|MEDICAID SUPERIOR|0.62||||0.62||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|United Healthcare|UNITED HEALTHCARE|||||0.62||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.62||||||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|0.62||||0.62||| 9504879|ERX|0250|VANCOMYCIN 500MG VIAL|Medicare|MEDICARE ACUTE|||||0.62||| 9504911|ERX|0250||Medicare|MEDICARE ACUTE|||||12.50||| 9504911|ERX|0250||Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||12.50||| 9504911|ERX|0250||Aetna|AETNA OTHER|12.50||||||| 9504929|ERX|0250|WATER FOR INJ.,STERILE 20|Medicare|MEDICARE ACUTE|||||8.75||| 9504929|ERX|0250|WATER FOR INJ.,STERILE 20|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|8.75||||||| 9504929|ERX|0250|WATER FOR INJ.,STERILE 20|Blue Cross HMO Specialty|BCBSTX HMO|8.75||||||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Managed Medicaid|MEDICAID SUPERIOR|||||9.25||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||9.25||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Medicare|MEDICARE ACUTE|||||9.25||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Managed Medicaid|MEDICAID AMERIGROUP|||||9.25||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Medicaid|MEDICAID TEXAS CHILDRENS|9.25||||||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Blue Cross PPO Specialty|BCBSTX PPO|9.25||||9.25||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Cigna|CIGNA|||||9.25||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Medicaid|MORRIS COUNTY INDIGENT|||||9.25||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||9.25||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||9.25||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Access Direct Platinum|HEALTHFIRST TPA UMR|9.25||||||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||9.25||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Humana Medicare Advantage|HUMANA MA|9.25||||||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Blue Cross HMO Specialty|BCBSTX HMO|||||9.25||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|United Healthcare|UNITED HEALTHCARE|||||9.25||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||9.25||| 9504952|ERX|0250|SODIUM CHLORIDE 0.9% 50ML|Tricare|TRICARE EAST REGION|||||9.25||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Medicare|MEDICARE ACUTE|41.50||||41.50||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|United Medicare Advantage|UHC MEDICARE GOLD MA|||||41.50||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||41.50||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|NON CONTRACTED|COMMERCIAL OTHER 1|||||41.50||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Managed Medicaid|MEDICAID UNITED HEALTHCARE|41.50||||41.50||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||41.50||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Blue Cross PPO Specialty|BCBSTX PPO|41.50||||41.50||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Blue Cross HMO Specialty|BCBSTX HMO|||||41.50||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Humana Medicare Advantage|HUMANA MA|41.50||||41.50||| 9504994|ERX|0250|LIDOCAINE ABBOJECT 100MG/|Medicare|MEDICARE ACUTE|||||23.50||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.55||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|Blue Cross PPO Specialty|BCBSTX PPO|||||0.55||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|Humana Medicare Advantage|HUMANA MA|||||0.55||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|United Healthcare|UNITED HEALTHCARE|||||0.55||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|Medicare|MEDICARE ACUTE|0.55||||0.55||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||118.25||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Medicare|MEDICARE ACUTE|118.25||||118.25||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||118.25||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|United Healthcare|UNITED HEALTHCARE|||||118.25||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Humana Medicare Advantage|HUMANA MA|118.25||||118.25||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|United Medicare Advantage|UHC MEDICARE GOLD MA|||||118.25||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Blue Cross PPO Specialty|BCBSTX PPO|||||118.25||| 9505025|ERX|0250|CA CHLORIDE 1000MG/10ML|Medicare|MEDICARE ACUTE|||||4.75||| 9505025|ERX|0250|CA CHLORIDE 1000MG/10ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.75||| 9505025|ERX|0250|CA CHLORIDE 1000MG/10ML|Blue Cross PPO Specialty|BCBSTX PPO|||||4.75||| 9505025|ERX|0250|CA CHLORIDE 1000MG/10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.75||| 9505033|ERX|0250|CEFTAZIDIME 1 G VIAL|Managed Medicaid|MEDICAID SUPERIOR|140.25||||||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.13||||0.13||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.13||||||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|United Healthcare|UNITED HEALTHCARE|0.13||||||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Managed Medicaid|MEDICAID AMERIGROUP|0.13||||||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|NON CONTRACTED|COMMERCIAL OTHER 1|0.13||||||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Medicare|MEDICARE ACUTE|0.13||||0.13||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||0.13||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.13||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.13||||||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.13||| 9505090|ERX|0250|FUROSEMIDE 20MG/2ML|Humana Medicare Advantage|HUMANA MA|0.13||||0.13||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|17.75||||17.75||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|17.75||||17.75||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Managed Medicaid|MEDICAID AMERIGROUP|17.75||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Managed Medicare|HEALTHSPRING MA|17.75||||17.75||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Humana Medicare Advantage|HUMANA MA|17.75||||17.75||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|17.75||||17.75||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Aenta Medicare Advantage|AETNA MEDICARE MA|17.75||||17.75||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Medicare|MEDICARE ACUTE|17.75||||17.75||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Medicaid|MEDICAID|||||17.75||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|United Healthcare|UNITED HEALTHCARE|17.75||||17.75||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||17.75||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Blue Cross PPO Specialty|BCBSTX PPO|17.75||||17.75||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|17.75||||17.75||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Veterans Affairs|VETERANS ADMINISTRATION|||||17.75||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Cigna|CIGNA|||||17.75||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|17.75||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|United Medicare Advantage|UHC MEDICARE GOLD MA|17.75||||17.75||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|United Healthcare|UNITED HEALTHCARE|||||17.75||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|17.75||||||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|Medicare|MEDICARE ACUTE|8.75||||||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|United Healthcare|UNITED HEALTHCARE|8.75||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|NON CONTRACTED|COMMERCIAL OTHER 1|1.79||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Humana Medicare Advantage|HUMANA MA|1.79||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|1.79||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Cigna|CIGNA|1.79||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Managed Medicaid|MEDICAID SUPERIOR|1.79||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Medicare|MEDICARE ACUTE|1.79||||1.79||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|United Healthcare|UNITED HEALTHCARE|||||1.79||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|United Healthcare|UNITED HEALTHCARE|1.79||||||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|United Healthcare|UNITED HEALTHCARE|||||0.27||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Tricare|TRICARE EAST REGION|0.27||||||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Medicare|MEDICARE ACUTE|0.27||||0.27||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|United Medicare Advantage|UHC MEDICARE GOLD MA|0.27||||||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Managed Medicaid|MEDICAID SUPERIOR|||||0.27||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.27||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.27||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.27||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.27||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Blue Cross PPO Specialty|BCBSTX PPO|0.27||||0.27||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Humana Medicare Advantage|HUMANA MA|0.27||||0.27||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Cigna|CIGNA|||||0.27||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|United Healthcare|UNITED HEALTHCARE OTHER|0.27||||||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Blue Cross HMO Specialty|BCBSTX HMO|||||0.27||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Access Direct Platinum|HEALTHFIRST TPA UMR|0.27||||||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.27||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Medicaid|MEDICAID|16.25||||16.25||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Aenta Medicare Advantage|AETNA MEDICARE MA|||||16.25||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Humana Medicare Advantage|HUMANA MA|16.25||||16.25||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Blue Cross PPO Specialty|BCBSTX PPO|||||16.25||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Workers Compensation|WORKERS COMPENSATION OTHER|||||16.25||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|United Medicare Advantage|UHC MEDICARE GOLD MA|16.25||||16.25||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Medicare|MEDICARE ACUTE|16.25||||16.25||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||16.25||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|NON CONTRACTED|COMMERCIAL OTHER 1|||||16.25||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|United Healthcare|UNITED HEALTHCARE|||||16.25||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|1.25||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||1.25||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||1.25||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Aetna|AETNA OTHER|||||1.25||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Cigna|CIGNA|0.80||||||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Blue Cross PPO Specialty|BCBSTX PPO|0.80||||0.80||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.80||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.80||||||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.80||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Managed Medicaid|MEDICAID AMERIGROUP|||||0.80||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.80||||0.80||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Managed Medicare|HEALTHSPRING MA|0.80||||||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Managed Medicaid|MEDICAID SUPERIOR|||||0.80||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.80||||0.80||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|NON CONTRACTED|COMMERCIAL OTHER 1|0.80||||||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Humana Medicare Advantage|HUMANA MA|0.80||||0.80||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Cigna|CIGNA|||||0.80||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Tricare|TRICARE EAST REGION|0.80||||||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Medicaid|MEDICAID|0.80||||||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Veterans Affairs|VETERANS ADMINISTRATION|||||0.80||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|United Healthcare|UNITED HEALTHCARE|0.80||||||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|United Healthcare|UNITED HEALTHCARE|0.80||||0.80||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Medicare|MEDICARE ACUTE|0.80||||0.80||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.80||||||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.80||||0.80||| 9505264|ERX|0250|MAGNESIUM SULF 2 GM/50ML|Veterans Affairs|VETERANS ADMINISTRATION|0.80||||||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Veterans Affairs|VETERANS ADMINISTRATION|||||11.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Medicare|MEDICARE ACUTE|||||11.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||11.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|United Healthcare|UNITED HEALTHCARE OTHER|11.25||||||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||11.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Humana Medicare Advantage|HUMANA MA|||||11.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|11.25||||11.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Blue Cross PPO Specialty|BCBSTX PPO|11.25||||11.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||11.25||| 9505272|ERX|0250|K CHLORIDE 20 MEQ/100ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||11.25||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Medicaid|MEDICAID|1.25||||||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|1.25||||||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||1.25||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|United Healthcare|UNITED HEALTHCARE|1.25||||||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||||| 9505298|ERX|0250|CARVEDILOL 6.25MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9505314|ERX|0250|DEX 5%-NS KCL 20 MEQ 1000|Managed Medicaid|MEDICAID SUPERIOR|0.12||||0.12||| 9505314|ERX|0250|DEX 5%-NS KCL 20 MEQ 1000|Managed Medicaid|MEDICAID AMERIGROUP|0.12||||||| 9505314|ERX|0250|DEX 5%-NS KCL 20 MEQ 1000|Blue Cross HMO Specialty|BCBSTX HMO|0.12||||||| 9505314|ERX|0250|DEX 5%-NS KCL 20 MEQ 1000|Medicaid|MEDICAID|0.12||||||| 9505314|ERX|0250|DEX 5%-NS KCL 20 MEQ 1000|Blue Cross PPO Specialty|BCBSTX PPO|0.12||||||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|NON CONTRACTED|COMMERCIAL OTHER 1|0.13||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|United Healthcare|UNITED HEALTHCARE|0.13||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|United Medicare Advantage|UHC MEDICARE GOLD MA|0.13||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Medicare|MEDICARE ACUTE|0.13||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|United Healthcare|UNITED HEALTHCARE OTHER|||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|United Healthcare|UNITED HEALTHCARE|||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Access Direct Platinum|HEALTHFIRST TPA UMR|0.13||||||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.13||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Tricare|TRICARE EAST REGION|||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Cigna|CIGNA|||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Humana Medicare Advantage|HUMANA MA|0.13||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.13||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.13||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Managed Medicaid|MEDICAID AMERIGROUP|||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Blue Cross HMO Specialty|BCBSTX HMO|||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Managed Medicaid|MEDICAID SUPERIOR|0.13||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Medicaid|MEDICAID|||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Medicaid|MEDICAID TEXAS CHILDRENS|||||0.13||| 9505397|ERX|0250|NA CHLORIDE 0.9%,1000ML I|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||0.13||| 9505405|ERX|0250|WATER FOR IRRIGATION 1000|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|22.50||||||| 9505405|ERX|0250|WATER FOR IRRIGATION 1000|Medicare|MEDICARE ACUTE|||||22.50||| 9505405|ERX|0250|WATER FOR IRRIGATION 1000|Workers Compensation|WORKERS COMPENSATION OTHER|||||22.50||| 9505405|ERX|0250|WATER FOR IRRIGATION 1000|United Medicare Advantage|UHC MEDICARE GOLD MA|||||22.50||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.13||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.13||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|United Healthcare|UNITED HEALTHCARE|||||0.13||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Medicare|MEDICARE ACUTE|||||0.13||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.13||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Humana Medicare Advantage|HUMANA MA|0.13||||0.13||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Managed Medicaid|MEDICAID SUPERIOR|||||0.13||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Medicaid|MEDICAID|||||0.13||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Managed Medicare|HEALTHSPRING MA|||||0.13||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|Humana Medicare Advantage|HUMANA MA|0.07||||0.07||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.07||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|Medicare|MEDICARE ACUTE|0.07||||0.07||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.07||||0.07||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.07||||||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.07||||0.07||| 9505470|ERX|0250|CARVEDILOL 25MG TABLET|Tricare|TRICARE EAST REGION|0.07||||||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|United Medicare Advantage|UHC MEDICARE GOLD MA|||||113.75||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|NON CONTRACTED|COMMERCIAL OTHER 1|||||113.75||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|Medicare|MEDICARE ACUTE|||||113.75||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||113.75||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||113.75||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||113.75||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|Humana Medicare Advantage|HUMANA MA|113.75||||113.75||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|Blue Cross PPO Specialty|BCBSTX PPO|||||113.75||| 9505561|ERX|0250|DOPAMINE 800MG/500ML D5W|Medicare|MEDICARE ACUTE|||||153.25||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|102.75||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||102.75||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Managed Medicaid|MEDICAID AMERIGROUP|102.75||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Managed Medicaid|MEDICAID SUPERIOR|102.75||||102.75||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Humana Medicare Advantage|HUMANA MA|102.75||||102.75||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Medicaid|MEDICAID TEXAS CHILDRENS|102.75||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Access Direct Platinum|HEALTHFIRST TPA UMR|102.75||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|102.75||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|United Medicare Advantage|UHC MEDICARE GOLD MA|102.75||||102.75||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||102.75||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|NON CONTRACTED|COMMERCIAL OTHER 1|102.75||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Blue Cross PPO Specialty|BCBSTX PPO|102.75||||102.75||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Medicare|MEDICARE ACUTE|102.75||||102.75||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Medicaid|MEDICAID|102.75||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Cigna|CIGNA|102.75||||102.75||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|United Healthcare|UNITED HEALTHCARE|||||102.75||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|United Healthcare|UNITED HEALTHCARE|102.75||||102.75||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|United Healthcare|UNITED HEALTHCARE OTHER|102.75||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Tricare|TRICARE EAST REGION|102.75||||||| 9505603|ERX|0250|GENTAMICIN 80MG/100ML NS|United Healthcare|UNITED HEALTHCARE|||||72.25||| 9505603|ERX|0250|GENTAMICIN 80MG/100ML NS|Managed Medicaid|MEDICAID SUPERIOR|72.25||||||| 9505611|ERX|0250|DEX 5%-1/4NS KCL 20 MEQ 1|Managed Medicaid|MEDICAID SUPERIOR|46.75||||46.75||| 9505751|ERX|0250|DEXTROSE 5%-1/4 NS 1000ML|Medicaid|MEDICAID TEXAS CHILDRENS|122.25||||||| 9505751|ERX|0250|DEXTROSE 5%-1/4 NS 1000ML|Medicare|MEDICARE ACUTE|122.25||||||| 9505785|ERX|0250|DEXTROSE 10%-WATER 500ML|Humana Medicare Advantage|HUMANA MA|||||92.75||| 9505785|ERX|0250|DEXTROSE 10%-WATER 500ML|Medicare|MEDICARE ACUTE|||||92.75||| 9505793|ERX|0250|DEXTROSE 10%-WATER 1000ML|Medicare|MEDICARE ACUTE|1.39||||1.39||| 9505793|ERX|0250|DEXTROSE 10%-WATER 1000ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.39||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Access Direct Platinum|HEALTHFIRST TPA UMR|13.25||||||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|13.25||||13.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Blue Cross PPO Specialty|BCBSTX PPO|13.25||||13.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||13.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Blue Cross HMO Specialty|BCBSTX HMO|||||13.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Managed Medicaid|MEDICAID AMERIGROUP|||||13.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||13.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Cigna|CIGNA|||||13.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Managed Medicaid|MEDICAID SUPERIOR|||||13.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Medicaid|MEDICAID TEXAS CHILDRENS|13.25||||13.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Veterans Affairs|VETERANS ADMINISTRATION|13.25||||||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|13.25||||||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||13.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|United Medicare Advantage|UHC MEDICARE GOLD MA|||||13.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|NON CONTRACTED|COMMERCIAL OTHER 1|||||13.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Tricare|TRICARE EAST REGION|13.25||||||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|United Healthcare|UNITED HEALTHCARE OTHER|13.25||||||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|United Healthcare|UNITED HEALTHCARE|13.25||||13.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Medicare|MEDICARE ACUTE|13.25||||13.25||| 9505868|ERX|0250|NA CHLORIDE 0.9%,3000ML I|Humana Medicare Advantage|HUMANA MA|13.25||||13.25||| 9505892|ERX|0250|SODIUM CHLORIDE 0.9% 500M|NON CONTRACTED|COMMERCIAL OTHER 1|||||140.25||| 9505892|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Managed Medicaid|MEDICAID SUPERIOR|140.25||||140.25||| 9505892|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Tricare|TRICARE EAST REGION|||||140.25||| 9505892|ERX|0250|SODIUM CHLORIDE 0.9% 500M|United Healthcare|UNITED HEALTHCARE|140.25||||140.25||| 9505892|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Medicaid|MEDICAID HMO|||||140.25||| 9505892|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Veterans Affairs|VETERANS ADMINISTRATION|||||140.25||| 9505892|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|140.25||||140.25||| 9505892|ERX|0250|SODIUM CHLORIDE 0.9% 500M|United Medicare Advantage|UHC MEDICARE GOLD MA|140.25||||140.25||| 9505892|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Managed Medicaid|MEDICAID AMERIGROUP|140.25||||140.25||| 9505892|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Humana Medicare Advantage|HUMANA MA|140.25||||140.25||| 9505892|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Medicaid|MEDICAID|||||140.25||| 9505892|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Medicare|MEDICARE ACUTE|140.25||||140.25||| 9505892|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Managed Medicare|HEALTHSPRING MA|140.25||||||| 9505892|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||140.25||| 9505892|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Blue Cross HMO Specialty|BCBSTX HMO|140.25||||140.25||| 9505892|ERX|0250|SODIUM CHLORIDE 0.9% 500M|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||140.25||| 9505892|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||140.25||| 9505892|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|140.25||||||| 9505892|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Aetna|AETNA PPO|||||140.25||| 9505892|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Blue Cross PPO Specialty|BCBSTX PPO|140.25||||140.25||| 9505892|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|140.25||||140.25||| 9505892|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Cigna|CIGNA|||||140.25||| 9505892|ERX|0250|SODIUM CHLORIDE 0.9% 500M|Aenta Medicare Advantage|AETNA MEDICARE MA|||||140.25||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.93||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Aetna|AETNA OTHER|||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.93||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Access Direct Platinum|HEALTHFIRST TPA UMR|1.93||||||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Blue Cross HMO Specialty|BCBSTX HMO|1.93||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Blue Cross PPO Specialty|BCBSTX PPO|1.93||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Aetna|AETNA PPO|||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Cigna|CIGNA|1.93||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Aenta Medicare Advantage|AETNA MEDICARE MA|1.93||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.93||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Humana Medicare Advantage|HUMANA MA|1.93||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.93||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Managed Medicaid|MEDICAID AMERIGROUP|1.93||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Medicaid|MORRIS COUNTY INDIGENT|||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Managed Medicare|HEALTHSPRING MA|1.93||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Medicaid|MEDICAID|1.93||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Medicaid|MEDICAID BCBSTX|||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.93||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Managed Medicaid|MEDICAID SUPERIOR|1.93||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Medicaid|MEDICAID HMO|||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Managed Medicare|BCBS MEDICARE PPO MA|||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Veterans Affairs|VETERANS ADMINISTRATION|||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|United Medicare Advantage|UHC MEDICARE GOLD MA|1.93||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.93||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.93||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Tricare|TRICARE FOR LIFE|||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|PHCS|HUMANA INSURANCE|||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Medicare|MEDICARE ACUTE|1.93||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Medicare|MEDICARE PART B ONLY IP|1.93||||||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|PHCS|GROUP AND PENSION|||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Veterans Affairs|VETERANS ADMINISTRATION|1.93||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|United Healthcare|TML GROUP BENEFITS|||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|United Healthcare|UNITED HEALTHCARE OTHER|1.93||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|NON CONTRACTED|COMMERCIAL OTHER 1|1.93||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|Tricare|TRICARE EAST REGION|1.93||||1.93||| 9505900|ERX|0250|SODIUM CHLORIDE 0.9% 1000|United Healthcare|UNITED HEALTHCARE|1.93||||1.93||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|Tricare|TRICARE EAST REGION|||||1.25||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.25||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||153.25||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Blue Cross HMO Specialty|BCBSTX HMO|||||153.25||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Aetna|AETNA PPO|||||153.25||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||153.25||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Aenta Medicare Advantage|AETNA MEDICARE MA|153.25||||||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Medicaid|MORRIS COUNTY INDIGENT|||||153.25||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Humana Medicare Advantage|HUMANA MA|153.25||||||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Blue Cross PPO Specialty|BCBSTX PPO|153.25||||153.25||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Managed Medicaid|MEDICAID SUPERIOR|||||153.25||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Managed Medicaid|MEDICAID AMERIGROUP|||||153.25||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|NON CONTRACTED|COMMERCIAL OTHER 1|||||153.25||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|United Medicare Advantage|UHC MEDICARE GOLD MA|153.25||||153.25||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Medicare|MEDICARE ACUTE|153.25||||153.25||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Tricare|TRICARE EAST REGION|153.25||||153.25||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|United Healthcare|UNITED HEALTHCARE|||||153.25||| 9505959|ERX|0250|SODIUM CHLORIDE 0.45% 100|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|153.25||||153.25||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|Medicare|MEDICARE ACUTE|114.50||||114.50||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|Blue Cross PPO Specialty|BCBSTX PPO|114.50||||114.50||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||114.50||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||114.50||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||114.50||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||114.50||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||114.50||| 9505983|ERX|0250|ETOMIDATE 2MG/ML, 10ML|Humana Medicare Advantage|HUMANA MA|||||114.50||| 9506015|ERX|0250|PHYTONADIONE 10MG/1ML|Humana Medicare Advantage|HUMANA MA|102.50||||102.50||| 9506015|ERX|0250|PHYTONADIONE 10MG/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|102.50||||||| 9506015|ERX|0250|PHYTONADIONE 10MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|102.50||||||| 9506015|ERX|0250|PHYTONADIONE 10MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|102.50||||||| 9506015|ERX|0250|PHYTONADIONE 10MG/1ML|Medicare|MEDICARE ACUTE|||||102.50||| 9506064|ERX|0250|ESTRADIOL 1MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9506064|ERX|0250|ESTRADIOL 1MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||||| 9506064|ERX|0250|ESTRADIOL 1MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9506106|ERX|0250|ESTRADIOL 0.01% VAG CRM,4|Humana Medicare Advantage|HUMANA MA|||||693.50||| 9506106|ERX|0250|ESTRADIOL 0.01% VAG CRM,4|Medicaid|MORRIS COUNTY INDIGENT|||||693.50||| 9506106|ERX|0250|ESTRADIOL 0.01% VAG CRM,4|Managed Medicaid|MEDICAID SUPERIOR|||||693.50||| 9506106|ERX|0250|ESTRADIOL 0.01% VAG CRM,4|Managed Medicaid|MEDICAID AMERIGROUP|||||693.50||| 9506106|ERX|0250|ESTRADIOL 0.01% VAG CRM,4|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||693.50||| 9506106|ERX|0250|ESTRADIOL 0.01% VAG CRM,4|Blue Cross PPO Specialty|BCBSTX PPO|||||693.50||| 9506106|ERX|0250|ESTRADIOL 0.01% VAG CRM,4|Medicare|MEDICARE ACUTE|||||693.50||| 9506106|ERX|0250|ESTRADIOL 0.01% VAG CRM,4|Tricare|TRICARE EAST REGION|||||693.50||| 9506106|ERX|0250|ESTRADIOL 0.01% VAG CRM,4|United Healthcare|UNITED HEALTHCARE|||||693.50||| 9506106|ERX|0250|ESTRADIOL 0.01% VAG CRM,4|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||693.50||| 9506106|ERX|0250|ESTRADIOL 0.01% VAG CRM,4|Blue Cross HMO Specialty|BCBSTX HMO|||||693.50||| 9506106|ERX|0250|ESTRADIOL 0.01% VAG CRM,4|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||693.50||| 9506114|ERX|0250|NA HYPOCHLOR 0.25% SOLN,4|United Medicare Advantage|UHC MEDICARE GOLD MA|60.75||||||| 9506114|ERX|0250|NA HYPOCHLOR 0.25% SOLN,4|United Healthcare|UNITED HEALTHCARE|60.75||||||| 9506114|ERX|0250|NA HYPOCHLOR 0.25% SOLN,4|Humana Medicare Advantage|HUMANA MA|60.75||||||| 9506114|ERX|0250|NA HYPOCHLOR 0.25% SOLN,4|Medicare|MEDICARE ACUTE|60.75||||60.75||| 9506114|ERX|0250|NA HYPOCHLOR 0.25% SOLN,4|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|60.75||||||| 9506114|ERX|0250|NA HYPOCHLOR 0.25% SOLN,4|Managed Medicaid|MEDICAID UNITED HEALTHCARE|60.75||||||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Medicaid|MEDICAID|||||1.25||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9506197|ERX|0250|THYROID 60MG TABLET|Tricare|TRICARE EAST REGION|1.25||||||| 9506197|ERX|0250|THYROID 60MG TABLET|Aetna|AETNA OTHER|||||1.25||| 9506197|ERX|0250|THYROID 60MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|NON CONTRACTED|COMMERCIAL OTHER 1|1.25||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.25||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Cigna|CIGNA|1.25||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|1.25||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||1.25||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9506254|ERX|0250|LEVOTHYROXINE 88MCG TABLE|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9506254|ERX|0250|LEVOTHYROXINE 88MCG TABLE|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9506254|ERX|0250|LEVOTHYROXINE 88MCG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.25||| 9506270|ERX|0250|VENLAFAXINE XL 37.5MG CAP|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||||| 9506296|ERX|0250|NEBIVOLOL 5MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|5.50||||||| 9506346|ERX|0250|MEMANTINE HCL 5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||||| 9506346|ERX|0250|MEMANTINE HCL 5MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9506346|ERX|0250|MEMANTINE HCL 5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9506346|ERX|0250|MEMANTINE HCL 5MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||1.25||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.25||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.25||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|1.25||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|United Healthcare|TML GROUP BENEFITS|||||1.25||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|1.25||||1.25||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Tricare|TRICARE EAST REGION|1.25||||1.25||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||1.25||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.25||||1.25||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|1.25||||1.25||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||1.25||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Cigna|CIGNA|1.25||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|United Healthcare|UNITED HEALTHCARE|1.25||||1.25||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|United Healthcare|UNITED HEALTHCARE|1.25||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||1.25||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||1.25||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|1.25||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Aetna|AETNA PPO|||||1.25||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||1.25||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||1.25||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.25||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Managed Medicaid|MEDICAID SUPERIOR|109.75||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Humana Medicare Advantage|HUMANA MA|109.75||||109.75||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Medicaid|MEDICAID|109.75||||109.75||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||109.75||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|109.75||||109.75||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Managed Medicaid|MEDICAID AMERIGROUP|109.75||||109.75||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Blue Cross HMO Specialty|BCBSTX HMO|109.75||||109.75||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Medicaid|MEDICAID TEXAS CHILDRENS|||||109.75||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Managed Medicare|HEALTHSPRING MA|109.75||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|109.75||||109.75||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Aetna|AETNA PPO|||||109.75||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|109.75||||109.75||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|109.75||||109.75||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|109.75||||109.75||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Cigna|CIGNA|109.75||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|109.75||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Cigna|CIGNA|109.75||||109.75||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||109.75||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Medicare|MEDICARE ACUTE|109.75||||109.75||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|United Healthcare|UNITED HEALTHCARE OTHER|||||109.75||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|109.75||||109.75||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|109.75||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|109.75||||109.75||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Veterans Affairs|VETERANS ADMINISTRATION|||||109.75||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|United Healthcare|UNITED HEALTHCARE|109.75||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Tricare|TRICARE EAST REGION|109.75||||109.75||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||109.75||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|NON CONTRACTED|COMMERCIAL OTHER 1|109.75||||109.75||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|United Healthcare|UNITED HEALTHCARE|||||109.75||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|United Medicare Advantage|UHC MEDICARE GOLD MA|20.75||||20.75||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Medicare|MEDICARE ACUTE|20.75||||20.75||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|20.75||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|20.75||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Managed Medicaid|MEDICAID AMERIGROUP|20.75||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|20.75||||20.75||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Humana Medicare Advantage|HUMANA MA|||||20.75||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|20.75||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||20.75||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|United Healthcare|UNITED HEALTHCARE|||||20.75||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|Humana Medicare Advantage|HUMANA MA|||||9.25||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|Managed Medicaid|MEDICAID SUPERIOR|||||9.25||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||9.25||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|Managed Medicaid|MEDICAID AMERIGROUP|||||9.25||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|Blue Cross PPO Specialty|BCBSTX PPO|9.25||||9.25||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|Blue Cross PPO Specialty|BCBSTX OTHER|||||9.25||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|Tricare|TRICARE EAST REGION|||||9.25||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Veterans Affairs|VETERANS ADMINISTRATION|16.25||||||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|United Medicare Advantage|UHC MEDICARE GOLD MA|16.25||||||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|16.25||||16.25||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Medicare|MEDICARE ACUTE|16.25||||16.25||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|NON CONTRACTED|COMMERCIAL OTHER 1|16.25||||||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Tricare|TRICARE EAST REGION|||||16.25||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|United Healthcare|UNITED HEALTHCARE|16.25||||||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Blue Cross PPO Specialty|BCBSTX PPO|16.25||||16.25||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|16.25||||||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Aenta Medicare Advantage|AETNA MEDICARE MA|16.25||||||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Humana Medicare Advantage|HUMANA MA|16.25||||16.25||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Managed Medicaid|MEDICAID AMERIGROUP|16.25||||16.25||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Managed Medicaid|MEDICAID UNITED HEALTHCARE|16.25||||||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Managed Medicaid|MEDICAID SUPERIOR|||||16.25||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|Humana Medicare Advantage|HUMANA MA|10.75||||||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|10.75||||||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|10.75||||||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|Blue Cross PPO Specialty|BCBSTX PPO|10.75||||||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|Medicare|MEDICARE ACUTE|10.75||||10.75||| 9506783|ERX|0250|METHYLENE BLUE 10MG/ML, 1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||865.84||| 9506791|ERX|0250|INDIGOTINDISULFON 8MG/ML,|NON CONTRACTED|COMMERCIAL OTHER 1|||||25.75||| 9506791|ERX|0250|INDIGOTINDISULFON 8MG/ML,|United Healthcare|UNITED HEALTHCARE|||||25.75||| 9506791|ERX|0250|INDIGOTINDISULFON 8MG/ML,|Medicaid|MORRIS COUNTY INDIGENT|||||25.75||| 9506791|ERX|0250|INDIGOTINDISULFON 8MG/ML,|Medicare|MEDICARE ACUTE|||||25.75||| 9506791|ERX|0250|INDIGOTINDISULFON 8MG/ML,|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||25.75||| 9506791|ERX|0250|INDIGOTINDISULFON 8MG/ML,|Managed Medicaid|MEDICAID AMERIGROUP|||||25.75||| 9506791|ERX|0250|INDIGOTINDISULFON 8MG/ML,|Aetna|AETNA PPO|||||25.75||| 9506791|ERX|0250|INDIGOTINDISULFON 8MG/ML,|Blue Cross PPO Specialty|BCBSTX PPO|25.75||||25.75||| 9506791|ERX|0250|INDIGOTINDISULFON 8MG/ML,|Managed Medicaid|MEDICAID SUPERIOR|||||25.75||| 9506791|ERX|0250|INDIGOTINDISULFON 8MG/ML,|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||25.75||| 9506791|ERX|0250|INDIGOTINDISULFON 8MG/ML,|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||25.75||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||1.25||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||1.25||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9506833|ERX|0250|ATROPINE 1MG/ML, 2ML VIAL|Humana Medicare Advantage|HUMANA MA|10.75||||||| 9506833|ERX|0250|ATROPINE 1MG/ML, 2ML VIAL|Medicare|MEDICARE ACUTE|10.75||||10.75||| 9506841|ERX|0250|VASOPRESSIN 20 UNIT/1ML|Blue Cross PPO Specialty|BCBSTX PPO|||||467.40||| 9506890|ERX|0250|CALCIUM CHLORIDE 10% 100M|Medicare|MEDICARE ACUTE|||||15.50||| 9506924|ERX|0250|HYDROXYZINE HCL 25MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|||||10.75||| 9506924|ERX|0250|HYDROXYZINE HCL 25MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||10.75||| 9506924|ERX|0250|HYDROXYZINE HCL 25MG/1ML|Medicaid|MORRIS COUNTY INDIGENT|||||10.75||| 9506924|ERX|0250|HYDROXYZINE HCL 25MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|||||10.75||| 9506924|ERX|0250|HYDROXYZINE HCL 25MG/1ML|Aetna|AETNA PPO|||||10.75||| 9506924|ERX|0250|HYDROXYZINE HCL 25MG/1ML|Blue Cross HMO Specialty|BCBSTX HMO|||||10.75||| 9506924|ERX|0250|HYDROXYZINE HCL 25MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||10.75||| 9506924|ERX|0250|HYDROXYZINE HCL 25MG/1ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||10.75||| 9506924|ERX|0250|HYDROXYZINE HCL 25MG/1ML|Medicare|MEDICARE ACUTE|10.75||||10.75||| 9506924|ERX|0250|HYDROXYZINE HCL 25MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|10.75||||10.75||| 9506924|ERX|0250|HYDROXYZINE HCL 25MG/1ML|United Healthcare|UNITED HEALTHCARE|||||10.75||| 9506924|ERX|0250|HYDROXYZINE HCL 25MG/1ML|Tricare|TRICARE EAST REGION|||||10.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|46.75||||||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|United Medicare Advantage|UHC MEDICARE GOLD MA|46.75||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Medicare|MEDICARE ACUTE|46.75||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Veterans Affairs|VETERANS ADMINISTRATION|||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|United Healthcare|UNITED HEALTHCARE|||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|United Healthcare|UNITED HEALTHCARE OTHER|||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|46.75||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Blue Cross HMO Specialty|BCBSTX HMO|46.75||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Blue Cross PPO Specialty|BCBSTX PPO|46.75||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|46.75||||||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Aetna|AETNA PPO|||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Cigna|CIGNA|||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Tricare|TRICARE EAST REGION|46.75||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|NON CONTRACTED|COMMERCIAL OTHER 1|46.75||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Humana Medicare Advantage|HUMANA MA|46.75||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Managed Medicaid|MEDICAID SUPERIOR|||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Managed Medicaid|MEDICAID AMERIGROUP|||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|46.75||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Medicaid|MEDICAID|||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|46.75||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||46.75||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Medicaid|MORRIS COUNTY INDIGENT|||||46.75||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Blue Cross HMO Specialty|BCBSTX HMO|25.75||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|NON CONTRACTED|COMMERCIAL OTHER 1|25.75||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Medicare|MEDICARE ACUTE|25.75||||25.75||| 9507039|ERX|0250|PRIMIDONE 50MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.25||| 9507039|ERX|0250|PRIMIDONE 50MG TABLET|Medicare|MEDICARE ACUTE|3.25||||3.25||| 9507039|ERX|0250|PRIMIDONE 50MG TABLET|Humana Medicare Advantage|HUMANA MA|||||3.25||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9507138|ERX|0250|TRIAZOLAM 0.25MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9507146|ERX|0250|DIPHENHYDRAMINE CREAM, 30|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9507328|ERX|0250|PHENYLEPH-SHK LV-MO-PET,W|Humana Medicare Advantage|HUMANA MA|22.25||||||| 9507328|ERX|0250|PHENYLEPH-SHK LV-MO-PET,W|Medicare|MEDICARE ACUTE|22.25||||||| 9507328|ERX|0250|PHENYLEPH-SHK LV-MO-PET,W|Managed Medicaid|MEDICAID SUPERIOR|22.25||||||| 9507369|ERX|0250|CHARCOAL-SORBITOL 50 G, 2|United Healthcare|UNITED HEALTHCARE|||||151.75||| 9507369|ERX|0250|CHARCOAL-SORBITOL 50 G, 2|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||151.75||| 9507369|ERX|0250|CHARCOAL-SORBITOL 50 G, 2|Medicaid|MEDICAID TEXAS CHILDRENS|||||151.75||| 9507393|ERX|0250|CHARCOAL AQ 50 G, 240ML|Managed Medicaid|MEDICAID AMERIGROUP|||||151.75||| 9507427|ERX|0250|ASPIRIN 300MG SUPP|United Medicare Advantage|UHC MEDICARE GOLD MA|||||7.75||| 9507427|ERX|0250|ASPIRIN 300MG SUPP|Medicare|MEDICARE ACUTE|7.75||||||| 9507450|ERX|0250|PROMETHAZINE 25MG SUPP|Medicaid|MEDICAID TEXAS CHILDRENS|||||30.50||| 9507450|ERX|0250|PROMETHAZINE 25MG SUPP|Blue Cross PPO Specialty|BCBSTX PPO|||||30.50||| 9507468|ERX|0250|PROMETHAZINE 12.5MG SUPP|Blue Cross PPO Specialty|BCBSTX PPO|||||0.21||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Medicaid|MEDICAID|||||1.25||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9507492|ERX|0250|DICYCLOMINE 10MG CAPSULE|Tricare|TRICARE EAST REGION|||||1.25||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.25||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Humana Medicare Advantage|HUMANA MA|2.25||||2.25||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.25||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Medicare|MEDICARE ACUTE|||||2.25||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.25||| 9507633|ERX|0250|ASPIRIN-DIPYRIDAMOLE 25-2|Medicare|MEDICARE ACUTE|1.25||||||| 9507633|ERX|0250|ASPIRIN-DIPYRIDAMOLE 25-2|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1,054.25||||1,054.25||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Humana Medicare Advantage|HUMANA MA|1,054.25||||||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1,054.25||||||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Blue Cross PPO Specialty|BCBSTX PPO|||||1,054.25||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1,054.25||||||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Blue Cross HMO Specialty|BCBSTX HMO|||||1,054.25||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Veterans Affairs|VETERANS ADMINISTRATION|||||1,054.25||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1,054.25||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1,054.25||||||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|United Medicare Advantage|UHC MEDICARE GOLD MA|1,054.25||||1,054.25||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1,054.25||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|NON CONTRACTED|COMMERCIAL OTHER 1|1,054.25||||1,054.25||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,054.25||||||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH,14|Medicare|MEDICARE ACUTE|1,054.25||||1,054.25||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|Medicaid|MEDICAID|1.25||||||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9507674|ERX|0250|CLONIDINE 0.1MG PATCH|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9507674|ERX|0250|CLONIDINE 0.1MG PATCH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9507674|ERX|0250|CLONIDINE 0.1MG PATCH|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||||| 9507682|ERX|0250|CLONIDINE 0.2MG PATCH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|114.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Cigna|CIGNA|||||1.25||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.25||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||1.25||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.25||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Tricare|TRICARE EAST REGION|||||1.25||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.25||| 9507724|ERX|0250|METHYLPREDNISOLONE 4MG TA|Medicare|MEDICARE ACUTE|1.25||||||| 9507922|ERX|0250|COLCHICINE 0.6MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9507922|ERX|0250|COLCHICINE 0.6MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9507922|ERX|0250|COLCHICINE 0.6MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9507922|ERX|0250|COLCHICINE 0.6MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|United Healthcare|UNITED HEALTHCARE OTHER|||||1.25||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Blue Cross HMO Specialty|BCBSTX HMO|||||1.25||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.25||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Cigna|CIGNA|||||1.25||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Managed Medicaid|MEDICAID SUPERIOR|1.25||||1.25||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Humana Medicare Advantage|HUMANA MA|||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|16.25||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Managed Medicaid|MEDICAID AMERIGROUP|||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Medicaid|MEDICAID|||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Blue Cross HMO Specialty|BCBSTX HMO|||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Blue Cross PPO Specialty|BCBSTX PPO|16.25||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Managed Medicare|HEALTHSPRING MA|||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Cigna|CIGNA|||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|16.25||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Veterans Affairs|VETERANS ADMINISTRATION|||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Managed Medicaid|MEDICAID SUPERIOR|||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|NON CONTRACTED|COMMERCIAL OTHER 1|16.25||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Tricare|TRICARE EAST REGION|||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Medicare|MEDICARE ACUTE|||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|PHCS|GROUP AND PENSION|||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|United Healthcare|UNITED HEALTHCARE|||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|United Healthcare|UNITED HEALTHCARE OTHER|||||16.25||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||16.25||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Medicare|MEDICARE ACUTE|0.13||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Tricare|TRICARE EAST REGION|||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|United Healthcare|TML GROUP BENEFITS|||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|United Healthcare|UNITED HEALTHCARE|||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|United Healthcare|UNITED HEALTHCARE|0.13||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.13||||||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Veterans Affairs|VETERANS ADMINISTRATION|||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Blue Cross HMO Specialty|BCBSTX HMO|||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Aetna|AETNA OTHER|0.13||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|United Healthcare|UNITED HEALTHCARE OTHER|||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Cigna|CIGNA|||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.13||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Humana Medicare Advantage|HUMANA MA|||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Managed Medicaid|MEDICAID AMERIGROUP|0.13||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Managed Medicaid|MEDICAID SUPERIOR|0.13||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.13||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.13||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Managed Medicare|HEALTHSPRING MA|||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.13||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Medicaid|MEDICAID|||||0.13||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Humana Medicare Advantage|HUMANA MA|37.50||||37.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||37.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Blue Cross PPO Specialty|BCBSTX PPO|||||37.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||37.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||37.