"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" 10005|EAP|0361|US FNA 1ST LESION ULTRASO|Medicare|MEDICARE ACUTE|26.16||||||| 10030|EAP|0481|GUIDE CATHET FLUID DRAINA|Medicare|MEDICARE ACUTE|12.52||||||| 10160|EAP|0361|CT PUNCT ASP ABSC/CYST/HE|Medicare|MEDICARE ACUTE|563.50||||||| 157|DRG||DENTAL & ORAL DISEASES W MCC|Medicare|MEDICARE ACUTE|4,414.09|27560.05|27560.05|27560.05|||| 163|DRG||MAJOR CHEST PROCEDURES W MCC|Medicare|MEDICARE ACUTE|427,290.65|39984.22|83866.07|1127|||| 163|DRG||MAJOR CHEST PROCEDURES W MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,167,201.76|1127|83866.07|1127|||| 163|DRG||MAJOR CHEST PROCEDURES W MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|759,650.53|67214.21|83866.07|1127|||| 163|DRG||MAJOR CHEST PROCEDURES W MCC|Humana Medicare Advantage|HUMANA MA|560,779.37|83866.07|83866.07|1127|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|990.81|103.5|19425.12|92|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Humana Medicare Advantage|HUMANA MA|155,675.25|19425.12|19425.12|92|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Blue Cross PPO Specialty|BCBSTX PPO|134,881.75|92|19425.12|92|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|105,242.23|10203.63|19425.12|92|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Medicare|MEDICARE ACUTE|1,353.31|14981.81|19425.12|92|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|136,194.75|12908.39|19425.12|92|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|90,306.80|17548.99|19425.12|92|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Blue Cross HMO Specialty|BCBSTX HMO|204,887.98|178.25|19425.12|92|||| 178|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W CC|Medicare|MEDICARE ACUTE|24,748.35|3814.33|3814.33|3814.33|||| 179|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W/O CC/MCC|Medicare|MEDICARE ACUTE|392.20|5859.87|5859.87|5859.87|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Medicare|MEDICARE ACUTE|217,789.83|20590.59|50038.1|253|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Blue Cross HMO Specialty|BCBSTX HMO|306,177.55|253|50038.1|253|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Blue Cross PPO Specialty|BCBSTX PPO|373,997.25|408|50038.1|253|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Humana Medicare Advantage|HUMANA MA|105,017.78|9677.02|50038.1|253|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Managed Medicare|HEALTHSPRING MA|636,545.45|50038.1|50038.1|253|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Medicare|MEDICARE ACUTE|220.22|3546.45|3546.45|3546.45|||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|Medicare|MEDICARE ACUTE|121,289.75|12793.67|12793.67|12793.67|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Medicare|MEDICARE ACUTE|90,931.10|10547.38|10547.38|10547.38|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|Humana Medicare Advantage|HUMANA MA|494,351.07|33404.6|33404.6|33404.6|||| 196|DRG||INTERSTITIAL LUNG DISEASE W MCC|Medicare|MEDICARE ACUTE|1,379.93|11540.4|11540.4|11540.4|||| 20610|EAP|0361|XR JOINT ASPIRATION|Medicare|MEDICARE ACUTE|9.43||||||| 207|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS|Medicare|MEDICARE ACUTE|608,041.39|69015.04|147185.97|310.25|||| 207|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS|Aenta Medicare Advantage|AETNA MEDICARE MA|335,826.83|33127.74|147185.97|310.25|||| 207|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|582,528.29|310.25|147185.97|310.25|||| 207|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS|Medicaid|MEDICAID|1,160,077.71|23092.49|147185.97|310.25|||| 207|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS|Texas Workforce Commission|DIS DETER SERV (DDS)|2,259.26|2259.26|147185.97|310.25|||| 207|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS|PHCS|HUMANA INSURANCE|2,133.13|147185.97|147185.97|310.25|||| 207|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS|Aetna|AETNA OTHER|447,850.50|79642.5|147185.97|310.25|||| 207|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS|Humana Medicare Advantage|HUMANA MA|474,175.31|43337.45|147185.97|310.25|||| 207|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS|Blue Cross PPO Specialty|BCBSTX PPO|732,384.35|504|147185.97|310.25|||| 207|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS|Managed Medicare|BCBS MEDICARE PPO MA|270,699.63|23410.85|147185.97|310.25|||| 208|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS|Medicare|MEDICARE ACUTE|140,955.03|12166.055|41963.76|1780.69|||| 208|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS|Medicare|MEDICARE PART B ONLY IP|47,472.70|1780.69|41963.76|1780.69|||| 208|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS|Humana Medicare Advantage|HUMANA MA|380,980.25|41963.76|41963.76|1780.69|||| 21550|EAP|0350|CT BIOPSY SOFT TISS NECK/|Medicare|MEDICARE ACUTE|25.66||||||| 270|DRG||OTHER MAJOR CARDIOVASCULAR PROCEDURES W MCC|Medicare|MEDICARE ACUTE|726,799.61|58548.23|58548.23|58548.23|||| 280|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC|Medicare|MEDICARE ACUTE|465,243.08|23498.45|23498.45|23498.45|||| 286|DRG||CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH W MCC|Medicare|MEDICARE ACUTE|179,444.75|19940.9|19940.9|19940.9|||| 288|DRG||ACUTE & SUBACUTE ENDOCARDITIS W MCC|Medicare|MEDICARE ACUTE|366,594.50|27629.41|27629.41|27629.41|||| 289|DRG||ACUTE & SUBACUTE ENDOCARDITIS W CC|Medicare|MEDICARE ACUTE|356,497.98|20699.04|20699.04|20699.04|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Medicare|MEDICARE ACUTE|225,479.50|22413.08|22413.08|22413.08|||| 292|DRG||HEART FAILURE & SHOCK W CC|Medicare|MEDICARE ACUTE|98,470.60|6344.73|6344.73|6344.73|||| 299|DRG||PERIPHERAL VASCULAR DISORDERS W MCC|Medicare|MEDICARE ACUTE|365,526.78|31147.7|31147.7|31147.7|||| 3|DRG||ECMO OR TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O.R.|Medicare|MEDICARE ACUTE|1,020,263.25|128952.215|128952.215|128952.215|||| 306|DRG||CARDIAC CONGENITAL & VALVULAR DISORDERS W MCC|Medicare|MEDICARE ACUTE|276,058.71|23641.345|23641.345|23641.345|||| 314|DRG||OTHER CIRCULATORY SYSTEM DIAGNOSES W MCC|Medicare|MEDICARE ACUTE|272,857.25|24210.59|24210.59|24210.59|||| 315|DRG||OTHER CIRCULATORY SYSTEM DIAGNOSES W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,900.99|161|17765.83|161|||| 315|DRG||OTHER CIRCULATORY SYSTEM DIAGNOSES W CC|Medicare|MEDICARE ACUTE|337,380.50|17765.83|17765.83|161|||| 315|DRG||OTHER CIRCULATORY SYSTEM DIAGNOSES W CC|United Healthcare|UNITED HEALTHCARE OTHER|226,908.10|9695.27|17765.83|161|||| 31500|EAP|0361|INTUBATION ASSIST|Medicare|MEDICARE ACUTE|3.04||||||| 31500|EAP|0361|INTUBATION ASSIST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.04||||||| 31622|EAP|0410|BRONCH PERC TRACH|Humana Medicare Advantage|HUMANA MA|3,496.94||||||| 31622|EAP|0410|BRONCH PERC TRACH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|32.99||||||| 31622|EAP|0410|BRONCH PERC TRACH|Medicare|MEDICARE ACUTE|3,496.94||||||| 31624|EAP|0410|BRONCH BAL|Medicare|MEDICARE ACUTE|30.46||||||| 31624|EAP|0410|BRONCH BAL|Aenta Medicare Advantage|AETNA MEDICARE MA|3,228.76||||||| 31624|EAP|0410|BRONCH BAL|Managed Medicare|BCBS MEDICARE PPO MA|30.46||||||| 31624|EAP|0410|BRONCH BAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|30.46||||||| 31624|EAP|0410|BRONCH BAL|Humana Medicare Advantage|HUMANA MA|3,228.76||||||| 31624|EAP|0410|BRONCH BAL|Medicaid|MEDICAID|30.46||||||| 31628|EAP|0320|BRONCHOSCOPY|Medicare|MEDICARE ACUTE|9.30||||||| 31641|EAP|0361|BRONCHOSCOPY AEX GEN TUMO|Humana Medicare Advantage|HUMANA MA|7,188.84||||||| 32555|EAP|0400|THOROCENTESIS/CHEST RT|Medicare|MEDICARE ACUTE|14.74||||||| 32555|EAP|0361|THORACENTESIS/CHEST LT|Medicare|MEDICARE ACUTE|14.74||||||| 356|DRG||OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W MCC|Medicare|MEDICARE ACUTE|734,408.31|48042.83|48042.83|30965.03|||| 356|DRG||OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W MCC|Access Direct Platinum|HEALTHFIRST TPA|1,114,901.85|30965.03|48042.83|30965.03|||| 36415|EAP|0300|VENIPUNCTURE|Texas Workforce Commission|DIS DETER SERV (DDS)|0.82||||||| 36415|EAP|0300|VENIPUNCTURE|Managed Medicare|BCBS MEDICARE PPO MA|0.82||||||| 36415|EAP|0300|VENIPUNCTURE|PHCS|HUMANA INSURANCE|0.82||||||| 36415|EAP|0300|VENIPUNCTURE|United Medicare Advantage|UHC AARP WELLMED HMO MA|0.82||||||| 36415|EAP|0300|VENIPUNCTURE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.82||||||| 36415|EAP|0300|VENIPUNCTURE|Cigna|CIGNA OTHER|0.82||||||| 36415|EAP|0300|VENIPUNCTURE|Managed Medicare|HEALTHSPRING MA|0.82||||||| 36415|EAP|0300|VENIPUNCTURE|Tricare|TRICARE FOR LIFE|0.82||||||| 36415|EAP|0300|VENIPUNCTURE|Medicaid|MEDICAID|0.82||||||| 36415|EAP|0300|VENIPUNCTURE|Medicare|MEDICARE PART B ONLY IP|0.82||||||| 36415|EAP|0300|VENIPUNCTURE|Access Direct Platinum|HEALTHFIRST TPA|0.82||||||| 36415|EAP|0300|VENIPUNCTURE|Humana Medicare Advantage|HUMANA MA|0.82||||||| 36415|EAP|0300|VENIPUNCTURE|United Healthcare|UNITED HEALTHCARE OTHER|0.82||||||| 36415|EAP|0300|VENIPUNCTURE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.82||||||| 36415|EAP|0300|VENIPUNCTURE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.82||||||| 36415|EAP|0300|VENIPUNCTURE|Blue Cross HMO Specialty|BCBSTX HMO|0.82||||||| 36415|EAP|0300|VENIPUNCTURE|Blue Cross PPO Specialty|BCBSTX PPO|0.82||||||| 36415|EAP|0300|VENIPUNCTURE|Workers Compensation|WORKERS COMPENSATION OTHER|0.82||||||| 36415|EAP|0300|VENIPUNCTURE|Aenta Medicare Advantage|AETNA MEDICARE MA|0.82||||||| 36415|EAP|0300|VENIPUNCTURE|Aetna|AETNA OTHER|0.82||||||| 36415|EAP|0300|VENIPUNCTURE|Medicare|MEDICARE ACUTE|0.82||||||| 36415|EAP|0300|VENIPUNCTURE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|0.82||||||| 36415|EAP|0300|VENIPUNCTURE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.82||||||| 36415|EAP|0300|VENIPUNCTURE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.82||||||| 36556|EAP|0361|INS NON TUN CVAC OVR 5YO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|26.75||||||| 36556|EAP|0361|INS NON TUN CVAC OVR 5YO|Humana Medicare Advantage|HUMANA MA|26.75||||||| 36556|EAP|0361|INS NON TUN CVAC OVR 5YO|Medicare|MEDICARE ACUTE|26.75||||||| 36556|EAP|0361|INS NON TUN CVAC OVR 5YO|United Medicare Advantage|UHC MEDICARE GOLD MA|26.75||||||| 36573|EAP|0761|PICC LINE >5YRS W/IMAGING|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|29.49||||||| 36573|EAP|0761|PICC LINE >5YRS W/IMAGING|Medicaid|MEDICAID|29.49||||||| 36573|EAP|0761|PICC LINE >5YRS W/IMAGING|Medicare|MEDICARE ACUTE|29.49||||||| 36573|EAP|0761|PICC LINE >5YRS W/IMAGING|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|29.49||||||| 36573|EAP|0761|PICC LINE >5YRS W/IMAGING|Aenta Medicare Advantage|AETNA MEDICARE MA|29.49||||||| 36573|EAP|0761|PICC LINE >5YRS W/IMAGING|Humana Medicare Advantage|HUMANA MA|29.49||||||| 36573|EAP|0761|PICC LINE >5YRS W/IMAGING|Blue Cross PPO Specialty|BCBSTX PPO|29.49||||||| 36573|EAP|0761|PICC LINE >5YRS W/IMAGING|Managed Medicare|HEALTHSPRING MA|29.49||||||| 36589|EAP|0361|REM TUN CVC WO PORT/PUMP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|26.75||||||| 36589|EAP|0361|REM TUN CVC WO PORT/PUMP|Humana Medicare Advantage|HUMANA MA|26.75||||||| 369|DRG||MAJOR ESOPHAGEAL DISORDERS W CC|Aetna|AETNA OTHER|109,037.25|387.75|387.75|387.75|||| 36905|EAP|0323|THRMBC/NFS DIALYSIS CIRCU|Medicare|MEDICARE ACUTE|376.91||||||| 371|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC|Medicare|MEDICARE ACUTE|315,351.70|25854.145|34939.52|448.5|||| 371|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC|United Medicare Advantage|UHC AARP WELLMED HMO MA|407,915.26|34598.67|34939.52|448.5|||| 371|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|443,757.58|448.5|34939.52|448.5|||| 371|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC|Humana Medicare Advantage|HUMANA MA|370,067.92|34939.52|34939.52|448.5|||| 371|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|856,631.36|13951.27|34939.52|448.5|||| 372|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC|Medicare|MEDICARE ACUTE|1,105.75|10333.28|10333.28|218.5|||| 372|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|233,615.10|218.5|10333.28|218.5|||| 374|DRG||DIGESTIVE MALIGNANCY W MCC|Medicare|MEDICARE ACUTE|248,712.96|26956.305|26956.305|26956.305|||| 380|DRG||COMPLICATED PEPTIC ULCER W MCC|Medicare|MEDICARE ACUTE|378,616.79|38807.03|38807.03|38807.03|||| 391|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC|Tricare|TRICARE FOR LIFE|154,337.90|100319.63|121685.1|37393.46|||| 391|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC|Medicare|MEDICARE ACUTE|525,939.51|37393.46|121685.1|37393.46|||| 391|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC|Cigna|CIGNA OTHER|245,201.40|121685.1|121685.1|37393.46|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Medicare|MEDICARE ACUTE|821,928.56|52280.98|52280.98|52280.98|||| 393|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC|Humana Medicare Advantage|HUMANA MA|362,080.40|40458.95|47010.11|4843.54|||| 393|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC|Medicare|MEDICARE ACUTE|501,039.25|30034.795|47010.11|4843.54|||| 393|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC|Medicaid|MEDICAID|238,786.05|4843.54|47010.11|4843.54|||| 393|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC|Managed Medicare|HEALTHSPRING MA|596,803.70|47010.11|47010.11|4843.54|||| 4|DRG||TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R.|Medicare|MEDICARE ACUTE|195,826.71|25233.09|120820.63|390|||| 4|DRG||TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R.|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|634,687.85|390|120820.63|390|||| 4|DRG||TRACH W MV >96 HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R.|Humana Medicare Advantage|HUMANA MA|897,499.86|120820.63|120820.63|390|||| 43762|EAP|0750|CHANGING GASTRO TUBE W/O|Workers Compensation|WORKERS COMPENSATION OTHER|790.05||||||| 43762|EAP|0750|CHANGING GASTRO TUBE W/O|Medicare|MEDICARE ACUTE|6.87||||||| 43762|EAP|0750|CHANGING GASTRO TUBE W/O|Managed Medicare|BCBS MEDICARE PPO MA|6.87||||||| 441|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|184,927.25|161|161|161|||| 463|DRG||WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W MCC|Medicare|MEDICARE ACUTE|514,459.55|40392.4|40392.4|40392.4|||| 49083|EAP|0400|US PARACENTESIS|Medicare|MEDICARE ACUTE|21.41||||||| 49180|EAP|0350|CT BG CONT/ABD,RETRO MASS|Medicare|MEDICARE ACUTE|34.05||||||| 49405|EAP|0320|IMAGE CATH FLUID COLXN VI|Medicare|MEDICARE ACUTE|94.29||||||| 49406|EAP|0320|IMAGE CATH FLUID PERI/RET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|94.24||||||| 49406|EAP|0320|IMAGE CATH FLUID PERI/RET|Access Direct Platinum|HEALTHFIRST TPA|94.24||||||| 49406|EAP|0320|IMAGE CATH FLUID PERI/RET|Humana Medicare Advantage|HUMANA MA|94.24||||||| 49406|EAP|0320|IMAGE CATH FLUID PERI/RET|Medicare|MEDICARE ACUTE|94.24||||||| 49451|EAP|0361|REPLACE DUODENOSTOMY/J TU|Medicare|MEDICARE ACUTE|30.53||||||| 49452|EAP|0361|RPLCMNT EXISTING G/J TUBE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|30.08||||||| 49452|EAP|0361|RPLCMNT EXISTING G/J TUBE|Medicare|MEDICARE ACUTE|30.08||||||| 49465|EAP|0360|XR-FLURO EXAM OF G/COLON|Managed Medicare|HEALTHSPRING MA|14.83||||||| 49465|EAP|0360|XR-FLURO EXAM OF G/COLON|United Medicare Advantage|UHC AARP WELLMED HMO MA|14.83||||||| 49465|EAP|0360|XR-FLURO EXAM OF G/COLON|Medicaid|MEDICAID|14.83||||||| 49465|EAP|0360|XR-FLURO EXAM OF G/COLON|Medicare|MEDICARE ACUTE|14.83||||||| 49465|EAP|0360|XR-FLURO EXAM OF G/COLON|Workers Compensation|WORKERS COMPENSATION OTHER|14.83||||||| 49465|EAP|0360|XR-FLURO EXAM OF G/COLON|Humana Medicare Advantage|HUMANA MA|14.83||||||| 501|DRG||SOFT TISSUE PROCEDURES W CC|Medicare|MEDICARE ACUTE|706,910.06|53660.88|53660.88|53660.88|||| 50431|EAP|0361|NJX PX NFROSGRM &/URTRGRM|Medicare|MEDICARE ACUTE|8.20||||||| 50432|EAP|0361|PLMT NEPHROSTOMY CATHETER|Medicare|MEDICARE ACUTE|21.79||||||| 50435|EAP|0361|EXCHANGE NEPHROSTOMY CATH|Medicare|MEDICARE ACUTE|30.78||||||| 50693|EAP|0361|PLMT URETERAL STENT PRQ|Medicare|MEDICARE ACUTE|44.94||||||| 516|DRG||OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W CC|Medicare|MEDICARE ACUTE|319,980.49|46006.12|46006.12|46006.12|||| 519|DRG||BACK & NECK PROC EXC SPINAL FUSION W CC|Blue Cross PPO Specialty|BCBSTX PPO|904,174.27|672|672|672|||| 539|DRG||OSTEOMYELITIS W MCC|Medicare|MEDICARE PART B ONLY IP|442,733.40|6348.34|39435.43|115|||| 539|DRG||OSTEOMYELITIS W MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|132,834.80|115|39435.43|115|||| 539|DRG||OSTEOMYELITIS W MCC|Medicare|MEDICARE ACUTE|479,747.83|39435.43|39435.43|115|||| 540|DRG||OSTEOMYELITIS W CC|Medicare|MEDICARE ACUTE|234,379.05|19459.35|19459.35|19459.35|||| 548|DRG||SEPTIC ARTHRITIS W MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|891.48|506|506|506|||| 551|DRG||MEDICAL BACK PROBLEMS W MCC|Medicare|MEDICARE ACUTE|287,180.95|41464.74|41464.74|41464.74|||| 557|DRG||TENDONITIS, MYOSITIS & BURSITIS W MCC|Blue Cross HMO Specialty|BCBSTX HMO|581,491.96|402.5|402.5|402.5|||| 559|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC|Medicare|MEDICARE ACUTE|487,425.68|34503.82|34503.82|34503.82|||| 560|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC|Humana Medicare Advantage|HUMANA MA|222,494.50|30716.72|30716.72|30716.72|||| 560|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC|Medicare|MEDICARE ACUTE|231,930.33|30716.72|30716.72|30716.72|||| 564|DRG||OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W MCC|Medicare|MEDICARE ACUTE|361,981.40|26059.165|26059.165|26059.165|||| 565|DRG||OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W CC|Medicare|MEDICARE ACUTE|274,983.67|27257.54|27257.54|27257.54|||| 576|DRG||SKIN GRAFT EXC FOR SKIN ULCER OR CELLULITIS W MCC|Blue Cross PPO Specialty|BCBSTX PPO|537,413.37|50501.62|50501.62|50501.62|||| 592|DRG||SKIN ULCERS W MCC|Blue Cross PPO Specialty|BCBSTX PPO|296,548.50|336|30991.185|336|||| 592|DRG||SKIN ULCERS W MCC|Medicare|MEDICARE ACUTE|332,044.79|30991.185|30991.185|336|||| 603|DRG||CELLULITIS W/O MCC|Humana Medicare Advantage|HUMANA MA|448,957.78|28844.03|28844.03|264.5|||| 603|DRG||CELLULITIS W/O MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|274,577.29|264.5|28844.03|264.5|||| 603|DRG||CELLULITIS W/O MCC|Medicare|MEDICARE ACUTE|144,524.55|12601.99|28844.03|264.5|||| 616|DRG||AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS W MCC|Medicare|MEDICARE ACUTE|607,115.09|40593.8|40593.8|40593.8|||| 617|DRG||AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS W CC|Blue Cross PPO Specialty|BCBSTX PPO|257,546.30|192|192|192|||| 622|DRG||SKIN GRAFTS & WOUND DEBRID FOR ENDOC, NUTRIT & METAB DIS W MCC|Medicare|MEDICARE ACUTE|11,878.01|82073.55|82073.55|82073.55|||| 62270|EAP|0361|LUMBAR PUNCTURE|Blue Cross HMO Specialty|BCBSTX HMO|17.02||||||| 62270|EAP|0361|LUMBAR PUNCTURE|Medicare|MEDICARE ACUTE|17.02||||||| 62270|EAP|0361|LUMBAR PUNCTURE|Aenta Medicare Advantage|AETNA MEDICARE MA|17.02||||||| 637|DRG||DIABETES W MCC|Medicare|MEDICARE ACUTE|211,201.38|31771.985|31771.985|31771.985|||| 638|DRG||DIABETES W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|399,742.50|425.5|16486.33|234|||| 638|DRG||DIABETES W CC|Medicare|MEDICARE ACUTE|229,801.13|16486.33|16486.33|234|||| 638|DRG||DIABETES W CC|Blue Cross HMO Specialty|BCBSTX HMO|287,292.99|304.75|16486.33|234|||| 638|DRG||DIABETES W CC|Blue Cross PPO Specialty|BCBSTX PPO|239,890.98|234|16486.33|234|||| 640|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W MCC|Medicare|MEDICARE ACUTE|256,355.24|19120.33|19120.33|19120.33|||| 673|DRG||OTHER KIDNEY & URINARY TRACT PROCEDURES W MCC|Medicare|MEDICARE ACUTE|467,655.15|54076.55|54076.55|54076.55|||| 682|DRG||RENAL FAILURE W MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|174,898.60|161|35956.52|161|||| 682|DRG||RENAL FAILURE W MCC|Medicare|MEDICARE ACUTE|526,516.05|35956.52|35956.52|161|||| 683|DRG||RENAL FAILURE W CC|Medicare|MEDICARE ACUTE|50,117.50|4812.34|4812.34|4812.34|||| 686|DRG||KIDNEY & URINARY TRACT NEOPLASMS W MCC|Medicare|MEDICARE ACUTE|540,431.86|32123.44|32123.44|32123.44|||| 689|DRG||KIDNEY & URINARY TRACT INFECTIONS W MCC|Medicare|MEDICARE ACUTE|263,997.35|21708.26|21708.26|21708.26|||| 698|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC|Medicare|MEDICARE ACUTE|525,221.75|29201.72|29201.72|29201.72|||| 70|DRG||NONSPECIFIC CEREBROVASCULAR DISORDERS W MCC|Medicare|MEDICARE ACUTE|310,846.85|31969.66|31969.66|31969.66|||| 70100|EAP|0320|MANDIBLE 3VW PORT|Medicare|MEDICARE ACUTE|536.50||||||| 70150|EAP|0320|FACIAL BONES LIMIT 3VW|Medicare|MEDICARE ACUTE|593.75||||||| 70355|EAP|0320|PANOREX 1VW - TMJ|Medicare|MEDICARE ACUTE|7.22||||||| 70371|EAP|0320|ESOPHA VIDEO W/ SPEECH PA|United Medicare Advantage|UHC MEDICARE GOLD MA|11.20||||||| 70371|EAP|0320|ESOPHA VIDEO W/ SPEECH PA|Medicare|MEDICARE ACUTE|11.20||||||| 70371|EAP|0320|ESOPHA VIDEO W/ SPEECH PA|Blue Cross PPO Specialty|BCBSTX PPO|11.20||||||| 70371|EAP|0320|ESOPHA VIDEO W/ SPEECH PA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|11.20||||||| 70371|EAP|0320|ESOPHA VIDEO W/ SPEECH PA|Humana Medicare Advantage|HUMANA MA|11.20||||||| 70371|EAP|0320|ESOPHA VIDEO W/ SPEECH PA|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|11.20||||||| 70371|EAP|0320|ESOPHA VIDEO W/ SPEECH PA|Blue Cross HMO Specialty|BCBSTX HMO|11.20||||||| 70371|EAP|0320|ESOPHA VIDEO W/ SPEECH PA|Aetna|AETNA OTHER|11.20||||||| 70450|EAP|0350|CT HEAD E1M1115|Blue Cross PPO Specialty|BCBSTX PPO|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|Medicaid|MEDICAID|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|Managed Medicare|HEALTHSPRING MA|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|Workers Compensation|WORKERS COMPENSATION OTHER|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|United Medicare Advantage|UHC MEDICARE GOLD MA|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|Managed Medicare|BCBS MEDICARE PPO MA|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|Blue Cross HMO Specialty|BCBSTX HMO|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|45.60||||||| 70450|EAP|0350|CT HEAD E1M1115|Medicare|MEDICARE ACUTE|45.60||||||| 70486|EAP|0350|CT MAX-FACE|Humana Medicare Advantage|HUMANA MA|45.60||||||| 70486|EAP|0350|CT MAX-FACE|Medicaid|MEDICAID|45.60||||||| 70486|EAP|0350|CT MAX-FACE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|45.60||||||| 70487|EAP|0350|CT MAX-FACE W/CONT 100CC|Medicare|MEDICARE ACUTE|59.57||||||| 70490|EAP|0350|CT NECK E1M1238|Medicare|MEDICARE ACUTE|45.60||||||| 70491|EAP|0350|CT NECK-SOFT TIS W/CONT 1|Medicare|MEDICARE ACUTE|59.57||||||| 70491|EAP|0350|CT NECK-SOFT TIS W/CONT 1|Medicaid|MEDICAID|59.57||||||| 70491|EAP|0350|CT NECK-SOFT TIS W/CONT 1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|59.57||||||| 70496|EAP|0350|CT ANGIO HEAD|United Medicare Advantage|UHC AARP WELLMED HMO MA|75.53||||||| 70496|EAP|0350|CT ANGIO HEAD|Medicare|MEDICARE ACUTE|75.53||||||| 70496|EAP|0350|CT ANGIO HEAD|Medicaid|MEDICAID|75.53||||||| 70498|EAP|0350|CT ANGIO NECK|Medicare|MEDICARE ACUTE|75.53||||||| 70498|EAP|0350|CT ANGIO NECK|United Medicare Advantage|UHC AARP WELLMED HMO MA|75.53||||||| 70547|EAP|0610|MRA CAROTID WO CONT|Medicare|MEDICARE ACUTE|47.15||||||| 70551|EAP|0610|MRI HEAD WO/ CONTRAST|Medicare|MEDICARE ACUTE|47.15||||||| 70551|EAP|0610|MRI HEAD WO/ CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|47.15||||||| 70551|EAP|0610|MRI HEAD WO/ CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|47.15||||||| 70551|EAP|0610|MRI HEAD WO/ CONTRAST|Humana Medicare Advantage|HUMANA MA|47.15||||||| 70551|EAP|0610|MRI HEAD WO/ CONTRAST|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|47.15||||||| 70551|EAP|0610|MRI HEAD WO/ CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|47.15||||||| 70551|EAP|0610|MRI HEAD WO/ CONTRAST|Medicaid|MEDICAID|47.15||||||| 70551|EAP|0610|MRI HEAD WO/ CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|47.15||||||| 70553|EAP|0610|MRI HEAD W/WO CONT|Medicare|MEDICARE ACUTE|63.79||||||| 70553|EAP|0610|MRI HEAD W/WO CONT|Blue Cross HMO Specialty|BCBSTX HMO|63.79||||||| 70553|EAP|0610|MRI HEAD W/WO CONT|Aenta Medicare Advantage|AETNA MEDICARE MA|63.79||||||| 709|DRG||PENIS PROCEDURES W CC/MCC|Medicare|MEDICARE ACUTE|329,527.80|57344.58|57344.58|57344.58|||| 71|DRG||NONSPECIFIC CEREBROVASCULAR DISORDERS W CC|Medicare|MEDICARE ACUTE|121,768.50|11979.98|11979.98|11979.98|||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Blue Cross PPO Specialty|BCBSTX PPO|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Medicare|MEDICARE ACUTE|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Aenta Medicare Advantage|AETNA MEDICARE MA|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|United Medicare Advantage|UHC MEDICARE GOLD MA|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Blue Cross HMO Specialty|BCBSTX HMO|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Aetna|AETNA OTHER|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Managed Medicare|HEALTHSPRING MA|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Humana Medicare Advantage|HUMANA MA|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Workers Compensation|WORKERS COMPENSATION OTHER|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Tricare|TRICARE FOR LIFE|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|PHCS|HUMANA INSURANCE|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|United Medicare Advantage|UHC AARP WELLMED HMO MA|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Managed Medicare|BCBS MEDICARE PPO MA|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Texas Workforce Commission|DIS DETER SERV (DDS)|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|7.48||||||| 71045|EAP|0320|XR-EXAM CHEST 1 VIEW|Medicaid|MEDICAID|7.48||||||| 71046|EAP|0320|XR-EXAM CHEST 2 VIEWS|Medicare|MEDICARE ACUTE|6.44||||||| 71046|EAP|0320|XR-EXAM CHEST 2 VIEWS|United Medicare Advantage|UHC AARP WELLMED HMO MA|6.44||||||| 71046|EAP|0320|XR-EXAM CHEST 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA|6.44||||||| 71046|EAP|0320|XR-EXAM CHEST 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|6.44||||||| 71048|EAP|0320|XR-EXAM CHEST 4+ VIEWS|Medicare|MEDICARE ACUTE|7.82||||||| 71101|EAP|0320|RIBS UNIL 3VW|Medicare|MEDICARE ACUTE|9.12||||||| 71250|EAP|0350|CT CHEST E1M1021|Managed Medicare|BCBS MEDICARE PPO MA|42.70||||||| 71250|EAP|0350|CT CHEST E1M1021|Aenta Medicare Advantage|AETNA MEDICARE MA|42.70||||||| 71250|EAP|0350|CT CHEST E1M1021|Humana Medicare Advantage|HUMANA MA|42.70||||||| 71250|EAP|0350|CT CHEST E1M1021|Blue Cross PPO Specialty|BCBSTX PPO|42.70||||||| 71250|EAP|0350|CT CHEST E1M1021|Medicare|MEDICARE ACUTE|42.70||||||| 71250|EAP|0350|CT CHEST E1M1021|Medicaid|MEDICAID|42.70||||||| 71250|EAP|0350|CT CHEST E1M1021|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|42.70||||||| 71250|EAP|0350|CT CHEST E1M1021|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|42.70||||||| 71260|EAP|0350|CT CHEST W/CONT 100CC E1|Blue Cross PPO Specialty|BCBSTX PPO|55.78||||||| 71260|EAP|0350|CT CHEST W/CONT 100CC E1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|55.78||||||| 71260|EAP|0350|CT CHEST W/CONT 100CC E1|Medicare|MEDICARE ACUTE|55.78||||||| 71275|EAP|0350|CT PE CHEST ANGIOGRAPHY|Medicare|MEDICARE ACUTE|70.74||||||| 71275|EAP|0350|CT PE CHEST ANGIOGRAPHY|Blue Cross PPO Specialty|BCBSTX PPO|70.74||||||| 717|DRG||OTHER MALE REPRODUCTIVE SYSTEM O.R. PROC EXC MALIGNANCY W CC/MCC|Medicare|MEDICARE ACUTE|1,339,675.18|92631.55|92631.55|92631.55|||| 72020|EAP|0320|SPINE CER LAT 1VW|Medicare|MEDICARE ACUTE|7.22||||||| 72100|EAP|0320|SPINE LUM 2VW PORT|Medicare|MEDICARE ACUTE|8.24||||||| 72125|EAP|0350|CT SPINE CERVICAL|Medicare|MEDICARE ACUTE|45.60||||||| 72125|EAP|0350|CT SPINE CERVICAL|Medicaid|MEDICAID|45.60||||||| 72131|EAP|0350|CT SPINE LUMBAR|Medicare|MEDICARE ACUTE|42.70||||||| 72146|EAP|0610|MRI T SPINE WO/ CONTRAST|Medicare|MEDICARE ACUTE|57.91||||||| 72148|EAP|0610|MRI L SPINE WO/ CONTRAST|Medicare|MEDICARE ACUTE|57.91||||||| 72149|EAP|0610|MRI L-SPINE W/CONT ONLY|Medicare|MEDICARE ACUTE|68.91||||||| 72156|EAP|0610|MRI C-SPINE W/WO CONT|Medicare|MEDICARE ACUTE|63.79||||||| 72158|EAP|0610|MRI L-SPINE W/WO CONT|Cigna|CIGNA OTHER|78.34||||||| 72158|EAP|0610|MRI L-SPINE W/WO CONT|Medicare|MEDICARE ACUTE|78.34||||||| 72158|EAP|0610|MRI L-SPINE W/WO CONT|Blue Cross PPO Specialty|BCBSTX PPO|78.34||||||| 72170|EAP|0320|PELVIS 1VW PORT|Humana Medicare Advantage|HUMANA MA|8.24||||||| 72192|EAP|0350|CT PELVIS E1M1236|Humana Medicare Advantage|HUMANA MA|42.70||||||| 72192|EAP|0350|CT PELVIS E1M1236|Medicare|MEDICARE ACUTE|42.70||||||| 72193|EAP|0350|CT PELVIS W/ CONTRAST 100|Medicare|MEDICARE ACUTE|55.78||||||| 72193|EAP|0350|CT PELVIS W/ CONTRAST 100|Blue Cross HMO Specialty|BCBSTX HMO|55.78||||||| 72220|EAP|0320|SACRUM 2VW|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|8.24||||||| 73020|EAP|0320|SHOULDER 1VW|Humana Medicare Advantage|HUMANA MA|7.22||||||| 73030|EAP|0320|XR SHOULDER 2 VIEW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|8.24||||||| 73030|EAP|0320|XR SHOULDER 2 VIEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|8.24||||||| 73030|EAP|0320|XR SHOULDER 2 VIEW|Medicare|MEDICARE ACUTE|8.24||||||| 73090|EAP|0320|FOREARM 2VW|Humana Medicare Advantage|HUMANA MA|8.24||||||| 73100|EAP|0320|WRIST POST REDUCTION|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|6.31||||||| 73100|EAP|0320|WRIST POST REDUCTION|Managed Medicaid|MEDICAID UNITED HEALTHCARE|6.31||||||| 73130|EAP|0320|HAND 3VW|Medicare|MEDICARE ACUTE|9.12||||||| 73200|EAP|0350|CT EXT-ARM|Blue Cross PPO Specialty|BCBSTX PPO|42.70||||||| 73200|EAP|0350|CT SHOULDER W/O CONT|Medicare|MEDICARE ACUTE|2,857.25||||||| 73223|EAP|0610|MRI SHOULDER LT W/WO CONT|Medicare|MEDICARE ACUTE|78.34||||||| 73501|EAP|0320|X-RAY EXAM HIP UNI 1 VIEW|Medicare|MEDICARE ACUTE|0.97||||||| 73502|EAP|0320|X-RAY EXAM HIP UNI 2-3 VI|Medicare|MEDICARE ACUTE|0.97||||||| 73502|EAP|0320|X-RAY EXAM HIP UNI 2-3 VI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.97||||||| 73522|EAP|0320|X-RAY EXAM HIPS BI 3-4 VI|Medicare|MEDICARE ACUTE|1.61||||||| 73552|EAP|0320|X-RAY EXAM OF FEMUR 2/> L|Medicare|MEDICARE ACUTE|0.97||||||| 73560|EAP|0320|KNEE 2VW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|7.22||||||| 73560|EAP|0320|KNEE 2VW|Medicare|MEDICARE ACUTE|7.22||||||| 73560|EAP|0320|KNEE 2VW|Blue Cross PPO Specialty|BCBSTX PPO|7.22||||||| 73590|EAP|0320|XR TIBIA FIBULA 1 VIEW|Medicare|MEDICARE ACUTE|8.24||||||| 73701|EAP|0350|CT EXT-LEG W/CONT 150CC|Medicare|MEDICARE ACUTE|55.78||||||| 73701|EAP|0350|CT EXT-LEG W/CONT 150CC|United Medicare Advantage|UHC MEDICARE GOLD MA|55.78||||||| 73701|EAP|0350|CT EXT-LEG W/CONT 150CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|55.78||||||| 73701|EAP|0350|CT FOOT W/CONT 100CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3,459.75||||||| 73706|EAP|0350|CT ANGIO LOWER EXTREMITY|Medicare|MEDICARE ACUTE|70.74||||||| 74000|EAP|0320|XR ABDOMEN 1 VIEW|Medicare|MEDICARE ACUTE|6.42||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|United Medicare Advantage|UHC AARP WELLMED HMO MA|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|United Medicare Advantage|UHC MEDICARE GOLD MA|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|Managed Medicare|HEALTHSPRING MA|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|Medicaid|MEDICAID|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|Workers Compensation|WORKERS COMPENSATION OTHER|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|Blue Cross PPO Specialty|BCBSTX PPO|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|Humana Medicare Advantage|HUMANA MA|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|Managed Medicare|BCBS MEDICARE PPO MA|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|Medicare|MEDICARE ACUTE|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|Aenta Medicare Advantage|AETNA MEDICARE MA|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.45||||||| 74018|EAP|0320|XR-EXAM ABDOMEN 1 VIEW|Aetna|AETNA OTHER|7.45||||||| 74022|EAP|0320|ABDOMEN SERIES 3VW|Access Direct Platinum|HEALTHFIRST TPA|5.29||||||| 74150|EAP|0350|CT ABDOMEN E1M0805|Medicare|MEDICARE ACUTE|42.70||||||| 74176|EAP|0350|CT ABD/PELV WO CONT|United Medicare Advantage|UHC AARP WELLMED HMO MA|85.40||||||| 74176|EAP|0350|CT ABD/PELV WO CONT|Blue Cross PPO Specialty|BCBSTX PPO|85.40||||||| 74176|EAP|0350|CT ABD/PELV WO CONT|Medicaid|MEDICAID|85.40||||||| 74176|EAP|0350|CT ABD/PELV WO CONT|Aetna|AETNA OTHER|85.40||||||| 74176|EAP|0350|CT ABD/PELV WO CONT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|85.40||||||| 74176|EAP|0350|CT ABD/PELV WO CONT|Medicare|MEDICARE ACUTE|85.40||||||| 74176|EAP|0350|CT ABD/PELV WO CONT|Access Direct Platinum|HEALTHFIRST TPA|85.40||||||| 74176|EAP|0350|CT ABD/PELV WO CONT|Managed Medicare|BCBS MEDICARE PPO MA|85.40||||||| 74176|EAP|0350|CT ABD/PELV WO CONT|Humana Medicare Advantage|HUMANA MA|85.40||||||| 74177|EAP|0350|CT ABD/PELV W CONT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|111.57||||||| 74177|EAP|0350|CT ABD/PELV W CONT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|111.57||||||| 74177|EAP|0350|CT ABD/PELV W CONT|Blue Cross PPO Specialty|BCBSTX PPO|111.57||||||| 74177|EAP|0350|CT ABD/PELV W CONT|Medicare|MEDICARE ACUTE|111.57||||||| 74177|EAP|0350|CT ABD/PELV W CONT|Humana Medicare Advantage|HUMANA MA|111.57||||||| 74177|EAP|0350|CT ABD/PELV W CONT|Managed Medicare|HEALTHSPRING MA|111.57||||||| 74177|EAP|0350|CT ABD/PELV W CONT|United Medicare Advantage|UHC MEDICARE GOLD MA|111.57||||||| 74177|EAP|0350|CT ABD/PELV W CONT|Blue Cross HMO Specialty|BCBSTX HMO|111.57||||||| 74177|EAP|0350|CT ABD/PELV W CONT|Access Direct Platinum|HEALTHFIRST TPA|111.57||||||| 74178|EAP|0350|CT ABD/PELV W-WO CONT|Medicare|MEDICARE ACUTE|126.52||||||| 74181|EAP|0610|MRI ABDOMEN IP18700|Medicare|MEDICARE ACUTE|57.91||||||| 74181|EAP|0610|MRI ABDOMEN IP18700|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|57.91||||||| 74183|EAP|0610|MRI ABDOMEN W/O & W/DYE|Humana Medicare Advantage|HUMANA MA|78.34||||||| 74220|EAP|0320|ESOPHAG B/SWAL|Aetna|AETNA OTHER|8.46||||||| 74241|EAP|0320|UPPER GI|Medicare|MEDICARE ACUTE|10.63||||||| 74241|EAP|0320|UPPER GI|Humana Medicare Advantage|HUMANA MA|10.63||||||| 74246|EAP|0020|X-RAY XM UPR GI TRC 2CNTR|Medicare|MEDICARE ACUTE|4.92||||||| 74248|EAP|0320|X-RAY SM INT F-THRU STD|Medicare|MEDICARE ACUTE|2.50||||||| 74250|EAP|0320|SMALL BOWEL SER|United Medicare Advantage|UHC AARP WELLMED HMO MA|9.31||||||| 74330|EAP|0320|ENDOSCOP COMBIN|Medicare|MEDICARE ACUTE|22.51||||||| 74425|EAP|0320|NEPHROSTOGRAM|Medicare|MEDICARE ACUTE|15.36||||||| 75635|EAP|0350|CT ANGIO AORTO-ILLOFEMORA|Medicare|MEDICARE ACUTE|31.47||||||| 75710|EAP|0320|OR ARTERIOGRAM|Medicare|MEDICARE ACUTE|99.08||||||| 758|DRG||INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|369,480.69|4256.29|4256.29|4256.29|||| 76000|EAP|0320|FLUORO 0 - 30 MIN.|Medicare|MEDICARE ACUTE|12.51||||||| 76000|EAP|0320|OR FLUORO 0 - 30 MIN|Blue Cross PPO Specialty|BCBSTX PPO|12.51||||||| 76000|EAP|0320|OR FLUORO 0 - 30 MIN|Medicare|MEDICARE ACUTE|12.51||||||| 76000|EAP|0320|XR-CHEST X-RAY AND FLUORO|Medicare|MEDICARE ACUTE|8.92||||||| 76003|EAP|0320|CHEST TUBE PLACEMENT|Medicare|MEDICARE ACUTE|17.84||||||| 76080|EAP|0320|X-RAY EXAM OF FISTULA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|12.21||||||| 76604|EAP|0400|CHEST U/S PORT|Medicare|MEDICARE ACUTE|10.92||||||| 76641|EAP|0402|BC US BREAST COMPLETE UNI|Medicare|MEDICARE ACUTE|5.99||||||| 76700|EAP|0400|ABDOMINAL ECHO COMPL|Humana Medicare Advantage|HUMANA MA|12.21||||||| 76700|EAP|0400|ABDOMINAL ECHO COMPL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|12.21||||||| 76700|EAP|0400|ABDOMINAL ECHO COMPL|Blue Cross PPO Specialty|BCBSTX PPO|12.21||||||| 76700|EAP|0400|ABDOMINAL ECHO COMPL|Medicare|MEDICARE ACUTE|12.21||||||| 76705|EAP|0400|GALLBLADDER ULTRASOUND Q7|Access Direct Platinum|HEALTHFIRST TPA|820.25||||||| 76705|EAP|0400|US ABDOMEN LIMITED|Workers Compensation|WORKERS COMPENSATION OTHER|8.08||||||| 76705|EAP|0400|US ABDOMEN LIMITED|Medicaid|MEDICAID|8.08||||||| 76705|EAP|0400|US ABDOMEN LIMITED|Medicare|MEDICARE ACUTE|8.08||||||| 76705|EAP|0400|LIVER U/S Q730500|Medicare|MEDICARE ACUTE|820.25||||||| 76705|EAP|0400|GALLBLADDER ULTRASOUND Q7|Humana Medicare Advantage|HUMANA MA|820.25||||||| 76770|EAP|0400|RENAL ECHO|Medicare|MEDICARE ACUTE|826.75||||||| 76770|EAP|0400|AORTA U/S|Medicare|MEDICARE ACUTE|11.66||||||| 76770|EAP|0400|AORTA U/S|Humana Medicare Advantage|HUMANA MA|11.66||||||| 76770|EAP|0400|RENAL ECHO|Humana Medicare Advantage|HUMANA MA|826.75||||||| 76776|EAP|0400|RENAL TX W W/O DOP PORT L|Medicare|MEDICARE ACUTE|12.66||||||| 76856|EAP|0400|PELVIC ECHO NON OB|Medicare|MEDICARE ACUTE|10.68||||||| 76870|EAP|0400|SCROTUM U/S Q761500|Medicare|MEDICARE ACUTE|9.16||||||| 76870|EAP|0400|SCROTUM U/S Q761500|Humana Medicare Advantage|HUMANA MA|9.16||||||| 76881|EAP|0402|US EXTREMITY NON VASCULAR|Medicare|MEDICARE ACUTE|9.16||||||| 76882|EAP|0402|EXTREMITY NON VASCULAR U/|Humana Medicare Advantage|HUMANA MA|7.83||||||| 76937|EAP|0320|US GUIDANCE CVAD|United Medicare Advantage|UHC MEDICARE GOLD MA|15.07||||||| 76937|EAP|0320|US GUIDANCE CVAD|Humana Medicare Advantage|HUMANA MA|15.07||||||| 76937|EAP|0320|US GUIDANCE CVAD|Medicare|MEDICARE ACUTE|15.07||||||| 76937|EAP|0320|US GUIDANCE CVAD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|15.07||||||| 77001|EAP|0320|FLUORO GUIDANCE CVAD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.99||||||| 77001|EAP|0320|FLUORO GUIDANCE CVAD|Humana Medicare Advantage|HUMANA MA|9.99||||||| 77001|EAP|0320|FLUORO GUIDANCE CVAD|United Medicare Advantage|UHC MEDICARE GOLD MA|9.99||||||| 77001|EAP|0320|FLUORO GUIDANCE CVAD|Medicare|MEDICARE ACUTE|9.99||||||| 77012|EAP|0350|CYST ASPIRATION|Access Direct Platinum|HEALTHFIRST TPA|29.06||||||| 77066|EAP|0401|BC DX MAMMO INCL CAD BI|Medicare|MEDICARE ACUTE|7.39||||||| 77413|EAP|0333|RADIATION THERAPY THREE 6|Medicare|MEDICARE ACUTE|2,311.50||||||| 77413|EAP|0333|RADIATION THERAPY THREE 6|Managed Medicare|HEALTHSPRING MA|2,311.50||||||| 77413|EAP|0333|RADIATION THERAPY THREE 6|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2,311.50||||||| 78226|EAP|0340|HEPATOBILIARY STUDY W/O C|Medicare|MEDICARE ACUTE|24.93||||||| 78278|EAP|0340|G I BLEEDING SCAN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|29.29||||||| 78278|EAP|0340|G I BLEEDING SCAN|Medicare|MEDICARE ACUTE|29.29||||||| 78278|EAP|0340|G I BLEEDING SCAN|Humana Medicare Advantage|HUMANA MA|29.29||||||| 78306|EAP|0340|BONE SCAN WB|Medicare|MEDICARE ACUTE|23.85||||||| 78452|EAP|0340|NM MYOCARDIAL PERFUSION S|Aetna|AETNA OTHER|65.68||||||| 78580|EAP|0340|LUNG PERFUSION|Medicare|MEDICARE ACUTE|23.42||||||| 78582|EAP|0340|NM PULMONARY VENTILATION|Medicare|MEDICARE ACUTE|36.23||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Texas Workforce Commission|DIS DETER SERV (DDS)|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|United Healthcare|UNITED HEALTHCARE OTHER|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|United Medicare Advantage|UHC MEDICARE GOLD MA|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Workers Compensation|WORKERS COMPENSATION OTHER|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|PHCS|HUMANA INSURANCE|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|United Medicare Advantage|UHC AARP WELLMED HMO MA|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Tricare|TRICARE FOR LIFE|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Medicare|MEDICARE PART B ONLY IP|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Humana Medicare Advantage|HUMANA MA|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Medicaid|MEDICAID|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Blue Cross HMO Specialty|BCBSTX HMO|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Managed Medicare|HEALTHSPRING MA|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Access Direct Platinum|HEALTHFIRST TPA|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Blue Cross PPO Specialty|BCBSTX PPO|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Medicare|MEDICARE ACUTE|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Managed Medicare|BCBS MEDICARE PPO MA|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Aenta Medicare Advantage|AETNA MEDICARE MA|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Cigna|CIGNA OTHER|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Aetna|AETNA OTHER|2.09||||||| 80048|EAP|0300|BASIC METABOLIC PROFILE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.09||||||| 80051|EAP|0300|ELECTROLYTES PANEL|Blue Cross HMO Specialty|BCBSTX HMO|2.48||||||| 80051|EAP|0300|ELECTROLYTES PANEL|Medicare|MEDICARE ACUTE|2.48||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Aenta Medicare Advantage|AETNA MEDICARE MA|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|United Medicare Advantage|UHC MEDICARE GOLD MA|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Workers Compensation|WORKERS COMPENSATION OTHER|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|PHCS|HUMANA INSURANCE|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Blue Cross HMO Specialty|BCBSTX HMO|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|United Healthcare|UNITED HEALTHCARE OTHER|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Blue Cross PPO Specialty|BCBSTX PPO|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Access Direct Platinum|HEALTHFIRST TPA|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Tricare|TRICARE FOR LIFE|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Humana Medicare Advantage|HUMANA MA|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Managed Medicare|BCBS MEDICARE PPO MA|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Medicare|MEDICARE