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|37.50||||||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||37.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||37.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Medicare|MEDICARE ACUTE|37.50||||37.50||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|United Healthcare|UNITED HEALTHCARE|37.50||||||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Medicare|MEDICARE ACUTE|||||0.26||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|United Healthcare|UNITED HEALTHCARE|||||0.26||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Aetna|AETNA OTHER|||||0.26||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Blue Cross PPO Specialty|BCBSTX PPO|||||0.26||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Humana Medicare Advantage|HUMANA MA|||||0.26||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.26||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Medicaid|MEDICAID|||||0.26||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.26||| 9508185|ERX|0250|CHLORPROMAZINE 25MG/1ML|Medicare|MEDICARE ACUTE|||||72.25||| 9508185|ERX|0250|CHLORPROMAZINE 25MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||72.25||| 9508185|ERX|0250|CHLORPROMAZINE 25MG/1ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||72.25||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||0.13||| 9508235|ERX|0250|ESMOLOL 100MG/10ML|Medicare|MEDICARE ACUTE|||||0.76||| 9508235|ERX|0250|ESMOLOL 100MG/10ML|Blue Cross HMO Specialty|BCBSTX HMO|||||0.76||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||1.25||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|Medicare|MEDICARE ACUTE|1.25||||||| 9508367|ERX|0250|GLYCERIN, PEDIATRIC SUPP|Cigna|CIGNA|||||3.50||| 9508367|ERX|0250|GLYCERIN, PEDIATRIC SUPP|Blue Cross HMO Specialty|BCBSTX HMO|3.50||||||| 9508367|ERX|0250|GLYCERIN, PEDIATRIC SUPP|Managed Medicaid|MEDICAID SUPERIOR|||||3.50||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.13||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|United Medicare Advantage|UHC MEDICARE GOLD MA|0.13||||||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|0.13||||0.13||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Humana Medicare Advantage|HUMANA MA|0.13||||0.13||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.13||||||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.13||||||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Medicare|MEDICARE ACUTE|0.13||||0.13||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Managed Medicaid|MEDICAID SUPERIOR|0.13||||0.13||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Managed Medicaid|MEDICAID AMERIGROUP|0.13||||0.13||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Managed Medicare|HEALTHSPRING MA|0.13||||||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Medicaid|MEDICAID|||||0.13||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Aetna|AETNA OTHER|||||0.13||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Blue Cross PPO Specialty|BCBSTX PPO|||||0.13||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.13||||||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.13||||||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Aenta Medicare Advantage|AETNA MEDICARE MA|0.13||||||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.13||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Humana Medicare Advantage|HUMANA MA|||||8.25||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||8.25||| 9508383|ERX|0250|BISACODYL 10MG SUPP|United Medicare Advantage|UHC MEDICARE GOLD MA|8.25||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Medicare|MEDICARE ACUTE|8.25||||||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|NON CONTRACTED|COMMERCIAL OTHER 1|0.07||||||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Medicare|MEDICARE ACUTE|0.07||||0.07||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.07||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.07||||||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Blue Cross PPO Specialty|BCBSTX PPO|||||0.07||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Humana Medicare Advantage|HUMANA MA|0.07||||0.07||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.07||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Medicaid|MEDICAID TEXAS CHILDRENS|||||0.07||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Humana Medicare Advantage|HUMANA MA|||||1.25||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Medicaid|MEDICAID|||||1.25||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Medicaid|MEDICAID HMO|||||1.25||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|||||1.25||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.25||||1.25||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|1.25||||||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.25||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9508433|ERX|0250|FLUOXETINE 10MG CAPSULE|Medicare|MEDICARE ACUTE|||||1.25||| 9508433|ERX|0250|FLUOXETINE 10MG CAPSULE|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.40||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.40||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Humana Medicare Advantage|HUMANA MA|0.40||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Medicaid|MEDICAID|0.40||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Medicare|MEDICARE ACUTE|0.40||||0.40||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.40||||||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|United Medicare Advantage|UHC MEDICARE GOLD MA|43.25||||43.25||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|43.25||||43.25||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Veterans Affairs|VETERANS ADMINISTRATION|||||43.25||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|NON CONTRACTED|COMMERCIAL OTHER 1|||||43.25||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Tricare|TRICARE EAST REGION|||||43.25||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|United Healthcare|UNITED HEALTHCARE|||||43.25||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||43.25||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Humana Medicare Advantage|HUMANA MA|43.25||||43.25||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Managed Medicaid|MEDICAID SUPERIOR|||||43.25||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Managed Medicaid|MEDICAID AMERIGROUP|||||43.25||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Managed Medicaid|MEDICAID UNITED HEALTHCARE|43.25||||43.25||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Medicare|MEDICARE ACUTE|43.25||||43.25||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|43.25||||||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|43.25||||43.25||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Medicaid|MEDICAID|||||43.25||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||43.25||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Managed Medicare|HEALTHSPRING MA|||||43.25||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Blue Cross HMO Specialty|BCBSTX HMO|43.25||||||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Aetna|AETNA OTHER|||||43.25||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||43.25||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Blue Cross PPO Specialty|BCBSTX PPO|43.25||||43.25||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|43.25||||43.25||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||43.25||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Cigna|CIGNA|||||43.25||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Aenta Medicare Advantage|AETNA MEDICARE MA|43.25||||43.25||| 9508581|ERX|0250|IMIPRAMINE 25MG TABLET|Humana Medicare Advantage|HUMANA MA|||||1.25||| 9508581|ERX|0250|IMIPRAMINE 25MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|0.13||||||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Medicare|MEDICARE ACUTE|0.13||||0.13||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Humana Medicare Advantage|HUMANA MA|0.13||||0.13||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.13||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|||||0.13||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|||||0.13||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.13||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.13||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Medicaid|MEDICAID TEXAS CHILDRENS|||||0.13||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.13||| 9508656|ERX|0250|CLINDAMYCIN 150MG CAPSULE|United Healthcare|UNITED HEALTHCARE|||||0.13||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|Managed Medicaid|MEDICAID SUPERIOR|||||233.75||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||233.75||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|Managed Medicaid|MEDICAID AMERIGROUP|||||233.75||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|Blue Cross HMO Specialty|BCBSTX HMO|||||233.75||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|Cigna|CIGNA|||||233.75||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|Blue Cross PPO Specialty|BCBSTX PPO|233.75||||233.75||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||233.75||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|Medicaid|MORRIS COUNTY INDIGENT|||||233.75||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||233.75||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|NON CONTRACTED|COMMERCIAL OTHER 1|||||233.75||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|Medicare|MEDICARE ACUTE|||||233.75||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||233.75||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|United Healthcare|UNITED HEALTHCARE|||||233.75||| 9508797|ERX|0250|CALAMINE LOTION, 120ML|Medicare|MEDICARE ACUTE|11.75||||||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9508839|ERX|0250|CYANOCOBALAMIN 250MCG TAB|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9508839|ERX|0250|CYANOCOBALAMIN 250MCG TAB|Veterans Affairs|VETERANS ADMINISTRATION|||||1.25||| 9508839|ERX|0250|CYANOCOBALAMIN 250MCG TAB|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9508839|ERX|0250|CYANOCOBALAMIN 250MCG TAB|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9508839|ERX|0250|CYANOCOBALAMIN 250MCG TAB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9508839|ERX|0250|CYANOCOBALAMIN 250MCG TAB|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9508847|ERX|0250|PSEUDOEPHEDRINE 60MG TABL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||||| 9508862|ERX|0250|GEMFIBROZIL 600MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9508862|ERX|0250|GEMFIBROZIL 600MG TABLET|Medicare|MEDICARE ACUTE|||||1.25||| 9508870|ERX|0250|PENTOXIFYLLINE 400MG TABL|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||||| 9508870|ERX|0250|PENTOXIFYLLINE 400MG TABL|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9509134|ERX|0250|ATROPINE 1% EYE DROP, 5ML|NON CONTRACTED|COMMERCIAL OTHER 1|165.50||||||| 9509134|ERX|0250|ATROPINE 1% EYE DROP, 5ML|Medicare|MEDICARE ACUTE|165.50||||||| 9509282|ERX|0250|MIDAZOLAM 5MG/1ML|Humana Medicare Advantage|HUMANA MA|85.50||||85.50||| 9509282|ERX|0250|MIDAZOLAM 5MG/1ML|Cigna|CIGNA|||||85.50||| 9509282|ERX|0250|MIDAZOLAM 5MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|||||85.50||| 9509282|ERX|0250|MIDAZOLAM 5MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|85.50||||||| 9509282|ERX|0250|MIDAZOLAM 5MG/1ML|Medicare|MEDICARE ACUTE|85.50||||85.50||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Medicare|MEDICARE ACUTE|16.25||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Tricare|TRICARE EAST REGION|16.25||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|United Healthcare|UNITED HEALTHCARE|16.25||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|United Healthcare|UNITED HEALTHCARE|||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Blue Cross HMO Specialty|BCBSTX HMO|||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Aetna|AETNA PPO|||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|16.25||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|16.25||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|16.25||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|United Healthcare|UNITED HEALTHCARE OTHER|||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Humana Medicare Advantage|HUMANA MA|||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Managed Medicaid|MEDICAID AMERIGROUP|||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Managed Medicaid|MEDICAID SUPERIOR|16.25||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Medicaid|MORRIS COUNTY INDIGENT|||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Medicaid|MEDICAID TEXAS CHILDRENS|16.25||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Cigna|CIGNA|||||16.25||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Medicaid|MEDICAID|16.25||||16.25||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Humana Medicare Advantage|HUMANA MA|||||10.75||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|||||10.75||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|||||10.75||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||10.75||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||10.75||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Medicaid|MORRIS COUNTY INDIGENT|||||10.75||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Blue Cross HMO Specialty|BCBSTX HMO|||||10.75||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Aetna|AETNA PPO|||||10.75||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||10.75||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||10.75||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|10.75||||10.75||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||10.75||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Cigna|CIGNA|||||10.75||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|10.75||||10.75||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|United Healthcare|UNITED HEALTHCARE|||||10.75||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||10.75||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Medicare|MEDICARE ACUTE|||||10.75||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Tricare|TRICARE EAST REGION|||||10.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Medicare|MEDICARE ACUTE|||||11.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|United Healthcare|UNITED HEALTHCARE|||||11.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Aetna|AETNA OTHER|||||11.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|11.75||||11.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||11.75||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|||||11.75||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UMR|40.85||||||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|Tricare|TRICARE EAST REGION|||||40.85||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|Medicaid|MORRIS COUNTY INDIGENT|||||40.85||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|||||40.85||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|Humana Medicare Advantage|HUMANA MA|||||40.85||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||127.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Veterans Affairs|VETERANS ADMINISTRATION|||||127.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||127.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Medicare|MEDICARE ACUTE|127.50||||127.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Cigna|CIGNA|||||127.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||127.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Blue Cross PPO Specialty|BCBSTX PPO|||||127.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Humana Medicare Advantage|HUMANA MA|||||127.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||127.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Managed Medicaid|MEDICAID AMERIGROUP|127.50||||127.50||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||127.50||| 9509456|ERX|0250|METHYLPREDNIS DEPO 80MG/M|Blue Cross PPO Specialty|BCBSTX PPO|||||60.75||| 9509456|ERX|0250|METHYLPREDNIS DEPO 80MG/M|Medicare|MEDICARE ACUTE|||||60.75||| 9509456|ERX|0250|METHYLPREDNIS DEPO 80MG/M|Medicaid|MEDICAID|||||60.75||| 9509464|ERX|0250|DILTIAZEM 50MG 10ML|Medicare|MEDICARE ACUTE|||||112.25||| 9509464|ERX|0250|DILTIAZEM 50MG 10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||112.25||| 9509464|ERX|0250|DILTIAZEM 50MG 10ML|Humana Medicare Advantage|HUMANA MA|||||112.25||| 9509464|ERX|0250|DILTIAZEM 50MG 10ML|Cigna|CIGNA|||||112.25||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Humana Medicare Advantage|HUMANA MA|||||46.75||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|46.75||||46.75||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Managed Medicaid|MEDICAID SUPERIOR|||||46.75||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||46.75||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Managed Medicaid|MEDICAID AMERIGROUP|||||46.75||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Medicaid|MEDICAID|46.75||||||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Blue Cross HMO Specialty|BCBSTX HMO|||||46.75||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Access Direct Platinum|HEALTHFIRST TPA UMR|46.75||||||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Aetna|AETNA PPO|||||46.75||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Blue Cross PPO Specialty|BCBSTX PPO|46.75||||46.75||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Medicaid|MORRIS COUNTY INDIGENT|||||46.75||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||46.75||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|46.75||||46.75||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||46.75||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Cigna|CIGNA|||||46.75||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Workers Compensation|WORKERS COMPENSATION OTHER|||||46.75||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||46.75||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|46.75||||46.75||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||46.75||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||46.75||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Medicare|MEDICARE ACUTE|46.75||||46.75||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Tricare|TRICARE EAST REGION|46.75||||46.75||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|United Healthcare|UNITED HEALTHCARE|||||46.75||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.25||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|Humana Medicare Advantage|HUMANA MA|||||1.25||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Medicaid|MEDICAID|0.20||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Humana Medicare Advantage|HUMANA MA|||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Managed Medicaid|MEDICAID AMERIGROUP|||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.20||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Medicaid|MEDICAID TEXAS CHILDRENS|0.20||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Blue Cross PPO Specialty|BCBSTX OTHER|||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Medicaid|MORRIS COUNTY INDIGENT|||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Blue Cross HMO Specialty|BCBSTX HMO|||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.20||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Aetna|AETNA PPO|||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|0.20||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Access Direct Platinum|HEALTHFIRST TPA UMR|0.20||||||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Cigna|CIGNA|||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Managed Medicaid|MEDICAID SUPERIOR|0.20||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.20||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Veterans Affairs|VETERANS ADMINISTRATION|||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.20||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|NON CONTRACTED|COMMERCIAL OTHER 1|0.20||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Medicare|MEDICARE ACUTE|0.20||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Tricare|TRICARE EAST REGION|0.20||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|United Healthcare|UNITED HEALTHCARE OTHER|0.20||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|United Healthcare|UNITED HEALTHCARE|||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|United Healthcare|UNITED HEALTHCARE|0.20||||0.20||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.20||| 9509779|ERX|0250|PREDNISOLONE 1% EYE DROP,|Medicare|MEDICARE ACUTE|1.96||||||| 9509811|ERX|0250|OFLOXACIN 0.3% EYE DROP,|Aetna|AETNA PPO|||||377.75||| 9509811|ERX|0250|OFLOXACIN 0.3% EYE DROP,|Blue Cross PPO Specialty|BCBSTX PPO|||||377.75||| 9509811|ERX|0250|OFLOXACIN 0.3% EYE DROP,|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||377.75||| 9509811|ERX|0250|OFLOXACIN 0.3% EYE DROP,|Cigna|CIGNA|||||377.75||| 9509811|ERX|0250|OFLOXACIN 0.3% EYE DROP,|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||377.75||| 9509811|ERX|0250|OFLOXACIN 0.3% EYE DROP,|Humana Medicare Advantage|HUMANA MA|377.75||||||| 9509811|ERX|0250|OFLOXACIN 0.3% EYE DROP,|Managed Medicaid|MEDICAID AMERIGROUP|||||377.75||| 9509811|ERX|0250|OFLOXACIN 0.3% EYE DROP,|Managed Medicaid|MEDICAID SUPERIOR|||||377.75||| 9509811|ERX|0250|OFLOXACIN 0.3% EYE DROP,|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||377.75||| 9509811|ERX|0250|OFLOXACIN 0.3% EYE DROP,|Medicaid|MEDICAID|||||377.75||| 9509811|ERX|0250|OFLOXACIN 0.3% EYE DROP,|Medicaid|MEDICAID TEXAS CHILDRENS|||||377.75||| 9509811|ERX|0250|OFLOXACIN 0.3% EYE DROP,|Blue Cross HMO Specialty|BCBSTX HMO|||||377.75||| 9509811|ERX|0250|OFLOXACIN 0.3% EYE DROP,|NON CONTRACTED|COMMERCIAL OTHER 1|||||377.75||| 9509811|ERX|0250|OFLOXACIN 0.3% EYE DROP,|Medicare|MEDICARE ACUTE|||||377.75||| 9509811|ERX|0250|OFLOXACIN 0.3% EYE DROP,|Tricare|TRICARE EAST REGION|||||377.75||| 9509811|ERX|0250|OFLOXACIN 0.3% EYE DROP,|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||377.75||| 9509811|ERX|0250|OFLOXACIN 0.3% EYE DROP,|United Healthcare|UNITED HEALTHCARE|||||377.75||| 9509837|ERX|0250|LANOLIN 50% OINT, 130G|NON CONTRACTED|COMMERCIAL OTHER 1|30.75||||||| 9509837|ERX|0250|LANOLIN 50% OINT, 130G|NON CONTRACTED|COMMERCIAL OTHER 2|30.75||||||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Medicaid|MEDICAID|1.25||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Managed Medicare|HEALTHSPRING MA|||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Aetna|AETNA OTHER|||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Aetna|AETNA PPO|||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Medicaid|MORRIS COUNTY INDIGENT|||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Cigna|CIGNA|||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|1.25||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|United Healthcare|UNITED HEALTHCARE|1.25||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|PHCS|HUMANA INSURANCE|||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Tricare|TRICARE EAST REGION|||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|United Healthcare|GEHA|||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.25||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|1.25||||||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9510215|ERX|0250|GENTAMICIN EYE OINT, 3.5G|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.90||| 9510215|ERX|0250|GENTAMICIN EYE OINT, 3.5G|Blue Cross PPO Specialty|BCBSTX PPO|||||0.90||| 9510215|ERX|0250|GENTAMICIN EYE OINT, 3.5G|Medicare|MEDICARE ACUTE|||||0.90||| 9510272|ERX|0250|NA CHLORIDE 5% DROP,15ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|125.50||||||| 9510298|ERX|0250|TIMOLOL 0.5% EYE DROP, 5M|Humana Medicare Advantage|HUMANA MA|||||117.50||| 9510298|ERX|0250|TIMOLOL 0.5% EYE DROP, 5M|Medicare|MEDICARE ACUTE|117.50||||117.50||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.25||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Medicare|MEDICARE ACUTE|||||2.25||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Tricare|TRICARE EAST REGION|||||2.25||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.25||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Tricare|TRICARE FOR LIFE|||||2.25||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.25||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|United Healthcare|GEHA|||||2.25||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|United Healthcare|UNITED HEALTHCARE|||||2.25||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Blue Cross PPO Specialty|BCBSTX PPO|||||2.25||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.25||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Cigna|CIGNA|||||2.25||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Humana Medicare Advantage|HUMANA MA|||||2.25||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Managed Medicaid|MEDICAID AMERIGROUP|||||2.25||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.25||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.25||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Managed Medicaid|MEDICAID SUPERIOR|||||2.25||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Medicaid|MEDICAID|||||2.25||| 9510348|ERX|0250|FLUORESCEIN EYE STRIP|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.25||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Humana Medicare Advantage|HUMANA MA|||||2.22||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Managed Medicaid|MEDICAID SUPERIOR|||||2.22||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.22||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.22||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Medicaid|MEDICAID|||||2.22||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Blue Cross HMO Specialty|BCBSTX HMO|||||2.22||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Blue Cross PPO Specialty|BCBSTX PPO|||||2.22||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.22||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.22||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Medicare|MEDICARE ACUTE|2.22||||2.22||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Tricare|TRICARE EAST REGION|||||2.22||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|United Healthcare|UNITED HEALTHCARE|||||2.22||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|United Healthcare|UNITED HEALTHCARE OTHER|||||2.22||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.22||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|Veterans Affairs|VETERANS ADMINISTRATION|||||2.22||| 9510470|ERX|0250|CLINDAMYCIN 600MG 4ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.22||| 9510512|ERX|0250|NAPROXEN SODIUM 220MG TAB|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.02||||||| 9510587|ERX|0250|PSYLLIUM SEED (SUGAR FREE|Medicare|MEDICARE ACUTE|3.50||||||| 9510678|ERX|0250|AMMONIA AROMATIC AMPULE|Blue Cross PPO Specialty|BCBSTX PPO|||||6.75||| 9510777|ERX|0250|CALCITRIOL 0.25MCG CAPSUL|Medicare|MEDICARE ACUTE|0.12||||0.12||| 9510777|ERX|0250|CALCITRIOL 0.25MCG CAPSUL|Humana Medicare Advantage|HUMANA MA|||||0.12||| 9510801|ERX|0250|CLINDAMYCIN 300MG/2ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||46.75||| 9510835|ERX|0250|CALCIUM ACETATE 667MG CAP|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||6.75||| 9510850|ERX|0250|HYDROCORTISONE 100MG/2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|22.25||||22.25||| 9510850|ERX|0250|HYDROCORTISONE 100MG/2ML|Medicare|MEDICARE ACUTE|||||22.25||| 9510850|ERX|0250|HYDROCORTISONE 100MG/2ML|Veterans Affairs|VETERANS ADMINISTRATION|||||22.25||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.07||||0.07||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Medicare|MEDICARE ACUTE|0.07||||0.07||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|United Healthcare|UNITED HEALTHCARE|0.07||||||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.07||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Blue Cross PPO Specialty|BCBSTX PPO|||||0.07||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.07||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Cigna|CIGNA|||||0.07||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Humana Medicare Advantage|HUMANA MA|0.07||||0.07||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Managed Medicaid|MEDICAID AMERIGROUP|||||0.07||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.07||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Medicaid|MEDICAID|0.07||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Humana Medicare Advantage|HUMANA MA|0.05||||0.05||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Managed Medicaid|MEDICAID SUPERIOR|||||0.05||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.05||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.05||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Medicaid|MEDICAID|||||0.05||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.05||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Managed Medicare|HEALTHSPRING MA|||||0.05||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.05||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Blue Cross HMO Specialty|BCBSTX HMO|0.05||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||0.05||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Aetna|AETNA OTHER|||||0.05||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.05||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Aenta Medicare Advantage|AETNA MEDICARE MA|0.05||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Blue Cross PPO Specialty|BCBSTX PPO|0.05||||0.05||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.05||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.05||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Managed Medicaid|MEDICAID AMERIGROUP|0.05||||0.05||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Medicare|MEDICARE PART B ONLY IP|0.05||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Medicare|MEDICARE ACUTE|0.05||||0.05||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Tricare|TRICARE EAST REGION|||||0.05||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|United Healthcare|UNITED HEALTHCARE|0.05||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.05||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|United Medicare Advantage|UHC MEDICARE GOLD MA|0.05||||0.05||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|0.05||||0.05||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.05||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Veterans Affairs|VETERANS ADMINISTRATION|||||0.05||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|United Medicare Advantage|UHC MEDICARE GOLD MA|39.75||||||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Workers Compensation|WORKERS COMPENSATION OTHER|||||39.75||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Medicare|MEDICARE ACUTE|39.75||||39.75||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||39.75||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|39.75||||||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Medicaid|MEDICAID|||||39.75||| 9511080|ERX|0250|HYDROXYZINE HCL 10MG TABL|Medicare|MEDICARE ACUTE|6.50||||||| 9511098|ERX|0250|ERGOCALCIFEROL 50000 UNIT|Humana Medicare Advantage|HUMANA MA|14.75||||||| 9511247|ERX|0250|LOPERAMIDE 1MG 5ML|Medicare|MEDICARE ACUTE|24.75||||||| 9511262|ERX|0250|SOTALOL 80MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9511262|ERX|0250|SOTALOL 80MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9511270|ERX|0250|METHYLPREDNISOL DEPO 40MG|United Medicare Advantage|UHC MEDICARE GOLD MA|||||71.25||| 9511270|ERX|0250|METHYLPREDNISOL DEPO 40MG|Medicare|MEDICARE ACUTE|||||71.25||| 9511270|ERX|0250|METHYLPREDNISOL DEPO 40MG|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||71.25||| 9511270|ERX|0250|METHYLPREDNISOL DEPO 40MG|Blue Cross PPO Specialty|BCBSTX PPO|||||71.25||| 9511270|ERX|0250|METHYLPREDNISOL DEPO 40MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||71.25||| 9511270|ERX|0250|METHYLPREDNISOL DEPO 40MG|Aenta Medicare Advantage|AETNA MEDICARE MA|||||71.25||| 9511270|ERX|0250|METHYLPREDNISOL DEPO 40MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||71.25||| 9511270|ERX|0250|METHYLPREDNISOL DEPO 40MG|Managed Medicaid|MEDICAID AMERIGROUP|||||71.25||| 9511270|ERX|0250|METHYLPREDNISOL DEPO 40MG|Humana Medicare Advantage|HUMANA MA|||||71.25||| 9511361|ERX|0250|FENTANYL 25MCG PATCH|Managed Medicaid|MEDICAID SUPERIOR|8.50||||||| 9511361|ERX|0250|FENTANYL 25MCG PATCH|Medicare|MEDICARE ACUTE|8.50||||||| 9511379|ERX|0250|FENTANYL 50MCG PATCH|United Medicare Advantage|UHC MEDICARE GOLD MA|||||13.25||| 9511379|ERX|0250|FENTANYL 50MCG PATCH|Blue Cross HMO Specialty|BCBSTX HMO|||||13.25||| 9511379|ERX|0250|FENTANYL 50MCG PATCH|Blue Cross PPO Specialty|BCBSTX PPO|13.25||||||| 9511379|ERX|0250|FENTANYL 50MCG PATCH|Access Direct Platinum|HEALTHFIRST TPA UMR|13.25||||||| 9511379|ERX|0250|FENTANYL 50MCG PATCH|Humana Medicare Advantage|HUMANA MA|13.25||||||| 9511379|ERX|0250|FENTANYL 50MCG PATCH|Managed Medicaid|MEDICAID SUPERIOR|13.25||||||| 9511445|ERX|0250|RISPERIDONE 1MG TABLET|Humana Medicare Advantage|HUMANA MA|||||1.25||| 9511445|ERX|0250|RISPERIDONE 1MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| 9511445|ERX|0250|RISPERIDONE 1MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9511445|ERX|0250|RISPERIDONE 1MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9511445|ERX|0250|RISPERIDONE 1MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|United Medicare Advantage|UHC MEDICARE GOLD MA|121.75||||121.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|121.75||||||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Medicare|MEDICARE ACUTE|121.75||||121.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|United Healthcare|UNITED HEALTHCARE|121.75||||||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Aetna|AETNA PPO|||||121.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Blue Cross PPO Specialty|BCBSTX PPO|||||121.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Cigna|CIGNA|121.75||||||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Humana Medicare Advantage|HUMANA MA|121.75||||121.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Managed Medicaid|MEDICAID UNITED HEALTHCARE|121.75||||121.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Managed Medicaid|MEDICAID SUPERIOR|||||121.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|121.75||||121.75||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Managed Medicaid|MEDICAID AMERIGROUP|121.75||||||| 9511460|ERX|0250|RISPERIDONE 0.25MG TABLET|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.25||| 9511460|ERX|0250|RISPERIDONE 0.25MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9511551|ERX|0250|CLINDAMYCIN 300MG/50ML D5|Blue Cross HMO Specialty|BCBSTX HMO|0.89||||||| 9511650|ERX|0250|LEVETIRACETAM 500MG/5ML|Managed Medicaid|MEDICAID AMERIGROUP|||||2.59||| 9511650|ERX|0250|LEVETIRACETAM 500MG/5ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.59||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|Medicare|MEDICARE ACUTE|138.75||||||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|Blue Cross PPO Specialty|BCBSTX PPO|||||138.75||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|Humana Medicare Advantage|HUMANA MA|138.75||||138.75||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|Managed Medicaid|MEDICAID SUPERIOR|138.75||||||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|138.75||||138.75||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|9.25||||9.25||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|9.25||||||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Medicare|MEDICARE ACUTE|9.25||||9.25||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||9.25||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Managed Medicaid|MEDICAID AMERIGROUP|||||9.25||| 9511775|ERX|0250|ACETAMINOPHEN 650MG TABLE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.25||| 9511775|ERX|0250|ACETAMINOPHEN 650MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|||||2.25||| 9511775|ERX|0250|ACETAMINOPHEN 650MG TABLE|Managed Medicaid|MEDICAID SUPERIOR|||||2.25||| 9511775|ERX|0250|ACETAMINOPHEN 650MG TABLE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2.25||| 9511775|ERX|0250|ACETAMINOPHEN 650MG TABLE|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.25||| 9511775|ERX|0250|ACETAMINOPHEN 650MG TABLE|Medicaid|MEDICAID|||||2.25||| 9511783|ERX|0250|ACETAMINOPHEN 3840MG/120M|Managed Medicaid|MEDICAID SUPERIOR|||||43.25||| 9511783|ERX|0250|ACETAMINOPHEN 3840MG/120M|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||43.25||| 9511783|ERX|0250|ACETAMINOPHEN 3840MG/120M|Medicare|MEDICARE ACUTE|43.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Veterans Affairs|VETERANS ADMINISTRATION|1.25||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Medicare|MEDICARE PART B ONLY IP|1.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Tricare|TRICARE EAST REGION|1.25||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|United Healthcare|UNITED HEALTHCARE OTHER|1.25||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|1.25||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|United Healthcare|TML GROUP BENEFITS|||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Aetna|AETNA OTHER|||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Cigna|CIGNA|1.25||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|NON CONTRACTED|COMMERCIAL OTHER 1|1.25||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|United Healthcare|UNITED HEALTHCARE|1.25||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Managed Medicaid|MEDICAID SUPERIOR|1.25||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Medicaid|MEDICAID|||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Medicaid|MEDICAID TEXAS CHILDRENS|1.25||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Medicaid|MORRIS COUNTY INDIGENT|||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Managed Medicare|HEALTHSPRING MA|||||1.25||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Medicaid|MEDICAID HMO|||||1.25||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.14||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.14||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Managed Medicaid|MEDICAID SUPERIOR|||||1.14||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Medicaid|MEDICAID|||||1.14||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.14||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.14||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Humana Medicare Advantage|HUMANA MA|||||1.14||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Managed Medicare|HEALTHSPRING MA|||||1.14||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.14||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Blue Cross HMO Specialty|BCBSTX HMO|||||1.14||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Blue Cross PPO Specialty|BCBSTX PPO|1.14||||1.14||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1.14||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Managed Medicaid|MEDICAID AMERIGROUP|||||1.14||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.14||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.14||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Cigna|CIGNA|||||1.14||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Medicare|MEDICARE ACUTE|1.14||||1.14||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Tricare|TRICARE EAST REGION|||||1.14||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.14||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.14||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|United Healthcare|UNITED HEALTHCARE|||||1.14||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Veterans Affairs|VETERANS ADMINISTRATION|||||1.14||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.14||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.14||| 9511817|ERX|0250|METHYLPREDNISOL DEPO 80MG|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.14||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Veterans Affairs|VETERANS ADMINISTRATION|1.25||||1.25||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||1.25||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.25||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.25||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|NON CONTRACTED|COMMERCIAL OTHER 1|1.25||||1.25||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Tricare|TRICARE EAST REGION|1.25||||1.25||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|United Healthcare|UNITED HEALTHCARE|1.25||||1.25||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.25||||1.25||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|United Healthcare|UNITED HEALTHCARE OTHER|1.25||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Access Direct Platinum|HEALTHFIRST TPA UMR|1.25||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|1.25||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Aetna|AETNA PPO|||||1.25||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Aetna|AETNA OTHER|||||1.25||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||1.25||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.25||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Cigna|CIGNA|1.25||||1.25||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||1.25||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Managed Medicaid|MEDICAID SUPERIOR|1.25||||1.25||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||1.25||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.25||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Medicaid|MEDICAID|1.25||||1.25||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.25||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.25||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Aetna|AETNA PPO|||||1.25||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Access Direct Platinum|HEALTHFIRST TPA UMR|1.25||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|United Healthcare|UNITED HEALTHCARE|1.25||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.25||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||1.25||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.25||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9511940|ERX|0250|CARISOPRODOL 350MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9511940|ERX|0250|CARISOPRODOL 350MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9511940|ERX|0250|CARISOPRODOL 350MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9511999|ERX|0250|DIPHENOX-ATROP 2.5-0.025M|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9511999|ERX|0250|DIPHENOX-ATROP 2.5-0.025M|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9511999|ERX|0250|DIPHENOX-ATROP 2.5-0.025M|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.25||||||| 9511999|ERX|0250|DIPHENOX-ATROP 2.5-0.025M|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9511999|ERX|0250|DIPHENOX-ATROP 2.5-0.025M|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1.25||| 9511999|ERX|0250|DIPHENOX-ATROP 2.5-0.025M|Humana Medicare Advantage|HUMANA MA|||||1.25||| 9511999|ERX|0250|DIPHENOX-ATROP 2.5-0.025M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9511999|ERX|0250|DIPHENOX-ATROP 2.5-0.025M|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.25||| 9511999|ERX|0250|DIPHENOX-ATROP 2.5-0.025M|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| 9511999|ERX|0250|DIPHENOX-ATROP 2.5-0.025M|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.25||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Medicare|MEDICARE ACUTE|||||0.02||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.25||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|United Healthcare|UNITED HEALTHCARE|1.25||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Medicare|MEDICARE PART B ONLY IP|1.25||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||1.25||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.25||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||1.25||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||1.25||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Managed Medicare|HEALTHSPRING MA|1.25||||1.25||| 9512070|ERX|0250|MIRTAZAPINE 15MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9512070|ERX|0250|MIRTAZAPINE 15MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9512070|ERX|0250|MIRTAZAPINE 15MG TABLET|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9512070|ERX|0250|MIRTAZAPINE 15MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||||| 9512070|ERX|0250|MIRTAZAPINE 15MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||||| 9512070|ERX|0250|MIRTAZAPINE 15MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9512070|ERX|0250|MIRTAZAPINE 15MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Medicare|MEDICARE ACUTE|3.50||||3.50||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|||||3.50||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||3.50||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|||||3.50||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3.50||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.50||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.50||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Humana Medicare Advantage|HUMANA MA|||||3.50||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.50||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3.50||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3.50||| 9512104|ERX|0250|MECLIZINE 25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||3.50||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||1.25||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Managed Medicaid|MEDICAID AMERIGROUP|1.25||||||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.25||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Tricare|TRICARE EAST REGION|1.25||||||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|Tricare|TRICARE EAST REGION|1.25||||||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|Cigna|CIGNA|||||1.25||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|Humana Medicare Advantage|HUMANA MA|||||1.25||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|Medicare|MEDICARE ACUTE|||||1.25||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|United Healthcare|UNITED HEALTHCARE|1.25||||||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|Humana Medicare Advantage|HUMANA MA|||||1.25||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|Medicaid|MEDICAID|||||1.25||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|Managed Medicaid|MEDICAID SUPERIOR|1.25||||||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.25||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9512153|ERX|0250|METRONIDAZOLE 250MG TABLE|Cigna|CIGNA|||||1.25||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.25||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.25||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Aetna|AETNA OTHER|||||1.25||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||1.25||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Medicaid|MEDICAID|||||1.25||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.25||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9512195|ERX|0250|AMITRIPTYLINE 10MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9512195|ERX|0250|AMITRIPTYLINE 10MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9512195|ERX|0250|AMITRIPTYLINE 10MG TABLET|Medicaid|MEDICAID|1.25||||||| 9512203|ERX|0250|LORATADINE 10MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||||| 9512203|ERX|0250|LORATADINE 10MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||1.25||| 9512203|ERX|0250|LORATADINE 10MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9512203|ERX|0250|LORATADINE 10MG TABLET|Aetna|AETNA PPO|||||1.25||| 9512203|ERX|0250|LORATADINE 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||||| 9512203|ERX|0250|LORATADINE 10MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9512203|ERX|0250|LORATADINE 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9512203|ERX|0250|LORATADINE 10MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||||| 9512203|ERX|0250|LORATADINE 10MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||1.25||| 9512203|ERX|0250|LORATADINE 10MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9512203|ERX|0250|LORATADINE 10MG TABLET|Tricare|TRICARE EAST REGION|||||1.25||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.25||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.25||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Veterans Affairs|VETERANS ADMINISTRATION|||||1.25||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.25||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Medicaid|MEDICAID|||||1.25||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Medicaid|MEDICAID HMO|||||1.25||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.25||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.25||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.25||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.25||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Cigna|CIGNA|||||1.25||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.25||| 9512260|ERX|0250|INDOMETHACIN 25MG CAPSULE|Humana Medicare Advantage|HUMANA MA|0.05||||||| 9512260|ERX|0250|INDOMETHACIN 25MG CAPSULE|Medicare|MEDICARE ACUTE|0.05||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.25||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.25||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|United Healthcare|UNITED HEALTHCARE|1.25||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9512351|ERX|0250|BENZTROPINE 1MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Medicaid|MEDICAID|||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Medicaid|MEDICAID TEXAS CHILDRENS|1.25||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Aetna|AETNA PPO|||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Cigna|CIGNA|1.25||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|1.25||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|1.25||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|Tricare|TRICARE EAST REGION|||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|PHCS|HUMANA INSURANCE|||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9512377|ERX|0250|IBUPROFEN 400MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|||||1.25||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|||||1.25||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9512419|ERX|0250|DIAZEPAM 2MG TABLET|Humana Medicare Advantage|HUMANA MA|||||1.25||| 9512419|ERX|0250|DIAZEPAM 2MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Medicare|MEDICARE ACUTE|||||1.25||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Cigna|CIGNA|||||1.25||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||1.25||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||1.25||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Medicaid|MEDICAID|1.25||||||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.25||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|1.25||||1.25||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.25||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Managed Medicare|HEALTHSPRING MA|1.25||||1.25||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Medicaid|MEDICAID|1.25||||1.25||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.25||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||1.25||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Aetna|AETNA PPO|||||1.25||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Cigna|CIGNA|||||1.25||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.25||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.25||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|United Healthcare|GEHA|||||1.25||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||1.25||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||1.25||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|United Healthcare|UNITED HEALTHCARE|1.25||||1.25||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.25||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Tricare|TRICARE EAST REGION|1.25||||1.25||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.25||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.25||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||1.25||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.25||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1.25||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|United Healthcare|UNITED HEALTHCARE|1.25||||1.25||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||1.25||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Aetna|AETNA PPO|||||1.25||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|1.25||||1.25||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||1.25||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||1.25||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Medicaid|MEDICAID|||||1.25||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Managed Medicare|HEALTHSPRING MA|||||1.25||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Medicaid|MEDICAID|1.25||||1.25||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|NON CONTRACTED|COMMERCIAL OTHER 1|1.25||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Tricare|TRICARE EAST REGION|1.25||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|United Healthcare|UNITED HEALTHCARE|1.25||||1.25||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Cigna|CIGNA|1.25||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||1.25||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Aetna|AETNA OTHER|||||1.25||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9512567|ERX|0250|CILOSTAZOL 100MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9512567|ERX|0250|CILOSTAZOL 100MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9512567|ERX|0250|CILOSTAZOL 100MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|United Healthcare|UNITED HEALTHCARE|1.25||||||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9512575|ERX|0250|GLIMEPIRIDE 2MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|1.25||||1.25||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||1.25||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Medicare|MEDICARE PART B ONLY IP|1.25||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Tricare|TRICARE EAST REGION|1.25||||1.25||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||1.25||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||||| 9512617|ERX|0250|LINEZOLID 600MG TABLET|Medicare|MEDICARE ACUTE|229.50||||||| 9512617|ERX|0250|LINEZOLID 600MG TABLET|Humana Medicare Advantage|HUMANA MA|229.50||||||| 9512633|ERX|0250|MEGESTROL 40MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9512658|ERX|0250|DOXEPIN 25MG CAPSULE|Medicare|MEDICARE ACUTE|||||1.25||| 9512690|ERX|0250|AMANTADINE 100MG CAPSULE|Medicare|MEDICARE ACUTE|1.25||||||| 9512773|ERX|0250|CHLORPROMAZINE 25MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9512781|ERX|0250|FUROSEMIDE 80MG TABLET|Medicare|MEDICARE PART B ONLY IP|1.25||||||| 9512781|ERX|0250|FUROSEMIDE 80MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9512781|ERX|0250|FUROSEMIDE 80MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||1.25||| 9512781|ERX|0250|FUROSEMIDE 80MG TABLET|Humana Medicare Advantage|HUMANA MA|||||1.25||| 9512799|ERX|0250|PROCHLORPERAZINE 5MG TABL|Blue Cross PPO Specialty|BCBSTX PPO|||||6.50||| 9512799|ERX|0250|PROCHLORPERAZINE 5MG TABL|Medicare|MEDICARE ACUTE|||||6.50||| 9512799|ERX|0250|PROCHLORPERAZINE 5MG TABL|United Healthcare|UNITED HEALTHCARE|||||6.50||| 9513011|ERX|0250|AMOXICILLIN 500MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9513011|ERX|0250|AMOXICILLIN 500MG CAPSULE|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.25||| 9513011|ERX|0250|AMOXICILLIN 500MG CAPSULE|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9513011|ERX|0250|AMOXICILLIN 500MG CAPSULE|Humana Medicare Advantage|HUMANA MA|||||1.25||| 9513011|ERX|0250|AMOXICILLIN 500MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| 9513011|ERX|0250|AMOXICILLIN 500MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9513011|ERX|0250|AMOXICILLIN 500MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9513011|ERX|0250|AMOXICILLIN 500MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||1.25||| 9513011|ERX|0250|AMOXICILLIN 500MG CAPSULE|Medicaid|MEDICAID|||||1.25||| 9513011|ERX|0250|AMOXICILLIN 500MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|||||1.25||| 9513011|ERX|0250|AMOXICILLIN 500MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9513011|ERX|0250|AMOXICILLIN 500MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9513011|ERX|0250|AMOXICILLIN 500MG CAPSULE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.25||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||1.25||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Aetna|AETNA OTHER|||||1.25||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.25||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||1.25||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Cigna|CIGNA|||||1.25||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.25||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Tricare|TRICARE EAST REGION|1.25||||1.25||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Veterans Affairs|VETERANS ADMINISTRATION|||||1.25||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9513128|ERX|0250|TOLTERODINE XL 4MG CAPSUL|Medicare|MEDICARE ACUTE|16.25||||||| 9513136|ERX|0250|VERAPAMIL 80MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|1.25||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||1.25||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.25||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Medicare|MEDICARE ACUTE|1.25||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Tricare|TRICARE FOR LIFE|||||1.25||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.25||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Cigna|CIGNA|1.25||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||1.25||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||1.25||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.25||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.25||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|1.25||||||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|1.25||||1.25||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.25||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.25||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.25||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|PHCS|MULTIPLAN PHCS|||||1.25||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Aetna|AETNA OTHER|||||1.25||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||1.25||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Cigna|CIGNA|1.25||||1.25||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||1.25||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|1.25||||1.25||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Medicaid|MEDICAID|||||1.25||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.25||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Medicaid|MEDICAID TEXAS CHILDRENS|1.25||||1.25||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Humana Medicare Advantage|HUMANA MA|||||2.25||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.25||||||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||2.25||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.25||||||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.25||||||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Medicare|MEDICARE ACUTE|2.25||||2.25||| 9513235|ERX|0250|CARBIDOPA-LEVODOPA 10-100|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9513235|ERX|0250|CARBIDOPA-LEVODOPA 10-100|Humana Medicare Advantage|HUMANA MA|||||1.25||| 9513243|ERX|0250|CARBIDOPA-LEVODOPA 25-100|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9513243|ERX|0250|CARBIDOPA-LEVODOPA 25-100|Medicare|MEDICARE ACUTE|1.25||||||| 9513250|ERX|0250|ATENOLOL 25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9513250|ERX|0250|ATENOLOL 25MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9513250|ERX|0250|ATENOLOL 25MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.25||| 9513250|ERX|0250|ATENOLOL 25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9513250|ERX|0250|ATENOLOL 25MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||1.25||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||1.25||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||||| 9513292|ERX|0250|NAPROXEN 500MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.25||| 9513292|ERX|0250|NAPROXEN 500MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|||||1.25||| 9513292|ERX|0250|NAPROXEN 500MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.25||| 9513292|ERX|0250|NAPROXEN 500MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9513292|ERX|0250|NAPROXEN 500MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9513292|ERX|0250|NAPROXEN 500MG TABLET|Cigna|CIGNA|||||1.25||| 9513292|ERX|0250|NAPROXEN 500MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9513292|ERX|0250|NAPROXEN 500MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||1.25||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||1.25||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Managed Medicare|HEALTHSPRING MA|1.25||||1.25||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Medicaid|MEDICAID|||||1.25||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Access Direct Platinum|HEALTHFIRST TPA UMR|||||1.25||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Aetna|AETNA PPO|||||1.25||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||1.25||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Cigna|CIGNA|||||1.25||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Managed Medicaid|MEDICAID AMERIGROUP|1.25||||1.25||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Medicaid|MORRIS COUNTY INDIGENT|||||1.25||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||1.25||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.25||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.25||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.25||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Veterans Affairs|VETERANS ADMINISTRATION|||||1.25||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|NON CONTRACTED|COMMERCIAL OTHER 1|1.25||||1.25||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Medicare|MEDICARE PART B ONLY IP|1.25||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Tricare|TRICARE EAST REGION|||||1.25||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|United Healthcare|UNITED HEALTHCARE|1.25||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|United Healthcare|UNITED HEALTHCARE|1.25||||1.25||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|Tricare|TRICARE EAST REGION|1.25||||||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9513417|ERX|0250|INDAPAMIDE 2.5MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9513417|ERX|0250|INDAPAMIDE 2.5MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9513433|ERX|0250|SUCRALFATE 1 G TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.25||| 9513433|ERX|0250|SUCRALFATE 1 G TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9513433|ERX|0250|SUCRALFATE 1 G TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9513458|ERX|0250|GLYBURIDE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9513466|ERX|0250|RANITIDINE 150MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9513466|ERX|0250|RANITIDINE 150MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9513466|ERX|0250|RANITIDINE 150MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9513466|ERX|0250|RANITIDINE 150MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9513466|ERX|0250|RANITIDINE 150MG TABLET|Medicaid|MEDICAID|||||1.25||| 9513557|ERX|0250|LABETALOL 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||||| 9513557|ERX|0250|LABETALOL 100MG TABLET|Humana Medicare Advantage|HUMANA MA|||||1.25||| 9513557|ERX|0250|LABETALOL 100MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9513557|ERX|0250|LABETALOL 100MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9513573|ERX|0250|TRIAMTERENE/HCTZ 37.5-25M|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9513573|ERX|0250|TRIAMTERENE/HCTZ 37.5-25M|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.25||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.25||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||1.25||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.25||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.25||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Tricare|TRICARE EAST REGION|||||1.25||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Cigna|CIGNA|1.25||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Aetna|AETNA OTHER|||||1.25||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.25||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||1.25||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Medicaid|MEDICAID|||||1.25||| 9513730|ERX|0250|SOLIFENACIN 5MG TABLET|Medicare|MEDICARE ACUTE|0.14||||||| 9513748|ERX|0250|CHLORHEXIDINE 0.12% ORAL|Medicare|MEDICARE ACUTE|1.14||||||| 9513789|ERX|0250|BISOPROLOL 5MG TABLET|Humana Medicare Advantage|HUMANA MA|||||8.25||| 9513789|ERX|0250|BISOPROLOL 5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|8.25||||||| 9513789|ERX|0250|BISOPROLOL 5MG TABLET|Medicare|MEDICARE ACUTE|8.25||||8.25||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|Medicare|MEDICARE ACUTE|||||314.75||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|Humana Medicare Advantage|HUMANA MA|||||314.75||| 9513938|ERX|0250|AZTREONAM 1000MG VIAL|Humana Medicare Advantage|HUMANA MA|251.50||||||| 9513938|ERX|0250|AZTREONAM 1000MG VIAL|Medicare|MEDICARE ACUTE|251.50||||251.50||| 9513953|ERX|0250|CEFEPIME 1 G VIAL|Medicare|MEDICARE ACUTE|||||1.56||| 9513953|ERX|0250|CEFEPIME 1 G VIAL|Blue Cross PPO Specialty|BCBSTX PPO|||||1.56||| 9514001|ERX|0250|NYSTATIN CREAM, 15 GM|Managed Medicaid|MEDICAID SUPERIOR|0.35||||0.35||| 9514001|ERX|0250|NYSTATIN CREAM, 15 GM|Blue Cross HMO Specialty|BCBSTX HMO|0.35||||||| 9514001|ERX|0250|NYSTATIN CREAM, 15 GM|Aetna|AETNA OTHER|0.35||||||| 9514001|ERX|0250|NYSTATIN CREAM, 15 GM|United Medicare Advantage|UHC MEDICARE GOLD MA|0.35||||||| 9514001|ERX|0250|NYSTATIN CREAM, 15 GM|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|0.35||||||| 9514001|ERX|0250|NYSTATIN CREAM, 15 GM|Medicare|MEDICARE ACUTE|0.35||||||| 9514019|ERX|0250|CLOTRIMAZOLE 1% CREAM, 15|Medicare|MEDICARE ACUTE|46.75||||||| 9514043|ERX|0250|ACETAZOLAMIDE 250MG TABLE|Medicare|MEDICARE ACUTE|1.25||||||| 9514084|ERX|0250|PEG 3350, 4L|Blue Cross PPO Specialty|BCBSTX PPO|1.24||||||| 9514084|ERX|0250|PEG 3350, 4L|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.24||| 9514100|ERX|0250|LATANOPROST EYE DROP, 2.5|Medicare|MEDICARE ACUTE|405.75||||405.75||| 9514100|ERX|0250|LATANOPROST EYE DROP, 2.5|United Healthcare|UNITED HEALTHCARE|||||405.75||| 9514100|ERX|0250|LATANOPROST EYE DROP, 2.5|Managed Medicaid|MEDICAID AMERIGROUP|405.75||||||| 9514100|ERX|0250|LATANOPROST EYE DROP, 2.5|Humana Medicare Advantage|HUMANA MA|405.75||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.04||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Aetna|AETNA OTHER|0.04||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Blue Cross PPO Specialty|BCBSTX PPO|0.04||||0.04||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Medicaid|MEDICAID|0.04||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Managed Medicaid|MEDICAID AMERIGROUP|0.04||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.04||||0.04||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.04||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Humana Medicare Advantage|HUMANA MA|0.04||||0.04||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Managed Medicare|HEALTHSPRING MA|0.04||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.04||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|United Medicare Advantage|UHC MEDICARE GOLD MA|0.04||||0.04||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.04||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Medicare|MEDICARE ACUTE|0.04||||0.04||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Tricare|TRICARE EAST REGION|0.04||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|United Healthcare|UNITED HEALTHCARE|0.04||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Tricare|TRICARE EAST REGION|||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|United Healthcare|UNITED HEALTHCARE|1.25||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Veterans Affairs|VETERANS ADMINISTRATION|||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Medicaid|MEDICAID|||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Managed Medicaid|MEDICAID SUPERIOR|1.25||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Managed Medicare|HEALTHSPRING MA|||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Blue Cross HMO Specialty|BCBSTX HMO|||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Access Direct Platinum|HEALTHFIRST TPA UMR|||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Aetna|AETNA PPO|||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Aetna|AETNA OTHER|||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Cigna|CIGNA|||||1.25||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||1.25||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Blue Cross HMO Specialty|BCBSTX HMO|||||3.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Managed Medicaid|MEDICAID AMERIGROUP|||||3.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Managed Medicaid|MEDICAID SUPERIOR|||||3.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Humana Medicare Advantage|HUMANA MA|||||3.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Blue Cross PPO Specialty|BCBSTX PPO|3.50||||3.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Medicaid|MEDICAID TEXAS CHILDRENS|3.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Medicaid|MEDICAID|||||3.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|United Medicare Advantage|UHC MEDICARE GOLD MA|3.50||||3.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Workers Compensation|WORKERS COMPENSATION OTHER|||||3.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Veterans Affairs|VETERANS ADMINISTRATION|||||3.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|NON CONTRACTED|COMMERCIAL OTHER 1|3.50||||3.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Medicare|MEDICARE ACUTE|3.50||||3.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Tricare|TRICARE EAST REGION|||||3.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|United Healthcare|UNITED HEALTHCARE|||||3.50||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|United Healthcare|UNITED HEALTHCARE|3.50||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Medicare|MEDICARE ACUTE|3.50||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|United Healthcare|UNITED HEALTHCARE|||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Veterans Affairs|VETERANS ADMINISTRATION|||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|United Medicare Advantage|UHC MEDICARE GOLD MA|3.50||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Medicaid|MORRIS COUNTY INDIGENT|||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.50||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Managed Medicaid|MEDICAID SUPERIOR|||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Managed Medicaid|MEDICAID AMERIGROUP|||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Workers Compensation|WORKERS COMPENSATION OTHER|||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|3.50||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Humana Medicare Advantage|HUMANA MA|3.50||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|NON CONTRACTED|COMMERCIAL OTHER 1|3.50||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Medicaid|MEDICAID|||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Blue Cross HMO Specialty|BCBSTX HMO|||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|3.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Aetna|AETNA OTHER|||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Blue Cross PPO Specialty|BCBSTX PPO|3.50||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Blue Cross PPO Specialty|BCBSTX OTHER|||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Cigna|CIGNA|3.50||||3.50||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3.50||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|14.25||||||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Cigna|CIGNA|||||14.25||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Cigna|CIGNA|14.25||||||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||14.25||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||14.25||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Medicaid|MEDICAID|||||14.25||| 9514340|ERX|0250|METOLAZONE 2.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9514340|ERX|0250|METOLAZONE 2.5MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9514340|ERX|0250|METOLAZONE 2.5MG TABLET|United Healthcare|UNITED HEALTHCARE|1.25||||||| 9514340|ERX|0250|METOLAZONE 2.5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||1.25||| 9514340|ERX|0250|METOLAZONE 2.5MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9514340|ERX|0250|METOLAZONE 2.5MG TABLET|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9514340|ERX|0250|METOLAZONE 2.5MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||1.25||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||1.25||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|1.25||||1.25||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Medicare|MEDICARE PART B ONLY IP|1.25||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Tricare|TRICARE EAST REGION|||||1.25||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.25||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||1.25||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.25||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.25||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Medicare|MEDICARE PART B ONLY IP|4.25||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Medicare|MEDICARE ACUTE|4.25||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.25||||||| 9514480|ERX|0250|MESALAMINE 250MG CAPSULE|NON CONTRACTED|COMMERCIAL OTHER 1|1.25||||||| 9514480|ERX|0250|MESALAMINE 250MG CAPSULE|Medicare|MEDICARE ACUTE|1.25||||||| 9514704|ERX|0250|MILRINONE 20MG/20ML|Medicare|MEDICARE ACUTE|63.89||||||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|||||244.50||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|Humana Medicare Advantage|HUMANA MA|244.50||||||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|244.50||||244.50||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|Medicare|MEDICARE ACUTE|||||244.50||| 9514761|ERX|0250|AMIODARONE 150MG/3ML|Medicare|MEDICARE ACUTE|3.45||||||| 9514761|ERX|0250|AMIODARONE 150MG/3ML|Managed Medicaid|MEDICAID AMERIGROUP|3.45||||||| 9514761|ERX|0250|AMIODARONE 150MG/3ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.45||| 9514761|ERX|0250|AMIODARONE 150MG/3ML|Humana Medicare Advantage|HUMANA MA|||||3.45||| 9514761|ERX|0250|AMIODARONE 150MG/3ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|3.45||||||| 9514761|ERX|0250|AMIODARONE 150MG/3ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.45||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||88.75||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Blue Cross PPO Specialty|BCBSTX PPO|||||88.75||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||88.75||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Cigna|CIGNA|||||88.75||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||88.75||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Managed Medicaid|MEDICAID AMERIGROUP|||||88.75||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||88.75||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Managed Medicaid|MEDICAID SUPERIOR|||||88.75||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Humana Medicare Advantage|HUMANA MA|||||88.75||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Medicaid|MORRIS COUNTY INDIGENT|||||88.75||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||88.75||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||88.75||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Veterans Affairs|VETERANS ADMINISTRATION|||||88.75||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|Medicare|MEDICARE ACUTE|||||88.75||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||88.75||| 9514779|ERX|0250|DICYCLOMINE 10MG/ML, 2ML|United Healthcare|UNITED HEALTHCARE|||||88.75||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.48||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Medicare|MEDICARE ACUTE|0.48||||0.48||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|United Healthcare|UNITED HEALTHCARE|0.48||||||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Veterans Affairs|VETERANS ADMINISTRATION|||||0.48||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.48||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.48||||0.48||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Managed Medicaid|MEDICAID AMERIGROUP|0.48||||0.48||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Managed Medicaid|MEDICAID SUPERIOR|||||0.48||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Humana Medicare Advantage|HUMANA MA|0.48||||0.48||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.48||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Managed Medicare|BCBS MEDICARE PPO MA|||||0.48||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.48||||0.48||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Blue Cross PPO Specialty|BCBSTX PPO|0.48||||0.48||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Cigna|CIGNA|||||0.48||| 9514829|ERX|0250|TERBUTALINE 1MG/ML|Managed Medicaid|MEDICAID SUPERIOR|||||16.25||| 9514944|ERX|0250|POLYMYXIN B 500000 UNIT V|United Medicare Advantage|UHC MEDICARE GOLD MA|||||32.50||| 9514944|ERX|0250|POLYMYXIN B 500000 UNIT V|NON CONTRACTED|COMMERCIAL OTHER 1|||||32.50||| 9514944|ERX|0250|POLYMYXIN B 500000 UNIT V|Tricare|TRICARE EAST REGION|||||32.50||| 9514944|ERX|0250|POLYMYXIN B 500000 UNIT V|United Healthcare|UNITED HEALTHCARE|32.50||||||| 9514944|ERX|0250|POLYMYXIN B 500000 UNIT V|United Healthcare|UNITED HEALTHCARE|||||32.50||| 9514944|ERX|0250|POLYMYXIN B 500000 UNIT V|Medicare|MEDICARE ACUTE|||||32.50||| 9514944|ERX|0250|POLYMYXIN B 500000 UNIT V|Blue Cross HMO Specialty|BCBSTX HMO|||||32.50||| 9514944|ERX|0250|POLYMYXIN B 500000 UNIT V|Aetna|AETNA PPO|||||32.50||| 9514944|ERX|0250|POLYMYXIN B 500000 UNIT V|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||32.50||| 9514944|ERX|0250|POLYMYXIN B 500000 UNIT V|Blue Cross PPO Specialty|BCBSTX PPO|32.50||||32.50||| 9514944|ERX|0250|POLYMYXIN B 500000 UNIT V|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||32.50||| 9514944|ERX|0250|POLYMYXIN B 500000 UNIT V|Cigna|CIGNA|||||32.50||| 9514944|ERX|0250|POLYMYXIN B 500000 UNIT V|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||32.50||| 9514944|ERX|0250|POLYMYXIN B 500000 UNIT V|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||32.50||| 9514944|ERX|0250|POLYMYXIN B 500000 UNIT V|Managed Medicaid|MEDICAID SUPERIOR|||||32.50||| 9514944|ERX|0250|POLYMYXIN B 500000 UNIT V|Managed Medicaid|MEDICAID AMERIGROUP|||||32.50||| 9514944|ERX|0250|POLYMYXIN B 500000 UNIT V|Humana Medicare Advantage|HUMANA MA|||||32.50||| 9514944|ERX|0250|POLYMYXIN B 500000 UNIT V|Medicaid|MORRIS COUNTY INDIGENT|||||32.50||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||67.75||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|||||67.75||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||67.75||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|||||67.75||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||67.75||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Medicaid|MEDICAID|||||67.75||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Humana Medicare Advantage|HUMANA MA|||||67.75||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||67.75||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||67.75||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|||||67.75||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Cigna|CIGNA|||||67.75||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|United Healthcare|UNITED HEALTHCARE|||||67.75||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Medicare|MEDICARE ACUTE|||||67.75||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||67.75||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||67.75||| 9514993|ERX|0250|BUTORPHANOL 2MG/1ML|Veterans Affairs|VETERANS ADMINISTRATION|||||67.75||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Medicare|MEDICARE ACUTE|1.25||||||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|United Healthcare|UNITED HEALTHCARE|1.25||||||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||1.25||| 9515107|ERX|0250|BUMETANIDE 2.5MG/10ML|Medicare|MEDICARE ACUTE|49.75||||||| 9515107|ERX|0250|BUMETANIDE 2.5MG/10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|49.75||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Medicaid|MEDICAID|1.25||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.25||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|PHCS|GROUP AND PENSION|||||1.25||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||1.25||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.25||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||1.25||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Medicaid|MORRIS COUNTY INDIGENT|||||1.25||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.25||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Medicaid|MEDICAID|||||1.25||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Aetna|AETNA OTHER|||||1.25||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.25||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Cigna|CIGNA|||||1.25||| 9515446|ERX|0250|KETOROLAC 10MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.25||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|Aetna|AETNA OTHER|||||1.25||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.25||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.25||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||1.25||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|Cigna|CIGNA|||||1.25||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||1.25||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|Managed Medicare|HEALTHSPRING MA|||||1.25||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|Managed Medicare|BCBS MEDICARE PPO MA|||||1.25||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.25||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1.25||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.25||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|Veterans Affairs|VETERANS ADMINISTRATION|||||1.25||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.25||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|Tricare|TRICARE EAST REGION|||||1.25||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.25||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Medicare|MEDICARE ACUTE|8.50||||8.50||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|United Medicare Advantage|UHC MEDICARE GOLD MA|8.50||||8.50||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|8.50||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Humana Medicare Advantage|HUMANA MA|8.50||||8.50||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Medicaid|MEDICAID|8.50||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|8.50||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Blue Cross PPO Specialty|BCBSTX PPO|||||8.50||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Aenta Medicare Advantage|AETNA MEDICARE MA|||||8.50||| 9515776|ERX|0250|ARIPIPRAZOLE 10MG TABLET|Cigna|CIGNA|32.75||||||| 9515776|ERX|0250|ARIPIPRAZOLE 10MG TABLET|Humana Medicare Advantage|HUMANA MA|||||32.75||| 9515776|ERX|0250|ARIPIPRAZOLE 10MG TABLET|Medicare|MEDICARE ACUTE|||||32.75||| 9515925|ERX|0250|NITROGLYCERIN SPRAY|Medicare|MEDICARE ACUTE|1.87||||1.87||| 9515925|ERX|0250|NITROGLYCERIN SPRAY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.87||| 9515925|ERX|0250|NITROGLYCERIN SPRAY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.87||| 9515925|ERX|0250|NITROGLYCERIN SPRAY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.87||||||| 9516063|ERX|0250|METHIMAZOLE 5MG TABLET|Medicare|MEDICARE ACUTE|8.50||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Cigna|CIGNA|||||1.25||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Blue Cross HMO Specialty|BCBSTX HMO|1.25||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||1.25||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.25||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||1.25||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|1.25||||1.25||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||1.25||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||1.25||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|1.25||||1.25||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Managed Medicare|HEALTHSPRING MA|1.25||||1.25||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.25||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Medicaid|MEDICAID|1.25||||1.25||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Veterans Affairs|VETERANS ADMINISTRATION|1.25||||1.25||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.25||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||1.25||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Aetna|AETNA PPO|||||1.25||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.25||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|NON CONTRACTED|COMMERCIAL OTHER 1|1.25||||1.25||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|NON CONTRACTED|COMMERCIAL OTHER 2|1.25||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|PHCS|HUMANA INSURANCE|||||1.25||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Tricare|TRICARE EAST REGION|1.25||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|United Healthcare|UNITED HEALTHCARE OTHER|||||1.25||| 9516329|ERX|0250|GLYCOPYRROLATE 0.2MG/ML,|NON CONTRACTED|COMMERCIAL OTHER 1|0.12||||0.12||| 9516329|ERX|0250|GLYCOPYRROLATE 0.2MG/ML,|Medicare|MEDICARE ACUTE|0.12||||0.12||| 9516329|ERX|0250|GLYCOPYRROLATE 0.2MG/ML,|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.12||| 9516329|ERX|0250|GLYCOPYRROLATE 0.2MG/ML,|United Healthcare|UNITED HEALTHCARE|||||0.12||| 9516329|ERX|0250|GLYCOPYRROLATE 0.2MG/ML,|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.12||| 9516329|ERX|0250|GLYCOPYRROLATE 0.2MG/ML,|Medicaid|MEDICAID TEXAS CHILDRENS|||||0.12||| 9516329|ERX|0250|GLYCOPYRROLATE 0.2MG/ML,|Managed Medicaid|MEDICAID AMERIGROUP|||||0.12||| 9516329|ERX|0250|GLYCOPYRROLATE 0.2MG/ML,|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.12||| 9516329|ERX|0250|GLYCOPYRROLATE 0.2MG/ML,|Managed Medicaid|MEDICAID SUPERIOR|||||0.12||| 9516329|ERX|0250|GLYCOPYRROLATE 0.2MG/ML,|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.12||| 9516329|ERX|0250|GLYCOPYRROLATE 0.2MG/ML,|Humana Medicare Advantage|HUMANA MA|||||0.12||| 9516329|ERX|0250|GLYCOPYRROLATE 0.2MG/ML,|Medicaid|MEDICAID|0.12||||||| 9516329|ERX|0250|GLYCOPYRROLATE 0.2MG/ML,|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.12||||0.12||| 9516329|ERX|0250|GLYCOPYRROLATE 0.2MG/ML,|Blue Cross PPO Specialty|BCBSTX PPO|||||0.12||| 9516329|ERX|0250|GLYCOPYRROLATE 0.2MG/ML,|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.12||| 9516329|ERX|0250|GLYCOPYRROLATE 0.2MG/ML,|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.12||| 9516329|ERX|0250|GLYCOPYRROLATE 0.2MG/ML,|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.12||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Blue Cross HMO Specialty|BCBSTX HMO|||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Aetna|AETNA OTHER|||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Cigna|CIGNA|0.13||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.13||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Managed Medicaid|MEDICAID SUPERIOR|0.13||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Managed Medicaid|MEDICAID AMERIGROUP|||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Humana Medicare Advantage|HUMANA MA|0.13||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Managed Medicare|HEALTHSPRING MA|||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Medicaid|MORRIS COUNTY INDIGENT|||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Blue Cross PPO Specialty|BCBSTX OTHER|||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Medicaid|MEDICAID|0.13||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.13||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Veterans Affairs|VETERANS ADMINISTRATION|||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|NON CONTRACTED|COMMERCIAL OTHER 1|0.13||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Medicare|MEDICARE ACUTE|0.13||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|PHCS|GROUP AND PENSION|||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Tricare|TRICARE EAST REGION|0.13||||||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.13||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|United Healthcare|UNITED HEALTHCARE|0.13||||0.13||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|Tricare|TRICARE EAST REGION|||||0.35||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|United Healthcare|TML GROUP BENEFITS|||||0.35||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.35||||0.35||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|Medicare|MEDICARE ACUTE|||||0.35||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.35||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|Managed Medicaid|MEDICAID AMERIGROUP|||||0.35||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|Managed Medicaid|MEDICAID SUPERIOR|||||0.35||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.35||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|Humana Medicare Advantage|HUMANA MA|||||0.35||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|Medicaid|MEDICAID|||||0.35||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|Blue Cross PPO Specialty|BCBSTX PPO|||||0.35||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.35||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.35||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|Cigna|CIGNA|||||0.35||| 9516410|ERX|0250|CIPROFLOXACIN 0.3% DROP,5|Managed Medicaid|MEDICAID AMERIGROUP|||||92.75||| 9516477|ERX|0250|NEOMYC-POLYMYX-HC EAR,10M|Medicare|MEDICARE ACUTE|||||210.50||| 9516477|ERX|0250|NEOMYC-POLYMYX-HC EAR,10M|Blue Cross PPO Specialty|BCBSTX PPO|||||210.50||| 9516477|ERX|0250|NEOMYC-POLYMYX-HC EAR,10M|Medicaid|MEDICAID|||||210.50||| 9516477|ERX|0250|NEOMYC-POLYMYX-HC EAR,10M|Managed Medicaid|MEDICAID AMERIGROUP|||||210.50||| 9516477|ERX|0250|NEOMYC-POLYMYX-HC EAR,10M|Managed Medicaid|MEDICAID SUPERIOR|||||210.50||| 9516501|ERX|0250|NEOMYC-POLYMYX-GRAMIC,10M|Medicare|MEDICARE ACUTE|79.50||||||| 9516592|ERX|0250|SILVER SULFADIAZINE 1% 2|Managed Medicaid|MEDICAID AMERIGROUP|||||16.25||| 9516592|ERX|0250|SILVER SULFADIAZINE 1% 2|Managed Medicaid|MEDICAID SUPERIOR|||||16.25||| 9516600|ERX|0250|SILVER SULFADIAZINE 1% ,4|Medicare|MEDICARE ACUTE|||||407.50||| 9516634|ERX|0250|FLUDROCORTISONE 0.1MG TAB|Medicare|MEDICARE ACUTE|2.25||||2.25||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Blue Cross PPO Specialty|BCBSTX PPO|30.50||||30.50||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|30.50||||30.50||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Managed Medicare|HEALTHSPRING MA|||||30.50||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Medicaid|MEDICAID|30.50||||30.50||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|30.50||||||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|30.50||||30.50||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Humana Medicare Advantage|HUMANA MA|30.50||||||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Veterans Affairs|VETERANS ADMINISTRATION|30.50||||||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Medicare|MEDICARE ACUTE|30.50||||30.50||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|PHCS|HUMANA INSURANCE|||||30.50||| 9516774|ERX|0250|PERMETHRIN 5% CREAM, 60 G|Blue Cross PPO Specialty|BCBSTX PPO|112.25||||||| 9516790|ERX|0250|DONEPEZIL 5MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9516790|ERX|0250|DONEPEZIL 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9516790|ERX|0250|DONEPEZIL 5MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9516790|ERX|0250|DONEPEZIL 5MG TABLET|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9516790|ERX|0250|DONEPEZIL 5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||||| 9516873|ERX|0250|CYCLOSPORINE 0.05% UD OPT|Medicare|MEDICARE ACUTE|16.75||||||| 9516972|ERX|0250|BRIMONIDINE 0.15% DROP,5M|Medicare|MEDICARE ACUTE|3.91||||||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Blue Cross PPO Specialty|BCBSTX PPO|9.25||||9.25||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.25||||9.25||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||9.25||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|9.25||||||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Humana Medicare Advantage|HUMANA MA|9.25||||||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Medicaid|MEDICAID|9.25||||9.25||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Veterans Affairs|VETERANS ADMINISTRATION|9.25||||||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Medicare|MEDICARE ACUTE|9.25||||9.25||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|PHCS|HUMANA INSURANCE|||||9.25||| 9517053|ERX|0250|BIMATOPROST 0.03% DROP,2.|Medicare|MEDICARE ACUTE|2.77||||||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Managed Medicare|HEALTHSPRING MA|||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Medicaid|MEDICAID|||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|52.75||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Humana Medicare Advantage|HUMANA MA|52.75||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Blue Cross HMO Specialty|BCBSTX HMO|||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Cigna|CIGNA|||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Aetna|AETNA QHP HMO|||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Aetna|AETNA OTHER|||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|52.75||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Blue Cross PPO Specialty|BCBSTX OTHER|||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Aetna|AETNA PPO|||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Access Direct Platinum|HEALTHFIRST TPA UMR|52.75||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|52.75||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|52.75||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Cigna|CIGNA|52.75||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Veterans Affairs|VETERANS ADMINISTRATION|||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|NON CONTRACTED|COMMERCIAL OTHER 2|52.75||||||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|NON CONTRACTED|COMMERCIAL OTHER 1|52.75||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Medicare|MEDICARE ACUTE|52.75||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Medicare|MEDICARE PART B ONLY IP|52.75||||||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|PHCS|GROUP AND PENSION|||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Tricare|TRICARE EAST REGION|52.75||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|United Healthcare|UNITED HEALTHCARE|52.75||||52.75||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|United Healthcare|UNITED HEALTHCARE|||||52.75||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|Medicare|MEDICARE ACUTE|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|Tricare|TRICARE FOR LIFE|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|United Healthcare|UNITED HEALTHCARE OTHER|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|United Healthcare|UNITED HEALTHCARE|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|Blue Cross HMO Specialty|BCBSTX HMO|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|Aetna|AETNA OTHER|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|Aetna|AETNA PPO|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|Cigna|CIGNA|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|Managed Medicaid|MEDICAID SUPERIOR|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|Managed Medicaid|MEDICAID AMERIGROUP|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|Humana Medicare Advantage|HUMANA MA|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|Managed Medicare|HEALTHSPRING MA|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.76||| 9517129|ERX|0250|KETOROLAC 60MG/2ML|Medicaid|MEDICAID|||||0.76||| 9517137|ERX|0250|GENTAMICIN PF 10MG/ML, 2M|Managed Medicaid|MEDICAID SUPERIOR|41.25||||||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Veterans Affairs|VETERANS ADMINISTRATION|11.75||||||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Medicare|MEDICARE ACUTE|11.75||||11.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|PHCS|HUMANA INSURANCE|||||11.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Blue Cross PPO Specialty|BCBSTX PPO|11.75||||||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|11.75||||11.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|11.75||||11.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|11.75||||||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Managed Medicare|HEALTHSPRING MA|||||11.75||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Medicaid|MEDICAID|11.75||||11.75||| 9517244|ERX|0250|CA GLUC 10% 0.465 MEQ/ML,|Humana Medicare Advantage|HUMANA MA|||||11.25||| 9517244|ERX|0250|CA GLUC 10% 0.465 MEQ/ML,|Blue Cross PPO Specialty|BCBSTX PPO|11.25||||||| 9517244|ERX|0250|CA GLUC 10% 0.465 MEQ/ML,|Medicare|MEDICARE ACUTE|11.25||||11.25||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Medicare|MEDICARE ACUTE|||||98.25||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|||||98.25||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||98.25||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||98.25||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||98.25||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|||||98.25||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Humana Medicare Advantage|HUMANA MA|||||98.25||| 9517301|ERX|0250|AMPICILLIN 250MG VIAL|Managed Medicaid|MEDICAID SUPERIOR|||||0.26||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|Veterans Affairs|VETERANS ADMINISTRATION|||||0.35||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.35||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.35||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|NON CONTRACTED|COMMERCIAL OTHER 1|0.35||||0.35||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|Medicare|MEDICARE ACUTE|0.35||||0.35||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|Tricare|TRICARE FOR LIFE|||||0.35||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|Tricare|TRICARE EAST REGION|0.35||||0.35||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|United Healthcare|UNITED HEALTHCARE|0.35||||0.35||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|United Healthcare|UNITED HEALTHCARE|0.35||||||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|Aetna|AETNA PPO|||||0.35||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|0.35||||0.35||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.35||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.35||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.35||||0.35||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.35||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|0.35||||||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.35||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|Humana Medicare Advantage|HUMANA MA|0.35||||0.35||| 9517400|ERX|0250|OFLOXACIN EAR DROPS, 5ML|Managed Medicaid|MEDICAID AMERIGROUP|||||1.66||| 9517400|ERX|0250|OFLOXACIN EAR DROPS, 5ML|Managed Medicaid|MEDICAID SUPERIOR|||||1.66||| 9517400|ERX|0250|OFLOXACIN EAR DROPS, 5ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.66||| 9517400|ERX|0250|OFLOXACIN EAR DROPS, 5ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.66||| 9517400|ERX|0250|OFLOXACIN EAR DROPS, 5ML|Medicaid|MEDICAID|||||1.66||| 9517400|ERX|0250|OFLOXACIN EAR DROPS, 5ML|Blue Cross HMO Specialty|BCBSTX HMO|||||1.66||| 9517400|ERX|0250|OFLOXACIN EAR DROPS, 5ML|Aetna|AETNA PPO|||||1.66||| 9517400|ERX|0250|OFLOXACIN EAR DROPS, 5ML|Blue Cross PPO Specialty|BCBSTX PPO|||||1.66||| 9517400|ERX|0250|OFLOXACIN EAR DROPS, 5ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.66||| 9517400|ERX|0250|OFLOXACIN EAR DROPS, 5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.66||| 9517400|ERX|0250|OFLOXACIN EAR DROPS, 5ML|Cigna|CIGNA|||||1.66||| 9517400|ERX|0250|OFLOXACIN EAR DROPS, 5ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.66||| 9517400|ERX|0250|OFLOXACIN EAR DROPS, 5ML|Tricare|TRICARE EAST REGION|||||1.66||| 9517400|ERX|0250|OFLOXACIN EAR DROPS, 5ML|United Healthcare|UNITED HEALTHCARE|||||1.66||| 9517400|ERX|0250|OFLOXACIN EAR DROPS, 5ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.66||| 9517418|ERX|0250|ESZOPICLONE 1MG TABLET|Managed Medicare|HEALTHSPRING MA|0.13||||||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|0.13||||||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|United Medicare Advantage|UHC MEDICARE GOLD MA|0.13||||||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Veterans Affairs|VETERANS ADMINISTRATION|||||0.13||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|NON CONTRACTED|COMMERCIAL OTHER 1|0.13||||||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Medicare|MEDICARE ACUTE|0.13||||0.13||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|United Healthcare|UNITED HEALTHCARE|0.13||||||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Aetna|AETNA OTHER|0.13||||||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.13||||||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Aenta Medicare Advantage|AETNA MEDICARE MA|0.13||||||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Managed Medicaid|MEDICAID SUPERIOR|||||0.13||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.13||||||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Managed Medicaid|MEDICAID AMERIGROUP|0.13||||0.13||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Humana Medicare Advantage|HUMANA MA|0.13||||||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.13||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|Managed Medicaid|MEDICAID SUPERIOR|||||0.13||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|Managed Medicaid|MEDICAID AMERIGROUP|||||0.13||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|Humana Medicare Advantage|HUMANA MA|0.13||||0.13||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|Cigna|CIGNA|||||0.13||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|Medicare|MEDICARE ACUTE|0.13||||0.13||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|Veterans Affairs|VETERANS ADMINISTRATION|0.13||||||| 9517475|ERX|0250|LEVALBUTEROL NEB 1.25MG/3|United Medicare Advantage|UHC MEDICARE GOLD MA|0.13||||0.13||| 9517574|ERX|0250|OXYCODONE-ACETAM 5-325MG|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9517574|ERX|0250|OXYCODONE-ACETAM 5-325MG|United Healthcare|UNITED HEALTHCARE|1.25||||||| 9517574|ERX|0250|OXYCODONE-ACETAM 5-325MG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||||| 9517574|ERX|0250|OXYCODONE-ACETAM 5-325MG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.25||||||| 9517574|ERX|0250|OXYCODONE-ACETAM 5-325MG|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||55.75||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||55.75||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Humana Medicare Advantage|HUMANA MA|||||55.75||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Blue Cross PPO Specialty|BCBSTX OTHER|||||55.75||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Blue Cross PPO Specialty|BCBSTX PPO|||||55.75||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|55.75||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|United Medicare Advantage|UHC MEDICARE GOLD MA|55.75||||55.75||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Medicare|MEDICARE ACUTE|55.75||||55.75||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|35.75||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Tricare|TRICARE EAST REGION|35.75||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Medicare|MEDICARE ACUTE|35.75||||35.75||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|35.75||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||35.75||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|35.75||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|35.75||||35.75||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Cigna|CIGNA|||||35.75||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|35.75||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|35.75||||35.75||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|35.75||||35.75||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||35.75||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Managed Medicare|HEALTHSPRING MA|35.75||||35.75||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Humana Medicare Advantage|HUMANA MA|35.75||||35.75||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Medicaid|MEDICAID|35.75||||35.75||| 9517657|ERX|0250|TORSEMIDE 20MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9517657|ERX|0250|TORSEMIDE 20MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||1.25||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|1.25||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Tricare|TRICARE EAST REGION|||||1.25||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||1.25||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9517673|ERX|0250|GUAIFEN-DEXTROMETH 600-30|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9517673|ERX|0250|GUAIFEN-DEXTROMETH 600-30|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9517673|ERX|0250|GUAIFEN-DEXTROMETH 600-30|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9517756|ERX|0250|DILTIAZEM XL 120MG CAPSUL|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9517756|ERX|0250|DILTIAZEM XL 120MG CAPSUL|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9517756|ERX|0250|DILTIAZEM XL 120MG CAPSUL|Humana Medicare Advantage|HUMANA MA|||||1.25||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.25||||||| 9517772|ERX|0250|DILTIAZEM XL 240MG CAPSUL|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9517772|ERX|0250|DILTIAZEM XL 240MG CAPSUL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9517772|ERX|0250|DILTIAZEM XL 240MG CAPSUL|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9517806|ERX|0250|LUBIPROSTONE 24MCG CAPSUL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.25||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Aetna|AETNA PPO|||||1.25||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9517830|ERX|0250|LACTOBACILLUS TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9517871|ERX|0250|AZATHIOPRINE 50MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||8.25||| 9517889|ERX|0250|COLESEVELAM 625MG TABLET|Medicare|MEDICARE ACUTE|2.25||||||| 9517905|ERX|0250|HYDROCORTISONE 2.5% RECT|Medicare|MEDICARE ACUTE|114.50||||||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9518150|ERX|0250|EPINEPHRINE 30MG/30ML|Medicare|MEDICARE ACUTE|||||31.50||| 9518150|ERX|0250|EPINEPHRINE 30MG/30ML|Tricare|TRICARE EAST REGION|||||31.50||| 9518150|ERX|0250|EPINEPHRINE 30MG/30ML|United Healthcare|UNITED HEALTHCARE|||||31.50||| 9518150|ERX|0250|EPINEPHRINE 30MG/30ML|Managed Medicaid|MEDICAID SUPERIOR|||||31.50||| 9518150|ERX|0250|EPINEPHRINE 30MG/30ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||31.50||| 9518150|ERX|0250|EPINEPHRINE 30MG/30ML|Managed Medicaid|MEDICAID AMERIGROUP|||||31.50||| 9518150|ERX|0250|EPINEPHRINE 30MG/30ML|Humana Medicare Advantage|HUMANA MA|||||31.50||| 9518150|ERX|0250|EPINEPHRINE 30MG/30ML|Medicaid|MEDICAID|||||31.50||| 9518150|ERX|0250|EPINEPHRINE 30MG/30ML|Aetna|AETNA PPO|||||31.50||| 9518150|ERX|0250|EPINEPHRINE 30MG/30ML|Blue Cross PPO Specialty|BCBSTX PPO|||||31.50||| 9518150|ERX|0250|EPINEPHRINE 30MG/30ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||31.50||| 9518150|ERX|0250|EPINEPHRINE 30MG/30ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||31.50||| 9518150|ERX|0250|EPINEPHRINE 30MG/30ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||31.50||| 9518150|ERX|0250|EPINEPHRINE 30MG/30ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||31.50||| 9518184|ERX|0250|RANOLAZINE 500MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|10.75||||||| 9518184|ERX|0250|RANOLAZINE 500MG TABLET|Humana Medicare Advantage|HUMANA MA|10.75||||10.75||| 9518184|ERX|0250|RANOLAZINE 500MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||10.75||| 9518184|ERX|0250|RANOLAZINE 500MG TABLET|Medicare|MEDICARE ACUTE|10.75||||||| 9518184|ERX|0250|RANOLAZINE 500MG TABLET|Tricare|TRICARE EAST REGION|10.75||||||| 9518259|ERX|0250|CLORAZEPATE 