ACUTE|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Medicare|MEDICARE PART B ONLY IP|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Managed Medicare|HEALTHSPRING MA|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.07||||||| 80053|EAP|0300|COMPREHENSIVE METABOLIC P|Medicaid|MEDICAID|3.07||||||| 80059|EAP|0300|HEPATITIS P 5 IB23098|Medicare|MEDICARE ACUTE|18.53||||||| 80061|EAP|0300|CARDIAC RISK PROFILE|United Medicare Advantage|UHC MEDICARE GOLD MA|1.98||||||| 80061|EAP|0300|CARDIAC RISK PROFILE|Managed Medicare|HEALTHSPRING MA|1.98||||||| 80061|EAP|0300|CARDIAC RISK PROFILE|Aenta Medicare Advantage|AETNA MEDICARE MA|1.98||||||| 80061|EAP|0300|CARDIAC RISK PROFILE|Medicare|MEDICARE ACUTE|1.98||||||| 80069|EAP|0300|RENAL PROFILE|United Medicare Advantage|UHC MEDICARE GOLD MA|3.07||||||| 80069|EAP|0300|RENAL PROFILE|Humana Medicare Advantage|HUMANA MA|3.07||||||| 80069|EAP|0300|RENAL PROFILE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.07||||||| 80069|EAP|0300|RENAL PROFILE|Blue Cross PPO Specialty|BCBSTX PPO|3.07||||||| 80069|EAP|0300|RENAL PROFILE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.07||||||| 80069|EAP|0300|RENAL PROFILE|Medicaid|MEDICAID|3.07||||||| 80069|EAP|0300|RENAL PROFILE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|3.07||||||| 80069|EAP|0300|RENAL PROFILE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|3.07||||||| 80069|EAP|0300|RENAL PROFILE|Blue Cross HMO Specialty|BCBSTX HMO|3.07||||||| 80069|EAP|0300|RENAL PROFILE|Medicare|MEDICARE PART B ONLY IP|3.07||||||| 80069|EAP|0300|RENAL PROFILE|Aenta Medicare Advantage|AETNA MEDICARE MA|3.07||||||| 80069|EAP|0300|RENAL PROFILE|Medicare|MEDICARE ACUTE|3.07||||||| 80069|EAP|0300|RENAL PROFILE|Cigna|CIGNA OTHER|3.07||||||| 80069|EAP|0300|RENAL PROFILE|Access Direct Platinum|HEALTHFIRST TPA|3.07||||||| 80069|EAP|0300|RENAL PROFILE|Aetna|AETNA OTHER|3.07||||||| 80069|EAP|0300|RENAL PROFILE|Workers Compensation|WORKERS COMPENSATION OTHER|3.07||||||| 80074|EAP|0300|HEPATITIS PROFILE I|Medicare|MEDICARE PART B ONLY IP|18.53||||||| 80074|EAP|0300|HEPATITIS PROFILE I|Medicaid|MEDICAID|18.53||||||| 80074|EAP|0300|HEPATITIS PROFILE I|Humana Medicare Advantage|HUMANA MA|18.53||||||| 80074|EAP|0300|HEPATITIS PROFILE I|Medicare|MEDICARE ACUTE|18.53||||||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Medicare|MEDICARE ACUTE|2.89||||||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Medicaid|MEDICAID|2.89||||||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Humana Medicare Advantage|HUMANA MA|2.89||||||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Blue Cross HMO Specialty|BCBSTX HMO|2.89||||||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Managed Medicare|HEALTHSPRING MA|2.89||||||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Blue Cross PPO Specialty|BCBSTX PPO|2.89||||||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Aenta Medicare Advantage|AETNA MEDICARE MA|2.89||||||| 80076|EAP|0300|HEPATIC FUNCTION PANEL|Access Direct Platinum|HEALTHFIRST TPA|2.89||||||| 80150|EAP|0300|AMIKACIN IA11981|Medicare|MEDICARE ACUTE|4.71||||||| 80162|EAP|0300|DIGOXIN|Aenta Medicare Advantage|AETNA MEDICARE MA|4.15||||||| 80162|EAP|0300|DIGOXIN|Medicare|MEDICARE ACUTE|4.15||||||| 80162|EAP|0300|DIGOXIN|Humana Medicare Advantage|HUMANA MA|4.15||||||| 80164|EAP|0300|VALPROIC ACID QUANT GL217|Managed Medicare|HEALTHSPRING MA|4.24||||||| 80164|EAP|0300|VALPROIC ACID QUANT GL217|Medicare|MEDICARE ACUTE|4.24||||||| 80170|EAP|0300|RANDOM GENTAMICIN BLOOD L|Medicare|MEDICARE ACUTE|5.13||||||| 80170|EAP|0300|GENTAMICIN QUANT RIA|Blue Cross PPO Specialty|BCBSTX PPO|5.13||||||| 80170|EAP|0300|GENTAMICIN QUANT RIA|Medicare|MEDICARE ACUTE|5.13||||||| 80170|EAP|0300|RANDOM GENTAMICIN BLOOD L|United Medicare Advantage|UHC MEDICARE GOLD MA|5.13||||||| 80171|EAP|0300|DS QUANT GABAPENTIN|Humana Medicare Advantage|HUMANA MA|4.07||||||| 80184|EAP|0300|PHENOBARBITAL LEVEL GH108|Workers Compensation|WORKERS COMPENSATION OTHER|3.58||||||| 80185|EAP|0300|DILANTIN GD01350|Medicare|MEDICARE ACUTE|4.15||||||| 80185|EAP|0300|DILANTIN GD01350|Medicaid|MEDICAID|4.15||||||| 80185|EAP|0300|DILANTIN GD01350|Workers Compensation|WORKERS COMPENSATION OTHER|4.15||||||| 80185|EAP|0300|DILANTIN GD01350|Blue Cross HMO Specialty|BCBSTX HMO|4.15||||||| 80197|EAP|0300|TACROLIMUS (FK506)|Medicare|MEDICARE ACUTE|546.75||||||| 80198|EAP|0300|THEOPHYLLINE LEVEL GK3307|Humana Medicare Advantage|HUMANA MA|4.42||||||| 80200|EAP|0300|TOBRAMYCIN RANDOM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.04||||||| 80200|EAP|0300|TOBRAMYCIN RANDOM|Managed Medicare|BCBS MEDICARE PPO MA|5.04||||||| 80200|EAP|0300|TOBRAMYCIN RANDOM|Medicare|MEDICARE ACUTE|5.04||||||| 80200|EAP|0300|TOBRAMYCIN GK47800|Medicare|MEDICARE ACUTE|5.04||||||| 80202|EAP|0300|VANCOMYCIN LEVEL RL21775|United Medicare Advantage|UHC MEDICARE GOLD MA|4.24||||||| 80202|EAP|0300|VANCOMYCIN LEVEL RL21775|United Healthcare|UNITED HEALTHCARE OTHER|4.24||||||| 80202|EAP|0300|VANCOMYCIN LEVEL RL21775|United Medicare Advantage|UHC AARP WELLMED HMO MA|4.24||||||| 80202|EAP|0300|VANCOMYCIN LEVEL RL21775|PHCS|HUMANA INSURANCE|4.24||||||| 80202|EAP|0300|VANCOMYCIN LEVEL RL21775|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.24||||||| 80202|EAP|0300|VANCOMYCIN LEVEL RL21775|Managed Medicare|BCBS MEDICARE PPO MA|4.24||||||| 80202|EAP|0300|VANCOMYCIN LEVEL RL21775|Blue Cross PPO Specialty|BCBSTX PPO|4.24||||||| 80202|EAP|0300|VANCOMYCIN LEVEL RL21775|Medicaid|MEDICAID|4.24||||||| 80202|EAP|0300|VANCOMYCIN LEVEL RL21775|Medicare|MEDICARE ACUTE|4.24||||||| 80202|EAP|0300|VANCOMYCIN LEVEL RL21775|Humana Medicare Advantage|HUMANA MA|4.24||||||| 80202|EAP|0300|VANCOMYCIN LEVEL RL21775|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.24||||||| 80202|EAP|0300|VANCOMYCIN LEVEL RL21775|Aenta Medicare Advantage|AETNA MEDICARE MA|4.24||||||| 80299|EAP|0300|KEPPRA LEVATIRACETAM|Medicare|MEDICARE ACUTE|545.75||||||| 80299|EAP|0300|KEPPRA LEVATIRACETAM|Workers Compensation|WORKERS COMPENSATION OTHER|545.75||||||| 80307|EAP|0300|ACETAMINOPHEN|Medicare|MEDICARE ACUTE|1.43||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|United Medicare Advantage|UHC AARP WELLMED HMO MA|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Medicaid|MEDICAID|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|United Medicare Advantage|UHC MEDICARE GOLD MA|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|PHCS|HUMANA INSURANCE|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Cigna|CIGNA OTHER|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Blue Cross HMO Specialty|BCBSTX HMO|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Tricare|TRICARE FOR LIFE|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Humana Medicare Advantage|HUMANA MA|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Access Direct Platinum|HEALTHFIRST TPA|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Blue Cross PPO Specialty|BCBSTX PPO|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Medicare|MEDICARE PART B ONLY IP|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Managed Medicare|HEALTHSPRING MA|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Medicare|MEDICARE ACUTE|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Aenta Medicare Advantage|AETNA MEDICARE MA|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Aetna|AETNA OTHER|1.01||||||| 81001|EAP|0300|URINALYSIS AUTO W/MICROSC|Managed Medicare|BCBS MEDICARE PPO MA|1.01||||||| 81015|EAP|0300|EOSINOPHIL COUNT URINE|Medicare|MEDICARE ACUTE|1.20||||||| 81015|EAP|0300|EOSINOPHIL COUNT URINE|Humana Medicare Advantage|HUMANA MA|1.20||||||| 81015|EAP|0300|EOSINOPHIL COUNT URINE|Managed Medicare|BCBS MEDICARE PPO MA|1.20||||||| 81015|EAP|0300|EOSINOPHIL COUNT URINE|Blue Cross PPO Specialty|BCBSTX PPO|1.20||||||| 81240|EAP|0300|PROTHROMBIN G20210A MUTAT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|159.75||||||| 81241|EAP|0300|FACTOR V LEIDEN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|15.91||||||| 81256|EAP|0300|HEMOCHROMATOSIS(HFE) PCR|Humana Medicare Advantage|HUMANA MA|8.36||||||| 82040|EAP|0300|ALBUMIN SERUM|United Medicare Advantage|UHC MEDICARE GOLD MA|1.00||||||| 82040|EAP|0300|ALBUMIN SERUM|Blue Cross HMO Specialty|BCBSTX HMO|1.00||||||| 82040|EAP|0300|ALBUMIN SERUM|Workers Compensation|WORKERS COMPENSATION OTHER|1.00||||||| 82040|EAP|0300|ALBUMIN SERUM|Medicaid|MEDICAID|1.00||||||| 82040|EAP|0300|ALBUMIN SERUM|Medicare|MEDICARE ACUTE|1.00||||||| 82042|EAP|0300|ALBUMIN 24HR QUANT URINE|Medicare|MEDICARE ACUTE|1.04||||||| 82105|EAP|0300|ALPHA FETOPROTEIN|Medicare|MEDICARE ACUTE|3.72||||||| 82140|EAP|0300|AMMONIA|United Medicare Advantage|UHC MEDICARE GOLD MA|2.94||||||| 82140|EAP|0300|AMMONIA|Medicare|MEDICARE ACUTE|2.94||||||| 82140|EAP|0300|AMMONIA|Humana Medicare Advantage|HUMANA MA|2.94||||||| 82140|EAP|0300|AMMONIA|Managed Medicare|HEALTHSPRING MA|2.94||||||| 82140|EAP|0300|AMMONIA|Blue Cross PPO Specialty|BCBSTX PPO|2.94||||||| 82140|EAP|0300|AMMONIA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.94||||||| 82140|EAP|0300|AMMONIA|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|2.94||||||| 82140|EAP|0300|AMMONIA|Aenta Medicare Advantage|AETNA MEDICARE MA|2.94||||||| 82150|EAP|0300|AMYLASE|Access Direct Platinum|HEALTHFIRST TPA|1.31||||||| 82150|EAP|0300|AMYLASE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.31||||||| 82150|EAP|0300|AMYLASE|Medicare|MEDICARE ACUTE|1.31||||||| 82150|EAP|0300|AMYLASE|Aenta Medicare Advantage|AETNA MEDICARE MA|1.31||||||| 82150|EAP|0300|AMYLASE|Workers Compensation|WORKERS COMPENSATION OTHER|1.31||||||| 82164|EAP|0300|ANGIOTENSIN CONVERT ENZY|Medicaid|MEDICAID|581.50||||||| 82270|EAP|0300|OCCULT BLOOD FECES QUAL|Medicare|MEDICARE ACUTE|0.66||||||| 82270|EAP|0300|OCCULT BLOOD FECES QUAL|Aenta Medicare Advantage|AETNA MEDICARE MA|0.66||||||| 82270|EAP|0300|OCCULT BLOOD FECES QUAL|Humana Medicare Advantage|HUMANA MA|0.66||||||| 82270|EAP|0300|OCCULT BLOOD FECES QUAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.66||||||| 82270|EAP|0300|OCCULT BLOOD FECES QUAL|Managed Medicare|HEALTHSPRING MA|0.66||||||| 82270|EAP|0300|OCCULT BLOOD FECES QUAL|Medicaid|MEDICAID|0.66||||||| 82270|EAP|0300|OCCULT BLOOD FECES QUAL|United Medicare Advantage|UHC AARP WELLMED HMO MA|0.66||||||| 82306|EAP|0300|25 HYDROXY VITAMIN D RL39|Managed Medicare|BCBS MEDICARE PPO MA|1,082.50||||||| 82306|EAP|0300|25 HYDROXY VITAMIN D RL39|Humana Medicare Advantage|HUMANA MA|1,082.50||||||| 82306|EAP|0300|25 HYDROXY VITAMIN D RL39|Access Direct Platinum|HEALTHFIRST TPA|1,082.50||||||| 82306|EAP|0300|25 HYDROXY VITAMIN D RL39|Aetna|AETNA OTHER|1,082.50||||||| 82306|EAP|0300|25 HYDROXY VITAMIN D RL39|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1,082.50||||||| 82306|EAP|0300|25 HYDROXY VITAMIN D RL39|Medicaid|MEDICAID|1,082.50||||||| 82306|EAP|0300|25 HYDROXY VITAMIN D RL39|Managed Medicare|HEALTHSPRING MA|1,082.50||||||| 82306|EAP|0300|25 HYDROXY VITAMIN D RL39|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1,082.50||||||| 82306|EAP|0300|25 HYDROXY VITAMIN D RL39|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1,082.50||||||| 82306|EAP|0300|25 HYDROXY VITAMIN D RL39|Blue Cross HMO Specialty|BCBSTX HMO|1,082.50||||||| 82306|EAP|0300|25 HYDROXY VITAMIN D RL39|Aenta Medicare Advantage|AETNA MEDICARE MA|1,082.50||||||| 82306|EAP|0300|25 HYDROXY VITAMIN D RL39|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1,082.50||||||| 82306|EAP|0300|25 HYDROXY VITAMIN D RL39|Medicare|MEDICARE ACUTE|1,082.50||||||| 82306|EAP|0300|25 HYDROXY VITAMIN D RL39|Blue Cross PPO Specialty|BCBSTX PPO|1,082.50||||||| 82306|EAP|0300|25 HYDROXY VITAMIN D RL39|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,082.50||||||| 82306|EAP|0300|25 HYDROXY VITAMIN D RL39|Tricare|TRICARE FOR LIFE|1,082.50||||||| 82306|EAP|0300|25 HYDROXY VITAMIN D RL39|United Healthcare|UNITED HEALTHCARE OTHER|1,082.50||||||| 82306|EAP|0300|25 HYDROXY VITAMIN D RL39|Workers Compensation|WORKERS COMPENSATION OTHER|1,082.50||||||| 82306|EAP|0300|25 HYDROXY VITAMIN D RL39|Texas Workforce Commission|DIS DETER SERV (DDS)|1,082.50||||||| 82306|EAP|0300|25 HYDROXY VITAMIN D RL39|United Medicare Advantage|UHC AARP WELLMED HMO MA|1,082.50||||||| 82306|EAP|0300|25 HYDROXY VITAMIN D RL39|PHCS|HUMANA INSURANCE|1,082.50||||||| 82306|EAP|0300|25 HYDROXY VITAMIN D RL39|United Medicare Advantage|UHC MEDICARE GOLD MA|1,082.50||||||| 82330|EAP|0300|CALCIUM, IONIZED (FREE)|Medicare|MEDICARE ACUTE|2.76||||||| 82330|EAP|0300|CALCIUM, IONIZED (FREE)|Aenta Medicare Advantage|AETNA MEDICARE MA|2.76||||||| 82397|EAP|0300|PTH-RELATED PROTEIN|Blue Cross HMO Specialty|BCBSTX HMO|5.63||||||| 82397|EAP|0300|INTERLUKIN 6|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.63||||||| 82397|EAP|0300|INTERLUKIN 6|Humana Medicare Advantage|HUMANA MA|5.63||||||| 82397|EAP|0300|PTH-RELATED PROTEIN|Medicare|MEDICARE ACUTE|5.63||||||| 82397|EAP|0300|INTERLUKIN 6|Medicare|MEDICARE ACUTE|5.63||||||| 82397|EAP|0300|PTH-RELATED PROTEIN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|5.63||||||| 82435|EAP|0300|CHLORIDE|Blue Cross PPO Specialty|BCBSTX PPO|0.93||||||| 82435|EAP|0300|CHLORIDE GC31000|Medicare|MEDICARE ACUTE|0.93||||||| 82435|EAP|0300|CHLORIDE|Medicare|MEDICARE ACUTE|0.93||||||| 82465|EAP|0300|CHOLESTEROL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.88||||||| 82465|EAP|0300|CHOLESTEROL|Medicare|MEDICARE ACUTE|0.88||||||| 82465|EAP|0300|CHOLESTEROL|Aenta Medicare Advantage|AETNA MEDICARE MA|0.88||||||| 82533|EAP|0300|PLASMA CORTISOL GC638|United Medicare Advantage|UHC MEDICARE GOLD MA|3.62||||||| 82533|EAP|0300|PLASMA CORTISOL GC638|United Medicare Advantage|UHC AARP WELLMED HMO MA|3.62||||||| 82533|EAP|0300|PLASMA CORTISOL GC638|Aenta Medicare Advantage|AETNA MEDICARE MA|3.62||||||| 82533|EAP|0300|PLASMA CORTISOL GC638|Medicare|MEDICARE ACUTE|3.62||||||| 82550|EAP|0300|CREATINE KINASE|Humana Medicare Advantage|HUMANA MA|1.31||||||| 82550|EAP|0300|CREATINE KINASE|Medicare|MEDICARE ACUTE|1.31||||||| 82550|EAP|0300|CREATINE KINASE|Blue Cross PPO Specialty|BCBSTX PPO|1.31||||||| 82565|EAP|0300|CREATININE BLOOD|United Medicare Advantage|UHC MEDICARE GOLD MA|1.03||||||| 82565|EAP|0300|CREATININE BLOOD|Medicaid|MEDICAID|1.03||||||| 82565|EAP|0300|CREATININE GC68800|Medicare|MEDICARE ACUTE|1.03||||||| 82565|EAP|0300|CREATININE BLOOD|Medicare|MEDICARE ACUTE|1.03||||||| 82565|EAP|0300|CREATININE GC68800|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.03||||||| 82565|EAP|0300|CREATININE BLOOD|Access Direct Platinum|HEALTHFIRST TPA|1.03||||||| 82565|EAP|0300|CREATININE BLOOD|Blue Cross PPO Specialty|BCBSTX PPO|1.03||||||| 82565|EAP|0300|CREATININE BLOOD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.03||||||| 82565|EAP|0300|CREATININE BLOOD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.03||||||| 82570|EAP|0300|CREATININE OTHER SOURCE|Aetna|AETNA OTHER|0.45||||||| 82570|EAP|0300|CREATININE OTHER SOURCE|Medicaid|MEDICAID|0.45||||||| 82570|EAP|0300|CREATININE OTHER SOURCE|Medicare|MEDICARE ACUTE|0.45||||||| 82570|EAP|0300|CREATININE OTHER SOURCE|Humana Medicare Advantage|HUMANA MA|0.45||||||| 82570|EAP|0300|CREATININE OTHER SOURCE|Managed Medicare|BCBS MEDICARE PPO MA|0.45||||||| 82570|EAP|0300|CREATININE OTHER SOURCE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.45||||||| 82607|EAP|0300|VITAMIN B-12|United Medicare Advantage|UHC MEDICARE GOLD MA|3.34||||||| 82607|EAP|0300|VITAMIN B-12|United Medicare Advantage|UHC AARP WELLMED HMO MA|3.34||||||| 82607|EAP|0300|VITAMIN B-12|United Healthcare|UNITED HEALTHCARE OTHER|3.34||||||| 82607|EAP|0300|VITAMIN B-12|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.34||||||| 82607|EAP|0300|VITAMIN B-12|Blue Cross HMO Specialty|BCBSTX HMO|3.34||||||| 82607|EAP|0300|VITAMIN B-12|Managed Medicare|HEALTHSPRING MA|3.34||||||| 82607|EAP|0300|VITAMIN B-12|Blue Cross PPO Specialty|BCBSTX PPO|3.34||||||| 82607|EAP|0300|VITAMIN B-12|Medicare|MEDICARE ACUTE|3.34||||||| 82607|EAP|0300|VITAMIN B-12|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|3.34||||||| 82607|EAP|0300|VITAMIN B-12|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.34||||||| 82607|EAP|0300|VITAMIN B-12|Humana Medicare Advantage|HUMANA MA|3.34||||||| 82607|EAP|0300|VITAMIN B-12|Aenta Medicare Advantage|AETNA MEDICARE MA|3.34||||||| 82652|EAP|0300|1,25 DIHYDROXY-VIT D RL39|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1,381.75||||||| 82652|EAP|0300|1,25 DIHYDROXY-VIT D RL39|Medicare|MEDICARE ACUTE|1,381.75||||||| 82728|EAP|0300|FERRITIN ASSAY SERUM GD|Blue Cross HMO Specialty|BCBSTX HMO|3.02||||||| 82728|EAP|0300|FERRITIN ASSAY SERUM GD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.02||||||| 82728|EAP|0300|FERRITIN ASSAY SERUM GD|Humana Medicare Advantage|HUMANA MA|3.02||||||| 82728|EAP|0300|FERRITIN ASSAY SERUM GD|Aenta Medicare Advantage|AETNA MEDICARE MA|3.02||||||| 82728|EAP|0300|FERRITIN ASSAY SERUM GD|Managed Medicare|HEALTHSPRING MA|3.02||||||| 82728|EAP|0300|FERRITIN ASSAY SERUM GD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.02||||||| 82728|EAP|0300|FERRITIN ASSAY SERUM GD|Medicare|MEDICARE ACUTE|3.02||||||| 82728|EAP|0300|FERRITIN ASSAY SERUM GD|Blue Cross PPO Specialty|BCBSTX PPO|3.02||||||| 82746|EAP|0300|FOLIC ACID GD71950|United Medicare Advantage|UHC AARP WELLMED HMO MA|3.26||||||| 82746|EAP|0300|FOLIC ACID GD71950|Blue Cross PPO Specialty|BCBSTX PPO|3.26||||||| 82746|EAP|0300|FOLIC ACID GD71950|Managed Medicare|HEALTHSPRING MA|3.26||||||| 82746|EAP|0300|FOLIC ACID GD71950|Aenta Medicare Advantage|AETNA MEDICARE MA|3.26||||||| 82746|EAP|0300|FOLIC ACID GD71950|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.26||||||| 82746|EAP|0300|FOLIC ACID GD71950|Humana Medicare Advantage|HUMANA MA|3.26||||||| 82746|EAP|0300|FOLIC ACID GD71950|Aetna|AETNA OTHER|3.26||||||| 82746|EAP|0300|FOLIC ACID GD71950|Blue Cross HMO Specialty|BCBSTX HMO|3.26||||||| 82746|EAP|0300|FOLIC ACID GD71950|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.26||||||| 82746|EAP|0300|FOLIC ACID GD71950|Medicare|MEDICARE ACUTE|3.26||||||| 82787|EAP|0300|IMMUNOGLOBUL IGG SUBCLASS|Medicare|MEDICARE ACUTE|1.67||||||| 82947|EAP|0300|GLUCOSE BLOOD GJ99600|Medicare|MEDICARE ACUTE|0.79||||||| 82947|EAP|0300|GLUCOSE CSF GK02200|Medicare|MEDICARE ACUTE|0.79||||||| 82947|EAP|0300|GLUCOSE CSF GK02200|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.79||||||| 82947|EAP|0300|GLUCOSE CSF GK02200|Blue Cross HMO Specialty|BCBSTX HMO|0.79||||||| 82947|EAP|0300|GLUCOSE CSF GK02200|Blue Cross PPO Specialty|BCBSTX PPO|0.79||||||| 82947|EAP|0300|GLUCOSE CSF GK02200|Aenta Medicare Advantage|AETNA MEDICARE MA|0.79||||||| 82947|EAP|0300|GLUCOSE BLOOD GJ99600|Blue Cross PPO Specialty|BCBSTX PPO|0.79||||||| 82962|EAP|0300|GLUCOSE TEST WITH ACCU-CH|United Medicare Advantage|UHC MEDICARE GOLD MA|0.57||||||| 82962|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Workers Compensation|WORKERS COMPENSATION OTHER|0.57||||||| 82962|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Tricare|TRICARE FOR LIFE|0.57||||||| 82962|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Aenta Medicare Advantage|AETNA MEDICARE MA|0.57||||||| 82962|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Texas Workforce Commission|DIS DETER SERV (DDS)|0.57||||||| 82962|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Access Direct Platinum|HEALTHFIRST TPA|0.57||||||| 82962|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Cigna|CIGNA OTHER|0.57||||||| 82962|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Medicare|MEDICARE ACUTE|0.57||||||| 82962|EAP|0300|GLUCOSE TEST WITH ACCU-CH|United Medicare Advantage|UHC AARP WELLMED HMO MA|0.57||||||| 82962|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.57||||||| 82962|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Medicaid|MEDICAID|0.57||||||| 82962|EAP|0300|GLUCOSE TEST WITH ACCU-CH|PHCS|HUMANA INSURANCE|0.57||||||| 82962|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Blue Cross PPO Specialty|BCBSTX PPO|0.57||||||| 82962|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Aetna|AETNA OTHER|0.57||||||| 82962|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Blue Cross HMO Specialty|BCBSTX HMO|0.57||||||| 82962|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.57||||||| 82962|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Managed Medicare|HEALTHSPRING MA|0.57||||||| 82962|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Humana Medicare Advantage|HUMANA MA|0.57||||||| 82962|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.57||||||| 82962|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.57||||||| 82962|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.57||||||| 82962|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|0.57||||||| 82962|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Medicare|MEDICARE PART B ONLY IP|0.57||||||| 82962|EAP|0300|GLUCOSE TEST WITH ACCU-CH|Managed Medicare|BCBS MEDICARE PPO MA|0.57||||||| 82977|EAP|0300|GAMMA GT GE05375|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.55||||||| 82977|EAP|0300|GAMMA GT GE05375|Medicare|MEDICARE ACUTE|0.55||||||| 83010|EAP|0300|HAPTOGLOBIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.54||||||| 83010|EAP|0300|HAPTOGLOBIN|Medicare|MEDICARE ACUTE|2.54||||||| 83036|EAP|0300|GLYCOHEMOGLOBIN GE38200|United Medicare Advantage|UHC MEDICARE GOLD MA|386.50||||||| 83036|EAP|0300|GLYCOHEMOGLOBIN GE38200|Tricare|TRICARE FOR LIFE|386.50||||||| 83036|EAP|0300|GLYCOHEMOGLOBIN GE38200|Blue Cross PPO Specialty|BCBSTX PPO|386.50||||||| 83036|EAP|0300|GLYCOHEMOGLOBIN GE38200|Cigna|CIGNA OTHER|386.50||||||| 83036|EAP|0300|GLYCOHEMOGLOBIN GE38200|Managed Medicare|HEALTHSPRING MA|386.50||||||| 83036|EAP|0300|GLYCOHEMOGLOBIN GE38200|Humana Medicare Advantage|HUMANA MA|386.50||||||| 83036|EAP|0300|GLYCOHEMOGLOBIN GE38200|Aenta Medicare Advantage|AETNA MEDICARE MA|386.50||||||| 83036|EAP|0300|GLYCOHEMOGLOBIN GE38200|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|386.50||||||| 83036|EAP|0300|GLYCOHEMOGLOBIN GE38200|Blue Cross HMO Specialty|BCBSTX HMO|386.50||||||| 83036|EAP|0300|GLYCOHEMOGLOBIN GE38200|Medicare|MEDICARE ACUTE|386.50||||||| 83036|EAP|0300|GLYCOHEMOGLOBIN GE38200|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|386.50||||||| 83516|EAP|0300|AB GLOMERULAR BASEMENT IG|Aenta Medicare Advantage|AETNA MEDICARE MA|98.63||||||| 83516|EAP|0300|GANGLIOSIDE GM1 AB|Aenta Medicare Advantage|AETNA MEDICARE MA|4.13||||||| 83525|EAP|0300|INSULIN RF15525|Medicare|MEDICARE ACUTE|455.25||||||| 83540|EAP|0300|SERUM IRON GF21800|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.31||||||| 83540|EAP|0300|SERUM IRON GF21800|United Medicare Advantage|UHC AARP WELLMED HMO MA|1.31||||||| 83540|EAP|0300|SERUM IRON GF21800|Blue Cross PPO Specialty|BCBSTX PPO|1.31||||||| 83540|EAP|0300|SERUM IRON GF21800|Blue Cross HMO Specialty|BCBSTX HMO|1.31||||||| 83540|EAP|0300|SERUM IRON GF21800|Aetna|AETNA OTHER|1.31||||||| 83540|EAP|0300|SERUM IRON GF21800|Managed Medicare|HEALTHSPRING MA|1.31||||||| 83540|EAP|0300|SERUM IRON GF21800|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.31||||||| 83540|EAP|0300|SERUM IRON GF21800|Humana Medicare Advantage|HUMANA MA|1.31||||||| 83540|EAP|0300|SERUM IRON GF21800|Aenta Medicare Advantage|AETNA MEDICARE MA|1.31||||||| 83540|EAP|0300|SERUM IRON GF21800|Cigna|CIGNA OTHER|1.31||||||| 83540|EAP|0300|SERUM IRON GF21800|Medicare|MEDICARE ACUTE|1.31||||||| 83540|EAP|0300|SERUM IRON GF21800|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.31||||||| 83550|EAP|0300|IRON BIND CAP GF20900|Blue Cross HMO Specialty|BCBSTX HMO|1.77||||||| 83550|EAP|0300|IRON BIND CAP GF20900|Humana Medicare Advantage|HUMANA MA|1.77||||||| 83550|EAP|0300|IRON BIND CAP GF20900|Blue Cross PPO Specialty|BCBSTX PPO|1.77||||||| 83550|EAP|0300|IRON BIND CAP GF20900|Aenta Medicare Advantage|AETNA MEDICARE MA|1.77||||||| 83550|EAP|0300|IRON BIND CAP GF20900|Managed Medicare|HEALTHSPRING MA|1.77||||||| 83550|EAP|0300|IRON BIND CAP GF20900|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.77||||||| 83550|EAP|0300|IRON BIND CAP GF20900|Cigna|CIGNA OTHER|1.77||||||| 83550|EAP|0300|IRON BIND CAP GF20900|Medicare|MEDICARE ACUTE|1.77||||||| 83550|EAP|0300|IRON BIND CAP GF20900|Aetna|AETNA OTHER|1.77||||||| 83550|EAP|0300|IRON BIND CAP GF20900|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.77||||||| 83550|EAP|0300|IRON BIND CAP GF20900|United Medicare Advantage|UHC AARP WELLMED HMO MA|1.77||||||| 83550|EAP|0300|IRON BIND CAP GF20900|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.77||||||| 83605|EAP|0300|LACTIC ACID GF46500|Workers Compensation|WORKERS COMPENSATION OTHER|2.15||||||| 83605|EAP|0300|LACTIC ACID GF46500|United Medicare Advantage|UHC AARP WELLMED HMO MA|2.15||||||| 83605|EAP|0300|LACTIC ACID GF46500|Medicaid|MEDICAID|2.15||||||| 83605|EAP|0300|LACTIC ACID GF46500|United Medicare Advantage|UHC MEDICARE GOLD MA|2.15||||||| 83605|EAP|0300|LACTIC ACID GF46500|Medicare|MEDICARE ACUTE|2.15||||||| 83605|EAP|0300|LACTIC ACID GF46500|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.15||||||| 83605|EAP|0300|LACTIC ACID GF46500|Aenta Medicare Advantage|AETNA MEDICARE MA|2.15||||||| 83605|EAP|0300|LACTIC ACID GF46500|Blue Cross PPO Specialty|BCBSTX PPO|2.15||||||| 83605|EAP|0300|LACTIC ACID GF46500|Humana Medicare Advantage|HUMANA MA|2.15||||||| 83605|EAP|0300|LACTIC ACID GF46500|Managed Medicare|BCBS MEDICARE PPO MA|2.15||||||| 83615|EAP|0300|LACTATE DEHYDROGENASE|Humana Medicare Advantage|HUMANA MA|1.22||||||| 83615|EAP|0300|LDH GF47100|Medicare|MEDICARE ACUTE|1.22||||||| 83615|EAP|0300|LACTATE DEHYDROGENASE LDH|Aenta Medicare Advantage|AETNA MEDICARE MA|835.50||||||| 83615|EAP|0300|LACTATE DEHYDROGENASE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.22||||||| 83615|EAP|0300|LDH GF47100|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.22||||||| 83615|EAP|0300|LDH GF47100|Aenta Medicare Advantage|AETNA MEDICARE MA|1.22||||||| 83615|EAP|0300|LDH GF47100|Blue Cross PPO Specialty|BCBSTX PPO|1.22||||||| 83615|EAP|0300|LACTATE DEHYDROGENASE|Blue Cross PPO Specialty|BCBSTX PPO|1.22||||||| 83615|EAP|0300|LACTATE DEHYDROGENASE|Medicare|MEDICARE ACUTE|1.22||||||| 83615|EAP|0300|LACTATE DEHYDROGENASE|United Healthcare|UNITED HEALTHCARE OTHER|1.22||||||| 83690|EAP|0300|LIPASE GF57700|Access Direct Platinum|HEALTHFIRST TPA|1.39||||||| 83690|EAP|0300|LIPASE GF57700|Medicare|MEDICARE ACUTE|1.39||||||| 83690|EAP|0300|LIPASE GF57700|Humana Medicare Advantage|HUMANA MA|1.39||||||| 83735|EAP|0300|MAGNESIUM GF84300|United Medicare Advantage|UHC MEDICARE GOLD MA|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|PHCS|HUMANA INSURANCE|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|United Healthcare|UNITED HEALTHCARE OTHER|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Blue Cross PPO Specialty|BCBSTX PPO|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Managed Medicare|HEALTHSPRING MA|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Workers Compensation|WORKERS COMPENSATION OTHER|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Cigna|CIGNA OTHER|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Aenta Medicare Advantage|AETNA MEDICARE MA|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Tricare|TRICARE FOR LIFE|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|United Medicare Advantage|UHC AARP WELLMED HMO MA|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Medicare|MEDICARE ACUTE|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Texas Workforce Commission|DIS DETER SERV (DDS)|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Managed Medicare|BCBS MEDICARE PPO MA|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Medicaid|MEDICAID|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Blue Cross HMO Specialty|BCBSTX HMO|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Aetna|AETNA OTHER|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Access Direct Platinum|HEALTHFIRST TPA|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Humana Medicare Advantage|HUMANA MA|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Medicare|MEDICARE PART B ONLY IP|1.35||||||| 83735|EAP|0300|MAGNESIUM GF84300|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.35||||||| 83880|EAP|0300|B-TYPE NATRIURETIC PEPTID|Aetna|AETNA OTHER|5.16||||||| 83880|EAP|0300|B-TYPE NATRIURETIC PEPTID|Blue Cross PPO Specialty|BCBSTX PPO|5.16||||||| 83880|EAP|0300|B-TYPE NATRIURETIC PEPTID|Medicare|MEDICARE ACUTE|5.16||||||| 83880|EAP|0300|B-TYPE NATRIURETIC PEPTID|Aenta Medicare Advantage|AETNA MEDICARE MA|5.16||||||| 83880|EAP|0300|B-TYPE NATRIURETIC PEPTID|United Medicare Advantage|UHC MEDICARE GOLD MA|5.16||||||| 83880|EAP|0300|B-TYPE NATRIURETIC PEPTID|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.16||||||| 83880|EAP|0300|B-TYPE NATRIURETIC PEPTID|Humana Medicare Advantage|HUMANA MA|5.16||||||| 83921|EAP|0300|METHYLMALONIC ACID, QN, S|Medicare|MEDICARE ACUTE|6.56||||||| 83930|EAP|0300|OSMOLALITY SERUM GG53800|Humana Medicare Advantage|HUMANA MA|1.09||||||| 83930|EAP|0300|OSMOLALITY SERUM GG53800|Medicare|MEDICARE ACUTE|1.09||||||| 83930|EAP|0300|OSMOLALITY SERUM GG53800|United Medicare Advantage|UHC MEDICARE GOLD MA|1.09||||||| 83935|EAP|0300|OSMOLALITY URINE GG54000|Medicare|MEDICARE ACUTE|0.99||||||| 83935|EAP|0300|OSMOLALITY URINE GG54000|Humana Medicare Advantage|HUMANA MA|0.99||||||| 83935|EAP|0300|OSMOLALITY URINE GG54000|United Medicare Advantage|UHC MEDICARE GOLD MA|0.99||||||| 83986|EAP|0300|PH URINE GH08500|Blue Cross PPO Specialty|BCBSTX PPO|1.41||||||| 83986|EAP|0300|PH URINE GH08500|Medicare|MEDICARE ACUTE|1.41||||||| 84100|EAP|0300|PHOSPHORUS|Workers Compensation|WORKERS COMPENSATION OTHER|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Tricare|TRICARE FOR LIFE|0.96||||||| 84100|EAP|0300|PHOSPHORUS|United Medicare Advantage|UHC MEDICARE GOLD MA|0.96||||||| 84100|EAP|0300|PHOSPHORUS|PHCS|HUMANA INSURANCE|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Texas Workforce Commission|DIS DETER SERV (DDS)|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Blue Cross HMO Specialty|BCBSTX HMO|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Managed Medicare|BCBS MEDICARE PPO MA|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Access Direct Platinum|HEALTHFIRST TPA|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.96||||||| 84100|EAP|0300|PHOSPHORUS|United Healthcare|UNITED HEALTHCARE OTHER|0.96||||||| 84100|EAP|0300|PHOSPHORUS|United Medicare Advantage|UHC AARP WELLMED HMO MA|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Medicare|MEDICARE ACUTE|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Cigna|CIGNA OTHER|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Blue Cross PPO Specialty|BCBSTX PPO|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Managed Medicare|HEALTHSPRING MA|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Aenta Medicare Advantage|AETNA MEDICARE MA|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Medicaid|MEDICAID|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Humana Medicare Advantage|HUMANA MA|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Medicare|MEDICARE PART B ONLY IP|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Aetna|AETNA OTHER|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.96||||||| 84100|EAP|0300|PHOSPHORUS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.96||||||| 84132|EAP|0300|POTASSIUM|Humana Medicare Advantage|HUMANA MA|0.93||||||| 84132|EAP|0300|POTASSIUM|Aetna|AETNA OTHER|0.93||||||| 84132|EAP|0300|POTASSIUM|Medicare|MEDICARE ACUTE|0.93||||||| 84132|EAP|0300|POTASSIUM|Medicaid|MEDICAID|0.93||||||| 84132|EAP|0300|POTASSIUM|Blue Cross PPO Specialty|BCBSTX PPO|0.93||||||| 84132|EAP|0300|POTASSIUM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.93||||||| 84132|EAP|0300|POTASSIUM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.93||||||| 84132|EAP|0300|POTASSIUM|Access Direct Platinum|HEALTHFIRST TPA|0.93||||||| 84132|EAP|0300|POTASSIUM|Managed Medicare|HEALTHSPRING MA|0.93||||||| 84132|EAP|0300|POTASSIUM (K) GH40100|Medicare|MEDICARE ACUTE|0.93||||||| 84132|EAP|0300|POTASSIUM|Aenta Medicare Advantage|AETNA MEDICARE MA|0.93||||||| 84132|EAP|0300|POTASSIUM|Cigna|CIGNA OTHER|0.93||||||| 84132|EAP|0300|POTASSIUM|Blue Cross HMO Specialty|BCBSTX HMO|0.93||||||| 84132|EAP|0300|POTASSIUM|Workers Compensation|WORKERS COMPENSATION OTHER|0.93||||||| 84132|EAP|0300|POTASSIUM|United Medicare Advantage|UHC MEDICARE GOLD MA|0.93||||||| 84132|EAP|0300|POTASSIUM|Texas Workforce Commission|DIS DETER SERV (DDS)|0.93||||||| 84132|EAP|0300|POTASSIUM|United Medicare Advantage|UHC AARP WELLMED HMO MA|0.93||||||| 84132|EAP|0300|POTASSIUM|Tricare|TRICARE FOR LIFE|0.93||||||| 84134|EAP|0300|PRE ALBUMIN|Tricare|TRICARE FOR LIFE|1.70||||||| 84134|EAP|0300|PRE ALBUMIN|United Medicare Advantage|UHC MEDICARE GOLD MA|1.70||||||| 84134|EAP|0300|PRE ALBUMIN|United Healthcare|UNITED HEALTHCARE OTHER|1.70||||||| 84134|EAP|0300|PRE ALBUMIN|Texas Workforce Commission|DIS DETER SERV (DDS)|1.70||||||| 84134|EAP|0300|PRE ALBUMIN|Medicare|MEDICARE ACUTE|1.70||||||| 84134|EAP|0300|PRE ALBUMIN|Medicaid|MEDICAID|1.70||||||| 84134|EAP|0300|PRE ALBUMIN|PHCS|HUMANA INSURANCE|1.70||||||| 84134|EAP|0300|PRE ALBUMIN|Blue Cross HMO Specialty|BCBSTX HMO|1.70||||||| 84134|EAP|0300|PRE ALBUMIN|Aetna|AETNA OTHER|1.70||||||| 84134|EAP|0300|PRE ALBUMIN|Medicare|MEDICARE PART B ONLY IP|1.70||||||| 84134|EAP|0300|PRE ALBUMIN|United Medicare Advantage|UHC AARP WELLMED HMO MA|1.70||||||| 84134|EAP|0300|PRE ALBUMIN|Managed Medicare|HEALTHSPRING MA|1.70||||||| 84134|EAP|0300|PRE ALBUMIN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.70||||||| 84134|EAP|0300|PRE ALBUMIN|Managed Medicare|BCBS MEDICARE PPO MA|1.70||||||| 84134|EAP|0300|PRE ALBUMIN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.70||||||| 84134|EAP|0300|PRE ALBUMIN|Access Direct Platinum|HEALTHFIRST TPA|1.70||||||| 84134|EAP|0300|PRE ALBUMIN|Blue Cross PPO Specialty|BCBSTX PPO|1.70||||||| 84134|EAP|0300|PRE ALBUMIN|Humana Medicare Advantage|HUMANA MA|1.70||||||| 84134|EAP|0300|PRE ALBUMIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.70||||||| 84134|EAP|0300|PRE ALBUMIN|Cigna|CIGNA OTHER|1.70||||||| 84134|EAP|0300|PRE ALBUMIN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.70||||||| 84134|EAP|0300|PRE ALBUMIN|Aenta Medicare Advantage|AETNA MEDICARE MA|1.70||||||| 84145|EAP|0300|PROCALCITONIN (PCT)|Medicare|MEDICARE ACUTE|958.25||||||| 84145|EAP|0300|PROCALCITONIN (PCT)|Blue Cross PPO Specialty|BCBSTX PPO|958.25||||||| 84145|EAP|0300|PROCALCITONIN (PCT)|Humana Medicare Advantage|HUMANA MA|958.25||||||| 84153|EAP|0300|PROSTATIC SPECIFIC ANTIGE|Medicare|MEDICARE ACUTE|4.08||||||| 84153|EAP|0300|PROSTATIC SPECIFIC ACID,|Medicare|MEDICARE ACUTE|732.75||||||| 84153|EAP|0300|PROSTATIC SPECIFIC ANTIGE|Blue Cross HMO Specialty|BCBSTX HMO|4.08||||||| 84155|EAP|0300|PROTEIN, CSF GH55700|Aenta Medicare Advantage|AETNA MEDICARE MA|0.74||||||| 84155|EAP|0300|PROTEIN TOTAL|Medicare|MEDICARE ACUTE|0.74||||||| 84155|EAP|0300|PROTEIN, TOTAL, A/G GH573|Medicare|MEDICARE ACUTE|0.48||||||| 84155|EAP|0300|PROTEIN, TOTAL, A/G GH573|Humana Medicare Advantage|HUMANA MA|0.48||||||| 84155|EAP|0300|PROTEIN, CSF GH55700|Blue Cross HMO Specialty|BCBSTX HMO|0.74||||||| 84155|EAP|0300|PROTEIN, CSF GH55700|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.74||||||| 84155|EAP|0300|PROTEIN, CSF GH55700|Blue Cross PPO Specialty|BCBSTX PPO|0.74||||||| 84155|EAP|0300|PROTEIN TOTAL|Blue Cross PPO Specialty|BCBSTX PPO|0.74||||||| 84155|EAP|0300|PROTEIN, CSF GH55700|Medicare|MEDICARE ACUTE|0.74||||||| 84156|EAP|0300|PR0TEIN TOTAL URINE 24 HR|Medicare|MEDICARE ACUTE|0.48||||||| 84166|EAP|0300|URINE PROTEIN ELECTROPHOR|Medicare|MEDICARE ACUTE|1.46||||||| 84295|EAP|0300|SODIUM (NA) GJ66200|United Medicare Advantage|UHC MEDICARE GOLD MA|0.97||||||| 84295|EAP|0300|SODIUM (NA) GJ66200|Aetna|AETNA OTHER|0.97||||||| 84295|EAP|0300|SODIUM|Medicare|MEDICARE ACUTE|0.97||||||| 84295|EAP|0300|SODIUM (NA) GJ66200|Managed Medicare|BCBS MEDICARE PPO MA|0.97||||||| 84295|EAP|0300|SODIUM|Blue Cross PPO Specialty|BCBSTX PPO|0.97||||||| 84295|EAP|0300|SODIUM (NA) GJ66200|Medicaid|MEDICAID|0.97||||||| 84295|EAP|0300|SODIUM (NA) GJ66200|Humana Medicare Advantage|HUMANA MA|0.97||||||| 84295|EAP|0300|SODIUM|Humana Medicare Advantage|HUMANA MA|0.97||||||| 84295|EAP|0300|SODIUM (NA) GJ66200|Medicare|MEDICARE ACUTE|0.97||||||| 84425|EAP|0300|THIAMINE VITAMIN B1|Medicare|MEDICARE ACUTE|2.71||||||| 84436|EAP|0300|THYROXINE (T-4) ID3964|Medicare|MEDICARE ACUTE|1.52||||||| 84439|EAP|0300|T4 FREE RK19395|United Medicare Advantage|UHC MEDICARE GOLD MA|359.25||||||| 84439|EAP|0300|T4 FREE RK19395|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|359.25||||||| 84439|EAP|0300|T4 FREE RK19395|Medicare|MEDICARE ACUTE|359.25||||||| 84443|EAP|0300|TSH GK41700|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.73||||||| 84443|EAP|0300|TSH GK41700|Humana Medicare Advantage|HUMANA MA|3.73||||||| 84443|EAP|0300|TSH GK41700|Aenta Medicare Advantage|AETNA MEDICARE MA|3.73||||||| 84443|EAP|0300|TSH GK41700|Medicare|MEDICARE ACUTE|3.73||||||| 84443|EAP|0300|TSH GK41700|Managed Medicare|BCBS MEDICARE PPO MA|3.73||||||| 84443|EAP|0300|TSH GK41700|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|3.73||||||| 84443|EAP|0300|TSH GK41700|Managed Medicare|HEALTHSPRING MA|3.73||||||| 84443|EAP|0300|TSH GK41700|United Healthcare|UNITED HEALTHCARE OTHER|3.73||||||| 84443|EAP|0300|TSH GK41700|Tricare|TRICARE FOR LIFE|3.73||||||| 84443|EAP|0300|TSH GK41700|United Medicare Advantage|UHC MEDICARE GOLD MA|3.73||||||| 84466|EAP|0300|TRANSFERRIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.86||||||| 84478|EAP|0300|TRIGLYCERIDES|Access Direct Platinum|HEALTHFIRST TPA|1.16||||||| 84478|EAP|0300|TRIGLYCERIDES|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.16||||||| 84478|EAP|0300|TRIGLYCERIDES|Aenta Medicare Advantage|AETNA MEDICARE MA|1.16||||||| 84478|EAP|0300|TRIGLYCERIDES|Humana Medicare Advantage|HUMANA MA|1.16||||||| 84478|EAP|0300|TRIGLYCERIDES|Medicare|MEDICARE ACUTE|1.16||||||| 84479|EAP|0300|T-3 UPTAKE ID71500|Medicare|MEDICARE ACUTE|257.75||||||| 84480|EAP|0300|T3 RIA ID71500|United Medicare Advantage|UHC MEDICARE GOLD MA|3.15||||||| 84480|EAP|0300|T3 RIA ID71500|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|3.15||||||| 84481|EAP|0300|T3 FREE RK62610|Medicare|MEDICARE ACUTE|675.25||||||| 84484|EAP|0300|TROPONIN QUANT|United Medicare Advantage|UHC AARP WELLMED HMO MA|1.99||||||| 84484|EAP|0300|TROPONIN QUANT|United Medicare Advantage|UHC MEDICARE GOLD MA|1.99||||||| 84484|EAP|0300|TROPONIN QUANT|Managed Medicare|BCBS MEDICARE PPO MA|1.99||||||| 84484|EAP|0300|TROPONIN QUANT|Aetna|AETNA OTHER|1.99||||||| 84484|EAP|0300|TROPONIN QUANT|Medicare|MEDICARE ACUTE|1.99||||||| 84484|EAP|0300|TROPONIN QUANT|Humana Medicare Advantage|HUMANA MA|1.99||||||| 84520|EAP|0300|BUN GK86500|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.80||||||| 84520|EAP|0300|BUN|Medicare|MEDICARE ACUTE|0.38||||||| 84520|EAP|0300|BUN|Medicaid|MEDICAID|0.38||||||| 84520|EAP|0300|BUN|Blue Cross PPO Specialty|BCBSTX PPO|0.38||||||| 84520|EAP|0300|BUN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.38||||||| 84520|EAP|0300|BUN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.38||||||| 84520|EAP|0300|BUN GK86500|Medicare|MEDICARE ACUTE|0.80||||||| 84520|EAP|0300|BUN|Access Direct Platinum|HEALTHFIRST TPA|0.38||||||| 84520|EAP|0300|BUN|United Medicare Advantage|UHC MEDICARE GOLD MA|0.38||||||| 84540|EAP|0300|UUNRAN|Medicare|MEDICARE ACUTE|0.96||||||| 84540|EAP|0300|UUNRAN|United Medicare Advantage|UHC MEDICARE GOLD MA|0.96||||||| 84550|EAP|0300|URIC ACID|Blue Cross PPO Specialty|BCBSTX PPO|0.91||||||| 84550|EAP|0300|URIC ACID|Humana Medicare Advantage|HUMANA MA|0.91||||||| 84550|EAP|0300|URIC ACID|United Medicare Advantage|UHC MEDICARE GOLD MA|0.91||||||| 84550|EAP|0300|URIC ACID|Medicare|MEDICARE ACUTE|0.91||||||| 84560|EAP|0300|URIC ACID URINE QUANT|United Medicare Advantage|UHC MEDICARE GOLD MA|189.25||||||| 84560|EAP|0300|URIC ACID URINE QUANT|Medicare|MEDICARE ACUTE|189.25||||||| 84999|EAP|0300|POTASSIUM FECES|Medicare|MEDICARE ACUTE|3.80||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|United Medicare Advantage|UHC MEDICARE GOLD MA|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Medicaid|MEDICAID|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Access Direct Platinum|HEALTHFIRST TPA|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Blue Cross HMO Specialty|BCBSTX HMO|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|United Medicare Advantage|UHC AARP WELLMED HMO MA|1.57||||||| 85007|EAP|0300|PERIPHERL BLOOD SMEAR GH0|Medicare|MEDICARE ACUTE|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Managed Medicare|HEALTHSPRING MA|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Blue Cross PPO Specialty|BCBSTX PPO|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|United Healthcare|UNITED HEALTHCARE OTHER|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Managed Medicare|BCBS MEDICARE PPO MA|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Aetna|AETNA OTHER|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Aenta Medicare Advantage|AETNA MEDICARE MA|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Medicare|MEDICARE PART B ONLY IP|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Cigna|CIGNA OTHER|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Medicare|MEDICARE ACUTE|1.57||||||| 85007|EAP|0300|DIFFERENTIAL COUNT GC9960|Humana Medicare Advantage|HUMANA MA|1.57||||||| 85013|EAP|0300|HEMATOCRIT GE68500|Medicare|MEDICARE ACUTE|1.08||||||| 85013|EAP|0300|HEMATOCRIT GE68500|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.08||||||| 85013|EAP|0300|HEMATOCRIT GE68500|Blue Cross