3.75MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9518309|ERX|0250|HYDROXYCHLOROQUINE 200MG|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9518309|ERX|0250|HYDROXYCHLOROQUINE 200MG|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||||| 9518309|ERX|0250|HYDROXYCHLOROQUINE 200MG|Cigna|CIGNA|1.25||||||| 9518309|ERX|0250|HYDROXYCHLOROQUINE 200MG|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9518309|ERX|0250|HYDROXYCHLOROQUINE 200MG|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9518390|ERX|0250|MAGNESIUM CHLORIDE TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9518390|ERX|0250|MAGNESIUM CHLORIDE TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9518390|ERX|0250|MAGNESIUM CHLORIDE TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|Medicare|MEDICARE ACUTE|1.25||||||| 9518440|ERX|0250|MEGESTROL 400MG/10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9518440|ERX|0250|MEGESTROL 400MG/10ML|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|Blue Cross HMO Specialty|BCBSTX HMO|||||1.25||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.25||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|Managed Medicare|BCBS MEDICARE PPO MA|||||1.25||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|Humana Medicare Advantage|HUMANA MA|||||1.25||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|Medicaid|MEDICAID|||||1.25||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|Medicare|MEDICARE ACUTE|1.25||||||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.25||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9518606|ERX|0250|ELECTROLYTE,ORAL 240ML|Managed Medicaid|MEDICAID AMERIGROUP|||||4.75||| 9518606|ERX|0250|ELECTROLYTE,ORAL 240ML|Managed Medicaid|MEDICAID SUPERIOR|4.75||||4.75||| 9518606|ERX|0250|ELECTROLYTE,ORAL 240ML|Medicaid|MEDICAID|||||4.75||| 9518606|ERX|0250|ELECTROLYTE,ORAL 240ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||4.75||| 9518655|ERX|0250|COD LIVER OIL-ZN OXIDE ,3|Managed Medicaid|MEDICAID SUPERIOR|0.20||||0.20||| 9518663|ERX|0250|CHOLECALCIFEROL 400 UNIT|United Medicare Advantage|UHC MEDICARE GOLD MA|0.02||||||| 9518663|ERX|0250|CHOLECALCIFEROL 400 UNIT|Humana Medicare Advantage|HUMANA MA|0.02||||||| 9518721|ERX|0250|METHOTREXATE PF 50MG/2ML|Medicaid|MEDICAID|29.25||||||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|NON CONTRACTED|COMMERCIAL OTHER 1|35.50||||35.50||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|Medicare|MEDICARE ACUTE|35.50||||35.50||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|Medicare|MEDICARE PART B ONLY IP|35.50||||||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|Veterans Affairs|VETERANS ADMINISTRATION|35.50||||||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|United Medicare Advantage|UHC MEDICARE GOLD MA|||||35.50||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|Blue Cross PPO Specialty|BCBSTX PPO|35.50||||35.50||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|35.50||||||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|Access Direct Platinum|HEALTHFIRST TPA UMR|35.50||||||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|35.50||||||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|35.50||||35.50||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|35.50||||||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|35.50||||||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|Managed Medicaid|MEDICAID SUPERIOR|35.50||||||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|Humana Medicare Advantage|HUMANA MA|35.50||||35.50||| 9518770|ERX|0250|SODIUM CHLORIDE 0.9%,100M|Medicaid|MEDICAID TEXAS CHILDRENS|35.50||||||| 9518895|ERX|0250|ZOLPIDEM CR 6.25MG TABLET|Medicare|MEDICARE ACUTE|11.75||||||| 9518994|ERX|0250|EMPTY CONTAINER 1000ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|80.25||||80.25||| 9518994|ERX|0250|EMPTY CONTAINER 1000ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||80.25||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|Medicaid|MEDICAID|16.25||||||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|Managed Medicaid|MEDICAID AMERIGROUP|16.25||||||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|Managed Medicaid|MEDICAID SUPERIOR|||||16.25||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|Medicare|MEDICARE ACUTE|16.25||||16.25||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||16.25||| 9519158|ERX|0250|FENTANYL 12MCG PATCH|Medicare|MEDICARE ACUTE|32.25||||||| 9519323|ERX|0250|SPIRONOLACTONE 50MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||||| 9519323|ERX|0250|SPIRONOLACTONE 50MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.25||| 9519323|ERX|0250|SPIRONOLACTONE 50MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9519323|ERX|0250|SPIRONOLACTONE 50MG TABLE|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9519455|ERX|0250|DRONEDARONE 400MG TABLET|Medicare|MEDICARE ACUTE|21.75||||21.75||| 9519455|ERX|0250|DRONEDARONE 400MG TABLET|Humana Medicare Advantage|HUMANA MA|21.75||||||| 9519513|ERX|0250|NICARDIPINE 20MG/200MLSAL|Humana Medicare Advantage|HUMANA MA|5.59||||5.59||| 9519513|ERX|0250|NICARDIPINE 20MG/200MLSAL|Medicare|MEDICARE ACUTE|||||5.59||| 9519513|ERX|0250|NICARDIPINE 20MG/200MLSAL|United Healthcare|UNITED HEALTHCARE|||||5.59||| 9519729|ERX|0250|DESVENLAFAXINE 50MG TABLE|Medicare|MEDICARE ACUTE|||||18.75||| 9519950|ERX|0250|CELECOXIB 100MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9519950|ERX|0250|CELECOXIB 100MG CAPSULE|Medicare|MEDICARE ACUTE|1.25||||||| 9520065|ERX|0250|BACITRACIN ZINC 500 UNIT,|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.05||| 9520065|ERX|0250|BACITRACIN ZINC 500 UNIT,|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.05||| 9520065|ERX|0250|BACITRACIN ZINC 500 UNIT,|Medicare|MEDICARE ACUTE|||||0.05||| 9520065|ERX|0250|BACITRACIN ZINC 500 UNIT,|Blue Cross PPO Specialty|BCBSTX PPO|||||0.05||| 9520065|ERX|0250|BACITRACIN ZINC 500 UNIT,|Cigna|CIGNA|||||0.05||| 9520065|ERX|0250|BACITRACIN ZINC 500 UNIT,|Managed Medicaid|MEDICAID SUPERIOR|||||0.05||| 9520107|ERX|0250|DICLOFENAC 1% GEL, 100 GM|NON CONTRACTED|COMMERCIAL OTHER 1|477.25||||||| 9520107|ERX|0250|DICLOFENAC 1% GEL, 100 GM|Medicare|MEDICARE ACUTE|477.25||||||| 9520149|ERX|0250|POLYETHYLENE GLYCOL 3350,|Medicare|MEDICARE ACUTE|1.26||||1.26||| 9520222|ERX|0250|NYSTATIN 500000 UNIT,5ML|Managed Medicaid|MEDICAID AMERIGROUP|7.50||||||| 9520222|ERX|0250|NYSTATIN 500000 UNIT,5ML|Managed Medicaid|MEDICAID SUPERIOR|||||7.50||| 9520222|ERX|0250|NYSTATIN 500000 UNIT,5ML|Humana Medicare Advantage|HUMANA MA|7.50||||7.50||| 9520222|ERX|0250|NYSTATIN 500000 UNIT,5ML|Blue Cross HMO Specialty|BCBSTX HMO|7.50||||||| 9520222|ERX|0250|NYSTATIN 500000 UNIT,5ML|Blue Cross PPO Specialty|BCBSTX PPO|7.50||||||| 9520222|ERX|0250|NYSTATIN 500000 UNIT,5ML|Cigna|CIGNA|7.50||||||| 9520222|ERX|0250|NYSTATIN 500000 UNIT,5ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|7.50||||||| 9520222|ERX|0250|NYSTATIN 500000 UNIT,5ML|Medicare|MEDICARE ACUTE|7.50||||||| 9520255|ERX|0250|VERAPAMIL SR 240MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9520255|ERX|0250|VERAPAMIL SR 240MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||||| 9520255|ERX|0250|VERAPAMIL SR 240MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9520370|ERX|0250|NIACIN SR 250MG CAPSULE|Humana Medicare Advantage|HUMANA MA|0.09||||||| 9520495|ERX|0250|MIDAZOLAM 10MG/5ML, 5ML|Tricare|TRICARE EAST REGION|||||35.25||| 9520495|ERX|0250|MIDAZOLAM 10MG/5ML, 5ML|United Healthcare|UNITED HEALTHCARE|||||35.25||| 9520495|ERX|0250|MIDAZOLAM 10MG/5ML, 5ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||35.25||| 9520495|ERX|0250|MIDAZOLAM 10MG/5ML, 5ML|Managed Medicaid|MEDICAID SUPERIOR|||||35.25||| 9520495|ERX|0250|MIDAZOLAM 10MG/5ML, 5ML|Managed Medicaid|MEDICAID AMERIGROUP|||||35.25||| 9520495|ERX|0250|MIDAZOLAM 10MG/5ML, 5ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||35.25||| 9520578|ERX|0250|NITROGLYCERIN 25MG/250ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.78||| 9520578|ERX|0250|NITROGLYCERIN 25MG/250ML|Humana Medicare Advantage|HUMANA MA|||||0.78||| 9520578|ERX|0250|NITROGLYCERIN 25MG/250ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.78||| 9520578|ERX|0250|NITROGLYCERIN 25MG/250ML|Medicare|MEDICARE ACUTE|||||0.78||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.13||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Medicare|MEDICARE ACUTE|||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Tricare|TRICARE EAST REGION|0.13||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|United Healthcare|UNITED HEALTHCARE|||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Blue Cross HMO Specialty|BCBSTX HMO|||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Aetna|AETNA PPO|||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Cigna|CIGNA|||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Access Direct Platinum|HEALTHFIRST TPA UMR|0.13||||||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|NON CONTRACTED|COMMERCIAL OTHER 1|0.13||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Medicaid|MEDICAID|0.13||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Managed Medicaid|MEDICAID SUPERIOR|||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Managed Medicaid|MEDICAID AMERIGROUP|||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Humana Medicare Advantage|HUMANA MA|0.13||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Medicaid|MEDICAID TEXAS CHILDRENS|0.13||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Medicaid|MORRIS COUNTY INDIGENT|||||0.13||| 9520602|ERX|0250|LIDOCAINE PF 2%, 5ML|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||0.13||| 9520636|ERX|0250|FEBUXOSTAT 40MG TABLET|Medicare|MEDICARE ACUTE|31.50||||31.50||| 9520834|ERX|0250|DABIGATRAN 75MG CAPSULE|Medicare|MEDICARE ACUTE|0.26||||||| 9520875|ERX|0250|ACETAMINOPHEN INJ 100ML B|Medicaid|MEDICAID TEXAS CHILDRENS|||||68.75||| 9520875|ERX|0250|ACETAMINOPHEN INJ 100ML B|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|68.75||||||| 9520875|ERX|0250|ACETAMINOPHEN INJ 100ML B|Humana Medicare Advantage|HUMANA MA|68.75||||||| 9520875|ERX|0250|ACETAMINOPHEN INJ 100ML B|Medicaid|MEDICAID|||||68.75||| 9520875|ERX|0250|ACETAMINOPHEN INJ 100ML B|Blue Cross PPO Specialty|BCBSTX PPO|||||68.75||| 9520875|ERX|0250|ACETAMINOPHEN INJ 100ML B|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||68.75||| 9520875|ERX|0250|ACETAMINOPHEN INJ 100ML B|Cigna|CIGNA|68.75||||||| 9520875|ERX|0250|ACETAMINOPHEN INJ 100ML B|Aenta Medicare Advantage|AETNA MEDICARE MA|68.75||||||| 9520875|ERX|0250|ACETAMINOPHEN INJ 100ML B|Veterans Affairs|VETERANS ADMINISTRATION|||||68.75||| 9520875|ERX|0250|ACETAMINOPHEN INJ 100ML B|NON CONTRACTED|COMMERCIAL OTHER 1|||||68.75||| 9520875|ERX|0250|ACETAMINOPHEN INJ 100ML B|Medicare|MEDICARE ACUTE|68.75||||||| 9521097|ERX|0250|SODIUM CHLORIDE IRRIG SOL|Managed Medicaid|MEDICAID SUPERIOR|||||95.75||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Medicare|MEDICARE ACUTE|66.50||||66.50||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|United Healthcare|UNITED HEALTHCARE OTHER|||||66.50||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Veterans Affairs|VETERANS ADMINISTRATION|||||66.50||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||66.50||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||66.50||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||66.50||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|66.50||||66.50||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Medicaid|MEDICAID HMO|||||66.50||| 9521188|ERX|0250|MUPIROCIN 2% CREAM, 15 G|Medicare|MEDICARE ACUTE|16.50||||||| 9521253|ERX|0250|PAROXETINE 20MG TABLET|Humana Medicare Advantage|HUMANA MA|||||1.25||| 9521253|ERX|0250|PAROXETINE 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||||| 9521253|ERX|0250|PAROXETINE 20MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9521311|ERX|0250|AMOX-CLAV 500-125MG TABLE|Medicare|MEDICARE ACUTE|1.25||||||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|||||1.25||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.25||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Cigna|CIGNA|||||1.25||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||1.25||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Humana Medicare Advantage|HUMANA MA|||||1.25||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||1.25||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.25||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.25||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9521345|ERX|0250|AMOX-CLAV 250-62.5MG/5ML,|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9521345|ERX|0250|AMOX-CLAV 250-62.5MG/5ML,|Managed Medicaid|MEDICAID SUPERIOR|1.25||||1.25||| 9521345|ERX|0250|AMOX-CLAV 250-62.5MG/5ML,|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.25||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|Medicare|MEDICARE ACUTE|||||46.75||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|United Healthcare|UNITED HEALTHCARE|||||46.75||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||46.75||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||46.75||| 9521501|ERX|0250|TRIAMCINOLONE 40MG/ML, 1M|Humana Medicare Advantage|HUMANA MA|46.75||||46.75||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Managed Medicaid|MEDICAID SUPERIOR|395.50||||395.50||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||395.50||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|395.50||||||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Humana Medicare Advantage|HUMANA MA|395.50||||395.50||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Blue Cross HMO Specialty|BCBSTX HMO|395.50||||||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Aetna|AETNA OTHER|||||395.50||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Blue Cross PPO Specialty|BCBSTX PPO|395.50||||395.50||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|395.50||||||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Aenta Medicare Advantage|AETNA MEDICARE MA|395.50||||||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Veterans Affairs|VETERANS ADMINISTRATION|395.50||||395.50||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|United Medicare Advantage|UHC MEDICARE GOLD MA|395.50||||395.50||| 9521543|ERX|0250|LEVOFLOXACIN 750MG/150ML|Medicare|MEDICARE ACUTE|395.50||||395.50||| 9521550|ERX|0250|LEVOFLOXACIN 250MG/50ML D|Medicare|MEDICARE ACUTE|102.75||||||| 9521550|ERX|0250|LEVOFLOXACIN 250MG/50ML D|United Medicare Advantage|UHC MEDICARE GOLD MA|102.75||||||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Blue Cross PPO Specialty|BCBSTX PPO|360.75||||360.75||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|360.75||||||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Cigna|CIGNA|360.75||||360.75||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Aenta Medicare Advantage|AETNA MEDICARE MA|360.75||||||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Medicaid|MORRIS COUNTY INDIGENT|||||360.75||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|360.75||||360.75||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|360.75||||360.75||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Blue Cross HMO Specialty|BCBSTX HMO|||||360.75||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Managed Medicaid|MEDICAID AMERIGROUP|||||360.75||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Managed Medicare|HEALTHSPRING MA|360.75||||||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Humana Medicare Advantage|HUMANA MA|360.75||||360.75||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Managed Medicaid|MEDICAID SUPERIOR|||||360.75||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Medicaid|MEDICAID|360.75||||360.75||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|United Medicare Advantage|UHC MEDICARE GOLD MA|360.75||||||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|360.75||||360.75||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Veterans Affairs|VETERANS ADMINISTRATION|||||360.75||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Medicare|MEDICARE ACUTE|360.75||||360.75||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Tricare|TRICARE EAST REGION|360.75||||||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.04||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Tricare|TRICARE FOR LIFE|||||0.04||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|United Healthcare|UNITED HEALTHCARE OTHER|||||0.04||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.04||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|United Healthcare|UNITED HEALTHCARE|||||0.04||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Tricare|TRICARE EAST REGION|||||0.04||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.04||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Medicaid|MEDICAID|||||0.04||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Managed Medicaid|MEDICAID AMERIGROUP|0.04||||0.04||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Managed Medicaid|MEDICAID SUPERIOR|0.04||||0.04||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.04||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Medicaid|MEDICAID HMO|||||0.04||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||0.04||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Blue Cross HMO Specialty|BCBSTX HMO|||||0.04||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Blue Cross PPO Specialty|BCBSTX OTHER|||||0.04||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Blue Cross PPO Specialty|BCBSTX PPO|||||0.04||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.04||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Cigna|CIGNA|||||0.04||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Managed Medicare|HEALTHSPRING MA|71.50||||||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Managed Medicaid|MEDICAID SUPERIOR|||||71.50||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Humana Medicare Advantage|HUMANA MA|71.50||||71.50||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||71.50||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|71.50||||||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||71.50||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||71.50||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|71.50||||||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|71.50||||||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Veterans Affairs|VETERANS ADMINISTRATION|||||71.50||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|NON CONTRACTED|COMMERCIAL OTHER 1|71.50||||||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|||||71.50||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|NON CONTRACTED|COMMERCIAL OTHER 2|71.50||||||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Medicare|MEDICARE ACUTE|71.50||||71.50||| 9521667|ERX|0250|TOPIRAMATE 25MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|1.25||||||| 9521667|ERX|0250|TOPIRAMATE 25MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9521667|ERX|0250|TOPIRAMATE 25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9521667|ERX|0250|TOPIRAMATE 25MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9521675|ERX|0250|TOPIRAMATE 100MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|1.25||||||| 9521675|ERX|0250|TOPIRAMATE 100MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||1.25||| 9521675|ERX|0250|TOPIRAMATE 100MG TABLET|Medicaid|MEDICAID|||||1.25||| 9521675|ERX|0250|TOPIRAMATE 100MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9521675|ERX|0250|TOPIRAMATE 100MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|1.25||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Medicare|MEDICARE PART B ONLY IP|1.25||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|United Healthcare|UNITED HEALTHCARE|1.25||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.25||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Aetna|AETNA PPO|||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Tricare|TRICARE EAST REGION|1.25||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Cigna|CIGNA|1.25||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Medicaid|MORRIS COUNTY INDIGENT|||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||1.25||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||100.50||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||100.50||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|100.50||||100.50||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Humana Medicare Advantage|HUMANA MA|100.50||||100.50||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Medicaid|MEDICAID|||||100.50||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|100.50||||100.50||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||100.50||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Cigna|CIGNA|100.50||||100.50||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||100.50||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|100.50||||100.50||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||100.50||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Medicare|MEDICARE ACUTE|100.50||||100.50||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Tricare|TRICARE EAST REGION|||||100.50||| 9521808|ERX|0250|ESTROGENS,CONJ VAG CRM,42|Blue Cross HMO Specialty|BCBSTX HMO|||||268.75||| 9521808|ERX|0250|ESTROGENS,CONJ VAG CRM,42|Blue Cross PPO Specialty|BCBSTX PPO|||||268.75||| 9521808|ERX|0250|ESTROGENS,CONJ VAG CRM,42|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||268.75||| 9521808|ERX|0250|ESTROGENS,CONJ VAG CRM,42|Humana Medicare Advantage|HUMANA MA|||||268.75||| 9521949|ERX|0250|GLIPIZIDE XL 5MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9521949|ERX|0250|GLIPIZIDE XL 5MG TABLET|Humana Medicare Advantage|HUMANA MA|||||1.25||| 9521964|ERX|0250|GLIPIZIDE XL 2.5MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9521980|ERX|0250|DOXAZOSIN 2MG TABLET|Medicare|MEDICARE PART B ONLY IP|1.25||||||| 9521980|ERX|0250|DOXAZOSIN 2MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9521980|ERX|0250|DOXAZOSIN 2MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||||| 9521980|ERX|0250|DOXAZOSIN 2MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9522038|ERX|0250|FLUCONAZOLE 200MG/100ML N|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|550.50||||||| 9522038|ERX|0250|FLUCONAZOLE 200MG/100ML N|United Medicare Advantage|UHC MEDICARE GOLD MA|550.50||||||| 9522038|ERX|0250|FLUCONAZOLE 200MG/100ML N|Medicare|MEDICARE ACUTE|550.50||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.25||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|1.25||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Aetna|AETNA OTHER|1.25||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Cigna|CIGNA|||||1.25||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|||||101.50||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||101.50||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|Humana Medicare Advantage|HUMANA MA|101.50||||||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|101.50||||||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|Medicare|MEDICARE ACUTE|101.50||||101.50||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|United Healthcare|UNITED HEALTHCARE OTHER|||||101.50||| 9522111|ERX|0250|ZIPRASIDONE 20MG CAPSULE|Humana Medicare Advantage|HUMANA MA|16.25||||16.25||| 9522111|ERX|0250|ZIPRASIDONE 20MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||16.25||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|United Healthcare|UNITED HEALTHCARE|1.25||||1.25||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|1.25||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Aetna|AETNA OTHER|||||1.25||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Medicaid|MEDICAID|1.25||||1.25||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|Managed Medicare|HEALTHSPRING MA|49.25||||||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|Humana Medicare Advantage|HUMANA MA|49.25||||||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|49.25||||49.25||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|Medicare|MEDICARE ACUTE|49.25||||||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Medicare|MEDICARE ACUTE|91.25||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Tricare|TRICARE EAST REGION|91.25||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|United Healthcare|UNITED HEALTHCARE OTHER|91.25||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|United Healthcare|UNITED HEALTHCARE|||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|91.25||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Blue Cross HMO Specialty|BCBSTX HMO|||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Aetna|AETNA PPO|||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Blue Cross PPO Specialty|BCBSTX PPO|91.25||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Access Direct Platinum|HEALTHFIRST TPA UMR|91.25||||||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|91.25||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|United Healthcare|UNITED HEALTHCARE|91.25||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Cigna|CIGNA|||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Medicaid|MEDICAID|91.25||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Medicaid|MORRIS COUNTY INDIGENT|||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Managed Medicaid|MEDICAID AMERIGROUP|||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Managed Medicaid|MEDICAID SUPERIOR|||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|91.25||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Humana Medicare Advantage|HUMANA MA|91.25||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||91.25||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Medicaid|MEDICAID TEXAS CHILDRENS|91.25||||91.25||| 9522269|ERX|0250|NYSTATIN POWDER, 15 GM|Humana Medicare Advantage|HUMANA MA|122.75||||122.75||| 9522269|ERX|0250|NYSTATIN POWDER, 15 GM|Aenta Medicare Advantage|AETNA MEDICARE MA|122.75||||||| 9522269|ERX|0250|NYSTATIN POWDER, 15 GM|United Medicare Advantage|UHC MEDICARE GOLD MA|122.75||||122.75||| 9522269|ERX|0250|NYSTATIN POWDER, 15 GM|Medicare|MEDICARE ACUTE|122.75||||122.75||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|1.25||||1.25||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Tricare|TRICARE EAST REGION|||||1.25||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|United Healthcare|TML GROUP BENEFITS|||||1.25||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|United Healthcare|UNITED HEALTHCARE|||||1.25||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.25||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1.25||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.25||||1.25||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||1.25||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Aetna|AETNA OTHER|||||1.25||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Cigna|CIGNA|||||1.25||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Medicaid|MEDICAID|||||1.25||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|Humana Medicare Advantage|HUMANA MA|58.50||||58.50||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|58.50||||58.50||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|Managed Medicaid|MEDICAID SUPERIOR|||||58.50||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||58.50||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|Blue Cross PPO Specialty|BCBSTX PPO|58.50||||||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||58.50||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|United Medicare Advantage|UHC MEDICARE GOLD MA|||||58.50||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|Veterans Affairs|VETERANS ADMINISTRATION|||||58.50||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|NON CONTRACTED|COMMERCIAL OTHER 1|||||58.50||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|Medicare|MEDICARE ACUTE|58.50||||58.50||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Medicare|MEDICARE ACUTE|||||1.25||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.25||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Cigna|CIGNA|||||1.25||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Medicaid|MEDICAID|||||11.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Managed Medicare|HEALTHSPRING MA|||||11.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Managed Medicaid|MEDICAID SUPERIOR|11.75||||11.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||11.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Managed Medicaid|MEDICAID AMERIGROUP|11.75||||11.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||11.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Humana Medicare Advantage|HUMANA MA|11.75||||11.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Aenta Medicare Advantage|AETNA MEDICARE MA|||||11.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Blue Cross HMO Specialty|BCBSTX HMO|11.75||||11.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|11.75||||11.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Blue Cross PPO Specialty|BCBSTX PPO|11.75||||11.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||11.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||11.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||11.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||11.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Cigna|CIGNA|||||11.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Medicaid|MEDICAID TEXAS CHILDRENS|||||11.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Veterans Affairs|VETERANS ADMINISTRATION|||||11.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|United Medicare Advantage|UHC MEDICARE GOLD MA|||||11.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|11.75||||||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|NON CONTRACTED|COMMERCIAL OTHER 1|||||11.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|United Healthcare|UNITED HEALTHCARE|||||11.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|PHCS|HUMANA INSURANCE|||||11.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Medicare|MEDICARE ACUTE|11.75||||11.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|United Healthcare|TML GROUP BENEFITS|||||11.75||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||11.75||| 9522673|ERX|0250|METHOTREXATE 2.5MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9522707|ERX|0250|METHADONE 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9522707|ERX|0250|METHADONE 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9522707|ERX|0250|METHADONE 10MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9522731|ERX|0250|WARFARIN 1MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9522731|ERX|0250|WARFARIN 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9522731|ERX|0250|WARFARIN 1MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||||| 9522731|ERX|0250|WARFARIN 1MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9522731|ERX|0250|WARFARIN 1MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9522756|ERX|0250|WARFARIN 5MG TABLET|Humana Medicare Advantage|HUMANA MA|3.50||||3.50||| 9522756|ERX|0250|WARFARIN 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|3.50||||||| 9522756|ERX|0250|WARFARIN 5MG TABLET|Medicare|MEDICARE ACUTE|3.50||||3.50||| 9522764|ERX|0250|WARFARIN 7.5MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9522764|ERX|0250|WARFARIN 7.5MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9522780|ERX|0250|WARFARIN 2.5MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|1.25||||||| 9522780|ERX|0250|WARFARIN 2.5MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9522913|ERX|0250|COLLAGENASE OINT, 30 GM|Medicare|MEDICARE ACUTE|382.50||||||| 9522913|ERX|0250|COLLAGENASE OINT, 30 GM|Managed Medicare|HEALTHSPRING MA|382.50||||||| 9522913|ERX|0250|COLLAGENASE OINT, 30 GM|Humana Medicare Advantage|HUMANA MA|382.50||||||| 9522954|ERX|0250|OLOPATADINE 0.1% EYE DROP|Medicare|MEDICARE ACUTE|321.50||||||| 9523044|ERX|0250|TOBRAMYCIN 0.3% EYE DROP,|Medicare|MEDICARE ACUTE|85.50||||||| 9523069|ERX|0250|TOBRAMYCIN/DEXAMETH, 2.5M|Managed Medicaid|MEDICAID SUPERIOR|||||127.50||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.21||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.21||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.21||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Tricare|TRICARE FOR LIFE|||||0.21||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Tricare|TRICARE EAST REGION|||||0.21||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|United Healthcare|UNITED HEALTHCARE|||||0.21||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Medicare|MEDICARE ACUTE|||||0.21||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.21||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|United Healthcare|TML GROUP BENEFITS|||||0.21||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|United Healthcare|GEHA|||||0.21||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Cigna|CIGNA|||||0.21||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Blue Cross PPO Specialty|BCBSTX PPO|||||0.21||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.21||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.21||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.21||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Managed Medicaid|MEDICAID AMERIGROUP|||||0.21||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.21||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Managed Medicaid|MEDICAID SUPERIOR|||||0.21||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Humana Medicare Advantage|HUMANA MA|||||0.21||| 9523135|ERX|0250|TETRACAINE 0.5% EYE DROP,|Medicaid|MEDICAID|||||0.21||| 9523184|ERX|0250|CIPROFLOX-DEXAMETH DROP,|Managed Medicaid|MEDICAID SUPERIOR|||||257.25||| 9523184|ERX|0250|CIPROFLOX-DEXAMETH DROP,|Blue Cross HMO Specialty|BCBSTX HMO|257.25||||||| 9523184|ERX|0250|CIPROFLOX-DEXAMETH DROP,|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|257.25||||||| 9523234|ERX|0250|SCOPOLAMINE 1.5MG PATCH|Tricare|TRICARE EAST REGION|||||0.28||| 9523234|ERX|0250|SCOPOLAMINE 1.5MG PATCH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.28||| 9523234|ERX|0250|SCOPOLAMINE 1.5MG PATCH|Managed Medicaid|MEDICAID SUPERIOR|||||0.28||| 9523259|ERX|0250|NICOTINE 14MG PATCH|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9523259|ERX|0250|NICOTINE 14MG PATCH|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9523259|ERX|0250|NICOTINE 14MG PATCH|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||4.50||| 9523259|ERX|0250|NICOTINE 14MG PATCH|Medicare|MEDICARE ACUTE|4.50||||4.50||| 9523259|ERX|0250|NICOTINE 14MG PATCH|Tricare|TRICARE EAST REGION|4.50||||||| 9523267|ERX|0250|NICOTINE 21MG PATCH|NON CONTRACTED|COMMERCIAL OTHER 1|3.50||||||| 9523267|ERX|0250|NICOTINE 21MG PATCH|PHCS|HUMANA INSURANCE|||||3.50||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Medicare|MEDICARE ACUTE|3.50||||3.50||| 9523267|ERX|0250|NICOTINE 21MG PATCH|United Healthcare|UNITED HEALTHCARE|||||3.50||| 9523267|ERX|0250|NICOTINE 21MG PATCH|United Medicare Advantage|UHC MEDICARE GOLD MA|3.50||||3.50||| 9523267|ERX|0250|NICOTINE 21MG PATCH|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|3.50||||3.50||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Veterans Affairs|VETERANS ADMINISTRATION|3.50||||||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Aenta Medicare Advantage|AETNA MEDICARE MA|3.50||||||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Aetna|AETNA PPO|||||3.50||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Blue Cross PPO Specialty|BCBSTX PPO|3.50||||3.50||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Managed Medicare|HEALTHSPRING MA|||||3.50||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|3.50||||||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.50||||||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Humana Medicare Advantage|HUMANA MA|3.50||||3.50||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Medicaid|MEDICAID|3.50||||3.50||| 9523317|ERX|0250|RIFAMPIN 300MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|1.25||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||1.25||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|1.25||||1.25||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|1.25||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|United Healthcare|UNITED HEALTHCARE|1.25||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|United Healthcare|UNITED HEALTHCARE|1.25||||1.25||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.25||||1.25||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||1.25||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Medicaid|MEDICAID|1.25||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||1.25||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UMR|||||1.25||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||1.25||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.25||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||1.25||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Aetna|AETNA OTHER|||||0.04||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.04||||0.04||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.04||||0.04||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Cigna|CIGNA|||||0.04||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.04||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||0.04||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Medicaid|MEDICAID HMO|||||0.04||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.04||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.04||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||0.04||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||0.04||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Humana Medicare Advantage|HUMANA MA|||||0.04||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.04||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Medicare|MEDICARE ACUTE|0.04||||0.04||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Tricare|TRICARE EAST REGION|||||0.04||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.04||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.04||| 9523473|ERX|0250|AZITHROMYCIN 500MG VIAL|Medicare|MEDICARE ACUTE|||||1.31||| 9523473|ERX|0250|AZITHROMYCIN 500MG VIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.31||| 9523473|ERX|0250|AZITHROMYCIN 500MG VIAL|Humana Medicare Advantage|HUMANA MA|||||1.31||| 9523473|ERX|0250|AZITHROMYCIN 500MG VIAL|Aetna|AETNA OTHER|1.31||||||| 9523473|ERX|0250|AZITHROMYCIN 500MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|1.31||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||1.25||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||1.25||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.25||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Medicaid|MEDICAID|1.25||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||1.25||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.25||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.25||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|United Healthcare|UNITED HEALTHCARE|1.25||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|United Healthcare|UNITED HEALTHCARE|1.25||||1.25||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Tricare|TRICARE EAST REGION|1.25||||1.25||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.25||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|||||1.25||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||1.25||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Medicaid|MEDICAID|1.25||||1.25||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||1.25||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||||| 9523598|ERX|0250|PHENYTOIN 100MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||||| 9523598|ERX|0250|PHENYTOIN 100MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||1.25||| 9523598|ERX|0250|PHENYTOIN 100MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| 9523598|ERX|0250|PHENYTOIN 100MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9523598|ERX|0250|PHENYTOIN 100MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9523598|ERX|0250|PHENYTOIN 100MG CAPSULE|Medicare|MEDICARE ACUTE|||||1.25||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|||||1.25||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Aetna|AETNA OTHER|||||1.25||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Medicaid|MEDICAID|||||1.25||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||1.25||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||1.25||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|||||1.25||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Medicare|MEDICARE PART B ONLY IP|1.25||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Tricare|TRICARE EAST REGION|1.25||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|United Healthcare|UNITED HEALTHCARE|1.25||||1.25||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|Medicaid|MEDICAID|1.25||||||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|Humana Medicare Advantage|HUMANA MA|||||1.25||| 9523655|ERX|0250|PREGABALIN 50MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|11.25||||||| 9523655|ERX|0250|PREGABALIN 50MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|11.25||||||| 9523655|ERX|0250|PREGABALIN 50MG CAPSULE|Humana Medicare Advantage|HUMANA MA|11.25||||11.25||| 9523655|ERX|0250|PREGABALIN 50MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||11.25||| 9523655|ERX|0250|PREGABALIN 50MG CAPSULE|Medicare|MEDICARE ACUTE|11.25||||11.25||| 9523655|ERX|0250|PREGABALIN 50MG CAPSULE|United Healthcare|UNITED HEALTHCARE|11.25||||||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|NON CONTRACTED|COMMERCIAL OTHER 1|8.25||||||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|Medicare|MEDICARE ACUTE|8.25||||8.25||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|Veterans Affairs|VETERANS ADMINISTRATION|8.25||||||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||8.25||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|8.25||||8.25||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|Humana Medicare Advantage|HUMANA MA|8.25||||||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|||||8.25||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|8.25||||||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|1.25||||1.25||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|1.25||||||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|1.25||||||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Medicaid|MEDICAID|||||1.25||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.25||| 9523689|ERX|0250|CLONAZEPAM 1MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9523804|ERX|0250|HYDROMORPHONE 2MG TABLET|Medicare|MEDICARE ACUTE|0.04||||||| 9523804|ERX|0250|HYDROMORPHONE 2MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|0.04||||||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|||||10.25||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|10.25||||||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|10.25||||||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|Humana Medicare Advantage|HUMANA MA|10.25||||10.25||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|10.25||||||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|Medicare|MEDICARE ACUTE|10.25||||10.25||| 9523986|ERX|0250|TERAZOSIN 1MG CAPSULE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.25||| 9523986|ERX|0250|TERAZOSIN 1MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 9524000|ERX|0250|TERAZOSIN 5MG CAPSULE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||17.25||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||17.25||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|Managed Medicaid|MEDICAID SUPERIOR|||||17.25||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||17.25||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|Medicare|MEDICARE ACUTE|17.25||||||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||17.25||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.55||||0.55||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|0.55||||0.55||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.55||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Veterans Affairs|VETERANS ADMINISTRATION|0.55||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|NON CONTRACTED|COMMERCIAL OTHER 1|0.55||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Medicare|MEDICARE ACUTE|0.55||||0.55||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Medicare|MEDICARE PART B ONLY IP|0.55||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Tricare|TRICARE EAST REGION|0.55||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Medicaid|MEDICAID|0.55||||0.55||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|United Healthcare|UNITED HEALTHCARE|0.55||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.55||||0.55||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.55||||0.55||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Managed Medicaid|MEDICAID SUPERIOR|0.55||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Managed Medicaid|MEDICAID AMERIGROUP|0.55||||0.55||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Managed Medicare|HEALTHSPRING MA|0.55||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.55||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Humana Medicare Advantage|HUMANA MA|0.55||||0.55||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.55||||0.55||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Blue Cross HMO Specialty|BCBSTX HMO|0.55||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Blue Cross PPO Specialty|BCBSTX PPO|0.55||||0.55||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Access Direct Platinum|HEALTHFIRST TPA UMR|0.55||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.55||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.55||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.55||||0.55||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.55||||0.55||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Cigna|CIGNA|0.55||||0.55||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Cigna|CIGNA|0.55||||||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|154.25||||154.25||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Managed Medicare|BCBS MEDICARE PPO MA|||||154.25||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||154.25||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|154.25||||||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Humana Medicare Advantage|HUMANA MA|154.25||||154.25||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Medicare|MEDICARE ACUTE|154.25||||154.25||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|154.25||||||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||154.25||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||424.50||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||424.50||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Veterans Affairs|VETERANS ADMINISTRATION|||||424.50||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Medicaid|MEDICAID|||||424.50||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Medicare|MEDICARE ACUTE|424.50||||424.50||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Managed Medicare|HEALTHSPRING MA|||||424.50||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Managed Medicaid|MEDICAID AMERIGROUP|||||424.50||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||424.50||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Humana Medicare Advantage|HUMANA MA|424.50||||424.50||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Blue Cross HMO Specialty|BCBSTX HMO|||||424.50||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Blue Cross PPO Specialty|BCBSTX PPO|424.50||||424.50||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Cigna|CIGNA|||||424.50||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||424.50||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||424.50||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||424.50||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|300.50||||300.50||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||300.50||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||300.50||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Cigna|CIGNA|||||300.50||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||300.50||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|300.50||||300.50||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|||||300.50||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||300.50||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Humana Medicare Advantage|HUMANA MA|300.50||||300.50||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||300.50||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Medicare|MEDICARE ACUTE|300.50||||300.50||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|United Healthcare|UNITED HEALTHCARE|||||300.50||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Veterans Affairs|VETERANS ADMINISTRATION|||||300.50||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||300.50||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||300.50||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|United Medicare Advantage|UHC MEDICARE GOLD MA|1.52||||1.52||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Veterans Affairs|VETERANS ADMINISTRATION|||||1.52||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|NON CONTRACTED|COMMERCIAL OTHER 1|1.52||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Medicare|MEDICARE ACUTE|1.52||||1.52||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|United Healthcare|UNITED HEALTHCARE|1.52||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.52||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.52||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Humana Medicare Advantage|HUMANA MA|1.52||||1.52||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Aenta Medicare Advantage|AETNA MEDICARE MA|1.52||||1.52||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Blue Cross HMO Specialty|BCBSTX HMO|||||1.52||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Blue Cross PPO Specialty|BCBSTX PPO|1.52||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.52||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.52||||||| 9524562|ERX|0250|RIVASTIGMINE 1.5MG CAPSUL|Medicare|MEDICARE ACUTE|1.25||||||| 9524562|ERX|0250|RIVASTIGMINE 1.5MG CAPSUL|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9524653|ERX|0250|NATEGLINIDE 60MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9524695|ERX|0250|FAMCICLOVIR 500MG TABLET|Veterans Affairs|VETERANS ADMINISTRATION|92.75||||||| 9524695|ERX|0250|FAMCICLOVIR 500MG TABLET|Medicare|MEDICARE ACUTE|92.75||||||| 9524919|ERX|0250|OXCARBAZEPINE 150MG TABLE|Managed Medicaid|MEDICAID AMERIGROUP|||||4.75||| 9524919|ERX|0250|OXCARBAZEPINE 150MG TABLE|Medicaid|MEDICAID TEXAS CHILDRENS|||||4.75||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.39||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|0.39||||0.39||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.39||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Medicare|MEDICARE ACUTE|0.39||||0.39||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Tricare|TRICARE EAST REGION|||||0.39||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.39||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|United Healthcare|UNITED HEALTHCARE OTHER|||||0.39||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|United Healthcare|UNITED HEALTHCARE|||||0.39||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Medicaid|MEDICAID|||||0.39||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|0.39||||0.39||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Blue Cross PPO Specialty|BCBSTX OTHER|||||0.39||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|||||0.39||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||0.39||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.39||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Managed Medicaid|MEDICAID SUPERIOR|||||0.39||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.39||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Managed Medicaid|MEDICAID AMERIGROUP|||||0.39||| 9525221|ERX|0250|OSELTAMIVIR 75MG CAPSULE|Humana Medicare Advantage|HUMANA MA|||||0.39||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|133.25||||||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||133.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Managed Medicaid|MEDICAID SUPERIOR|||||133.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Humana Medicare Advantage|HUMANA MA|133.25||||133.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Aetna|AETNA OTHER|||||133.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Blue Cross PPO Specialty|BCBSTX PPO|133.25||||133.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||133.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|NON CONTRACTED|COMMERCIAL OTHER 1|133.25||||||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Medicare|MEDICARE ACUTE|133.25||||133.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|United Healthcare|UNITED HEALTHCARE|||||133.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|United Medicare Advantage|UHC MEDICARE GOLD MA|133.25||||133.25||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||133.25||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Medicaid|MEDICAID HMO|||||1.25||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Medicaid|MEDICAID|||||1.25||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Veterans Affairs|VETERANS ADMINISTRATION|||||1.25||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.25||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.25||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Cigna|CIGNA|||||1.25||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||1.25||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Managed Medicaid|MEDICAID SUPERIOR|1.25||||1.25||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||1.25||| 9525262|ERX|0250|CIPROFLOXACIN 500MG TABLE|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9525296|ERX|0250|CIPROFLOXACIN 250MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9525296|ERX|0250|CIPROFLOXACIN 250MG TABLE|Medicare|MEDICARE ACUTE|1.25||||||| 9525379|ERX|0250|K BICARB-CIT AC 25 MEQ TA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||11.75||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||1.25||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|1.25||||1.25||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Tricare|TRICARE EAST REGION|1.25||||||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Medicaid|MEDICAID|||||1.25||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Managed Medicare|HEALTHSPRING MA|1.25||||||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|1.25||||||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|||||1.25||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||1.25||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|||||1.25||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.25||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Cigna|CIGNA|||||1.25||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.25||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||1.25||| 9525460|ERX|0250|METFORMIN 500MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.25||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Medicare|MEDICARE ACUTE|1.25||||1.25||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Medicare|MEDICARE PART B ONLY IP|1.25||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Medicaid|MEDICAID|1.25||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|United Healthcare|UNITED HEALTHCARE|1.25||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||1.25||| 9525460|ERX|0250|METFORMIN 500MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.25||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.25||||||| 9525486|ERX|0250|METFORMIN XL 500MG TABLET|Medicaid|MEDICAID|1.25||||||| 9525486|ERX|0250|METFORMIN XL 500MG TABLET|Humana Medicare Advantage|HUMANA MA|1.25||||||| 9525486|ERX|0250|METFORMIN XL 500MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|1.25||||||| 9525494|ERX|0250|METFORMIN 850MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9525577|ERX|0250|CALCIUM CARB 500 W/VIT D|Humana Medicare Advantage|HUMANA MA|3.50||||3.50||| 9525577|ERX|0250|CALCIUM CARB 500 W/VIT D|Medicare|MEDICARE ACUTE|3.50||||3.50||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.39||||0.39||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.39||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|NON CONTRACTED|COMMERCIAL OTHER 1|0.39||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Medicare|MEDICARE ACUTE|0.39||||0.39||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Tricare|TRICARE EAST REGION|0.39||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|United Healthcare|UNITED HEALTHCARE|0.39||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Medicaid|MEDICAID|0.39||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|United Healthcare|UNITED HEALTHCARE OTHER|0.39||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Blue Cross HMO Specialty|BCBSTX HMO|||||0.39||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Blue Cross PPO Specialty|BCBSTX PPO|0.39||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.39||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.39||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.39||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.39||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Managed Medicaid|MEDICAID AMERIGROUP|||||0.39||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.39||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Humana Medicare Advantage|HUMANA MA|0.39||||0.39||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Managed Medicare|HEALTHSPRING MA|||||51.50||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Managed Medicaid|MEDICAID SUPERIOR|||||51.50||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||51.50||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||51.50||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Humana Medicare Advantage|HUMANA MA|||||51.50||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Blue Cross HMO Specialty|BCBSTX HMO|||||51.50||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|||||51.50||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Cigna|CIGNA|||||51.50||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||51.50||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Managed Medicaid|MEDICAID AMERIGROUP|||||51.50||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||51.50||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|PHCS|GROUP AND PENSION|||||51.50||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Medicare|MEDICARE ACUTE|||||51.50||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|United Healthcare|UNITED HEALTHCARE|||||51.50||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Medicaid|MEDICAID|||||51.50||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Veterans Affairs|VETERANS ADMINISTRATION|||||51.50||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||51.50||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||51.50||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||51.50||| 9525627|ERX|0250|ORPHENADRINE 60MG/2ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||51.50||| 9525775|ERX|0250|NORTRIPTYLINE 25MG CAPSUL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| 9525775|ERX|0250|NORTRIPTYLINE 25MG CAPSUL|Medicare|MEDICARE ACUTE|1.25||||||| 9525825|ERX|0250|CEFTRIAXONE 2 G VIAL|Blue Cross HMO Specialty|BCBSTX HMO|495.50||||||| 9525825|ERX|0250|CEFTRIAXONE 2 G VIAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|495.50||||||| 9525825|ERX|0250|CEFTRIAXONE 2 G VIAL|Managed Medicaid|MEDICAID SUPERIOR|495.50||||||| 9525825|ERX|0250|CEFTRIAXONE 2 G VIAL|Medicare|MEDICARE ACUTE|||||495.50||| 9525890|ERX|0250|AMOXICILLIN 250MG/5ML,100|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||3.50||| 9525890|ERX|0250|AMOXICILLIN 250MG/5ML,100|Medicaid|MEDICAID HMO|||||3.50||| 9525890|ERX|0250|AMOXICILLIN 250MG/5ML,100|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3.50||| 9525890|ERX|0250|AMOXICILLIN 250MG/5ML,100|Medicaid|MEDICAID|||||3.50||| 9525890|ERX|0250|AMOXICILLIN 250MG/5ML,100|United Healthcare|UNITED HEALTHCARE|||||3.50||| 9525890|ERX|0250|AMOXICILLIN 250MG/5ML,100|Managed Medicaid|MEDICAID SUPERIOR|||||3.50||| 9525890|ERX|0250|AMOXICILLIN 250MG/5ML,100|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.50||| 9525890|ERX|0250|AMOXICILLIN 250MG/5ML,100|Managed Medicaid|MEDICAID AMERIGROUP|||||3.50||| 9525890|ERX|0250|AMOXICILLIN 250MG/5ML,100|Blue Cross PPO Specialty|BCBSTX PPO|||||3.50||| 9525890|ERX|0250|AMOXICILLIN 250MG/5ML,100|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3.50||| 9525908|ERX|0250|CEPHALEXIN 250MG/5ML,100M|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3.50||| 9525908|ERX|0250|CEPHALEXIN 250MG/5ML,100M|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3.50||| 9525957|ERX|0250|TORSEMIDE 100MG TABLET|Medicare|MEDICARE ACUTE|1.25||||||| 9525957|ERX|0250|TORSEMIDE 100MG TABLET|Humana Medicare Advantage|HUMANA MA|||||1.25||| 9525973|ERX|0250|VENLAFAXINE 37.5MG TABLET|Medicare|MEDICARE ACUTE|17.25||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Humana Medicare Advantage|HUMANA MA|||||1.25||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|United Medicare Advantage|UHC MEDICARE GOLD MA|1.25||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Medicare|MEDICARE ACUTE|1.25||||||| 9526179|ERX|0250|DIPHENHYDRAMINE ELIX 25MG|Medicaid|MEDICAID|||||0.05||| 9526179|ERX|0250|DIPHENHYDRAMINE ELIX 25MG|Tricare|TRICARE EAST REGION|||||0.05||| 9526179|ERX|0250|DIPHENHYDRAMINE ELIX 25MG|Medicare|MEDICARE ACUTE|0.05||||||| 9526179|ERX|0250|DIPHENHYDRAMINE ELIX 25MG|United Healthcare|UNITED HEALTHCARE|||||0.05||| 9526179|ERX|0250|DIPHENHYDRAMINE ELIX 25MG|Blue Cross PPO Specialty|BCBSTX PPO|||||0.05||| 9526179|ERX|0250|DIPHENHYDRAMINE ELIX 25MG|Managed Medicaid|MEDICAID SUPERIOR|||||0.05||| 9526179|ERX|0250|DIPHENHYDRAMINE ELIX 25MG|Managed Medicaid|MEDICAID AMERIGROUP|||||0.05||| 9526302|ERX|0250|SODIUM CHLORIDE INHALANT,|Managed Medicaid|MEDICAID SUPERIOR|||||0.08||| 9526302|ERX|0250|SODIUM CHLORIDE INHALANT,|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.08||| 9526302|ERX|0250|SODIUM CHLORIDE INHALANT,|Managed Medicaid|MEDICAID AMERIGROUP|||||0.08||| 9526302|ERX|0250|SODIUM CHLORIDE INHALANT,|Humana Medicare Advantage|HUMANA MA|||||0.08||| 9526302|ERX|0250|SODIUM CHLORIDE INHALANT,|Blue Cross HMO Specialty|BCBSTX HMO|0.08||||||| 9526302|ERX|0250|SODIUM CHLORIDE INHALANT,|Blue Cross PPO Specialty|BCBSTX OTHER|||||0.08||| 9526302|ERX|0250|SODIUM CHLORIDE INHALANT,|Blue Cross PPO Specialty|BCBSTX PPO|0.08||||0.08||| 9526302|ERX|0250|SODIUM CHLORIDE INHALANT,|Tricare|TRICARE EAST REGION|||||0.08||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Medicaid|MEDICAID TEXAS CHILDRENS|||||0.05||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Tricare|TRICARE FOR LIFE|||||0.05||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Tricare|TRICARE EAST REGION|||||0.05||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.05||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.05||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Medicaid|MEDICAID HMO|||||0.05||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Medicaid|MEDICAID|||||0.05||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|United Healthcare|UNITED HEALTHCARE|||||0.05||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Blue Cross HMO Specialty|BCBSTX HMO|0.05||||0.05||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Blue Cross PPO Specialty|BCBSTX PPO|||||0.05||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.05||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.05||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Managed Medicaid|MEDICAID AMERIGROUP|0.05||||0.05||| 9526310|ERX|0250|ACETAMINOPHEN 160MG/5ML C|Managed Medicaid|MEDICAID SUPERIOR|0.05||||0.05||| 9526401|ERX|0250|SILVER NITRATE STK 10CT.|Managed Medicaid|MEDICAID SUPERIOR|||||7.50||| 9526401|ERX|0250|SILVER NITRATE STK 10CT.|Humana Medicare Advantage|HUMANA MA|7.50||||||| 9526401|ERX|0250|SILVER NITRATE STK 10CT.|United Medicare Advantage|UHC MEDICARE GOLD MA|||||7.50||| 9526534|ERX|0636||Medicare|MEDICARE ACUTE|17.75||||17.75||| 9526534|ERX|0636||Medicaid|MEDICAID|17.75||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Medicaid|MEDICAID TEXAS CHILDRENS|||||17.75||| 9526534|ERX|0250|NON-FORMULARY DRUG|Medicaid|MEDICAID|17.75||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Veterans Affairs|VETERANS ADMINISTRATION|17.75||||||| 9526534|ERX|0636||United Medicare Advantage|UHC MEDICARE GOLD MA|17.75||||17.75||| 9526534|ERX|0250|NON-FORMULARY DRUG|Workers Compensation|UT EMPLOYEE INJURY|||||17.75||| 9526534|ERX|0250|NON-FORMULARY DRUG|Aenta Medicare Advantage|AETNA MEDICARE MA|||||17.75||| 9526534|ERX|0636||Aenta Medicare Advantage|AETNA MEDICARE MA|17.75||||17.75||| 9526534|ERX|0636||Blue Cross HMO Specialty|BCBSTX HMO|17.75||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Medicare|MEDICARE ACUTE|17.75||||17.75||| 9526534|ERX|0250|NON-FORMULARY DRUG|Aetna|AETNA PPO|||||17.75||| 9526534|ERX|0250|NON-FORMULARY DRUG|Blue Cross PPO Specialty|BCBSTX PPO|17.75||||||| 9526534|ERX|0636||Access Direct Platinum|HEALTHFIRST TPA UMR|||||17.75||| 9526534|ERX|0636||Blue Cross PPO Specialty|BCBSTX PPO|17.75||||17.75||| 9526534|ERX|0250|NON-FORMULARY DRUG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|17.75||||||| 9526534|ERX|0636||Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|17.75||||||| 9526534|ERX|0636||Managed Medicaid|MEDICAID SUPERIOR|17.75||||||| 9526534|ERX|0636||Cigna|CIGNA|17.75||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||17.75||| 9526534|ERX|0250|NON-FORMULARY DRUG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|17.75||||||| 9526534|ERX|0636||Humana Medicare Advantage|HUMANA MA|17.75||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Humana Medicare Advantage|HUMANA MA|17.75||||17.75||| 9526609|ERX|0250|RANITIDINE 50MG INJECTION|Managed Medicaid|MEDICAID AMERIGROUP|||||33.25||| 9526716|ERX|0250|SODIUM CHLORIDE 0.45% KCL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.47||| 9526716|ERX|0250|SODIUM CHLORIDE 0.45% KCL|Humana Medicare Advantage|HUMANA MA|1.47||||||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Tricare|TRICARE EAST REGION|||||9.50||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Medicare|MEDICARE ACUTE|9.50||||9.50||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Medicaid|MEDICAID|||||9.50||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Medicaid|MEDICAID TEXAS CHILDRENS|||||9.50||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||9.50||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||9.50||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Managed Medicaid|MEDICAID SUPERIOR|||||9.50||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Managed Medicaid|MEDICAID AMERIGROUP|||||9.50||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||9.50||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Aetna|AETNA PPO|||||9.50||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Aetna|AETNA OTHER|9.50||||||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Blue Cross PPO Specialty|BCBSTX PPO|||||9.50||| 9526773|ERX|0250|RIVAROXABAN 10 MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|43.25||||||| 9526773|ERX|0250|RIVAROXABAN 10 MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|43.25||||||| 9526773|ERX|0250|RIVAROXABAN 10 MG TABLET|Humana Medicare Advantage|HUMANA MA|43.25||||||| 9526773|ERX|0250|RIVAROXABAN 10 MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|43.25||||||| 9526773|ERX|0250|RIVAROXABAN 10 MG TABLET|Medicare|MEDICARE ACUTE|43.25||||||| 9526781|ERX|0250|HEPARIN 100 UNIT/ML 5 ML|Medicare|MEDICARE ACUTE|0.08||||0.08||| 9526781|ERX|0250|HEPARIN 100 UNIT/ML 5 ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.08||| 9526781|ERX|0250|HEPARIN 100 UNIT/ML 5 ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.08||| 9526781|ERX|0250|HEPARIN 100 UNIT/ML 5 ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.08||||0.08||| 9526781|ERX|0250|HEPARIN 100 UNIT/ML 5 ML|Humana Medicare Advantage|HUMANA MA|||||0.08||| 9526781|ERX|0250|HEPARIN 100 UNIT/ML 5 ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.08||| 9526781|ERX|0250|HEPARIN 100 UNIT/ML 5 ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.08||| 9526914|ERX|0250||Blue Cross PPO Specialty|BCBSTX PPO|32.75||||32.75||| 9526914|ERX|0250||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|32.75||||||| 9526914|ERX|0250||Managed Medicaid|MEDICAID SUPERIOR|32.75||||32.75||| 9526914|ERX|0250||Humana Medicare Advantage|HUMANA MA|32.75||||32.75||| 9526914|ERX|0250||United Medicare Advantage|UHC MEDICARE GOLD MA|32.75||||||| 9526914|ERX|0250||United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||32.75||| 9526914|ERX|0250||Medicaid|MEDICAID|||||32.75||| 9526914|ERX|0250||NON CONTRACTED|COMMERCIAL OTHER 1|32.75||||||| 9526914|ERX|0250||Medicare|MEDICARE ACUTE|32.75||||32.75||| 9526948|ERX|0250|RIVAROXABAN 15MG TABLET|Medicare|MEDICARE ACUTE|0.40||||||| 9526948|ERX|0250|RIVAROXABAN 15MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.40||||||| 9527003|ERX|0250|IBUPROFEN INFT 50 MG/1.25|Managed Medicaid|MEDICAID SUPERIOR|33.25||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Veterans Affairs|VETERANS ADMINISTRATION|2.25||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|United Medicare Advantage|UHC MEDICARE GOLD MA|2.25||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.25||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Medicaid|MEDICAID|||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Medicaid|MORRIS COUNTY INDIGENT|||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|NON CONTRACTED|COMMERCIAL OTHER 1|2.25||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Tricare|TRICARE EAST REGION|||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Medicare|MEDICARE ACUTE|2.25||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|United Healthcare|TML GROUP BENEFITS|||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|United Healthcare|UNITED HEALTHCARE|||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Aenta Medicare Advantage|AETNA MEDICARE MA|2.25||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Blue Cross HMO Specialty|BCBSTX HMO|2.25||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.25||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Blue Cross PPO Specialty|BCBSTX PPO|2.25||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.25||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Cigna|CIGNA|||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.25||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Humana Medicare Advantage|HUMANA MA|2.25||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Managed Medicare|HEALTHSPRING MA|2.25||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Managed Medicare|BCBS MEDICARE PPO MA|||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Managed Medicaid|MEDICAID AMERIGROUP|||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.25||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.25||||2.25||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Managed Medicaid|MEDICAID SUPERIOR|2.25||||2.25||| 9527235|ERX|0250|WARFARIN 4MG TABLET|Humana Medicare Advantage|HUMANA MA|9.25||||||| 9527235|ERX|0250|WARFARIN 4MG TABLET|Medicare|MEDICARE ACUTE|9.25||||9.25||| 9527243|ERX|0250|PYRIDOXINE 100MG TABLET|Medicare|MEDICARE ACUTE|7.50||||||| 9527276|ERX|0250|HYDROCORTISONE 5MG TABLET|Medicare|MEDICARE ACUTE|7.50||||||| 9527284|ERX|0250|PRAMIPEXOLE 0.5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|17.50||||17.50||| 9527284|ERX|0250|PRAMIPEXOLE 0.5MG TABLET|Humana Medicare Advantage|HUMANA MA|17.50||||17.50||| 9527284|ERX|0250|PRAMIPEXOLE 0.5MG TABLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||17.50||| 9527284|ERX|0250|PRAMIPEXOLE 0.5MG TABLET|Medicare|MEDICARE ACUTE|||||17.50||| 9527300|ERX|0250|PHENAZOPYRIDINE 200MG TAB|PHCS|HUMANA INSURANCE|||||7.50||| 9527300|ERX|0250|PHENAZOPYRIDINE 200MG TAB|Medicare|MEDICARE ACUTE|7.50||||||| 9527300|ERX|0250|PHENAZOPYRIDINE 200MG TAB|United Medicare Advantage|UHC MEDICARE GOLD MA|||||7.50||| 9527300|ERX|0250|PHENAZOPYRIDINE 200MG TAB|Managed Medicaid|MEDICAID SUPERIOR|||||7.50||| 9527300|ERX|0250|PHENAZOPYRIDINE 200MG TAB|Blue Cross PPO Specialty|BCBSTX PPO|||||7.50||| 9527300|ERX|0250|PHENAZOPYRIDINE 200MG TAB|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||7.50||| 9527300|ERX|0250|PHENAZOPYRIDINE 200MG TAB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||7.50||| 9527300|ERX|0250|PHENAZOPYRIDINE 200MG TAB|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||7.50||| 9527318|ERX|0250|VANCOMYCIN 125MG CAPSULE|Humana Medicare Advantage|HUMANA MA|114.50||||||| 9527318|ERX|0250|VANCOMYCIN 125MG CAPSULE|Medicare|MEDICARE ACUTE|114.50||||||| 9527326|ERX|0250|ACYCLOVIR 400MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|||||11.25||| 9527326|ERX|0250|ACYCLOVIR 400MG TABLET|Medicare|MEDICARE ACUTE|11.25||||11.25||| 9527326|ERX|0250|ACYCLOVIR 400MG TABLET|Humana Medicare Advantage|HUMANA MA|11.25||||||| 9527334|ERX|0250|AZITHROMYCIN 100MG/5ML-15|Aetna|AETNA OTHER|148.25||||||| 9527334|ERX|0250|AZITHROMYCIN 100MG/5ML-15|Blue Cross PPO Specialty|BCBSTX PPO|||||148.25||| 9527334|ERX|0250|AZITHROMYCIN 100MG/5ML-15|Managed Medicaid|MEDICAID SUPERIOR|148.25||||148.25||| 9527334|ERX|0250|AZITHROMYCIN 100MG/5ML-15|Managed Medicaid|MEDICAID AMERIGROUP|||||148.25||| 9527334|ERX|0250|AZITHROMYCIN 100MG/5ML-15|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||148.25||| 9527334|ERX|0250|AZITHROMYCIN 100MG/5ML-15|Medicaid|MEDICAID|||||148.25||| 9527375|ERX|0250|FISH OIL (OM3FA) 1200MG C|United Medicare Advantage|UHC MEDICARE GOLD MA|7.50||||7.50||| 9527375|ERX|0250|FISH OIL (OM3FA) 1200MG C|Medicare|MEDICARE ACUTE|7.50||||7.50||| 9527383|ERX|0250|LAMOTRIGINE 200MG TABLET|Tricare|TRICARE EAST REGION|30.25||||||| 9527383|ERX|0250|LAMOTRIGINE 200MG TABLET|Medicare|MEDICARE ACUTE|||||30.25||| 9527383|ERX|0250|LAMOTRIGINE 200MG TABLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|30.25||||||| 9527391|ERX|0250|QUETIAPINE XR 50MG TABLET|Medicare|MEDICARE ACUTE|0.31||||||| 9527409|ERX|0250|RESINOL OINTMENT 3.3 OZ J|Humana Medicare Advantage|HUMANA MA|28.25||||28.25||| 9527409|ERX|0250|RESINOL OINTMENT 3.3 OZ J|Managed Medicare|HEALTHSPRING MA|28.25||||||| 9527409|ERX|0250|RESINOL OINTMENT 3.3 OZ J|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|28.25||||||| 9527409|ERX|0250|RESINOL OINTMENT 3.3 OZ J|Managed Medicaid|MEDICAID UNITED HEALTHCARE|28.25||||||| 9527409|ERX|0250|RESINOL OINTMENT 3.3 OZ J|Blue Cross PPO Specialty|BCBSTX PPO|28.25||||||| 9527409|ERX|0250|RESINOL OINTMENT 3.3 OZ J|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|28.25||||||| 9527409|ERX|0250|RESINOL OINTMENT 3.3 OZ J|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|28.25||||||| 9527409|ERX|0250|RESINOL OINTMENT 3.3 OZ J|Veterans Affairs|VETERANS ADMINISTRATION|28.25||||||| 9527409|ERX|0250|RESINOL OINTMENT 3.3 OZ J|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|28.25||||||| 9527409|ERX|0250|RESINOL OINTMENT 3.3 OZ J|United Medicare Advantage|AARP UHC WEST COMPLETE MA|28.25||||||| 9527409|ERX|0250|RESINOL OINTMENT 3.3 OZ J|United Medicare Advantage|UHC MEDICARE GOLD MA|28.25||||28.25||| 9527409|ERX|0250|RESINOL OINTMENT 3.3 OZ J|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|28.25||||||| 9527409|ERX|0250|RESINOL OINTMENT 3.3 OZ J|NON CONTRACTED|COMMERCIAL OTHER 1|28.25||||||| 9527409|ERX|0250|RESINOL OINTMENT 3.3 OZ J|Medicare|MEDICARE ACUTE|28.25||||||| 9527409|ERX|0250|RESINOL OINTMENT 3.3 OZ J|United Healthcare|UNITED HEALTHCARE|28.25||||||| 9527417|ERX|0250|ROFLUMILAST 500MG TABLET|Medicare|MEDICARE ACUTE|0.34||||0.34||| 9527433|ERX|0250|ALFUZOSIN ER 10MG TABLET|Humana Medicare Advantage|HUMANA MA|0.25||||||| 9527433|ERX|0250|ALFUZOSIN ER 10MG TABLET|Medicare|MEDICARE ACUTE|||||0.25||| 9527458|ERX|0250|FENOFIBRATE 145MG TABLET|NON CONTRACTED|COMMERCIAL OTHER 1|31.50||||||| 9527458|ERX|0250|FENOFIBRATE 145MG TABLET|Medicare|MEDICARE ACUTE|31.50||||||| 9527458|ERX|0250|FENOFIBRATE 145MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|31.50||||||| 9527458|ERX|0250|FENOFIBRATE 145MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|31.50||||||| 9527458|ERX|0250|FENOFIBRATE 145MG TABLET|Humana Medicare Advantage|HUMANA MA|||||31.50||| 9527524|ERX|0250|HYDROGEN PEROXIDE 3%, 4OZ|Blue Cross PPO Specialty|BCBSTX PPO|||||7.50||| 9527540|ERX|0250|LIDOCAINE + EPINEPHRINE 1|United Medicare Advantage|UHC MEDICARE GOLD MA|72.25||||72.25||| 9527540|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Workers Compensation|WORKERS COMPENSATION OTHER|||||72.25||| 9527540|ERX|0250|LIDOCAINE + EPINEPHRINE 1|NON CONTRACTED|COMMERCIAL OTHER 1|||||72.25||| 9527540|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||72.25||| 9527540|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Medicaid|MORRIS COUNTY INDIGENT|||||72.25||| 9527540|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Tricare|TRICARE EAST REGION|||||72.25||| 9527540|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Medicare|MEDICARE ACUTE|72.25||||72.25||| 9527540|ERX|0250|LIDOCAINE + EPINEPHRINE 1|United Healthcare|UNITED HEALTHCARE|||||72.25||| 9527540|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Medicaid|MEDICAID|||||72.25||| 9527540|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Humana Medicare Advantage|HUMANA MA|72.25||||72.25||| 9527540|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Managed Medicaid|MEDICAID SUPERIOR|72.25||||72.25||| 9527540|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Managed Medicaid|MEDICAID AMERIGROUP|||||72.25||| 9527540|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|72.25||||72.25||| 9527540|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||72.25||| 9527540|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Aenta Medicare Advantage|AETNA MEDICARE MA|||||72.25||| 9527540|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Blue Cross HMO Specialty|BCBSTX HMO|||||72.25||| 9527540|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Aetna|AETNA PPO|||||72.25||| 9527540|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Blue Cross PPO Specialty|BCBSTX PPO|72.25||||72.25||| 9527540|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||72.25||| 9527540|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||72.25||| 9527540|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Cigna|CIGNA|||||72.25||| 9527540|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||72.25||| 9527540|ERX|0250|LIDOCAINE + EPINEPHRINE 1|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||72.25||| 9527557|ERX|0250|LIDOCAINE + EPINEPHRINE 2|Aenta Medicare Advantage|AETNA MEDICARE MA|||||72.25||| 9527557|ERX|0250|LIDOCAINE + EPINEPHRINE 2|Blue Cross PPO Specialty|BCBSTX PPO|||||72.25||| 9527557|ERX|0250|LIDOCAINE + EPINEPHRINE 2|Cigna|CIGNA|||||72.25||| 9527557|ERX|0250|LIDOCAINE + EPINEPHRINE 2|Humana Medicare Advantage|HUMANA MA|||||72.25||| 9527557|ERX|0250|LIDOCAINE + EPINEPHRINE 2|Managed Medicaid|MEDICAID SUPERIOR|||||72.25||| 9527557|ERX|0250|LIDOCAINE + EPINEPHRINE 2|NON CONTRACTED|COMMERCIAL OTHER 1|||||72.25||| 9527557|ERX|0250|LIDOCAINE + EPINEPHRINE 2|Medicare|MEDICARE ACUTE|72.25||||72.25||| 9527557|ERX|0250|LIDOCAINE + EPINEPHRINE 2|United Healthcare|UNITED HEALTHCARE|||||72.25||| 9527557|ERX|0250|LIDOCAINE + EPINEPHRINE 2|United Medicare Advantage|UHC MEDICARE GOLD MA|||||72.25||| 9527557|ERX|0250|LIDOCAINE + EPINEPHRINE 2|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||72.25||| 9527557|ERX|0250|LIDOCAINE + EPINEPHRINE 2|Workers Compensation|WORKERS COMPENSATION OTHER|||||72.25||| 9527565|ERX|0250|MAGNESIUM SULFATE 1G/100M|United Medicare Advantage|UHC MEDICARE GOLD MA|72.25||||||| 9527565|ERX|0250|MAGNESIUM SULFATE 1G/100M|Medicaid|MEDICAID|72.25||||||| 9527565|ERX|0250|MAGNESIUM SULFATE 1G/100M|Medicare|MEDICARE ACUTE|||||72.25||| 9527565|ERX|0250|MAGNESIUM SULFATE 1G/100M|Humana Medicare Advantage|HUMANA MA|72.25||||72.25||| 9527565|ERX|0250|MAGNESIUM SULFATE 1G/100M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||72.25||| 9527623|ERX|0250|AMIODARONE 150MG/100ML D5|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|72.25||||||| 9527623|ERX|0250|AMIODARONE 150MG/100ML D5|Humana Medicare Advantage|HUMANA MA|72.25||||72.25||| 9527623|ERX|0250|AMIODARONE 150MG/100ML D5|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||72.25||| 9527623|ERX|0250|AMIODARONE 150MG/100ML D5|United Medicare Advantage|UHC MEDICARE GOLD MA|||||72.25||| 9527649|ERX|0250|AMPICILLIN 1G/50ML NS|Managed Medicaid|MEDICAID SUPERIOR|72.25||||||| 9527656|ERX|0250|AMPICILLIN 500MG/50ML NS|Blue Cross PPO Specialty|BCBSTX PPO|72.25||||||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|NON CONTRACTED|COMMERCIAL OTHER 1|146.25||||146.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Medicaid|MEDICAID|146.25||||146.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||146.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|146.25||||||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|United Medicare Advantage|UHC MEDICARE GOLD MA|146.25||||146.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|146.25||||146.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Veterans Affairs|VETERANS ADMINISTRATION|||||146.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||146.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Humana Medicare Advantage|HUMANA MA|146.25||||146.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Medicare|MEDICARE ACUTE|146.25||||146.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Managed Medicaid|MEDICAID AMERIGROUP|||||146.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Managed Medicaid|MEDICAID SUPERIOR|||||146.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||146.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|146.25||||146.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Aenta Medicare Advantage|AETNA MEDICARE MA|146.25||||146.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Blue Cross HMO Specialty|BCBSTX HMO|146.25||||146.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Blue Cross PPO Specialty|BCBSTX PPO|146.25||||146.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|146.25||||146.25||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Cigna|CIGNA|146.25||||||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|146.25||||||| 9527664|ERX|0250|AZITHROMYCIN 500MG/250ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|146.25||||||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|Humana Medicare Advantage|HUMANA MA|173.25||||||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|173.25||||||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|Medicare|MEDICARE ACUTE|173.25||||173.25||| 9527680|ERX|0250|BACTRIM 800MG-160MG/250ML|Medicare|MEDICARE ACUTE|72.25||||||| 9527680|ERX|0250|BACTRIM 800MG-160MG/250ML|Humana Medicare Advantage|HUMANA MA|72.25||||||| 9527698|ERX|0250|CEFAZOLIN 1G/100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|||||83.75||| 9527698|ERX|0250|CEFAZOLIN 1G/100ML NS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||83.75||| 9527698|ERX|0250|CEFAZOLIN 1G/100ML NS|Humana Medicare Advantage|HUMANA MA|83.75||||83.75||| 9527698|ERX|0250|CEFAZOLIN 1G/100ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||83.75||| 9527698|ERX|0250|CEFAZOLIN 1G/100ML NS|Managed Medicaid|MEDICAID SUPERIOR|||||83.75||| 9527698|ERX|0250|CEFAZOLIN 1G/100ML NS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|83.75||||83.75||| 9527698|ERX|0250|CEFAZOLIN 1G/100ML NS|Medicaid|MEDICAID TEXAS CHILDRENS|83.75||||||| 9527698|ERX|0250|CEFAZOLIN 1G/100ML NS|Tricare|TRICARE EAST REGION|83.75||||||| 9527698|ERX|0250|CEFAZOLIN 1G/100ML NS|Medicare|MEDICARE ACUTE|83.75||||83.75||| 9527698|ERX|0250|CEFAZOLIN 1G/100ML NS|United Healthcare|UNITED HEALTHCARE|||||83.75||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Medicare|MEDICARE ACUTE|98.50||||98.50||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|98.50||||98.50||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Humana Medicare Advantage|HUMANA MA|98.50||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Managed Medicaid|MEDICAID SUPERIOR|||||98.50||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|98.50||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|98.50||||||| 9527722|ERX|0250|CEFOXITIN 1G/100ML NS|Blue Cross HMO Specialty|BCBSTX HMO|||||72.25||| 9527722|ERX|0250|CEFOXITIN 1G/100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|72.25||||72.25||| 9527722|ERX|0250|CEFOXITIN 1G/100ML NS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||72.25||| 9527722|ERX|0250|CEFOXITIN 1G/100ML NS|Humana Medicare Advantage|HUMANA MA|||||72.25||| 9527722|ERX|0250|CEFOXITIN 1G/100ML NS|Managed Medicaid|MEDICAID AMERIGROUP|||||72.25||| 9527722|ERX|0250|CEFOXITIN 1G/100ML NS|Managed Medicaid|MEDICAID SUPERIOR|||||72.25||| 9527722|ERX|0250|CEFOXITIN 1G/100ML NS|NON CONTRACTED|COMMERCIAL OTHER 1|||||72.25||| 9527722|ERX|0250|CEFOXITIN 1G/100ML NS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||72.25||| 9527730|ERX|0250|CEFTAZIDIME 1G/100ML NS|Medicare|MEDICARE ACUTE|||||72.50||| 9527748|ERX|0250|CEFTAZIDIME 2G/100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|1.23||||||| 9527748|ERX|0250|CEFTAZIDIME 2G/100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.23||||||| 9527748|ERX|0250|CEFTAZIDIME 2G/100ML NS|Medicare|MEDICARE ACUTE|1.23||||||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Veterans Affairs|VETERANS ADMINISTRATION|||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|341.25||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|341.25||||||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|341.25||||||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|NON CONTRACTED|COMMERCIAL OTHER 1|341.25||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Medicaid|MEDICAID TEXAS CHILDRENS|||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Medicaid|MEDICAID|341.25||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Medicare|MEDICARE ACUTE|341.25||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Medicare|MEDICARE PART B ONLY IP|341.25||||||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|United Healthcare|UNITED HEALTHCARE|341.25||||||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|United Healthcare|TML GROUP BENEFITS|||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|United Healthcare|UNITED HEALTHCARE|||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|United Healthcare|UNITED HEALTHCARE OTHER|||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Humana Medicare Advantage|HUMANA MA|341.25||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Managed Medicare|HEALTHSPRING MA|341.25||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|341.25||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Managed Medicaid|MEDICAID SUPERIOR|341.25||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|341.25||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Managed Medicaid|MEDICAID AMERIGROUP|341.25||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Aenta Medicare Advantage|AETNA MEDICARE MA|341.25||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Blue Cross HMO Specialty|BCBSTX HMO|341.25||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Aetna|AETNA OTHER|||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|341.25||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|341.25||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Cigna|CIGNA|341.25||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Cigna|CIGNA|341.25||||||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|341.25||||341.25||| 9527755|ERX|0250|CEFTRIAXONE 1G/100ML NS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|341.25||||||| 9527763|ERX|0250|CEFTRIAXONE 2G/100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.54||| 9527763|ERX|0250|CEFTRIAXONE 2G/100ML NS|Humana Medicare Advantage|HUMANA MA|1.54||||1.54||| 9527763|ERX|0250|CEFTRIAXONE 2G/100ML NS|Medicare|MEDICARE ACUTE|1.54||||1.54||| 9527763|ERX|0250|CEFTRIAXONE 2G/100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|1.54||||1.54||| 9527763|ERX|0250|CEFTRIAXONE 2G/100ML NS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.54||||||| 9527763|ERX|0250|CEFTRIAXONE 2G/100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|1.54||||||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Medicaid|MEDICAID HMO|||||85.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Managed Medicaid|MEDICAID AMERIGROUP|85.50||||85.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Medicare|MEDICARE ACUTE|||||85.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||85.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Managed Medicaid|MEDICAID SUPERIOR|85.50||||85.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||85.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||85.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||85.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Cigna|CIGNA|||||85.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Blue Cross HMO Specialty|BCBSTX HMO|||||85.50||| 9527771|ERX|0250|CEFTRIAXONE 250MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|||||85.50||| 9527789|ERX|0250|CEFTRIAXONE 500MG VIAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||219.75||| 9527789|ERX|0250|CEFTRIAXONE 500MG VIAL|Managed Medicaid|MEDICAID SUPERIOR|219.75||||219.75||| 9527789|ERX|0250|CEFTRIAXONE 500MG VIAL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||219.75||| 9527789|ERX|0250|CEFTRIAXONE 500MG VIAL|Medicaid|MEDICAID|||||219.75||| 9527789|ERX|0250|CEFTRIAXONE 500MG VIAL|Managed Medicaid|MEDICAID AMERIGROUP|219.75||||219.75||| 9527789|ERX|0250|CEFTRIAXONE 500MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|219.75||||219.75||| 9527862|ERX|0250|DILTIAZEM 125MG/100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||72.25||| 9527862|ERX|0250|DILTIAZEM 125MG/100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|||||72.25||| 9527862|ERX|0250|DILTIAZEM 125MG/100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||72.25||| 9527862|ERX|0250|DILTIAZEM 125MG/100ML NS|Medicare|MEDICARE ACUTE|72.25||||72.25||| 9527862|ERX|0250|DILTIAZEM 125MG/100ML NS|Managed Medicaid|MEDICAID AMERIGROUP|72.25||||72.25||| 9527862|ERX|0250|DILTIAZEM 125MG/100ML NS|Humana Medicare Advantage|HUMANA MA|||||72.25||| 9527870|ERX|0250|DOXYCYCLINE 100MG/100ML N|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|72.25||||||| 9527870|ERX|0250|DOXYCYCLINE 100MG/100ML N|Aenta Medicare Advantage|AETNA MEDICARE MA|72.25||||||| 9527870|ERX|0250|DOXYCYCLINE 100MG/100ML N|Managed Medicaid|MEDICAID UNITED HEALTHCARE|72.25||||||| 9527870|ERX|0250|DOXYCYCLINE 100MG/100ML N|Managed Medicaid|MEDICAID SUPERIOR|72.25||||||| 9527870|ERX|0250|DOXYCYCLINE 100MG/100ML N|United Medicare Advantage|UHC MEDICARE GOLD MA|72.25||||72.25||| 9527870|ERX|0250|DOXYCYCLINE 100MG/100ML N|Humana Medicare Advantage|HUMANA MA|72.25||||72.25||| 9527870|ERX|0250|DOXYCYCLINE 100MG/100ML N|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|72.25||||||| 9527870|ERX|0250|DOXYCYCLINE 100MG/100ML N|Medicare|MEDICARE ACUTE|72.25||||72.25||| 9527870|ERX|0250|DOXYCYCLINE 100MG/100ML N|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|72.25||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|Medicaid|MORRIS COUNTY INDIGENT|||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|Medicare|MEDICARE ACUTE|72.25||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|United Healthcare|UNITED HEALTHCARE|72.25||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|72.25||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|Managed Medicaid|MEDICAID SUPERIOR|72.25||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|Access Direct Platinum|HEALTHFIRST TPA UMR|72.25||||||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|Managed Medicaid|MEDICAID AMERIGROUP|||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|Tricare|TRICARE EAST REGION|72.25||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|Medicaid|MEDICAID|72.25||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|Medicaid|MEDICAID TEXAS CHILDRENS|72.25||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|Aetna|AETNA PPO|||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|NON CONTRACTED|COMMERCIAL OTHER 1|72.25||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|Humana Medicare Advantage|HUMANA MA|72.25||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|Cigna|CIGNA|||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|United Healthcare|UNITED HEALTHCARE|||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|72.25||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|Blue Cross PPO Specialty|BCBSTX PPO|72.25||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|72.25||||72.25||| 9527904|ERX|0250|FAMOTIDINE 20MG/50ML NS|Blue Cross HMO Specialty|BCBSTX HMO|||||72.25||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||276.50||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|Medicaid|MORRIS COUNTY INDIGENT|||||276.50||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||276.50||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||276.50||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|Medicare|MEDICARE ACUTE|276.50||||276.50||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|Medicaid|MEDICAID|276.50||||||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|Tricare|TRICARE EAST REGION|276.50||||||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|Blue Cross HMO Specialty|BCBSTX HMO|||||276.50||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|276.50||||276.50||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|Humana Medicare Advantage|HUMANA MA|||||276.50||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|Blue Cross PPO Specialty|BCBSTX PPO|276.50||||276.50||| 9527946|ERX|0250|INSULIN,REG 100UNIT/100ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|276.50||||276.50||| 9527979|ERX|0250|MAGNESIUM SULFATE 1G/100M|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|72.25||||||| 9527979|ERX|0250|MAGNESIUM SULFATE 1G/100M|United Medicare Advantage|UHC MEDICARE GOLD MA|||||72.25||| 9527979|ERX|0250|MAGNESIUM SULFATE 1G/100M|Humana Medicare Advantage|HUMANA MA|72.25||||72.25||| 9527979|ERX|0250|MAGNESIUM SULFATE 1G/100M|Medicaid|MEDICAID|72.25||||||| 9527979|ERX|0250|MAGNESIUM SULFATE 1G/100M|Medicare|MEDICARE ACUTE|72.25||||72.25||| 9527979|ERX|0250|MAGNESIUM SULFATE 1G/100M|Managed Medicaid|MEDICAID SUPERIOR|||||72.25||| 9527979|ERX|0250|MAGNESIUM SULFATE 1G/100M|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||72.25||| 9527979|ERX|0250|MAGNESIUM SULFATE 1G/100M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||72.25||| 9527979|ERX|0250|MAGNESIUM SULFATE 1G/100M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|72.25||||||| 9528019|ERX|0250|NOREPINEPHRINE 4MG/250ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||72.25||| 9528019|ERX|0250|NOREPINEPHRINE 4MG/250ML|PHCS|HUMANA INSURANCE|||||72.25||| 9528019|ERX|0250|NOREPINEPHRINE 4MG/250ML|Veterans Affairs|VETERANS ADMINISTRATION|72.25||||||| 9528019|ERX|0250|NOREPINEPHRINE 4MG/250ML|Medicare|MEDICARE ACUTE|72.25||||72.25||| 9528019|ERX|0250|NOREPINEPHRINE 4MG/250ML|United Medicare Advantage|UHC MEDICARE GOLD MA|72.25||||||| 9528019|ERX|0250|NOREPINEPHRINE 4MG/250ML|Humana Medicare Advantage|HUMANA MA|||||72.25||| 9528019|ERX|0250|NOREPINEPHRINE 4MG/250ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||72.25||| 9528019|ERX|0250|NOREPINEPHRINE 4MG/250ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||72.25||| 9528019|ERX|0250|NOREPINEPHRINE 4MG/250ML|Medicaid|MEDICAID|||||72.25||| 9528027|ERX|0250|PANTOPRAZOLE 40MG/100ML N|Medicare|MEDICARE ACUTE|72.25||||||| 9528027|ERX|0250|PANTOPRAZOLE 40MG/100ML N|Veterans Affairs|VETERANS ADMINISTRATION|||||72.25||| 9528027|ERX|0250|PANTOPRAZOLE 40MG/100ML N|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||72.25||| 9528027|ERX|0250|PANTOPRAZOLE 40MG/100ML N|Blue Cross PPO Specialty|BCBSTX PPO|72.25||||||| 9528050|ERX|0250|IMIPENEM-CILAST 1G/100ML|Medicare|MEDICARE ACUTE|359.75||||||| 9528050|ERX|0250|IMIPENEM-CILAST 1G/100ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|359.75||||||| 9528100|ERX|0250|TOBRAMYCIN 80MG/100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|72.25||||||| 9528118|ERX|0250|UNASYN 1.5G/100ML NS|United Healthcare|UNITED HEALTHCARE|||||72.25||| 9528118|ERX|0250|UNASYN 1.5G/100ML NS|Medicare|MEDICARE ACUTE|72.25||||||| 9528118|ERX|0250|UNASYN 1.5G/100ML NS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|72.25||||||| 9528118|ERX|0250|UNASYN 1.5G/100ML NS|Tricare|TRICARE EAST REGION|72.25||||||| 9528118|ERX|0250|UNASYN 1.5G/100ML NS|Medicaid|MEDICAID TEXAS CHILDRENS|||||72.25||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Medicare|MEDICARE ACUTE|0.85||||0.85||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Humana Medicare Advantage|HUMANA MA|0.85||||0.85||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|0.85||||||| 9528126|ERX|0250|UNASYN 3G/100ML NS|United Healthcare|UNITED HEALTHCARE|||||0.85||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Managed Medicaid|MEDICAID SUPERIOR|0.85||||||| 9528126|ERX|0250|UNASYN 3G/100ML NS|Aenta Medicare Advantage|AETNA MEDICARE MA|0.85||||||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Veterans Affairs|VETERANS ADMINISTRATION|||||72.25||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|United Healthcare|UNITED HEALTHCARE OTHER|72.25||||||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Medicare|MEDICARE ACUTE|72.25||||72.25||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|72.25||||72.25||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|United Healthcare|UNITED HEALTHCARE|72.25||||||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|72.25||||||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Aenta Medicare Advantage|AETNA MEDICARE MA|72.25||||72.25||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|NON CONTRACTED|COMMERCIAL OTHER 1|72.25||||72.25||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Blue Cross PPO Specialty|BCBSTX PPO|72.25||||72.25||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Blue Cross HMO Specialty|BCBSTX HMO|72.25||||72.25||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Humana Medicare Advantage|HUMANA MA|72.25||||72.25||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Managed Medicaid|MEDICAID AMERIGROUP|72.25||||||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|72.25||||72.25||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Managed Medicaid|MEDICAID SUPERIOR|72.25||||||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|72.25||||72.25||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Cigna|CIGNA|72.25||||72.25||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||72.25||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Managed Medicare|HEALTHSPRING MA|||||72.25||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|72.25||||72.25||| 9528134|ERX|0250|VANCOMYCIN 1G/250ML NS|Veterans Affairs|VETERANS ADMINISTRATION|72.25||||72.25||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|Aenta Medicare Advantage|AETNA MEDICARE MA|90.25||||90.25||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|90.25||||||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|Medicare|MEDICARE ACUTE|90.25||||90.25||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||90.25||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|Managed Medicaid|MEDICAID SUPERIOR|||||90.25||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|Humana Medicare Advantage|HUMANA MA|90.25||||90.25||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|90.25||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Tricare|TRICARE EAST REGION|98.50||||98.50||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|98.50||||98.50||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|NON CONTRACTED|COMMERCIAL OTHER 1|98.50||||98.50||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|98.50||||98.50||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Veterans Affairs|VETERANS ADMINISTRATION|||||98.50||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Veterans Affairs|VETERANS ADMINISTRATION|98.50||||98.50||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|98.50||||98.50||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|98.50||||98.50||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|United Healthcare|UNITED HEALTHCARE|98.50||||98.50||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|United Healthcare|TML GROUP BENEFITS|||||98.50||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||98.50||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Medicare|MEDICARE ACUTE|98.50||||98.50||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|United Healthcare|UNITED HEALTHCARE|||||98.50||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|United Healthcare|UNITED HEALTHCARE OTHER|98.50||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Aenta Medicare Advantage|AETNA MEDICARE MA|98.50||||98.50||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|98.50||||98.50||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Access Direct Platinum|HEALTHFIRST TPA UMR|98.50||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|98.50||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|98.50||||98.50||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||98.50||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|98.50||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Aetna|AETNA OTHER|||||98.50||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Cigna|CIGNA|98.50||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Managed Medicare|HEALTHSPRING MA|||||98.50||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|98.50||||98.50||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Medicaid|MEDICAID|98.50||||98.50||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Managed Medicaid|MEDICAID SUPERIOR|98.50||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Managed Medicaid|MEDICAID AMERIGROUP|98.50||||98.50||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Blue Cross HMO Specialty|BCBSTX HMO|||||98.50||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Cigna|CIGNA|||||98.50||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Humana Medicare Advantage|HUMANA MA|98.50||||98.50||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Cigna|CIGNA|||||123.25||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|NON CONTRACTED|COMMERCIAL OTHER 1|123.25||||||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|123.25||||123.25||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Humana Medicare Advantage|HUMANA MA|123.25||||123.25||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|123.25||||||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Medicaid|MEDICAID TEXAS CHILDRENS|123.25||||||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Workers Compensation|WORKERS COMPENSATION OTHER|||||123.25||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Medicare|MEDICARE ACUTE|123.25||||123.25||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|123.25||||||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Veterans Affairs|VETERANS ADMINISTRATION|123.25||||||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Tricare|TRICARE EAST REGION|123.25||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Veterans Affairs|VETERANS ADMINISTRATION|||||72.50||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|United Medicare Advantage|AARP UHC WEST COMPLETE MA|72.50||||72.50||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|NON CONTRACTED|COMMERCIAL OTHER 1|72.50||||72.50||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|72.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|United Medicare Advantage|UHC MEDICARE GOLD MA|72.50||||72.50||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Tricare|TRICARE EAST REGION|72.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Medicare|MEDICARE ACUTE|72.50||||72.50||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|72.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|72.50||||72.50||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|72.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Access Direct Platinum|HEALTHFIRST TPA UMR|||||72.50||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Blue Cross PPO Specialty|BCBSTX PPO|72.50||||72.50||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|72.50||||72.50||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|PHCS|MERITAIN HEALTH|||||72.50||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Blue Cross HMO Specialty|BCBSTX HMO|||||72.50||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|72.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Humana Medicare Advantage|HUMANA MA|72.50||||72.50||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Managed Medicare|HEALTHSPRING MA|72.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Managed Medicaid|MEDICAID AMERIGROUP|||||72.50||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Aenta Medicare Advantage|AETNA MEDICARE MA|72.50||||72.50||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|United Healthcare|UNITED HEALTHCARE|72.