PPO Specialty|BCBSTX PPO|1.08||||||| 85013|EAP|0300|HEMATOCRIT GE68500|Medicaid|MEDICAID|1.08||||||| 85013|EAP|0300|HEMATOCRIT GE68500|Humana Medicare Advantage|HUMANA MA|1.08||||||| 85014|EAP|0300|HEMATOCRIT|United Healthcare|UNITED HEALTHCARE OTHER|1.08||||||| 85014|EAP|0300|HEMATOCRIT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.08||||||| 85014|EAP|0300|HEMATOCRIT|Medicare|MEDICARE ACUTE|1.08||||||| 85014|EAP|0300|HEMATOCRIT|Blue Cross HMO Specialty|BCBSTX HMO|1.08||||||| 85014|EAP|0300|HEMATOCRIT|Humana Medicare Advantage|HUMANA MA|1.08||||||| 85014|EAP|0300|HEMATOCRIT|Aenta Medicare Advantage|AETNA MEDICARE MA|1.08||||||| 85014|EAP|0300|HEMATOCRIT|United Medicare Advantage|UHC MEDICARE GOLD MA|1.08||||||| 85018|EAP|0300|HEMOGLOBIN|Blue Cross HMO Specialty|BCBSTX HMO|1.08||||||| 85018|EAP|0300|HEMOGLOBIN GE70400|Humana Medicare Advantage|HUMANA MA|1.08||||||| 85018|EAP|0300|HEMOGLOBIN GE70400|Medicaid|MEDICAID|1.08||||||| 85018|EAP|0300|HEMOGLOBIN|Aenta Medicare Advantage|AETNA MEDICARE MA|1.08||||||| 85018|EAP|0300|HEMOGLOBIN GE70400|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.08||||||| 85018|EAP|0300|HEMOGLOBIN|Humana Medicare Advantage|HUMANA MA|1.08||||||| 85018|EAP|0300|HEMOGLOBIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.08||||||| 85018|EAP|0300|HEMOGLOBIN|Medicare|MEDICARE ACUTE|1.08||||||| 85018|EAP|0300|HEMOGLOBIN GE70400|Medicare|MEDICARE ACUTE|1.08||||||| 85018|EAP|0300|HEMOGLOBIN|United Medicare Advantage|UHC MEDICARE GOLD MA|1.08||||||| 85018|EAP|0300|HEMOGLOBIN GE70400|Blue Cross PPO Specialty|BCBSTX PPO|1.08||||||| 85018|EAP|0300|HEMOGLOBIN|United Healthcare|UNITED HEALTHCARE OTHER|1.08||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Managed Medicare|BCBS MEDICARE PPO MA|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Blue Cross PPO Specialty|BCBSTX PPO|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Blue Cross HMO Specialty|BCBSTX HMO|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Aenta Medicare Advantage|AETNA MEDICARE MA|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Medicare|MEDICARE ACUTE|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Cigna|CIGNA OTHER|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Aetna|AETNA OTHER|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Access Direct Platinum|HEALTHFIRST TPA|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Medicare|MEDICARE PART B ONLY IP|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Humana Medicare Advantage|HUMANA MA|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Texas Workforce Commission|DIS DETER SERV (DDS)|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|United Medicare Advantage|UHC AARP WELLMED HMO MA|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Workers Compensation|WORKERS COMPENSATION OTHER|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|PHCS|HUMANA INSURANCE|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Tricare|TRICARE FOR LIFE|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|United Healthcare|UNITED HEALTHCARE OTHER|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|United Medicare Advantage|UHC MEDICARE GOLD MA|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Medicaid|MEDICAID|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Managed Medicare|HEALTHSPRING MA|1.61||||||| 85025|EAP|0300|COMPLETE BLOOD COUNT|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.61||||||| 85027|EAP|0300|CBC W/O DIFF|Blue Cross PPO Specialty|BCBSTX PPO|2.96||||||| 85027|EAP|0300|CBC W/O DIFF|Medicaid|MEDICAID|2.96||||||| 85027|EAP|0300|CBC W/O DIFF|Humana Medicare Advantage|HUMANA MA|2.96||||||| 85027|EAP|0300|CBC W/O DIFF|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.96||||||| 85027|EAP|0300|CBC W/O DIFF|Aenta Medicare Advantage|AETNA MEDICARE MA|2.96||||||| 85027|EAP|0300|CBC W/O DIFF|Medicare|MEDICARE PART B ONLY IP|2.96||||||| 85027|EAP|0300|CBC W/O DIFF|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.96||||||| 85027|EAP|0300|CBC W/O DIFF|Medicare|MEDICARE ACUTE|2.96||||||| 85027|EAP|0300|CBC W/O DIFF|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.96||||||| 85027|EAP|0300|CBC W/O DIFF|Workers Compensation|WORKERS COMPENSATION OTHER|2.96||||||| 85027|EAP|0300|CBC W/O DIFF|United Medicare Advantage|UHC MEDICARE GOLD MA|2.96||||||| 85044|EAP|0300|RETICULOCYTE COUNT GJ149|United Medicare Advantage|UHC AARP WELLMED HMO MA|1.96||||||| 85044|EAP|0300|RETICULOCYTE COUNT GJ149|Humana Medicare Advantage|HUMANA MA|1.96||||||| 85044|EAP|0300|RETICULOCYTE COUNT GJ149|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.96||||||| 85044|EAP|0300|RETICULOCYTE COUNT GJ149|Medicare|MEDICARE ACUTE|1.96||||||| 85044|EAP|0300|RETICULOCYTE COUNT GJ149|Blue Cross PPO Specialty|BCBSTX PPO|1.96||||||| 85044|EAP|0300|RETICULOCYTE COUNT GJ149|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.96||||||| 85044|EAP|0300|RETICULOCYTE COUNT GJ149|Aenta Medicare Advantage|AETNA MEDICARE MA|1.96||||||| 85210|EAP|0300|FACTOR II GD52700|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.94||||||| 85230|EAP|0300|FACTOR VII GD53600|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|8.19||||||| 85244|EAP|0300|FACTOR VIII RELATED ANTIG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.33||||||| 85245|EAP|0300|FACTOR VIII RISTOCETIN CO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.26||||||| 85260|EAP|0300|FACTOR X GD54600|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|8.19||||||| 85303|EAP|0300|PROTEIN C ACTIVITY|Medicare|MEDICARE ACUTE|550.75||||||| 85303|EAP|0300|PROTEIN S ACTIVITY|Medicare|MEDICARE ACUTE|550.75||||||| 85347|EAP|0300|ACTIVATED CLOTTING TIME|Medicare|MEDICARE ACUTE|2.36||||||| 85362|EAP|0300|FIBRIN DEGRAD PROD GD6700|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.15||||||| 85362|EAP|0300|FIBRIN DEGRAD PROD GD6700|Medicare|MEDICARE ACUTE|3.15||||||| 85378|EAP|0300|D-DIMERS|Aenta Medicare Advantage|AETNA MEDICARE MA|3.26||||||| 85378|EAP|0300|D-DIMERS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.26||||||| 85378|EAP|0300|D-DIMERS|Medicare|MEDICARE ACUTE|3.26||||||| 85378|EAP|0300|D-DIMERS|Humana Medicare Advantage|HUMANA MA|3.26||||||| 85384|EAP|0300|FIBRINOGEN GD66700|United Medicare Advantage|UHC MEDICARE GOLD MA|3.88||||||| 85384|EAP|0300|FIBRINOGEN GD66700|Medicare|MEDICARE ACUTE|3.88||||||| 85384|EAP|0300|FIBRINOGEN GD66700|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.88||||||| 85384|EAP|0300|FIBRINOGEN GD66700|Humana Medicare Advantage|HUMANA MA|3.88||||||| 85397|EAP|0300|ADAMTS-13 ACTIVITY|Medicare|MEDICARE ACUTE|3.14||||||| 85520|EAP|0300|HEPARIN ASSAY|Humana Medicare Advantage|HUMANA MA|5.98||||||| 85576|EAP|0300|PLATELET FUNCTION TEST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.82||||||| 85576|EAP|0300|PLATELET FUNCTION TEST|Humana Medicare Advantage|HUMANA MA|9.82||||||| 85576|EAP|0300|PLATELET FUNCTION ASSAY P|Medicare|MEDICARE ACUTE|9.82||||||| 85576|EAP|0300|PLATELET FUNCTION ASSAY P|Humana Medicare Advantage|HUMANA MA|9.82||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|United Medicare Advantage|UHC MEDICARE GOLD MA|1.07||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.07||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|Blue Cross PPO Specialty|BCBSTX PPO|1.07||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|Access Direct Platinum|HEALTHFIRST TPA|1.07||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|Medicare|MEDICARE ACUTE|1.07||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|Aenta Medicare Advantage|AETNA MEDICARE MA|1.07||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.07||||||| 85610|EAP|0300|PROTHROMBIN TIME GH62500|Humana Medicare Advantage|HUMANA MA|1.07||||||| 85613|EAP|0300|LUPUS ANTICOAGULANT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.20||||||| 85652|EAP|0300|SEDIMENTATION RATE (ESR)|United Medicare Advantage|UHC MEDICARE GOLD MA|1.62||||||| 85652|EAP|0300|SEDIMENTATION RATE (ESR)|Blue Cross PPO Specialty|BCBSTX PPO|1.62||||||| 85652|EAP|0300|SEDIMENTATION RATE (ESR)|Medicare|MEDICARE ACUTE|1.62||||||| 85652|EAP|0300|SEDIMENTATION RATE (ESR)|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.62||||||| 85652|EAP|0300|SEDIMENTATION RATE (ESR)|Managed Medicare|HEALTHSPRING MA|1.62||||||| 85652|EAP|0300|SEDIMENTATION RATE (ESR)|Medicaid|MEDICAID|1.62||||||| 85652|EAP|0300|SEDIMENTATION RATE (ESR)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.62||||||| 85652|EAP|0300|SEDIMENTATION RATE (ESR)|Humana Medicare Advantage|HUMANA MA|1.62||||||| 85652|EAP|0300|SEDIMENTATION RATE (ESR)|Blue Cross HMO Specialty|BCBSTX HMO|1.62||||||| 85652|EAP|0300|SEDIMENTATION RATE (ESR)|Access Direct Platinum|HEALTHFIRST TPA|1.62||||||| 85652|EAP|0300|SEDIMENTATION RATE (ESR)|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.62||||||| 85730|EAP|0300|PARTIAL THROMB TIME (PTT)|Aenta Medicare Advantage|AETNA MEDICARE MA|1.49||||||| 85730|EAP|0300|PARTIAL THROMB TIME (PTT)|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.49||||||| 85730|EAP|0300|PARTIAL THROMB TIME (PTT)|Blue Cross PPO Specialty|BCBSTX PPO|1.49||||||| 85730|EAP|0300|PARTIAL THROMB TIME (PTT)|Access Direct Platinum|HEALTHFIRST TPA|1.49||||||| 85730|EAP|0300|PARTIAL THROMB TIME (PTT)|Medicare|MEDICARE ACUTE|1.49||||||| 85730|EAP|0300|PARTIAL THROMB TIME (PTT)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.49||||||| 85730|EAP|0300|PARTIAL THROMB TIME (PTT)|Humana Medicare Advantage|HUMANA MA|1.49||||||| 85730|EAP|0300|PARTIAL THROMB TIME (PTT)|United Medicare Advantage|UHC MEDICARE GOLD MA|1.49||||||| 86022|EAP|0300|HEP INDUCED PLATELET AB|Medicare|MEDICARE ACUTE|3.90||||||| 86038|EAP|0300|ANTINUCLEAR ANTIBODY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.38||||||| 86140|EAP|0300|C-REACTIVE PROTEIN|United Medicare Advantage|UHC AARP WELLMED HMO MA|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN|Texas Workforce Commission|DIS DETER SERV (DDS)|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN|United Healthcare|UNITED HEALTHCARE OTHER|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN|Tricare|TRICARE FOR LIFE|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN|United Medicare Advantage|UHC MEDICARE GOLD MA|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN|Medicaid|MEDICAID|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN|Cigna|CIGNA OTHER|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN|Blue Cross HMO Specialty|BCBSTX HMO|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN|Aetna|AETNA OTHER|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN|Blue Cross PPO Specialty|BCBSTX PPO|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN|PHCS|HUMANA INSURANCE|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN|Medicare|MEDICARE PART B ONLY IP|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN|Medicare|MEDICARE ACUTE|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN|Managed Medicare|HEALTHSPRING MA|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN|Access Direct Platinum|HEALTHFIRST TPA|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN|Managed Medicare|BCBS MEDICARE PPO MA|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN|Aenta Medicare Advantage|AETNA MEDICARE MA|1.02||||||| 86140|EAP|0300|C-REACTIVE PROTEIN|Humana Medicare Advantage|HUMANA MA|1.02||||||| 86146|EAP|0300|AB GLYCOPROTEIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|301.50||||||| 86147|EAP|0300|PHOSPHOLIPID AB IGM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.13||||||| 86147|EAP|0300|PHOSPHOLIPID AB IGG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.13||||||| 86147|EAP|0300|PHOSPHOLIPID AB IGA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.13||||||| 862|DRG||POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W MCC|Medicare|MEDICARE ACUTE|201,412.21|14856.13|14856.13|14856.13|||| 86235|EAP|0300|ANTI-SMOOTH MUSCLE|Medicare|MEDICARE ACUTE|714.75||||||| 86255|EAP|0300|NEUROMYLITIS OPTICA AB|Medicare|MEDICARE ACUTE|530.25||||||| 86255|EAP|0300|AB ANTI-NEUTROPHIL CYTOPL|Medicare|MEDICARE ACUTE|480.50||||||| 86255|EAP|0300|AB ANTI-NEUTROPHIL CYTOPL|Aenta Medicare Advantage|AETNA MEDICARE MA|480.50||||||| 86280|EAP|0300|ANTIMITOCHONRL ANTIBDY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|326.25||||||| 863|DRG||POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W/O MCC|Medicare|MEDICARE ACUTE|317,809.82|29128.9|29128.9|29128.9|||| 863|DRG||POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W/O MCC|Humana Medicare Advantage|HUMANA MA|271,382.23|29128.9|29128.9|29128.9|||| 86335|EAP|0300|IMMUNFIX E-PHORSIS/URINE/|Medicare|MEDICARE ACUTE|2.43||||||| 86376|EAP|0300|AB MICROSOMAL LIVER KIDNE|Aenta Medicare Advantage|AETNA MEDICARE MA|558.75||||||| 86403|EAP|0300|CRYPTOCOCCAL ANTIGEN|Medicare|MEDICARE ACUTE|2.00||||||| 86403|EAP|0300|CRYPTOCOCCAL ANTIGEN|Aenta Medicare Advantage|AETNA MEDICARE MA|2.00||||||| 86403|EAP|0300|CRYPTOCOCCAL ANTIGEN|Humana Medicare Advantage|HUMANA MA|2.00||||||| 86592|EAP|0300|RPR SERUM|Medicare|MEDICARE ACUTE|0.84||||||| 86592|EAP|0300|VDRL CEREBROSPINAL FLUID|Aenta Medicare Advantage|AETNA MEDICARE MA|282.25||||||| 86611|EAP|0300|AB BARTONELLA QUINTANA IG|Aenta Medicare Advantage|AETNA MEDICARE MA|3.26||||||| 86611|EAP|0300|AB BARTONELLA HENSELAE IG|Aenta Medicare Advantage|AETNA MEDICARE MA|3.26||||||| 86635|EAP|0300|AB COCCIDIODES|Aenta Medicare Advantage|AETNA MEDICARE MA|3.26||||||| 86701|EAP|0300|HIV-ANTIBODY GE91037|Medicare|MEDICARE ACUTE|7.13||||||| 86701|EAP|0300|HIV-ANTIBODY GE91037|Aenta Medicare Advantage|AETNA MEDICARE MA|7.13||||||| 86704|EAP|0300|AB HEPATITIS B CORE|Medicare|MEDICARE ACUTE|2.61||||||| 86704|EAP|0300|AB HEPATITIS B CORE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.61||||||| 86705|EAP|0300|AB HEPATITIS B CORE IGM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|468.75||||||| 86705|EAP|0300|AB HEPATITIS B CORE IGM|Medicare|MEDICARE ACUTE|468.75||||||| 86706|EAP|0300|AB HEPATITIS B SURFACE|Managed Medicare|BCBS MEDICARE PPO MA|4.28||||||| 86706|EAP|0300|AB HEPATITIS B SURFACE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.28||||||| 86706|EAP|0300|AB HEPATITIS B SURFACE|Humana Medicare Advantage|HUMANA MA|4.28||||||| 86706|EAP|0300|AB HEPATITIS B SURFACE|Medicare|MEDICARE ACUTE|4.28||||||| 86713|EAP|0300|LEGIONELLA DIRECT DNA RF5|United Medicare Advantage|UHC AARP WELLMED HMO MA|478.25||||||| 86713|EAP|0300|LEGIONELLA DIRECT DNA RF5|Humana Medicare Advantage|HUMANA MA|514.12||||||| 86713|EAP|0300|LEGIONELLA DIRECT DNA RF5|Medicaid|MEDICAID|478.25||||||| 86713|EAP|0300|LEGIONELLA DIRECT DNA RF5|Medicare|MEDICARE ACUTE|478.25||||||| 86777|EAP|0300|TOXOPLASMOSIS GK53400|Aenta Medicare Advantage|AETNA MEDICARE MA|573.50||||||| 86800|EAP|0300|AB THYROGLOBULIN|Aenta Medicare Advantage|AETNA MEDICARE MA|6.11||||||| 86870|EAP|0300|ANTIBODY IDENTIFICATION|Medicaid|MEDICAID|7.36||||||| 86870|EAP|0300|ANTIBODY IDENTIFICATION|Medicare|MEDICARE ACUTE|7.36||||||| 86886|EAP|0300|COOMBS INDIRECT GC57100|United Healthcare|UNITED HEALTHCARE OTHER|2.44||||||| 86886|EAP|0300|COOMBS INDIRECT GC57100|United Medicare Advantage|UHC MEDICARE GOLD MA|2.44||||||| 86886|EAP|0300|COOMBS INDIRECT GC57100|United Medicare Advantage|UHC AARP WELLMED HMO MA|2.44||||||| 86886|EAP|0300|COOMBS INDIRECT GC57100|Humana Medicare Advantage|HUMANA MA|2.44||||||| 86886|EAP|0300|COOMBS INDIRECT GC57100|Blue Cross HMO Specialty|BCBSTX HMO|2.44||||||| 86886|EAP|0300|COOMBS INDIRECT GC57100|Blue Cross PPO Specialty|BCBSTX PPO|2.44||||||| 86886|EAP|0300|COOMBS INDIRECT GC57100|Access Direct Platinum|HEALTHFIRST TPA|2.44||||||| 86886|EAP|0300|COOMBS INDIRECT GC57100|Aenta Medicare Advantage|AETNA MEDICARE MA|2.44||||||| 86886|EAP|0300|COOMBS INDIRECT GC57100|Medicaid|MEDICAID|2.44||||||| 86886|EAP|0300|COOMBS INDIRECT GC57100|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.44||||||| 86886|EAP|0300|COOMBS INDIRECT GC57100|Medicare|MEDICARE ACUTE|2.44||||||| 86886|EAP|0300|COOMBS INDIRECT GC57100|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.44||||||| 86900|EAP|0300|ABO GROUP ONLY|Humana Medicare Advantage|HUMANA MA|1.27||||||| 86900|EAP|0300|ABO GROUP ONLY|Blue Cross HMO Specialty|BCBSTX HMO|1.27||||||| 86900|EAP|0300|ABO GROUP ONLY|Access Direct Platinum|HEALTHFIRST TPA|1.27||||||| 86900|EAP|0300|ABO GROUP ONLY|Medicaid|MEDICAID|1.27||||||| 86900|EAP|0300|ABO GROUP ONLY|Medicare|MEDICARE ACUTE|1.27||||||| 86900|EAP|0300|ABO GROUP ONLY|Aenta Medicare Advantage|AETNA MEDICARE MA|1.27||||||| 86900|EAP|0300|ABO GROUP ONLY|Blue Cross PPO Specialty|BCBSTX PPO|1.27||||||| 86900|EAP|0300|ABO GROUP ONLY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.27||||||| 86900|EAP|0300|ABO GROUP ONLY|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.27||||||| 86900|EAP|0300|ABO GROUP ONLY|United Medicare Advantage|UHC MEDICARE GOLD MA|1.27||||||| 86900|EAP|0300|ABO GROUP ONLY|United Medicare Advantage|UHC AARP WELLMED HMO MA|1.27||||||| 86900|EAP|0300|ABO GROUP ONLY|United Healthcare|UNITED HEALTHCARE OTHER|1.27||||||| 86901|EAP|0300|RH TYPE ONLY|United Medicare Advantage|UHC MEDICARE GOLD MA|1.27||||||| 86901|EAP|0300|RH TYPE ONLY|United Medicare Advantage|UHC AARP WELLMED HMO MA|1.27||||||| 86901|EAP|0300|RH TYPE ONLY|United Healthcare|UNITED HEALTHCARE OTHER|1.27||||||| 86901|EAP|0300|RH TYPE ONLY|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.27||||||| 86901|EAP|0300|RH TYPE ONLY|Blue Cross HMO Specialty|BCBSTX HMO|1.27||||||| 86901|EAP|0300|RH TYPE ONLY|Aenta Medicare Advantage|AETNA MEDICARE MA|1.27||||||| 86901|EAP|0300|RH TYPE ONLY|Medicare|MEDICARE ACUTE|1.27||||||| 86901|EAP|0300|RH TYPE ONLY|Blue Cross PPO Specialty|BCBSTX PPO|1.27||||||| 86901|EAP|0300|RH TYPE ONLY|Access Direct Platinum|HEALTHFIRST TPA|1.27||||||| 86901|EAP|0300|RH TYPE ONLY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.27||||||| 86901|EAP|0300|RH TYPE ONLY|Medicaid|MEDICAID|1.27||||||| 86901|EAP|0300|RH TYPE ONLY|Humana Medicare Advantage|HUMANA MA|1.27||||||| 86903|EAP|0300|ANTIGEN SCREEN EA UNIT|Medicare|MEDICARE ACUTE|4.03||||||| 86922|EAP|0300|TYPE-CROSS MATCH M000200|Humana Medicare Advantage|HUMANA MA|4.23||||||| 86922|EAP|0300|TYPE-CROSS MATCH M000200|Blue Cross PPO Specialty|BCBSTX PPO|4.23||||||| 86922|EAP|0300|TYPE-CROSS MATCH M000200|Medicaid|MEDICAID|4.23||||||| 86922|EAP|0300|TYPE-CROSS MATCH M000200|Aenta Medicare Advantage|AETNA MEDICARE MA|4.23||||||| 86922|EAP|0300|COMPATABILITY TEST EA UNI|Medicare|MEDICARE ACUTE|7.36||||||| 86922|EAP|0300|COMPATABILITY TEST EA UNI|Medicaid|MEDICAID|7.36||||||| 86922|EAP|0300|TYPE-CROSS MATCH M000200|Medicare|MEDICARE ACUTE|4.23||||||| 86923|EAP|0300|COMPATABILITY TEST EA UNI|United Medicare Advantage|UHC MEDICARE GOLD MA|4.23||||||| 86923|EAP|0300|COMPATABILITY TEST EA UNI|United Healthcare|UNITED HEALTHCARE OTHER|4.23||||||| 86923|EAP|0300|COMPATABILITY TEST EA UNI|United Medicare Advantage|UHC AARP WELLMED HMO MA|4.23||||||| 86923|EAP|0300|COMPATABILITY TEST EA UNI|Humana Medicare Advantage|HUMANA MA|4.23||||||| 86923|EAP|0300|COMPATABILITY TEST EA UNI|Medicare|MEDICARE ACUTE|4.23||||||| 86923|EAP|0300|COMPATABILITY TEST EA UNI|Blue Cross HMO Specialty|BCBSTX HMO|4.23||||||| 86923|EAP|0300|COMPATABILITY TEST EA UNI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.23||||||| 86923|EAP|0300|COMPATABILITY TEST EA UNI|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.23||||||| 86923|EAP|0300|COMPATABILITY TEST EA UNI|Medicaid|MEDICAID|4.23||||||| 86923|EAP|0300|COMPATABILITY TEST EA UNI|Access Direct Platinum|HEALTHFIRST TPA|4.23||||||| 86923|EAP|0300|COMPATABILITY TEST EA UNI|Aenta Medicare Advantage|AETNA MEDICARE MA|4.23||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Humana Medicare Advantage|HUMANA MA|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Blue Cross HMO Specialty|BCBSTX HMO|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Managed Medicare|BCBS MEDICARE PPO MA|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Managed Medicare|HEALTHSPRING MA|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Medicaid|MEDICAID|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Access Direct Platinum|HEALTHFIRST TPA|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Medicare|MEDICARE ACUTE|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Aenta Medicare Advantage|AETNA MEDICARE MA|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Blue Cross PPO Specialty|BCBSTX PPO|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|United Medicare Advantage|UHC MEDICARE GOLD MA|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|PHCS|HUMANA INSURANCE|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|Workers Compensation|WORKERS COMPENSATION OTHER|4.88||||||| 87040|EAP|0300|BLOOD CULTURE GB56200|United Medicare Advantage|UHC AARP WELLMED HMO MA|4.88||||||| 87045|EAP|0300|STOOL CULTURE (87045)|Medicare|MEDICARE ACUTE|4.46||||||| 87070|EAP|0300|RESPIRATORY CULT|United Medicare Advantage|UHC MEDICARE GOLD MA|4.07||||||| 87070|EAP|0300|RESPIRATORY CULT|Workers Compensation|WORKERS COMPENSATION OTHER|4.07||||||| 87070|EAP|0300|RESPIRATORY CULT|PHCS|HUMANA INSURANCE|4.07||||||| 87070|EAP|0300|CULTURE (87070) GC78200|Workers Compensation|WORKERS COMPENSATION OTHER|4.07||||||| 87070|EAP|0300|BODY FLUID CULTURE|Humana Medicare Advantage|HUMANA MA|3.15||||||| 87070|EAP|0300|BODY FLUID CULTURE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|3.15||||||| 87070|EAP|0300|RESPIRATORY CULT|Blue Cross HMO Specialty|BCBSTX HMO|4.07||||||| 87070|EAP|0300|BODY FLUID CULTURE|Blue Cross HMO Specialty|BCBSTX HMO|3.15||||||| 87070|EAP|0300|CULTURE (87070) GC78200|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.07||||||| 87070|EAP|0300|CULTURE (87070) GC78200|Humana Medicare Advantage|HUMANA MA|4.07||||||| 87070|EAP|0300|BODY FLUID CULTURE|Aenta Medicare Advantage|AETNA MEDICARE MA|3.15||||||| 87070|EAP|0300|CULTURE (87070) GC78200|Aetna|AETNA OTHER|4.07||||||| 87070|EAP|0300|CULTURE, BRONCHIAL BRUSH|Medicare|MEDICARE ACUTE|4.07||||||| 87070|EAP|0300|RESPIRATORY CULT|Aenta Medicare Advantage|AETNA MEDICARE MA|4.07||||||| 87070|EAP|0300|CULTURE CATH TIP|Blue Cross PPO Specialty|BCBSTX PPO|4.46||||||| 87070|EAP|0300|CULTURE (87070) GC78200|Medicare|MEDICARE ACUTE|4.07||||||| 87070|EAP|0300|BODY FLUID CULTURE|Medicare|MEDICARE ACUTE|3.15||||||| 87070|EAP|0300|CULTURE (87070) GC78200|Access Direct Platinum|HEALTHFIRST TPA|4.07||||||| 87070|EAP|0300|RESPIRATORY CULT|United Medicare Advantage|UHC AARP WELLMED HMO MA|4.07||||||| 87070|EAP|0300|RESPIRATORY CULT|Managed Medicare|BCBS MEDICARE PPO MA|4.07||||||| 87070|EAP|0300|RESPIRATORY CULT|Medicaid|MEDICAID|4.07||||||| 87070|EAP|0300|RESPIRATORY CULT|Blue Cross PPO Specialty|BCBSTX PPO|4.07||||||| 87070|EAP|0300|RESPIRATORY CULT|Humana Medicare Advantage|HUMANA MA|4.07||||||| 87070|EAP|0300|CULTURE (87070) GC78200|Blue Cross PPO Specialty|BCBSTX PPO|4.07||||||| 87070|EAP|0300|RESPIRATORY CULT|Medicare|MEDICARE ACUTE|4.07||||||| 87070|EAP|0300|CULTURE CATH TIP|Medicare|MEDICARE ACUTE|4.46||||||| 87070|EAP|0300|RESPIRATORY CULT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.07||||||| 87070|EAP|0300|BODY FLUID CULTURE|Blue Cross PPO Specialty|BCBSTX PPO|3.15||||||| 87075|EAP|0300|ANAEROBIC CULTURE|Humana Medicare Advantage|HUMANA MA|4.47||||||| 87075|EAP|0300|ANAEROBIC CULTURE|Blue Cross PPO Specialty|BCBSTX PPO|4.47||||||| 87075|EAP|0300|ANAEROBIC CULTURE|Access Direct Platinum|HEALTHFIRST TPA|4.47||||||| 87075|EAP|0300|ANAEROBIC CULTURE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.47||||||| 87075|EAP|0300|ANAEROBIC CULTURE|Medicare|MEDICARE ACUTE|4.47||||||| 87076|EAP|0300|ANAEROBE|Medicare|MEDICARE ACUTE|3.83||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|United Medicare Advantage|UHC AARP WELLMED HMO MA|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|United Medicare Advantage|UHC MEDICARE GOLD MA|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|PHCS|HUMANA INSURANCE|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Medicare|MEDICARE ACUTE|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Blue Cross HMO Specialty|BCBSTX HMO|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Aetna|AETNA OTHER|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Humana Medicare Advantage|HUMANA MA|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Medicaid|MEDICAID|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Cigna|CIGNA OTHER|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Managed Medicare|HEALTHSPRING MA|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Workers Compensation|WORKERS COMPENSATION OTHER|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Blue Cross PPO Specialty|BCBSTX PPO|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Access Direct Platinum|HEALTHFIRST TPA|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Aenta Medicare Advantage|AETNA MEDICARE MA|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Managed Medicare|BCBS MEDICARE PPO MA|1.31||||||| 87077|EAP|0300|DEFINITIVE ID, AEROBIC|Medicare|MEDICARE PART B ONLY IP|1.31||||||| 87081|EAP|0300|CULTURE BETA STREP SCREEN|Medicare|MEDICARE ACUTE|3.14||||||| 87081|EAP|0300|CULTURE, MRSA|Workers Compensation|WORKERS COMPENSATION OTHER|1.64||||||| 87081|EAP|0300|CULTURE VRE|Workers Compensation|WORKERS COMPENSATION OTHER|3.14||||||| 87088|EAP|0300|URINE CULTURE (87086)|United Medicare Advantage|UHC MEDICARE GOLD MA|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Workers Compensation|WORKERS COMPENSATION OTHER|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Texas Workforce Commission|DIS DETER SERV (DDS)|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|PHCS|HUMANA INSURANCE|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Humana Medicare Advantage|HUMANA MA|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Medicare|MEDICARE ACUTE|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|United Medicare Advantage|UHC AARP WELLMED HMO MA|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Blue Cross HMO Specialty|BCBSTX HMO|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Managed Medicare|BCBS MEDICARE PPO MA|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Managed Medicare|HEALTHSPRING MA|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Blue Cross PPO Specialty|BCBSTX PPO|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Medicaid|MEDICAID|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Access Direct Platinum|HEALTHFIRST TPA|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Aenta Medicare Advantage|AETNA MEDICARE MA|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Aetna|AETNA OTHER|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Cigna|CIGNA OTHER|1.92||||||| 87088|EAP|0300|URINE CULTURE (87086)|Medicare|MEDICARE PART B ONLY IP|1.92||||||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Medicare|MEDICARE ACUTE|266,468.60|23592.82|23592.82|23592.82|||| 87102|EAP|0300|FUNGUS CULTURE GD87000|Humana Medicare Advantage|HUMANA MA|3.98||||||| 87102|EAP|0300|FUNGUS CULTURE GD87000|Blue Cross PPO Specialty|BCBSTX PPO|3.98||||||| 87102|EAP|0300|FUNGUS CULTURE GD87000|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.98||||||| 87102|EAP|0300|FUNGUS CULTURE GD87000|Medicaid|MEDICAID|3.98||||||| 87102|EAP|0300|FUNGUS CULTURE GD87000|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|3.98||||||| 87102|EAP|0300|FUNGUS CULTURE GD87000|Aenta Medicare Advantage|AETNA MEDICARE MA|3.98||||||| 87102|EAP|0300|FUNGUS CULTURE GD87000|Medicare|MEDICARE ACUTE|3.98||||||| 87116|EAP|0306|CULTURE TUBERCLE, ACID FA|Humana Medicare Advantage|HUMANA MA|3.78||||||| 87116|EAP|0306|CULTURE TUBERCLE, ACID FA|Medicaid|MEDICAID|3.78||||||| 87116|EAP|0306|CULTURE TUBERCLE, ACID FA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.78||||||| 87116|EAP|0306|CULTURE TUBERCLE, ACID FA|Medicare|MEDICARE ACUTE|3.78||||||| 87116|EAP|0306|CULTURE TUBERCLE, ACID FA|Aenta Medicare Advantage|AETNA MEDICARE MA|3.78||||||| 87116|EAP|0306|CULTURE TUBERCLE, ACID FA|Blue Cross PPO Specialty|BCBSTX PPO|3.78||||||| 87181|EAP|0300|ANTIBIOTIC SENSITIVITY 1|Medicare|MEDICARE ACUTE|1.01||||||| 87186|EAP|0300|SENSITIVITY|Workers Compensation|WORKERS COMPENSATION OTHER|1.78||||||| 87186|EAP|0300|SENSITIVITY|PHCS|HUMANA INSURANCE|1.78||||||| 87186|EAP|0300|SENSITIVITY|United Medicare Advantage|UHC AARP WELLMED HMO MA|1.78||||||| 87186|EAP|0300|SENSITIVITY|United Medicare Advantage|UHC MEDICARE GOLD MA|1.78||||||| 87186|EAP|0300|SENSITIVITY|Humana Medicare Advantage|HUMANA MA|1.78||||||| 87186|EAP|0300|SENSITIVITY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.78||||||| 87186|EAP|0300|SENSITIVITY|Blue Cross HMO Specialty|BCBSTX HMO|1.78||||||| 87186|EAP|0300|SENSITIVITY|Aetna|AETNA OTHER|1.78||||||| 87186|EAP|0300|SENSITIVITY|Access Direct Platinum|HEALTHFIRST TPA|1.78||||||| 87186|EAP|0300|SENSITIVITY|Managed Medicare|BCBS MEDICARE PPO MA|1.78||||||| 87186|EAP|0300|SENSITIVITY|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.78||||||| 87186|EAP|0300|SENSITIVITY|Cigna|CIGNA OTHER|1.78||||||| 87186|EAP|0300|SENSITIVITY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.78||||||| 87186|EAP|0300|SENSITIVITY|Aenta Medicare Advantage|AETNA MEDICARE MA|1.78||||||| 87186|EAP|0300|SENSITIVITY|Blue Cross PPO Specialty|BCBSTX PPO|1.78||||||| 87186|EAP|0300|SENSITIVITY|Managed Medicare|HEALTHSPRING MA|1.78||||||| 87186|EAP|0300|SENSITIVITY|Medicaid|MEDICAID|1.78||||||| 87186|EAP|0300|SENSITIVITY|Medicare|MEDICARE ACUTE|1.78||||||| 87205|EAP|0300|GRAM STAIN SMEAR GE44000|Managed Medicare|BCBS MEDICARE PPO MA|2.01||||||| 87205|EAP|0300|GRAM STAIN SMEAR GE44000|Medicare|MEDICARE ACUTE|2.01||||||| 87206|EAP|0300|ACID FAST DIRECT|United Medicare Advantage|UHC AARP WELLMED HMO MA|213.75||||||| 87206|EAP|0306|SMEAR ACID FAST|Humana Medicare Advantage|HUMANA MA|1.33||||||| 87206|EAP|0306|SMEAR ACID FAST|Blue Cross PPO Specialty|BCBSTX PPO|1.33||||||| 87206|EAP|0306|SMEAR ACID FAST|Medicaid|MEDICAID|1.33||||||| 87206|EAP|0306|SMEAR ACID FAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.33||||||| 87206|EAP|0306|SMEAR ACID FAST|Medicare|MEDICARE ACUTE|1.33||||||| 87206|EAP|0306|SMEAR ACID FAST|Aenta Medicare Advantage|AETNA MEDICARE MA|1.33||||||| 87210|EAP|0300|INDIA INK PREP GF11300|Medicare|MEDICARE ACUTE|2.01||||||| 87252|EAP|0300|HERPES CULTURE SCREEN RE|Humana Medicare Advantage|HUMANA MA|3.15||||||| 87299|EAP|0300|PNEUMOCYSTIS CARINII DETE|Humana Medicare Advantage|HUMANA MA|610.60||||||| 87299|EAP|0300|PNEUMOCYSTIS CARINII DETE|Medicaid|MEDICAID|5.68||||||| 87299|EAP|0300|PNEUMOCYSTIS CARINII DETE|Medicare|MEDICARE ACUTE|5.68||||||| 87300|EAP|0300|RESPIRATORY VIRAL ANTIGEN|Humana Medicare Advantage|HUMANA MA|610.60||||||| 87300|EAP|0300|RESPIRATORY VIRAL ANTIGEN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.68||||||| 87300|EAP|0300|RESPIRATORY VIRAL ANTIGEN|Aenta Medicare Advantage|AETNA MEDICARE MA|5.68||||||| 87300|EAP|0300|RESPIRATORY VIRAL ANTIGEN|Medicaid|MEDICAID|5.68||||||| 87300|EAP|0300|RESPIRATORY VIRAL ANTIGEN|Medicare|MEDICARE ACUTE|5.68||||||| 87340|EAP|0300|HEPATITIS B SURFAC AG|Humana Medicare Advantage|HUMANA MA|5.37||||||| 87340|EAP|0300|HEPATITIS B SURFAC AG|Managed Medicare|BCBS MEDICARE PPO MA|5.37||||||| 87340|EAP|0300|HEPATITIS B SURFAC AG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.37||||||| 87340|EAP|0300|HEPATITIS B SURFAC AG|Medicare|MEDICARE ACUTE|5.37||||||| 87385|EAP|0300|HISTOPLASMA AG,URINE|Aenta Medicare Advantage|AETNA MEDICARE MA|478.25||||||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Medicare|MEDICARE ACUTE|4.69||||||| 87529|EAP|0300|HSV BY PCR|Humana Medicare Advantage|HUMANA MA|1,367.75||||||| 87529|EAP|0300|HSV BY PCR|Aenta Medicare Advantage|AETNA MEDICARE MA|1,367.75||||||| 87798|EAP|0300|INFECT AGENT DET BY NA NO|Aenta Medicare Advantage|AETNA MEDICARE MA|1,367.75||||||| 88104|EAP|0311|CYTOPATH - FLUIDS WASHING|Medicare|MEDICARE ACUTE|1.39||||||| 88112|EAP|0311|CYTOPATH-SEL CELL ENHANCE|Medicare|MEDICARE ACUTE|1.83||||||| 88300|EAP|0312|LEVEL I GROSS|Medicare|MEDICARE ACUTE|88.50||||||| 88304|EAP|0312|LEVEL III GROSS & MICRO|Medicare|MEDICARE ACUTE|211.75||||||| 88305|EAP|0312|LEVEL IV GROSS & MICRO|Humana Medicare Advantage|HUMANA MA|376.25||||||| 88305|EAP|0312|LEVEL IV GROSS & MICRO|Medicare|MEDICARE ACUTE|281.25||||||| 88307|EAP|0312|LEVEL V GROSS & MICRO|Medicare|MEDICARE ACUTE|4.17||||||| 88312|EAP|0312|SPECIAL STAIN GRP 1|Humana Medicare Advantage|HUMANA MA|207.75||||||| 88323|EAP|0310|CONSULT AND REPORT MICROS|Medicare|MEDICARE ACUTE|0.50||||||| 88341|EAP|0310|IHC QUALITATIVE ADDT'L SI|Medicare|MEDICARE ACUTE|0.52||||||| 88342|EAP|0312|IMMUNOSTAIN|Medicare|MEDICARE ACUTE|238.75||||||| 88342|EAP|0310|IHC PER SPECIMEN, INITIAL|Medicare|MEDICARE ACUTE|0.52||||||| 89051|EAP|0300|CELL COUNT, CSF GC24300|Humana Medicare Advantage|HUMANA MA|279.45||||||| 89051|EAP|0300|CELL COUNT, CSF GC24300|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.43||||||| 89051|EAP|0300|CELL COUNT, CSF GC24300|Aenta Medicare Advantage|AETNA MEDICARE MA|2.43||||||| 89051|EAP|0300|CELL COUNT, CSF GC24300|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.43||||||| 89051|EAP|0300|CELL COUNT, CSF GC24300|Medicare|MEDICARE ACUTE|2.43||||||| 89051|EAP|0300|CELL COUNT, CSF GC24300|Blue Cross HMO Specialty|BCBSTX HMO|2.43||||||| 89051|EAP|0300|CELL COUNT, CSF GC24300|Blue Cross PPO Specialty|BCBSTX PPO|2.43||||||| 89055|EAP|0300|LEUKOCYTE ASSESSMENT FECA|Medicare|MEDICARE ACUTE|0.99||||||| 89060|EAP|0300|BODY FLUID CRYSTALS|Medicare|MEDICARE ACUTE|3.67||||||| 90686|ERX|0250|INFLUENZA VACCINE|United Medicare Advantage|UHC MEDICARE GOLD MA|100.35||||||| 90686|ERX|0250|INFLUENZA VACCINE|Blue Cross PPO Specialty|BCBSTX PPO|100.35||||||| 90686|ERX|0250|INFLUENZA VACCINE|Medicare|MEDICARE ACUTE|100.35||||||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Humana Medicare Advantage|HUMANA MA|413.75||||||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Aetna|AETNA OTHER|413.75||||||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Blue Cross PPO Specialty|BCBSTX PPO|413.75||||||| 90732|ERX|0636|PNEUMOCOCCAL VACC 25MCG/0|Medicare|MEDICARE ACUTE|413.75||||||| 908|DRG||OTHER O.R. PROCEDURES FOR INJURIES W CC|Medicare|MEDICARE ACUTE|325,568.63|29949.27|29949.27|29949.27|||| 91|DRG||OTHER DISORDERS OF NERVOUS SYSTEM W MCC|Workers Compensation|WORKERS COMPENSATION OTHER|7,516,853.99|464817.685|464817.685|464817.685|||| 919|DRG||COMPLICATIONS OF TREATMENT W MCC|Medicare|MEDICARE ACUTE|238,528.75|26015.72|26015.72|26015.72|||| 921|DRG||COMPLICATIONS OF TREATMENT W/O CC/MCC|Medicare|MEDICARE ACUTE|254,788.80|29949.27|29949.27|29949.27|||| 92597|EAP|0440|ORAL SPEECH DEVICE EVAL|Medicare|MEDICARE ACUTE|6.65||||||| 92597|EAP|0440|ORAL SPEECH DEVICE EVAL|Humana Medicare Advantage|HUMANA MA|6.65||||||| 92597|EAP|0440|ORAL SPEECH DEVICE EVAL|Blue Cross PPO Specialty|BCBSTX PPO|6.65||||||| 92599|EAP|0440|FAMILY CONFERENCE|United Medicare Advantage|UHC MEDICARE GOLD MA|350.50||||||| 92599|EAP|0440|FAMILY CONFERENCE|United Healthcare|UNITED HEALTHCARE OTHER|350.50||||||| 92599|EAP|0440|FAMILY CONFERENCE|Humana Medicare Advantage|HUMANA MA|350.50||||||| 92599|EAP|0440|FAMILY CONFERENCE|Blue Cross PPO Specialty|BCBSTX PPO|350.50||||||| 92599|EAP|0440|FAMILY CONFERENCE|Medicare|MEDICARE ACUTE|350.50||||||| 92599|EAP|0440|FAMILY CONFERENCE|Blue Cross HMO Specialty|BCBSTX HMO|350.50||||||| 92599|EAP|0440|FAMILY CONFERENCE|Medicare|MEDICARE PART B ONLY IP|350.50||||||| 92611|EAP|0440|MOTION FLUOROSCOPIC EVAL|Humana Medicare Advantage|HUMANA MA|7.35||||||| 92611|EAP|0440|MOTION FLUOROSCOPIC EVAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|7.35||||||| 92611|EAP|0440|MOTION FLUOROSCOPIC EVAL|Aetna|AETNA OTHER|7.35||||||| 92611|EAP|0440|MOTION FLUOROSCOPIC EVAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.35||||||| 92611|EAP|0440|MOTION FLUOROSCOPIC EVAL|Blue Cross HMO Specialty|BCBSTX HMO|7.35||||||| 92611|EAP|0440|MOTION FLUOROSCOPIC EVAL|Blue Cross PPO Specialty|BCBSTX PPO|7.35||||||| 92611|EAP|0440|MOTION FLUOROSCOPIC EVAL|Medicare|MEDICARE ACUTE|7.35||||||| 92700|EAP|0440|SPEECH EVALUATION|Texas Workforce Commission|DIS DETER SERV (DDS)|789.25||||||| 92700|EAP|0440|SPEECH THER 30MN IP|United Medicare Advantage|UHC MEDICARE GOLD MA|651.25||||||| 92700|EAP|0440|SPEECH THER 15MN IP|United Medicare Advantage|UHC MEDICARE GOLD MA|3.40||||||| 92700|EAP|0440|SPEECH EVALUATION|PHCS|HUMANA INSURANCE|789.25||||||| 92700|EAP|0440|SPEECH THER 30MN IP|PHCS|HUMANA INSURANCE|651.25||||||| 92700|EAP|0440|SPEECH THER 45MN IP|United Medicare Advantage|UHC MEDICARE GOLD MA|838.25||||||| 92700|EAP|0440|SPEECH THER 15MN IP|United Healthcare|UNITED HEALTHCARE OTHER|3.40||||||| 92700|EAP|0440|SPEECH EVALUATION|United Healthcare|UNITED HEALTHCARE OTHER|789.25||||||| 92700|EAP|0440|SPEECH THER 30MN IP|Managed Medicare|HEALTHSPRING MA|651.25||||||| 92700|EAP|0440|SPEECH EVALUATION|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|789.25||||||| 92700|EAP|0440|SPEECH THER 45MN IP|Humana Medicare Advantage|HUMANA MA|838.25||||||| 92700|EAP|0440|SPEECH THER 30MN IP|Humana Medicare Advantage|HUMANA MA|651.25||||||| 92700|EAP|0440|SPEECH THER 15MN IP|Medicare|MEDICARE PART B ONLY IP|3.40||||||| 92700|EAP|0440|SPEECH EVALUATION|Managed Medicare|HEALTHSPRING MA|789.25||||||| 92700|EAP|0440|SPEECH THER 15MN IP|Blue Cross PPO Specialty|BCBSTX PPO|3.40||||||| 92700|EAP|0470|EVAL ADDITIONAL 15 MINUTE|Medicaid|MEDICAID|2.31||||||| 92700|EAP|0440|SPEECH THER 60MN IP|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1,127.50||||||| 92700|EAP|0440|SPEECH EVALUATION|Managed Medicaid|MEDICAID UNITED HEALTHCARE|789.25||||||| 92700|EAP|0440|SPEECH THER 30MN IP|Blue Cross HMO Specialty|BCBSTX HMO|651.25||||||| 92700|EAP|0440|SPEECH THER 45MN IP|Managed Medicare|HEALTHSPRING MA|838.25||||||| 92700|EAP|0440|SPEECH THER 15MN IP|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|3.40||||||| 92700|EAP|0440|SPEECH EVALUATION|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|789.25||||||| 92700|EAP|0440|SPEECH EVALUATION|Blue Cross HMO Specialty|BCBSTX HMO|789.25||||||| 92700|EAP|0440|SPEECH THER 15MN IP|Humana Medicare Advantage|HUMANA MA|3.40||||||| 92700|EAP|0440|SPEECH THER 60MN IP|Blue Cross PPO Specialty|BCBSTX PPO|1,127.50||||||| 92700|EAP|0440|SPEECH THER 60MN IP|Blue Cross HMO Specialty|BCBSTX HMO|1,127.50||||||| 92700|EAP|0440|SPEECH THER 45MN IP|Aetna|AETNA OTHER|838.25||||||| 92700|EAP|0440|SPEECH THER 15MN IP|Aetna|AETNA OTHER|3.40||||||| 92700|EAP|0440|SPEECH THER 15MN IP|Medicaid|MEDICAID|3.40||||||| 92700|EAP|0440|SPEECH EVALUATION|Medicaid|MEDICAID|789.25||||||| 92700|EAP|0440|SPEECH THER 15MN IP|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|3.40||||||| 92700|EAP|0440|SPEECH EVALUATION|Humana Medicare Advantage|HUMANA MA|789.25||||||| 92700|EAP|0470|EVAL ADDITIONAL 15 MINUTE|Blue Cross HMO Specialty|BCBSTX HMO|2.31||||||| 92700|EAP|0440|SPEECH THER 30MN IP|Medicaid|MEDICAID|651.25||||||| 92700|EAP|0440|SPEECH THER 30MN IP|Blue Cross PPO Specialty|BCBSTX PPO|651.25||||||| 92700|EAP|0440|SPEECH THER 15MN IP|Blue Cross HMO Specialty|BCBSTX HMO|3.40||||||| 92700|EAP|0440|SPEECH EVALUATION|Blue Cross PPO Specialty|BCBSTX PPO|789.25||||||| 92700|EAP|0440|SPEECH THER 30MN IP|Medicare|MEDICARE ACUTE|651.25||||||| 92700|EAP|0440|SPEECH THER 45MN IP|Blue Cross HMO Specialty|BCBSTX HMO|838.25||||||| 92700|EAP|0440|SPEECH EVALUATION|Aetna|AETNA OTHER|789.25||||||| 92700|EAP|0440|SPEECH THER 30MN IP|Aetna|AETNA OTHER|651.25||||||| 92700|EAP|0440|SPEECH THER 15MN IP|Managed Medicare|HEALTHSPRING MA|3.40||||||| 92700|EAP|0440|SPEECH THER 45MN IP|Blue Cross PPO Specialty|BCBSTX PPO|838.25||||||| 92700|EAP|0440|SPEECH THER 30MN IP|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|651.25||||||| 92700|EAP|0440|SPEECH THER 15MN IP|Medicare|MEDICARE ACUTE|3.40||||||| 92700|EAP|0440|SPEECH EVALUATION|United Medicare Advantage|UHC MEDICARE GOLD MA|789.25||||||| 92700|EAP|0440|SPEECH EVALUATION|Medicare|MEDICARE ACUTE|789.25||||||| 92700|EAP|0440|SPEECH THER 60MN IP|Medicare|MEDICARE ACUTE|1,127.50||||||| 92700|EAP|0470|EVAL ADDITIONAL 15 MINUTE|Medicare|MEDICARE ACUTE|2.31||||||| 92700|EAP|0440|SPEECH EVALUATION|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|789.25||||||| 92700|EAP|0440|SPEECH THER 15MN IP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.40||||||| 92700|EAP|0440|SPEECH THER 45MN IP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|838.25||||||| 92700|EAP|0440|SPEECH THER 30MN IP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|651.25||||||| 92700|EAP|0470|EVAL ADDITIONAL 15 MINUTE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.31||||||| 92700|EAP|0440|SPEECH THER 45MN IP|Medicare|MEDICARE ACUTE|838.25||||||| 92700|EAP|0440|SPEECH THER 30MN IP|Medicare|MEDICARE PART B ONLY IP|651.25||||||| 92700|EAP|0470|EVAL ADDITIONAL 15 MINUTE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|2.31||||||| 928|DRG||FULL THICKNESS BURN W SKIN GRAFT OR INHAL INJ W CC/MCC|Medicare|MEDICARE ACUTE|537,372.84|29949.27|29949.27|29949.27|||| 93005|EAP|0730|EKG 12 LEAD|United Medicare Advantage|UHC MEDICARE GOLD MA|5.58||||||| 93005|EAP|0730|EKG 12 LEAD|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|5.58||||||| 93005|EAP|0730|STAT EKG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|890.25||||||| 93005|EAP|0730|STAT EKG|Humana Medicare Advantage|HUMANA MA|890.25||||||| 93005|EAP|0730|EKG 12 LEAD|Humana Medicare Advantage|HUMANA MA|5.58||||||| 93005|EAP|0730|EKG 12 LEAD|Blue Cross PPO Specialty|BCBSTX PPO|5.58||||||| 93005|EAP|0730|EKG 12 LEAD|Aetna|AETNA OTHER|5.58||||||| 93005|EAP|0730|EKG 12 LEAD|Managed Medicare|BCBS MEDICARE PPO MA|5.58||||||| 93005|EAP|0730|EKG 12 LEAD|Medicare|MEDICARE ACUTE|5.58||||||| 93005|EAP|0730|EKG 12 LEAD|Aenta Medicare Advantage|AETNA MEDICARE MA|5.58||||||| 93005|EAP|0730|EKG 12 LEAD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.58||||||| 93005|EAP|0730|STAT EKG|Medicare|MEDICARE ACUTE|890.25||||||| 93017|EAP|0442|STRESS W TREADMILL/PHARM|Aetna|AETNA OTHER|35.48||||||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Aenta Medicare Advantage|AETNA MEDICARE MA|50.53||||||| 93306|EAP|0483|ECHOCARDIOGRAM 2D M DOPLR|Medicare|MEDICARE ACUTE|50.53||||||| 93308|EAP|0483|ECHO LTD OR FOLLOW UP|Medicare|MEDICARE ACUTE|11.64||||||| 93308|EAP|0483|ECHO LTD OR F/U W/CONTRAS|Medicare|MEDICARE ACUTE|13.78||||||| 93312|EAP|0483|TRANSESOPHAGEAL ECHO|United Medicare Advantage|UHC MEDICARE GOLD MA|48.38||||||| 93312|EAP|0483|TRANSESOPHAGEAL ECHO|Medicare|MEDICARE ACUTE|48.38||||||| 93312|EAP|0483|TRANSESOPHAGEAL ECHO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|48.38||||||| 93325|EAP|0480|ECHO COLOR FLOW MAPPING|Medicare|MEDICARE ACUTE|16.60||||||| 93325|EAP|0480|ECHO COLOR FLOW MAPPING|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|16.60||||||| 93325|EAP|0480|ECHO COLOR FLOW MAPPING|United Medicare Advantage|UHC MEDICARE GOLD MA|16.60||||||| 93454|EAP|0481|ANGIO CORONARIES ONLY|United Medicare Advantage|UHC MEDICARE GOLD MA|59.94||||||| 93880|EAP|0921|CAROTID DUPLEX BILATERAL|Aetna|AETNA OTHER|34.06||||||| 93880|EAP|0921|CAROTID DUPLEX BILATERAL|Aenta Medicare Advantage|AETNA MEDICARE MA|34.06||||||| 93880|EAP|0921|CAROTID DUPLEX BILATERAL|Medicare|MEDICARE ACUTE|34.06||||||| 93882|EAP|0921|CAROTID DUPLEX LIMITED|Medicare|MEDICARE ACUTE|15.21||||||| 93886|EAP|0740|TRANSCRANIAL DOPPLER|Medicare|MEDICARE ACUTE|37.39||||||| 93892|EAP|0740|TCD EMBOLI DETECT W/O INJ|Medicare|MEDICARE ACUTE|27.12||||||| 93925|EAP|0921|ARTERIAL DUPLEX LOWER EXT|Medicare|MEDICARE ACUTE|35.89||||||| 93926|EAP|0921|PSUEDO ANEURYSM RULE OUT|Medicare|MEDICARE ACUTE|19.89||||||| 93970|EAP|0921|VENOUS DUPLEX LOWER EXT B|Medicare|MEDICARE ACUTE|48.89||||||| 93970|EAP|0921|VENOUS DUPLEX LOWER EXT B|Humana Medicare Advantage|HUMANA MA|48.89||||||| 93970|EAP|0921|VENOUS DUPLEX UPPER EXT B|Medicare|MEDICARE ACUTE|48.89||||||| 93970|EAP|0921|VEIN MAPPING BILATERAL|Medicare|MEDICARE ACUTE|48.89||||||| 93971|EAP|0921|VENOUS DUPLEX UPPER EXT U|Humana Medicare Advantage|HUMANA MA|29.48||||||| 93971|EAP|0921|VENOUS DUPLEX UPPER EXT U|Medicaid|MEDICAID|29.48||||||| 93971|EAP|0921|VENOUS DUPLEX UPPER EXT U|Medicare|MEDICARE ACUTE|29.48||||||| 93971|EAP|0921|VENOUS DUPLEX LOWER EXT U|Medicare|MEDICARE ACUTE|29.48||||||| 94|DRG||BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W MCC|Medicare|MEDICARE ACUTE|451,538.56|35182.55|35182.55|35182.55|||| 94002|EAP|0410|VENTILATOR ASSIST/MGMT FI|United Medicare Advantage|UHC MEDICARE GOLD MA|106.34||||||| 94002|EAP|0410|VENTILATOR ASSIST/MGMT FI|Texas Workforce Commission|DIS DETER SERV (DDS)|106.34||||||| 94002|EAP|0410|VENTILATOR ASSIST/MGMT FI|PHCS|HUMANA INSURANCE|106.34||||||| 94002|EAP|0410|VENTILATOR ASSIST/MGMT FI|Humana Medicare Advantage|HUMANA MA|106.34||||||| 94002|EAP|0410|VENTILATOR ASSIST/MGMT FI|Aetna|AETNA OTHER|106.34||||||| 94002|EAP|0410|VENTILATOR ASSIST/MGMT FI|Managed Medicare|BCBS MEDICARE PPO MA|106.34||||||| 94002|EAP|0410|VENTILATOR ASSIST/MGMT FI|Medicaid|MEDICAID|106.34||||||| 94002|EAP|0410|VENTILATOR ASSIST/MGMT FI|Blue Cross PPO Specialty|BCBSTX PPO|106.34||||||| 94002|EAP|0410|VENTILATOR ASSIST/MGMT FI|Aenta Medicare Advantage|AETNA MEDICARE MA|106.34||||||| 94002|EAP|0410|VENTILATOR ASSIST/MGMT FI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|106.34||||||| 94002|EAP|0410|VENTILATOR ASSIST/MGMT FI|Medicare|MEDICARE ACUTE|106.34||||||| 94003|EAP|0410|VENTILATOR ASSIST/MGMT SU|Humana Medicare Advantage|HUMANA MA|88.62||||||| 94003|EAP|0410|VENTILATOR ASSIST/MGMT SU|Managed Medicare|BCBS MEDICARE PPO MA|88.62||||||| 94003|EAP|0410|VENTILATOR ASSIST/MGMT SU|Medicaid|MEDICAID|88.62||||||| 94003|EAP|0410|VENTILATOR ASSIST/MGMT SU|Blue Cross PPO Specialty|BCBSTX PPO|88.62||||||| 94003|EAP|0410|VENTILATOR ASSIST/MGMT SU|Aetna|AETNA OTHER|88.62||||||| 94003|EAP|0410|VENTILATOR ASSIST/MGMT SU|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|88.62||||||| 94003|EAP|0410|VENTILATOR ASSIST/MGMT SU|Blue Cross HMO Specialty|BCBSTX HMO|88.62||||||| 94003|EAP|0410|VENTILATOR ASSIST/MGMT SU|Aenta Medicare Advantage|AETNA MEDICARE MA|88.62||||||| 94003|EAP|0410|VENTILATOR ASSIST/MGMT SU|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|88.62||||||| 94003|EAP|0410|VENTILATOR ASSIST/MGMT SU|Medicare|MEDICARE ACUTE|88.62||||||| 94003|EAP|0410|VENTILATOR ASSIST/MGMT SU|United Medicare Advantage|UHC MEDICARE GOLD MA|88.62||||||| 94003|EAP|0410|VENTILATOR ASSIST/MGMT SU|Workers Compensation|WORKERS COMPENSATION OTHER|88.62||||||| 94003|EAP|0410|VENTILATOR ASSIST/MGMT SU|Texas Workforce Commission|DIS DETER SERV (DDS)|88.62||||||| 94003|EAP|0410|VENTILATOR ASSIST/MGMT SU|PHCS|HUMANA INSURANCE|88.62||||||| 94640|EAP|0410|AEROMED THERAPY|PHCS|HUMANA INSURANCE|3.98||||||| 94640|EAP|0410|INCENTIVE SPIROMETRY THER|PHCS|HUMANA INSURANCE|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|United Medicare Advantage|UHC MEDICARE GOLD MA|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|United Medicare Advantage|UHC AARP WELLMED HMO MA|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Texas Workforce Commission|DIS DETER SERV (DDS)|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Workers Compensation|WORKERS COMPENSATION OTHER|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Humana Medicare Advantage|HUMANA MA|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Medicare|MEDICARE PART B ONLY IP|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|United Healthcare|UNITED HEALTHCARE OTHER|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Aetna|AETNA OTHER|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Medicare|MEDICARE ACUTE|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Blue Cross PPO Specialty|BCBSTX PPO|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Medicaid|MEDICAID|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Managed Medicare|BCBS MEDICARE PPO MA|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Managed Medicare|HEALTHSPRING MA|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Aenta Medicare Advantage|AETNA MEDICARE MA|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Blue Cross HMO Specialty|BCBSTX HMO|3.98||||||| 94640|EAP|0410|INCENTIVE SPIROMETRY THER|Medicare|MEDICARE ACUTE|3.98||||||| 94640|EAP|0410|AEROMED THERAPY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|3.98||||||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|Humana Medicare Advantage|HUMANA MA|51.03||||||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|51.03||||||| 94660|EAP|0410|CPAP/BIPAP SUBSEQ DAY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|41.62||||||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|51.03||||||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|Aetna|AETNA OTHER|51.03||||||| 94660|EAP|0410|CPAP/BIPAP SUBSEQ DAY|Aetna|AETNA OTHER|41.62||||||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|Blue Cross PPO Specialty|BCBSTX PPO|51.03||||||| 94660|EAP|0410|CPAP/BIPAP SUBSEQ DAY|Humana Medicare Advantage|HUMANA MA|41.62||||||| 94660|EAP|0410|CPAP/BIPAP SUBSEQ DAY|Medicaid|MEDICAID|41.62||||||| 94660|EAP|0410|CPAP/BIPAP SUBSEQ DAY|Blue Cross PPO Specialty|BCBSTX PPO|41.62||||||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|Medicaid|MEDICAID|51.03||||||| 94660|EAP|0410|CPAP/BIPAP SUBSEQ DAY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|41.62||||||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|51.03||||||| 94660|EAP|0410|CPAP/BIPAP SUBSEQ DAY|Medicare|MEDICARE PART B ONLY IP|41.62||||||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|Medicare|MEDICARE ACUTE|51.03||||||| 94660|EAP|0410|CPAP/BIPAP SUBSEQ DAY|Medicare|MEDICARE ACUTE|41.62||||||| 94660|EAP|0410|CPAP/BIPAP SUBSEQ DAY|PHCS|HUMANA INSURANCE|41.62||||||| 94660|EAP|0410|CPAP/BIPAP SUBSEQ DAY|United Medicare Advantage|UHC MEDICARE GOLD MA|41.62||||||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|United Medicare Advantage|UHC MEDICARE GOLD MA|51.03||||||| 94667|EAP|0410|CHEST PHYSIOTHERAPY|United Medicare Advantage|UHC AARP WELLMED HMO MA|3.46||||||| 94667|EAP|0410|CHEST PHYSIOTHERAPY|Humana Medicare Advantage|HUMANA MA|3.46||||||| 94667|EAP|0410|CHEST PHYSIOTHERAPY|Aetna|AETNA OTHER|3.46||||||| 94667|EAP|0410|CHEST PHYSIOTHERAPY|Medicaid|MEDICAID|3.46||||||| 94667|EAP|0410|CHEST PHYSIOTHERAPY|Medicare|MEDICARE ACUTE|3.46||||||| 94762|EAP|0410|PULSE 0XIMTRY MAX PER DAY|Humana Medicare Advantage|HUMANA MA|1,284.75||||||| 94762|EAP|0410|PULSE 0XIMTRY MAX PER DAY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1,284.75||||||| 94762|EAP|0410|PULSE 0XIMTRY MAX PER DAY|Blue Cross HMO Specialty|BCBSTX HMO|1,284.75||||||| 94762|EAP|0410|PULSE 0XIMTRY MAX PER DAY|Managed Medicare|BCBS MEDICARE PPO MA|1,284.75||||||| 94762|EAP|0410|PULSE 0XIMTRY MAX PER DAY|Managed Medicare|HEALTHSPRING MA|1,284.75||||||| 94762|EAP|0410|PULSE 0XIMTRY MAX PER DAY|Medicare|MEDICARE ACUTE|1,284.75||||||| 94762|EAP|0410|PULSE 0XIMTRY MAX PER DAY|Aetna|AETNA OTHER|1,284.75||||||| 94762|EAP|0410|PULSE 0XIMTRY MAX PER DAY|Medicaid|MEDICAID|1,284.75||||||| 94762|EAP|0410|PULSE 0XIMTRY MAX PER DAY|Aenta Medicare Advantage|AETNA MEDICARE MA|1,284.75||||||| 94762|EAP|0410|PULSE 0XIMTRY MAX PER DAY|Blue Cross PPO Specialty|BCBSTX PPO|1,284.75||||||| 94762|EAP|0410|PULSE 0XIMTRY MAX PER DAY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,284.75||||||| 94762|EAP|0410|PULSE 0XIMTRY MAX PER DAY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1,284.75||||||| 94762|EAP|0410|PULSE 0XIMTRY MAX PER DAY|Medicare|MEDICARE PART B ONLY IP|1,284.75||||||| 94762|EAP|0410|PULSE 0XIMTRY MAX PER DAY|United Medicare Advantage|UHC MEDICARE GOLD MA|1,284.75||||||| 94762|EAP|0410|PULSE 0XIMTRY MAX PER DAY|Workers Compensation|WORKERS COMPENSATION OTHER|1,284.75||||||| 94762|EAP|0410|PULSE 0XIMTRY MAX PER DAY|PHCS|HUMANA INSURANCE|1,284.75||||||| 94762|EAP|0410|PULSE 0XIMTRY MAX PER DAY|Texas Workforce Commission|DIS DETER SERV (DDS)|1,284.75||||||| 94762|EAP|0410|PULSE 0XIMTRY MAX PER DAY|United Medicare Advantage|UHC AARP WELLMED HMO MA|1,284.75||||||| 94799|EAP|0410|AEROSOL TUBING W\ NEB ADA|United Medicare Advantage|UHC MEDICARE GOLD MA|1.55||||||| 94799|EAP|0250|HUMID RES 1000ML|Workers Compensation|WORKERS COMPENSATION OTHER|1.99||||||| 94799|EAP|0410|MDI THERAPY|Texas Workforce Commission|DIS DETER SERV (DDS)|181.25||||||| 94799|EAP|0250|HUMID RES 1000ML|Texas Workforce Commission|DIS DETER SERV (DDS)|1.99||||||| 94799|EAP|0250|HUMID RES 1000ML|United Medicare Advantage|UHC MEDICARE GOLD MA|1.99||||||| 94799|EAP|0250|HUMID RES 1000ML|United Medicare Advantage|UHC AARP WELLMED HMO MA|1.99||||||| 94799|EAP|0410|AEROSOL TUBING W\ NEB ADA|Humana Medicare Advantage|HUMANA MA|1.55||||||| 94799|EAP|0410|MDI THERAPY|Humana Medicare Advantage|HUMANA MA|181.25||||||| 94799|EAP|0250|HUMID RES 1000ML|Humana Medicare Advantage|HUMANA MA|1.99||||||| 94799|EAP|0410|MDI THERAPY|Medicare|MEDICARE ACUTE|181.25||||||| 94799|EAP|0250|HUMID RES 1000ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.99||||||| 94799|EAP|0410|MDI THERAPY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|181.25||||||| 94799|EAP|0410|AEROSOL TUBING W\ NEB ADA|Blue Cross HMO Specialty|BCBSTX HMO|1.55||||||| 94799|EAP|0410|AEROSOL TUBING W\ NEB ADA|Aetna|AETNA OTHER|1.55||||||| 94799|EAP|0410|MAN RESUSCITATOR S|Humana Medicare Advantage|HUMANA MA|674.50||||||| 94799|EAP|0250|HUMID RES 1000ML|Blue Cross PPO Specialty|BCBSTX PPO|1.99||||||| 94799|EAP|0250|HUMID RES 1000ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.99||||||| 94799|EAP|0250|HUMID RES 1000ML|Managed Medicare|HEALTHSPRING MA|1.99||||||| 94799|EAP|0410|AEROSOL TUBING W\ NEB ADA|Medicare|MEDICARE ACUTE|1.55||||||| 94799|EAP|0410|AEROSOL TUBING W\ NEB ADA|PHCS|HUMANA INSURANCE|1.55||||||| 94799|EAP|0410|AEROSOL TUBING W\ NEB ADA|Medicaid|MEDICAID|1.55||||||| 94799|EAP|0410|MAN RESUSCITATOR S|Medicare|MEDICARE ACUTE|674.50||||||| 94799|EAP|0250|HUMID RES 1000ML|Blue Cross HMO Specialty|BCBSTX HMO|1.99||||||| 94799|EAP|0410|FIBEROPTIC BRONCH PROC SI|Medicare|MEDICARE ACUTE|3,007.22||||||| 94799|EAP|0410|MDI THERAPY|PHCS|HUMANA INSURANCE|181.25||||||| 94799|EAP|0250|HUMID RES 1000ML|Medicare|MEDICARE ACUTE|1.99||||||| 94799|EAP|0410|AEROSOL TUBING W\ NEB ADA|Blue Cross PPO Specialty|BCBSTX PPO|1.55||||||| 94799|EAP|0410|AEROSOL TUBING W\ NEB ADA|Managed Medicare|HEALTHSPRING MA|1.55||||||| 94799|EAP|0410|MDI THERAPY|Blue Cross PPO Specialty|BCBSTX PPO|181.25||||||| 94799|EAP|0250|HUMID RES 1000ML|Medicaid|MEDICAID|1.99||||||| 94799|EAP|0410|AEROSOL TUBING W\ NEB ADA|Aenta Medicare Advantage|AETNA MEDICARE MA|1.55||||||| 94799|EAP|0410|MDI THERAPY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|181.25||||||| 94799|EAP|0410|AEROSOL TUBING W\ NEB ADA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.55||||||| 94799|EAP|0250|HUMID RES 1000ML|Aetna|AETNA OTHER|1.99||||||| 949|DRG||AFTERCARE W CC/MCC|Medicare|MEDICARE ACUTE|252,187.65|16074.21|16074.21|16074.21|||| 9500034|ERX|0250|ACETAM-COD 120-12MG/5ML E|Medicare|MEDICARE ACUTE|11.75||||||| 9500117|ERX|0250|METOCLOPRAMIDE 5MG/5ML, 1|Workers Compensation|WORKERS COMPENSATION OTHER|9.25||||||| 9500117|ERX|0250|METOCLOPRAMIDE 5MG/5ML, 1|United Medicare Advantage|UHC AARP WELLMED HMO MA|9.25||||||| 9500117|ERX|0250|METOCLOPRAMIDE 5MG/5ML, 1|Blue Cross PPO Specialty|BCBSTX PPO|9.25||||||| 9500117|ERX|0250|METOCLOPRAMIDE 5MG/5ML, 1|Medicaid|MEDICAID|9.25||||||| 9500117|ERX|0250|METOCLOPRAMIDE 5MG/5ML, 1|Medicare|MEDICARE ACUTE|9.25||||||| 9500117|ERX|0250|METOCLOPRAMIDE 5MG/5ML, 1|Humana Medicare Advantage|HUMANA MA|9.25||||||| 9500117|ERX|0250|METOCLOPRAMIDE 5MG/5ML, 1|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|9.25||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Aetna|AETNA OTHER|11.50||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Blue Cross PPO Specialty|BCBSTX PPO|11.50||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Medicare|MEDICARE ACUTE|11.50||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Humana Medicare Advantage|HUMANA MA|11.50||||||| 9500125|ERX|0250|MAG-AL HYDROX-SIMETH,30ML|Blue Cross HMO Specialty|BCBSTX HMO|11.50||||||| 9500174|ERX|0250|GLYCERIN SUPP|Aenta Medicare Advantage|AETNA MEDICARE MA|2.50||||||| 9500174|ERX|0250|GLYCERIN SUPP|Medicare|MEDICARE ACUTE|2.50||||||| 9500331|ERX|0250|MENTHOL-CAMPHOR LOTION,22|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|87.50||||||| 9500331|ERX|0250|MENTHOL-CAMPHOR LOTION,22|Medicare|MEDICARE ACUTE|87.50||||||| 9500349|ERX|0250|FLUMAZENIL 0.5MG/5ML|Medicare|MEDICARE ACUTE|851.25||||||| 9500364|ERX|0250|NITROFURANTOIN MONO 100MG|Medicare|MEDICARE ACUTE|28.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Workers Compensation|WORKERS COMPENSATION OTHER|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|United Medicare Advantage|UHC MEDICARE GOLD MA|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Texas Workforce Commission|DIS DETER SERV (DDS)|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Tricare|TRICARE FOR LIFE|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|United Medicare Advantage|UHC AARP WELLMED HMO MA|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Medicare|MEDICARE ACUTE|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Blue Cross PPO Specialty|BCBSTX PPO|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Managed Medicare|HEALTHSPRING MA|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Humana Medicare Advantage|HUMANA MA|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Medicaid|MEDICAID|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Blue Cross HMO Specialty|BCBSTX HMO|5.25||||||| 9500398|ERX|0250|MAGNESIUM OXIDE 400MG TAB|Cigna|CIGNA OTHER|5.25||||||| 9500406|ERX|0250|TRIAMCINOLONE ACET 0.1% ,|Blue Cross PPO Specialty|BCBSTX PPO|44.25||||||| 9500406|ERX|0250|TRIAMCINOLONE ACET 0.1% ,|Medicare|MEDICARE ACUTE|44.25||||||| 9500414|ERX|0250|TRIAMCINOLONE ACET 0.1% ,|Medicare|MEDICARE ACUTE|44.25||||||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|United Medicare Advantage|UHC MEDICARE GOLD MA|35.50||||||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|Managed Medicare|HEALTHSPRING MA|35.50||||||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|Medicare|MEDICARE ACUTE|35.50||||||| 9500430|ERX|0250|BACITRACIN OINT, 15 GM|Humana Medicare Advantage|HUMANA MA|35.50||||||| 9500448|ERX|0250|NEOMY-BACITRA-POLYMX UD P|Medicare|MEDICARE ACUTE|0.10||||||| 9500455|ERX|0250|NEOMY-BACITRAC-POLYMYX ,1|Medicare|MEDICARE ACUTE|46.25||||||| 9500539|ERX|0250|NEOMYC-BACITR-POLYMYX ,3.|Medicare|MEDICARE ACUTE|1.03||||||| 9500554|ERX|0250|VITAMINS A AND D OINT, 60|Medicare|MEDICARE ACUTE|26.75||||||| 9500562|ERX|0250|BETAMETHASONE VAL 0.1% 1|Access Direct Platinum|HEALTHFIRST TPA|71.25||||||| 9500620|ERX|0250|ERYTHROMYCIN EYE OINT, 3.|Medicare|MEDICARE ACUTE|112.50||||||| 9500638|ERX|0250|GENTAMICIN 0.1% CREAM, 15|United Medicare Advantage|UHC MEDICARE GOLD MA|0.46||||||| 9500638|ERX|0250|GENTAMICIN 0.1% CREAM, 15|Blue Cross PPO Specialty|BCBSTX PPO|0.46||||||| 9500638|ERX|0250|GENTAMICIN 0.1% CREAM, 15|Medicare|MEDICARE PART B ONLY IP|0.46||||||| 9500638|ERX|0250|GENTAMICIN 0.1% CREAM, 15|Medicare|MEDICARE ACUTE|0.46||||||| 9500653|ERX|0250|NYSTATIN-TRIAMCINOLONE 1|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|54.50||||||| 9500653|ERX|0250|NYSTATIN-TRIAMCINOLONE 1|Managed Medicare|HEALTHSPRING MA|54.50||||||| 9500653|ERX|0250|NYSTATIN-TRIAMCINOLONE 1|Blue Cross PPO Specialty|BCBSTX PPO|54.50||||||| 9500653|ERX|0250|NYSTATIN-TRIAMCINOLONE 1|Medicare|MEDICARE ACUTE|54.50||||||| 9500653|ERX|0250|NYSTATIN-TRIAMCINOLONE 1|Humana Medicare Advantage|HUMANA MA|54.50||||||| 9500679|ERX|0250|MICONAZOLE 2% CREAM, 30 G|United Medicare Advantage|UHC AARP WELLMED HMO MA|39.50||||||| 9500679|ERX|0250|MICONAZOLE 2% CREAM, 30 G|United Medicare Advantage|UHC MEDICARE GOLD MA|39.50||||||| 9500679|ERX|0250|MICONAZOLE 2% CREAM, 30 G|Medicare|MEDICARE ACUTE|39.50||||||| 9500679|ERX|0250|MICONAZOLE 2% CREAM, 30 G|Humana Medicare Advantage|HUMANA MA|39.50||||||| 9500679|ERX|0250|MICONAZOLE 2% CREAM, 30 G|Blue Cross HMO Specialty|BCBSTX HMO|39.50||||||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|Medicare|MEDICARE ACUTE|0.47||||||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|Managed Medicare|HEALTHSPRING MA|0.47||||||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|Blue Cross PPO Specialty|BCBSTX PPO|0.47||||||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|Humana Medicare Advantage|HUMANA MA|0.47||||||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|Blue Cross HMO Specialty|BCBSTX HMO|0.47||||||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|Texas Workforce Commission|DIS DETER SERV (DDS)|0.47||||||| 9500687|ERX|0250|LUBRICANT EYE OINTMENT, 3|Workers Compensation|WORKERS COMPENSATION OTHER|0.47||||||| 9500695|ERX|0250|LIDOCAINE 5% OINT, 35 GM|Medicare|MEDICARE ACUTE|1.56||||||| 9500737|ERX|0250|POLYCARBOPHIL 625MG TABLE|Medicare|MEDICARE ACUTE|2.75||||||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|0.10||||||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Medicare|MEDICARE ACUTE|0.10||||||| 9500760|ERX|0250|NITROGLYCERIN 1 INCH PACK|Humana Medicare Advantage|HUMANA MA|0.10||||||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Medicare|MEDICARE ACUTE|43.50||||||| 9500810|ERX|0250|DULOXETINE 30MG CAPSULE|Humana Medicare Advantage|HUMANA MA|43.50||||||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Tricare|TRICARE FOR LIFE|25.50||||||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|25.50||||||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|25.50||||||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Medicare|MEDICARE ACUTE|25.50||||||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Humana Medicare Advantage|HUMANA MA|25.50||||||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|PHCS|HUMANA INSURANCE|25.50||||||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Aetna|AETNA OTHER|25.50||||||| 9500901|ERX|0250|CITALOPRAM 20MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|25.50||||||| 9500927|ERX|0250|MINOCYCLINE 50MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|51.75||||||| 9500927|ERX|0250|MINOCYCLINE 50MG CAPSULE|Medicare|MEDICARE ACUTE|51.75||||||| 9501016|ERX|0250|BUPROPION SR 150MG TABLET|Medicare|MEDICARE ACUTE|38.25||||||| 9501024|ERX|0250|BUPROPION 75MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|25.50||||||| 9501032|ERX|0250|BUPROPION 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|31.25||||||| 9501032|ERX|0250|BUPROPION 100MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|31.25||||||| 9501032|ERX|0250|BUPROPION 100MG TABLET|Humana Medicare Advantage|HUMANA MA|31.25||||||| 9501032|ERX|0250|BUPROPION 100MG TABLET|Aetna|AETNA OTHER|31.25||||||| 9501040|ERX|0250|PYRIMETHAMINE 25MG TABLET|Medicare|MEDICARE ACUTE|3,391.50||||||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|7.25||||||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.25||||||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Humana Medicare Advantage|HUMANA MA|7.25||||||| 9501065|ERX|0250|DIGOXIN 125MCG TABLET|Medicare|MEDICARE ACUTE|7.25||||||| 9501115|ERX|0250|CLOBETASOL 0.05% CREAM, 1|Medicare|MEDICARE ACUTE|527.75||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|United Medicare Advantage|UHC AARP WELLMED HMO MA|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Managed Medicare|HEALTHSPRING MA|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Medicare|MEDICARE ACUTE|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Humana Medicare Advantage|HUMANA MA|8.80||||||| 9501180|ERX|0250|ONDANSETRON 4MG TABLET|Cigna|CIGNA OTHER|8.80||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|536.75||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Managed Medicaid|MEDICAID UNITED HEALTHCARE|536.75||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Medicare|MEDICARE ACUTE|536.75||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Humana Medicare Advantage|HUMANA MA|536.75||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Blue Cross HMO Specialty|BCBSTX HMO|536.75||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|United Healthcare|UNITED HEALTHCARE OTHER|536.75||||||| 9501214|ERX|0250|FLUTICASONE 0.05% NASAL,|Workers Compensation|WORKERS COMPENSATION OTHER|536.75||||||| 9501255|ERX|0250|LAMOTRIGINE 25MG TABLET|Medicare|MEDICARE ACUTE|49.75||||||| 9501255|ERX|0250|LAMOTRIGINE 25MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|49.75||||||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|United Medicare Advantage|UHC AARP WELLMED HMO MA|8.80||||||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Tricare|TRICARE FOR LIFE|8.80||||||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Managed Medicare|HEALTHSPRING MA|8.80||||||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Medicare|MEDICARE ACUTE|8.80||||||| 9501289|ERX|0250|ONDANSETRON ODT 4MG TABLE|Humana Medicare Advantage|HUMANA MA|8.80||||||| 9501305|ERX|0250|LAMOTRIGINE 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|54.25||||||| 9501305|ERX|0250|LAMOTRIGINE 100MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|54.25||||||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Texas Workforce Commission|DIS DETER SERV (DDS)|282.25||||||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Humana Medicare Advantage|HUMANA MA|282.25||||||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Aenta Medicare Advantage|AETNA MEDICARE MA|282.25||||||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Medicare|MEDICARE ACUTE|282.25||||||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|282.25||||||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|Blue Cross PPO Specialty|BCBSTX PPO|282.25||||||| 9501354|ERX|0250|ALBUTEROL INHALER, 8G|PHCS|HUMANA INSURANCE|282.25||||||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|54.50||||||| 9501453|ERX|0250|BUPROPION XL 150MG TABLET|Medicare|MEDICARE ACUTE|54.50||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|72.25||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Humana Medicare Advantage|HUMANA MA|72.25||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|PHCS|HUMANA INSURANCE|72.25||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|72.25||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Medicaid|MEDICAID|72.25||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|72.25||||||| 9501511|ERX|0250|VALACYCLOVIR 500MG TABLET|Medicare|MEDICARE ACUTE|72.25||||||| 9501560|ERX|0250|ACYCLOVIR 200MG CAPSULE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.30||||||| 9501560|ERX|0250|ACYCLOVIR 200MG CAPSULE|Medicare|MEDICARE ACUTE|0.30||||||| 9501560|ERX|0250|ACYCLOVIR 200MG CAPSULE|Humana Medicare Advantage|HUMANA MA|0.30||||||| 9501602|ERX|0250|FINASTERIDE 5MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|35.50||||||| 9501602|ERX|0250|FINASTERIDE 5MG TABLET|Medicare|MEDICARE ACUTE|35.50||||||| 9501610|ERX|0250|CALCIUM CITRATE W/VIT D T|Medicare|MEDICARE ACUTE|2.50||||||| 9501651|ERX|0250|CYANOCOBALAMIN 500MCG TAB|Medicare|MEDICARE ACUTE|2.50||||||| 9501651|ERX|0250|CYANOCOBALAMIN 500MCG TAB|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|United Medicare Advantage|UHC AARP WELLMED HMO MA|2.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|2.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|2.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Managed Medicare|HEALTHSPRING MA|2.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Medicare|MEDICARE ACUTE|2.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.50||||||| 9501669|ERX|0250|THIAMINE 100MG TABLET|Cigna|CIGNA OTHER|2.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Medicare|MEDICARE ACUTE|2.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|2.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Medicaid|MEDICAID|2.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9501685|ERX|0250|ASCORBIC ACID 500MG TABLE|United Medicare Advantage|UHC AARP WELLMED HMO MA|2.50||||||| 9501693|ERX|0250|VITAMIN E 200 UNIT CAPSUL|Medicare|MEDICARE ACUTE|2.50||||||| 9501727|ERX|0250|PYRIDOXINE 50MG TABLET|Medicare|MEDICARE ACUTE|2.50||||||| 9501750|ERX|0250|PREDNISONE 5MG TABLET|Medicare|MEDICARE ACUTE|2.50||||||| 9501750|ERX|0250|PREDNISONE 5MG TABLET|Medicare|MEDICARE PART B ONLY IP|2.50||||||| 9501750|ERX|0250|PREDNISONE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9501750|ERX|0250|PREDNISONE 5MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|2.50||||||| 9501768|ERX|0250|ASPIRIN EC 325MG TABLET|Medicare|MEDICARE ACUTE|2.50||||||| 9501776|ERX|0250|ISOSORBIDE DINITRATE 10MG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.25||||||| 9501776|ERX|0250|ISOSORBIDE DINITRATE 10MG|Humana Medicare Advantage|HUMANA MA|4.25||||||| 9501776|ERX|0250|ISOSORBIDE DINITRATE 10MG|Medicare|MEDICARE ACUTE|4.25||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|6.75||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|6.75||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|6.75||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|6.75||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Medicare|MEDICARE ACUTE|6.75||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Humana Medicare Advantage|HUMANA MA|6.75||||||| 9501792|ERX|0250|HYDRALAZINE 25MG TABLET|Aetna|AETNA OTHER|6.75||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|41.75||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|41.75||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Medicare|MEDICARE ACUTE|41.75||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|41.75||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|Humana Medicare Advantage|HUMANA MA|41.75||||||| 9501800|ERX|0250|MONTELUKAST 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|41.75||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|United Medicare Advantage|UHC AARP WELLMED HMO MA|2.75||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Medicare|MEDICARE ACUTE|2.75||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.75||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Blue Cross PPO Specialty|BCBSTX PPO|2.75||||||| 9501826|ERX|0250|HYDROCHLOROTHIAZIDE 25MG|Blue Cross HMO Specialty|BCBSTX HMO|2.75||||||| 9501875|ERX|0250|HYDRALAZINE 10MG TABLET|Medicare|MEDICARE ACUTE|4.75||||||| 9501883|ERX|0250|CYANOCOBALAMIN 1000MCG TA|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9501883|ERX|0250|CYANOCOBALAMIN 1000MCG TA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9501883|ERX|0250|CYANOCOBALAMIN 1000MCG TA|Medicare|MEDICARE ACUTE|2.50||||||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|9.25||||||| 9501909|ERX|0250|DOXYCYCLINE 100MG CAPSULE|Medicare|MEDICARE ACUTE|9.25||||||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.08||||||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|Medicare|MEDICARE ACUTE|0.08||||||| 9501933|ERX|0250|OXYBUTYNIN 5MG TABLET|United Medicare Advantage|UHC AARP WELLMED HMO MA|0.08||||||| 9501982|ERX|0250|THEOPHYLLINE SR 300MG TAB|Humana Medicare Advantage|HUMANA MA|0.12||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Medicaid|MEDICAID|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|PHCS|HUMANA INSURANCE|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Medicare|MEDICARE ACUTE|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Aetna|AETNA OTHER|2.50||||||| 9501990|ERX|0250|ASPIRIN 81MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.50||||||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|26.25||||||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|Humana Medicare Advantage|HUMANA MA|26.25||||||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|Medicare|MEDICARE ACUTE|26.25||||||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|Blue Cross HMO Specialty|BCBSTX HMO|26.25||||||| 9502006|ERX|0250|OXYMETAZOLINE NASAL,15ML|United Medicare Advantage|UHC AARP WELLMED HMO MA|26.25||||||| 9502089|ERX|0250|PROPRANOLOL 10MG TABLET|PHCS|HUMANA INSURANCE|0.05||||||| 9502089|ERX|0250|PROPRANOLOL 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.05||||||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.50||||||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|Managed Medicare|HEALTHSPRING MA|2.50||||||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|Medicare|MEDICARE ACUTE|2.50||||||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|Medicaid|MEDICAID|2.50||||||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|Cigna|CIGNA OTHER|2.50||||||| 9502154|ERX|0250|FERROUS SULFATE 325MG TAB|Aetna|AETNA OTHER|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Medicare|MEDICARE ACUTE|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9502188|ERX|0250|MULTIVITAMIN W/MINERALS T|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9502212|ERX|0250|CARBAMIDE PEROXIDE DROP,|Medicare|MEDICARE ACUTE|36.75||||||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Medicare|MEDICARE ACUTE|0.10||||||| 9502279|ERX|0250|PROMETHAZINE 25MG TABLET|Humana Medicare Advantage|HUMANA MA|0.10||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|2.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Medicare|MEDICARE PART B ONLY IP|2.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Medicare|MEDICARE ACUTE|2.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9502287|ERX|0250|BISACODYL 5MG TABLET|Aetna|AETNA OTHER|2.50||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Medicare|MEDICARE ACUTE|4.25||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.25||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Humana Medicare Advantage|HUMANA MA|4.25||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.25||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|Aetna|AETNA OTHER|4.25||||||| 9502295|ERX|0250|SIMETHICONE CHEWABLE 80MG|United Medicare Advantage|UHC MEDICARE GOLD MA|4.25||||||| 9502402|ERX|0250|CHOLESTYRAMINE-ASPART 4G|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|34.50||||||| 9502402|ERX|0250|CHOLESTYRAMINE-ASPART 4G|Managed Medicare|HEALTHSPRING MA|34.50||||||| 9502402|ERX|0250|CHOLESTYRAMINE-ASPART 4G|Medicare|MEDICARE ACUTE|34.50||||||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|United Medicare Advantage|UHC MEDICARE GOLD MA|38.25||||||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Medicare|MEDICARE ACUTE|38.25||||||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Blue Cross PPO Specialty|BCBSTX PPO|38.25||||||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|38.25||||||| 9502436|ERX|0250|LIDOCAINE 1% MDV 20ML|Medicare|MEDICARE PART B ONLY IP|38.25||||||| 9502444|ERX|0250|LIDOCAINE 2%MDV 20ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.43||||||| 9502444|ERX|0250|LIDOCAINE 2%MDV 20ML|Aetna|AETNA OTHER|0.43||||||| 9502444|ERX|0250|LIDOCAINE 2%MDV 20ML|Managed Medicare|BCBS MEDICARE PPO MA|0.43||||||| 9502444|ERX|0250|LIDOCAINE 2%MDV 20ML|Medicare|MEDICARE ACUTE|0.43||||||| 9502444|ERX|0250|LIDOCAINE 2%MDV 20ML|Humana Medicare Advantage|HUMANA MA|0.43||||||| 9502444|ERX|0250|LIDOCAINE 2%MDV 20ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.43||||||| 9502469|ERX|0250|OLANZAPINE 5MG TABLET|Managed Medicare|HEALTHSPRING MA|89.50||||||| 9502469|ERX|0250|OLANZAPINE 5MG TABLET|Medicare|MEDICARE ACUTE|89.50||||||| 9502493|ERX|0250|LIDOCAINE 2%MDV 50ML|Medicare|MEDICARE ACUTE|76.25||||||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|37.75||||||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Blue Cross PPO Specialty|BCBSTX PPO|37.75||||||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|37.75||||||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Medicaid|MEDICAID|37.75||||||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Blue Cross HMO Specialty|BCBSTX HMO|37.75||||||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Medicare|MEDICARE ACUTE|37.75||||||| 9502501|ERX|0250|LIDOCAINE 1%PF 5ML|Access Direct Platinum|HEALTHFIRST TPA|37.75||||||| 9502519|ERX|0250|LIDOCAINE 4%PF 40MG/ML, 5|Medicare|MEDICARE ACUTE|93.25||||||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Medicare|MEDICARE ACUTE|231.75||||||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Blue Cross PPO Specialty|BCBSTX PPO|231.75||||||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Access Direct Platinum|HEALTHFIRST TPA|231.75||||||| 9502527|ERX|0250|LIDOCAINE 4% SOLUTION, 50|Humana Medicare Advantage|HUMANA MA|231.75||||||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|United Medicare Advantage|UHC AARP WELLMED HMO MA|94.50||||||| 9502543|ERX|0250|LIDOCAINE 2% JELLY, 5ML|Medicare|MEDICARE ACUTE|94.50||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Aetna|AETNA OTHER|15.50||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|15.50||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Blue Cross PPO Specialty|BCBSTX PPO|15.50||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|15.50||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Medicare|MEDICARE ACUTE|15.50||||||| 9502667|ERX|0250|METOPROLOL SUCCINATE 25MG|Blue Cross HMO Specialty|BCBSTX HMO|15.50||||||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Blue Cross PPO Specialty|BCBSTX PPO|15.50||||||| 9502675|ERX|0250|METOPROLOL SUCCINATE 50MG|Medicare|MEDICARE ACUTE|15.50||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|United Healthcare|UNITED HEALTHCARE OTHER|72.50||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|72.50||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Aenta Medicare Advantage|AETNA MEDICARE MA|72.50||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|72.50||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|72.50||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Medicare|MEDICARE ACUTE|72.50||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Medicaid|MEDICAID|72.50||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Medicare|MEDICARE PART B ONLY IP|72.50||||||| 9502741|ERX|0250|BUDESONIDE NEB 0.5MG/2ML|Humana Medicare Advantage|HUMANA MA|72.50||||||| 9502758|ERX|0250|ESOMEPRAZOLE 40MG PACKET|Aenta Medicare Advantage|AETNA MEDICARE MA|43.25||||||| 9502758|ERX|0250|ESOMEPRAZOLE 40MG PACKET|Blue Cross HMO Specialty|BCBSTX HMO|43.25||||||| 9502758|ERX|0250|ESOMEPRAZOLE 40MG PACKET|Managed Medicare|BCBS MEDICARE PPO MA|43.25||||||| 9502758|ERX|0250|ESOMEPRAZOLE 40MG PACKET|Blue Cross PPO Specialty|BCBSTX PPO|43.25||||||| 9502758|ERX|0250|ESOMEPRAZOLE 40MG PACKET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|43.25||||||| 9502758|ERX|0250|ESOMEPRAZOLE 40MG PACKET|Humana Medicare Advantage|HUMANA MA|43.25||||||| 9502758|ERX|0250|ESOMEPRAZOLE 40MG PACKET|Medicare|MEDICARE PART B ONLY IP|43.25||||||| 9502758|ERX|0250|ESOMEPRAZOLE 40MG PACKET|Medicare|MEDICARE ACUTE|43.25||||||| 9502758|ERX|0250|ESOMEPRAZOLE 40MG PACKET|Managed Medicare|HEALTHSPRING MA|43.25||||||| 9502758|ERX|0250|ESOMEPRAZOLE 40MG PACKET|Workers Compensation|WORKERS COMPENSATION OTHER|43.25||||||| 9502758|ERX|0250|ESOMEPRAZOLE 40MG PACKET|United Medicare Advantage|UHC MEDICARE GOLD MA|43.25||||||| 9502782|ERX|0250|ESOMEPRAZOLE 40MG VIAL|Medicare|MEDICARE ACUTE|2.26||||||| 9502824|ERX|0250|PYRIDOSTIGMINE 60MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|15.50||||||| 9502824|ERX|0250|PYRIDOSTIGMINE 60MG TABLE|Medicare|MEDICARE ACUTE|15.50||||||| 9502865|ERX|0250|FLUCYTOSINE 250MG CAPSULE|Medicare|MEDICARE ACUTE|65.75||||||| 9502865|ERX|0250|FLUCYTOSINE 250MG CAPSULE|Humana Medicare Advantage|HUMANA MA|65.75||||||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|Medicare|MEDICARE ACUTE|0.25||||||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.25||||||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.25||||||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|Humana Medicare Advantage|HUMANA MA|0.25||||||| 9502956|ERX|0250|LOSARTAN 25MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.25||||||| 9503046|ERX|0250|SODIUM CHLORIDE 1 G TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9503046|ERX|0250|SODIUM CHLORIDE 1 G TABLE|Managed Medicare|HEALTHSPRING MA|2.50||||||| 9503046|ERX|0250|SODIUM CHLORIDE 1 G TABLE|Medicaid|MEDICAID|2.50||||||| 9503046|ERX|0250|SODIUM CHLORIDE 1 G TABLE|Medicare|MEDICARE ACUTE|2.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Access Direct Platinum|HEALTHFIRST TPA|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Managed Medicare|HEALTHSPRING MA|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Medicaid|MEDICAID|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Medicare|MEDICARE ACUTE|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Cigna|CIGNA OTHER|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Blue Cross HMO Specialty|BCBSTX HMO|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Aetna|AETNA OTHER|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|PHCS|HUMANA INSURANCE|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Tricare|TRICARE FOR LIFE|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Workers Compensation|WORKERS COMPENSATION OTHER|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|Texas Workforce Commission|DIS DETER SERV (DDS)|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9503111|ERX|0250|K CHLORIDE 20 MEQ PACKET|United Medicare Advantage|UHC AARP WELLMED HMO MA|4.