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Medicaid|MEDICAID|72.50||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|72.50||||72.50||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|United Healthcare|UNITED HEALTHCARE OTHER|72.50||||||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Managed Medicaid|MEDICAID SUPERIOR|||||41.75||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Aetna|AETNA PPO|||||41.75||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|41.75||||41.75||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Blue Cross HMO Specialty|BCBSTX HMO|||||41.75||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Medicaid|MEDICAID|41.75||||||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Cigna|CIGNA|||||41.75||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Medicaid|MORRIS COUNTY INDIGENT|||||41.75||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|41.75||||41.75||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Aenta Medicare Advantage|AETNA MEDICARE MA|||||41.75||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Blue Cross PPO Specialty|BCBSTX PPO|41.75||||41.75||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Humana Medicare Advantage|HUMANA MA|41.75||||41.75||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Tricare|TRICARE EAST REGION|41.75||||||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Managed Medicare|HEALTHSPRING MA|||||41.75||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|United Healthcare|UNITED HEALTHCARE|41.75||||41.75||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Veterans Affairs|VETERANS ADMINISTRATION|||||41.75||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||41.75||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|41.75||||41.75||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||41.75||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||41.75||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|NON CONTRACTED|COMMERCIAL OTHER 1|||||41.75||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|41.75||||41.75||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||41.75||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Medicare|MEDICARE ACUTE|41.75||||41.75||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Managed Medicaid|MEDICAID AMERIGROUP|||||41.75||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|41.75||||||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|United Medicare Advantage|UHC MEDICARE GOLD MA|41.75||||41.75||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|41.75||||||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|Medicare|MEDICARE ACUTE|38.50||||38.50||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|Humana Medicare Advantage|HUMANA MA|||||38.50||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||38.50||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|Blue Cross PPO Specialty|BCBSTX PPO|||||38.50||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|United Medicare Advantage|UHC MEDICARE GOLD MA|||||38.50||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|Medicaid|MEDICAID|38.50||||||| 9528225|ERX|0250|CLINIMIX E 4.25-10 1000ML|Medicare|MEDICARE ACUTE|210.50||||||| 9528225|ERX|0250|CLINIMIX E 4.25-10 1000ML|United Medicare Advantage|UHC MEDICARE GOLD MA|210.50||||||| 9528233|ERX|0250|OXYMETAZOLINE 0.05%, 30ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||12.25||| 9528233|ERX|0250|OXYMETAZOLINE 0.05%, 30ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||12.25||| 9528233|ERX|0250|OXYMETAZOLINE 0.05%, 30ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||12.25||| 9528233|ERX|0250|OXYMETAZOLINE 0.05%, 30ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||12.25||| 9528233|ERX|0250|OXYMETAZOLINE 0.05%, 30ML|Medicare|MEDICARE ACUTE|12.25||||12.25||| 9528233|ERX|0250|OXYMETAZOLINE 0.05%, 30ML|Managed Medicaid|MEDICAID AMERIGROUP|||||12.25||| 9528233|ERX|0250|OXYMETAZOLINE 0.05%, 30ML|Cigna|CIGNA|||||12.25||| 9528233|ERX|0250|OXYMETAZOLINE 0.05%, 30ML|Blue Cross PPO Specialty|BCBSTX PPO|||||12.25||| 9528233|ERX|0250|OXYMETAZOLINE 0.05%, 30ML|Humana Medicare Advantage|HUMANA MA|12.25||||12.25||| 9528241|ERX|0250|EYE-STREAM, 30ML BOTTLE|Medicare|MEDICARE ACUTE|||||0.89||| 9528241|ERX|0250|EYE-STREAM, 30ML BOTTLE|Managed Medicaid|MEDICAID AMERIGROUP|||||0.89||| 9528241|ERX|0250|EYE-STREAM, 30ML BOTTLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.89||| 9528241|ERX|0250|EYE-STREAM, 30ML BOTTLE|Blue Cross PPO Specialty|BCBSTX PPO|||||0.89||| 9528241|ERX|0250|EYE-STREAM, 30ML BOTTLE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.89||||0.89||| 9528241|ERX|0250|EYE-STREAM, 30ML BOTTLE|Cigna|CIGNA|||||0.89||| 9528241|ERX|0250|EYE-STREAM, 30ML BOTTLE|Managed Medicaid|MEDICAID SUPERIOR|||||0.89||| 9528241|ERX|0250|EYE-STREAM, 30ML BOTTLE|Tricare|TRICARE FOR LIFE|||||0.89||| 9528241|ERX|0250|EYE-STREAM, 30ML BOTTLE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.89||| 9528241|ERX|0250|EYE-STREAM, 30ML BOTTLE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.89||| 9528241|ERX|0250|EYE-STREAM, 30ML BOTTLE|Humana Medicare Advantage|HUMANA MA|||||0.89||| 9528241|ERX|0250|EYE-STREAM, 30ML BOTTLE|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.89||| 9528241|ERX|0250|EYE-STREAM, 30ML BOTTLE|Medicaid|MEDICAID|||||0.89||| 9528258|ERX|0250|CEPACOL LOZENGE|Blue Cross PPO Specialty|BCBSTX PPO|7.50||||||| 9528258|ERX|0250|CEPACOL LOZENGE|Aenta Medicare Advantage|AETNA MEDICARE MA|7.50||||||| 9528258|ERX|0250|CEPACOL LOZENGE|Humana Medicare Advantage|HUMANA MA|7.50||||7.50||| 9528258|ERX|0250|CEPACOL LOZENGE|NON CONTRACTED|COMMERCIAL OTHER 1|7.50||||||| 9528258|ERX|0250|CEPACOL LOZENGE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|7.50||||||| 9528258|ERX|0250|CEPACOL LOZENGE|Medicare|MEDICARE ACUTE|7.50||||||| 9528258|ERX|0250|CEPACOL LOZENGE|United Medicare Advantage|UHC MEDICARE GOLD MA|7.50||||||| 9528258|ERX|0250|CEPACOL LOZENGE|Veterans Affairs|VETERANS ADMINISTRATION|7.50||||||| 9528274|ERX|0250|DEXAMETHASONE 10MG/ML, 10|Managed Medicaid|MEDICAID SUPERIOR|||||29.75||| 9528324|ERX|0250|PHENYEPHRINE 0.25% NASAL|Medicaid|MEDICAID TEXAS CHILDRENS|||||22.50||| 9528324|ERX|0250|PHENYEPHRINE 0.25% NASAL|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||22.50||| 9528324|ERX|0250|PHENYEPHRINE 0.25% NASAL|Medicaid|MEDICAID|||||22.50||| 9528324|ERX|0250|PHENYEPHRINE 0.25% NASAL|Tricare|TRICARE EAST REGION|||||22.50||| 9528324|ERX|0250|PHENYEPHRINE 0.25% NASAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||22.50||| 9528324|ERX|0250|PHENYEPHRINE 0.25% NASAL|Blue Cross PPO Specialty|BCBSTX PPO|||||22.50||| 9528324|ERX|0250|PHENYEPHRINE 0.25% NASAL|Medicare|MEDICARE ACUTE|||||22.50||| 9528324|ERX|0250|PHENYEPHRINE 0.25% NASAL|United Healthcare|UNITED HEALTHCARE OTHER|||||22.50||| 9528324|ERX|0250|PHENYEPHRINE 0.25% NASAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||22.50||| 9528324|ERX|0250|PHENYEPHRINE 0.25% NASAL|United Healthcare|UNITED HEALTHCARE|||||22.50||| 9528324|ERX|0250|PHENYEPHRINE 0.25% NASAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||22.50||| 9528324|ERX|0250|PHENYEPHRINE 0.25% NASAL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||22.50||| 9528324|ERX|0250|PHENYEPHRINE 0.25% NASAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||22.50||| 9528324|ERX|0250|PHENYEPHRINE 0.25% NASAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||22.50||| 9528324|ERX|0250|PHENYEPHRINE 0.25% NASAL|Managed Medicaid|MEDICAID AMERIGROUP|||||22.50||| 9528324|ERX|0250|PHENYEPHRINE 0.25% NASAL|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||22.50||| 9528324|ERX|0250|PHENYEPHRINE 0.25% NASAL|Humana Medicare Advantage|HUMANA MA|||||22.50||| 9528324|ERX|0250|PHENYEPHRINE 0.25% NASAL|Managed Medicaid|MEDICAID SUPERIOR|||||22.50||| 9528324|ERX|0250|PHENYEPHRINE 0.25% NASAL|Aetna|AETNA PPO|||||22.50||| 9528340|ERX|0250|PEPTO-BISMOL LIQUID, 118M|Humana Medicare Advantage|HUMANA MA|0.11||||||| 9528365|ERX|0250|TEARS NATURALE FREE, 0.03|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|48.75||||||| 9528365|ERX|0250|TEARS NATURALE FREE, 0.03|United Medicare Advantage|UHC MEDICARE GOLD MA|48.75||||||| 9528365|ERX|0250|TEARS NATURALE FREE, 0.03|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|48.75||||||| 9528365|ERX|0250|TEARS NATURALE FREE, 0.03|Medicare|MEDICARE ACUTE|48.75||||||| 9528365|ERX|0250|TEARS NATURALE FREE, 0.03|Humana Medicare Advantage|HUMANA MA|48.75||||48.75||| 9528365|ERX|0250|TEARS NATURALE FREE, 0.03|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|48.75||||||| 9528407|ERX|0250|PAIN EASE SPRAY (1 APPLIC|Medicaid|MEDICAID|||||0.17||| 9528407|ERX|0250|PAIN EASE SPRAY (1 APPLIC|Humana Medicare Advantage|HUMANA MA|||||0.17||| 9528407|ERX|0250|PAIN EASE SPRAY (1 APPLIC|Aetna|AETNA PPO|||||0.17||| 9528423|ERX|0250|CALCIUM GLUC 1G IN 250ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||72.25||| 9528423|ERX|0250|CALCIUM GLUC 1G IN 250ML|Medicare|MEDICARE ACUTE|72.25||||72.25||| 9528423|ERX|0250|CALCIUM GLUC 1G IN 250ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||72.25||| 9528423|ERX|0250|CALCIUM GLUC 1G IN 250ML|Humana Medicare Advantage|HUMANA MA|72.25||||72.25||| 9528423|ERX|0250|CALCIUM GLUC 1G IN 250ML|Blue Cross PPO Specialty|BCBSTX PPO|72.25||||72.25||| 9528423|ERX|0250|CALCIUM GLUC 1G IN 250ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|72.25||||||| 9528423|ERX|0250|CALCIUM GLUC 1G IN 250ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||72.25||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|||||1.83||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.83||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.83||||1.83||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Humana Medicare Advantage|HUMANA MA|1.83||||1.83||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Managed Medicaid|MEDICAID SUPERIOR|1.83||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.83||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.83||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|1.83||||1.83||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|United Healthcare|UNITED HEALTHCARE|1.83||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Veterans Affairs|VETERANS ADMINISTRATION|1.83||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Medicare|MEDICARE ACUTE|1.83||||1.83||| 9528456|ERX|0250|ERTAPENEM 1G IN 100ML NS|Medicare|MEDICARE ACUTE|321.75||||||| 9528456|ERX|0250|ERTAPENEM 1G IN 100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|321.75||||321.75||| 9528456|ERX|0250|ERTAPENEM 1G IN 100ML NS|Humana Medicare Advantage|HUMANA MA|321.75||||||| 9528456|ERX|0250|ERTAPENEM 1G IN 100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|321.75||||||| 9528464|ERX|0250|PENICILLIN G 5MU IN 100ML|Humana Medicare Advantage|HUMANA MA|72.25||||||| 9528464|ERX|0250|PENICILLIN G 5MU IN 100ML|Managed Medicaid|MEDICAID AMERIGROUP|72.25||||||| 9528464|ERX|0250|PENICILLIN G 5MU IN 100ML|Veterans Affairs|VETERANS ADMINISTRATION|72.25||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Managed Medicaid|MEDICAID SUPERIOR|72.25||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Managed Medicaid|MEDICAID UNITED HEALTHCARE|72.25||||72.25||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Humana Medicare Advantage|HUMANA MA|72.25||||72.25||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Medicaid|MEDICAID|72.25||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|72.25||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Cigna|CIGNA|72.25||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|72.25||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Medicare|MEDICARE ACUTE|72.25||||72.25||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|United Medicare Advantage|UHC MEDICARE GOLD MA|72.25||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Veterans Affairs|VETERANS ADMINISTRATION|72.25||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Blue Cross PPO Specialty|BCBSTX PPO|72.25||||72.25||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|72.25||||||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|Aenta Medicare Advantage|AETNA MEDICARE MA|||||64.25||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|Managed Medicaid|MEDICAID AMERIGROUP|||||64.25||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|Managed Medicaid|MEDICAID SUPERIOR|||||64.25||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|Humana Medicare Advantage|HUMANA MA|||||64.25||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||64.25||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|Aetna|AETNA PPO|||||64.25||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|Blue Cross PPO Specialty|BCBSTX PPO|||||64.25||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||64.25||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||64.25||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|Medicare|MEDICARE ACUTE|||||64.25||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|United Healthcare|UNITED HEALTHCARE|||||64.25||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|Medicaid|MEDICAID|||||64.25||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|Tricare|TRICARE EAST REGION|||||64.25||| 9528571|ERX|0250|BETADINE 5% EYE SOLUTION,|United Medicare Advantage|UHC MEDICARE GOLD MA|||||64.25||| 9528605|ERX|0250|LIDOCAINE 4% PF, 5ML VIAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.24||| 9528605|ERX|0250|LIDOCAINE 4% PF, 5ML VIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.24||| 9528605|ERX|0250|LIDOCAINE 4% PF, 5ML VIAL|Medicare|MEDICARE ACUTE|||||0.24||| 9528605|ERX|0250|LIDOCAINE 4% PF, 5ML VIAL|Blue Cross PPO Specialty|BCBSTX PPO|||||0.24||| 9528647|ERX|0250|MONSEL'S SOLUTION, 8ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.60||| 9528647|ERX|0250|MONSEL'S SOLUTION, 8ML|Blue Cross HMO Specialty|BCBSTX HMO|||||0.60||| 9528647|ERX|0250|MONSEL'S SOLUTION, 8ML|Medicare|MEDICARE ACUTE|||||0.60||| 9528647|ERX|0250|MONSEL'S SOLUTION, 8ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.60||| 9528647|ERX|0250|MONSEL'S SOLUTION, 8ML|Tricare|TRICARE EAST REGION|||||0.60||| 9528647|ERX|0250|MONSEL'S SOLUTION, 8ML|United Healthcare|UNITED HEALTHCARE|||||0.60||| 9528647|ERX|0250|MONSEL'S SOLUTION, 8ML|Blue Cross PPO Specialty|BCBSTX PPO|0.60||||0.60||| 9528647|ERX|0250|MONSEL'S SOLUTION, 8ML|Managed Medicaid|MEDICAID AMERIGROUP|||||0.60||| 9528654|ERX|0250|ROXANOL 20MG/1ML ORAL SYR|Medicare|MEDICARE ACUTE|7.50||||||| 9528704|ERX|0250|SODIUM CHLORIDE 0.9% IRRI|Managed Medicaid|MEDICAID SUPERIOR|||||72.25||| 9528704|ERX|0250|SODIUM CHLORIDE 0.9% IRRI|United Medicare Advantage|UHC MEDICARE GOLD MA|||||72.25||| 9528704|ERX|0250|SODIUM CHLORIDE 0.9% IRRI|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||72.25||| 9528704|ERX|0250|SODIUM CHLORIDE 0.9% IRRI|Aetna|AETNA PPO|||||72.25||| 9528704|ERX|0250|SODIUM CHLORIDE 0.9% IRRI|NON CONTRACTED|COMMERCIAL OTHER 1|||||72.25||| 9528704|ERX|0250|SODIUM CHLORIDE 0.9% IRRI|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||72.25||| 9528704|ERX|0250|SODIUM CHLORIDE 0.9% IRRI|Blue Cross HMO Specialty|BCBSTX HMO|||||72.25||| 9528704|ERX|0250|SODIUM CHLORIDE 0.9% IRRI|Blue Cross PPO Specialty|BCBSTX PPO|||||72.25||| 9528704|ERX|0250|SODIUM CHLORIDE 0.9% IRRI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||72.25||| 9528704|ERX|0250|SODIUM CHLORIDE 0.9% IRRI|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||72.25||| 9528704|ERX|0250|SODIUM CHLORIDE 0.9% IRRI|Humana Medicare Advantage|HUMANA MA|||||72.25||| 9528704|ERX|0250|SODIUM CHLORIDE 0.9% IRRI|Cigna|CIGNA|||||72.25||| 9528704|ERX|0250|SODIUM CHLORIDE 0.9% IRRI|Managed Medicaid|MEDICAID AMERIGROUP|||||72.25||| 9528704|ERX|0250|SODIUM CHLORIDE 0.9% IRRI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||72.25||| 9528704|ERX|0250|SODIUM CHLORIDE 0.9% IRRI|Medicaid|MORRIS COUNTY INDIGENT|||||72.25||| 9528704|ERX|0250|SODIUM CHLORIDE 0.9% IRRI|United Healthcare|UNITED HEALTHCARE|||||72.25||| 9528704|ERX|0250|SODIUM CHLORIDE 0.9% IRRI|Medicare|MEDICARE ACUTE|72.25||||72.25||| 9528704|ERX|0250|SODIUM CHLORIDE 0.9% IRRI|Tricare|TRICARE EAST REGION|||||72.25||| 9528746|ERX|0250|POTASSIUM CHLORIDE 40MEQ/|Humana Medicare Advantage|HUMANA MA|||||72.25||| 9528746|ERX|0250|POTASSIUM CHLORIDE 40MEQ/|Medicaid|MEDICAID|72.25||||||| 9528746|ERX|0250|POTASSIUM CHLORIDE 40MEQ/|Blue Cross PPO Specialty|BCBSTX PPO|72.25||||||| 9528746|ERX|0250|POTASSIUM CHLORIDE 40MEQ/|Medicare|MEDICARE ACUTE|72.25||||72.25||| 9528746|ERX|0250|POTASSIUM CHLORIDE 40MEQ/|Managed Medicaid|MEDICAID AMERIGROUP|||||72.25||| 9528902|ERX|0250|CEFAZOLIN 2G IN 100ML NS|Blue Cross HMO Specialty|BCBSTX HMO|||||72.25||| 9528902|ERX|0250|CEFAZOLIN 2G IN 100ML NS|NON CONTRACTED|COMMERCIAL OTHER 1|||||72.25||| 9528902|ERX|0250|CEFAZOLIN 2G IN 100ML NS|United Healthcare|UNITED HEALTHCARE OTHER|72.25||||||| 9528902|ERX|0250|CEFAZOLIN 2G IN 100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|||||72.25||| 9529009|ERX|0250|VANCOMYCIN 500MG IN 100ML|Managed Medicaid|MEDICAID SUPERIOR|72.25||||||| 9529009|ERX|0250|VANCOMYCIN 500MG IN 100ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|72.25||||||| 9529009|ERX|0250|VANCOMYCIN 500MG IN 100ML|Humana Medicare Advantage|HUMANA MA|72.25||||||| 9529009|ERX|0250|VANCOMYCIN 500MG IN 100ML|Medicare|MEDICARE ACUTE|72.25||||72.25||| 9529009|ERX|0250|VANCOMYCIN 500MG IN 100ML|Medicare|MEDICARE PART B ONLY IP|72.25||||||| 9529009|ERX|0250|VANCOMYCIN 500MG IN 100ML|Aenta Medicare Advantage|AETNA MEDICARE MA|72.25||||||| 9529017|ERX|0250|MEROPENEM 500MG IN 100ML|Aenta Medicare Advantage|AETNA MEDICARE MA|166.25||||||| 9529017|ERX|0250|MEROPENEM 500MG IN 100ML|Humana Medicare Advantage|HUMANA MA|166.25||||166.25||| 9529017|ERX|0250|MEROPENEM 500MG IN 100ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|166.25||||||| 9529017|ERX|0250|MEROPENEM 500MG IN 100ML|Medicare|MEDICARE ACUTE|166.25||||166.25||| 9529017|ERX|0250|MEROPENEM 500MG IN 100ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||166.25||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|United Healthcare|UNITED HEALTHCARE|332.25||||||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|Medicare|MEDICARE ACUTE|332.25||||332.25||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|Humana Medicare Advantage|HUMANA MA|332.25||||332.25||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|||||332.25||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|332.25||||||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|Aenta Medicare Advantage|AETNA MEDICARE MA|332.25||||||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|332.25||||||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|Veterans Affairs|VETERANS ADMINISTRATION|332.25||||||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|332.25||||||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|332.25||||||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|332.25||||||| 9529025|ERX|0250|MEROPENEM 1G IN 100ML NS|Blue Cross HMO Specialty|BCBSTX HMO|332.25||||||| 9529041|ERX|0250|GUAIFENSESIN SF 100MG/5ML|Medicare|MEDICARE ACUTE|27.75||||||| 9529041|ERX|0250|GUAIFENSESIN SF 100MG/5ML|Humana Medicare Advantage|HUMANA MA|27.75||||||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Medicare|MEDICARE ACUTE|490.20||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|490.20||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Medicaid|MEDICAID TEXAS CHILDRENS|490.20||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Medicaid|MORRIS COUNTY INDIGENT|||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Medicaid|MEDICAID|490.20||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Tricare|TRICARE EAST REGION|490.20||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|United Healthcare|UNITED HEALTHCARE|||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|United Healthcare|UNITED HEALTHCARE|490.20||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|490.20||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Access Direct Platinum|HEALTHFIRST TPA UMR|490.20||||||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Blue Cross HMO Specialty|BCBSTX HMO|||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|United Healthcare|UNITED HEALTHCARE OTHER|490.20||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Blue Cross PPO Specialty|BCBSTX PPO|490.20||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Cigna|CIGNA|||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Humana Medicare Advantage|HUMANA MA|490.20||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Managed Medicaid|MEDICAID AMERIGROUP|||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Aetna|AETNA PPO|||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||490.20||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Managed Medicaid|MEDICAID SUPERIOR|||||490.20||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Managed Medicaid|MEDICAID SUPERIOR|||||5,915.18||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Humana Medicare Advantage|HUMANA MA|||||5,915.18||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Managed Medicaid|MEDICAID AMERIGROUP|||||5,915.18||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Managed Medicare|HEALTHSPRING MA|||||4,742.75||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Cigna|CIGNA|||||4,742.75||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Medicare|MEDICARE ACUTE|||||4,742.75||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Tricare|TRICARE EAST REGION|||||4,742.75||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||4,742.75||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4,742.75||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Blue Cross HMO Specialty|BCBSTX HMO|||||5,915.18||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||5,915.18||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4,742.75||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4,742.75||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||4,742.75||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|United Healthcare|UNITED HEALTHCARE|||||4,742.75||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Veterans Affairs|VETERANS ADMINISTRATION|||||5,915.18||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Medicaid|MEDICAID|||||4,742.75||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||5,328.97||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Blue Cross PPO Specialty|BCBSTX PPO|||||5,915.18||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||5,915.18||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4,742.75||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|United Healthcare|UNITED HEALTHCARE|||||6,409.08||| 95811|EAP|0740|POLYSOMNOGRAM SPLIT NIGHT|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||6,409.08||| 95811|EAP|0740|POLYSOMNOGRAM SPLIT NIGHT|Veterans Affairs|VETERANS ADMINISTRATION|||||5,138.75||| 95811|EAP|0740|POLYSOMNOGRAM SPLIT NIGHT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||6,409.08||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|Medicare|MEDICARE ACUTE|||||5,138.75||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||5,138.75||| 95811|EAP|0740|POLYSOMNOGRAM SPLIT NIGHT|Medicare|MEDICARE ACUTE|||||5,138.75||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|Medicaid|MEDICAID|||||5,138.75||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||5,138.75||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||5,138.75||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|Humana Medicare Advantage|HUMANA MA|||||5,138.75||| 95811|EAP|0740|POLYSOMNOGRAM SPLIT NIGHT|Humana Medicare Advantage|HUMANA MA|||||5,138.75||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|NON CONTRACTED|COMMERCIAL OTHER 4|||||5,138.75||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|United Medicare Advantage|UHC MEDICARE GOLD MA|||||6,409.08||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||5,773.92||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|Managed Medicare|HEALTHSPRING MA|||||6,409.08||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|Cigna|CIGNA|||||5,773.92||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||5,773.92||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|Blue Cross HMO Specialty|BCBSTX HMO|||||6,409.08||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|NON CONTRACTED|COMMERCIAL OTHER 1|||||5,138.75||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||6,409.08||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||5,138.75||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|Blue Cross PPO Specialty|BCBSTX PPO|||||5,138.75||| 9582933|ERX|0250|AMIODARONE 360MG 200ML DE|Managed Medicaid|MEDICAID AMERIGROUP|2.22||||||| 9582933|ERX|0250|AMIODARONE 360MG 200ML DE|Humana Medicare Advantage|HUMANA MA|2.22||||||| 9582933|ERX|0250|AMIODARONE 360MG 200ML DE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.22||| 9582933|ERX|0250|AMIODARONE 360MG 200ML DE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.22||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|United Healthcare|TML GROUP BENEFITS|||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|Aenta Medicare Advantage|AETNA MEDICARE MA|||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|Blue Cross HMO Specialty|BCBSTX HMO|||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|United Medicare Advantage|UHC MEDICARE GOLD MA|9.75||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|9.75||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|Cigna|CIGNA|||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|Humana Medicare Advantage|HUMANA MA|9.75||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|Managed Medicaid|MEDICAID AMERIGROUP|||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|Veterans Affairs|VETERANS ADMINISTRATION|||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|United Healthcare|UNITED HEALTHCARE OTHER|9.75||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|Blue Cross PPO Specialty|BCBSTX PPO|9.75||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|Managed Medicaid|MEDICAID SUPERIOR|9.75||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|Blue Cross PPO Specialty|BCBSTX OTHER|||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|Workers Compensation|WORKERS COMPENSATION OTHER|||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|Tricare|TRICARE EAST REGION|9.75||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|NON CONTRACTED|COMMERCIAL OTHER 1|9.75||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|Medicaid|MEDICAID|||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|PHCS|GROUP AND PENSION|||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|Medicare|MEDICARE ACUTE|9.75||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|United Healthcare|UNITED HEALTHCARE|9.75||||9.75||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|United Healthcare|UNITED HEALTHCARE|||||9.75||| 9583048|ERX|0250|PREDNISOLONE 15MG 5ML SYR|Managed Medicaid|MEDICAID AMERIGROUP|||||14.25||| 9583048|ERX|0250|PREDNISOLONE 15MG 5ML SYR|Blue Cross PPO Specialty|BCBSTX PPO|||||14.25||| 9583048|ERX|0250|PREDNISOLONE 15MG 5ML SYR|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||14.25||| 9583048|ERX|0250|PREDNISOLONE 15MG 5ML SYR|Tricare|TRICARE EAST REGION|||||14.25||| 9583048|ERX|0250|PREDNISOLONE 15MG 5ML SYR|Medicaid|MEDICAID|||||14.25||| 9583048|ERX|0250|PREDNISOLONE 15MG 5ML SYR|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||14.25||| 9583048|ERX|0250|PREDNISOLONE 15MG 5ML SYR|Medicaid|MEDICAID HMO|||||14.25||| 9583048|ERX|0250|PREDNISOLONE 15MG 5ML SYR|Blue Cross HMO Specialty|BCBSTX HMO|14.25||||||| 9583048|ERX|0250|PREDNISOLONE 15MG 5ML SYR|Managed Medicaid|MEDICAID SUPERIOR|14.25||||14.25||| 9583071|ERX|0250|GUAIFENESIN-DM 100-10MG/5|Medicare|MEDICARE ACUTE|7.50||||7.50||| 9583071|ERX|0250|GUAIFENESIN-DM 100-10MG/5|United Medicare Advantage|UHC MEDICARE GOLD MA|7.50||||7.50||| 9583071|ERX|0250|GUAIFENESIN-DM 100-10MG/5|Blue Cross HMO Specialty|BCBSTX HMO|||||7.50||| 9583071|ERX|0250|GUAIFENESIN-DM 100-10MG/5|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||7.50||| 9583071|ERX|0250|GUAIFENESIN-DM 100-10MG/5|NON CONTRACTED|COMMERCIAL OTHER 1|7.50||||||| 9583071|ERX|0250|GUAIFENESIN-DM 100-10MG/5|Aenta Medicare Advantage|AETNA MEDICARE MA|7.50||||||| 9583071|ERX|0250|GUAIFENESIN-DM 100-10MG/5|Blue Cross PPO Specialty|BCBSTX PPO|7.50||||7.50||| 9583071|ERX|0250|GUAIFENESIN-DM 100-10MG/5|Cigna|CIGNA|7.50||||||| 9583071|ERX|0250|GUAIFENESIN-DM 100-10MG/5|Managed Medicaid|MEDICAID UNITED HEALTHCARE|7.50||||||| 9583071|ERX|0250|GUAIFENESIN-DM 100-10MG/5|Managed Medicaid|MEDICAID SUPERIOR|||||7.50||| 9583071|ERX|0250|GUAIFENESIN-DM 100-10MG/5|Humana Medicare Advantage|HUMANA MA|7.50||||7.50||| 9583105|ERX|0250|REFRESH PLUS 0.5% UD EYE|Medicare|MEDICARE ACUTE|7.50||||||| 9583253|ERX|0250|DOPAMINE 400MG/250ML D5W|Medicare|MEDICARE ACUTE|72.25||||72.25||| 9583253|ERX|0250|DOPAMINE 400MG/250ML D5W|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||72.25||| 9583253|ERX|0250|DOPAMINE 400MG/250ML D5W|Humana Medicare Advantage|HUMANA MA|72.25||||72.25||| 9583253|ERX|0250|DOPAMINE 400MG/250ML D5W|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||72.25||| 9583378|ERX|0250|ROPIVACAINE 1% 20ML VIAL|Medicaid|MEDICAID TEXAS CHILDRENS|103.25||||||| 9583378|ERX|0250|ROPIVACAINE 1% 20ML VIAL|Access Direct Platinum|HEALTHFIRST TPA UMR|103.25||||||| 9583378|ERX|0250|ROPIVACAINE 1% 20ML VIAL|Humana Medicare Advantage|HUMANA MA|103.25||||||| 9583378|ERX|0250|ROPIVACAINE 1% 20ML VIAL|Blue Cross PPO Specialty|BCBSTX PPO|103.25||||||| 9583378|ERX|0250|ROPIVACAINE 1% 20ML VIAL|Tricare|TRICARE EAST REGION|103.25||||||| 9583428|ERX|0250|LISINOPRIL 40MG TABLET|Humana Medicare Advantage|HUMANA MA|||||7.50||| 9583428|ERX|0250|LISINOPRIL 40MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||7.50||| 9583428|ERX|0250|LISINOPRIL 40MG TABLET|Aetna|AETNA OTHER|||||7.50||| 9583428|ERX|0250|LISINOPRIL 40MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|7.50||||7.50||| 9583428|ERX|0250|LISINOPRIL 40MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|7.50||||||| 9583428|ERX|0250|LISINOPRIL 40MG TABLET|Tricare|TRICARE EAST REGION|7.50||||||| 9583428|ERX|0250|LISINOPRIL 40MG TABLET|Medicare|MEDICARE ACUTE|7.50||||7.50||| 9583428|ERX|0250|LISINOPRIL 40MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|7.50||||||| 9583428|ERX|0250|LISINOPRIL 40MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|7.50||||||| 9583535|ERX|0250|ALBUTEROL .42% 1.25MG/3ML|Medicare|MEDICARE ACUTE|0.10||||0.10||| 9583535|ERX|0250|ALBUTEROL .42% 1.25MG/3ML|Managed Medicaid|MEDICAID AMERIGROUP|||||0.10||| 9583535|ERX|0250|ALBUTEROL .42% 1.25MG/3ML|Medicaid|MEDICAID|||||0.10||| 9583535|ERX|0250|ALBUTEROL .42% 1.25MG/3ML|Managed Medicaid|MEDICAID SUPERIOR|||||0.10||| 9583568|ERX|0250|DEXTROSE 10% 250ML BAG|Medicare|MEDICARE ACUTE|||||72.25||| 9583568|ERX|0250|DEXTROSE 10% 250ML BAG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|72.25||||||| 9583576|ERX|0250|PROMETHAZINE W.COD 6.25MG|Managed Medicaid|MEDICAID AMERIGROUP|||||7.50||| 9583576|ERX|0250|PROMETHAZINE W.COD 6.25MG|United Medicare Advantage|UHC MEDICARE GOLD MA|||||7.50||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|Aenta Medicare Advantage|AETNA MEDICARE MA|||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|Access Direct Platinum|HEALTHFIRST TPA UMR|50.75||||||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|Blue Cross HMO Specialty|BCBSTX HMO|||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|Aetna|AETNA PPO|||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|Cigna|CIGNA|||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|Humana Medicare Advantage|HUMANA MA|50.75||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|50.75||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|Medicaid|MEDICAID|50.75||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|United Healthcare|UNITED HEALTHCARE|50.75||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|Managed Medicaid|MEDICAID AMERIGROUP|||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|Medicaid|MEDICAID TEXAS CHILDRENS|50.75||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|NON CONTRACTED|COMMERCIAL OTHER 1|50.75||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|Tricare|TRICARE EAST REGION|50.75||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|Blue Cross PPO Specialty|BCBSTX PPO|50.75||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|Medicaid|MORRIS COUNTY INDIGENT|||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|Medicare|MEDICARE ACUTE|50.75||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|United Healthcare|UNITED HEALTHCARE OTHER|50.75||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|50.75||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|Managed Medicaid|MEDICAID SUPERIOR|||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|United Healthcare|UNITED HEALTHCARE|||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|United Medicare Advantage|UHC MEDICARE GOLD MA|50.75||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||50.75||| 9583592|ERX|0250|SEVOFLURANE (15 MIN SESSI|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||50.75||| 9583642|ERX|0250|CETIRIZINE SYRUP 5MG/5ML|Blue Cross PPO Specialty|BCBSTX PPO|||||0.09||| 9583642|ERX|0250|CETIRIZINE SYRUP 5MG/5ML|Aetna|AETNA OTHER|0.09||||||| 9583642|ERX|0250|CETIRIZINE SYRUP 5MG/5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.09||| 9583642|ERX|0250|CETIRIZINE SYRUP 5MG/5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.09||||||| 9583709|ERX|0250|PIOGLITAZONE 30MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|29.75||||||| 9583709|ERX|0250|PIOGLITAZONE 30MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|29.75||||||| 9583733|ERX|0250|OSELTAMIVIR 6MG/ML SUSP 6|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||442.25||| 9583733|ERX|0250|OSELTAMIVIR 6MG/ML SUSP 6|Humana Medicare Advantage|HUMANA MA|||||442.25||| 9583733|ERX|0250|OSELTAMIVIR 6MG/ML SUSP 6|Managed Medicaid|MEDICAID AMERIGROUP|||||442.25||| 9583733|ERX|0250|OSELTAMIVIR 6MG/ML SUSP 6|Managed Medicaid|MEDICAID SUPERIOR|||||442.25||| 9583733|ERX|0250|OSELTAMIVIR 6MG/ML SUSP 6|Blue Cross HMO Specialty|BCBSTX HMO|||||442.25||| 9583733|ERX|0250|OSELTAMIVIR 6MG/ML SUSP 6|Medicare|MEDICARE ACUTE|442.25||||442.25||| 9583733|ERX|0250|OSELTAMIVIR 6MG/ML SUSP 6|Aetna|AETNA OTHER|||||442.25||| 9583733|ERX|0250|OSELTAMIVIR 6MG/ML SUSP 6|Medicaid|MEDICAID TEXAS CHILDRENS|||||442.25||| 9583733|ERX|0250|OSELTAMIVIR 6MG/ML SUSP 6|Blue Cross PPO Specialty|BCBSTX PPO|442.25||||442.25||| 9583733|ERX|0250|OSELTAMIVIR 6MG/ML SUSP 6|United Medicare Advantage|UHC MEDICARE GOLD MA|||||442.25||| 9583816|ERX|0250|PROCALAMINE 1000ML BOTTLE|Medicare|MEDICARE ACUTE|544.75||||||| 9583857|ERX|0250|POTASSIUM CHLORIDE O/S 20|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|7.50||||||| 9583857|ERX|0250|POTASSIUM CHLORIDE O/S 20|Aenta Medicare Advantage|AETNA MEDICARE MA|||||7.50||| 9583857|ERX|0250|POTASSIUM CHLORIDE O/S 20|Blue Cross PPO Specialty|BCBSTX PPO|||||7.50||| 9583857|ERX|0250|POTASSIUM CHLORIDE O/S 20|Cigna|CIGNA|||||7.50||| 9583857|ERX|0250|POTASSIUM CHLORIDE O/S 20|Humana Medicare Advantage|HUMANA MA|||||7.50||| 9583857|ERX|0250|POTASSIUM CHLORIDE O/S 20|Managed Medicaid|MEDICAID AMERIGROUP|||||7.50||| 9583857|ERX|0250|POTASSIUM CHLORIDE O/S 20|Managed Medicaid|MEDICAID SUPERIOR|||||7.50||| 9583857|ERX|0250|POTASSIUM CHLORIDE O/S 20|United Medicare Advantage|UHC MEDICARE GOLD MA|7.50||||7.50||| 9583857|ERX|0250|POTASSIUM CHLORIDE O/S 20|Medicaid|MEDICAID TEXAS CHILDRENS|||||7.50||| 9583857|ERX|0250|POTASSIUM CHLORIDE O/S 20|Medicaid|MEDICAID|||||7.50||| 9583857|ERX|0250|POTASSIUM CHLORIDE O/S 20|Medicare|MEDICARE ACUTE|7.50||||7.50||| 9583857|ERX|0250|POTASSIUM CHLORIDE O/S 20|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||7.50||| 9583857|ERX|0250|POTASSIUM CHLORIDE O/S 20|United Healthcare|TML GROUP BENEFITS|||||7.50||| 9583857|ERX|0250|POTASSIUM CHLORIDE O/S 20|United Healthcare|UNITED HEALTHCARE|||||7.50||| 9584343|ERX|0250|AMPICILLIN 2G IN 100ML NS|Humana Medicare Advantage|HUMANA MA|72.25||||||| 9584343|ERX|0250|AMPICILLIN 2G IN 100ML NS|Medicare|MEDICARE ACUTE|72.25||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Humana Medicare Advantage|HUMANA MA|7.50||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|7.50||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Veterans Affairs|VETERANS ADMINISTRATION|||||7.50||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Managed Medicaid|MEDICAID UNITED HEALTHCARE|7.50||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|7.50||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Blue Cross PPO Specialty|BCBSTX PPO|7.50||||7.50||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Aenta Medicare Advantage|AETNA MEDICARE MA|7.50||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Medicare|MEDICARE ACUTE|7.50||||7.50||| 9584608|ERX|0250|SULFA-TRIMETH LIQUID 200-|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||7.50||| 9584608|ERX|0250|SULFA-TRIMETH LIQUID 200-|Medicaid|MEDICAID|||||7.50||| 9584608|ERX|0250|SULFA-TRIMETH LIQUID 200-|Managed Medicaid|MEDICAID SUPERIOR|7.50||||7.50||| 9584608|ERX|0250|SULFA-TRIMETH LIQUID 200-|Managed Medicaid|MEDICAID AMERIGROUP|||||7.50||| 9584608|ERX|0250|SULFA-TRIMETH LIQUID 200-|Blue Cross PPO Specialty|BCBSTX OTHER|||||7.50||| 9584608|ERX|0250|SULFA-TRIMETH LIQUID 200-|Blue Cross PPO Specialty|BCBSTX PPO|||||7.50||| 9584723|ERX|0250|BELLAD ALKALOIDS-PHENOB 5|Blue Cross PPO Specialty|BCBSTX PPO|54.23||||54.23||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|Medicare|MEDICARE ACUTE|20.50||||20.50||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|20.50||||||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|20.50||||20.50||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|Medicaid|MEDICAID|||||20.50||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|United Healthcare|UNITED HEALTHCARE|20.50||||||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|Humana Medicare Advantage|HUMANA MA|20.50||||20.50||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|Managed Medicaid|MEDICAID AMERIGROUP|||||20.50||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|20.50||||||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|20.50||||||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|||||20.50||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||20.50||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|20.50||||||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|Aetna|AETNA OTHER|72.25||||||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|72.25||||||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|72.25||||||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|72.25||||||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|Managed Medicaid|MEDICAID SUPERIOR|72.25||||||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|Blue Cross PPO Specialty|BCBSTX PPO|72.25||||72.25||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|Blue Cross HMO Specialty|BCBSTX HMO|72.25||||||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|Medicare|MEDICARE ACUTE|72.25||||||| 9585282|ERX|0250|VANCOMYCIN 750 MG IN 100M|Aenta Medicare Advantage|AETNA MEDICARE MA|72.25||||||| 9586033|ERX|0250|LOMOTIL 2.5-.025MG/5ML UD|Medicare|MEDICARE ACUTE|7.50||||||| 9586322|ERX|0250|NIFEDIPINE XL 30MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|9.45||||||| 9586322|ERX|0250|NIFEDIPINE XL 30MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|||||9.45||| 9586322|ERX|0250|NIFEDIPINE XL 30MG TABLET|Medicare|MEDICARE ACUTE|9.45||||9.45||| 9586322|ERX|0250|NIFEDIPINE XL 30MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|9.45||||||| 9586322|ERX|0250|NIFEDIPINE XL 30MG TABLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|9.45||||||| 9586322|ERX|0250|NIFEDIPINE XL 30MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.45||||||| 9586322|ERX|0250|NIFEDIPINE XL 30MG TABLET|Humana Medicare Advantage|HUMANA MA|9.45||||9.45||| 9589185|ERX|0250|HYDROC-ACET 2.5-108MG/5ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||28.35||| 9589219|ERX|0250|HEPARIN LOCK 100 UNIT/ML,|Medicare|MEDICARE ACUTE|||||14.09||| 9589219|ERX|0250|HEPARIN LOCK 100 UNIT/ML,|Humana Medicare Advantage|HUMANA MA|||||14.09||| 9589540|ERX|0250|LEVETIRACETAM 500MG/5ML U|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|16.50||||||| 9589540|ERX|0250|LEVETIRACETAM 500MG/5ML U|Managed Medicaid|MEDICAID UNITED HEALTHCARE|16.50||||||| 9589540|ERX|0250|LEVETIRACETAM 500MG/5ML U|Medicare|MEDICARE ACUTE|16.50||||||| 9590035|ERX|0250|PANTOPRAZOLE 80 MG/100 ML|Blue Cross PPO Specialty|BCBSTX PPO|||||0.85||| 9590035|ERX|0250|PANTOPRAZOLE 80 MG/100 ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.85||| 9590035|ERX|0250|PANTOPRAZOLE 80 MG/100 ML|Humana Medicare Advantage|HUMANA MA|0.85||||0.85||| 9590035|ERX|0250|PANTOPRAZOLE 80 MG/100 ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.85||||||| 9590035|ERX|0250|PANTOPRAZOLE 80 MG/100 ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.85||| 9590035|ERX|0250|PANTOPRAZOLE 80 MG/100 ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.85||| 9590035|ERX|0250|PANTOPRAZOLE 80 MG/100 ML|Medicare|MEDICARE ACUTE|0.85||||0.85||| 9590035|ERX|0250|PANTOPRAZOLE 80 MG/100 ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.85||| 9590142|ERX|0250|BENZOCAINE ORAL SPRAY 0.5|Medicare|MEDICARE ACUTE|||||67.90||| 9590142|ERX|0250|BENZOCAINE ORAL SPRAY 0.5|Managed Medicaid|MEDICAID SUPERIOR|||||67.90||| 9590142|ERX|0250|BENZOCAINE ORAL SPRAY 0.5|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||67.90||| 9590142|ERX|0250|BENZOCAINE ORAL SPRAY 0.5|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||67.90||| 9590456|ERX|0250|LINAGLIPTIN(TRADJENTA) 5M|Humana Medicare Advantage|HUMANA MA|76.73||||||| 9590456|ERX|0250|LINAGLIPTIN(TRADJENTA) 5M|United Medicare Advantage|UHC MEDICARE GOLD MA|||||76.73||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|187.50||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Medicare|MEDICARE ACUTE|187.50||||187.50||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Medicaid|MEDICAID|187.50||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Veterans Affairs|VETERANS ADMINISTRATION|187.50||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|187.50||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Aenta Medicare Advantage|AETNA MEDICARE MA|187.50||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Humana Medicare Advantage|HUMANA MA|187.50||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|187.50||||||| 9590514|ERX|0250|VANCOMYCIN 1500MG IN 250M|Humana Medicare Advantage|HUMANA MA|0.85||||||| 9590514|ERX|0250|VANCOMYCIN 1500MG IN 250M|Cigna|CIGNA|0.85||||||| 9590514|ERX|0250|VANCOMYCIN 1500MG IN 250M|United Medicare Advantage|UHC MEDICARE GOLD MA|0.85||||||| 9590514|ERX|0250|VANCOMYCIN 1500MG IN 250M|Blue Cross PPO Specialty|BCBSTX PPO|0.85||||||| 9590514|ERX|0250|VANCOMYCIN 1500MG IN 250M|NON CONTRACTED|COMMERCIAL OTHER 1|0.85||||||| 9590514|ERX|0250|VANCOMYCIN 1500MG IN 250M|Medicare|MEDICARE ACUTE|0.85||||0.85||| 9590514|ERX|0250|VANCOMYCIN 1500MG IN 250M|United Healthcare|UNITED HEALTHCARE|0.85||||||| 9590514|ERX|0250|VANCOMYCIN 1500MG IN 250M|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.85||||||| 9590514|ERX|0250|VANCOMYCIN 1500MG IN 250M|Veterans Affairs|VETERANS ADMINISTRATION|||||0.85||| 9590514|ERX|0250|VANCOMYCIN 1500MG IN 250M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.85||||||| 96360|EAP|0450|IV INFUSION HYDRATION UP|NON CONTRACTED|COMMERCIAL OTHER 1|||||473.20||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Medicare|MEDICARE ACUTE|473.20||||3.64||| 96360|EAP|0450|IV INFUSION HYDRATION UP|PHCS|MERITAIN HEALTH|||||473.20||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Medicaid|MEDICAID|||||473.20||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Veterans Affairs|VETERANS ADMINISTRATION|||||473.20||| 96360|EAP|0450|IV INFUSION HYDRATION UP|United Healthcare|TML GROUP BENEFITS|||||3.64||| 96360|EAP|0450|IV INFUSION HYDRATION UP|United Healthcare|UNITED HEALTHCARE|||||3.64||| 96360|EAP|0450|IV INFUSION HYDRATION UP|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||473.20||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Aenta Medicare Advantage|AETNA MEDICARE MA|||||473.20||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Blue Cross PPO Specialty|BCBSTX PPO|||||3.64||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.64||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Veterans Affairs|VETERANS ADMINISTRATION|||||3.64||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Humana Medicare Advantage|HUMANA MA|3.64||||3.64||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||473.20||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Managed Medicaid|MEDICAID AMERIGROUP|||||473.20||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.64||||473.20||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Cigna|CIGNA|||||3.64||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Managed Medicaid|MEDICAID SUPERIOR|||||418.60||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Aetna|AETNA OTHER|||||473.20||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Blue Cross HMO Specialty|BCBSTX HMO|473.20||||||| 96360|EAP|0260|IV INFUSION FOR HYDRATION|Blue Cross PPO Specialty|BCBSTX PPO|||||701.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.64||| 96360|EAP|0450|IV INFUSION HYDRATION UP|United Medicare Advantage|UHC MEDICARE GOLD MA|||||418.60||| 96360|EAP|0450|IV INFUSION HYDRATION UP|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3.64||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||178.10||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Managed Medicaid|MEDICAID SUPERIOR|||||1.37||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|157.55||||157.55||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Managed Medicaid|MEDICAID AMERIGROUP|||||1.37||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Managed Medicare|BCBS MEDICARE PPO MA|||||178.10||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Managed Medicare|HEALTHSPRING MA|||||1.37||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|178.10||||157.55||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||178.10||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.37||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Blue Cross PPO Specialty|BCBSTX PPO|1.37||||1.37||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Healthcare|UNITED HEALTHCARE|||||178.10||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Healthcare|TML GROUP BENEFITS|||||1.37||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.37||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.37||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.37||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Veterans Affairs|VETERANS ADMINISTRATION|178.10||||157.55||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Medicare|MEDICARE ACUTE|178.10||||1.37||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|NON CONTRACTED|COMMERCIAL OTHER 1|||||178.10||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|PHCS|MERITAIN HEALTH|||||178.10||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Cigna|CIGNA|||||1.37||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|PHCS|GROUP AND PENSION|||||1.37||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||157.55||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Workers Compensation|WORKERS COMPENSATION OTHER|||||157.55||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||1.37||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Medicaid|MEDICAID TEXAS CHILDRENS|||||178.10||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Medicaid|MEDICAID BCBSTX|||||1.37||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Aetna|AETNA OTHER|||||157.55||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Medicaid|MEDICAID|1.37||||1.37||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||178.10||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Healthcare|UNITED HEALTHCARE OTHER|||||1.37||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||178.10||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Tricare|TRICARE EAST REGION|178.10||||178.10||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||157.55||| 96361|EAP|0260|IV INFUSION HYDRATION EA|Blue Cross PPO Specialty|BCBSTX PPO|||||349.25||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Blue Cross HMO Specialty|BCBSTX HMO|||||1.37||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Humana Medicare Advantage|HUMANA MA|1.37||||1.37||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.37||| 96365|EAP|0260|IV INFUSION THERAPY INIT|NON CONTRACTED|COMMERCIAL OTHER 1|4.12||||535.60||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Medicare|MEDICARE ACUTE|535.60||||589.50||| 96365|EAP|0260|IV INFUSION THERAPY INIT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||473.80||| 96365|EAP|0260|IV INFUSION THERAPY INIT|United Healthcare|UNITED HEALTHCARE|||||473.80||| 96365|EAP|0260|IV INFUSION THERAPY INIT|United Healthcare|UNITED HEALTHCARE|||||535.60||| 96365|EAP|0260|IV INFUSION THERAPY INIT|Medicare|MEDICARE ACUTE|535.60||||535.60||| 96365|EAP|0260|IV INFUSION THERAPY INIT|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||535.60||| 96365|EAP|0260|IV INFUSION THERAPY INIT|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||535.60||| 96365|EAP|0260|IV INFUSION THERAPY INIT|Medicaid|MEDICAID TEXAS CHILDRENS|||||4.12||| 96365|EAP|0260|IV INFUSION THERAPY INIT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||535.60||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||589.50||| 96365|EAP|0260|IV INFUSION THERAPY INIT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.12||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||589.50||| 96365|EAP|0260|IV INFUSION THERAPY INIT|Aenta Medicare Advantage|AETNA MEDICARE MA|||||535.60||| 96365|EAP|0260|IV INFUSION THERAPY INIT|Medicaid|MEDICAID|4.12||||4.12||| 96365|EAP|0260|IV INFUSION THERAPY INIT|Blue Cross HMO Specialty|BCBSTX HMO|||||473.80||| 96365|EAP|0260|IV INFUSION THERAPY INIT|Veterans Affairs|VETERANS ADMINISTRATION|535.60||||4.12||| 96365|EAP|0260|IV INFUSION THERAPY INIT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||535.60||| 96365|EAP|0260|IV INFUSION THERAPY INIT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|535.60||||||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Blue Cross PPO Specialty|BCBSTX PPO|4.12||||589.50||| 96365|EAP|0260|IV INFUSION THERAPY INIT|Aetna|AETNA OTHER|||||473.80||| 96365|EAP|0260|IV INFUSION THERAPY INIT|Blue Cross PPO Specialty|BCBSTX PPO|4.12||||4.12||| 96365|EAP|0260|IV INFUSION THERAPY INIT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|535.60||||473.80||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|535.60||||589.50||| 96365|EAP|0260|IV INFUSION THERAPY INIT|Cigna|CIGNA|||||4.12||| 96365|EAP|0260|IV INFUSION THERAPY INIT|Humana Medicare Advantage|HUMANA MA|||||535.60||| 96365|EAP|0260|IV INFUSION THERAPY INIT|Aetna|AETNA PPO|||||4.12||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Humana Medicare Advantage|HUMANA MA|||||589.50||| 96365|EAP|0260|IV INFUSION THERAPY INIT|Managed Medicare|HEALTHSPRING MA|||||473.80||| 96365|EAP|0260|IV INFUSION THERAPY INIT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.12||| 96365|EAP|0260|IV INFUSION THERAPY INIT|Managed Medicaid|MEDICAID SUPERIOR|||||535.60||| 96365|EAP|0260|IV INFUSION THERAPY INIT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.12||||4.12||| 96365|EAP|0260|IV INFUSION THERAPY INIT|Managed Medicaid|MEDICAID AMERIGROUP|||||535.60||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Managed Medicaid|MEDICAID AMERIGROUP|||||589.50||| 96365|EAP|0260|IV INFUSION THERAPY INIT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.12||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|227.50||||227.50||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Managed Medicaid|MEDICAID AMERIGROUP|||||295.75||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Managed Medicare|HEALTHSPRING MA|||||227.50||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Humana Medicare Advantage|HUMANA MA|||||261.63||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|295.75||||295.75||| 96366|EAP|0260|OC IV INFUSION EACH ADDIT|Blue Cross PPO Specialty|BCBSTX PPO|||||2.08||| 96366|EAP|0260|OC IV INFUSION EACH ADDIT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.08||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Blue Cross PPO Specialty|BCBSTX PPO|295.75||||261.63||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Veterans Affairs|VETERANS ADMINISTRATION|||||227.50||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||295.75||| 96366|EAP|0260|OC IV INFUSION EACH ADDIT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.08||| 96366|EAP|0450|IV INF THER PROPH DX EA A|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||227.50||| 96366|EAP|0450|IV INF THER PROPH DX EA A|United Medicare Advantage|UHC MEDICARE GOLD MA|||||227.50||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||227.50||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Medicare|MEDICARE ACUTE|227.50||||227.50||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|295.75||||||| 96366|EAP|0450|IV INF THER PROPH DX EA A|NON CONTRACTED|COMMERCIAL OTHER 1|||||295.75||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Medicaid|MEDICAID|||||261.63||| 96366|EAP|0260|OC IV INFUSION EACH ADDIT|Medicare|MEDICARE ACUTE|||||395.20||| 96367|EAP|0450|INTRAVENOUS INFUSION THER|Medicare|MEDICARE ACUTE|69.58||||60.50||| 96367|EAP|0260|INTRAVENOUS INFUSION ADD|Medicare|MEDICARE ACUTE|||||371.20||| 96367|EAP|0450|INTRAVENOUS INFUSION THER|Veterans Affairs|VETERANS ADMINISTRATION|78.65||||||| 96367|EAP|0450|INTRAVENOUS INFUSION THER|United Medicare Advantage|UHC MEDICARE GOLD MA|||||78.65||| 96367|EAP|0450|INTRAVENOUS INFUSION THER|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||78.65||| 96367|EAP|0450|INTRAVENOUS INFUSION THER|Aenta Medicare Advantage|AETNA MEDICARE MA|||||78.65||| 96367|EAP|0450|INTRAVENOUS INFUSION THER|Blue Cross HMO Specialty|BCBSTX HMO|||||60.50||| 96367|EAP|0450|INTRAVENOUS INFUSION THER|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|78.65||||||| 96367|EAP|0450|INTRAVENOUS INFUSION THER|Blue Cross PPO Specialty|BCBSTX PPO|||||60.50||| 96367|EAP|0450|INTRAVENOUS INFUSION THER|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||60.50||| 96367|EAP|0450|INTRAVENOUS INFUSION THER|Managed Medicaid|MEDICAID SUPERIOR|||||60.50||| 96367|EAP|0450|INTRAVENOUS INFUSION THER|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|60.50||||78.65||| 96367|EAP|0450|INTRAVENOUS INFUSION THER|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||60.50||| 96367|EAP|0450|INTRAVENOUS INFUSION THER|Humana Medicare Advantage|HUMANA MA|||||78.65||| 96368|EAP|0450|IV INF TX DX CONCURRENT|Managed Medicaid|MEDICAID AMERIGROUP|||||147.88||| 96368|EAP|0450|IV INF TX DX CONCURRENT|Humana Medicare Advantage|HUMANA MA|||||147.88||| 96368|EAP|0450|IV INF TX DX CONCURRENT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|147.88||||||| 96368|EAP|0450|IV INF TX DX CONCURRENT|United Healthcare|UNITED HEALTHCARE|||||147.88||| 96368|EAP|0450|IV INF TX DX CONCURRENT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||113.75||| 96368|EAP|0450|IV INF TX DX CONCURRENT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||147.88||| 96368|EAP|0450|IV INF TX DX CONCURRENT|Medicare|MEDICARE ACUTE|||||113.75||| 96368|EAP|0450|IV INF TX DX CONCURRENT|NON CONTRACTED|COMMERCIAL OTHER 1|||||147.88||| 96368|EAP|0450|IV INF TX DX CONCURRENT|Medicaid|MEDICAID|||||147.88||| 96368|EAP|0450|IV INF TX DX CONCURRENT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|113.75||||113.75||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Medicare|MEDICARE ACUTE|82.23||||71.50||| 96372|EAP|0940|OC INJ ADM THERP OR DIAGN|Medicare|MEDICARE ACUTE|||||60.75||| 96372|EAP|0940|OC INJ ADM THERP OR DIAGN|NON CONTRACTED|COMMERCIAL OTHER 1|||||60.75||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|PHCS|MERITAIN HEALTH|||||92.95||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|NON CONTRACTED|COMMERCIAL OTHER 1|||||71.50||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|PHCS|HUMANA INSURANCE|||||92.95||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Medicaid|MORRIS COUNTY INDIGENT|||||71.50||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||92.95||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||71.50||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Medicaid|MEDICAID TEXAS CHILDRENS|||||71.50||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Medicaid|MEDICAID HMO|||||71.50||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Medicaid|MEDICAID|||||71.50||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Tricare|TRICARE FOR LIFE|||||71.50||| 96372|EAP|0940|OC INJ ADM THERP OR DIAGN|United Healthcare|UNITED HEALTHCARE|||||291.25||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Tricare|TRICARE EAST REGION|||||71.50||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Veterans Affairs|VETERANS ADMINISTRATION|||||71.50||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|United Healthcare|TML GROUP BENEFITS|||||92.95||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|United Healthcare|UNITED HEALTHCARE OTHER|||||71.50||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|United Healthcare|UNITED HEALTHCARE|||||92.95||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||71.50||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||82.23||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||71.50||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||71.50||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||71.50||| 96372|EAP|0940|OC INJ ADM THERP OR DIAGN|United Medicare Advantage|UHC MEDICARE GOLD MA|||||291.25||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||71.50||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|United Healthcare|UNITED HEALTHCARE|||||82.23||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||71.50||| 96372|EAP|0940|OC INJ ADM THERP OR DIAGN|Aenta Medicare Advantage|AETNA MEDICARE MA|||||60.75||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Blue Cross HMO Specialty|BCBSTX HMO|||||92.95||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||92.95||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Workers Compensation|WORKERS COMPENSATION OTHER|||||92.95||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|92.95||||92.95||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Aetna|AETNA QHP HMO|||||92.95||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Veterans Affairs|VETERANS ADMINISTRATION|||||92.95||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Aetna|AETNA OTHER|||||71.50||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||92.95||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Blue Cross PPO Specialty|BCBSTX PPO|71.50||||71.50||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Blue Cross PPO Specialty|BCBSTX OTHER|||||71.50||| 96372|EAP|0940|OC INJ ADM THERP OR DIAGN|Blue Cross PPO Specialty|BCBSTX PPO|||||60.75||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||71.50||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Aetna|AETNA PPO|||||82.23||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||71.50||| 96372|EAP|0940|OC INJ ADM THERP OR DIAGN|Humana Medicare Advantage|HUMANA MA|||||60.75||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|PHCS|GROUP AND PENSION|||||71.50||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Cigna|CIGNA|||||71.50||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||92.95||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Managed Medicaid|MEDICAID SUPERIOR|||||71.50||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|71.50||||71.50||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Managed Medicaid|MEDICAID AMERIGROUP|||||71.50||| 96372|EAP|0940|OC INJ ADM THERP OR DIAGN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||60.75||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Access Direct Platinum|HEALTHFIRST TPA UMR|||||82.23||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||82.23||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Managed Medicare|BCBS MEDICARE PPO MA|||||71.50||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Managed Medicare|HEALTHSPRING MA|||||71.50||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Managed Medicare|WELLCARE CHOICE MA|||||71.50||| 96372|EAP|0450|INJ THER/DIAG INTRAMUSCUL|Humana Medicare Advantage|HUMANA MA|92.95||||71.50||| 96372|EAP|0450|INJ SUBQ/IM|Humana Medicare Advantage|HUMANA MA|92.95||||118.50||| 96374|EAP|0940|IVP THERAP/DIAGNOSTIC INI|Humana Medicare Advantage|HUMANA MA|||||387.25||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Cigna|CIGNA|231.15||||231.15||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Cigna|CIGNA|2.01||||231.15||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.01||||261.30||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicaid|MEDICAID SUPERIOR|261.30||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|261.30||||261.30||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicare|HEALTHSPRING MA|||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||261.30||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Humana Medicare Advantage|HUMANA MA|2.01||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicare|BCBS MEDICARE PPO MA|||||261.30||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.01||||261.30||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Aenta Medicare Advantage|AETNA MEDICARE MA|||||261.30||| 96374|EAP|0940|IVP THERAP/DIAGNOSTIC INI|Aenta Medicare Advantage|AETNA MEDICARE MA|||||210.