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|United Healthcare|UNITED HEALTHCARE OTHER|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Texas Workforce Commission|DIS DETER SERV (DDS)|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|United Medicare Advantage|UHC MEDICARE GOLD MA|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Aenta Medicare Advantage|AETNA MEDICARE MA|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|PHCS|HUMANA INSURANCE|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Tricare|TRICARE FOR LIFE|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Blue Cross PPO Specialty|BCBSTX PPO|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Medicaid|MEDICAID|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Cigna|CIGNA OTHER|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Humana Medicare Advantage|HUMANA MA|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Medicare|MEDICARE PART B ONLY IP|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Medicare|MEDICARE ACUTE|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Blue Cross HMO Specialty|BCBSTX HMO|5.50||||||| 9503129|ERX|0250|POTASSIUM CHLORIDE 10 MEQ|Aetna|AETNA OTHER|5.50||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.50||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.50||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Medicaid|MEDICAID|2.50||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Blue Cross HMO Specialty|BCBSTX HMO|2.50||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|Medicare|MEDICARE ACUTE|2.50||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9503145|ERX|0250|ZINC SULFATE 220MG CAPSUL|United Medicare Advantage|UHC AARP WELLMED HMO MA|2.50||||||| 9503152|ERX|0250|MULTIVITAMINS TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.50||||||| 9503152|ERX|0250|MULTIVITAMINS TABLET|Medicare|MEDICARE ACUTE|2.50||||||| 9503202|ERX|0250|NA CHL 0.65% NASAL SPRAY,|Medicare|MEDICARE ACUTE|39.50||||||| 9503202|ERX|0250|NA CHL 0.65% NASAL SPRAY,|PHCS|HUMANA INSURANCE|39.50||||||| 9503210|ERX|0250|MAGNESIUM GLUCONATE 500MG|Blue Cross PPO Specialty|BCBSTX PPO|4.25||||||| 9503210|ERX|0250|MAGNESIUM GLUCONATE 500MG|Medicare|MEDICARE ACUTE|4.25||||||| 9503251|ERX|0250|SODIUM CHLORIDE 3% 500ML|Medicare|MEDICARE ACUTE|89.50||||||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.46||||||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.46||||||| 9503459|ERX|0250|QUETIAPINE 100MG TABLET|Medicare|MEDICARE ACUTE|0.46||||||| 9503475|ERX|0250|DORZOLAMIDE 2% EYE DROP,|Medicare|MEDICARE ACUTE|514.50||||||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|26.75||||||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|26.75||||||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Humana Medicare Advantage|HUMANA MA|26.75||||||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|26.75||||||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|26.75||||||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Medicare|MEDICARE ACUTE|26.75||||||| 9503483|ERX|0250|QUETIAPINE 25MG TABLET|Medicare|MEDICARE PART B ONLY IP|26.75||||||| 9503509|ERX|0250|PROPOFOL 500MG/50ML|Medicare|MEDICARE ACUTE|499.75||||||| 9503509|ERX|0250|PROPOFOL 500MG/50ML|Humana Medicare Advantage|HUMANA MA|499.75||||||| 9503517|ERX|0250|MEROPENEM 1 G VIAL|Managed Medicare|HEALTHSPRING MA|709.75||||||| 9503517|ERX|0250|MEROPENEM 1 G VIAL|Medicare|MEDICARE ACUTE|709.75||||||| 9503517|ERX|0250|MEROPENEM 1 G VIAL|Humana Medicare Advantage|HUMANA MA|709.75||||||| 9503517|ERX|0250|MEROPENEM 1 G VIAL|Blue Cross HMO Specialty|BCBSTX HMO|709.75||||||| 9503574|ERX|0250|ROSUVASTATIN 10MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.39||||||| 9503574|ERX|0250|ROSUVASTATIN 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.39||||||| 9503574|ERX|0250|ROSUVASTATIN 10MG TABLET|Medicare|MEDICARE ACUTE|0.39||||||| 9503582|ERX|0250|ROSUVASTATIN 20MG TABLET|Medicare|MEDICARE ACUTE|0.39||||||| 9503640|ERX|0258|CEFAZOLIN 1 GM/50ML D5W|Medicare|MEDICARE ACUTE|110.50||||||| 9503657|ERX|0258|VANCOMYCIN 1000MG/200ML D|Medicare|MEDICARE ACUTE|377.50||||||| 9503657|ERX|0258|VANCOMYCIN 1000MG/200ML D|Humana Medicare Advantage|HUMANA MA|377.50||||||| 9503657|ERX|0258|VANCOMYCIN 1000MG/200ML D|PHCS|HUMANA INSURANCE|377.50||||||| 9503657|ERX|0258|VANCOMYCIN 1000MG/200ML D|United Healthcare|UNITED HEALTHCARE OTHER|377.50||||||| 9503657|ERX|0258|VANCOMYCIN 1000MG/200ML D|United Medicare Advantage|UHC AARP WELLMED HMO MA|377.50||||||| 9503657|ERX|0258|VANCOMYCIN 1000MG/200ML D|Managed Medicare|BCBS MEDICARE PPO MA|377.50||||||| 9503657|ERX|0258|VANCOMYCIN 1000MG/200ML D|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|377.50||||||| 9503657|ERX|0258|VANCOMYCIN 1000MG/200ML D|Blue Cross PPO Specialty|BCBSTX PPO|377.50||||||| 9503657|ERX|0258|VANCOMYCIN 1000MG/200ML D|Aenta Medicare Advantage|AETNA MEDICARE MA|377.50||||||| 9503657|ERX|0258|VANCOMYCIN 1000MG/200ML D|Medicaid|MEDICAID|377.50||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Aenta Medicare Advantage|AETNA MEDICARE MA|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Managed Medicare|HEALTHSPRING MA|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Blue Cross PPO Specialty|BCBSTX PPO|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Medicare|MEDICARE ACUTE|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Humana Medicare Advantage|HUMANA MA|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Aetna|AETNA OTHER|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Blue Cross HMO Specialty|BCBSTX HMO|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|United Medicare Advantage|UHC MEDICARE GOLD MA|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|United Medicare Advantage|UHC AARP WELLMED HMO MA|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Tricare|TRICARE FOR LIFE|5.25||||||| 9503673|ERX|0250|METOPROLOL TARTRATE 25MG|Texas Workforce Commission|DIS DETER SERV (DDS)|5.25||||||| 9503780|ERX|0250|TIMOLOL/DORZOLAM DROP,10M|Medicare|MEDICARE ACUTE|1,010.25||||||| 9503863|ERX|0250|LEVOTHYROXINE 25MCG TABLE|Managed Medicare|BCBS MEDICARE PPO MA|5.25||||||| 9503863|ERX|0250|LEVOTHYROXINE 25MCG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.25||||||| 9503863|ERX|0250|LEVOTHYROXINE 25MCG TABLE|Medicare|MEDICARE ACUTE|5.25||||||| 9503863|ERX|0250|LEVOTHYROXINE 25MCG TABLE|Humana Medicare Advantage|HUMANA MA|5.25||||||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Humana Medicare Advantage|HUMANA MA|5.25||||||| 9503871|ERX|0250|LEVOTHYROXINE 50MCG TABLE|Medicare|MEDICARE ACUTE|5.25||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|5.50||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Cigna|CIGNA OTHER|5.50||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.50||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Medicaid|MEDICAID|5.50||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Medicare|MEDICARE ACUTE|5.50||||||| 9503889|ERX|0250|LEVOTHYROXINE 75MCG TABLE|Humana Medicare Advantage|HUMANA MA|5.50||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.50||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|Medicare|MEDICARE ACUTE|5.50||||||| 9503897|ERX|0250|LEVOTHYROXINE 100MCG TABL|United Medicare Advantage|UHC MEDICARE GOLD MA|5.50||||||| 9503905|ERX|0250|LEVOTHYROXINE 112MCG TABL|Medicare|MEDICARE ACUTE|6.75||||||| 9503905|ERX|0250|LEVOTHYROXINE 112MCG TABL|Humana Medicare Advantage|HUMANA MA|6.75||||||| 9503913|ERX|0250|LEVOTHYROXINE 125MCG TABL|United Medicare Advantage|UHC MEDICARE GOLD MA|6.75||||||| 9503913|ERX|0250|LEVOTHYROXINE 125MCG TABL|Medicare|MEDICARE ACUTE|6.75||||||| 9503913|ERX|0250|LEVOTHYROXINE 125MCG TABL|Humana Medicare Advantage|HUMANA MA|6.75||||||| 9503970|ERX|0250|NITROGLYCERIN 0.4MG PATCH|Medicare|MEDICARE ACUTE|0.24||||||| 9504002|ERX|0250|GLYCERIN 30ML|Medicare|MEDICARE ACUTE|0.10||||||| 9504028|ERX|0250|OLANZAPINE 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|134.50||||||| 9504028|ERX|0250|OLANZAPINE 10MG TABLET|Texas Workforce Commission|DIS DETER SERV (DDS)|134.50||||||| 9504028|ERX|0250|OLANZAPINE 10MG TABLET|Humana Medicare Advantage|HUMANA MA|134.50||||||| 9504028|ERX|0250|OLANZAPINE 10MG TABLET|Medicare|MEDICARE ACUTE|134.50||||||| 9504051|ERX|0250|MORPHINE ER 15MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.14||||||| 9504051|ERX|0250|MORPHINE ER 15MG TABLET|Medicare|MEDICARE ACUTE|0.14||||||| 9504101|ERX|0250|TEMAZEPAM 7.5MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|76.25||||||| 9504101|ERX|0250|TEMAZEPAM 7.5MG CAPSULE|Medicare|MEDICARE ACUTE|76.25||||||| 9504176|ERX|0250|VERAPAMIL 5MG/2ML|Medicare|MEDICARE ACUTE|17.25||||||| 9504218|ERX|0250|GENTAMICIN 40MG/ML, 2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.13||||||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|Medicare|MEDICARE ACUTE|0.55||||||| 9504226|ERX|0250|NALOXONE 0.4MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.55||||||| 9504234|ERX|0636|MORPHINE 10MG/1ML|Medicare|MEDICARE ACUTE|17.50||||||| 9504259|ERX|0250|DIAZEPAM 5MG/ML, 2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.60||||||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|17.50||||||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|17.50||||||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|17.50||||||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Humana Medicare Advantage|HUMANA MA|17.50||||||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Medicare|MEDICARE ACUTE|17.50||||||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Cigna|CIGNA OTHER|17.50||||||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Access Direct Platinum|HEALTHFIRST TPA|17.50||||||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Blue Cross HMO Specialty|BCBSTX HMO|17.50||||||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Aetna|AETNA OTHER|17.50||||||| 9504267|ERX|0250|HYDROMORPHONE PF 2MG/1ML|Tricare|TRICARE FOR LIFE|17.50||||||| 9504275|ERX|0250|PHENYTOIN 100MG/2ML|Workers Compensation|WORKERS COMPENSATION OTHER|0.23||||||| 9504325|ERX|0250|NOREPINEPHRINE 4MG/4ML|Aenta Medicare Advantage|AETNA MEDICARE MA|84.75||||||| 9504325|ERX|0250|NOREPINEPHRINE 4MG/4ML|Medicaid|MEDICAID|84.75||||||| 9504325|ERX|0250|NOREPINEPHRINE 4MG/4ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|84.75||||||| 9504325|ERX|0250|NOREPINEPHRINE 4MG/4ML|Medicare|MEDICARE ACUTE|84.75||||||| 9504325|ERX|0250|NOREPINEPHRINE 4MG/4ML|Managed Medicare|BCBS MEDICARE PPO MA|84.75||||||| 9504325|ERX|0250|NOREPINEPHRINE 4MG/4ML|Humana Medicare Advantage|HUMANA MA|84.75||||||| 9504325|ERX|0250|NOREPINEPHRINE 4MG/4ML|United Medicare Advantage|UHC MEDICARE GOLD MA|84.75||||||| 9504374|ERX|0250|BUPIVACAINE 0.25%PF 10ML|Blue Cross PPO Specialty|BCBSTX PPO|30.75||||||| 9504382|ERX|0250|BUPIVACAINE 0.25%PF 30ML|Medicare|MEDICARE ACUTE|0.36||||||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Blue Cross PPO Specialty|BCBSTX PPO|34.75||||||| 9504408|ERX|0250|BUPIVACAINE 0.5%PF 30ML|Medicare|MEDICARE ACUTE|34.75||||||| 9504432|ERX|0258|NA CHLORIDE 0.9%,250MLGLA|Medicare|MEDICARE ACUTE|118.50||||||| 9504457|ERX|0250|BUPIVACAINE 0.25% MDV 50M|Medicare|MEDICARE ACUTE|59.50||||||| 9504473|ERX|0250|BUPIVACAINE 0.5% MDV 50ML|Medicare|MEDICARE ACUTE|0.46||||||| 9504515|ERX|0250|BUPIVACAINE-EPI 0.5%PF 10|Medicare|MEDICARE ACUTE|0.39||||||| 9504523|ERX|0250|BUPIVACAINE-EPI 0.5%PF 30|Medicare|MEDICARE ACUTE|67.25||||||| 9504531|ERX|0250|BUPIVACAINE-EPI 0.25%MDV|Medicare|MEDICARE ACUTE|0.70||||||| 9504598|ERX|0250|AMIKACIN 250MG/ML|Medicare|MEDICARE ACUTE|129.50||||||| 9504598|ERX|0250|AMIKACIN 250MG/ML|Humana Medicare Advantage|HUMANA MA|129.50||||||| 9504606|ERX|0250|NA CHLORIDE 0.9%(B'STAT)|Medicare|MEDICARE ACUTE|0.13||||||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Blue Cross PPO Specialty|BCBSTX PPO|4.66||||||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Medicare|MEDICARE ACUTE|4.66||||||| 9504648|ERX|0250|LABETALOL 100MG/20ML|Blue Cross HMO Specialty|BCBSTX HMO|4.66||||||| 9504671|ERX|0258|DOBUTAMINE 250MG/250ML D5|Medicare|MEDICARE ACUTE|186.25||||||| 9504697|ERX|0250|EPHEDRINE 50MG/ML|Medicare|MEDICARE ACUTE|0.13||||||| 9504705|ERX|0250|LIDOCAINE-EPI 1% MDV 30ML|Humana Medicare Advantage|HUMANA MA|62.50||||||| 9504705|ERX|0250|LIDOCAINE-EPI 1% MDV 30ML|Medicare|MEDICARE ACUTE|62.50||||||| 9504705|ERX|0250|LIDOCAINE-EPI 1% MDV 30ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|62.50||||||| 9504713|ERX|0250|LIDOCAINE/EPI 2%MDV 20ML|Aenta Medicare Advantage|AETNA MEDICARE MA|32.50||||||| 9504713|ERX|0250|LIDOCAINE/EPI 2%MDV 20ML|Humana Medicare Advantage|HUMANA MA|32.50||||||| 9504713|ERX|0250|LIDOCAINE/EPI 2%MDV 20ML|Medicare|MEDICARE ACUTE|32.50||||||| 9504804|ERX|0250|FONDAPARINUX 2.5MG/0.5ML|Medicare|MEDICARE ACUTE|4.47||||||| 9504937|ERX|0250|WATER FOR INJ.,STERILE 50|Humana Medicare Advantage|HUMANA MA|16.75||||||| 9504945|ERX|0250|SODIUM CHLORIDE 0.9% 10ML|Medicare|MEDICARE ACUTE|0.13||||||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|United Medicare Advantage|UHC MEDICARE GOLD MA|61.50||||||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Aenta Medicare Advantage|AETNA MEDICARE MA|61.50||||||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Managed Medicare|BCBS MEDICARE PPO MA|61.50||||||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Medicare|MEDICARE ACUTE|61.50||||||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|61.50||||||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Blue Cross PPO Specialty|BCBSTX PPO|61.50||||||| 9504986|ERX|0250|D50%-WATER,ABBOJECT 25 G/|Humana Medicare Advantage|HUMANA MA|61.50||||||| 9504994|ERX|0250|LIDOCAINE ABBOJECT 100MG/|Medicare|MEDICARE ACUTE|46.50||||||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|Aenta Medicare Advantage|AETNA MEDICARE MA|0.48||||||| 9505009|ERX|0250|ATROPINE ABBOJECT 1MG/10M|Medicare|MEDICARE ACUTE|0.48||||||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Aenta Medicare Advantage|AETNA MEDICARE MA|150.25||||||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Medicare|MEDICARE ACUTE|150.25||||||| 9505017|ERX|0250|EPINEPHRINE ABBOJECT 1MG/|Humana Medicare Advantage|HUMANA MA|150.25||||||| 9505025|ERX|0250|CA CHLORIDE 1000MG/10ML|Medicare|MEDICARE ACUTE|49.25||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.13||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.13||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|PHCS|HUMANA INSURANCE|0.13||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.13||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Medicare|MEDICARE ACUTE|0.13||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.13||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Humana Medicare Advantage|HUMANA MA|0.13||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Blue Cross HMO Specialty|BCBSTX HMO|0.13||||||| 9505108|ERX|0250|FUROSEMIDE 40MG/4ML|Aetna|AETNA OTHER|0.13||||||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|Medicaid|MEDICAID|0.13||||||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|Medicare|MEDICARE ACUTE|0.13||||||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|Humana Medicare Advantage|HUMANA MA|0.13||||||| 9505116|ERX|0250|FUROSEMIDE 100MG/10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.13||||||| 9505124|ERX|0258|NA CHLORIDE 0.9%,500ML IR|Medicare|MEDICARE ACUTE|142.25||||||| 9505124|ERX|0258|NA CHLORIDE 0.9%,500ML IR|Aenta Medicare Advantage|AETNA MEDICARE MA|142.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|114.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Medicaid|MEDICAID|114.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|114.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|114.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Medicare|MEDICARE ACUTE|114.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|114.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|Humana Medicare Advantage|HUMANA MA|114.25||||||| 9505173|ERX|0250|VANCOMYCIN 1000MG VIAL|PHCS|HUMANA INSURANCE|114.25||||||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Humana Medicare Advantage|HUMANA MA|36.75||||||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|36.75||||||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Medicare|MEDICARE ACUTE|36.75||||||| 9505207|ERX|0250|SUCCINYLCHOLINE 20MG/ML,|Blue Cross PPO Specialty|BCBSTX PPO|36.75||||||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Aenta Medicare Advantage|AETNA MEDICARE MA|42.75||||||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|42.75||||||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Medicare|MEDICARE ACUTE|42.75||||||| 9505215|ERX|0250|NA BICARB 8.4% 50 MEQ/50M|Humana Medicare Advantage|HUMANA MA|42.75||||||| 9505223|ERX|0250|K CHLORIDE 2 MEQ/ML,20ML|Medicare|MEDICARE ACUTE|0.13||||||| 9505223|ERX|0250|K CHLORIDE 2 MEQ/ML,20ML|Access Direct Platinum|HEALTHFIRST TPA|0.13||||||| 9505223|ERX|0250|K CHLORIDE 2 MEQ/ML,20ML|Cigna|CIGNA OTHER|0.13||||||| 9505223|ERX|0250|K CHLORIDE 2 MEQ/ML,20ML|Humana Medicare Advantage|HUMANA MA|0.13||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|25.50||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|25.50||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Medicare|MEDICARE ACUTE|25.50||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|25.50||||||| 9505231|ERX|0250|CARVEDILOL 3.125MG TABLET|Humana Medicare Advantage|HUMANA MA|25.50||||||| 9505256|ERX|0258|MAGNESIUM SULF 4 G/100ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|195.25||||||| 9505256|ERX|0258|MAGNESIUM SULF 4 G/100ML|Managed Medicare|HEALTHSPRING MA|195.25||||||| 9505256|ERX|0258|MAGNESIUM SULF 4 G/100ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|195.25||||||| 9505256|ERX|0258|MAGNESIUM SULF 4 G/100ML|Medicare|MEDICARE ACUTE|195.25||||||| 9505256|ERX|0258|MAGNESIUM SULF 4 G/100ML|Humana Medicare Advantage|HUMANA MA|195.25||||||| 9505264|ERX|0258|MAGNESIUM SULF 2 GM/50ML|Tricare|TRICARE FOR LIFE|1.19||||||| 9505264|ERX|0258|MAGNESIUM SULF 2 GM/50ML|United Medicare Advantage|UHC AARP WELLMED HMO MA|1.19||||||| 9505264|ERX|0258|MAGNESIUM SULF 2 GM/50ML|United Medicare Advantage|UHC MEDICARE GOLD MA|1.19||||||| 9505264|ERX|0258|MAGNESIUM SULF 2 GM/50ML|Blue Cross HMO Specialty|BCBSTX HMO|1.19||||||| 9505264|ERX|0258|MAGNESIUM SULF 2 GM/50ML|Aetna|AETNA OTHER|1.19||||||| 9505264|ERX|0258|MAGNESIUM SULF 2 GM/50ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.19||||||| 9505264|ERX|0258|MAGNESIUM SULF 2 GM/50ML|Medicare|MEDICARE ACUTE|1.19||||||| 9505264|ERX|0258|MAGNESIUM SULF 2 GM/50ML|Managed Medicare|HEALTHSPRING MA|1.19||||||| 9505264|ERX|0258|MAGNESIUM SULF 2 GM/50ML|Cigna|CIGNA OTHER|1.19||||||| 9505264|ERX|0258|MAGNESIUM SULF 2 GM/50ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.19||||||| 9505264|ERX|0258|MAGNESIUM SULF 2 GM/50ML|Blue Cross PPO Specialty|BCBSTX PPO|1.19||||||| 9505264|ERX|0258|MAGNESIUM SULF 2 GM/50ML|Medicaid|MEDICAID|1.19||||||| 9505264|ERX|0258|MAGNESIUM SULF 2 GM/50ML|Humana Medicare Advantage|HUMANA MA|1.19||||||| 9505264|ERX|0258|MAGNESIUM SULF 2 GM/50ML|Access Direct Platinum|HEALTHFIRST TPA|1.19||||||| 9505272|ERX|0258|K CHLORIDE 20 MEQ/100ML|Aetna|AETNA OTHER|207.75||||||| 9505272|ERX|0258|K CHLORIDE 20 MEQ/100ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|207.75||||||| 9505272|ERX|0258|K CHLORIDE 20 MEQ/100ML|Medicare|MEDICARE ACUTE|207.75||||||| 9505272|ERX|0258|K CHLORIDE 20 MEQ/100ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|207.75||||||| 9505272|ERX|0258|K CHLORIDE 20 MEQ/100ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|207.75||||||| 9505272|ERX|0258|K CHLORIDE 20 MEQ/100ML|Access Direct Platinum|HEALTHFIRST TPA|207.75||||||| 9505272|ERX|0258|K CHLORIDE 20 MEQ/100ML|Humana Medicare Advantage|HUMANA MA|207.75||||||| 9505272|ERX|0258|K CHLORIDE 20 MEQ/100ML|United Medicare Advantage|UHC MEDICARE GOLD MA|207.75||||||| 9505314|ERX|0258|DEX 5%-NS KCL 20 MEQ 1000|Medicaid|MEDICAID|2.15||||||| 9505314|ERX|0258|DEX 5%-NS KCL 20 MEQ 1000|Medicare|MEDICARE ACUTE|2.15||||||| 9505330|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|United Healthcare|UNITED HEALTHCARE OTHER|218.50||||||| 9505330|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|218.50||||||| 9505330|ERX|0258|SOD CHL 0.9% KCL 20MEQ/10|Medicare|MEDICARE ACUTE|218.50||||||| 9505355|ERX|0258|WATER FOR INJECTION 100ML|Cigna|CIGNA OTHER|19.25||||||| 9505355|ERX|0258|WATER FOR INJECTION 100ML|Medicare|MEDICARE ACUTE|19.25||||||| 9505355|ERX|0258|WATER FOR INJECTION 100ML|Managed Medicare|HEALTHSPRING MA|19.25||||||| 9505355|ERX|0258|WATER FOR INJECTION 100ML|Access Direct Platinum|HEALTHFIRST TPA|19.25||||||| 9505363|ERX|0258|DEX 70%-WATER 238 KCAL 10|Cigna|CIGNA OTHER|35.25||||||| 9505363|ERX|0258|DEX 70%-WATER 238 KCAL 10|Medicare|MEDICARE ACUTE|35.25||||||| 9505363|ERX|0258|DEX 70%-WATER 238 KCAL 10|Access Direct Platinum|HEALTHFIRST TPA|35.25||||||| 9505371|ERX|0258|AMINO ACID 15% 15 G/100ML|Medicare|MEDICARE ACUTE|62.80||||||| 9505371|ERX|0258|AMINO ACID 15% 15 G/100ML|Cigna|CIGNA OTHER|62.80||||||| 9505371|ERX|0258|AMINO ACID 15% 15 G/100ML|Access Direct Platinum|HEALTHFIRST TPA|62.80||||||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|25.50||||||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|25.50||||||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|25.50||||||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Medicare|MEDICARE ACUTE|25.50||||||| 9505389|ERX|0250|CARVEDILOL 12.5MG TABLET|Humana Medicare Advantage|HUMANA MA|25.50||||||| 9505397|ERX|0258|NA CHLORIDE 0.9%,1000ML I|Medicare|MEDICARE ACUTE|145.50||||||| 9505397|ERX|0258|NA CHLORIDE 0.9%,1000ML I|Blue Cross PPO Specialty|BCBSTX PPO|145.50||||||| 9505397|ERX|0258|NA CHLORIDE 0.9%,1000ML I|Access Direct Platinum|HEALTHFIRST TPA|145.50||||||| 9505405|ERX|0258|WATER FOR IRRIGATION 1000|United Medicare Advantage|UHC MEDICARE GOLD MA|190.25||||||| 9505405|ERX|0258|WATER FOR IRRIGATION 1000|Blue Cross PPO Specialty|BCBSTX PPO|190.25||||||| 9505405|ERX|0258|WATER FOR IRRIGATION 1000|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|190.25||||||| 9505405|ERX|0258|WATER FOR IRRIGATION 1000|Humana Medicare Advantage|HUMANA MA|190.25||||||| 9505405|ERX|0258|WATER FOR IRRIGATION 1000|Medicare|MEDICARE ACUTE|190.25||||||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Blue Cross PPO Specialty|BCBSTX PPO|0.19||||||| 9505413|ERX|0250|EPINEPHRINE 1MG/ML|Medicare|MEDICARE ACUTE|0.19||||||| 9505421|ERX|0250|HETASTARCH IN NS 500ML|Medicare|MEDICARE ACUTE|323.50||||||| 9505439|ERX|0250|K PHOSPHATE 3 MMOL/ML,15M|Cigna|CIGNA OTHER|0.13||||||| 9505439|ERX|0250|K PHOSPHATE 3 MMOL/ML,15M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.13||||||| 9505439|ERX|0250|K PHOSPHATE 3 MMOL/ML,15M|Medicare|MEDICARE ACUTE|0.13||||||| 9505439|ERX|0250|K PHOSPHATE 3 MMOL/ML,15M|Blue Cross HMO Specialty|BCBSTX HMO|0.13||||||| 9505447|ERX|0250|NA PHOSPHATE 3 MMOL/ML,15|United Medicare Advantage|UHC MEDICARE GOLD MA|0.13||||||| 9505447|ERX|0250|NA PHOSPHATE 3 MMOL/ML,15|Texas Workforce Commission|DIS DETER SERV (DDS)|0.13||||||| 9505447|ERX|0250|NA PHOSPHATE 3 MMOL/ML,15|Managed Medicare|HEALTHSPRING MA|0.13||||||| 9505447|ERX|0250|NA PHOSPHATE 3 MMOL/ML,15|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||||| 9505447|ERX|0250|NA PHOSPHATE 3 MMOL/ML,15|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.13||||||| 9505447|ERX|0250|NA PHOSPHATE 3 MMOL/ML,15|Humana Medicare Advantage|HUMANA MA|0.13||||||| 9505447|ERX|0250|NA PHOSPHATE 3 MMOL/ML,15|Medicare|MEDICARE PART B ONLY IP|0.13||||||| 9505447|ERX|0250|NA PHOSPHATE 3 MMOL/ML,15|Medicare|MEDICARE ACUTE|0.13||||||| 9505447|ERX|0250|NA PHOSPHATE 3 MMOL/ML,15|Cigna|CIGNA OTHER|0.13||||||| 9505447|ERX|0250|NA PHOSPHATE 3 MMOL/ML,15|Blue Cross HMO Specialty|BCBSTX HMO|0.13||||||| 9505553|ERX|0250|HEPARIN 25,000 UNITS/500M|Medicare|MEDICARE ACUTE|1.69||||||| 9505561|ERX|0258|DOPAMINE 800MG/500ML D5W|Medicare|MEDICARE ACUTE|2.31||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Blue Cross PPO Specialty|BCBSTX PPO|107.50||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Medicare|MEDICARE ACUTE|107.50||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Cigna|CIGNA OTHER|107.50||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Humana Medicare Advantage|HUMANA MA|107.50||||||| 9505579|ERX|0250|METRONIDAZOLE 500MG/100ML|Blue Cross HMO Specialty|BCBSTX HMO|107.50||||||| 9505603|ERX|0250|GENTAMICIN 80MG/100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|107.50||||||| 9505629|ERX|0258|DEX 5%-1/2NS KCL 20 MEQ 1|Medicare|MEDICARE ACUTE|127.25||||||| 9505686|ERX|0258|DEXTROSE 5%-WATER 250ML|PHCS|HUMANA INSURANCE|1.67||||||| 9505686|ERX|0258|DEXTROSE 5%-WATER 250ML|United Medicare Advantage|UHC MEDICARE GOLD MA|1.67||||||| 9505686|ERX|0258|DEXTROSE 5%-WATER 250ML|Managed Medicare|BCBS MEDICARE PPO MA|1.67||||||| 9505686|ERX|0258|DEXTROSE 5%-WATER 250ML|Medicaid|MEDICAID|1.67||||||| 9505686|ERX|0258|DEXTROSE 5%-WATER 250ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.67||||||| 9505686|ERX|0258|DEXTROSE 5%-WATER 250ML|Blue Cross PPO Specialty|BCBSTX PPO|1.67||||||| 9505686|ERX|0258|DEXTROSE 5%-WATER 250ML|Aenta Medicare Advantage|AETNA MEDICARE MA|1.67||||||| 9505686|ERX|0258|DEXTROSE 5%-WATER 250ML|Medicare|MEDICARE ACUTE|1.67||||||| 9505686|ERX|0258|DEXTROSE 5%-WATER 250ML|Humana Medicare Advantage|HUMANA MA|1.67||||||| 9505694|ERX|0258|DEXTROSE 5%-WATER 500ML|Medicare|MEDICARE ACUTE|171.75||||||| 9505694|ERX|0258|DEXTROSE 5%-WATER 500ML|Blue Cross PPO Specialty|BCBSTX PPO|171.75||||||| 9505694|ERX|0258|DEXTROSE 5%-WATER 500ML|Humana Medicare Advantage|HUMANA MA|171.75||||||| 9505702|ERX|0258|DEXTROSE 5%-WATER 1000ML|Aetna|AETNA OTHER|1.61||||||| 9505702|ERX|0258|DEXTROSE 5%-WATER 1000ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.61||||||| 9505702|ERX|0258|DEXTROSE 5%-WATER 1000ML|Blue Cross PPO Specialty|BCBSTX PPO|1.61||||||| 9505702|ERX|0258|DEXTROSE 5%-WATER 1000ML|Medicare|MEDICARE ACUTE|1.61||||||| 9505702|ERX|0258|DEXTROSE 5%-WATER 1000ML|Humana Medicare Advantage|HUMANA MA|1.61||||||| 9505710|ERX|0258|DEXTROSE 5%-WATER 150ML 1|United Medicare Advantage|UHC MEDICARE GOLD MA|1.11||||||| 9505710|ERX|0258|DEXTROSE 5%-WATER 150ML 1|Aenta Medicare Advantage|AETNA MEDICARE MA|1.11||||||| 9505710|ERX|0258|DEXTROSE 5%-WATER 150ML 1|Medicare|MEDICARE ACUTE|1.11||||||| 9505710|ERX|0258|DEXTROSE 5%-WATER 150ML 1|Humana Medicare Advantage|HUMANA MA|1.11||||||| 9505728|ERX|0258|DEXTROSE 5%-WATER 50ML|Medicare|MEDICARE ACUTE|203.50||||||| 9505728|ERX|0258|DEXTROSE 5%-WATER 50ML|Humana Medicare Advantage|HUMANA MA|203.50||||||| 9505728|ERX|0258|DEXTROSE 5%-WATER 50ML|Cigna|CIGNA OTHER|203.50||||||| 9505728|ERX|0258|DEXTROSE 5%-WATER 50ML|Aenta Medicare Advantage|AETNA MEDICARE MA|203.50||||||| 9505728|ERX|0258|DEXTROSE 5%-WATER 50ML|United Medicare Advantage|UHC MEDICARE GOLD MA|203.50||||||| 9505736|ERX|0258|DEXTROSE 5%-WATER 100ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|122.25||||||| 9505736|ERX|0258|DEXTROSE 5%-WATER 100ML|Aenta Medicare Advantage|AETNA MEDICARE MA|122.25||||||| 9505736|ERX|0258|DEXTROSE 5%-WATER 100ML|Medicare|MEDICARE ACUTE|122.25||||||| 9505736|ERX|0258|DEXTROSE 5%-WATER 100ML|Humana Medicare Advantage|HUMANA MA|122.25||||||| 9505769|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|Workers Compensation|WORKERS COMPENSATION OTHER|179.75||||||| 9505769|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|United Medicare Advantage|UHC MEDICARE GOLD MA|179.75||||||| 9505769|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|Medicare|MEDICARE ACUTE|179.75||||||| 9505769|ERX|0258|DEXTROSE 5%-1/2 NS 1000ML|Humana Medicare Advantage|HUMANA MA|179.75||||||| 9505793|ERX|0258|DEXTROSE 10%-WATER 1000ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|206.50||||||| 9505793|ERX|0258|DEXTROSE 10%-WATER 1000ML|Medicare|MEDICARE ACUTE|206.50||||||| 9505793|ERX|0258|DEXTROSE 10%-WATER 1000ML|Humana Medicare Advantage|HUMANA MA|206.50||||||| 9505819|ERX|0250|ROPINIROLE 0.25MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|28.50||||||| 9505819|ERX|0250|ROPINIROLE 0.25MG TABLET|Humana Medicare Advantage|HUMANA MA|28.50||||||| 9505819|ERX|0250|ROPINIROLE 0.25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|28.50||||||| 9505819|ERX|0250|ROPINIROLE 0.25MG TABLET|Medicare|MEDICARE ACUTE|28.50||||||| 9505827|ERX|0258|DEXTROSE 5%-NS 1000ML|Aenta Medicare Advantage|AETNA MEDICARE MA|1.96||||||| 9505827|ERX|0258|DEXTROSE 5%-NS 1000ML|Medicare|MEDICARE ACUTE|1.96||||||| 9505827|ERX|0258|DEXTROSE 5%-NS 1000ML|Humana Medicare Advantage|HUMANA MA|1.96||||||| 9505843|ERX|0258|LACTATED RINGERS 1000ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|180.25||||||| 9505843|ERX|0258|LACTATED RINGERS 1000ML|Medicare|MEDICARE ACUTE|180.25||||||| 9505843|ERX|0258|LACTATED RINGERS 1000ML|Blue Cross PPO Specialty|BCBSTX PPO|180.25||||||| 9505843|ERX|0258|LACTATED RINGERS 1000ML|Aenta Medicare Advantage|AETNA MEDICARE MA|180.25||||||| 9505843|ERX|0258|LACTATED RINGERS 1000ML|Access Direct Platinum|HEALTHFIRST TPA|180.25||||||| 9505843|ERX|0258|LACTATED RINGERS 1000ML|Humana Medicare Advantage|HUMANA MA|180.25||||||| 9505868|ERX|0258|NA CHLORIDE 0.9%,3000ML I|United Medicare Advantage|UHC MEDICARE GOLD MA|166.75||||||| 9505868|ERX|0258|NA CHLORIDE 0.9%,3000ML I|Blue Cross PPO Specialty|BCBSTX PPO|166.75||||||| 9505868|ERX|0258|NA CHLORIDE 0.9%,3000ML I|Medicare|MEDICARE ACUTE|166.75||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Blue Cross HMO Specialty|BCBSTX HMO|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Managed Medicare|HEALTHSPRING MA|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Medicare|MEDICARE ACUTE|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Medicaid|MEDICAID|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Blue Cross PPO Specialty|BCBSTX PPO|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Aenta Medicare Advantage|AETNA MEDICARE MA|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Medicare|MEDICARE PART B ONLY IP|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Humana Medicare Advantage|HUMANA MA|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|United Medicare Advantage|UHC MEDICARE GOLD MA|142.25||||||| 9505884|ERX|0258|SODIUM CHLORIDE 0.9% 250M|Texas Workforce Commission|DIS DETER SERV (DDS)|142.25||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|United Healthcare|UNITED HEALTHCARE OTHER|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Workers Compensation|WORKERS COMPENSATION OTHER|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|United Medicare Advantage|UHC AARP WELLMED HMO MA|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Blue Cross HMO Specialty|BCBSTX HMO|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Aetna|AETNA OTHER|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|United Medicare Advantage|UHC MEDICARE GOLD MA|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Managed Medicare|HEALTHSPRING MA|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Managed Medicare|BCBS MEDICARE PPO MA|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Blue Cross PPO Specialty|BCBSTX PPO|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Aenta Medicare Advantage|AETNA MEDICARE MA|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Cigna|CIGNA OTHER|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Medicaid|MEDICAID|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Medicare|MEDICARE ACUTE|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Access Direct Platinum|HEALTHFIRST TPA|154.75||||||| 9505892|ERX|0258|SODIUM CHLORIDE 0.9% 500M|Humana Medicare Advantage|HUMANA MA|154.75||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Blue Cross HMO Specialty|BCBSTX HMO|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Aetna|AETNA OTHER|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Cigna|CIGNA OTHER|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Managed Medicare|BCBS MEDICARE PPO MA|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Medicaid|MEDICAID|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Blue Cross PPO Specialty|BCBSTX PPO|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Aenta Medicare Advantage|AETNA MEDICARE MA|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Medicare|MEDICARE ACUTE|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Medicare|MEDICARE PART B ONLY IP|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Humana Medicare Advantage|HUMANA MA|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Access Direct Platinum|HEALTHFIRST TPA|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Workers Compensation|WORKERS COMPENSATION OTHER|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|Texas Workforce Commission|DIS DETER SERV (DDS)|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|United Healthcare|UNITED HEALTHCARE OTHER|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|United Medicare Advantage|UHC MEDICARE GOLD MA|1.78||||||| 9505900|ERX|0258|SODIUM CHLORIDE 0.9% 1000|United Medicare Advantage|UHC AARP WELLMED HMO MA|1.78||||||| 9505918|ERX|0258|SODIUM CHLORIDE 0.9% 150M|Medicare|MEDICARE ACUTE|117.50||||||| 9505926|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Blue Cross HMO Specialty|BCBSTX HMO|123.50||||||| 9505926|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|123.50||||||| 9505926|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Managed Medicare|BCBS MEDICARE PPO MA|123.50||||||| 9505926|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Medicaid|MEDICAID|123.50||||||| 9505926|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Medicare|MEDICARE ACUTE|123.50||||||| 9505926|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Aenta Medicare Advantage|AETNA MEDICARE MA|123.50||||||| 9505926|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Medicare|MEDICARE PART B ONLY IP|123.50||||||| 9505926|ERX|0258|SODIUM CHLORIDE 0.9% 50ML|Humana Medicare Advantage|HUMANA MA|123.50||||||| 9505934|ERX|0250|ROPINIROLE 1MG TABLET|Medicare|MEDICARE ACUTE|28.50||||||| 9505942|ERX|0258|SODIUM CHLORIDE 0.9% 100M|United Medicare Advantage|UHC MEDICARE GOLD MA|121.50||||||| 9505942|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Blue Cross HMO Specialty|BCBSTX HMO|121.50||||||| 9505942|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Managed Medicare|BCBS MEDICARE PPO MA|121.50||||||| 9505942|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Medicare|MEDICARE ACUTE|121.50||||||| 9505942|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Blue Cross PPO Specialty|BCBSTX PPO|121.50||||||| 9505942|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Aenta Medicare Advantage|AETNA MEDICARE MA|121.50||||||| 9505942|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Medicaid|MEDICAID|121.50||||||| 9505942|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Humana Medicare Advantage|HUMANA MA|121.50||||||| 9505942|ERX|0258|SODIUM CHLORIDE 0.9% 100M|Access Direct Platinum|HEALTHFIRST TPA|121.50||||||| 9505959|ERX|0258|SODIUM CHLORIDE 0.45% 100|Aenta Medicare Advantage|AETNA MEDICARE MA|2.18||||||| 9505959|ERX|0258|SODIUM CHLORIDE 0.45% 100|Medicare|MEDICARE ACUTE|2.18||||||| 9505959|ERX|0258|SODIUM CHLORIDE 0.45% 100|Humana Medicare Advantage|HUMANA MA|2.18||||||| 9505959|ERX|0258|SODIUM CHLORIDE 0.45% 100|Workers Compensation|WORKERS COMPENSATION OTHER|2.18||||||| 9505991|ERX|0250|K ACETATE 2 MEQ/ML,20ML|Medicare|MEDICARE ACUTE|0.13||||||| 9505991|ERX|0250|K ACETATE 2 MEQ/ML,20ML|Cigna|CIGNA OTHER|0.13||||||| 9506015|ERX|0250|PHYTONADIONE 10MG/1ML|Medicare|MEDICARE ACUTE|123.50||||||| 9506049|ERX|0258|FAT EMULSION 20% 250ML|Tricare|TRICARE FOR LIFE|95.54||||||| 9506049|ERX|0258|FAT EMULSION 20% 250ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|95.54||||||| 9506049|ERX|0258|FAT EMULSION 20% 250ML|Cigna|CIGNA OTHER|95.54||||||| 9506049|ERX|0258|FAT EMULSION 20% 250ML|Medicare|MEDICARE ACUTE|95.54||||||| 9506049|ERX|0258|FAT EMULSION 20% 250ML|Humana Medicare Advantage|HUMANA MA|95.54||||||| 9506049|ERX|0258|FAT EMULSION 20% 250ML|Access Direct Platinum|HEALTHFIRST TPA|95.54||||||| 9506064|ERX|0250|ESTRADIOL 1MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|22.25||||||| 9506072|ERX|0250|PHENAZOPYRIDINE 100MG TAB|Medicare|MEDICARE ACUTE|15.50||||||| 9506072|ERX|0250|PHENAZOPYRIDINE 100MG TAB|Blue Cross HMO Specialty|BCBSTX HMO|15.50||||||| 9506114|ERX|0250|NA HYPOCHLOR 0.25% SOLN,4|Blue Cross PPO Specialty|BCBSTX PPO|90.25||||||| 9506114|ERX|0250|NA HYPOCHLOR 0.25% SOLN,4|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|90.25||||||| 9506114|ERX|0250|NA HYPOCHLOR 0.25% SOLN,4|Medicare|MEDICARE ACUTE|90.25||||||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Medicare|MEDICARE ACUTE|0.46||||||| 9506148|ERX|0250|VENLAFAXINE XL 75MG CAPSU|Humana Medicare Advantage|HUMANA MA|0.46||||||| 9506189|ERX|0250|THYROID 30MG TABLET|Medicare|MEDICARE ACUTE|5.25||||||| 9506197|ERX|0250|THYROID 60MG TABLET|Medicare|MEDICARE ACUTE|5.25||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|16.75||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|16.75||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|16.75||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Medicare|MEDICARE ACUTE|16.75||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Humana Medicare Advantage|HUMANA MA|16.75||||||| 9506239|ERX|0250|BENZONATATE 100MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|16.75||||||| 9506254|ERX|0250|LEVOTHYROXINE 88MCG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.25||||||| 9506254|ERX|0250|LEVOTHYROXINE 88MCG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.25||||||| 9506254|ERX|0250|LEVOTHYROXINE 88MCG TABLE|Aetna|AETNA OTHER|5.25||||||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|United Medicare Advantage|UHC AARP WELLMED HMO MA|33.50||||||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|33.50||||||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Medicare|MEDICARE ACUTE|33.50||||||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Medicare|MEDICARE PART B ONLY IP|33.50||||||| 9506320|ERX|0250|ESCITALOPRAM 10MG TABLET|Humana Medicare Advantage|HUMANA MA|33.50||||||| 9506346|ERX|0250|MEMANTINE HCL 5MG TABLET|Medicare|MEDICARE ACUTE|29.75||||||| 9506361|ERX|0250|OLANZAPINE 5MG ODT TABLET|Medicare|MEDICARE ACUTE|101.50||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|United Medicare Advantage|UHC AARP WELLMED HMO MA|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Tricare|TRICARE FOR LIFE|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Texas Workforce Commission|DIS DETER SERV (DDS)|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Managed Medicare|HEALTHSPRING MA|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Cigna|CIGNA OTHER|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Medicare|MEDICARE ACUTE|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Humana Medicare Advantage|HUMANA MA|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Aetna|AETNA OTHER|46.75||||||| 9506379|ERX|0250|PANTOPRAZOLE 40MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|46.75||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|169.50||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|169.50||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Managed Medicare|BCBS MEDICARE PPO MA|169.50||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Medicaid|MEDICAID|169.50||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|169.50||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Medicare|MEDICARE ACUTE|169.50||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Cigna|CIGNA OTHER|169.50||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Humana Medicare Advantage|HUMANA MA|169.50||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Access Direct Platinum|HEALTHFIRST TPA|169.50||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Blue Cross HMO Specialty|BCBSTX HMO|169.50||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Aetna|AETNA OTHER|169.50||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Workers Compensation|WORKERS COMPENSATION OTHER|169.50||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|169.50||||||| 9506452|ERX|0250|PANTOPRAZOLE 40MG VIAL|Texas Workforce Commission|DIS DETER SERV (DDS)|169.50||||||| 9506494|ERX|0636|MICAFUNGIN 50MG VIAL|Humana Medicare Advantage|HUMANA MA|960.25||||||| 9506494|ERX|0636|MICAFUNGIN 50MG VIAL|Medicare|MEDICARE ACUTE|960.25||||||| 9506577|ERX|0250|NYSTATIN 100000 UNIT, 1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|174.25||||||| 9506577|ERX|0250|NYSTATIN 100000 UNIT, 1ML|United Medicare Advantage|UHC AARP WELLMED HMO MA|174.25||||||| 9506577|ERX|0250|NYSTATIN 100000 UNIT, 1ML|Workers Compensation|WORKERS COMPENSATION OTHER|174.25||||||| 9506577|ERX|0250|NYSTATIN 100000 UNIT, 1ML|Texas Workforce Commission|DIS DETER SERV (DDS)|174.25||||||| 9506577|ERX|0250|NYSTATIN 100000 UNIT, 1ML|Managed Medicare|BCBS MEDICARE PPO MA|174.25||||||| 9506577|ERX|0250|NYSTATIN 100000 UNIT, 1ML|Blue Cross PPO Specialty|BCBSTX PPO|174.25||||||| 9506577|ERX|0250|NYSTATIN 100000 UNIT, 1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|174.25||||||| 9506577|ERX|0250|NYSTATIN 100000 UNIT, 1ML|Medicare|MEDICARE ACUTE|174.25||||||| 9506577|ERX|0250|NYSTATIN 100000 UNIT, 1ML|Humana Medicare Advantage|HUMANA MA|174.25||||||| 9506577|ERX|0250|NYSTATIN 100000 UNIT, 1ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|174.25||||||| 9506577|ERX|0250|NYSTATIN 100000 UNIT, 1ML|Blue Cross HMO Specialty|BCBSTX HMO|174.25||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.31||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.31||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.31||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Blue Cross PPO Specialty|BCBSTX PPO|0.31||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Medicaid|MEDICAID|0.31||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.31||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Medicare|MEDICARE ACUTE|0.31||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Humana Medicare Advantage|HUMANA MA|0.31||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Blue Cross HMO Specialty|BCBSTX HMO|0.31||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|Aetna|AETNA OTHER|0.31||||||| 9506635|ERX|0250|LACTULOSE 10 G/15ML, 30ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.31||||||| 9506650|ERX|0250|PHENYTOIN 100MG/4ML|Workers Compensation|WORKERS COMPENSATION OTHER|0.25||||||| 9506650|ERX|0250|PHENYTOIN 100MG/4ML|Medicare|MEDICARE ACUTE|0.25||||||| 9506650|ERX|0250|PHENYTOIN 100MG/4ML|Blue Cross PPO Specialty|BCBSTX PPO|0.25||||||| 9506650|ERX|0250|PHENYTOIN 100MG/4ML|Medicaid|MEDICAID|0.25||||||| 9506668|ERX|0250|K PHOS,MONOBASIC 500MG TA|Humana Medicare Advantage|HUMANA MA|2.75||||||| 9506684|ERX|0250|RACEPINEPHRINE 2.25% NEB|Humana Medicare Advantage|HUMANA MA|25.50||||||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Workers Compensation|WORKERS COMPENSATION OTHER|16.75||||||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Aenta Medicare Advantage|AETNA MEDICARE MA|16.75||||||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Medicaid|MEDICAID|16.75||||||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|16.75||||||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Medicare|MEDICARE ACUTE|16.75||||||| 9506692|ERX|0250|IPRATROPIUM 0.02% INH 2.5|Humana Medicare Advantage|HUMANA MA|16.75||||||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|Cigna|CIGNA OTHER|15.50||||||| 9506775|ERX|0250|CYANOCOBALAMIN 1000MCG/ML|Medicare|MEDICARE ACUTE|15.50||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|0.48||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|0.48||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.48||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Medicare|MEDICARE ACUTE|0.48||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Medicare|MEDICARE PART B ONLY IP|0.48||||||| 9506809|ERX|0250|AMIODARONE 200MG TABLET|Humana Medicare Advantage|HUMANA MA|0.48||||||| 9506841|ERX|0250|VASOPRESSIN 20 UNIT/1ML|Managed Medicare|BCBS MEDICARE PPO MA|4.86||||||| 9506841|ERX|0250|VASOPRESSIN 20 UNIT/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|4.86||||||| 9506841|ERX|0250|VASOPRESSIN 20 UNIT/1ML|Medicare|MEDICARE ACUTE|4.86||||||| 9506841|ERX|0250|VASOPRESSIN 20 UNIT/1ML|Humana Medicare Advantage|HUMANA MA|4.86||||||| 9506866|ERX|0250|SODIUM ACETATE 2 MEQ/ML,|Medicare|MEDICARE ACUTE|0.29||||||| 9506866|ERX|0250|SODIUM ACETATE 2 MEQ/ML,|Cigna|CIGNA OTHER|0.29||||||| 9506866|ERX|0250|SODIUM ACETATE 2 MEQ/ML,|Access Direct Platinum|HEALTHFIRST TPA|0.29||||||| 9506908|ERX|0250|NA CHLORIDE 23.4% 4MEQ/ML|Tricare|TRICARE FOR LIFE|17.50||||||| 9506908|ERX|0250|NA CHLORIDE 23.4% 4MEQ/ML|Medicare|MEDICARE ACUTE|17.50||||||| 9506908|ERX|0250|NA CHLORIDE 23.4% 4MEQ/ML|Cigna|CIGNA OTHER|17.50||||||| 9506908|ERX|0250|NA CHLORIDE 23.4% 4MEQ/ML|Humana Medicare Advantage|HUMANA MA|17.50||||||| 9506908|ERX|0250|NA CHLORIDE 23.4% 4MEQ/ML|Access Direct Platinum|HEALTHFIRST TPA|17.50||||||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|13.50||||||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Medicare|MEDICARE ACUTE|13.50||||||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Blue Cross PPO Specialty|BCBSTX PPO|13.50||||||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|13.50||||||| 9506940|ERX|0250|DEXAMETHASONE 4MG/ML|Humana Medicare Advantage|HUMANA MA|13.50||||||| 9506957|ERX|0250|NA THIOSULFATE 25% 12.5G/|Medicare|MEDICARE ACUTE|231.50||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|United Medicare Advantage|UHC AARP WELLMED HMO MA|0.74||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Workers Compensation|WORKERS COMPENSATION OTHER|0.74||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Managed Medicare|HEALTHSPRING MA|0.74||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Aenta Medicare Advantage|AETNA MEDICARE MA|0.74||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Blue Cross PPO Specialty|BCBSTX PPO|0.74||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Medicaid|MEDICAID|0.74||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.74||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Medicare|MEDICARE ACUTE|0.74||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Humana Medicare Advantage|HUMANA MA|0.74||||||| 9506999|ERX|0250|ACETYLCYSTEINE 20%, 4ML V|Blue Cross HMO Specialty|BCBSTX HMO|0.74||||||| 9507005|ERX|0250|TRACE ELEMENTS 10ML|Medicare|MEDICARE ACUTE|0.63||||||| 9507005|ERX|0250|TRACE ELEMENTS 10ML|Humana Medicare Advantage|HUMANA MA|0.63||||||| 9507005|ERX|0250|TRACE ELEMENTS 10ML|Access Direct Platinum|HEALTHFIRST TPA|0.63||||||| 9507005|ERX|0250|TRACE ELEMENTS 10ML|Tricare|TRICARE FOR LIFE|0.63||||||| 9507039|ERX|0250|PRIMIDONE 50MG TABLET|Medicare|MEDICARE ACUTE|8.75||||||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|Medicare|MEDICARE ACUTE|0.30||||||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|Humana Medicare Advantage|HUMANA MA|0.30||||||| 9507088|ERX|0250|PHENOL-SOD PHENOLATE, 180|Blue Cross HMO Specialty|BCBSTX HMO|0.30||||||| 9507146|ERX|0250|DIPHENHYDRAMINE CREAM, 30|United Medicare Advantage|UHC AARP WELLMED HMO MA|40.75||||||| 9507146|ERX|0250|DIPHENHYDRAMINE CREAM, 30|United Healthcare|UNITED HEALTHCARE OTHER|40.75||||||| 9507146|ERX|0250|DIPHENHYDRAMINE CREAM, 30|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|40.75||||||| 9507146|ERX|0250|DIPHENHYDRAMINE CREAM, 30|Blue Cross PPO Specialty|BCBSTX PPO|40.75||||||| 9507146|ERX|0250|DIPHENHYDRAMINE CREAM, 30|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|40.75||||||| 9507146|ERX|0250|DIPHENHYDRAMINE CREAM, 30|Medicare|MEDICARE ACUTE|40.75||||||| 9507187|ERX|0250|MORPHINE PCA 1MG/ML 30MG/|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|169.50||||||| 9507187|ERX|0250|MORPHINE PCA 1MG/ML 30MG/|Medicare|MEDICARE ACUTE|169.50||||||| 9507203|ERX|0250|LIDOCAINE 2% URO-JET 20ML|Medicare|MEDICARE ACUTE|114.25||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|17.