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Blue Cross HMO Specialty|BCBSTX HMO|2.01||||261.30||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|231.15||||261.30||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|261.30||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Aetna|AETNA PPO|||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|261.30||||231.15||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Blue Cross PPO Specialty|BCBSTX PPO|231.15||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.01||| 96374|EAP|0940|IVP THERAP/DIAGNOSTIC INI|Blue Cross PPO Specialty|BCBSTX PPO|||||387.25||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||261.30||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||261.30||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Veterans Affairs|VETERANS ADMINISTRATION|2.01||||261.30||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Veterans Affairs|VETERANS ADMINISTRATION|||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Aetna|AETNA OTHER|2.01||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Healthcare|UNITED HEALTHCARE OTHER|||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Healthcare|UNITED HEALTHCARE|261.30||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Healthcare|UNITED HEALTHCARE|2.01||||261.30||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||261.30||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Healthcare|TML GROUP BENEFITS|||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Medicare Advantage|UHC MEDICARE GOLD MA|2.01||||2.01||| 96374|EAP|0940|IVP THERAP/DIAGNOSTIC INI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||387.25||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicaid|MEDICAID AMERIGROUP|2.01||||2.01||| 96374|EAP|0940|IVP THERAP/DIAGNOSTIC INI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||387.25||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.01||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicare|MEDICARE ACUTE|2.01||||2.01||| 96374|EAP|0940|IVP THERAP/DIAGNOSTIC INI|Medicare|MEDICARE ACUTE|||||2.99||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|NON CONTRACTED|COMMERCIAL OTHER 1|261.30||||261.30||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|PHCS|HUMANA INSURANCE|||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|PHCS|GROUP AND PENSION|||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicaid|MORRIS COUNTY INDIGENT|||||231.15||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||261.30||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicaid|MEDICAID TEXAS CHILDRENS|2.01||||261.30||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicaid|MEDICAID BCBSTX|||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicaid|MEDICAID|2.01||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Tricare|TRICARE FOR LIFE|||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Tricare|TRICARE EAST REGION|261.30||||261.30||| 96374|EAP|0940|IVP THERAP/DIAGNOSTIC INI|Medicaid|MEDICAID|||||210.75||| 96374|EAP|0940|IVP THERAP/DIAGNOSTIC INI|Medicaid|MEDICAID HMO|||||210.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Medicare|MEDICARE ACUTE|153.75||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|NON CONTRACTED|COMMERCIAL OTHER 1|199.88||||199.88||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|PHCS|GROUP AND PENSION|||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||199.88||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Medicaid|MEDICAID TEXAS CHILDRENS|||||199.88||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Medicaid|MEDICAID BCBSTX|||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Medicaid|MEDICAID|153.75||||176.82||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Tricare|TRICARE EAST REGION|199.88||||199.88||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EAC|NON CONTRACTED|COMMERCIAL OTHER 1|||||130.75||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EAC|United Healthcare|UNITED HEALTHCARE|||||317.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Veterans Affairs|VETERANS ADMINISTRATION|||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Medicaid|MORRIS COUNTY INDIGENT|||||153.75||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EAC|United Medicare Advantage|UHC MEDICARE GOLD MA|||||317.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Workers Compensation|WORKERS COMPENSATION OTHER|||||176.82||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Healthcare|UNITED HEALTHCARE OTHER|||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Healthcare|UNITED HEALTHCARE|199.88||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||199.88||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Healthcare|TML GROUP BENEFITS|||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Medicare Advantage|UHC MEDICARE GOLD MA|153.75||||199.88||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|153.75||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Aenta Medicare Advantage|AETNA MEDICARE MA|||||199.88||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|176.82||||199.88||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Blue Cross HMO Specialty|BCBSTX HMO|153.75||||199.88||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EAC|Blue Cross PPO Specialty|BCBSTX PPO|||||317.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Aetna|AETNA PPO|||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|176.82||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Aetna|AETNA OTHER|||||199.88||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Veterans Affairs|VETERANS ADMINISTRATION|153.75||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|PHCS|HUMANA INSURANCE|||||153.75||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EAC|Medicare|MEDICARE ACUTE|||||130.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Tricare|TRICARE FOR LIFE|||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|199.88||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||176.82||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Healthcare|UNITED HEALTHCARE|153.75||||199.88||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Blue Cross PPO Specialty|BCBSTX PPO|199.88||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Blue Cross PPO Specialty|BCBSTX OTHER|||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||176.82||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EAC|Humana Medicare Advantage|HUMANA MA|||||2.24||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Cigna|CIGNA|176.82||||199.88||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Cigna|CIGNA|153.75||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|153.75||||176.82||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicaid|MEDICAID SUPERIOR|199.88||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|153.75||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicaid|MEDICAID AMERIGROUP|153.75||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Humana Medicare Advantage|HUMANA MA|153.75||||199.88||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EAC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||130.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicare|BCBS MEDICARE PPO MA|||||176.82||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EAC|Managed Medicaid|MEDICAID SUPERIOR|||||317.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||199.88||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicare|HEALTHSPRING MA|||||176.82||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EAC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||130.75||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|Medicaid|MEDICAID TEXAS CHILDRENS|||||39.33||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|Medicaid|MEDICAID BCBSTX|||||30.25||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|Medicaid|MEDICAID|34.79||||30.25||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|Tricare|TRICARE FOR LIFE|||||30.25||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|Tricare|TRICARE EAST REGION|39.33||||39.33||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|Cigna|CIGNA|||||30.25||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|Managed Medicaid|MEDICAID UNITED HEALTHCARE|30.25||||30.25||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|Managed Medicaid|MEDICAID SUPERIOR|39.33||||30.25||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|Managed Medicaid|MEDICAID AMERIGROUP|30.25||||30.25||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||30.25||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|Humana Medicare Advantage|HUMANA MA|30.25||||39.33||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||34.79||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|Aenta Medicare Advantage|AETNA MEDICARE MA|||||39.33||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|Aetna|AETNA PPO|||||30.25||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|Aetna|AETNA OTHER|||||39.33||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||34.79||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||34.79||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|Veterans Affairs|VETERANS ADMINISTRATION|||||39.33||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|39.33||||34.79||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|Veterans Affairs|VETERANS ADMINISTRATION|||||30.25||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|Blue Cross PPO Specialty|BCBSTX PPO|39.33||||39.33||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|Workers Compensation|WORKERS COMPENSATION OTHER|||||30.25||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|United Healthcare|UNITED HEALTHCARE|39.33||||34.79||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|United Healthcare|UNITED HEALTHCARE|||||34.79||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||30.25||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|United Healthcare|UNITED HEALTHCARE OTHER|||||30.25||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|United Medicare Advantage|UHC MEDICARE GOLD MA|30.25||||30.25||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|30.25||||30.25||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|Medicare|MEDICARE ACUTE|30.25||||30.25||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|NON CONTRACTED|COMMERCIAL OTHER 1|||||39.33||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|Medicaid|MORRIS COUNTY INDIGENT|||||39.33||| 96376|EAP|0450|INJ THER/DIAG EA ADDITION|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||34.79||| 96413|EAP|0335|IV INFUSION 1 HOUR CHEMO|Medicare|MEDICARE ACUTE|||||740.50||| 96413|EAP|0335|IV INFUSION 1 HOUR CHEMO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||740.50||| 96413|EAP|0335|IV INFUSION 1 HOUR CHEMO|Blue Cross PPO Specialty|BCBSTX PPO|||||740.50||| 96413|EAP|0335|IV INFUSION 1 HOUR CHEMO|Humana Medicare Advantage|HUMANA MA|||||740.50||| 96415|EAP|0335|IV INFUSION CHEMO ADDL H|Humana Medicare Advantage|HUMANA MA|||||2.08||| 96415|EAP|0335|IV INFUSION CHEMO ADDL H|Blue Cross PPO Specialty|BCBSTX PPO|||||2.08||| 96523|EAP|0269|IRRIGATION DRUG DELIVERY|Medicare|MEDICARE ACUTE|||||182.25||| 96523|EAP|0269|IRRIGATION DRUG DELIVERY|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||182.25||| 96523|EAP|0269|IRRIGATION DRUG DELIVERY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||182.25||| 96523|EAP|0269|IRRIGATION DRUG DELIVERY|Blue Cross PPO Specialty|BCBSTX PPO|||||182.25||| 96523|EAP|0269|IRRIGATION DRUG DELIVERY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||182.25||| 96523|EAP|0269|IRRIGATION DRUG DELIVERY|Humana Medicare Advantage|HUMANA MA|||||182.25||| 97110|EAP|0420|PT EXERCISE UNIT-DEV STRG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|122.50||||||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Managed Medicaid|MEDICAID UNITED HEALTHCARE|151.75||||||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Managed Medicare|HEALTHSPRING MA|151.75||||||| 97110|EAP|0420|PT EXERCISE UNIT-DEV STRG|Humana Medicare Advantage|HUMANA MA|122.50||||122.50||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Humana Medicare Advantage|HUMANA MA|151.75||||151.75||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Aenta Medicare Advantage|AETNA MEDICARE MA|151.75||||||| 97110|EAP|0420|PT EXERCISE UNIT-DEV STRG|Aenta Medicare Advantage|AETNA MEDICARE MA|122.50||||||| 97110|EAP|0420|PT EXERCISE UNIT-DEV STRG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|122.50||||||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|151.75||||||| 97110|EAP|0420|PT EXERCISE UNIT-DEV STRG|United Healthcare|UNITED HEALTHCARE|122.50||||||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|United Healthcare|UNITED HEALTHCARE|151.75||||||| 97110|EAP|0420|PT EXERCISE UNIT-DEV STRG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|122.50||||||| 97110|EAP|0420|PT EXERCISE UNIT-DEV STRG|Managed Medicare|HEALTHSPRING MA|122.50||||||| 97110|EAP|0420|PT EXERCISE UNIT-DEV STRG|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|122.50||||||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|United Medicare Advantage|UHC MEDICARE GOLD MA|151.75||||151.75||| 97110|EAP|0420|PT EXERCISE UNIT-DEV STRG|United Medicare Advantage|UHC MEDICARE GOLD MA|122.50||||122.50||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|151.75||||||| 97110|EAP|0420|PT EXERCISE UNIT-DEV STRG|Medicare|MEDICARE ACUTE|122.50||||||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Blue Cross PPO Specialty|BCBSTX PPO|151.75||||||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Medicare|MEDICARE ACUTE|151.75||||||| 97110|EAP|0420|PT EXERCISE UNIT-DEV STRG|NON CONTRACTED|COMMERCIAL OTHER 1|122.50||||||| 97110|EAP|0420|PT EXERCISE UNIT-DEV STRG|Medicaid|MEDICAID|122.50||||||| 97110|EAP|0430|THERAPEUTIC EXERCISE, IND|Medicaid|MEDICAID|151.75||||||| 97112|EAP|0430|MUSCLE RE-EDUCATION|Medicare|MEDICARE ACUTE|151.75||||||| 97112|EAP|0430|MUSCLE RE-EDUCATION|NON CONTRACTED|COMMERCIAL OTHER 1|151.75||||||| 97112|EAP|0430|MUSCLE RE-EDUCATION|Medicaid|MEDICAID|151.75||||||| 97112|EAP|0430|MUSCLE RE-EDUCATION|Blue Cross PPO Specialty|BCBSTX PPO|151.75||||||| 97112|EAP|0430|MUSCLE RE-EDUCATION|Humana Medicare Advantage|HUMANA MA|151.75||||||| 97116|EAP|0420|PT GAIT TRAINING|Managed Medicaid|MEDICAID UNITED HEALTHCARE|182.50||||||| 97116|EAP|0420|PT GAIT TRAINING|Managed Medicare|HEALTHSPRING MA|182.50||||||| 97116|EAP|0420|PT GAIT TRAINING|Humana Medicare Advantage|HUMANA MA|182.50||||182.50||| 97116|EAP|0420|PT GAIT TRAINING|Aenta Medicare Advantage|AETNA MEDICARE MA|182.50||||||| 97116|EAP|0420|PT GAIT TRAINING|United Healthcare|UNITED HEALTHCARE|182.50||||||| 97116|EAP|0420|PT GAIT TRAINING|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|182.50||||||| 97116|EAP|0420|PT GAIT TRAINING|NON CONTRACTED|COMMERCIAL OTHER 1|182.50||||||| 97116|EAP|0420|PT GAIT TRAINING|Medicaid|MEDICAID|182.50||||||| 97116|EAP|0420|PT GAIT TRAINING|Medicare|MEDICARE ACUTE|182.50||||||| 97116|EAP|0420|PT GAIT TRAINING|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|182.50||||||| 97116|EAP|0420|PT GAIT TRAINING|United Medicare Advantage|UHC MEDICARE GOLD MA|182.50||||182.50||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|Medicare|MEDICARE ACUTE|2.73||||2.73||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|Tricare|TRICARE EAST REGION|2.73||||||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|United Healthcare|UNITED HEALTHCARE|2.73||||||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|United Medicare Advantage|UHC MEDICARE GOLD MA|2.73||||2.73||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.73||||||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.73||||||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.73||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.73||||||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|Blue Cross PPO Specialty|BCBSTX PPO|2.73||||||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.73||||||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.73||||||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|Humana Medicare Advantage|HUMANA MA|2.73||||2.73||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.48||||3.48||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|Aenta Medicare Advantage|AETNA MEDICARE MA|3.48||||||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|3.48||||||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|United Healthcare|UNITED HEALTHCARE|3.48||||||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3.48||||||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|United Medicare Advantage|UHC MEDICARE GOLD MA|3.48||||3.48||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|Managed Medicare|HEALTHSPRING MA|3.48||||||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|3.48||||||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|Medicare|MEDICARE ACUTE|3.48||||3.48||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|Medicaid|MEDICAID|3.48||||||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|Humana Medicare Advantage|HUMANA MA|3.48||||3.48||| 97163|EAP|0424|PHYSICAL THERAPY EVALUATI|Medicare|MEDICARE ACUTE|4.25||||||| 97163|EAP|0424|PHYSICAL THERAPY EVALUATI|NON CONTRACTED|COMMERCIAL OTHER 1|4.25||||||| 97163|EAP|0424|PHYSICAL THERAPY EVALUATI|United Healthcare|UNITED HEALTHCARE|4.25||||||| 97163|EAP|0424|PHYSICAL THERAPY EVALUATI|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.25||||||| 97163|EAP|0424|PHYSICAL THERAPY EVALUATI|United Medicare Advantage|UHC MEDICARE GOLD MA|4.25||||||| 97163|EAP|0424|PHYSICAL THERAPY EVALUATI|Humana Medicare Advantage|HUMANA MA|4.25||||||| 97165|EAP|0434|OCCUPATIONAL THERAPY EVAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.12||| 97165|EAP|0434|OCCUPATIONAL THERAPY EVAL|Aenta Medicare Advantage|AETNA MEDICARE MA|2.12||||2.12||| 97165|EAP|0434|OCCUPATIONAL THERAPY EVAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.12||||||| 97165|EAP|0434|OCCUPATIONAL THERAPY EVAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.12||||2.12||| 97165|EAP|0434|OCCUPATIONAL THERAPY EVAL|Managed Medicare|HEALTHSPRING MA|2.12||||||| 97165|EAP|0434|OCCUPATIONAL THERAPY EVAL|Humana Medicare Advantage|HUMANA MA|2.12||||2.12||| 97165|EAP|0434|OCCUPATIONAL THERAPY EVAL|United Healthcare|UNITED HEALTHCARE|2.12||||||| 97165|EAP|0434|OCCUPATIONAL THERAPY EVAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.12||||||| 97165|EAP|0434|OCCUPATIONAL THERAPY EVAL|United Medicare Advantage|UHC MEDICARE GOLD MA|2.12||||2.12||| 97165|EAP|0434|OCCUPATIONAL THERAPY EVAL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.12||||||| 97165|EAP|0434|OCCUPATIONAL THERAPY EVAL|Medicare|MEDICARE ACUTE|2.12||||2.12||| 97165|EAP|0434|OCCUPATIONAL THERAPY EVAL|NON CONTRACTED|COMMERCIAL OTHER 1|2.12||||||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|Medicare|MEDICARE ACUTE|2.88||||||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|Medicaid|MEDICAID|2.88||||||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.88||||||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|Blue Cross PPO Specialty|BCBSTX PPO|2.88||||||| 97168|EAP|0434|OCCUPATIONAL THERAPY RE-E|Medicaid|MEDICAID|1.26||||||| 97530|EAP|0420|PT THERAPEUTIC ACTIVITY 1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|92.50||||||| 97530|EAP|0420|PT THERAPEUTIC ACTIVITY 1|Humana Medicare Advantage|HUMANA MA|92.50||||92.50||| 97530|EAP|0420|PT THERAPEUTIC ACTIVITY 1|Aenta Medicare Advantage|AETNA MEDICARE MA|92.50||||||| 97530|EAP|0420|PT THERAPEUTIC ACTIVITY 1|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|92.50||||||| 97530|EAP|0420|PT THERAPEUTIC ACTIVITY 1|United Healthcare|UNITED HEALTHCARE|92.50||||||| 97530|EAP|0420|PT THERAPEUTIC ACTIVITY 1|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|92.50||||||| 97530|EAP|0420|PT THERAPEUTIC ACTIVITY 1|United Medicare Advantage|UHC MEDICARE GOLD MA|92.50||||||| 97530|EAP|0420|PT THERAPEUTIC ACTIVITY 1|Medicare|MEDICARE ACUTE|92.50||||||| 97530|EAP|0420|PT THERAPEUTIC ACTIVITY 1|NON CONTRACTED|COMMERCIAL OTHER 1|92.50||||||| 97530|EAP|0420|PT THERAPEUTIC ACTIVITY 1|Medicaid|MEDICAID|92.50||||||| 97533|EAP|0430|SENSORY INTEGRATION 15 MI|United Medicare Advantage|UHC MEDICARE GOLD MA|140.25||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|167.25||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Medicare|MEDICARE ACUTE|167.25||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|United Healthcare|UNITED HEALTHCARE|167.25||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|United Medicare Advantage|UHC MEDICARE GOLD MA|167.25||||167.25||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Medicaid|MEDICAID|167.25||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|167.25||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Humana Medicare Advantage|HUMANA MA|167.25||||167.25||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Managed Medicare|HEALTHSPRING MA|167.25||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|167.25||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|167.25||||||| 97535|EAP|0430|ACTIVITIES OF DAILY LIVIN|Aenta Medicare Advantage|AETNA MEDICARE MA|167.25||||||| 99152|EAP|0450|MODERATE SEDATION INITIAL|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.75||| 99152|EAP|0450|MODERATE SEDATION INITIAL|Blue Cross PPO Specialty|BCBSTX PPO|||||227.50||| 99204|EAP|0510|OC OUTPATIENT VISIT NEW L|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||148.75||| 99204|EAP|0510|OC OUTPATIENT VISIT NEW L|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||148.75||| 99204|EAP|0510|OC OUTPATIENT VISIT NEW L|Humana Medicare Advantage|HUMANA MA|||||148.75||| 99204|EAP|0510|OC OUTPATIENT VISIT NEW L|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||193.38||| 99204|EAP|0510|OC OUTPATIENT VISIT NEW L|Blue Cross HMO Specialty|BCBSTX HMO|||||193.38||| 99204|EAP|0510|OC OUTPATIENT VISIT NEW L|Medicare|MEDICARE ACUTE|||||193.38||| 99213|EAP|0510|OC OUTPATIENT VISIT EST L|United Healthcare|UNITED HEALTHCARE|||||1.02||| 99213|EAP|0510|OC OUTPATIENT VISIT EST L|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||132.60||| 99213|EAP|0510|OC OUTPATIENT VISIT EST L|United Medicare Advantage|UHC MEDICARE GOLD MA|||||132.60||| 99213|EAP|0510|OC OUTPATIENT VISIT EST L|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.02||| 99213|EAP|0510|OC OUTPATIENT VISIT EST L|Medicare|MEDICARE ACUTE|||||1.02||| 99213|EAP|0510|OC OUTPATIENT VISIT EST L|Tricare|TRICARE EAST REGION|||||132.60||| 99213|EAP|0510|OC OUTPATIENT VISIT EST L|Medicaid|MORRIS COUNTY INDIGENT|||||1.02||| 99213|EAP|0510|OC OUTPATIENT VISIT EST L|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.02||| 99213|EAP|0510|OC OUTPATIENT VISIT EST L|Aenta Medicare Advantage|AETNA MEDICARE MA|||||132.60||| 99213|EAP|0510|OC OUTPATIENT VISIT EST L|Blue Cross HMO Specialty|BCBSTX HMO|||||132.60||| 99213|EAP|0510|OC OUTPATIENT VISIT EST L|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.02||| 99213|EAP|0510|OC OUTPATIENT VISIT EST L|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||132.60||| 99213|EAP|0510|OC OUTPATIENT VISIT EST L|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.02||| 99213|EAP|0510|OC OUTPATIENT VISIT EST L|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.02||| 99213|EAP|0510|OC OUTPATIENT VISIT EST L|Humana Medicare Advantage|HUMANA MA|||||1.02||| 99213|EAP|0510|OC OUTPATIENT VISIT EST L|Cigna|CIGNA|||||1.02||| 99213|EAP|0510|OC OUTPATIENT VISIT EST L|Blue Cross PPO Specialty|BCBSTX PPO|||||1.02||| 99281|EAP|0450|ER VISIT LEVEL 1|Cigna|CIGNA|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Managed Medicaid|MEDICAID AMERIGROUP|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Humana Medicare Advantage|HUMANA MA|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Blue Cross HMO Specialty|BCBSTX HMO|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Aetna|AETNA PPO|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Aetna|AETNA OTHER|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Access Direct Platinum|HEALTHFIRST TPA UMR|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Blue Cross PPO Specialty|BCBSTX PPO|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Medicare|MEDICARE ACUTE|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Managed Medicare|HEALTHSPRING MA|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Medicaid|MEDICAID|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Tricare|TRICARE FOR LIFE|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Managed Medicaid|MEDICAID SUPERIOR|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Veterans Affairs|VETERANS ADMINISTRATION|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Workers Compensation|UT EMPLOYEE INJURY|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|United Healthcare|UNITED HEALTHCARE OTHER|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|United Healthcare|UNITED HEALTHCARE|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Medicaid|MEDICAID HMO|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Tricare|TRICARE EAST REGION|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.30||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Workers Compensation|WORKERS COMPENSATION OTHER|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Workers Compensation|WORKERS COMPENSATION OTHER|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|United Healthcare|UNITED HEALTHCARE|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|United Healthcare|UNITED HEALTHCARE|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|United Healthcare|TML GROUP BENEFITS|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Medicare|MEDICARE ACUTE|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Medicare|MEDICARE ACUTE|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|NON CONTRACTED|COMMERCIAL OTHER 2|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Medicaid|MORRIS COUNTY INDIGENT|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Medicaid|MEDICAID HMO|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Tricare|TRICARE EAST REGION|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Tricare|TRICARE EAST REGION|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Medicaid|MEDICAID TEXAS CHILDRENS|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Medicaid|MEDICAID|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Blue Cross HMO Specialty|BCBSTX HMO|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Blue Cross HMO Specialty|BCBSTX HMO|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Blue Cross PPO Specialty|BCBSTX PPO|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Blue Cross PPO Specialty|BCBSTX OTHER|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Blue Cross PPO Specialty|BCBSTX PPO|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Cigna|CIGNA|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Cigna|CIGNA|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|United Healthcare|UNITED HEALTHCARE OTHER|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Managed Medicaid|MEDICAID SUPERIOR|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Managed Medicaid|MEDICAID AMERIGROUP|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Managed Medicaid|MEDICAID SUPERIOR|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Managed Medicaid|MEDICAID AMERIGROUP|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Humana Medicare Advantage|HUMANA MA|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Humana Medicare Advantage|HUMANA MA|||||3.98||| 99283|EAP|0450|ER VISIT LEVEL 3|Cigna|CIGNA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Managed Medicaid|MEDICAID SUPERIOR|11.00||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Managed Medicaid|MEDICAID AMERIGROUP|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||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 AMERIGROUP|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Managed Medicare|HEALTHSPRING MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Managed Medicare|HEALTHSPRING MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Humana Medicare Advantage|HUMANA MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Humana Medicare Advantage|HUMANA MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|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|Blue Cross HMO Specialty|BCBSTX HMO|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Blue Cross HMO Specialty|BCBSTX HMO|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Aetna|AETNA PPO|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Aetna|AETNA OTHER|||||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 WITH PRO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||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 OTHER 1|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Access Direct Platinum|HEALTHFIRST TPA UMR|||||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 WITH PRO|Blue Cross PPO Specialty|BCBSTX PPO|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|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|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Medicare|MEDICARE ACUTE|11.00||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Medicare|MEDICARE ACUTE|11.00||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|NON CONTRACTED|COMMERCIAL OTHER 1|||||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|ZZZZZ LIABILITY INS OTHER 1|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|NON CONTRACTED|COMMERCIAL OTHER 1|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|PHCS|HUMANA INSURANCE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|PHCS|MULTIPLAN PHCS|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|PHCS|HUMANA INSURANCE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|PHCS|MULTIPLAN PHCS|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Tricare|TRICARE FOR LIFE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Tricare|TRICARE EAST REGION|||||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 WITH PRO|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Access Direct Platinum|HEALTHFIRST TPA UMR|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Medicaid|MORRIS COUNTY INDIGENT|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Medicaid|MEDICAID HMO|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Medicaid|MEDICAID|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Aetna|AETNA QHP HMO|||||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 HMO|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Medicaid|MEDICAID|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Medicaid|MEDICAID TEXAS CHILDRENS|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Medicaid|MORRIS COUNTY INDIGENT|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Veterans Affairs|VETERANS ADMINISTRATION|||||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|Veterans Affairs|VETERANS ADMINISTRATION|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Workers Compensation|WORKERS COMPENSATION OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Workers Compensation|WORKERS COMPENSATION OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|United Healthcare|UNITED HEALTHCARE ERS|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|United Healthcare|UNITED HEALTHCARE OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|United Healthcare|UNITED HEALTHCARE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|United Healthcare|TML GROUP BENEFITS|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|United Healthcare|GEHA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|United Healthcare|UNITED HEALTHCARE OTHER|||||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 WITH PRO|Cigna|CIGNA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|United Healthcare|GEHA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||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 DUAL COMPLETE HMO SNP MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Workers Compensation|UT EMPLOYEE INJURY|||||11.00||| 99284|EAP|0450|ER VISIT LEVEL 4|Veterans Affairs|VETERANS ADMINISTRATION|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Workers Compensation|WORKERS COMPENSATION OTHER|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Workers Compensation|UT EMPLOYEE INJURY|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|United Healthcare|UNITED HEALTHCARE OTHER|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|United Healthcare|UNITED HEALTHCARE|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|United Healthcare|UNITED HEALTHCARE OTHER|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|United Healthcare|UNITED HEALTHCARE|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|United Healthcare|TML GROUP BENEFITS|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|United Medicare Advantage|UHC MEDICARE GOLD MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Medicare|MEDICARE ACUTE|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|NON CONTRACTED|COMMERCIAL OTHER 1|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|NON CONTRACTED|COMMERCIAL OTHER 1|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|PHCS|GROUP AND PENSION|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Tricare|TRICARE FOR LIFE|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Tricare|TRICARE EAST REGION|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Tricare|TRICARE EAST REGION|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Medicaid|MORRIS COUNTY INDIGENT|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Medicaid|MEDICAID HMO|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Medicaid|MEDICAID|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Medicaid|MEDICAID TEXAS CHILDRENS|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Medicaid|MEDICAID HMO|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Aenta Medicare Advantage|AETNA MEDICARE MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Blue Cross HMO Specialty|BCBSTX HMO|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Blue Cross HMO Specialty|BCBSTX HMO|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Aetna|AETNA QHP HMO|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Medicaid|MEDICAID|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Medicaid|MORRIS COUNTY INDIGENT|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Aetna|AETNA PPO|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Aetna|AETNA OTHER|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Aetna|AETNA PPO|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Aetna|AETNA OTHER|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Medicaid|MEDICAID TEXAS CHILDRENS|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Access Direct Platinum|HEALTHFIRST TPA UMR|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Access Direct Platinum|HEALTHFIRST TPA UMR|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|PHCS|MERITAIN HEALTH|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Blue Cross PPO Specialty|BCBSTX PPO|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Blue Cross PPO Specialty|BCBSTX OTHER|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Blue Cross PPO Specialty|BCBSTX PPO|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Blue Cross PPO Specialty|BCBSTX OTHER|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Medicare|MEDICARE ACUTE|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Cigna|CIGNA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Cigna|CIGNA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|23.80||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Managed Medicaid|MEDICAID SUPERIOR|23.80||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|United Healthcare|TML GROUP BENEFITS|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|23.80||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Managed Medicaid|MEDICAID AMERIGROUP|23.80||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Managed Medicaid|MEDICAID UNITED HEALTHCARE|23.80||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Managed Medicaid|MEDICAID SUPERIOR|23.80||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Workers Compensation|WORKERS COMPENSATION OTHER|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|23.80||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Managed Medicaid|MEDICAID AMERIGROUP|23.80||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Managed Medicare|WELLCARE CHOICE MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Veterans Affairs|VETERANS ADMINISTRATION|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Managed Medicare|HEALTHSPRING MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Managed Medicare|WELLCARE CHOICE MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Managed Medicare|BCBS MEDICARE PPO MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Managed Medicare|BCBS MEDICARE PPO MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Managed Medicare|HEALTHSPRING MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Humana Medicare Advantage|HUMANA MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Humana Medicare Advantage|HUMANA MA|||||23.80||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Cigna|CIGNA|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Cigna|CIGNA|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Managed Medicaid|MEDICAID AMERIGROUP|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Managed Medicaid|MEDICAID UNITED HEALTHCARE|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Managed Medicaid|MEDICAID SUPERIOR|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Managed Medicaid|MEDICAID AMERIGROUP|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Managed Medicare|HEALTHSPRING MA|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Managed Medicare|HEALTHSPRING MA|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Managed Medicare|BCBS MEDICARE PPO MA|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Humana Medicare Advantage|HUMANA MA|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Blue Cross HMO Specialty|BCBSTX HMO|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Blue Cross HMO Specialty|BCBSTX HMO|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Aetna|AETNA PPO|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Aetna|AETNA OTHER|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Aetna|AETNA PPO|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Aetna|AETNA OTHER|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Access Direct Platinum|HEALTHFIRST TPA UMR|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Blue Cross PPO Specialty|BCBSTX PPO|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Blue Cross PPO Specialty|BCBSTX OTHER|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Blue Cross PPO Specialty|BCBSTX PPO|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Medicare|MEDICARE ACUTE|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Medicare|MEDICARE ACUTE|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|NON CONTRACTED|COMMERCIAL OTHER 1|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|NON CONTRACTED|COMMERCIAL OTHER 1|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|PHCS|HUMANA INSURANCE|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|PHCS|GROUP AND PENSION|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Tricare|TRICARE FOR LIFE|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Tricare|TRICARE EAST REGION|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Tricare|TRICARE EAST REGION|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Medicaid|MEDICAID HMO|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Medicaid|MEDICAID TEXAS CHILDRENS|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Aenta Medicare Advantage|AETNA MEDICARE MA|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Humana Medicare Advantage|HUMANA MA|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Medicaid|MEDICAID TEXAS CHILDRENS|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Medicaid|MEDICAID BCBSTX|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Medicaid|MEDICAID|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Medicaid|MORRIS COUNTY INDIGENT|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Medicaid|MEDICAID|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Veterans Affairs|VETERANS ADMINISTRATION|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Veterans Affairs|VETERANS ADMINISTRATION|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Veterans Affairs|VETERANS ADMINISTRATION|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Workers Compensation|WORKERS COMPENSATION OTHER|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Workers Compensation|WORKERS COMPENSATION OTHER|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Managed Medicaid|MEDICAID SUPERIOR|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|United Healthcare|UNITED HEALTHCARE OTHER|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|United Healthcare|UNITED HEALTHCARE|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|United Healthcare|UNITED HEALTHCARE|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|United Healthcare|UNITED HEALTHCARE OTHER|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|United Healthcare|TML GROUP BENEFITS|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|United Medicare Advantage|UHC MEDICARE GOLD MA|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|United Medicare Advantage|UHC MEDICARE GOLD MA|37.40||||37.40||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|United Healthcare|UNITED HEALTHCARE|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|22.65||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Medicare|MEDICARE ACUTE|22.65||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|NON CONTRACTED|COMMERCIAL OTHER 1|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|PHCS|HUMANA INSURANCE|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Medicaid|MEDICAID|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Aenta Medicare Advantage|AETNA MEDICARE MA|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Blue Cross PPO Specialty|BCBSTX PPO|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Cigna|CIGNA|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Managed Medicaid|MEDICAID SUPERIOR|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Humana Medicare Advantage|HUMANA MA|||||22.65||| 99292|EAP|0450|CRITICAL CARE EACH ADD 30|Blue Cross PPO Specialty|BCBSTX PPO|||||822.25||| 99292|EAP|0450|CRITICAL CARE EACH ADD 30|Medicare|MEDICARE ACUTE|||||822.25||| 99292|EAP|0450|CRITICAL CARE EACH ADD 30|Medicaid|MEDICAID|||||822.25||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|Medicare|MEDICARE ACUTE|||||12.50||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|Humana Medicare Advantage|HUMANA MA|12.50||||||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|Blue Cross HMO Specialty|BCBSTX HMO|||||12.50||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|Blue Cross PPO Specialty|BCBSTX PPO|||||12.50||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||12.50||| A4218|ERX|0636|SODIUM CHLORIDE 0.9% 50ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||140.25||| A4218|ERX|0636|SODIUM CHLORIDE 0.9% 100M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.45||| A4218|ERX|0636|SODIUM CHLORIDE 0.9% 100M|Blue Cross HMO Specialty|BCBSTX HMO|||||0.45||| A4218|ERX|0636|SODIUM CHLORIDE 0.9% 100M|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.45||| A4218|ERX|0636|SODIUM CHLORIDE 0.9% 50ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|140.25||||||| A4218|ERX|0636|SODIUM CHLORIDE 0.9% 100M|Blue Cross PPO Specialty|BCBSTX PPO|0.45||||0.45||| A4218|ERX|0636|SODIUM CHLORIDE 0.9% 100M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.45||||0.45||| A4218|ERX|0636|SODIUM CHLORIDE 0.9% 100M|Managed Medicaid|MEDICAID AMERIGROUP|0.45||||0.45||| A4218|ERX|0636|SODIUM CHLORIDE 0.9% 50ML|Managed Medicaid|MEDICAID SUPERIOR|140.25||||0.45||| A4218|ERX|0636|SODIUM CHLORIDE 0.9% 50ML|Managed Medicaid|MEDICAID AMERIGROUP|140.25||||0.45||| A4218|ERX|0636|SODIUM CHLORIDE 0.9% 100M|Aetna|AETNA PPO|||||0.45||| A4218|ERX|0636|SODIUM CHLORIDE 0.9% 100M|Managed Medicaid|MEDICAID SUPERIOR|0.45||||0.45||| A4218|ERX|0636|SODIUM CHLORIDE 0.9% 50ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.45||||140.25||| A4218|ERX|0636|SODIUM CHLORIDE 0.9% 100M|Cigna|CIGNA|||||0.45||| A4218|ERX|0636|SODIUM CHLORIDE 0.9% 50ML|Humana Medicare Advantage|HUMANA MA|140.25||||140.25||| A4218|ERX|0636|SODIUM CHLORIDE 0.9% 10ML|Humana Medicare Advantage|HUMANA MA|140.25||||0.63||| A4218|ERX|0636|SODIUM CHLORIDE 0.9% 100M|Humana Medicare Advantage|HUMANA MA|0.45||||0.45||| A4218|ERX|0636|SODIUM CHLORIDE 0.9% 50ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||140.25||| A4218|ERX|0636|SODIUM CHLORIDE 0.9% 100M|Medicare|MEDICARE ACUTE|0.45||||0.45||| A4218|ERX|0636|SODIUM CHLORIDE 0.9% 50ML|Medicare|MEDICARE ACUTE|140.25||||140.25||| A4218|ERX|0636|SODIUM CHLORIDE 0.9% 100M|Tricare|TRICARE EAST REGION|0.45||||||| A4218|ERX|0636|SODIUM CHLORIDE 0.9% 100M|Medicaid|MEDICAID|||||0.45||| A4218|ERX|0636|SODIUM CHLORIDE 0.9% 50ML|Medicaid|MORRIS COUNTY INDIGENT|||||140.25||| A4218|ERX|0636|SODIUM CHLORIDE 0.9% 100M|Medicaid|MORRIS COUNTY INDIGENT|||||0.45||| A9502|EAP|0343|NM TC 99M TETROFOSMIN MYO|Medicaid|MORRIS COUNTY INDIGENT|||||3.40||| A9502|EAP|0343|NM TC 99M TETROFOSMIN MYO|Tricare|TRICARE EAST REGION|||||3.40||| A9502|EAP|0343|NM TC 99M TETROFOSMIN MYO|Medicare|MEDICARE ACUTE|||||3.40||| A9502|EAP|0343|NM TC 99M TETROFOSMIN MYO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3.40||| A9502|EAP|0343|NM TC 99M TETROFOSMIN MYO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3.40||| A9502|EAP|0343|NM TC 99M TETROFOSMIN MYO|United Healthcare|UNITED HEALTHCARE|||||3.40||| A9502|EAP|0343|NM TC 99M TETROFOSMIN MYO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.40||| A9502|EAP|0343|NM TC 99M TETROFOSMIN MYO|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||3.40||| A9502|EAP|0343|NM TC 99M TETROFOSMIN MYO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.40||| A9502|EAP|0343|NM TC 99M TETROFOSMIN MYO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.40||| A9502|EAP|0343|NM TC 99M TETROFOSMIN MYO|Cigna|CIGNA|||||3.40||| A9502|EAP|0343|NM TC 99M TETROFOSMIN MYO|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.40||| A9502|EAP|0343|NM TC 99M TETROFOSMIN MYO|Humana Medicare Advantage|HUMANA MA|||||3.40||| A9502|EAP|0343|NM TC 99M TETROFOSMIN MYO|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||3.40||| A9502|EAP|0343|NM TC 99M TETROFOSMIN MYO|Managed Medicare|HEALTHSPRING MA|||||3.40||| A9502|EAP|0343|NM TC 99M TETROFOSMIN MYO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.40||| A9502|EAP|0343|NM TC 99M TETROFOSMIN MYO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3.40||| A9502|EAP|0343|NM TC 99M TETROFOSMIN MYO|Blue Cross HMO Specialty|BCBSTX HMO|||||3.40||| A9502|EAP|0343|NM TC 99M TETROFOSMIN MYO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.40||| A9502|EAP|0343|NM TC 99M TETROFOSMIN MYO|Aetna|AETNA PPO|||||3.40||| A9502|EAP|0343|NM TC 99M TETROFOSMIN MYO|Blue Cross PPO Specialty|BCBSTX PPO|||||3.40||| A9537|EAP|0343|NM TC 99M MEBROFENIN CHOL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.60||||1.60||| A9537|EAP|0343|NM TC 99M MEBROFENIN CHOL|Blue Cross HMO Specialty|BCBSTX HMO|||||1.60||| A9537|EAP|0343|NM TC 99M MEBROFENIN CHOL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.60||| A9537|EAP|0343|NM TC 99M MEBROFENIN CHOL|Aetna|AETNA PPO|||||1.60||| A9537|EAP|0343|NM TC 99M MEBROFENIN CHOL|Blue Cross PPO Specialty|BCBSTX PPO|||||1.60||| A9537|EAP|0343|NM TC 99M MEBROFENIN CHOL|Managed Medicaid|MEDICAID SUPERIOR|||||1.60||| A9537|EAP|0343|NM TC 99M MEBROFENIN CHOL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.60||| A9537|EAP|0343|NM TC 99M MEBROFENIN CHOL|Humana Medicare Advantage|HUMANA MA|||||1.60||| A9537|EAP|0343|NM TC 99M MEBROFENIN CHOL|Cigna|CIGNA|||||1.60||| A9537|EAP|0343|NM TC 99M MEBROFENIN CHOL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.60||| A9537|EAP|0343|NM TC 99M MEBROFENIN CHOL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.60||| A9537|EAP|0343|NM TC 99M MEBROFENIN CHOL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.60||| A9537|EAP|0343|NM TC 99M MEBROFENIN CHOL|Medicaid|MEDICAID|||||1.60||| A9537|EAP|0343|NM TC 99M MEBROFENIN CHOL|Tricare|TRICARE EAST REGION|1.60||||||| A9537|EAP|0343|NM TC 99M MEBROFENIN CHOL|Medicare|MEDICARE ACUTE|||||1.60||| A9541|EAP|0343|NM TC 99M SULFUR COLLOID|Blue Cross PPO Specialty|BCBSTX PPO|||||1.70||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|NON CONTRACTED|COMMERCIAL OTHER 1|||||9.24||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|Tricare|TRICARE EAST REGION|||||9.24||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|Medicare|MEDICARE ACUTE|9.24||||9.24||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|United Healthcare|UNITED HEALTHCARE|||||9.24||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||9.24||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|United Healthcare|UNITED HEALTHCARE|||||9.87||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|United Medicare Advantage|UHC MEDICARE GOLD MA|9.24||||9.24||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|United Medicare Advantage|UHC MEDICARE GOLD MA|9.24||||9.87||| A9576|EAP|0255|PROHANCE 5ML NDC 0270-111|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||9.24||| A9576|EAP|0255|PROHANCE 10 ML NDC 0270-0|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||9.24||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|Humana Medicare Advantage|HUMANA MA|9.24||||9.24||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|Humana Medicare Advantage|HUMANA MA|9.24||||9.87||| A9576|EAP|0255|PROHANCE 10 ML NDC 0270-0|Humana Medicare Advantage|HUMANA MA|9.24||||9.24||| A9576|EAP|0255|PROHANCE 10 ML NDC 0270-0|Managed Medicaid|MEDICAID UNITED HEALTHCARE|9.24||||9.24||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|Managed Medicaid|MEDICAID UNITED HEALTHCARE|9.24||||9.87||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||9.87||| A9576|EAP|0255|PROHANCE 10 ML NDC 0270-0|United Medicare Advantage|UHC MEDICARE GOLD MA|9.87||||9.24||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|Veterans Affairs|VETERANS ADMINISTRATION|||||9.87||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|Aenta Medicare Advantage|AETNA MEDICARE MA|||||9.24||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|9.87||||9.24||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|9.87||||9.87||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||9.87||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|Medicare|MEDICARE ACUTE|9.87||||9.87||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|Blue Cross HMO Specialty|BCBSTX HMO|||||9.24||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|Blue Cross HMO Specialty|BCBSTX HMO|||||9.87||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||9.24||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|Aetna|AETNA PPO|||||9.87||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|Aetna|AETNA OTHER|||||9.87||| A9576|EAP|0255|PROHANCE 5ML NDC 0270-111|Blue Cross PPO Specialty|BCBSTX PPO|9.24||||9.24||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|Blue Cross PPO Specialty|BCBSTX PPO|9.24||||9.24||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|Blue Cross PPO Specialty|BCBSTX PPO|9.24||||9.87||| A9576|EAP|0255|PROHANCE 5ML NDC 0270-111|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.24||||9.24||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.24||||9.24||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.24||||9.87||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|Cigna|CIGNA|||||9.87||| A9698|EAP|0621|SITZMARKERS- NON-RAD