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|17.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|17.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|17.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Medicare|MEDICARE ACUTE|17.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Humana Medicare Advantage|HUMANA MA|17.50||||||| 9507294|ERX|0250|ALPRAZOLAM 0.25MG TABLET|Aetna|AETNA OTHER|17.50||||||| 9507328|ERX|0250|PHENYLEPH-SHK LV-MO-PET,W|Medicare|MEDICARE ACUTE|0.68||||||| 9507328|ERX|0250|PHENYLEPH-SHK LV-MO-PET,W|Humana Medicare Advantage|HUMANA MA|0.68||||||| 9507385|ERX|0250|HYDROCORTISONE 10MG TABLE|Medicare|MEDICARE ACUTE|9.25||||||| 9507427|ERX|0250|ASPIRIN 300MG SUPP|Medicare|MEDICARE ACUTE|0.12||||||| 9507435|ERX|0250|ASPIRIN 600MG SUPP|Medicare|MEDICARE ACUTE|0.12||||||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.07||||||| 9507575|ERX|0250|METHOCARBAMOL 500MG TABLE|Medicare|MEDICARE ACUTE|0.07||||||| 9507609|ERX|0250|MINOXIDIL 2.5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|9.25||||||| 9507609|ERX|0250|MINOXIDIL 2.5MG TABLET|Medicare|MEDICARE ACUTE|9.25||||||| 9507641|ERX|0250|IPRATROP-ALBUTEROL INH, 4|Humana Medicare Advantage|HUMANA MA|1,450.75||||||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|United Medicare Advantage|UHC AARP WELLMED HMO MA|0.42||||||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|Medicare|MEDICARE ACUTE|0.42||||||| 9507666|ERX|0250|MELOXICAM 7.5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.42||||||| 9507674|ERX|0250|CLONIDINE 0.1MG PATCH|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|226.25||||||| 9507674|ERX|0250|CLONIDINE 0.1MG PATCH|Blue Cross PPO Specialty|BCBSTX PPO|226.25||||||| 9507674|ERX|0250|CLONIDINE 0.1MG PATCH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|226.25||||||| 9507674|ERX|0250|CLONIDINE 0.1MG PATCH|Medicare|MEDICARE ACUTE|226.25||||||| 9507682|ERX|0250|CLONIDINE 0.2MG PATCH|Blue Cross PPO Specialty|BCBSTX PPO|419.50||||||| 9507682|ERX|0250|CLONIDINE 0.2MG PATCH|Medicare|MEDICARE ACUTE|419.50||||||| 9507690|ERX|0250|CLONIDINE 0.3MG PATCH|Medicare|MEDICARE ACUTE|6.35||||||| 9507690|ERX|0250|CLONIDINE 0.3MG PATCH|Humana Medicare Advantage|HUMANA MA|6.35||||||| 9507690|ERX|0250|CLONIDINE 0.3MG PATCH|Aetna|AETNA OTHER|6.35||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|32.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|United Medicare Advantage|UHC AARP WELLMED HMO MA|32.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|32.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|32.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|32.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|32.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Medicare|MEDICARE ACUTE|32.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Cigna|CIGNA OTHER|32.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Medicare|MEDICARE PART B ONLY IP|32.50||||||| 9507716|ERX|0250|TAMSULOSIN 0.4MG CAPSULE|Humana Medicare Advantage|HUMANA MA|32.50||||||| 9507724|ERX|0250|METHYLPREDNISOLONE 4MG TA|Access Direct Platinum|HEALTHFIRST TPA|18.25||||||| 9507724|ERX|0250|METHYLPREDNISOLONE 4MG TA|Medicare|MEDICARE ACUTE|18.25||||||| 9507799|ERX|0250|PRAMIPEXOLE 0.25MG TABLET|Medicare|MEDICARE ACUTE|25.50||||||| 9507922|ERX|0250|COLCHICINE 0.6MG TABLET|Medicare|MEDICARE ACUTE|5.50||||||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Access Direct Platinum|HEALTHFIRST TPA|14.25||||||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Managed Medicare|HEALTHSPRING MA|14.25||||||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Blue Cross PPO Specialty|BCBSTX PPO|14.25||||||| 9507930|ERX|0250|HYDROXYZINE HCL 25MG TABL|Medicare|MEDICARE ACUTE|14.25||||||| 9508110|ERX|0250|DEXAMETHASONE 10MG/ML|Medicare|MEDICARE ACUTE|28.75||||||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.13||||||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.13||||||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.13||||||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Medicare|MEDICARE ACUTE|0.13||||||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Humana Medicare Advantage|HUMANA MA|0.13||||||| 9508128|ERX|0250|DIPHENHYDRAMINE 50MG/ML|Blue Cross HMO Specialty|BCBSTX HMO|0.13||||||| 9508136|ERX|0250|HEPARIN 1000 UNIT/1ML|Medicare|MEDICARE ACUTE|0.13||||||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.13||||||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.13||||||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Medicare|MEDICARE PART B ONLY IP|0.13||||||| 9508144|ERX|0250|HEPARIN 5000 UNIT/1ML|Medicare|MEDICARE ACUTE|0.13||||||| 9508169|ERX|0250|PHENOBARBITAL 130MG/1ML|Workers Compensation|WORKERS COMPENSATION OTHER|55.75||||||| 9508177|ERX|0250|PROCHLORPERAZINE 5MG/ML,|Humana Medicare Advantage|HUMANA MA|38.50||||||| 9508185|ERX|0250|CHLORPROMAZINE 25MG/1ML|Medicare|MEDICARE ACUTE|0.99||||||| 9508185|ERX|0250|CHLORPROMAZINE 25MG/1ML|Humana Medicare Advantage|HUMANA MA|0.99||||||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|20.50||||||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|United Medicare Advantage|UHC AARP WELLMED HMO MA|20.50||||||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Access Direct Platinum|HEALTHFIRST TPA|20.50||||||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|20.50||||||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Medicare|MEDICARE ACUTE|20.50||||||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Cigna|CIGNA OTHER|20.50||||||| 9508201|ERX|0250|PROMETHAZINE 25MG/1ML|Humana Medicare Advantage|HUMANA MA|20.50||||||| 9508219|ERX|0250|GENTAMICIN 40MG/ML, 20ML|Blue Cross PPO Specialty|BCBSTX PPO|1.29||||||| 9508219|ERX|0250|GENTAMICIN 40MG/ML, 20ML|Medicare|MEDICARE ACUTE|1.29||||||| 9508219|ERX|0250|GENTAMICIN 40MG/ML, 20ML|United Medicare Advantage|UHC MEDICARE GOLD MA|1.29||||||| 9508227|ERX|0250|HEPARIN 1000 UNIT/ML, 10M|United Medicare Advantage|UHC MEDICARE GOLD MA|15.50||||||| 9508227|ERX|0250|HEPARIN 1000 UNIT/ML, 10M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|15.50||||||| 9508227|ERX|0250|HEPARIN 1000 UNIT/ML, 10M|Medicare|MEDICARE PART B ONLY IP|15.50||||||| 9508227|ERX|0250|HEPARIN 1000 UNIT/ML, 10M|Medicare|MEDICARE ACUTE|15.50||||||| 9508227|ERX|0250|HEPARIN 1000 UNIT/ML, 10M|Humana Medicare Advantage|HUMANA MA|15.50||||||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|Aenta Medicare Advantage|AETNA MEDICARE MA|2.50||||||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|Access Direct Platinum|HEALTHFIRST TPA|2.50||||||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|2.50||||||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|Medicare|MEDICARE ACUTE|2.50||||||| 9508250|ERX|0250|SODIUM BICARBONATE 650MG|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9508359|ERX|0250|SULFA-TRIMETH 80-16MG/ML,|Medicare|MEDICARE ACUTE|66.25||||||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Medicare|MEDICARE ACUTE|0.40||||||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Humana Medicare Advantage|HUMANA MA|0.40||||||| 9508375|ERX|0250|METHYLPREDNISOLONE 40MG/1|Aetna|AETNA OTHER|0.40||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Workers Compensation|WORKERS COMPENSATION OTHER|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|United Medicare Advantage|UHC MEDICARE GOLD MA|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Managed Medicare|BCBS MEDICARE PPO MA|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Aenta Medicare Advantage|AETNA MEDICARE MA|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Blue Cross PPO Specialty|BCBSTX PPO|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Medicare|MEDICARE ACUTE|4.50||||||| 9508383|ERX|0250|BISACODYL 10MG SUPP|Humana Medicare Advantage|HUMANA MA|4.50||||||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Medicare|MEDICARE ACUTE|9.25||||||| 9508409|ERX|0250|ACETAMINOPHEN 650MG SUPP|Humana Medicare Advantage|HUMANA MA|9.25||||||| 9508425|ERX|0250|CEPHALEXIN 250MG CAPSULE|Medicare|MEDICARE ACUTE|26.25||||||| 9508433|ERX|0250|FLUOXETINE 10MG CAPSULE|Aenta Medicare Advantage|AETNA MEDICARE MA|58.25||||||| 9508433|ERX|0250|FLUOXETINE 10MG CAPSULE|Cigna|CIGNA OTHER|58.25||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|59.25||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Medicare|MEDICARE ACUTE|59.25||||||| 9508441|ERX|0250|FLUOXETINE 20MG CAPSULE|Humana Medicare Advantage|HUMANA MA|59.25||||||| 9508532|ERX|0250|HALOPERIDOL 1MG TABLET|Medicare|MEDICARE ACUTE|0.08||||||| 9508532|ERX|0250|HALOPERIDOL 1MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|0.08||||||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Medicare|MEDICARE ACUTE|62.75||||||| 9508557|ERX|0250|METHYLPREDNISOLONE 125MG/|Humana Medicare Advantage|HUMANA MA|62.75||||||| 9508565|ERX|0250|HALOPERIDOL 5MG TABLET|Medicare|MEDICARE ACUTE|0.15||||||| 9508714|ERX|0250|MENTHOL-LAN-CAL-ZN OX ,11|United Medicare Advantage|UHC MEDICARE GOLD MA|42.75||||||| 9508714|ERX|0250|MENTHOL-LAN-CAL-ZN OX ,11|Blue Cross PPO Specialty|BCBSTX PPO|42.75||||||| 9508714|ERX|0250|MENTHOL-LAN-CAL-ZN OX ,11|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|42.75||||||| 9508714|ERX|0250|MENTHOL-LAN-CAL-ZN OX ,11|Medicare|MEDICARE ACUTE|42.75||||||| 9508714|ERX|0250|MENTHOL-LAN-CAL-ZN OX ,11|Humana Medicare Advantage|HUMANA MA|42.75||||||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|Blue Cross PPO Specialty|BCBSTX PPO|156.50||||||| 9508722|ERX|0250|BACITRACIN 50000 UNIT VIA|Medicare|MEDICARE ACUTE|156.50||||||| 9508755|ERX|0250|VITAMIN E 1000 UNIT CAPSU|United Medicare Advantage|UHC AARP WELLMED HMO MA|2.75||||||| 9508755|ERX|0250|VITAMIN E 1000 UNIT CAPSU|Medicare|MEDICARE ACUTE|2.75||||||| 9508755|ERX|0250|VITAMIN E 1000 UNIT CAPSU|Humana Medicare Advantage|HUMANA MA|2.75||||||| 9508789|ERX|0250|VITAMIN A 10000 UNIT CAPS|Medicare|MEDICARE ACUTE|2.50||||||| 9508797|ERX|0250|CALAMINE LOTION, 120ML|Medicare|MEDICARE ACUTE|20.25||||||| 9508805|ERX|0250|COLESTIPOL 5 G PACKET|Medicare|MEDICARE ACUTE|26.75||||||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|United Medicare Advantage|UHC AARP WELLMED HMO MA|7.75||||||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|7.75||||||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.75||||||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Medicare|MEDICARE ACUTE|7.75||||||| 9508821|ERX|0250|BACLOFEN 10MG TABLET|Humana Medicare Advantage|HUMANA MA|7.75||||||| 9508839|ERX|0250|CYANOCOBALAMIN 250MCG TAB|Medicare|MEDICARE ACUTE|2.50||||||| 9508912|ERX|0250|SENNOSIDES 8.8MG/5ML, 60M|United Medicare Advantage|UHC MEDICARE GOLD MA|46.75||||||| 9508912|ERX|0250|SENNOSIDES 8.8MG/5ML, 60M|Managed Medicare|HEALTHSPRING MA|46.75||||||| 9508912|ERX|0250|SENNOSIDES 8.8MG/5ML, 60M|Managed Medicare|BCBS MEDICARE PPO MA|46.75||||||| 9508912|ERX|0250|SENNOSIDES 8.8MG/5ML, 60M|Blue Cross PPO Specialty|BCBSTX PPO|46.75||||||| 9508912|ERX|0250|SENNOSIDES 8.8MG/5ML, 60M|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|46.75||||||| 9508912|ERX|0250|SENNOSIDES 8.8MG/5ML, 60M|Medicare|MEDICARE ACUTE|46.75||||||| 9508912|ERX|0250|SENNOSIDES 8.8MG/5ML, 60M|Humana Medicare Advantage|HUMANA MA|46.75||||||| 9508912|ERX|0250|SENNOSIDES 8.8MG/5ML, 60M|Blue Cross HMO Specialty|BCBSTX HMO|46.75||||||| 9508938|ERX|0258|PERIT.DIALYSIS 1.5% DEX 2|Medicare|MEDICARE ACUTE|345.75||||||| 9508946|ERX|0258|PERIT.DIALYSIS 1.5% DEX 2|United Medicare Advantage|UHC MEDICARE GOLD MA|394.75||||||| 9508946|ERX|0258|PERIT.DIALYSIS 1.5% DEX 2|Medicare|MEDICARE ACUTE|394.75||||||| 9508961|ERX|0258|PERIT.DIALYSIS 2.5% DEX 2|Blue Cross PPO Specialty|BCBSTX PPO|385.75||||||| 9508961|ERX|0258|PERIT.DIALYSIS 2.5% DEX 2|Medicare|MEDICARE ACUTE|385.75||||||| 9508979|ERX|0258|PERIT.DIALYSIS 2.5% DEX 2|United Medicare Advantage|UHC MEDICARE GOLD MA|394.75||||||| 9508979|ERX|0258|PERIT.DIALYSIS 2.5% DEX 2|Medicare|MEDICARE ACUTE|394.75||||||| 9509001|ERX|0258|PERIT. DIALYSIS 4.25% 200|Medicare|MEDICARE ACUTE|389.25||||||| 9509209|ERX|0250|LUBRICANT EYE DROP, 15ML|United Medicare Advantage|UHC MEDICARE GOLD MA|97.25||||||| 9509209|ERX|0250|LUBRICANT EYE DROP, 15ML|United Medicare Advantage|UHC AARP WELLMED HMO MA|97.25||||||| 9509209|ERX|0250|LUBRICANT EYE DROP, 15ML|Texas Workforce Commission|DIS DETER SERV (DDS)|97.25||||||| 9509209|ERX|0250|LUBRICANT EYE DROP, 15ML|Blue Cross PPO Specialty|BCBSTX PPO|97.25||||||| 9509209|ERX|0250|LUBRICANT EYE DROP, 15ML|Medicare|MEDICARE ACUTE|97.25||||||| 9509209|ERX|0250|LUBRICANT EYE DROP, 15ML|Humana Medicare Advantage|HUMANA MA|97.25||||||| 9509274|ERX|0250|PROPOFOL 200MG/20ML|Blue Cross PPO Specialty|BCBSTX PPO|123.25||||||| 9509274|ERX|0250|PROPOFOL 200MG/20ML|Medicaid|MEDICAID|123.25||||||| 9509274|ERX|0250|PROPOFOL 200MG/20ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|123.25||||||| 9509274|ERX|0250|PROPOFOL 200MG/20ML|Access Direct Platinum|HEALTHFIRST TPA|123.25||||||| 9509274|ERX|0250|PROPOFOL 200MG/20ML|Medicare|MEDICARE ACUTE|123.25||||||| 9509274|ERX|0250|PROPOFOL 200MG/20ML|Blue Cross HMO Specialty|BCBSTX HMO|123.25||||||| 9509274|ERX|0250|PROPOFOL 200MG/20ML|United Medicare Advantage|UHC MEDICARE GOLD MA|123.25||||||| 9509290|ERX|0250|MIDAZOLAM 50MG/10ML|Medicare|MEDICARE ACUTE|102.25||||||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.13||||||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.13||||||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Access Direct Platinum|HEALTHFIRST TPA|0.13||||||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Medicare|MEDICARE ACUTE|0.13||||||| 9509308|ERX|0250|MIDAZOLAM 2MG/2ML|Humana Medicare Advantage|HUMANA MA|0.13||||||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Aenta Medicare Advantage|AETNA MEDICARE MA|28.50||||||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Blue Cross PPO Specialty|BCBSTX PPO|28.50||||||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Medicaid|MEDICAID|28.50||||||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|28.50||||||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Medicare|MEDICARE ACUTE|28.50||||||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|Humana Medicare Advantage|HUMANA MA|28.50||||||| 9509316|ERX|0250|MIDAZOLAM 5MG/5ML|United Medicare Advantage|UHC AARP WELLMED HMO MA|28.50||||||| 9509340|ERX|0250|MEPERIDINE 25MG/1ML|Medicare|MEDICARE ACUTE|17.50||||||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Medicare|MEDICARE ACUTE|17.50||||||| 9509357|ERX|0250|MEPERIDINE 50MG/1ML|Humana Medicare Advantage|HUMANA MA|17.50||||||| 9509399|ERX|0250|PHENYLEPHRINE 10MG/1ML|Medicare|MEDICARE ACUTE|42.50||||||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|38.50||||||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Aenta Medicare Advantage|AETNA MEDICARE MA|38.50||||||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Medicare|MEDICARE ACUTE|38.50||||||| 9509449|ERX|0250|DILTIAZEM 25MG 5ML|Humana Medicare Advantage|HUMANA MA|38.50||||||| 9509472|ERX|0250|CEFAZOLIN 1 G VIAL|Medicare|MEDICARE ACUTE|22.25||||||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|Medicare|MEDICARE ACUTE|25.50||||||| 9509548|ERX|0250|TIZANIDINE 4MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|25.50||||||| 9509571|ERX|0250|BENZOCAINE DENTAL GEL|Medicare|MEDICARE ACUTE|44.25||||||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|17.50||||||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|United Medicare Advantage|UHC AARP WELLMED HMO MA|17.50||||||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|17.50||||||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|17.50||||||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Access Direct Platinum|HEALTHFIRST TPA|17.50||||||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Medicare|MEDICARE ACUTE|17.50||||||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Medicaid|MEDICAID|17.50||||||| 9509605|ERX|0250|FENTANYL 100MCG/2ML|Humana Medicare Advantage|HUMANA MA|17.50||||||| 9509613|ERX|0250|FENTANYL 250MCG/5ML|Medicare|MEDICARE ACUTE|17.50||||||| 9509613|ERX|0250|FENTANYL 250MCG/5ML|Blue Cross PPO Specialty|BCBSTX PPO|17.50||||||| 9509712|ERX|0250|UREA 10% CREAM, 142 GM|United Medicare Advantage|UHC MEDICARE GOLD MA|106.25||||||| 9509712|ERX|0250|UREA 10% CREAM, 142 GM|United Medicare Advantage|UHC AARP WELLMED HMO MA|106.25||||||| 9509712|ERX|0250|UREA 10% CREAM, 142 GM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|106.25||||||| 9509712|ERX|0250|UREA 10% CREAM, 142 GM|Blue Cross PPO Specialty|BCBSTX PPO|106.25||||||| 9509712|ERX|0250|UREA 10% CREAM, 142 GM|Medicaid|MEDICAID|106.25||||||| 9509712|ERX|0250|UREA 10% CREAM, 142 GM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|106.25||||||| 9509712|ERX|0250|UREA 10% CREAM, 142 GM|Medicare|MEDICARE ACUTE|106.25||||||| 9509712|ERX|0250|UREA 10% CREAM, 142 GM|Cigna|CIGNA OTHER|106.25||||||| 9509712|ERX|0250|UREA 10% CREAM, 142 GM|Humana Medicare Advantage|HUMANA MA|106.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Blue Cross HMO Specialty|BCBSTX HMO|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Managed Medicaid|MEDICAID UNITED HEALTHCARE|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Managed Medicare|HEALTHSPRING MA|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Aetna|AETNA OTHER|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Blue Cross PPO Specialty|BCBSTX PPO|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Access Direct Platinum|HEALTHFIRST TPA|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Medicare|MEDICARE ACUTE|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Medicare|MEDICARE PART B ONLY IP|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Humana Medicare Advantage|HUMANA MA|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|United Medicare Advantage|UHC MEDICARE GOLD MA|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Workers Compensation|WORKERS COMPENSATION OTHER|84.25||||||| 9509720|ERX|0250|MICONAZOLE 2% POWDER, 85|Texas Workforce Commission|DIS DETER SERV (DDS)|84.25||||||| 9509779|ERX|0250|PREDNISOLONE 1% EYE DROP,|Medicare|MEDICARE ACUTE|291.25||||||| 9509837|ERX|0250|LANOLIN 50% OINT, 130G|United Healthcare|UNITED HEALTHCARE OTHER|0.46||||||| 9509837|ERX|0250|LANOLIN 50% OINT, 130G|Medicaid|MEDICAID|0.46||||||| 9509837|ERX|0250|LANOLIN 50% OINT, 130G|Medicare|MEDICARE ACUTE|0.46||||||| 9509878|ERX|0250|TESTOSTERONE CYPION 200MG|Medicare|MEDICARE ACUTE|291.50||||||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|2.50||||||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Medicare|MEDICARE ACUTE|2.50||||||| 9509894|ERX|0250|ASPIRIN 325MG TABLET|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9509993|ERX|0250|COLESTIPOL 1 G TABLET|Medicare|MEDICARE ACUTE|12.75||||||| 9509993|ERX|0250|COLESTIPOL 1 G TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|12.75||||||| 9510041|ERX|0250|SIMETHICONE 40MG/0.6ML, 3|United Medicare Advantage|UHC MEDICARE GOLD MA|110.75||||||| 9510041|ERX|0250|SIMETHICONE 40MG/0.6ML, 3|United Medicare Advantage|UHC AARP WELLMED HMO MA|110.75||||||| 9510041|ERX|0250|SIMETHICONE 40MG/0.6ML, 3|Managed Medicare|HEALTHSPRING MA|110.75||||||| 9510041|ERX|0250|SIMETHICONE 40MG/0.6ML, 3|Aenta Medicare Advantage|AETNA MEDICARE MA|110.75||||||| 9510041|ERX|0250|SIMETHICONE 40MG/0.6ML, 3|Blue Cross PPO Specialty|BCBSTX PPO|110.75||||||| 9510041|ERX|0250|SIMETHICONE 40MG/0.6ML, 3|Medicare|MEDICARE ACUTE|110.75||||||| 9510041|ERX|0250|SIMETHICONE 40MG/0.6ML, 3|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|110.75||||||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.42||||||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|Medicare|MEDICARE ACUTE|0.42||||||| 9510116|ERX|0250|OXYBUTYNIN XL 5MG TABLET|United Medicare Advantage|UHC AARP WELLMED HMO MA|0.42||||||| 9510140|ERX|0250|FLAVOXATE 100MG TABLET|Medicare|MEDICARE ACUTE|23.50||||||| 9510157|ERX|0250|NA CITRATE-CITRIC ACID 30|Medicare|MEDICARE ACUTE|20.75||||||| 9510181|ERX|0250|METHYLPREDNISOLONE 1000MG|Medicare|MEDICARE ACUTE|261.50||||||| 9510462|ERX|0250|GEMCITABINE 1000MG 26.3ML|Medicare|MEDICARE ACUTE|223.15||||||| 9510512|ERX|0250|NAPROXEN SODIUM 220MG TAB|Medicare|MEDICARE ACUTE|2.50||||||| 9510520|ERX|0250|THROMBIN (RECOMB) 5,000 U|Blue Cross PPO Specialty|BCBSTX PPO|637.75||||||| 9510579|ERX|0250|VITAMIN B COMP W-C TABLE|Medicare|MEDICARE ACUTE|2.50||||||| 9510587|ERX|0250|PSYLLIUM SEED (SUGAR FREE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|5.25||||||| 9510777|ERX|0250|CALCITRIOL 0.25MCG CAPSUL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|18.25||||||| 9510777|ERX|0250|CALCITRIOL 0.25MCG CAPSUL|Medicare|MEDICARE ACUTE|18.25||||||| 9510801|ERX|0250|CLINDAMYCIN 300MG/2ML|Humana Medicare Advantage|HUMANA MA|0.60||||||| 9510835|ERX|0250|CALCIUM ACETATE 667MG CAP|United Medicare Advantage|UHC MEDICARE GOLD MA|0.10||||||| 9510835|ERX|0250|CALCIUM ACETATE 667MG CAP|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.10||||||| 9510835|ERX|0250|CALCIUM ACETATE 667MG CAP|Blue Cross PPO Specialty|BCBSTX PPO|0.10||||||| 9510835|ERX|0250|CALCIUM ACETATE 667MG CAP|Medicare|MEDICARE ACUTE|0.10||||||| 9510835|ERX|0250|CALCIUM ACETATE 667MG CAP|Humana Medicare Advantage|HUMANA MA|0.10||||||| 9510850|ERX|0250|HYDROCORTISONE 100MG/2ML|Managed Medicare|BCBS MEDICARE PPO MA|43.25||||||| 9510850|ERX|0250|HYDROCORTISONE 100MG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|43.25||||||| 9510850|ERX|0250|HYDROCORTISONE 100MG/2ML|Medicare|MEDICARE ACUTE|43.25||||||| 9510850|ERX|0250|HYDROCORTISONE 100MG/2ML|Humana Medicare Advantage|HUMANA MA|43.25||||||| 9510850|ERX|0250|HYDROCORTISONE 100MG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|43.25||||||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|United Medicare Advantage|UHC MEDICARE GOLD MA|13.50||||||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Blue Cross HMO Specialty|BCBSTX HMO|13.50||||||| 9510918|ERX|0250|MAGNESIUM CITRATE 300ML|Medicare|MEDICARE ACUTE|13.50||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Managed Medicaid|MEDICAID UNITED HEALTHCARE|7.50||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|7.50||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Medicaid|MEDICAID|7.50||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.50||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Medicare|MEDICARE ACUTE|7.50||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|Humana Medicare Advantage|HUMANA MA|7.50||||||| 9510926|ERX|0250|ALBUTEROL 0.083% SOLN 2.5|United Healthcare|UNITED HEALTHCARE OTHER|7.50||||||| 9511015|ERX|0250|SILVER SULFADIAZINE 1% 5|Medicare|MEDICARE ACUTE|90.25||||||| 9511080|ERX|0250|HYDROXYZINE HCL 10MG TABL|Medicare|MEDICARE ACUTE|9.25||||||| 9511098|ERX|0250|ERGOCALCIFEROL 50000 UNIT|Medicare|MEDICARE ACUTE|21.75||||||| 9511213|ERX|0250|DORNASE ALFA 2.5MG 2.5ML|Medicare|MEDICARE ACUTE|582.75||||||| 9511213|ERX|0250|DORNASE ALFA 2.5MG 2.5ML|Humana Medicare Advantage|HUMANA MA|582.75||||||| 9511254|ERX|0250|AMANTADINE 50MG/5ML, 30ML|Managed Medicare|HEALTHSPRING MA|41.25||||||| 9511262|ERX|0250|SOTALOL 80MG TABLET|Medicare|MEDICARE ACUTE|0.36||||||| 9511361|ERX|0250|FENTANYL 25MCG PATCH|Tricare|TRICARE FOR LIFE|200.25||||||| 9511361|ERX|0250|FENTANYL 25MCG PATCH|Aenta Medicare Advantage|AETNA MEDICARE MA|200.25||||||| 9511361|ERX|0250|FENTANYL 25MCG PATCH|Blue Cross PPO Specialty|BCBSTX PPO|200.25||||||| 9511361|ERX|0250|FENTANYL 25MCG PATCH|Medicare|MEDICARE ACUTE|200.25||||||| 9511361|ERX|0250|FENTANYL 25MCG PATCH|Medicare|MEDICARE PART B ONLY IP|200.25||||||| 9511361|ERX|0250|FENTANYL 25MCG PATCH|Humana Medicare Advantage|HUMANA MA|200.25||||||| 9511379|ERX|0250|FENTANYL 50MCG PATCH|Aenta Medicare Advantage|AETNA MEDICARE MA|365.75||||||| 9511379|ERX|0250|FENTANYL 50MCG PATCH|Blue Cross PPO Specialty|BCBSTX PPO|365.75||||||| 9511379|ERX|0250|FENTANYL 50MCG PATCH|Medicare|MEDICARE PART B ONLY IP|365.75||||||| 9511379|ERX|0250|FENTANYL 50MCG PATCH|Medicare|MEDICARE ACUTE|365.75||||||| 9511379|ERX|0250|FENTANYL 50MCG PATCH|Humana Medicare Advantage|HUMANA MA|365.75||||||| 9511395|ERX|0250|FENTANYL 100MCG PATCH|Blue Cross PPO Specialty|BCBSTX PPO|740.50||||||| 9511395|ERX|0250|FENTANYL 100MCG PATCH|Medicare|MEDICARE ACUTE|740.50||||||| 9511395|ERX|0250|FENTANYL 100MCG PATCH|Humana Medicare Advantage|HUMANA MA|740.50||||||| 9511445|ERX|0250|RISPERIDONE 1MG TABLET|Managed Medicare|HEALTHSPRING MA|51.75||||||| 9511445|ERX|0250|RISPERIDONE 1MG TABLET|Medicare|MEDICARE ACUTE|51.75||||||| 9511445|ERX|0250|RISPERIDONE 1MG TABLET|Humana Medicare Advantage|HUMANA MA|51.75||||||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|United Medicare Advantage|UHC MEDICARE GOLD MA|181.25||||||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Aetna|AETNA OTHER|181.25||||||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Managed Medicare|BCBS MEDICARE PPO MA|181.25||||||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Blue Cross PPO Specialty|BCBSTX PPO|181.25||||||| 9511452|ERX|0250|CLINDAMYCIN 600MG/50ML D5|Medicare|MEDICARE ACUTE|181.25||||||| 9511551|ERX|0250|CLINDAMYCIN 300MG/50ML D5|Medicare|MEDICARE ACUTE|132.50||||||| 9511551|ERX|0250|CLINDAMYCIN 300MG/50ML D5|Humana Medicare Advantage|HUMANA MA|132.50||||||| 9511650|ERX|0250|LEVETIRACETAM 500MG/5ML|Medicaid|MEDICAID|385.25||||||| 9511650|ERX|0250|LEVETIRACETAM 500MG/5ML|Medicare|MEDICARE ACUTE|385.25||||||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|Medicare|MEDICARE ACUTE|2.06||||||| 9511668|ERX|0250|CLINDAMYCIN 900MG/50ML D5|PHCS|HUMANA INSURANCE|2.06||||||| 9511700|ERX|0250|LEVETIRACETAM 500MG TABLE|Medicare|MEDICARE ACUTE|38.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Workers Compensation|WORKERS COMPENSATION OTHER|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|United Healthcare|UNITED HEALTHCARE OTHER|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Aetna|AETNA OTHER|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Managed Medicare|HEALTHSPRING MA|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Medicare|MEDICARE PART B ONLY IP|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Medicare|MEDICARE ACUTE|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|9.25||||||| 9511809|ERX|0250|ACETAMINOPHEN 500MG TABLE|Humana Medicare Advantage|HUMANA MA|9.25||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Blue Cross HMO Specialty|BCBSTX HMO|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Managed Medicare|HEALTHSPRING MA|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Medicaid|MEDICAID|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Medicare|MEDICARE ACUTE|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Access Direct Platinum|HEALTHFIRST TPA|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9511825|ERX|0250|ACETAMINOPHEN 325MG TABLE|United Medicare Advantage|UHC AARP WELLMED HMO MA|2.50||||||| 9511833|ERX|0250|SALIVA SUBSTITUTE, 60ML|United Medicare Advantage|UHC AARP WELLMED HMO MA|54.50||||||| 9511833|ERX|0250|SALIVA SUBSTITUTE, 60ML|Medicare|MEDICARE ACUTE|54.50||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Managed Medicare|HEALTHSPRING MA|0.45||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.45||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Medicare|MEDICARE ACUTE|0.45||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Humana Medicare Advantage|HUMANA MA|0.45||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|0.45||||||| 9511874|ERX|0250|CEFUROXIME 250MG TABLET|United Medicare Advantage|UHC AARP WELLMED HMO MA|0.45||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Texas Workforce Commission|DIS DETER SERV (DDS)|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Medicaid|MEDICAID|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Medicare|MEDICARE PART B ONLY IP|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Medicare|MEDICARE ACUTE|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Access Direct Platinum|HEALTHFIRST TPA|2.50||||||| 9511890|ERX|0250|DOCUSATE SODIUM 100MG CAP|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.03||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.03||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.03||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Medicare|MEDICARE ACUTE|0.03||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Humana Medicare Advantage|HUMANA MA|0.03||||||| 9511932|ERX|0250|FOLIC ACID 1MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.03||||||| 9511940|ERX|0250|CARISOPRODOL 350MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.25||||||| 9511940|ERX|0250|CARISOPRODOL 350MG TABLET|Medicare|MEDICARE PART B ONLY IP|9.25||||||| 9511940|ERX|0250|CARISOPRODOL 350MG TABLET|Medicare|MEDICARE ACUTE|9.25||||||| 9511940|ERX|0250|CARISOPRODOL 350MG TABLET|Humana Medicare Advantage|HUMANA MA|9.25||||||| 9511999|ERX|0250|DIPHENOX-ATROP 2.5-0.025M|Medicare|MEDICARE ACUTE|8.50||||||| 9511999|ERX|0250|DIPHENOX-ATROP 2.5-0.025M|Medicare|MEDICARE PART B ONLY IP|8.50||||||| 9512021|ERX|0250|DOCUSATE CALCIUM 240MG CA|Medicare|MEDICARE ACUTE|2.50||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|2.75||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|United Medicare Advantage|UHC AARP WELLMED HMO MA|2.75||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Tricare|TRICARE FOR LIFE|2.75||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Aetna|AETNA OTHER|2.75||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|2.75||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Medicare|MEDICARE ACUTE|2.75||||||| 9512039|ERX|0250|FUROSEMIDE 20MG TABLET|Humana Medicare Advantage|HUMANA MA|2.75||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.03||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.03||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Medicare|MEDICARE ACUTE|0.03||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.03||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Humana Medicare Advantage|HUMANA MA|0.03||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.03||||||| 9512047|ERX|0250|FUROSEMIDE 40MG TABLET|PHCS|HUMANA INSURANCE|0.03||||||| 9512062|ERX|0250|ISONIAZID 300MG TABLET|Medicare|MEDICARE ACUTE|4.25||||||| 9512070|ERX|0250|MIRTAZAPINE 15MG TABLET|Managed Medicare|HEALTHSPRING MA|0.28||||||| 9512070|ERX|0250|MIRTAZAPINE 15MG TABLET|Medicare|MEDICARE ACUTE|0.28||||||| 9512070|ERX|0250|MIRTAZAPINE 15MG TABLET|Cigna|CIGNA OTHER|0.28||||||| 9512096|ERX|0250|MECLIZINE 12.5MG TABLET|Medicare|MEDICARE ACUTE|5.25||||||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.75||||||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Medicare|MEDICARE ACUTE|7.75||||||| 9512112|ERX|0250|SPIRONOLACTONE 25MG TABLE|Humana Medicare Advantage|HUMANA MA|7.75||||||| 9512120|ERX|0250|ACETAM-CODEINE 300-60MG T|Humana Medicare Advantage|HUMANA MA|9.25||||||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.07||||||| 9512138|ERX|0250|AMITRIPTYLINE 25MG TABLET|Medicare|MEDICARE ACUTE|0.07||||||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|Aetna|AETNA OTHER|6.25||||||| 9512146|ERX|0250|DICYCLOMINE 20MG TABLET|Medicare|MEDICARE ACUTE|6.25||||||| 9512161|ERX|0250|METRONIDAZOLE 500MG TABLE|Medicare|MEDICARE ACUTE|0.13||||||| 9512161|ERX|0250|METRONIDAZOLE 500MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||||| 9512161|ERX|0250|METRONIDAZOLE 500MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.13||||||| 9512161|ERX|0250|METRONIDAZOLE 500MG TABLE|Medicare|MEDICARE PART B ONLY IP|0.13||||||| 9512161|ERX|0250|METRONIDAZOLE 500MG TABLE|Humana Medicare Advantage|HUMANA MA|0.13||||||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.19||||||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Blue Cross PPO Specialty|BCBSTX PPO|0.19||||||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Medicare|MEDICARE ACUTE|0.19||||||| 9512179|ERX|0250|SULFAMETH-TRIMETH 800-160|Medicare|MEDICARE PART B ONLY IP|0.19||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|United Medicare Advantage|UHC MEDICARE GOLD MA|6.25||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|6.25||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Managed Medicaid|MEDICAID UNITED HEALTHCARE|6.25||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Blue Cross PPO Specialty|BCBSTX PPO|6.25||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|6.25||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Medicare|MEDICARE ACUTE|6.25||||||| 9512245|ERX|0250|ACETAM-CODEINE 300-30MG T|Humana Medicare Advantage|HUMANA MA|6.25||||||| 9512260|ERX|0250|INDOMETHACIN 25MG CAPSULE|Medicare|MEDICARE ACUTE|7.25||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.05||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.05||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.05||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Medicare|MEDICARE ACUTE|0.05||||||| 9512336|ERX|0250|ALLOPURINOL 100MG TABLET|Humana Medicare Advantage|HUMANA MA|0.05||||||| 9512351|ERX|0250|BENZTROPINE 1MG TABLET|Medicare|MEDICARE ACUTE|5.50||||||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|United Medicare Advantage|UHC AARP WELLMED HMO MA|5.25||||||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|5.25||||||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Aetna|AETNA OTHER|5.25||||||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|5.25||||||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|5.25||||||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Medicare|MEDICARE ACUTE|5.25||||||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Humana Medicare Advantage|HUMANA MA|5.25||||||| 9512393|ERX|0250|METOCLOPRAMIDE 10MG TABLE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|5.25||||||| 9512427|ERX|0250|DIAZEPAM 5MG TABLET|Medicare|MEDICARE ACUTE|5.75||||||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|5.25||||||| 9512443|ERX|0250|CLONIDINE 0.1MG TABLET|Medicare|MEDICARE ACUTE|5.25||||||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.14||||||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Managed Medicare|HEALTHSPRING MA|0.14||||||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Medicare|MEDICARE ACUTE|0.14||||||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Medicare|MEDICARE PART B ONLY IP|0.14||||||| 9512518|ERX|0250|LORAZEPAM 1MG TABLET|Humana Medicare Advantage|HUMANA MA|0.14||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|11.50||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|11.50||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|11.50||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|11.50||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Managed Medicare|HEALTHSPRING MA|11.50||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|11.50||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Cigna|CIGNA OTHER|11.50||||||| 9512534|ERX|0250|LORAZEPAM 0.5MG TABLET|Medicare|MEDICARE ACUTE|11.50||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|11.50||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Aetna|AETNA OTHER|11.50||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|11.50||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|11.50||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Medicare|MEDICARE ACUTE|11.50||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|Humana Medicare Advantage|HUMANA MA|11.50||||||| 9512542|ERX|0250|TEMAZEPAM 15MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|11.50||||||| 9512567|ERX|0250|CILOSTAZOL 100MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|23.50||||||| 9512583|ERX|0250|GLIMEPIRIDE 4MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|15.75||||||| 9512583|ERX|0250|GLIMEPIRIDE 4MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|15.75||||||| 9512583|ERX|0250|GLIMEPIRIDE 4MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|15.75||||||| 9512583|ERX|0250|GLIMEPIRIDE 4MG TABLET|Medicare|MEDICARE ACUTE|15.75||||||| 9512583|ERX|0250|GLIMEPIRIDE 4MG TABLET|Humana Medicare Advantage|HUMANA MA|15.75||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|7.75||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Managed Medicare|HEALTHSPRING MA|7.75||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Medicare|MEDICARE ACUTE|7.75||||||| 9512591|ERX|0250|TRAZODONE 50MG TABLET|Humana Medicare Advantage|HUMANA MA|7.75||||||| 9512617|ERX|0250|LINEZOLID 600MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|842.50||||||| 9512617|ERX|0250|LINEZOLID 600MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|842.50||||||| 9512617|ERX|0250|LINEZOLID 600MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|842.50||||||| 9512617|ERX|0250|LINEZOLID 600MG TABLET|Medicare|MEDICARE ACUTE|842.50||||||| 9512617|ERX|0250|LINEZOLID 600MG TABLET|Humana Medicare Advantage|HUMANA MA|842.50||||||| 9512633|ERX|0250|MEGESTROL 40MG TABLET|United Medicare Advantage|UHC AARP WELLMED HMO MA|15.50||||||| 9512633|ERX|0250|MEGESTROL 40MG TABLET|Tricare|TRICARE FOR LIFE|15.50||||||| 9512633|ERX|0250|MEGESTROL 40MG TABLET|Medicare|MEDICARE ACUTE|15.50||||||| 9512641|ERX|0250|DOXEPIN 10MG CAPSULE|Medicare|MEDICARE ACUTE|5.75||||||| 9512690|ERX|0250|AMANTADINE 100MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|9.25||||||| 9512773|ERX|0250|CHLORPROMAZINE 25MG TABLE|Workers Compensation|WORKERS COMPENSATION OTHER|5.25||||||| 9512773|ERX|0250|CHLORPROMAZINE 25MG TABLE|Medicare|MEDICARE ACUTE|5.25||||||| 9512807|ERX|0250|PROCHLORPERAZINE 10MG TAB|Aetna|AETNA OTHER|14.25||||||| 9512823|ERX|0250|LINEZOLID 100MG/5ML, 150M|Humana Medicare Advantage|HUMANA MA|4,210.25||||||| 9513003|ERX|0250|AMOXICILLIN 250MG CAPSULE|Medicare|MEDICARE ACUTE|5.25||||||| 9513029|ERX|0250|CEPHALEXIN 500MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.22||||||| 9513029|ERX|0250|CEPHALEXIN 500MG CAPSULE|Medicare|MEDICARE ACUTE|0.22||||||| 9513052|ERX|0250|PRAZOSIN 1MG CAPSULE|Medicare|MEDICARE ACUTE|5.50||||||| 9513052|ERX|0250|PRAZOSIN 1MG CAPSULE|Humana Medicare Advantage|HUMANA MA|5.50||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Blue Cross HMO Specialty|BCBSTX HMO|0.15||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.15||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Blue Cross PPO Specialty|BCBSTX PPO|0.15||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.15||||||| 9513060|ERX|0250|CYCLOBENZAPRINE 10MG TABL|Medicare|MEDICARE ACUTE|0.15||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|11.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|11.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|11.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|11.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Managed Medicare|HEALTHSPRING MA|11.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|11.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Medicare|MEDICARE ACUTE|11.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|11.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Medicare|MEDICARE PART B ONLY IP|11.50||||||| 9513169|ERX|0250|LOPERAMIDE 2MG CAPSULE|Humana Medicare Advantage|HUMANA MA|11.50||||||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Aetna|AETNA OTHER|47.25||||||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|47.25||||||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Medicare|MEDICARE ACUTE|47.25||||||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Medicare|MEDICARE PART B ONLY IP|47.25||||||| 9513177|ERX|0250|ZOLPIDEM 10MG TABLET|Humana Medicare Advantage|HUMANA MA|47.25||||||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Managed Medicare|HEALTHSPRING MA|2.50||||||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Cigna|CIGNA OTHER|2.50||||||| 9513185|ERX|0250|IBUPROFEN 200MG TABLET|Medicare|MEDICARE ACUTE|2.50||||||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.08||||||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Medicare|MEDICARE PART B ONLY IP|0.08||||||| 9513193|ERX|0250|DILTIAZEM 30MG TABLET|Medicare|MEDICARE ACUTE|0.08||||||| 9513201|ERX|0250|DILTIAZEM 60MG TABLET|Medicare|MEDICARE ACUTE|11.50||||||| 9513201|ERX|0250|DILTIAZEM 60MG TABLET|Humana Medicare Advantage|HUMANA MA|11.50||||||| 9513250|ERX|0250|ATENOLOL 25MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|12.50||||||| 9513250|ERX|0250|ATENOLOL 25MG TABLET|Managed Medicare|HEALTHSPRING MA|12.50||||||| 9513250|ERX|0250|ATENOLOL 25MG TABLET|Medicare|MEDICARE ACUTE|12.50||||||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|United Medicare Advantage|UHC AARP WELLMED HMO MA|12.25||||||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|12.25||||||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Medicare|MEDICARE ACUTE|12.25||||||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Humana Medicare Advantage|HUMANA MA|12.25||||||| 9513276|ERX|0250|ALPRAZOLAM 0.5MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|12.25||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Blue Cross HMO Specialty|BCBSTX HMO|9.25||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Aetna|AETNA OTHER|9.25||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Managed Medicare|HEALTHSPRING MA|9.25||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Aenta Medicare Advantage|AETNA MEDICARE MA|9.25||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Blue Cross PPO Specialty|BCBSTX PPO|9.25||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Medicare|MEDICARE PART B ONLY IP|9.25||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Medicare|MEDICARE ACUTE|9.25||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|Humana Medicare Advantage|HUMANA MA|9.25||||||| 9513300|ERX|0250|METOPROLOL TARTRATE 50MG|United Medicare Advantage|UHC MEDICARE GOLD MA|9.25||||||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.07||||||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.07||||||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.07||||||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|Medicare|MEDICARE ACUTE|0.07||||||| 9513367|ERX|0250|GLIPIZIDE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|0.07||||||| 9513433|ERX|0250|SUCRALFATE 1 G TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|12.25||||||| 9513433|ERX|0250|SUCRALFATE 1 G TABLET|Tricare|TRICARE FOR LIFE|12.25||||||| 9513433|ERX|0250|SUCRALFATE 1 G TABLET|Medicare|MEDICARE ACUTE|12.25||||||| 9513433|ERX|0250|SUCRALFATE 1 G TABLET|Humana Medicare Advantage|HUMANA MA|12.25||||||| 9513458|ERX|0250|GLYBURIDE 5MG TABLET|Medicare|MEDICARE ACUTE|0.09||||||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.50||||||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|Medicare|MEDICARE ACUTE|7.50||||||| 9513474|ERX|0250|BUMETANIDE 1MG TABLET|Humana Medicare Advantage|HUMANA MA|7.50||||||| 9513508|ERX|0250|CARBIDOPA-LEVO SR 50-200M|Medicare|MEDICARE ACUTE|25.50||||||| 9513516|ERX|0250|DILTIAZEM SR 60MG CAPSULE|Medicare|MEDICARE ACUTE|12.25||||||| 9513524|ERX|0250|DILTIAZEM SR 90MG CAPSULE|Medicare|MEDICARE ACUTE|13.25||||||| 9513557|ERX|0250|LABETALOL 100MG TABLET|Medicare|MEDICARE ACUTE|8.50||||||| 9513599|ERX|0250|ENALAPRIL 5MG TABLET|Medicare|MEDICARE ACUTE|15.50||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Aetna|AETNA OTHER|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Medicaid|MEDICAID|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Medicare|MEDICARE ACUTE|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Medicare|MEDICARE PART B ONLY IP|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Humana Medicare Advantage|HUMANA MA|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|22.25||||||| 9513623|ERX|0250|FAMOTIDINE 20MG TABLET|PHCS|HUMANA INSURANCE|22.25||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Blue Cross HMO Specialty|BCBSTX HMO|2.50||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.50||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Medicaid|MEDICAID|2.50||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Medicare|MEDICARE ACUTE|2.50||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|Medicare|MEDICARE PART B ONLY IP|2.50||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|PHCS|HUMANA INSURANCE|2.50||||||| 9513631|ERX|0250|DIPHENHYDRAMINE 25MG CAPS|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.14||||||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Medicare|MEDICARE ACUTE|0.14||||||| 9513672|ERX|0250|LISINOPRIL 5MG TABLET|Humana Medicare Advantage|HUMANA MA|0.14||||||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|United Medicare Advantage|UHC AARP WELLMED HMO MA|15.50||||||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|15.50||||||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|15.50||||||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|15.50||||||| 9513680|ERX|0250|LISINOPRIL 20MG TABLET|Medicare|MEDICARE ACUTE|15.50||||||| 9513730|ERX|0250|SOLIFENACIN 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.45||||||| 9513748|ERX|0250|CHLORHEXIDINE 0.12% ORAL|Texas Workforce Commission|DIS DETER SERV (DDS)|169.50||||||| 9513748|ERX|0250|CHLORHEXIDINE 0.12% ORAL|United Medicare Advantage|UHC MEDICARE GOLD MA|169.50||||||| 9513748|ERX|0250|CHLORHEXIDINE 0.12% ORAL|PHCS|HUMANA INSURANCE|169.50||||||| 9513748|ERX|0250|CHLORHEXIDINE 0.12% ORAL|Blue Cross HMO Specialty|BCBSTX HMO|169.50||||||| 9513748|ERX|0250|CHLORHEXIDINE 0.12% ORAL|Managed Medicare|HEALTHSPRING MA|169.50||||||| 9513748|ERX|0250|CHLORHEXIDINE 0.12% ORAL|Blue Cross PPO Specialty|BCBSTX PPO|169.50||||||| 9513748|ERX|0250|CHLORHEXIDINE 0.12% ORAL|Medicare|MEDICARE ACUTE|169.50||||||| 9513748|ERX|0250|CHLORHEXIDINE 0.12% ORAL|Humana Medicare Advantage|HUMANA MA|169.50||||||| 9513789|ERX|0250|BISOPROLOL 5MG TABLET|Medicare|MEDICARE ACUTE|31.25||||||| 9513912|ERX|0250|TRANEXAMIC 100MG/ML, 10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|467.75||||||| 9513938|ERX|0250|AZTREONAM 1000MG VIAL|Medicaid|MEDICAID|3.74||||||| 9513938|ERX|0250|AZTREONAM 1000MG VIAL|Medicare|MEDICARE ACUTE|3.74||||||| 9513938|ERX|0250|AZTREONAM 1000MG VIAL|Humana Medicare Advantage|HUMANA MA|3.74||||||| 9513953|ERX|0250|CEFEPIME 1 G VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|2.32||||||| 9513953|ERX|0250|CEFEPIME 1 G VIAL|Managed Medicare|HEALTHSPRING MA|2.32||||||| 9513953|ERX|0250|CEFEPIME 1 G VIAL|Medicare|MEDICARE PART B ONLY IP|2.32||||||| 9513953|ERX|0250|CEFEPIME 1 G VIAL|Medicare|MEDICARE ACUTE|2.32||||||| 9514001|ERX|0250|NYSTATIN CREAM, 15 GM|Medicare|MEDICARE ACUTE|33.50||||||| 9514043|ERX|0250|ACETAZOLAMIDE 250MG TABLE|Aenta Medicare Advantage|AETNA MEDICARE MA|7.75||||||| 9514043|ERX|0250|ACETAZOLAMIDE 250MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|7.75||||||| 9514043|ERX|0250|ACETAZOLAMIDE 250MG TABLE|Medicare|MEDICARE ACUTE|7.75||||||| 9514043|ERX|0250|ACETAZOLAMIDE 250MG TABLE|Humana Medicare Advantage|HUMANA MA|7.75||||||| 9514050|ERX|0250|RENAL VITAMIN TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|8.50||||||| 9514050|ERX|0250|RENAL VITAMIN TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|8.50||||||| 9514050|ERX|0250|RENAL VITAMIN TABLET|Blue Cross PPO Specialty|BCBSTX PPO|8.50||||||| 9514050|ERX|0250|RENAL VITAMIN TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|8.50||||||| 9514050|ERX|0250|RENAL VITAMIN TABLET|Medicare|MEDICARE ACUTE|8.50||||||| 9514050|ERX|0250|RENAL VITAMIN TABLET|Medicare|MEDICARE PART B ONLY IP|8.50||||||| 9514050|ERX|0250|RENAL VITAMIN TABLET|Humana Medicare Advantage|HUMANA MA|8.50||||||| 9514050|ERX|0250|RENAL VITAMIN TABLET|Access Direct Platinum|HEALTHFIRST TPA|8.50||||||| 9514076|ERX|0250|PRENATAL VIT-FE FUMARATE-|Medicare|MEDICARE ACUTE|5.75||||||| 9514084|ERX|0250|PEG 3350, 4L|Blue Cross HMO Specialty|BCBSTX HMO|198.75||||||| 9514084|ERX|0250|PEG 3350, 4L|Medicare|MEDICARE ACUTE|198.75||||||| 9514100|ERX|0250|LATANOPROST EYE DROP, 2.5|United Healthcare|UNITED HEALTHCARE OTHER|772.75||||||| 9514100|ERX|0250|LATANOPROST EYE DROP, 2.5|Medicare|MEDICARE ACUTE|772.75||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Aetna|AETNA OTHER|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Managed Medicare|HEALTHSPRING MA|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Aenta Medicare Advantage|AETNA MEDICARE MA|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Blue Cross HMO Specialty|BCBSTX HMO|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Blue Cross PPO Specialty|BCBSTX PPO|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Medicaid|MEDICAID|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Medicare|MEDICARE PART B ONLY IP|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Medicare|MEDICARE ACUTE|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Humana Medicare Advantage|HUMANA MA|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Access Direct Platinum|HEALTHFIRST TPA|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Texas Workforce Commission|DIS DETER SERV (DDS)|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|PHCS|HUMANA INSURANCE|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|Workers Compensation|WORKERS COMPENSATION OTHER|25.50||||||| 9514118|ERX|0250|POLYETHYLENE GLYCOL 17 G|United Medicare Advantage|UHC MEDICARE GOLD MA|25.50||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|United Medicare Advantage|UHC MEDICARE GOLD MA|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|United Medicare Advantage|UHC AARP WELLMED HMO MA|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Tricare|TRICARE FOR LIFE|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Blue Cross HMO Specialty|BCBSTX HMO|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Aetna|AETNA OTHER|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Managed Medicare|BCBS MEDICARE PPO MA|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Blue Cross PPO Specialty|BCBSTX PPO|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Medicare|MEDICARE ACUTE|21.25||||||| 9514191|ERX|0250|HYDROCOD-ACETAM 10-325MG|Humana Medicare Advantage|HUMANA MA|21.25||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Blue Cross HMO Specialty|BCBSTX HMO|15.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Blue Cross PPO Specialty|BCBSTX PPO|15.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Medicare|MEDICARE PART B ONLY IP|15.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|Medicare|MEDICARE ACUTE|15.50||||||| 9514217|ERX|0250|HYDROCOD-ACETAM 7.5-325MG|United Medicare Advantage|UHC AARP WELLMED HMO MA|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|United Medicare Advantage|UHC MEDICARE GOLD MA|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|United Medicare Advantage|UHC AARP WELLMED HMO MA|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Blue Cross HMO Specialty|BCBSTX HMO|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Access Direct Platinum|HEALTHFIRST TPA|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Blue Cross PPO Specialty|BCBSTX PPO|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Medicare|MEDICARE ACUTE|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Medicare|MEDICARE PART B ONLY IP|15.50||||||| 9514225|ERX|0250|HYDROCOD-ACETAM 5-325MG T|Humana Medicare Advantage|HUMANA MA|15.50||||||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Medicare|MEDICARE ACUTE|0.21||||||| 9514274|ERX|0250|BUTAL-ACETAM-CAFF 50-325-|Humana Medicare Advantage|HUMANA MA|0.21||||||| 9514290|ERX|0250|HYDROCODONE-CHLORPHEN, 5M|Blue Cross PPO Specialty|BCBSTX PPO|30.75||||||| 9514290|ERX|0250|HYDROCODONE-CHLORPHEN, 5M|Medicare|MEDICARE ACUTE|30.75||||||| 9514290|ERX|0250|HYDROCODONE-CHLORPHEN, 5M|Humana Medicare Advantage|HUMANA MA|30.75||||||| 9514340|ERX|0250|METOLAZONE 2.5MG TABLET|Medicare|MEDICARE ACUTE|0.23||||||| 9514340|ERX|0250|METOLAZONE 2.5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|0.23||||||| 9514340|ERX|0250|METOLAZONE 2.5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.23||||||| 9514340|ERX|0250|METOLAZONE 2.5MG TABLET|Humana Medicare Advantage|HUMANA MA|0.23||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|2.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Medicare|MEDICARE ACUTE|2.50||||||| 9514357|ERX|0250|ASPIRIN EC 81MG TABLET|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|31.50||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|31.50||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|31.50||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|31.50||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|31.50||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Medicare|MEDICARE PART B ONLY IP|31.50||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Medicare|MEDICARE ACUTE|31.50||||||| 9514431|ERX|0250|MIDODRINE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|31.50||||||| 9514498|ERX|0250|LANTHANUM CARBONATE 500MG|Medicare|MEDICARE ACUTE|55.75||||||| 9514548|ERX|0250|OXANDROLONE 2.5MG TABLET|Medicare|MEDICARE ACUTE|76.25||||||| 9514589|ERX|0250|FISH OIL (OM3FA) 1000MG C|Medicare|MEDICARE ACUTE|2.50||||||| 9514670|ERX|0250|ENALAPRILAT 1.25MG 1ML|Medicare|MEDICARE ACUTE|46.50||||||| 9514670|ERX|0250|ENALAPRILAT 1.25MG 1ML|Humana Medicare Advantage|HUMANA MA|46.50||||||| 9514696|ERX|0250|MILRINONE 10MG/10ML|Medicare|MEDICARE ACUTE|47.19||||||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|United Medicare Advantage|UHC AARP WELLMED HMO MA|18.75||||||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|18.75||||||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|18.75||||||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|18.75||||||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Medicare|MEDICARE ACUTE|18.75||||||| 9514712|ERX|0250|FAMOTIDINE 20MG/2ML|Humana Medicare Advantage|HUMANA MA|18.75||||||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|46.50||||||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|Medicare|MEDICARE ACUTE|46.50||||||| 9514720|ERX|0250|VECURONIUM 10MG VIAL|Humana Medicare Advantage|HUMANA MA|46.50||||||| 9514761|ERX|0250|AMIODARONE 150MG/3ML|Aenta Medicare Advantage|AETNA MEDICARE MA|127.25||||||| 9514761|ERX|0250|AMIODARONE 150MG/3ML|Medicare|MEDICARE ACUTE|127.25||||||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.31||||||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|0.31||||||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.31||||||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Blue Cross PPO Specialty|BCBSTX PPO|0.31||||||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.31||||||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Medicare|MEDICARE ACUTE|0.31||||||| 9514803|ERX|0250|METOPROLOL 5MG/5ML|Humana Medicare Advantage|HUMANA MA|0.31||||||| 9514837|ERX|0250|DOXYCYCLINE 100MG VIAL|Medicare|MEDICARE ACUTE|1.67||||||| 9514944|ERX|0250|POLYMYXIN B 500000 UNIT V|Medicare|MEDICARE ACUTE|170.75||||||| 9514969|ERX|0250|OCTREOTIDE 50MCG/1ML|Managed Medicare|HEALTHSPRING MA|140.50||||||| 9514969|ERX|0250|OCTREOTIDE 50MCG/1ML|Medicare|MEDICARE ACUTE|140.50||||||| 9514977|ERX|0636|OCTREOTIDE 100MCG/1ML|Humana Medicare Advantage|HUMANA MA|247.50||||||| 9514977|ERX|0636|OCTREOTIDE 100MCG/1ML|Managed Medicare|HEALTHSPRING MA|247.50||||||| 9514977|ERX|0636|OCTREOTIDE 100MCG/1ML|Medicare|MEDICARE ACUTE|247.50||||||| 9514977|ERX|0636|OCTREOTIDE 100MCG/1ML|Access Direct Platinum|HEALTHFIRST TPA|247.50||||||| 9515016|ERX|0636|PAMIDRONATE 30MG/10ML|Medicare|MEDICARE ACUTE|513.50||||||| 9515057|ERX|0250|ACETAZOLAMIDE 500MG VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|4.62||||||| 9515057|ERX|0250|ACETAZOLAMIDE 500MG VIAL|Medicare|MEDICARE ACUTE|4.62||||||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|United Medicare Advantage|UHC MEDICARE GOLD MA|21.75||||||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Aenta Medicare Advantage|AETNA MEDICARE MA|21.75||||||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Blue Cross PPO Specialty|BCBSTX PPO|21.75||||||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|21.75||||||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Medicare|MEDICARE ACUTE|21.75||||||| 9515081|ERX|0250|BUMETANIDE 1MG/4ML|Humana Medicare Advantage|HUMANA MA|21.75||||||| 9515107|ERX|0250|BUMETANIDE 2.5MG/10ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.74||||||| 9515107|ERX|0250|BUMETANIDE 2.5MG/10ML|Medicare|MEDICARE ACUTE|0.74||||||| 9515123|ERX|0250|ACYCLOVIR 500MG VIAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|118.50||||||| 9515123|ERX|0250|ACYCLOVIR 500MG VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|118.50||||||| 9515123|ERX|0250|ACYCLOVIR 500MG VIAL|Medicare|MEDICARE ACUTE|118.50||||||| 9515123|ERX|0250|ACYCLOVIR 500MG VIAL|Humana Medicare Advantage|HUMANA MA|118.50||||||| 9515131|ERX|0250|ETOMIDATE 2MG/ML, 20ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|143.50||||||| 9515131|ERX|0250|ETOMIDATE 2MG/ML, 20ML|Medicare|MEDICARE ACUTE|143.50||||||| 9515131|ERX|0250|ETOMIDATE 2MG/ML, 20ML|Humana Medicare Advantage|HUMANA MA|143.50||||||| 9515255|ERX|0250|CINACALCET 30MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|128.75||||||| 9515255|ERX|0250|CINACALCET 30MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|128.75||||||| 9515255|ERX|0250|CINACALCET 30MG TABLET|Medicare|MEDICARE ACUTE|128.75||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Blue Cross HMO Specialty|BCBSTX HMO|16.75||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Aetna|AETNA OTHER|16.75||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Blue Cross PPO Specialty|BCBSTX PPO|16.75||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|16.75||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Medicare|MEDICARE ACUTE|16.75||||||| 9515420|ERX|0250|ISOSORBIDE MONONITRATE 30|Humana Medicare Advantage|HUMANA MA|16.75||||||| 9515438|ERX|0250|ISOSORBIDE MONONITRATE 60|Medicare|MEDICARE ACUTE|17.25||||||| 9515479|ERX|0250|NITROGLYCERIN 0.4MG TAB,#|Medicare|MEDICARE ACUTE|0.47||||||| 9515628|ERX|0250|SEVELAMER 800MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|18.75||||||| 9515628|ERX|0250|SEVELAMER 800MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|18.75||||||| 9515628|ERX|0250|SEVELAMER 800MG TABLET|Medicare|MEDICARE ACUTE|18.75||||||| 9515628|ERX|0250|SEVELAMER 800MG TABLET|Humana Medicare Advantage|HUMANA MA|18.75||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Workers Compensation|WORKERS COMPENSATION OTHER|12.75||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|United Medicare Advantage|UHC MEDICARE GOLD MA|12.75||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Blue Cross HMO Specialty|BCBSTX HMO|12.75||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|12.75||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Blue Cross PPO Specialty|BCBSTX PPO|12.75||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Medicare|MEDICARE ACUTE|12.75||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Medicare|MEDICARE PART B ONLY IP|12.75||||||| 9515644|ERX|0250|CHOLECALCIFEROL 1000 UNIT|Humana Medicare Advantage|HUMANA MA|12.75||||||| 9515701|ERX|0250|OXYCODONE SR 20MG TABLET|Medicare|MEDICARE ACUTE|0.37||||||| 9515792|ERX|0250|OLANZAPINE 10MG/2ML|Medicare|MEDICARE ACUTE|239.25||||||| 9515800|ERX|0636|CARBOPLATIN 50MG/5ML|Medicare|MEDICARE ACUTE|75.50||||||| 9515883|ERX|0636|CARBOPLATIN 150MG/15ML|Medicare|MEDICARE ACUTE|162.25||||||| 9515917|ERX|0250|GLYCOPYRROLATE 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.30||||||| 9515917|ERX|0250|GLYCOPYRROLATE 1MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|0.30||||||| 9515917|ERX|0250|GLYCOPYRROLATE 1MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.30||||||| 9515917|ERX|0250|GLYCOPYRROLATE 1MG TABLET|Medicaid|MEDICAID|0.30||||||| 9516048|ERX|0250|ZOLPIDEM 5MG TABLET|Medicare|MEDICARE ACUTE|47.75||||||| 9516063|ERX|0250|METHIMAZOLE 5MG TABLET|Medicare|MEDICARE ACUTE|12.75||||||| 9516139|ERX|0250|METAXALONE 800MG TABLET|Medicare|MEDICARE ACUTE|0.35||||||| 9516204|ERX|0250|NADOLOL 40MG TABLET|Medicare|MEDICARE ACUTE|32.25||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Workers Compensation|WORKERS COMPENSATION OTHER|26.75||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|26.75||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Aetna|AETNA OTHER|26.75||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|26.75||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Access Direct Platinum|HEALTHFIRST TPA|26.75||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Managed Medicare|HEALTHSPRING MA|26.75||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Managed Medicare|BCBS MEDICARE PPO MA|26.75||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|26.75||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Medicaid|MEDICAID|26.75||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|26.75||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|26.75||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Cigna|CIGNA OTHER|26.75||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Medicare|MEDICARE ACUTE|26.75||||||| 9516246|ERX|0250|LORAZEPAM 2MG/1ML|Humana Medicare Advantage|HUMANA MA|26.75||||||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.13||||||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Medicaid|MEDICAID|0.13||||||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|0.13||||||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Medicare|MEDICARE ACUTE|0.13||||||| 9516311|ERX|0250|GLYCOPYRROLATE 0.2MG/1ML|Humana Medicare Advantage|HUMANA MA|0.13||||||| 9516329|ERX|0250|GLYCOPYRROLATE 0.2MG/ML,|Medicare|MEDICARE ACUTE|17.50||||||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Workers Compensation|WORKERS COMPENSATION OTHER|0.29||||||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.29||||||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|United Medicare Advantage|UHC AARP WELLMED HMO MA|0.29||||||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Aetna|AETNA OTHER|0.29||||||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.29||||||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Access Direct Platinum|HEALTHFIRST TPA|0.29||||||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Aenta Medicare Advantage|AETNA MEDICARE MA|0.29||||||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Medicaid|MEDICAID|0.29||||||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|0.29||||||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.29||||||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Medicare|MEDICARE ACUTE|0.29||||||| 9516345|ERX|0250|METOCLOPRAMIDE 10MG/2ML|Humana Medicare Advantage|HUMANA MA|0.29||||||| 9516352|ERX|0250|BRIMONIDINE 0.2% EYE DROP|Medicare|MEDICARE ACUTE|2.42||||||| 9516394|ERX|0250|GENTAMICIN EYE DROP, 5ML|Workers Compensation|WORKERS COMPENSATION OTHER|102.75||||||| 9516428|ERX|0250|OPIUM-BELLAD 16.2-60MG SU|Medicare|MEDICARE ACUTE|0.37||||||| 9516600|ERX|0250|SILVER SULFADIAZINE 1% ,4|United Medicare Advantage|UHC MEDICARE GOLD MA|605.75||||||| 9516600|ERX|0250|SILVER SULFADIAZINE 1% ,4|Medicaid|MEDICAID|605.75||||||| 9516600|ERX|0250|SILVER SULFADIAZINE 1% ,4|Blue Cross PPO Specialty|BCBSTX PPO|605.75||||||| 9516600|ERX|0250|SILVER SULFADIAZINE 1% ,4|Medicare|MEDICARE ACUTE|605.75||||||| 9516600|ERX|0250|SILVER SULFADIAZINE 1% ,4|Humana Medicare Advantage|HUMANA MA|605.75||||||| 9516634|ERX|0250|FLUDROCORTISONE 0.1MG TAB|Medicare|MEDICARE PART B ONLY IP|15.50||||||| 9516634|ERX|0250|FLUDROCORTISONE 0.1MG TAB|Medicare|MEDICARE ACUTE|15.50||||||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Tricare|TRICARE FOR LIFE|97.25||||||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|97.25||||||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Access Direct Platinum|HEALTHFIRST TPA|97.25||||||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Blue Cross PPO Specialty|BCBSTX PPO|97.25||||||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Cigna|CIGNA OTHER|97.25||||||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Medicare|MEDICARE ACUTE|97.25||||||| 9516675|ERX|0250|MVI,ADULT NO.1 W/ VIT K 1|Humana Medicare Advantage|HUMANA MA|97.25||||||| 9516790|ERX|0250|DONEPEZIL 5MG TABLET|Medicare|MEDICARE ACUTE|0.68||||||| 9516790|ERX|0250|DONEPEZIL 5MG TABLET|Medicare|MEDICARE PART B ONLY IP|0.68||||||| 9516790|ERX|0250|DONEPEZIL 5MG TABLET|Humana Medicare Advantage|HUMANA MA|0.68||||||| 9516824|ERX|0250|ZONISAMIDE 100MG CAPSULE|Medicare|MEDICARE ACUTE|0.31||||||| 9517020|ERX|0250|AMOX-CLAV 400-57MG/5ML,50|Medicare|MEDICARE ACUTE|360.50||||||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|140.75||||||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Aenta Medicare Advantage|AETNA MEDICARE MA|140.75||||||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Medicare|MEDICARE ACUTE|140.75||||||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Cigna|CIGNA OTHER|140.75||||||| 9517046|ERX|0250|THIAMINE 100MG/ML, 2ML|Humana Medicare Advantage|HUMANA MA|140.75||||||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|Access Direct Platinum|HEALTHFIRST TPA|13.25||||||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|Cigna|CIGNA OTHER|13.25||||||| 9517061|ERX|0250|MAGNESIUM SULFATE 4 MEQ/M|Medicare|MEDICARE ACUTE|13.25||||||| 9517111|ERX|0250|KETOROLAC 30MG/1ML|Medicare|MEDICARE ACUTE|61.50||||||| 9517145|ERX|0250|FOLIC ACID 5MG/ML, 10ML|Medicare|MEDICARE ACUTE|228.75||||||| 9517194|ERX|0250|PROPOFOL 1000MG/100ML|Texas Workforce Commission|DIS DETER SERV (DDS)|899.75||||||| 9517194|ERX|0250|PROPOFOL 1000MG/100ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|899.75||||||| 9517194|ERX|0250|PROPOFOL 1000MG/100ML|Medicare|MEDICARE ACUTE|899.75||||||| 9517194|ERX|0250|PROPOFOL 1000MG/100ML|Humana Medicare Advantage|HUMANA MA|899.75||||||| 9517236|ERX|0250|TOBRAMYCIN 40MG/ML, 2ML|Managed Medicare|BCBS MEDICARE PPO MA|0.52||||||| 9517236|ERX|0250|TOBRAMYCIN 40MG/ML, 2ML|Medicare|MEDICARE ACUTE|0.52||||||| 9517236|ERX|0250|TOBRAMYCIN 40MG/ML, 2ML|Humana Medicare Advantage|HUMANA MA|0.52||||||| 9517236|ERX|0250|TOBRAMYCIN 40MG/ML, 2ML|Workers Compensation|WORKERS COMPENSATION OTHER|0.52||||||| 9517244|ERX|0250|CA GLUC 10% 0.465 MEQ/ML,|Managed Medicare|BCBS MEDICARE PPO MA|16.50||||||| 9517244|ERX|0250|CA GLUC 10% 0.465 MEQ/ML,|Access Direct Platinum|HEALTHFIRST TPA|16.50||||||| 9517244|ERX|0250|CA GLUC 10% 0.465 MEQ/ML,|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|16.50||||||| 9517244|ERX|0250|CA GLUC 10% 0.465 MEQ/ML,|Cigna|CIGNA OTHER|16.50||||||| 9517244|ERX|0250|CA GLUC 10% 0.465 MEQ/ML,|Medicare|MEDICARE ACUTE|16.50||||||| 9517244|ERX|0250|CA GLUC 10% 0.465 MEQ/ML,|Humana Medicare Advantage|HUMANA MA|16.50||||||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|129.25||||||| 9517293|ERX|0250|NEOSTIGMINE 1MG/1ML|Medicare|MEDICARE ACUTE|129.25||||||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|Blue Cross HMO Specialty|BCBSTX HMO|169.50||||||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|Aetna|AETNA OTHER|169.50||||||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|Managed Medicare|BCBS MEDICARE PPO MA|169.50||||||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|169.50||||||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|Medicaid|MEDICAID|169.50||||||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|169.50||||||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|Medicare|MEDICARE ACUTE|169.50||||||| 9517376|ERX|0250|HYDRALAZINE 20MG/1ML|Humana Medicare Advantage|HUMANA MA|169.50||||||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Aenta Medicare Advantage|AETNA MEDICARE MA|97.50||||||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Blue Cross PPO Specialty|BCBSTX PPO|97.50||||||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|97.50||||||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Medicare|MEDICARE ACUTE|97.50||||||| 9517467|ERX|0250|LEVALBUTEROL NEB 0.63MG/3|Humana Medicare Advantage|HUMANA MA|97.50||||||| 9517483|ERX|0250|MODAFINIL 100MG TABLET|Medicare|MEDICARE ACUTE|79.75||||||| 9517483|ERX|0250|MODAFINIL 100MG TABLET|Humana Medicare Advantage|HUMANA MA|79.75||||||| 9517574|ERX|0250|OXYCODONE-ACETAM 5-325MG|Blue Cross PPO Specialty|BCBSTX PPO|18.25||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|United Medicare Advantage|UHC MEDICARE GOLD MA|82.75||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|United Medicare Advantage|UHC AARP WELLMED HMO MA|82.75||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Blue Cross HMO Specialty|BCBSTX HMO|82.75||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Blue Cross PPO Specialty|BCBSTX PPO|82.75||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|82.75||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Medicare|MEDICARE ACUTE|82.75||||||| 9517582|ERX|0250|LIDOCAINE 5% PATCH|Humana Medicare Advantage|HUMANA MA|82.75||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.53||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.53||||||| 9517608|ERX|0250|CLOPIDOGREL 75MG TABLET|Medicare|MEDICARE ACUTE|0.53||||||| 9517657|ERX|0250|TORSEMIDE 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|16.50||||||| 9517657|ERX|0250|TORSEMIDE 20MG TABLET|Medicare|MEDICARE ACUTE|16.50||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Texas Workforce Commission|DIS DETER SERV (DDS)|7.50||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|United Medicare Advantage|UHC AARP WELLMED HMO MA|7.50||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|7.50||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Aetna|AETNA OTHER|7.50||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|7.50||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|7.50||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|7.50||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Medicare|MEDICARE ACUTE|7.50||||||| 9517665|ERX|0250|GUAIFENESIN 600MG TABLET|Humana Medicare Advantage|HUMANA MA|7.50||||||| 9517673|ERX|0250|GUAIFEN-DEXTROMETH 600-30|Medicare|MEDICARE ACUTE|8.25||||||| 9517673|ERX|0250|GUAIFEN-DEXTROMETH 600-30|Humana Medicare Advantage|HUMANA MA|8.25||||||| 9517673|ERX|0250|GUAIFEN-DEXTROMETH 600-30|United Medicare Advantage|UHC MEDICARE GOLD MA|8.25||||||| 9517756|ERX|0250|DILTIAZEM XL 120MG CAPSUL|Medicare|MEDICARE ACUTE|25.50||||||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|30.75||||||| 9517764|ERX|0250|DILTIAZEM XL 180MG CAPSUL|Medicare|MEDICARE ACUTE|30.75||||||| 9517772|ERX|0250|DILTIAZEM XL 240MG CAPSUL|Medicare|MEDICARE ACUTE|43.75||||||| 9517806|ERX|0250|LUBIPROSTONE 24MCG CAPSUL|Medicare|MEDICARE ACUTE|0.37||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Texas Workforce Commission|DIS DETER SERV (DDS)|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|United Medicare Advantage|UHC AARP WELLMED HMO MA|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Blue Cross HMO Specialty|BCBSTX HMO|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Managed Medicare|HEALTHSPRING MA|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Medicaid|MEDICAID|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Medicare|MEDICARE ACUTE|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Humana Medicare Advantage|HUMANA MA|0.03||||||| 9517830|ERX|0250|LACTOBACILLUS TABLET|Medicare|MEDICARE PART B ONLY IP|0.03||||||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|9.25||||||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|9.25||||||| 9518077|ERX|0250|OXYCODONE 5MG TABLET|Medicare|MEDICARE ACUTE|9.25||||||| 9518119|ERX|0250|EZETIMIBE 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.36||||||| 9518150|ERX|0250|EPINEPHRINE 30MG/30ML|Medicare|MEDICARE ACUTE|106.50||||||| 9518184|ERX|0250|RANOLAZINE 500MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|38.25||||||| 9518184|ERX|0250|RANOLAZINE 500MG TABLET|Medicare|MEDICARE ACUTE|38.25||||||| 9518184|ERX|0250|RANOLAZINE 500MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|38.25||||||| 9518242|ERX|0250|NICARDIPINE 25MG/10ML|Medicare|MEDICARE ACUTE|1,440.75||||||| 9518309|ERX|0250|HYDROXYCHLOROQUINE 200MG|Medicare|MEDICARE ACUTE|26.50||||||| 9518390|ERX|0250|MAGNESIUM CHLORIDE TABLET|Managed Medicare|HEALTHSPRING MA|0.03||||||| 9518390|ERX|0250|MAGNESIUM CHLORIDE TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.03||||||| 9518390|ERX|0250|MAGNESIUM CHLORIDE TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.03||||||| 9518390|ERX|0250|MAGNESIUM CHLORIDE TABLET|Medicare|MEDICARE ACUTE|0.03||||||| 9518390|ERX|0250|MAGNESIUM CHLORIDE TABLET|Humana Medicare Advantage|HUMANA MA|0.03||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|5.25||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.25||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Medicare|MEDICARE ACUTE|5.25||||||| 9518416|ERX|0250|SENNOSIDES 8.6MG TABLET|Humana Medicare Advantage|HUMANA MA|5.25||||||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|United Medicare Advantage|UHC MEDICARE GOLD MA|8.50||||||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|PHCS|HUMANA INSURANCE|8.50||||||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|8.50||||||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|Blue Cross PPO Specialty|BCBSTX PPO|8.50||||||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|8.50||||||| 9518424|ERX|0250|SENNOSIDES-DOCUSATE SODIU|Medicare|MEDICARE ACUTE|8.50||||||| 9518440|ERX|0250|MEGESTROL 400MG/10ML|Managed Medicare|HEALTHSPRING MA|13.25||||||| 9518440|ERX|0250|MEGESTROL 400MG/10ML|Blue Cross PPO Specialty|BCBSTX PPO|13.25||||||| 9518440|ERX|0250|MEGESTROL 400MG/10ML|Medicare|MEDICARE ACUTE|13.25||||||| 9518440|ERX|0250|MEGESTROL 400MG/10ML|Humana Medicare Advantage|HUMANA MA|13.25||||||| 9518440|ERX|0250|MEGESTROL 400MG/10ML|United Healthcare|UNITED HEALTHCARE OTHER|13.25||||||| 9518440|ERX|0250|MEGESTROL 400MG/10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|13.25||||||| 9518440|ERX|0250|MEGESTROL 400MG/10ML|Tricare|TRICARE FOR LIFE|13.25||||||| 9518457|ERX|0250|METHYL SALIC/MENTHOL ,120|United Medicare Advantage|UHC AARP WELLMED HMO MA|0.54||||||| 9518457|ERX|0250|METHYL SALIC/MENTHOL ,120|Blue Cross PPO Specialty|BCBSTX PPO|0.54||||||| 9518457|ERX|0250|METHYL SALIC/MENTHOL ,120|Medicare|MEDICARE ACUTE|0.54||||||| 9518457|ERX|0250|METHYL SALIC/MENTHOL ,120|Humana Medicare Advantage|HUMANA MA|0.54||||||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|Blue Cross PPO Specialty|BCBSTX PPO|0.15||||||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|Cigna|CIGNA OTHER|0.15||||||| 9518507|ERX|0250|HYOSCYAMINE SULFATE 0.125|Medicare|MEDICARE ACUTE|0.15||||||| 9518580|ERX|0250|ETHAMBUTOL 400MG TABLET|Medicare|MEDICARE ACUTE|0.23||||||| 9518622|ERX|0250|MINERAL OIL-PETROLATUM 1|Medicaid|MEDICAID|0.72||||||| 9518622|ERX|0250|MINERAL OIL-PETROLATUM 1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.72||||||| 9518622|ERX|0250|MINERAL OIL-PETROLATUM 1|Medicare|MEDICARE ACUTE|0.72||||||| 9518655|ERX|0250|COD LIVER OIL-ZN OXIDE ,3|Blue Cross HMO Specialty|BCBSTX HMO|29.75||||||| 9518655|ERX|0250|COD LIVER OIL-ZN OXIDE ,3|Medicare|MEDICARE ACUTE|29.75||||||| 9518655|ERX|0250|COD LIVER OIL-ZN OXIDE ,3|Humana Medicare Advantage|HUMANA MA|29.75||||||| 9518689|ERX|0250|MENTHOL-CAMP-PHEN LIPBALM|United Medicare Advantage|UHC MEDICARE GOLD MA|10.50||||||| 9518689|ERX|0250|MENTHOL-CAMP-PHEN LIPBALM|Blue Cross HMO Specialty|BCBSTX HMO|10.50||||||| 9518689|ERX|0250|MENTHOL-CAMP-PHEN LIPBALM|Aetna|AETNA OTHER|10.50||||||| 9518689|ERX|0250|MENTHOL-CAMP-PHEN LIPBALM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|10.50||||||| 9518689|ERX|0250|MENTHOL-CAMP-PHEN LIPBALM|Medicaid|MEDICAID|10.50||||||| 9518689|ERX|0250|MENTHOL-CAMP-PHEN LIPBALM|Medicare|MEDICARE ACUTE|10.50||||||| 9518689|ERX|0250|MENTHOL-CAMP-PHEN LIPBALM|Blue Cross PPO Specialty|BCBSTX PPO|10.50||||||| 9518689|ERX|0250|MENTHOL-CAMP-PHEN LIPBALM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|10.50||||||| 9518689|ERX|0250|MENTHOL-CAMP-PHEN LIPBALM|Humana Medicare Advantage|HUMANA MA|10.50||||||| 9518770|ERX|0258|SODIUM CHLORIDE 0.9%,100M|Medicare|MEDICARE ACUTE|0.45||||||| 9518770|ERX|0258|SODIUM CHLORIDE 0.9%,100M|Humana Medicare Advantage|HUMANA MA|0.45||||||| 9518796|ERX|0250|LEVOTHYROZINE 100MCG VIAL|Cigna|CIGNA OTHER|563.50||||||| 9518796|ERX|0250|LEVOTHYROZINE 100MCG VIAL|Medicare|MEDICARE ACUTE|563.50||||||| 9518796|ERX|0250|LEVOTHYROZINE 100MCG VIAL|Humana Medicare Advantage|HUMANA MA|563.50||||||| 9518820|ERX|0250|RIVASTIGMINE 9.5MG PATCH|Medicare|MEDICARE ACUTE|60.75||||||| 9518903|ERX|0250|K-NA PHOS 280-160-250MG P|Texas Workforce Commission|DIS DETER SERV (DDS)|0.05||||||| 9518903|ERX|0250|K-NA PHOS 280-160-250MG P|United Medicare Advantage|UHC MEDICARE GOLD MA|0.05||||||| 9518903|ERX|0250|K-NA PHOS 280-160-250MG P|Blue Cross HMO Specialty|BCBSTX HMO|0.05||||||| 9518903|ERX|0250|K-NA PHOS 280-160-250MG P|Aetna|AETNA OTHER|0.05||||||| 9518903|ERX|0250|K-NA PHOS 280-160-250MG P|Managed Medicare|HEALTHSPRING MA|0.05||||||| 9518903|ERX|0250|K-NA PHOS 280-160-250MG P|Blue Cross PPO Specialty|BCBSTX PPO|0.05||||||| 9518903|ERX|0250|K-NA PHOS 280-160-250MG P|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.05||||||| 9518903|ERX|0250|K-NA PHOS 280-160-250MG P|Medicare|MEDICARE ACUTE|0.05||||||| 9518903|ERX|0250|K-NA PHOS 280-160-250MG P|Humana Medicare Advantage|HUMANA MA|0.05||||||| 9518952|ERX|0250|COENZYME Q10 100MG CAPSUL|Medicare|MEDICARE ACUTE|4.75||||||| 9518952|ERX|0250|COENZYME Q10 100MG CAPSUL|United Medicare Advantage|UHC MEDICARE GOLD MA|4.75||||||| 9518960|ERX|0250|HEMATINIC COMBO CAPSULE|Medicare|MEDICARE ACUTE|11.75||||||| 9519018|ERX|0250|FERROUS GLUCONATE 325MG T|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9519018|ERX|0250|FERROUS GLUCONATE 325MG T|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9519018|ERX|0250|FERROUS GLUCONATE 325MG T|Medicare|MEDICARE ACUTE|2.50||||||| 9519034|ERX|0258|CLINIMIX E 5/20 2000ML|Medicare|MEDICARE ACUTE|4.62||||||| 9519034|ERX|0258|CLINIMIX E 5/20 2000ML|Humana Medicare Advantage|HUMANA MA|4.62||||||| 9519042|ERX|0258|CLINIMIX E 5/15 2000ML|Tricare|TRICARE FOR LIFE|4.56||||||| 9519042|ERX|0258|CLINIMIX E 5/15 2000ML|Access Direct Platinum|HEALTHFIRST TPA|4.56||||||| 9519042|ERX|0258|CLINIMIX E 5/15 2000ML|Medicare|MEDICARE ACUTE|4.56||||||| 9519042|ERX|0258|CLINIMIX E 5/15 2000ML|Humana Medicare Advantage|HUMANA MA|4.56||||||| 9519075|ERX|0250|LACTOBACILLUS GRANULES 1|Blue Cross HMO Specialty|BCBSTX HMO|12.75||||||| 9519075|ERX|0250|LACTOBACILLUS GRANULES 1|Managed Medicare|HEALTHSPRING MA|12.75||||||| 9519075|ERX|0250|LACTOBACILLUS GRANULES 1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|12.75||||||| 9519075|ERX|0250|LACTOBACILLUS GRANULES 1|Medicare|MEDICARE ACUTE|12.75||||||| 9519075|ERX|0250|LACTOBACILLUS GRANULES 1|Humana Medicare Advantage|HUMANA MA|12.75||||||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|Texas Workforce Commission|DIS DETER SERV (DDS)|6.25||||||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|Workers Compensation|WORKERS COMPENSATION OTHER|6.25||||||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|United Medicare Advantage|UHC MEDICARE GOLD MA|6.25||||||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|Blue Cross HMO Specialty|BCBSTX HMO|6.25||||||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|Managed Medicare|BCBS MEDICARE PPO MA|6.25||||||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|Managed Medicare|HEALTHSPRING MA|6.25||||||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|6.25||||||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|6.25||||||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|Aenta Medicare Advantage|AETNA MEDICARE MA|6.25||||||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|Medicaid|MEDICAID|6.25||||||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|Blue Cross PPO Specialty|BCBSTX PPO|6.25||||||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|6.25||||||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|Medicare|MEDICARE ACUTE|6.25||||||| 9519133|ERX|0250|DOCUSATE