CONT|Managed Medicaid|MEDICAID SUPERIOR|||||409.58||| C1726|EAP|0278|BALLOON SINUPLASTY SYSTEM|Tricare|TRICARE EAST REGION|||||39.50||| C1726|EAP|0278|BALLOON SINUPLASTY SYSTEM|Medicare|MEDICARE ACUTE|||||39.50||| C1751|EAP|0278|PICC LINE|Aenta Medicare Advantage|AETNA MEDICARE MA|5.89||||||| C1751|EAP|0278|PICC LINE|Humana Medicare Advantage|HUMANA MA|5.89||||||| C1751|EAP|0278|PICC LINE|Managed Medicaid|MEDICAID SUPERIOR|5.89||||||| C1751|EAP|0278|PICC LINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.89||||||| C1751|EAP|0278|PICC LINE|United Medicare Advantage|UHC MEDICARE GOLD MA|5.89||||||| C1751|EAP|0278|PICC LINE|Medicare|MEDICARE ACUTE|5.89||||||| C1776|EAP|0278|JOINT DEVICE IMPLANTABLE|Medicare|MEDICARE ACUTE|||||4,142.50||| C1781|EAP|0278|VENTRALIGHT ST 11CM (4.5I|Humana Medicare Advantage|HUMANA MA|||||45.47||| C1781|EAP|0278|MESH IMPLANTABLE|Humana Medicare Advantage|HUMANA MA|||||1,101.50||| C1781|EAP|0278|MARLEX PLUG|Humana Medicare Advantage|HUMANA MA|||||5.98||| C1781|EAP|0278|MESH IMPLANTABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,101.50||| C1781|EAP|0278|MESH IMPLANTABLE|Blue Cross PPO Specialty|BCBSTX PPO|||||1,101.50||| C1781|EAP|0278|MARLEX PLUG|Blue Cross PPO Specialty|BCBSTX PPO|||||5.98||| C1781|EAP|0278|MARLEX PLUG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||5.98||| C1781|EAP|0278|MESH IMPLANTABLE|Medicare|MEDICARE ACUTE|||||1,101.50||| C1889|EAP|0272|LATERA ABSORBABLE NASAL I|Tricare|TRICARE EAST REGION|||||53.25||| C1889|EAP|0272|LATERA ABSORBABLE NASAL I|Medicare|MEDICARE ACUTE|||||53.25||| C1889|EAP|0272|LATERA ABSORBABLE NASAL I|Aenta Medicare Advantage|AETNA MEDICARE MA|||||53.25||| C1889|EAP|0272|LATERA ABSORBABLE NASAL I|Aetna|AETNA PPO|||||53.25||| C1889|EAP|0272|LATERA ABSORBABLE NASAL I|Blue Cross PPO Specialty|BCBSTX PPO|||||53.25||| C1889|EAP|0272|LATERA ABSORBABLE NASAL I|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||53.25||| C1889|EAP|0272|LATERA ABSORBABLE NASAL I|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||53.25||| C1889|EAP|0272|LATERA ABSORBABLE NASAL I|Managed Medicaid|MEDICAID SUPERIOR|||||53.25||| C1889|EAP|0272|LATERA ABSORBABLE NASAL I|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||53.25||| C2625|EAP|0278|STENT NON CORONARY IMPLAN|Medicare|MEDICARE ACUTE|||||18.25||| C8929|EAP|0483||Humana Medicare Advantage|HUMANA MA|||||27.68||| C8929|EAP|0483||Medicare|MEDICARE ACUTE|||||27.68||| G0105|EAP|0750|COLONOSCOPY SCREENING|Veterans Affairs|VETERANS ADMINISTRATION|||||2,413.83||| G0105|EAP|0750|COLONOSCOPY SCREENING|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2,413.83||| G0105|EAP|0750|COLONOSCOPY SCREENING|United Healthcare|TML GROUP BENEFITS|||||20.72||| G0105|EAP|0750|COLONOSCOPY SCREENING|United Healthcare|UNITED HEALTHCARE|||||2,242.92||| G0105|EAP|0750|COLONOSCOPY SCREENING|United Healthcare|UNITED HEALTHCARE OTHER|||||2,413.83||| G0105|EAP|0750|COLONOSCOPY SCREENING|United Healthcare|UNITED HEALTHCARE|||||20.72||| G0105|EAP|0750|COLONOSCOPY SCREENING|Medicare|MEDICARE ACUTE|||||20.72||| G0105|EAP|0750|COLONOSCOPY SCREENING|NON CONTRACTED|COMMERCIAL OTHER 1|||||20.72||| G0105|EAP|0750|COLONOSCOPY SCREENING|Tricare|TRICARE EAST REGION|||||20.72||| G0105|EAP|0750|COLONOSCOPY SCREENING|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||20.72||| G0105|EAP|0750|COLONOSCOPY SCREENING|Aenta Medicare Advantage|AETNA MEDICARE MA|||||20.72||| G0105|EAP|0750|COLONOSCOPY SCREENING|Blue Cross HMO Specialty|BCBSTX HMO|||||2,242.92||| G0105|EAP|0750|COLONOSCOPY SCREENING|Aetna|AETNA PPO|||||2,242.92||| G0105|EAP|0750|COLONOSCOPY SCREENING|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||20.72||| G0105|EAP|0750|COLONOSCOPY SCREENING|Aetna|AETNA OTHER|||||2,413.83||| G0105|EAP|0750|COLONOSCOPY SCREENING|Blue Cross PPO Specialty|BCBSTX PPO|||||20.72||| G0105|EAP|0750|COLONOSCOPY SCREENING|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||20.72||| G0105|EAP|0750|COLONOSCOPY SCREENING|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2,413.83||| G0105|EAP|0750|COLONOSCOPY SCREENING|Access Direct Platinum|HEALTHFIRST TPA UMR|||||20.72||| G0105|EAP|0750|COLONOSCOPY SCREENING|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||20.72||| G0105|EAP|0750|COLONOSCOPY SCREENING|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||20.72||| G0105|EAP|0750|COLONOSCOPY SCREENING|Humana Medicare Advantage|HUMANA MA|||||20.72||| G0105|EAP|0750|COLONOSCOPY SCREENING|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||20.72||| G0105|EAP|0750|COLONOSCOPY SCREENING|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||20.72||| G0105|EAP|0750|COLONOSCOPY SCREENING|Cigna|CIGNA|||||20.72||| G0260|EAP|0361|INJ FOR SACROILIAC JT ANE|Managed Medicaid|MEDICAID AMERIGROUP|||||1,658.72||| G0260|EAP|0361|INJ FOR SACROILIAC JT ANE|Humana Medicare Advantage|HUMANA MA|||||1,658.72||| G0260|EAP|0361|INJ FOR SACROILIAC JT ANE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,658.72||| G0260|EAP|0361|INJ FOR SACROILIAC JT ANE|Medicare|MEDICARE ACUTE|||||14.81||| G0260|EAP|0361|INJ FOR SACROILIAC JT ANE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,658.72||| G0297|EAP|0350|CT SCREENING LUNG|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.50||| G0297|EAP|0350|CT SCREENING LUNG|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.50||| G0297|EAP|0350|CT SCREENING LUNG|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.50||| G0297|EAP|0350|CT SCREENING LUNG|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.50||| G0297|EAP|0350|CT SCREENING LUNG|Medicare|MEDICARE ACUTE|||||1.50||| G0297|EAP|0350|CT SCREENING LUNG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.50||| G0297|EAP|0350|CT SCREENING LUNG|Aetna|AETNA PPO|||||1.95||| G0297|EAP|0350|CT SCREENING LUNG|Blue Cross PPO Specialty|BCBSTX PPO|||||172.50||| G0297|EAP|0350|CT SCREENING LUNG|Cigna|CIGNA|||||1.50||| G0297|EAP|0350|CT SCREENING LUNG|Humana Medicare Advantage|HUMANA MA|||||1.95||| G0297|EAP|0350|CT SCREENING LUNG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.95||| G0378|EAP|0762|OBSERVATION SERVICES PER|Humana Medicare Advantage|HUMANA MA|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Cigna|CIGNA|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Blue Cross HMO Specialty|BCBSTX HMO|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Aetna|AETNA PPO|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Aetna|AETNA OTHER|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Access Direct Platinum|HEALTHFIRST TPA UMR|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Medicare|MEDICARE ACUTE|1.25||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Tricare|TRICARE EAST REGION|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Medicaid|MEDICAID HMO|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Medicaid|MEDICAID|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Veterans Affairs|VETERANS ADMINISTRATION|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|United Healthcare|UNITED HEALTHCARE|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.25||| G1769|EAP|0272|K WIRES|Medicare|MEDICARE ACUTE|||||47.50||| J0131|ERX|0250||Humana Medicare Advantage|HUMANA MA|||||68.75||| J0131|ERX|0250||United Medicare Advantage|UHC MEDICARE GOLD MA|||||68.75||| J0131|ERX|0250||Medicare|MEDICARE ACUTE|||||68.75||| J0132|ERX|0636|ACETYLCYSTEINE 20%, 30ML|Managed Medicaid|MEDICAID AMERIGROUP|||||1,315.20||| J0153|ERX|0636|ADENOSINE 3MG/ML, 2ML VIA|Medicare|MEDICARE ACUTE|||||120.50||| J0153|ERX|0636|ADENOSINE 3MG/ML, 2ML VIA|Blue Cross HMO Specialty|BCBSTX HMO|||||120.50||| J0153|ERX|0636|ADENOSINE 3MG/ML, 2ML VIA|Blue Cross PPO Specialty|BCBSTX PPO|||||120.50||| J0153|ERX|0636|ADENOSINE 3MG/ML, 2ML VIA|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||120.50||| J0153|ERX|0636|ADENOSINE 3MG/ML, 2ML VIA|Managed Medicaid|MEDICAID SUPERIOR|||||120.50||| J0153|ERX|0636|ADENOSINE 3MG/ML, 2ML VIA|Cigna|CIGNA|||||120.50||| J0153|ERX|0636|ADENOSINE 3MG/ML, 2ML VIA|Humana Medicare Advantage|HUMANA MA|||||120.50||| J0490|ERX|0636|BELIMUMAB 120 MG VIAL (10|United Medicare Advantage|UHC MEDICARE GOLD MA|||||186.91||| J0561|ERX|0636|PENICILLIN G BENZATHINE 1|Managed Medicaid|MEDICAID AMERIGROUP|||||42.79||| J0561|ERX|0636|PENICILLIN G BENZATHINE 1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||42.79||| J0561|ERX|0636|PENICILLIN G BENZATHINE 1|Managed Medicaid|MEDICAID SUPERIOR|||||42.79||| J0561|ERX|0636|PENICILLIN G BENZ 600000|Managed Medicaid|MEDICAID SUPERIOR|||||50.29||| J0561|ERX|0636|PENICILLIN G BENZATHINE 1|Aetna|AETNA OTHER|||||42.79||| J0561|ERX|0636|PENICILLIN G BENZATHINE 1|Blue Cross PPO Specialty|BCBSTX PPO|||||42.79||| J0561|ERX|0636|PENICILLIN G BENZ 600000|Tricare|TRICARE EAST REGION|||||50.29||| J0561|ERX|0636|PENICILLIN G BENZATHINE 1|Medicaid|MEDICAID|||||42.79||| J0561|ERX|0636|PENICILLIN G BENZ 600000|United Healthcare|UNITED HEALTHCARE|||||50.29||| J069|ERX|0636||United Healthcare|UNITED HEALTHCARE|||||72.25||| J069|ERX|0636||NON CONTRACTED|COMMERCIAL OTHER 1|||||72.25||| J069|ERX|0636||Medicaid|MORRIS COUNTY INDIGENT|||||72.25||| J069|ERX|0636||Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||72.25||| J0690|ERX|0636|CEFAZOLIN 2GM 50ML D5W|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|72.25||||72.25||| J0690|ERX|0636|CEFAZOLIN 2GM 50ML D5W|Managed Medicaid|MEDICAID SUPERIOR|||||72.25||| J0690|ERX|0636|CEFAZOLIN 2GM 50ML D5W|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||72.25||| J0690|ERX|0636|CEFAZOLIN 2GM 50ML D5W|Humana Medicare Advantage|HUMANA MA|||||72.25||| J0690|ERX|0636|CEFAZOLIN 2GM 50ML D5W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||72.25||| J0690|ERX|0636|CEFAZOLIN 2GM 50ML D5W|Blue Cross HMO Specialty|BCBSTX HMO|||||72.25||| J0690|ERX|0636|CEFAZOLIN 2GM 50ML D5W|Managed Medicaid|MEDICAID AMERIGROUP|||||72.25||| J0690|ERX|0636|CEFAZOLIN 2GM 50ML D5W|Aetna|AETNA PPO|||||72.25||| J0690|ERX|0636|CEFAZOLIN 2GM 50ML D5W|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|72.25||||||| J0690|ERX|0636|CEFAZOLIN 2GM 50ML D5W|Blue Cross PPO Specialty|BCBSTX PPO|72.25||||72.25||| J0690|ERX|0636|CEFAZOLIN 2GM 50ML D5W|Medicare|MEDICARE ACUTE|72.25||||72.25||| J0690|ERX|0636|CEFAZOLIN 2GM 50ML D5W|NON CONTRACTED|COMMERCIAL OTHER 1|||||72.25||| J0690|ERX|0636|CEFAZOLIN 2GM 50ML D5W|Tricare|TRICARE EAST REGION|||||72.25||| J0690|ERX|0636|CEFAZOLIN 2GM 50ML D5W|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||72.25||| J0690|ERX|0636|CEFAZOLIN 2GM 50ML D5W|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||72.25||| J0690|ERX|0636|CEFAZOLIN 2GM 50ML D5W|Workers Compensation|WORKERS COMPENSATION OTHER|||||72.25||| J0690|ERX|0636|CEFAZOLIN 2GM 50ML D5W|United Healthcare|UNITED HEALTHCARE|72.25||||||| J0690|ERX|0636|CEFAZOLIN 2GM 50ML D5W|United Healthcare|UNITED HEALTHCARE|||||72.25||| J0690|ERX|0636|CEFAZOLIN 2GM 50ML D5W|United Medicare Advantage|UHC MEDICARE GOLD MA|||||72.25||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|Veterans Affairs|VETERANS ADMINISTRATION|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|Tricare|TRICARE EAST REGION|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|Medicaid|MEDICAID TEXAS CHILDRENS|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|Medicaid|MEDICAID HMO|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|United Healthcare|UNITED HEALTHCARE|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|Medicaid|MEDICAID|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|Blue Cross HMO Specialty|BCBSTX HMO|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|Aetna|AETNA OTHER|3.74||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|Medicare|MEDICARE ACUTE|3.74||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|Blue Cross PPO Specialty|BCBSTX PPO|3.74||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|Cigna|CIGNA|3.74||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|Humana Medicare Advantage|HUMANA MA|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|Managed Medicare|WELLCARE CHOICE MA|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|Managed Medicare|HEALTHSPRING MA|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|Managed Medicare|BCBS MEDICARE PPO MA|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|Managed Medicaid|MEDICAID AMERIGROUP|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.74||| J0696|ERX|0250|CEFTRIAXONE 1 G VIAL|Managed Medicaid|MEDICAID SUPERIOR|3.74||||3.74||| J0834|ERX|0636|COSYNTROPIN 0.25MG VIAL|Medicare|MEDICARE ACUTE|549.97||||||| J0885|ERX|0636|EPOETIN 40000 UNIT/1ML|Medicare|MEDICARE ACUTE|134.86||||||| J1160|ERX|0636|DIGOXIN 250MCG 1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|38.28||||38.28||| J1160|ERX|0636|DIGOXIN 250MCG 1ML|Managed Medicaid|MEDICAID AMERIGROUP|38.28||||||| J1160|ERX|0636|DIGOXIN 250MCG 1ML|Cigna|CIGNA|||||38.28||| J1160|ERX|0636|DIGOXIN 250MCG 1ML|Humana Medicare Advantage|HUMANA MA|38.28||||38.28||| J1160|ERX|0636|DIGOXIN 250MCG 1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||38.28||| J1160|ERX|0636|DIGOXIN 250MCG 1ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|38.28||||||| J1160|ERX|0636|DIGOXIN 250MCG 1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|38.28||||38.28||| J1160|ERX|0636|DIGOXIN 250MCG 1ML|Medicare|MEDICARE ACUTE|38.28||||38.28||| J1364|ERX|0636|ERYTHROMYCIN 500MG/250ML|Blue Cross PPO Specialty|BCBSTX PPO|297.50||||||| J1410|ERX|0636|ESTROGENS,CONJUGATED 25MG|Tricare|TRICARE EAST REGION|||||840.75||| J1442|ERX|0636|FILGRASTIM 300MCG/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|7.06||||7.06||| J1568|ERX|0636|OCTAGAM (5%) 10 GM/200 ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||301.70||| J1568|ERX|0636|OCTAGAM (10%) 20 GM/200 M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1.90||| J1602|ERX|0636|GOLIMUMAB 12.5 MG/ML 4 ML|Medicare|MEDICARE ACUTE|||||138.42||| J1610|ERX|0250|GLUCAGON 1MG VIAL|Humana Medicare Advantage|HUMANA MA|||||891.50||| J1610|ERX|0250|GLUCAGON 1MG VIAL|Aetna|AETNA OTHER|||||891.50||| J1610|ERX|0250|GLUCAGON 1MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|||||891.50||| J1610|ERX|0250|GLUCAGON 1MG VIAL|Medicare|MEDICARE ACUTE|||||891.50||| J1610|ERX|0250|GLUCAGON 1MG VIAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||891.50||| J1745|ERX|0636|INFLIXIMAB 100MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|||||508.65||| J1756|ERX|0636|IRON SUCROSE COMPL. 100/M|United Medicare Advantage|UHC MEDICARE GOLD MA|427.50||||427.50||| J1756|ERX|0636|IRON SUCROSE COMPL. 100/M|Medicare|MEDICARE ACUTE|427.50||||427.50||| J1756|ERX|0636|IRON SUCROSE COMPL. 100/M|Medicaid|MEDICAID|||||427.50||| J1756|ERX|0636|IRON SUCROSE COMPL. 100/M|Managed Medicaid|MEDICAID AMERIGROUP|||||427.50||| J1756|ERX|0636|IRON SUCROSE COMPL. 100/M|Blue Cross PPO Specialty|BCBSTX PPO|||||427.50||| J1953|ERX|0636|LEVETIRACETAM 500MG IN 10|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||197.25||| J1953|ERX|0636|LEVETIRACETAM 500MG IN 10|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|197.25||||197.25||| J1953|ERX|0636|LEVETIRACETAM 500MG IN 10|Managed Medicaid|MEDICAID AMERIGROUP|||||197.25||| J1953|ERX|0636|LEVETIRACETAM 500MG IN 10|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||197.25||| J1953|ERX|0636|LEVETIRACETAM 500MG IN 10|Medicare|MEDICARE ACUTE|197.25||||197.25||| J1953|ERX|0636|LEVETIRACETAM 500MG IN 10|Medicaid|MEDICAID TEXAS CHILDRENS|||||197.25||| J1953|ERX|0636|LEVETIRACETAM 500MG IN 10|United Medicare Advantage|UHC MEDICARE GOLD MA|||||197.25||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|United Healthcare|UNITED HEALTHCARE|4.80||||||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|Veterans Affairs|VETERANS ADMINISTRATION|4.80||||||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|United Medicare Advantage|UHC MEDICARE GOLD MA|4.80||||||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|4.80||||||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|Medicare|MEDICARE ACUTE|4.80||||4.80||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.80||||||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.80||||||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|Humana Medicare Advantage|HUMANA MA|4.80||||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 HMO Specialty|BCBSTX HMO|4.80||||||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|4.80||||||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|Blue Cross PPO Specialty|BCBSTX PPO|4.80||||||| 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|0.16||||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|Blue Cross HMO Specialty|BCBSTX HMO|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Blue Cross HMO Specialty|BCBSTX HMO|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Aetna|AETNA PPO|||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Aetna|AETNA OTHER|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.16||||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|||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Access Direct Platinum|HEALTHFIRST TPA UMR|0.16||||||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Blue Cross PPO Specialty|BCBSTX PPO|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Blue Cross PPO Specialty|BCBSTX PPO|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Managed Medicaid|MEDICAID AMERIGROUP|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Managed Medicaid|MEDICAID SUPERIOR|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicaid|MEDICAID SUPERIOR|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|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 CIGNA HEALTHSPRING|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Cigna|CIGNA|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Cigna|CIGNA|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Managed Medicare|BCBS MEDICARE PPO MA|||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicare|BCBS MEDICARE PPO MA|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Humana Medicare Advantage|HUMANA MA|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Humana Medicare Advantage|HUMANA MA|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Medicare|MEDICARE ACUTE|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Medicare|MEDICARE ACUTE|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|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 2MG/ML SYRINGE|NON CONTRACTED|COMMERCIAL OTHER 1|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Cigna|CIGNA|||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicaid|MEDICAID AMERIGROUP|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|PHCS|HUMANA INSURANCE|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Tricare|TRICARE FOR LIFE|||||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 2MG/ML SYRINGE|Medicaid|MEDICAID TEXAS CHILDRENS|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|MORRIS COUNTY INDIGENT|||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Medicaid|MEDICAID|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Medicaid|MORRIS COUNTY INDIGENT|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Medicaid|MEDICAID BCBSTX|||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Medicaid|MEDICAID BCBSTX|||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Medicaid|MEDICAID|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Medicaid|MEDICAID TEXAS CHILDRENS|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Veterans Affairs|VETERANS ADMINISTRATION|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Veterans Affairs|VETERANS ADMINISTRATION|||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Veterans Affairs|VETERANS ADMINISTRATION|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Veterans Affairs|VETERANS ADMINISTRATION|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|United Healthcare|UNITED HEALTHCARE OTHER|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|United Healthcare|UNITED HEALTHCARE|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|United Healthcare|UNITED HEALTHCARE|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|0.16||||0.16||| J2270|ERX|0636|MORPHINE 4MG/ML VIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|0.16||||0.16||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.16||| J2274|ERX|0636|MORPHINE (PF) 1MG, 2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|118.50||||||| J235|ERX|0636||NON CONTRACTED|COMMERCIAL OTHER 1|||||166.50||| J2354|ERX|0636|OCTREOTIDE 100MCG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||166.50||| J2354|ERX|0636|OCTREOTIDE 100MCG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||166.50||| J2354|ERX|0636|OCTREOTIDE 100MCG/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||166.50||| J2354|ERX|0636|OCTREOTIDE 100MCG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|||||166.50||| J2354|ERX|0636|OCTREOTIDE 100MCG/1ML|Medicare|MEDICARE ACUTE|||||166.50||| 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|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|United Healthcare|UNITED HEALTHCARE|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 Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||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|UHC DUAL COMPLETE HMO SNP MA|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Medicare|MEDICARE ACUTE|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|NON CONTRACTED|COMMERCIAL OTHER 1|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|PHCS|HUMANA INSURANCE|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Tricare|TRICARE FOR LIFE|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Tricare|TRICARE EAST REGION|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Medicaid|MEDICAID TEXAS CHILDRENS|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Medicaid|MORRIS COUNTY INDIGENT|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Medicaid|MEDICAID BCBSTX|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Medicaid|MEDICAID|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|PHCS|GROUP AND PENSION|||||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|Aenta Medicare Advantage|AETNA MEDICARE MA|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Blue Cross HMO Specialty|BCBSTX HMO|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Aetna|AETNA PPO|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Aetna|AETNA OTHER|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|United Healthcare|TML GROUP BENEFITS|||||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 UMR|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|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|Workers Compensation|WORKERS COMPENSATION OTHER|||||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||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|ChampVA|CHAMPVA HEALTH ADMIN CENTER|||||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 SUPERIOR|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Managed Medicaid|MEDICAID AMERIGROUP|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|Cigna|CIGNA|16.80||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Managed Medicare|HEALTHSPRING MA|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Managed Medicare|BCBS MEDICARE PPO MA|||||16.80||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Humana Medicare Advantage|HUMANA MA|16.80||||16.80||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Managed Medicaid|MEDICAID AMERIGROUP|||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Managed Medicaid|MEDICAID SUPERIOR|66.75||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Cigna|CIGNA|||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Humana Medicare Advantage|HUMANA MA|66.75||||66.75||| J2704|ERX|0636|PROPOFOL 1000MG/100ML|Humana Medicare Advantage|HUMANA MA|66.75||||1.27||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Blue Cross HMO Specialty|BCBSTX HMO|||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Aetna|AETNA PPO|||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Aetna|AETNA OTHER|||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Access Direct Platinum|HEALTHFIRST TPA UMR|66.75||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Blue Cross PPO Specialty|BCBSTX PPO|66.75||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Blue Cross PPO Specialty|BCBSTX PPO|1.27||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||66.75||| J2704|ERX|0636|PROPOFOL 1000MG/100ML|Medicare|MEDICARE ACUTE|1.27||||1.27||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Medicare|MEDICARE ACUTE|66.75||||66.75||| J2704|ERX|0636|PROPOFOL 500MG/50ML|Medicare|MEDICARE ACUTE|66.75||||94.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|NON CONTRACTED|COMMERCIAL OTHER 1|66.75||||66.75||| J2704|ERX|0636|PROPOFOL 1000MG/100ML|NON CONTRACTED|COMMERCIAL OTHER 1|66.75||||1.27||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|66.75||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Tricare|TRICARE FOR LIFE|||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Tricare|TRICARE EAST REGION|1.27||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Tricare|TRICARE EAST REGION|66.75||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Medicaid|MEDICAID TEXAS CHILDRENS|66.75||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Medicaid|MEDICAID|66.75||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||66.75||| J2704|ERX|0636|PROPOFOL 1000MG/100ML|Medicaid|MEDICAID|66.75||||1.27||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|66.75||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Medicaid|MORRIS COUNTY INDIGENT|||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|Veterans Affairs|VETERANS ADMINISTRATION|||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|United Healthcare|UNITED HEALTHCARE|||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|United Healthcare|TML GROUP BENEFITS|||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|United Healthcare|UNITED HEALTHCARE OTHER|66.75||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|United Medicare Advantage|UHC MEDICARE GOLD MA|1.27||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||66.75||| J2704|ERX|0636|PROPOFOL 200MG/20ML|United Medicare Advantage|UHC MEDICARE GOLD MA|66.75||||66.75||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1,009.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Blue Cross PPO Specialty|BCBSTX PPO|||||1,009.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Humana Medicare Advantage|HUMANA MA|||||1,009.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,009.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,009.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1,009.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Managed Medicare|HEALTHSPRING MA|||||1,009.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1,009.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|United Healthcare|UNITED HEALTHCARE|||||1,009.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1,009.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,009.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1,009.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Medicare|MEDICARE ACUTE|||||1,009.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,009.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Tricare|TRICARE EAST REGION|||||1,009.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Medicaid|MORRIS COUNTY INDIGENT|||||1,009.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,009.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1,009.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Blue Cross HMO Specialty|BCBSTX HMO|||||1,009.50||| J2785|ERX|0636|REGADENOSON 0.4MG 5ML|Aetna|AETNA PPO|||||1,009.50||| J2792|ERX|0636|RHO(D) IMMUNEGLOB 1500 UN|United Healthcare|UNITED HEALTHCARE|||||177.75||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Managed Medicaid|MEDICAID SUPERIOR|||||453.25||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||453.25||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Cigna|CIGNA|||||453.25||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Humana Medicare Advantage|HUMANA MA|||||453.25||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||453.25||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Blue Cross HMO Specialty|BCBSTX HMO|||||453.25||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Aetna|AETNA PPO|||||453.25||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||453.25||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|||||453.25||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Medicare|MEDICARE ACUTE|||||453.25||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Tricare|TRICARE EAST REGION|||||453.25||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|Medicaid|MEDICAID|||||453.25||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||453.25||| J2805|ERX|0636|SINCALIDE 5MCG VIAL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||453.25||| J2997|ERX|0250|ALTEPLASE 2MG VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|329.08||||||| J2997|ERX|0636|ALTEPLASE 100MG IN 100ML|Medicare|MEDICARE ACUTE|||||254.49||| J2997|ERX|0250|ALTEPLASE 2MG VIAL|NON CONTRACTED|COMMERCIAL OTHER 1|329.08||||||| J2997|ERX|0250|ALTEPLASE 2MG VIAL|Medicare|MEDICARE ACUTE|329.08||||||| J2997|ERX|0250|ALTEPLASE 2MG VIAL|United Healthcare|UNITED HEALTHCARE|329.08||||||| J2997|ERX|0250|ALTEPLASE 2MG VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|329.08||||||| J2997|ERX|0250|ALTEPLASE 2MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|329.08||||||| J2997|ERX|0636|ALTEPLASE 100MG IN 100ML|Humana Medicare Advantage|HUMANA MA|||||254.49||| J2997|ERX|0250|ALTEPLASE 2MG VIAL|Humana Medicare Advantage|HUMANA MA|329.08||||||| J2997|ERX|0250|ALTEPLASE 2MG VIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|329.08||||||| J310|ERX|0636||Blue Cross PPO Specialty|BCBSTX PPO|||||413.02||| J310|ERX|0636||NON CONTRACTED|COMMERCIAL OTHER 1|||||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|Humana Medicare Advantage|HUMANA MA|413.02||||||| J3411|ERX|0250|THIAMINE 100 MG IN 100 ML|Humana Medicare Advantage|HUMANA MA|0.85||||0.85||| J3411|ERX|0250|THIAMINE 100 MG IN 100 ML|Managed Medicare|HEALTHSPRING MA|||||0.85||| J3411|ERX|0250|THIAMINE 100 MG IN 100 ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.85||||0.85||| J3411|ERX|0250|THIAMINE 100 MG IN 100 ML|Managed Medicaid|MEDICAID AMERIGROUP|0.85||||||| J3411|ERX|0250|THIAMINE 100 MG IN 100 ML|Medicare|MEDICARE ACUTE|||||0.85||| J3411|ERX|0250|THIAMINE 100 MG IN 100 ML|Medicaid|MEDICAID|0.85||||||| J3489|ERX|0636|ZOLEDRONIC ACID 5 MG/100M|Medicare|MEDICARE ACUTE|||||3,777.20||| J3490|ERX|0636|SOD CHL 0.9% KCL 20MEQ/10|Blue Cross PPO Specialty|BCBSTX PPO|74.75||||74.75||| J3490|ERX|0636|SOD CHL 0.9% KCL 20MEQ/10|Humana Medicare Advantage|HUMANA MA|74.75||||||| J3490|ERX|0636|SOD CHL 0.9% KCL 20MEQ/10|Managed Medicaid|MEDICAID UNITED HEALTHCARE|74.75||||||| J3490|ERX|0636|SOD CHL 0.9% KCL 20MEQ/10|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||74.75||| J3490|ERX|0636|SOD CHL 0.9% KCL 20MEQ/10|Cigna|CIGNA|||||74.75||| J3490|ERX|0636|SOD CHL 0.9% KCL 20MEQ/10|Cigna|CIGNA|74.75||||||| J3490|ERX|0636|SOD CHL 0.9% KCL 20MEQ/10|Medicare|MEDICARE ACUTE|74.75||||74.75||| J3490|ERX|0636|SOD CHL 0.9% KCL 20MEQ/10|Medicaid|MEDICAID|||||74.75||| J7050|ERX|0636|SODIUM CHLORIDE 0.9% 250M|United Healthcare|UNITED HEALTHCARE|153.25||||||| J7050|ERX|0636|SODIUM CHLORIDE 0.9% 250M|United Medicare Advantage|UHC MEDICARE GOLD MA|||||153.25||| J7050|ERX|0636|SODIUM CHLORIDE 0.9% 250M|Medicare|MEDICARE ACUTE|153.25||||153.25||| J7050|ERX|0636|SODIUM CHLORIDE 0.9% 250M|NON CONTRACTED|COMMERCIAL OTHER 1|153.25||||||| J7050|ERX|0636|SODIUM CHLORIDE 0.9% 250M|Humana Medicare Advantage|HUMANA MA|153.25||||153.25||| J7050|ERX|0636|SODIUM CHLORIDE 0.9% 250M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|153.25||||||| J7050|ERX|0636|SODIUM CHLORIDE 0.9% 250M|Managed Medicaid|MEDICAID SUPERIOR|153.25||||153.25||| J7050|ERX|0636|SODIUM CHLORIDE 0.9% 250M|Blue Cross HMO Specialty|BCBSTX HMO|153.25||||||| J7050|ERX|0636|SODIUM CHLORIDE 0.9% 250M|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|153.25||||||| J7050|ERX|0636|SODIUM CHLORIDE 0.9% 250M|Blue Cross PPO Specialty|BCBSTX PPO|153.25||||153.25||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|140.25||||||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|140.25||||||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|Humana Medicare Advantage|HUMANA MA|140.25||||||| J7060|ERX|0250|DEXTROSE 5%-WATER 100ML|Managed Medicaid|MEDICAID AMERIGROUP|140.25||||37.50||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|Medicare|MEDICARE ACUTE|37.50||||140.25||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|Medicare|MEDICARE ACUTE|140.25||||140.25||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|United Healthcare|UNITED HEALTHCARE|||||140.25||| J7060|ERX|0250|DEXTROSE 5%-WATER 250ML|Veterans Affairs|VETERANS ADMINISTRATION|140.25||||||| J7070|ERX|0250|DEX 5%-1/2NS KCL 20 MEQ 1|United Medicare Advantage|UHC MEDICARE GOLD MA|177.75||||74.75||| J7070|ERX|0250|DEXTROSE 5%-LR 1000ML|Tricare|TRICARE EAST REGION|188.25||||||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|Medicare|MEDICARE ACUTE|188.25||||188.25||| J7070|ERX|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Medicare|MEDICARE ACUTE|74.75||||74.75||| J7070|ERX|0250|DEXTROSE 5%-1/2 NS 1000ML|Medicare|MEDICARE ACUTE|188.25||||188.25||| J7070|ERX|0250|DEXTROSE 5%-WATER 1000ML|Medicare|MEDICARE ACUTE|177.75||||188.25||| J7070|ERX|0250|DEXTROSE 5%-WATER 1000ML|Medicaid|MEDICAID|188.25||||177.75||| J7070|ERX|0250|DEXTROSE 5%-1/2 NS 1000ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||188.25||| J7070|ERX|0250|DEXTROSE 5%-LR 1000ML|United Healthcare|UNITED HEALTHCARE|188.25||||||| J7070|ERX|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Humana Medicare Advantage|HUMANA MA|188.25||||74.75||| J7070|ERX|0250|DEXTROSE 5%-1/2 NS 1000ML|Medicaid|MEDICAID|188.25||||188.25||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|Humana Medicare Advantage|HUMANA MA|188.25||||188.25||| J7070|ERX|0250|DEXTROSE 5%-LR 1000ML|Managed Medicaid|MEDICAID SUPERIOR|188.25||||188.25||| J7070|ERX|0250|DEXTROSE 5%-1/2 NS 1000ML|Managed Medicaid|MEDICAID SUPERIOR|188.25||||188.25||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|Managed Medicaid|MEDICAID SUPERIOR|188.25||||188.25||| J7070|ERX|0250|DEXTROSE 5%-LR 1000ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|188.25||||188.25||| J7070|ERX|0250|DEXTROSE 5%-1/2 NS 1000ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|188.25||||188.25||| J7070|ERX|0250|DEXTROSE 5%-WATER 1000ML|Veterans Affairs|VETERANS ADMINISTRATION|177.75||||||| J7070|ERX|0250|DEXTROSE 5%-WATER 1000ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|177.75||||177.75||| J7070|ERX|0250|DEXTROSE 5%-1/2 NS 1000ML|Managed Medicaid|MEDICAID AMERIGROUP|74.75||||188.25||| J7070|ERX|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Managed Medicaid|MEDICAID SUPERIOR|188.25||||74.75||| J7070|ERX|0250|DEXTROSE 5%-LR 1000ML|Aenta Medicare Advantage|AETNA MEDICARE MA|188.25||||188.25||| J7070|ERX|0250|DEXTROSE 5%-1/2 NS 1000ML|Aenta Medicare Advantage|AETNA MEDICARE MA|188.25||||188.25||| J7070|ERX|0250|DEXTROSE 5%-1/2 NS 1000ML|Aetna|AETNA OTHER|188.25||||||| J7070|ERX|0250|DEXTROSE 5%-NS 1000ML|Blue Cross PPO Specialty|BCBSTX PPO|188.25||||||| J7070|ERX|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Blue Cross PPO Specialty|BCBSTX PPO|74.75||||||| J7070|ERX|0250|DEXTROSE 5%-1/2 NS 1000ML|Blue Cross PPO Specialty|BCBSTX PPO|188.25||||||| J7070|ERX|0250|DEXTROSE 5%-LR 1000ML|Blue Cross PPO Specialty|BCBSTX PPO|188.25||||||| J7070|ERX|0250|DEXTROSE 5%-LR 1000ML|Cigna|CIGNA|188.25||||||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Aenta Medicare Advantage|AETNA MEDICARE MA|188.25||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Access Direct Platinum|HEALTHFIRST TPA UMR|188.25||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|188.25||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|188.25||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Blue Cross HMO Specialty|BCBSTX HMO|188.25||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Aetna|AETNA PPO|||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Blue Cross PPO Specialty|BCBSTX PPO|188.25||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|188.25||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Cigna|CIGNA|188.25||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Humana Medicare Advantage|HUMANA MA|188.25||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Managed Medicare|HEALTHSPRING MA|188.25||||||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Managed Medicaid|MEDICAID SUPERIOR|188.25||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|188.25||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|188.25||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Managed Medicaid|MEDICAID AMERIGROUP|188.25||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|NON CONTRACTED|COMMERCIAL OTHER 1|188.25||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|PHCS|MERITAIN HEALTH|||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Tricare|TRICARE EAST REGION|188.25||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Medicare|MEDICARE ACUTE|188.25||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Aetna|AETNA OTHER|||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|188.25||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|United Healthcare|TML GROUP BENEFITS|||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Medicaid|MEDICAID TEXAS CHILDRENS|188.25||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|United Healthcare|UNITED HEALTHCARE OTHER|188.25||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|United Healthcare|UNITED HEALTHCARE|188.25||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Medicaid|MEDICAID|188.25||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Medicaid|MORRIS COUNTY INDIGENT|||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Veterans Affairs|VETERANS ADMINISTRATION|188.25||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|Veterans Affairs|VETERANS ADMINISTRATION|||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|United Medicare Advantage|UHC MEDICARE GOLD MA|188.25||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|188.25||||188.25||| J7120|ERX|0250|LACTATED RINGERS 1000ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|188.25||||188.25||| J7613|ERX|0636|ALBUTEROL 0.021% 0.63MG/3|Medicare|MEDICARE ACUTE|0.05||||||| J7613|ERX|0636|ALBUTEROL 0.021% 0.63MG/3|Managed Medicaid|MEDICAID SUPERIOR|0.05||||0.05||| J7613|ERX|0636|ALBUTEROL 0.021% 0.63MG/3|Managed Medicaid|MEDICAID AMERIGROUP|0.05||||||| J9310|ERX|0636|RITUXIMAB 500MG/50ML|Humana Medicare Advantage|HUMANA MA|||||328.83||| L0172|EAP|0274|STIFF NECK CERVICAL COLLA|Veterans Affairs|VETERANS ADMINISTRATION|||||53.25||| L0172|EAP|0274|STIFF NECK CERVICAL COLLA|Blue Cross PPO Specialty|BCBSTX PPO|||||53.25||| L0172|EAP|0274|STIFF NECK CERVICAL COLLA|Cigna|CIGNA|||||53.25||| L0172|EAP|0274|STIFF NECK CERVICAL COLLA|Humana Medicare Advantage|HUMANA MA|||||53.25||| L0172|EAP|0274|STIFF NECK CERVICAL COLLA|Managed Medicaid|MEDICAID AMERIGROUP|||||53.25||| L0172|EAP|0274|STIFF NECK CERVICAL COLLA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||53.25||| L1830|EAP|0274|KNEE IMMOBILIZER|Humana Medicare Advantage|HUMANA MA|||||0.83||| L1830|EAP|0274|KNEE IMMOBILIZER|Managed Medicaid|MEDICAID SUPERIOR|||||0.83||| L1830|EAP|0274|KNEE IMMOBILIZER|Blue Cross HMO Specialty|BCBSTX HMO|||||0.83||| L1830|EAP|0274|KNEE IMMOBILIZER|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.83||| L1830|EAP|0274|KNEE IMMOBILIZER|Medicare|MEDICARE ACUTE|0.83||||0.83||| L1830|EAP|0274|KNEE IMMOBILIZER|Medicaid|MEDICAID TEXAS CHILDRENS|||||0.83||| L1830|EAP|0274|KNEE IMMOBILIZER|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.83||| L1830|EAP|0274|KNEE IMMOBILIZER|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.83||| L3808|EAP|0274|COCKUP SPLINT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.83||| L3808|EAP|0274|COCKUP SPLINT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.83||| L3808|EAP|0274|COCKUP SPLINT|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.83||| L3808|EAP|0274|COCKUP SPLINT|Medicare|MEDICARE ACUTE|0.83||||0.83||| L3808|EAP|0274|COCKUP SPLINT|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.83||| L3808|EAP|0274|COCKUP SPLINT|Medicaid|MEDICAID TEXAS CHILDRENS|||||0.83||| L3808|EAP|0274|COCKUP SPLINT|Blue Cross PPO Specialty|BCBSTX PPO|||||0.83||| L3808|EAP|0274|COCKUP SPLINT|Humana Medicare Advantage|HUMANA MA|||||0.83||| L3808|EAP|0274|COCKUP SPLINT|Managed Medicaid|MEDICAID SUPERIOR|||||0.83||| L3808|EAP|0274|COCKUP SPLINT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.83||| L3808|EAP|0274|COCKUP SPLINT|Managed Medicaid|MEDICAID AMERIGROUP|||||0.83||| L8699|EAP|0272||Managed Medicaid|MEDICAID SUPERIOR|||||53.25||| L8699|EAP|0272||Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||53.25||| L8699|EAP|0272||Blue Cross PPO Specialty|BCBSTX PPO|||||53.25||| L8699|EAP|0272||Tricare|TRICARE EAST REGION|||||53.25||| L8699|EAP|0272||Medicare|MEDICARE ACUTE|||||53.25||| P9016|EAP|0381|RBC LEUKOCYTES REDUCED|United Healthcare|UNITED HEALTHCARE|543.40||||375.50||| P9016|EAP|0381|BLOOD/UNIT RED BLOOD CELL|Veterans Affairs|VETERANS ADMINISTRATION|||||543.40||| P9016|EAP|0381|BLOOD/UNIT RED BLOOD CELL|Veterans Affairs|VETERANS ADMINISTRATION|||||4.18||| P9016|EAP|0381|RBC LEUKOCYTES REDUCED|United Medicare Advantage|UHC MEDICARE GOLD MA|375.50||||4.18||| P9016|EAP|0381|BLOOD/UNIT RED BLOOD CELL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.18||| P9016|EAP|0381|BLOOD/UNIT RED BLOOD CELL|United Medicare Advantage|UHC MEDICARE GOLD MA|4.18||||4.18||| P9016|EAP|0381|BLOOD/UNIT RED BLOOD CELL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||4.18||| P9016|EAP|0381|BLOOD/UNIT RED BLOOD CELL|NON CONTRACTED|COMMERCIAL OTHER 1|||||543.40||| P9016|EAP|0381|BLOOD/UNIT RED BLOOD CELL|Medicaid|MEDICAID|||||4.18||| P9016|EAP|0381|BLOOD/UNIT RED BLOOD CELL|Tricare|TRICARE EAST REGION|||||543.40||| P9016|EAP|0381|RBC LEUKOCYTES REDUCED|Medicare|MEDICARE ACUTE|543.40||||375.50||| P9016|EAP|0381|BLOOD/UNIT RED BLOOD CELL|Medicare|MEDICARE ACUTE|543.40||||543.40||| P9016|EAP|0381|BLOOD/UNIT RED BLOOD CELL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4.18||| P9016|EAP|0381|BLOOD/UNIT RED BLOOD CELL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||543.40||| P9016|EAP|0381|BLOOD/UNIT RED BLOOD CELL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||543.40||| P9016|EAP|0381|RBC LEUKOCYTES REDUCED|Blue Cross PPO Specialty|BCBSTX PPO|375.50||||4.18||| P9016|EAP|0381|BLOOD/UNIT RED BLOOD CELL|Blue Cross PPO Specialty|BCBSTX PPO|4.18||||4.18||| P9016|EAP|0381|BLOOD/UNIT RED BLOOD CELL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||480.70||| P9016|EAP|0381|BLOOD/UNIT RED BLOOD CELL|Managed Medicaid|MEDICAID SUPERIOR|4.18||||4.18||| P9016|EAP|0381|BLOOD/UNIT RED BLOOD CELL|Managed Medicaid|MEDICAID AMERIGROUP|||||543.40||| P9016|EAP|0381|BLOOD/UNIT RED BLOOD CELL|Cigna|CIGNA|||||4.18||| P9016|EAP|0381|RBC LEUKOCYTES REDUCED|Humana Medicare Advantage|HUMANA MA|4.18||||375.50||| P9016|EAP|0381|BLOOD/UNIT RED BLOOD CELL|Humana Medicare Advantage|HUMANA MA|4.18||||4.18||| P9016|EAP|0381|BLOOD/UNIT RED BLOOD CELL|Managed Medicare|HEALTHSPRING MA|4.18||||||| P9019|EAP|0384|PLATELET CONCENTRATE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.75||||||| P9019|EAP|0384|PLATELET CONCENTRATE|Blue Cross PPO Specialty|BCBSTX PPO|||||7.75||| P9019|EAP|0384|PLATELET CONCENTRATE|Medicare|MEDICARE ACUTE|1,007.50||||7.75||| P9031|EAP|0384|PLATELETS LEUKOCYTES REDU|Medicare|MEDICARE ACUTE|||||2.09||| P9031|EAP|0384|PLATELETS LEUKOCYTES REDU|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.09||||||| P9031|EAP|0384|PLATELETS LEUKOCYTES REDU|Blue Cross PPO Specialty|BCBSTX PPO|2.09||||2.09||| P9037|EAP|0384|PLATE PHERES LEUKOREDU IR|Blue Cross PPO Specialty|BCBSTX PPO|17.43||||17.43||| P9045|ERX|0636|ALBUMIN 5% 12.5 G 250ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||821.75||| P9045|ERX|0636|ALBUMIN 5% 12.5 G 250ML|Blue Cross PPO Specialty|BCBSTX PPO|821.75||||||| P9047|ERX|0250|ALBUMIN 25% 12.5G/50ML|United Medicare Advantage|UHC MEDICARE GOLD MA|1,155.75||||||| P9047|ERX|0250|ALBUMIN 25% 12.5G/50ML|Medicare|MEDICARE ACUTE|1,155.75||||1,155.75||| P9047|ERX|0250|ALBUMIN 25% 12.5G/50ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,155.75||| P9048|EAP|0382|PLASMA PER 250 ML|Managed Medicaid|MEDICAID AMERIGROUP|166.50||||||| P9048|EAP|0382|PLASMA PER 250 ML|Humana Medicare Advantage|HUMANA MA|166.50||||||| P9048|EAP|0382|PLASMA PER 250 ML|Medicare|MEDICARE ACUTE|||||166.50||| Q2009|ERX|0636|FOSPHENYTOIN 500MG/100 ML|Medicare|MEDICARE ACUTE|||||1.16||| Q2009|ERX|0636|FOSPHENYTOIN 500MG/10ML V|Medicare|MEDICARE ACUTE|||||1.16||| Q2009|ERX|0636|FOSPHENYTOIN 500MG/100 ML|Aetna|AETNA OTHER|||||1.16||| Q2009|ERX|0636|FOSPHENYTOIN 500MG/10ML V|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.16||| Q2009|ERX|0636|FOSPHENYTOIN 500MG/10ML V|Managed Medicaid|MEDICAID SUPERIOR|||||1.16||| Q2009|ERX|0636|FOSPHENYTOIN 500MG/10ML V|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.16||||1.16||| Q2009|ERX|0636|FOSPHENYTOIN 500MG/100 ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|33.60||||1.16||| Q4118|EAP|0636|MICROMATRIX 1000 MG|NON CONTRACTED|COMMERCIAL OTHER 1|||||114.12||| Q4118|EAP|0636|CYTAL WOUND MATRIX 3 LAYE|NON CONTRACTED|COMMERCIAL OTHER 1|||||44.53||| Q4186|EAP|0278|EPIFIX 5X6 CM|Medicare|MEDICARE ACUTE|||||539.50||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Humana Medicare Advantage|HUMANA MA|||||4.35||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.35||||||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.35||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Blue Cross HMO Specialty|BCBSTX HMO|||||4.35||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Aetna|AETNA OTHER|||||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|Blue Cross PPO Specialty|BCBSTX PPO|||||4.35||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.35||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Medicare|MEDICARE ACUTE|4.35||||4.35||| Q9965|EAP|0636|XR ISOVUE 300 PER ML|Medicare|MEDICARE ACUTE|||||0.09||| Q9965|EAP|0636|XR ISOVUE 300 PER ML|Medicaid|MEDICAID|||||0.09||| Q9965|EAP|0636|XR ISOVUE 300 PER ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.09||| Q9965|EAP|0636|XR ISOVUE 300 PER ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.09||| Q9965|EAP|0636|XR ISOVUE 300 PER ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.09||||||| Q9965|EAP|0636|XR ISOVUE 300 PER ML|Blue Cross PPO Specialty|BCBSTX PPO|||||0.09||| Q9965|EAP|0636|XR ISOVUE 300 PER ML|Humana Medicare Advantage|HUMANA MA|||||0.09||| Q9965|EAP|0636|XR ISOVUE 300 PER ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.09||| Q9965|EAP|0636|XR ISOVUE 300 PER ML|Managed Medicaid|MEDICAID SUPERIOR|||||0.09||| Q9965|EAP|0636|XR ISOVUE 300 PER ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.09||| Q9965|EAP|0636|XR ISOVUE 300 PER ML|Managed Medicaid|MEDICAID AMERIGROUP|0.09||||||| Q9965|EAP|0636|XR ISOVUE 300 PER ML|Cigna|CIGNA|||||0.09||| Q9967|EAP|0255|ISOVUE 300M 15ML VIAL/ML|Humana Medicare Advantage|HUMANA MA|||||2.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|10.75||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Managed Medicaid|MEDICAID SUPERIOR|10.75||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|10.75||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Managed Medicaid|MEDICAID AMERIGROUP|10.75||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Managed Medicare|HEALTHSPRING MA|||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||10.75||| Q9967|EAP|0255|ISOVUE 300M 15ML VIAL/ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.75||| Q9967|EAP|0255|ISOVUE 300M 15ML VIAL/ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.75||| Q9967|EAP|0255|ISOVUE 300M 15ML VIAL/ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.75||| Q9967|EAP|0255|ISOVUE 300M 15ML VIAL/ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Aenta Medicare Advantage|AETNA MEDICARE MA|10.75||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Blue Cross HMO Specialty|BCBSTX HMO|10.75||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Aetna|AETNA OTHER|||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|10.75||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Access Direct Platinum|HEALTHFIRST TPA UMR|||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|10.75||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|10.75||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Blue Cross PPO Specialty|BCBSTX PPO|10.75||||10.75||| Q9967|EAP|0255|ISOVUE 300M 15ML VIAL/ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.75||| Q9967|EAP|0255|ISOVUE 300M 15ML VIAL/ML|Blue Cross PPO Specialty|BCBSTX PPO|||||2.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Veterans Affairs|VETERANS ADMINISTRATION|10.75||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Veterans Affairs|VETERANS ADMINISTRATION|||||10.75||| Q9967|EAP|0255|ISOVUE 300M 15ML VIAL/ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|10.75||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|United Healthcare|UNITED HEALTHCARE|||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|United Healthcare|TML GROUP BENEFITS|||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|United Healthcare|UNITED HEALTHCARE OTHER|10.75||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Cigna|CIGNA|10.75||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|United Medicare Advantage|UHC MEDICARE GOLD MA|10.75||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|10.75||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Medicare|MEDICARE ACUTE|10.75||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|NON CONTRACTED|ZZZZZ LIABILITY INS OTHER 1|||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|NON CONTRACTED|COMMERCIAL OTHER 1|10.75||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|PHCS|HUMANA INSURANCE|||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|PHCS|GROUP AND PENSION|||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Humana Medicare Advantage|HUMANA MA|10.75||||10.75||| Q9967|EAP|0255|ISOVUE 300M 15ML VIAL/ML|Medicare|MEDICARE ACUTE|||||2.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Tricare|TRICARE EAST REGION|10.75||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Medicaid|MORRIS COUNTY INDIGENT|||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Medicaid|MEDICAID TEXAS CHILDRENS|10.75||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Medicaid|MEDICAID HMO|||||10.75||| Q9967|EAP|0636|XR ISOVUE 370 PER ML|Medicaid|MEDICAID|||||10.75||| Q9967|EAP|0255|ISOVUE 300M 15ML VIAL/ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.75||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Medicaid|MEDICAID|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Medicaid|MORRIS COUNTY INDIGENT|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Tricare|TRICARE EAST REGION|0.25||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.25||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|United Healthcare|UNITED HEALTHCARE|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Medicare|MEDICARE ACUTE|0.25||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.25||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Blue Cross HMO Specialty|BCBSTX HMO|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Aetna|AETNA PPO|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Blue Cross PPO Specialty|BCBSTX PPO|0.25||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Managed Medicaid|MEDICAID SUPERIOR|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Humana Medicare Advantage|HUMANA MA|0.25||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Cigna|CIGNA|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Managed Medicare|HEALTHSPRING MA|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.25||| U0001|EAP|0300|COVID - 19PCR|Managed Medicaid|MEDICAID SUPERIOR|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Humana Medicare Advantage|HUMANA MA|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Aenta Medicare Advantage|AETNA MEDICARE MA|1.80||||||| U0001|EAP|0300|COVID - 19PCR|Blue Cross HMO Specialty|BCBSTX HMO|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Blue Cross PPO Specialty|BCBSTX PPO|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Cigna|CIGNA|1.80||||1.80||| U0001|EAP|0300|COVID - 19PCR|Veterans Affairs|VETERANS ADMINISTRATION|||||1.80||| U0001|EAP|0300|COVID - 19PCR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.80||| U0001|EAP|0300|COVID - 19PCR|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Medicare|MEDICARE ACUTE|1.80||||1.80||| U0001|EAP|0300|COVID - 19PCR|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.80||| U0001|EAP|0300|COVID - 19PCR|United Healthcare|UNITED HEALTHCARE|||||1.80||| 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|Tricare|TRICARE EAST REGION|||||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|MORRIS COUNTY INDIGENT|||||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|||||1.54||| 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|United Healthcare|UNITED HEALTHCARE 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|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||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||| 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 MEDICARE SOLUTIONS MA|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||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 HMO Specialty|BCBSTX HMO|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Veterans Affairs|VETERANS ADMINISTRATION|||||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|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||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|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||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|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Access Direct Platinum|HEALTHFIRST TPA UMR|||||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|Blue Cross PPO Specialty|BCBSTX PPO|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||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|Cigna|CIGNA|||||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||| 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|Humana Medicare Advantage|HUMANA MA|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Managed Medicare|BCBS MEDICARE PPO MA|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Managed Medicare|HEALTHSPRING MA|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.54|||