SODIUM 100MG/10M|Humana Medicare Advantage|HUMANA MA|6.25||||||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|Cigna|CIGNA OTHER|0.28||||||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|Medicare|MEDICARE ACUTE|0.28||||||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|Humana Medicare Advantage|HUMANA MA|0.28||||||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.28||||||| 9519141|ERX|0250|SUCRALFATE 1 G/10ML|Tricare|TRICARE FOR LIFE|0.28||||||| 9519158|ERX|0250|FENTANYL 12MCG PATCH|Cigna|CIGNA OTHER|1.45||||||| 9519158|ERX|0250|FENTANYL 12MCG PATCH|Medicare|MEDICARE ACUTE|1.45||||||| 9519281|ERX|0250|AMPICILLIN 2 GM NS MB+ 10|Medicare|MEDICARE ACUTE|216.25||||||| 9519307|ERX|0250|ERTAPENEM 1 GM/100ML NS M|Aetna|AETNA OTHER|634.75||||||| 9519307|ERX|0250|ERTAPENEM 1 GM/100ML NS M|Access Direct Platinum|HEALTHFIRST TPA|634.75||||||| 9519307|ERX|0250|ERTAPENEM 1 GM/100ML NS M|Medicare|MEDICARE ACUTE|634.75||||||| 9519315|ERX|0250|CEFUROXIME 1.5 G/100ML NS|Humana Medicare Advantage|HUMANA MA|0.87||||||| 9519331|ERX|0250|MEROPENEM 1 GM/100ML MB+|Managed Medicare|BCBS MEDICARE PPO MA|709.75||||||| 9519331|ERX|0250|MEROPENEM 1 GM/100ML MB+|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|709.75||||||| 9519331|ERX|0250|MEROPENEM 1 GM/100ML MB+|Medicare|MEDICARE ACUTE|709.75||||||| 9519349|ERX|0250|MEROPENEM 500MG/100ML MB+|United Medicare Advantage|UHC MEDICARE GOLD MA|394.25||||||| 9519349|ERX|0250|MEROPENEM 500MG/100ML MB+|United Medicare Advantage|UHC AARP WELLMED HMO MA|394.25||||||| 9519349|ERX|0250|MEROPENEM 500MG/100ML MB+|Blue Cross HMO Specialty|BCBSTX HMO|394.25||||||| 9519349|ERX|0250|MEROPENEM 500MG/100ML MB+|Aetna|AETNA OTHER|394.25||||||| 9519349|ERX|0250|MEROPENEM 500MG/100ML MB+|Managed Medicare|BCBS MEDICARE PPO MA|394.25||||||| 9519349|ERX|0250|MEROPENEM 500MG/100ML MB+|Access Direct Platinum|HEALTHFIRST TPA|394.25||||||| 9519349|ERX|0250|MEROPENEM 500MG/100ML MB+|Aenta Medicare Advantage|AETNA MEDICARE MA|394.25||||||| 9519349|ERX|0250|MEROPENEM 500MG/100ML MB+|Medicaid|MEDICAID|394.25||||||| 9519349|ERX|0250|MEROPENEM 500MG/100ML MB+|Blue Cross PPO Specialty|BCBSTX PPO|394.25||||||| 9519349|ERX|0250|MEROPENEM 500MG/100ML MB+|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|394.25||||||| 9519349|ERX|0250|MEROPENEM 500MG/100ML MB+|Cigna|CIGNA OTHER|394.25||||||| 9519349|ERX|0250|MEROPENEM 500MG/100ML MB+|Medicare|MEDICARE PART B ONLY IP|394.25||||||| 9519349|ERX|0250|MEROPENEM 500MG/100ML MB+|Medicare|MEDICARE ACUTE|394.25||||||| 9519349|ERX|0250|MEROPENEM 500MG/100ML MB+|Humana Medicare Advantage|HUMANA MA|394.25||||||| 9519364|ERX|0250|NAFCILLIN 2 GM/100ML MB+|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|225.75||||||| 9519364|ERX|0250|NAFCILLIN 2 GM/100ML MB+|Medicare|MEDICARE ACUTE|225.75||||||| 9519364|ERX|0250|NAFCILLIN 2 GM/100ML MB+|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|225.75||||||| 9519372|ERX|0250|AMPICILL-SULBAC 1.5G/100|Medicare|MEDICARE ACUTE|118.50||||||| 9519380|ERX|0250|AMPICILLIN-SULBAC 3G/100M|Managed Medicare|HEALTHSPRING MA|199.75||||||| 9519380|ERX|0250|AMPICILLIN-SULBAC 3G/100M|Blue Cross PPO Specialty|BCBSTX PPO|199.75||||||| 9519380|ERX|0250|AMPICILLIN-SULBAC 3G/100M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|199.75||||||| 9519380|ERX|0250|AMPICILLIN-SULBAC 3G/100M|Medicare|MEDICARE ACUTE|199.75||||||| 9519398|ERX|0250|VANCOMYCIN 500MG/100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|58.25||||||| 9519398|ERX|0250|VANCOMYCIN 500MG/100ML NS|Medicare|MEDICARE ACUTE|58.25||||||| 9519398|ERX|0250|VANCOMYCIN 500MG/100ML NS|Humana Medicare Advantage|HUMANA MA|58.25||||||| 9519497|ERX|0258|LORAZEPAM 100MG/D5W 100ML|Medicare|MEDICARE ACUTE|257.25||||||| 9519505|ERX|0250|FLUCONAZOLE 100MG IN NS 5|Access Direct Platinum|HEALTHFIRST TPA|1.18||||||| 9519505|ERX|0250|FLUCONAZOLE 100MG IN NS 5|Medicare|MEDICARE ACUTE|1.18||||||| 9519505|ERX|0250|FLUCONAZOLE 100MG IN NS 5|Humana Medicare Advantage|HUMANA MA|1.18||||||| 9519513|ERX|0250|NICARDIPINE 20MG/200MLSAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|830.75||||||| 9519513|ERX|0250|NICARDIPINE 20MG/200MLSAL|Medicare|MEDICARE ACUTE|830.75||||||| 9519588|ERX|0250|CEFUROXIME 750MG/100ML NS|Medicare|MEDICARE ACUTE|88.50||||||| 9519661|ERX|0250|TOLVAPTAN 15MG (1/2 TABLE|United Medicare Advantage|UHC MEDICARE GOLD MA|9.68||||||| 9519687|ERX|0250|VANCO ORAL SOLN 250MG/5ML|Blue Cross PPO Specialty|BCBSTX PPO|158.50||||||| 9519687|ERX|0250|VANCO ORAL SOLN 250MG/5ML|Medicare|MEDICARE ACUTE|158.50||||||| 9519687|ERX|0250|VANCO ORAL SOLN 250MG/5ML|Humana Medicare Advantage|HUMANA MA|158.50||||||| 9519802|ERX|0250|WATER FOR INJ.,STERILE 10|Managed Medicare|HEALTHSPRING MA|0.13||||||| 9519802|ERX|0250|WATER FOR INJ.,STERILE 10|Aenta Medicare Advantage|AETNA MEDICARE MA|0.13||||||| 9519802|ERX|0250|WATER FOR INJ.,STERILE 10|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.13||||||| 9519802|ERX|0250|WATER FOR INJ.,STERILE 10|Medicare|MEDICARE ACUTE|0.13||||||| 9519869|ERX|0250|PRASUGREL 10MG TABLET|Medicare|MEDICARE ACUTE|48.25||||||| 9519976|ERX|0250|GLIMEPIRIDE 1MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|13.25||||||| 9519976|ERX|0250|GLIMEPIRIDE 1MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|13.25||||||| 9519976|ERX|0250|GLIMEPIRIDE 1MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|13.25||||||| 9519976|ERX|0250|GLIMEPIRIDE 1MG TABLET|Medicare|MEDICARE ACUTE|13.25||||||| 9519976|ERX|0250|GLIMEPIRIDE 1MG TABLET|Humana Medicare Advantage|HUMANA MA|13.25||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|United Medicare Advantage|UHC MEDICARE GOLD MA|13.25||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|United Medicare Advantage|UHC AARP WELLMED HMO MA|13.25||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Blue Cross HMO Specialty|BCBSTX HMO|13.25||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|13.25||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Managed Medicare|HEALTHSPRING MA|13.25||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Aenta Medicare Advantage|AETNA MEDICARE MA|13.25||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Blue Cross PPO Specialty|BCBSTX PPO|13.25||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Medicare|MEDICARE ACUTE|13.25||||||| 9520016|ERX|0250|CHOLECALCIFEROL 5000 UNIT|Humana Medicare Advantage|HUMANA MA|13.25||||||| 9520107|ERX|0250|DICLOFENAC 1% GEL, 100 GM|Blue Cross PPO Specialty|BCBSTX PPO|709.50||||||| 9520107|ERX|0250|DICLOFENAC 1% GEL, 100 GM|Medicare|MEDICARE ACUTE|709.50||||||| 9520123|ERX|0250|NA HYPOCHL 0.125% SOLN,47|United Medicare Advantage|UHC MEDICARE GOLD MA|67.75||||||| 9520123|ERX|0250|NA HYPOCHL 0.125% SOLN,47|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|67.75||||||| 9520123|ERX|0250|NA HYPOCHL 0.125% SOLN,47|Medicaid|MEDICAID|67.75||||||| 9520123|ERX|0250|NA HYPOCHL 0.125% SOLN,47|Access Direct Platinum|HEALTHFIRST TPA|67.75||||||| 9520123|ERX|0250|NA HYPOCHL 0.125% SOLN,47|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|67.75||||||| 9520123|ERX|0250|NA HYPOCHL 0.125% SOLN,47|Blue Cross PPO Specialty|BCBSTX PPO|67.75||||||| 9520123|ERX|0250|NA HYPOCHL 0.125% SOLN,47|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|67.75||||||| 9520123|ERX|0250|NA HYPOCHL 0.125% SOLN,47|Cigna|CIGNA OTHER|67.75||||||| 9520123|ERX|0250|NA HYPOCHL 0.125% SOLN,47|Medicare|MEDICARE ACUTE|67.75||||||| 9520289|ERX|0250|LIPASE-PROT-AMYL 6-19-30K|Medicare|MEDICARE ACUTE|12.25||||||| 9520479|ERX|0250|NORMAL SALINE SOLUTION, 1|Medicare|MEDICARE ACUTE|0.13||||||| 9520529|ERX|0250|FENOFIBRATE 54MG TABLET|Medicare|MEDICARE ACUTE|13.25||||||| 9520537|ERX|0250|FENOFIBRATE 134MG TABLET|Medicare|MEDICARE ACUTE|13.25||||||| 9520537|ERX|0250|FENOFIBRATE 134MG TABLET|Humana Medicare Advantage|HUMANA MA|13.25||||||| 9520719|ERX|0250|LACOSAMIDE 100MG TABLET|Medicare|MEDICARE ACUTE|51.25||||||| 9520818|ERX|0250|DEXAME-NYST-DIPHE-SUCRAL,|Medicare|MEDICARE ACUTE|128.75||||||| 9520875|ERX|0636|ACETAMINOPHEN INJ 100ML B|Access Direct Platinum|HEALTHFIRST TPA|102.25||||||| 9520875|ERX|0636|ACETAMINOPHEN INJ 100ML B|Humana Medicare Advantage|HUMANA MA|102.25||||||| 9520875|ERX|0636|ACETAMINOPHEN INJ 100ML B|Blue Cross PPO Specialty|BCBSTX PPO|102.25||||||| 9520875|ERX|0636|ACETAMINOPHEN INJ 100ML B|Medicare|MEDICARE ACUTE|102.25||||||| 9520909|ERX|0250|RIFAXIMIN 550MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|158.25||||||| 9520909|ERX|0250|RIFAXIMIN 550MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|158.25||||||| 9520909|ERX|0250|RIFAXIMIN 550MG TABLET|Medicare|MEDICARE ACUTE|158.25||||||| 9520909|ERX|0250|RIFAXIMIN 550MG TABLET|Humana Medicare Advantage|HUMANA MA|158.25||||||| 9521097|ERX|0258|SODIUM CHLORIDE IRRIG SOL|United Medicare Advantage|UHC MEDICARE GOLD MA|142.25||||||| 9521097|ERX|0258|SODIUM CHLORIDE IRRIG SOL|Managed Medicare|BCBS MEDICARE PPO MA|142.25||||||| 9521097|ERX|0258|SODIUM CHLORIDE IRRIG SOL|Managed Medicare|HEALTHSPRING MA|142.25||||||| 9521097|ERX|0258|SODIUM CHLORIDE IRRIG SOL|Medicaid|MEDICAID|142.25||||||| 9521097|ERX|0258|SODIUM CHLORIDE IRRIG SOL|Blue Cross PPO Specialty|BCBSTX PPO|142.25||||||| 9521097|ERX|0258|SODIUM CHLORIDE IRRIG SOL|Aenta Medicare Advantage|AETNA MEDICARE MA|142.25||||||| 9521097|ERX|0258|SODIUM CHLORIDE IRRIG SOL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|142.25||||||| 9521097|ERX|0258|SODIUM CHLORIDE IRRIG SOL|Medicare|MEDICARE ACUTE|142.25||||||| 9521097|ERX|0258|SODIUM CHLORIDE IRRIG SOL|Humana Medicare Advantage|HUMANA MA|142.25||||||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Managed Medicare|HEALTHSPRING MA|695.75||||||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Managed Medicare|BCBS MEDICARE PPO MA|695.75||||||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Medicaid|MEDICAID|695.75||||||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Aenta Medicare Advantage|AETNA MEDICARE MA|695.75||||||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Blue Cross PPO Specialty|BCBSTX PPO|695.75||||||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|695.75||||||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Medicare|MEDICARE ACUTE|695.75||||||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|Workers Compensation|WORKERS COMPENSATION OTHER|695.75||||||| 9521154|ERX|0250|MUPIROCIN 2% OINT, 22 GM|United Healthcare|UNITED HEALTHCARE OTHER|695.75||||||| 9521253|ERX|0250|PAROXETINE 20MG TABLET|Medicare|MEDICARE ACUTE|40.75||||||| 9521311|ERX|0250|AMOX-CLAV 500-125MG TABLE|Medicare|MEDICARE ACUTE|63.75||||||| 9521311|ERX|0250|AMOX-CLAV 500-125MG TABLE|Humana Medicare Advantage|HUMANA MA|63.75||||||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Managed Medicare|HEALTHSPRING MA|0.87||||||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.87||||||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Medicare|MEDICARE ACUTE|0.87||||||| 9521329|ERX|0250|AMOX-CLAV 875-125MG TABLE|Humana Medicare Advantage|HUMANA MA|0.87||||||| 9521378|ERX|0250|GUAIFENESIN 100MG/5ML, 11|Texas Workforce Commission|DIS DETER SERV (DDS)|56.25||||||| 9521378|ERX|0250|GUAIFENESIN 100MG/5ML, 11|PHCS|HUMANA INSURANCE|56.25||||||| 9521378|ERX|0250|GUAIFENESIN 100MG/5ML, 11|United Medicare Advantage|UHC MEDICARE GOLD MA|56.25||||||| 9521378|ERX|0250|GUAIFENESIN 100MG/5ML, 11|United Medicare Advantage|UHC AARP WELLMED HMO MA|56.25||||||| 9521378|ERX|0250|GUAIFENESIN 100MG/5ML, 11|Blue Cross HMO Specialty|BCBSTX HMO|56.25||||||| 9521378|ERX|0250|GUAIFENESIN 100MG/5ML, 11|Managed Medicare|HEALTHSPRING MA|56.25||||||| 9521378|ERX|0250|GUAIFENESIN 100MG/5ML, 11|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|56.25||||||| 9521378|ERX|0250|GUAIFENESIN 100MG/5ML, 11|Blue Cross PPO Specialty|BCBSTX PPO|56.25||||||| 9521378|ERX|0250|GUAIFENESIN 100MG/5ML, 11|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|56.25||||||| 9521378|ERX|0250|GUAIFENESIN 100MG/5ML, 11|Cigna|CIGNA OTHER|56.25||||||| 9521378|ERX|0250|GUAIFENESIN 100MG/5ML, 11|Medicare|MEDICARE ACUTE|56.25||||||| 9521378|ERX|0250|GUAIFENESIN 100MG/5ML, 11|Medicare|MEDICARE PART B ONLY IP|56.25||||||| 9521378|ERX|0250|GUAIFENESIN 100MG/5ML, 11|Humana Medicare Advantage|HUMANA MA|56.25||||||| 9521436|ERX|0250|LIPASE-PROT-AMYL 12-38-60|Medicare|MEDICARE ACUTE|18.25||||||| 9521451|ERX|0250|AZELASTINE NASAL SPRAY, 3|Medicare|MEDICARE ACUTE|972.75||||||| 9521550|ERX|0250|LEVOFLOXACIN 250MG/50ML D|Medicare|MEDICARE ACUTE|262.25||||||| 9521568|ERX|0250|LEVOFLOXACIN 500MG/100ML|Medicare|MEDICARE ACUTE|496.50||||||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|6.25||||||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Blue Cross PPO Specialty|BCBSTX PPO|6.25||||||| 9521618|ERX|0250|IBUPROFEN 100MG/5ML|Medicare|MEDICARE ACUTE|6.25||||||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|140.75||||||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Managed Medicare|HEALTHSPRING MA|140.75||||||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|140.75||||||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|140.75||||||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|Medicare|MEDICARE ACUTE|140.75||||||| 9521642|ERX|0250|HALOPERIDOL 5MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|140.75||||||| 9521667|ERX|0250|TOPIRAMATE 25MG TABLET|Medicare|MEDICARE ACUTE|25.50||||||| 9521675|ERX|0250|TOPIRAMATE 100MG TABLET|Medicare|MEDICARE ACUTE|67.75||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.19||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|United Medicare Advantage|UHC AARP WELLMED HMO MA|0.19||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.19||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.19||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|0.19||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.19||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.19||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.19||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Cigna|CIGNA OTHER|0.19||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Medicare|MEDICARE ACUTE|0.19||||||| 9521709|ERX|0250|TRAMADOL 50MG TABLET|Humana Medicare Advantage|HUMANA MA|0.19||||||| 9521717|ERX|0250|LACTASE 9000 UNIT TABLET|Aetna|AETNA OTHER|4.75||||||| 9521741|ERX|0250|LEVOFLOXACIN 500MG TABLET|Medicare|MEDICARE ACUTE|138.25||||||| 9521766|ERX|0250|PROPRANOLOL XL 60MG CAPSU|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|39.50||||||| 9521949|ERX|0250|GLIPIZIDE XL 5MG TABLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|9.25||||||| 9521949|ERX|0250|GLIPIZIDE XL 5MG TABLET|Medicare|MEDICARE ACUTE|9.25||||||| 9521964|ERX|0250|GLIPIZIDE XL 2.5MG TABLET|Medicare|MEDICARE ACUTE|9.25||||||| 9521964|ERX|0250|GLIPIZIDE XL 2.5MG TABLET|Humana Medicare Advantage|HUMANA MA|9.25||||||| 9521972|ERX|0250|DOXAZOSIN 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|20.75||||||| 9521972|ERX|0250|DOXAZOSIN 1MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|20.75||||||| 9521972|ERX|0250|DOXAZOSIN 1MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|20.75||||||| 9521972|ERX|0250|DOXAZOSIN 1MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|20.75||||||| 9521972|ERX|0250|DOXAZOSIN 1MG TABLET|Cigna|CIGNA OTHER|20.75||||||| 9521972|ERX|0250|DOXAZOSIN 1MG TABLET|Medicare|MEDICARE ACUTE|20.75||||||| 9521980|ERX|0250|DOXAZOSIN 2MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|20.75||||||| 9521980|ERX|0250|DOXAZOSIN 2MG TABLET|Medicaid|MEDICAID|20.75||||||| 9521980|ERX|0250|DOXAZOSIN 2MG TABLET|Medicare|MEDICARE ACUTE|20.75||||||| 9522012|ERX|0250|VORICONAZOLE 200MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|4.42||||||| 9522012|ERX|0250|VORICONAZOLE 200MG TABLET|Medicare|MEDICARE ACUTE|4.42||||||| 9522038|ERX|0250|FLUCONAZOLE 200MG/100ML N|United Medicare Advantage|UHC AARP WELLMED HMO MA|170.25||||||| 9522038|ERX|0250|FLUCONAZOLE 200MG/100ML N|Aetna|AETNA OTHER|170.25||||||| 9522038|ERX|0250|FLUCONAZOLE 200MG/100ML N|Medicare|MEDICARE ACUTE|170.25||||||| 9522038|ERX|0250|FLUCONAZOLE 200MG/100ML N|Humana Medicare Advantage|HUMANA MA|170.25||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Medicare|MEDICARE ACUTE|122.25||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|122.25||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|122.25||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Medicare|MEDICARE PART B ONLY IP|122.25||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|Humana Medicare Advantage|HUMANA MA|122.25||||||| 9522053|ERX|0250|FLUCONAZOLE 100MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|122.25||||||| 9522061|ERX|0250|FLUCONAZOLE 200MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|2.00||||||| 9522061|ERX|0250|FLUCONAZOLE 200MG TABLET|United Medicare Advantage|UHC AARP WELLMED HMO MA|2.00||||||| 9522061|ERX|0250|FLUCONAZOLE 200MG TABLET|Managed Medicare|HEALTHSPRING MA|2.00||||||| 9522061|ERX|0250|FLUCONAZOLE 200MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|2.00||||||| 9522061|ERX|0250|FLUCONAZOLE 200MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.00||||||| 9522061|ERX|0250|FLUCONAZOLE 200MG TABLET|Medicare|MEDICARE ACUTE|2.00||||||| 9522061|ERX|0250|FLUCONAZOLE 200MG TABLET|Humana Medicare Advantage|HUMANA MA|2.00||||||| 9522079|ERX|0250|FLUCONAZOLE 400MG/200ML N|Managed Medicaid|MEDICAID UNITED HEALTHCARE|271.75||||||| 9522079|ERX|0250|FLUCONAZOLE 400MG/200ML N|Medicare|MEDICARE ACUTE|271.75||||||| 9522079|ERX|0250|FLUCONAZOLE 400MG/200ML N|Humana Medicare Advantage|HUMANA MA|271.75||||||| 9522087|ERX|0250|TRIAMCINOLONE ACET 0.1%,|Workers Compensation|WORKERS COMPENSATION OTHER|5.10||||||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|Managed Medicare|HEALTHSPRING MA|150.75||||||| 9522103|ERX|0250|ZIPRASIDONE 20MG/1ML|Medicare|MEDICARE ACUTE|150.75||||||| 9522111|ERX|0250|ZIPRASIDONE 20MG CAPSULE|Medicare|MEDICARE ACUTE|67.50||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|38.25||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|38.25||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Medicaid|MEDICAID|38.25||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|38.25||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|38.25||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|38.25||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Medicare|MEDICARE ACUTE|38.25||||||| 9522152|ERX|0250|SERTRALINE 50MG TABLET|Humana Medicare Advantage|HUMANA MA|38.25||||||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|Managed Medicare|HEALTHSPRING MA|73.25||||||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|Medicaid|MEDICAID|73.25||||||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|73.25||||||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|Cigna|CIGNA OTHER|73.25||||||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|Medicare|MEDICARE PART B ONLY IP|73.25||||||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|Medicare|MEDICARE ACUTE|73.25||||||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|Humana Medicare Advantage|HUMANA MA|73.25||||||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|73.25||||||| 9522178|ERX|0250|DRONABINOL 2.5MG CAPSULE|United Medicare Advantage|UHC AARP WELLMED HMO MA|73.25||||||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Blue Cross PPO Specialty|BCBSTX PPO|2.04||||||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Access Direct Platinum|HEALTHFIRST TPA|2.04||||||| 9522236|ERX|0250|ROCURONIUM 50MG/5ML|Medicare|MEDICARE ACUTE|2.04||||||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Aetna|AETNA OTHER|4.25||||||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|4.25||||||| 9522301|ERX|0250|PREDNISONE 20MG TABLET|Medicare|MEDICARE ACUTE|4.25||||||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|United Medicare Advantage|UHC MEDICARE GOLD MA|89.25||||||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|United Medicare Advantage|UHC AARP WELLMED HMO MA|89.25||||||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|89.25||||||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|Medicare|MEDICARE ACUTE|89.25||||||| 9522343|ERX|0250|NA POLYSTY SULFONATE 15G/|Humana Medicare Advantage|HUMANA MA|89.25||||||| 9522558|ERX|0250|CALCIUM CARB 1250MG (500M|Medicare|MEDICARE ACUTE|0.03||||||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|9.25||||||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|9.25||||||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|9.25||||||| 9522608|ERX|0250|DEXAMETHASONE 4MG TABLET|Medicare|MEDICARE ACUTE|9.25||||||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Blue Cross HMO Specialty|BCBSTX HMO|0.16||||||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Managed Medicare|HEALTHSPRING MA|0.16||||||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Medicare|MEDICARE ACUTE|0.16||||||| 9522640|ERX|0250|LIDOCAINE 2% VISCOUS 5ML,|Humana Medicare Advantage|HUMANA MA|0.16||||||| 9522673|ERX|0250|METHOTREXATE 2.5MG TABLET|Medicare|MEDICARE ACUTE|36.50||||||| 9522699|ERX|0250|METHADONE 5MG TABLET|Medicare|MEDICARE ACUTE|0.07||||||| 9522707|ERX|0250|METHADONE 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|7.75||||||| 9522707|ERX|0250|METHADONE 10MG TABLET|Medicare|MEDICARE ACUTE|7.75||||||| 9522723|ERX|0250|PREDNISONE 1MG TABLET|Access Direct Platinum|HEALTHFIRST TPA|0.05||||||| 9522723|ERX|0250|PREDNISONE 1MG TABLET|Medicare|MEDICARE ACUTE|0.05||||||| 9522731|ERX|0250|WARFARIN 1MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.15||||||| 9522731|ERX|0250|WARFARIN 1MG TABLET|Medicare|MEDICARE ACUTE|0.15||||||| 9522749|ERX|0250|WARFARIN 2MG TABLET|Medicare|MEDICARE ACUTE|15.50||||||| 9522780|ERX|0250|WARFARIN 2.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|15.50||||||| 9522780|ERX|0250|WARFARIN 2.5MG TABLET|Medicare|MEDICARE ACUTE|15.50||||||| 9522814|ERX|0250|CARBIDOPA 25MG TABLET|Medicare|MEDICARE ACUTE|12.25||||||| 9522913|ERX|0250|COLLAGENASE OINT, 30 GM|Medicare|MEDICARE ACUTE|762.25||||||| 9522954|ERX|0250|OLOPATADINE 0.1% EYE DROP|Workers Compensation|WORKERS COMPENSATION OTHER|9.81||||||| 9522962|ERX|0250|BRINZOLAMIDE 1% EYE DROP,|United Healthcare|UNITED HEALTHCARE OTHER|675.25||||||| 9523051|ERX|0250|TOBRAMYCIN 0.3% EYE OINT,|Workers Compensation|WORKERS COMPENSATION OTHER|723.50||||||| 9523069|ERX|0250|TOBRAMYCIN/DEXAMETH, 2.5M|Medicare|MEDICARE ACUTE|421.50||||||| 9523226|ERX|0250|TERBINAFINE 1% CREAM, 12|Blue Cross PPO Specialty|BCBSTX PPO|0.92||||||| 9523234|ERX|0250|SCOPOLAMINE 1.5MG PATCH|Blue Cross HMO Specialty|BCBSTX HMO|97.75||||||| 9523234|ERX|0250|SCOPOLAMINE 1.5MG PATCH|Medicare|MEDICARE PART B ONLY IP|97.75||||||| 9523234|ERX|0250|SCOPOLAMINE 1.5MG PATCH|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|97.75||||||| 9523234|ERX|0250|SCOPOLAMINE 1.5MG PATCH|Cigna|CIGNA OTHER|97.75||||||| 9523234|ERX|0250|SCOPOLAMINE 1.5MG PATCH|Medicare|MEDICARE ACUTE|97.75||||||| 9523242|ERX|0250|NICOTINE 7MG PATCH|Blue Cross PPO Specialty|BCBSTX PPO|27.25||||||| 9523242|ERX|0250|NICOTINE 7MG PATCH|Medicare|MEDICARE ACUTE|27.25||||||| 9523259|ERX|0250|NICOTINE 14MG PATCH|United Healthcare|UNITED HEALTHCARE OTHER|27.25||||||| 9523259|ERX|0250|NICOTINE 14MG PATCH|Managed Medicare|HEALTHSPRING MA|27.25||||||| 9523259|ERX|0250|NICOTINE 14MG PATCH|Blue Cross PPO Specialty|BCBSTX PPO|27.25||||||| 9523259|ERX|0250|NICOTINE 14MG PATCH|Medicare|MEDICARE ACUTE|27.25||||||| 9523267|ERX|0250|NICOTINE 21MG PATCH|Medicare|MEDICARE ACUTE|27.25||||||| 9523267|ERX|0250|NICOTINE 21MG PATCH|United Healthcare|UNITED HEALTHCARE OTHER|27.25||||||| 9523317|ERX|0250|RIFAMPIN 300MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|33.25||||||| 9523317|ERX|0250|RIFAMPIN 300MG CAPSULE|Medicare|MEDICARE ACUTE|33.25||||||| 9523325|ERX|0250|RIFAMPIN 600MG VIAL|Medicare|MEDICARE ACUTE|1,024.50||||||| 9523325|ERX|0250|RIFAMPIN 600MG VIAL|Humana Medicare Advantage|HUMANA MA|1,024.50||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|28.50||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Aetna|AETNA OTHER|28.50||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|28.50||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|28.50||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|28.50||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Medicare|MEDICARE ACUTE|28.50||||||| 9523358|ERX|0250|CETIRIZINE 10MG TABLET|Humana Medicare Advantage|HUMANA MA|28.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|25.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Aetna|AETNA OTHER|25.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|25.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|25.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|25.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|25.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Medicare|MEDICARE ACUTE|25.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|25.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|Humana Medicare Advantage|HUMANA MA|25.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|25.50||||||| 9523408|ERX|0250|AMLODIPINE 5MG TABLET|United Medicare Advantage|UHC AARP WELLMED HMO MA|25.50||||||| 9523424|ERX|0250|CETIRIZINE-PSEUDOEPHED TA|Aenta Medicare Advantage|AETNA MEDICARE MA|17.50||||||| 9523424|ERX|0250|CETIRIZINE-PSEUDOEPHED TA|Medicare|MEDICARE ACUTE|17.50||||||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|109.25||||||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|109.25||||||| 9523432|ERX|0250|AZITHROMYCIN 250MG TABLET|Medicare|MEDICARE ACUTE|109.25||||||| 9523473|ERX|0250|AZITHROMYCIN 500MG VIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|367.75||||||| 9523473|ERX|0250|AZITHROMYCIN 500MG VIAL|Medicare|MEDICARE ACUTE|367.75||||||| 9523473|ERX|0250|AZITHROMYCIN 500MG VIAL|Humana Medicare Advantage|HUMANA MA|367.75||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|United Healthcare|UNITED HEALTHCARE OTHER|32.75||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|32.75||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|32.75||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Managed Medicare|BCBS MEDICARE PPO MA|32.75||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Medicare|MEDICARE ACUTE|32.75||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|32.75||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|32.75||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Cigna|CIGNA OTHER|32.75||||||| 9523523|ERX|0250|ATORVASTATIN 10MG TABLET|Humana Medicare Advantage|HUMANA MA|32.75||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|46.75||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|46.75||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Medicaid|MEDICAID|46.75||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|46.75||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|46.75||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|46.75||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Medicare|MEDICARE ACUTE|46.75||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|Humana Medicare Advantage|HUMANA MA|46.75||||||| 9523549|ERX|0250|ATORVASTATIN 40MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|46.75||||||| 9523598|ERX|0250|PHENYTOIN 100MG CAPSULE|Medicare|MEDICARE ACUTE|7.75||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Blue Cross HMO Specialty|BCBSTX HMO|13.50||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|13.50||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|13.50||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|13.50||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Medicare|MEDICARE ACUTE|13.50||||||| 9523614|ERX|0250|GABAPENTIN 100MG CAPSULE|Humana Medicare Advantage|HUMANA MA|13.50||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|25.50||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|25.50||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Medicare|MEDICARE ACUTE|25.50||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|25.50||||||| 9523622|ERX|0250|GABAPENTIN 300MG CAPSULE|Cigna|CIGNA OTHER|25.50||||||| 9523630|ERX|0250|GABAPENTIN 400MG CAPSULE|Medicare|MEDICARE ACUTE|25.50||||||| 9523648|ERX|0250|PREGABALIN 25MG CAPSULE|Medicare|MEDICARE ACUTE|25.50||||||| 9523648|ERX|0250|PREGABALIN 25MG CAPSULE|Humana Medicare Advantage|HUMANA MA|25.50||||||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|Tricare|TRICARE FOR LIFE|25.50||||||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|25.50||||||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|25.50||||||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|25.50||||||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|Medicare|MEDICARE ACUTE|25.50||||||| 9523663|ERX|0250|PREGABALIN 75MG CAPSULE|Humana Medicare Advantage|HUMANA MA|25.50||||||| 9523697|ERX|0250|GABAPENTIN 250MG/5ML|Blue Cross PPO Specialty|BCBSTX PPO|93.25||||||| 9523697|ERX|0250|GABAPENTIN 250MG/5ML|Medicare|MEDICARE ACUTE|93.25||||||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|18.75||||||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Managed Medicare|HEALTHSPRING MA|18.75||||||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Medicare|MEDICARE ACUTE|18.75||||||| 9523754|ERX|0250|CLONAZEPAM 0.5MG TABLET|Humana Medicare Advantage|HUMANA MA|18.75||||||| 9523804|ERX|0250|HYDROMORPHONE 2MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.13||||||| 9523804|ERX|0250|HYDROMORPHONE 2MG TABLET|Cigna|CIGNA OTHER|0.13||||||| 9523804|ERX|0250|HYDROMORPHONE 2MG TABLET|Medicare|MEDICARE ACUTE|0.13||||||| 9523895|ERX|0250|DULOXETINE 20MG CAPSULE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.39||||||| 9523895|ERX|0250|DULOXETINE 20MG CAPSULE|Medicare|MEDICARE ACUTE|0.39||||||| 9523903|ERX|0250|BUMETANIDE 0.5MG TABLET|Humana Medicare Advantage|HUMANA MA|11.75||||||| 9523903|ERX|0250|BUMETANIDE 0.5MG TABLET|Medicare|MEDICARE ACUTE|11.75||||||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|61.25||||||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|Blue Cross PPO Specialty|BCBSTX PPO|61.25||||||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|61.25||||||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|Medicare|MEDICARE ACUTE|61.25||||||| 9523960|ERX|0250|CEFDINIR 300MG CAPSULE|Humana Medicare Advantage|HUMANA MA|61.25||||||| 9523986|ERX|0250|TERAZOSIN 1MG CAPSULE|Medicare|MEDICARE ACUTE|25.50||||||| 9524000|ERX|0250|TERAZOSIN 5MG CAPSULE|Medicare|MEDICARE ACUTE|25.50||||||| 9524018|ERX|0250|DIVALPROEX ER 250MG TABLE|Medicare|MEDICARE ACUTE|0.22||||||| 9524075|ERX|0250|VALPROIC 250MG CAPSULE|Managed Medicare|HEALTHSPRING MA|28.50||||||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|Texas Workforce Commission|DIS DETER SERV (DDS)|25.50||||||| 9524117|ERX|0250|DIVALPROEX 250MG TABLET|Medicare|MEDICARE ACUTE|25.50||||||| 9524158|ERX|0250|ERYTHRO.ES 400MG/5ML,100M|Medicare|MEDICARE ACUTE|1,928.50||||||| 9524166|ERX|0250|ERYTHROMYCIN BASE 250MG T|Aetna|AETNA OTHER|0.26||||||| 9524166|ERX|0250|ERYTHROMYCIN BASE 250MG T|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.26||||||| 9524166|ERX|0250|ERYTHROMYCIN BASE 250MG T|Medicare|MEDICARE ACUTE|0.26||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|United Medicare Advantage|UHC MEDICARE GOLD MA|350.50||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|United Medicare Advantage|UHC AARP WELLMED HMO MA|350.50||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Blue Cross HMO Specialty|BCBSTX HMO|350.50||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Aetna|AETNA OTHER|350.50||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|350.50||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|350.50||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Medicaid|MEDICAID|350.50||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Blue Cross PPO Specialty|BCBSTX PPO|350.50||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|350.50||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Medicare|MEDICARE ACUTE|350.50||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Cigna|CIGNA OTHER|350.50||||||| 9524257|ERX|0250|ENOXAPARIN 40MG/0.4ML|Humana Medicare Advantage|HUMANA MA|350.50||||||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Aenta Medicare Advantage|AETNA MEDICARE MA|513.50||||||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Access Direct Platinum|HEALTHFIRST TPA|513.50||||||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Medicare|MEDICARE ACUTE|513.50||||||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Humana Medicare Advantage|HUMANA MA|513.50||||||| 9524265|ERX|0250|ENOXAPARIN 60MG/0.6ML|Texas Workforce Commission|DIS DETER SERV (DDS)|513.50||||||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Managed Medicare|HEALTHSPRING MA|6.31||||||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Aenta Medicare Advantage|AETNA MEDICARE MA|6.31||||||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Blue Cross PPO Specialty|BCBSTX PPO|6.31||||||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|6.31||||||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Medicare|MEDICARE ACUTE|6.31||||||| 9524273|ERX|0250|ENOXAPARIN 80MG/0.8ML|Humana Medicare Advantage|HUMANA MA|6.31||||||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|7.89||||||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.89||||||| 9524281|ERX|0250|ENOXAPARIN 100MG/1ML|Medicare|MEDICARE ACUTE|7.89||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Blue Cross HMO Specialty|BCBSTX HMO|262.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|262.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Managed Medicare|HEALTHSPRING MA|262.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Medicaid|MEDICAID|262.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Blue Cross PPO Specialty|BCBSTX PPO|262.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|262.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|262.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Medicare|MEDICARE PART B ONLY IP|262.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Medicare|MEDICARE ACUTE|262.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|Humana Medicare Advantage|HUMANA MA|262.75||||||| 9524299|ERX|0250|ENOXAPARIN 30MG/0.3ML|United Medicare Advantage|UHC MEDICARE GOLD MA|262.75||||||| 9524323|ERX|0250|ENOXAPARIN 120MG/0.8ML|Medicare|MEDICARE ACUTE|8.42||||||| 9524323|ERX|0250|ENOXAPARIN 120MG/0.8ML|Humana Medicare Advantage|HUMANA MA|8.42||||||| 9524471|ERX|0250|TERBINAFINE 250MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|163.75||||||| 9524679|ERX|0250|VALSARTAN 80MG TABLET|Medicare|MEDICARE ACUTE|25.50||||||| 9524737|ERX|0636|MYCOPHENOLATE SODIUM 360M|Medicare|MEDICARE ACUTE|0.67||||||| 9524950|ERX|0250|CARBAMAZEPINE 100MG TABLE|Medicare|MEDICARE ACUTE|8.50||||||| 9524976|ERX|0250|RIVASTIGMINE 4.6MG PATCH|Medicare|MEDICARE ACUTE|79.50||||||| 9525056|ERX|0250|FERROUS SULFATE 140MG TAB|Medicare|MEDICARE ACUTE|0.05||||||| 9525189|ERX|0250|NIFEDIPINE SA 30MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|20.75||||||| 9525189|ERX|0250|NIFEDIPINE SA 30MG TABLET|Medicare|MEDICARE ACUTE|20.75||||||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Managed Medicare|BCBS MEDICARE PPO MA|336.25||||||| 9525247|ERX|0250|CIPROFLOXACIN 400MG/200ML|Medicare|MEDICARE ACUTE|336.25||||||| 9525296|ERX|0250|CIPROFLOXACIN 250MG TABLE|Aetna|AETNA OTHER|56.50||||||| 9525296|ERX|0250|CIPROFLOXACIN 250MG TABLE|Managed Medicare|HEALTHSPRING MA|56.50||||||| 9525296|ERX|0250|CIPROFLOXACIN 250MG TABLE|Blue Cross PPO Specialty|BCBSTX PPO|56.50||||||| 9525296|ERX|0250|CIPROFLOXACIN 250MG TABLE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|56.50||||||| 9525296|ERX|0250|CIPROFLOXACIN 250MG TABLE|Medicare|MEDICARE ACUTE|56.50||||||| 9525296|ERX|0250|CIPROFLOXACIN 250MG TABLE|Humana Medicare Advantage|HUMANA MA|56.50||||||| 9525411|ERX|0250|BUSPIRONE 5MG TABLET|Medicare|MEDICARE ACUTE|15.50||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Blue Cross HMO Specialty|BCBSTX HMO|15.50||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|15.50||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Medicaid|MEDICAID|15.50||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Aenta Medicare Advantage|AETNA MEDICARE MA|15.50||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|15.50||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|15.50||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Medicare|MEDICARE ACUTE|15.50||||||| 9525460|ERX|0250|METFORMIN 500MG TABLET|Humana Medicare Advantage|HUMANA MA|15.50||||||| 9525486|ERX|0250|METFORMIN XL 500MG TABLET|Medicare|MEDICARE ACUTE|15.50||||||| 9525577|ERX|0250|CALCIUM CARB 500 W/VIT D|Medicare|MEDICARE ACUTE|2.50||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|58.25||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|United Medicare Advantage|UHC AARP WELLMED HMO MA|58.25||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Blue Cross HMO Specialty|BCBSTX HMO|58.25||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|58.25||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|58.25||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Aenta Medicare Advantage|AETNA MEDICARE MA|58.25||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Blue Cross PPO Specialty|BCBSTX PPO|58.25||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Access Direct Platinum|HEALTHFIRST TPA|58.25||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|58.25||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|58.25||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Medicare|MEDICARE ACUTE|58.25||||||| 9525593|ERX|0250|LANTUS 100 UNIT/1ML,10ML|Humana Medicare Advantage|HUMANA MA|58.25||||||| 9525635|ERX|0250|HC ACETAT-PRAMOXINE FOAM,|Medicare|MEDICARE ACUTE|674.75||||||| 9525775|ERX|0250|NORTRIPTYLINE 25MG CAPSUL|Medicare|MEDICARE ACUTE|12.25||||||| 9525783|ERX|0250|KETOCONAZOLE 2% CREAM, 15|United Medicare Advantage|UHC MEDICARE GOLD MA|169.25||||||| 9525783|ERX|0250|KETOCONAZOLE 2% CREAM, 15|Managed Medicare|HEALTHSPRING MA|169.25||||||| 9525783|ERX|0250|KETOCONAZOLE 2% CREAM, 15|Medicare|MEDICARE ACUTE|169.25||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Blue Cross HMO Specialty|BCBSTX HMO|7.75||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|7.75||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Blue Cross PPO Specialty|BCBSTX PPO|7.75||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Access Direct Platinum|HEALTHFIRST TPA|7.75||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Medicare|MEDICARE ACUTE|7.75||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|Humana Medicare Advantage|HUMANA MA|7.75||||||| 9526104|ERX|0250|MAG HYDROX 400MG/5ML,30ML|United Medicare Advantage|UHC MEDICARE GOLD MA|7.75||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Texas Workforce Commission|DIS DETER SERV (DDS)|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|United Healthcare|UNITED HEALTHCARE OTHER|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|United Medicare Advantage|UHC MEDICARE GOLD MA|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Blue Cross HMO Specialty|BCBSTX HMO|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Aenta Medicare Advantage|AETNA MEDICARE MA|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Blue Cross PPO Specialty|BCBSTX PPO|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Access Direct Platinum|HEALTHFIRST TPA|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Medicare|MEDICARE ACUTE|2.50||||||| 9526161|ERX|0250|MELATONIN 3MG TAB|Humana Medicare Advantage|HUMANA MA|2.50||||||| 9526179|ERX|0250|DIPHENHYDRAMINE ELIX 25MG|Medicare|MEDICARE ACUTE|7.25||||||| 9526336|ERX|0250|CEFAZOLIN 1 GM/100 ML MB+|Medicare|MEDICARE ACUTE|0.23||||||| 9526401|ERX|0250|SILVER NITRATE APPLICATOR|Medicare|MEDICARE ACUTE|0.29||||||| 9526401|ERX|0250|SILVER NITRATE APPLICATOR|Humana Medicare Advantage|HUMANA MA|0.29||||||| 9526468|ERX|0250|EPHEDRINE 50 MG/10 ML SYR|Blue Cross PPO Specialty|BCBSTX PPO|46.50||||||| 9526468|ERX|0250|EPHEDRINE 50 MG/10 ML SYR|Medicare|MEDICARE ACUTE|46.50||||||| 9526484|ERX|0250|PHENYLEPH 1,000 MCG/10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.39||||||| 9526484|ERX|0250|PHENYLEPH 1,000 MCG/10ML|Blue Cross PPO Specialty|BCBSTX PPO|0.39||||||| 9526484|ERX|0250|PHENYLEPH 1,000 MCG/10ML|Medicare|MEDICARE ACUTE|0.39||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Blue Cross HMO Specialty|BCBSTX HMO|32.25||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|32.25||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|32.25||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Medicare|MEDICARE ACUTE|32.25||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Humana Medicare Advantage|HUMANA MA|32.25||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|Workers Compensation|WORKERS COMPENSATION OTHER|32.25||||||| 9526534|ERX|0250|NON-FORMULARY DRUG|United Medicare Advantage|UHC MEDICARE GOLD MA|32.25||||||| 9526575|ERX|0250|COMBIGAN 5 ML OPTH DROP|Medicare|MEDICARE ACUTE|591.75||||||| 9526641|ERX|0250|DESFLURANE ANESTHETIC GAS|Medicare|MEDICARE ACUTE|337.75||||||| 9526666|ERX|0250|SEVOFLURANE ANESTHETIC GA|Blue Cross PPO Specialty|BCBSTX PPO|423.25||||||| 9526666|ERX|0250|SEVOFLURANE ANESTHETIC GA|Access Direct Platinum|HEALTHFIRST TPA|423.25||||||| 9526666|ERX|0250|SEVOFLURANE ANESTHETIC GA|Medicare|MEDICARE ACUTE|423.25||||||| 9526666|ERX|0250|SEVOFLURANE ANESTHETIC GA|United Medicare Advantage|UHC MEDICARE GOLD MA|423.25||||||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Cigna|CIGNA OTHER|14.25||||||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Medicaid|MEDICAID|14.25||||||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|14.25||||||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Managed Medicare|HEALTHSPRING MA|14.25||||||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Medicare|MEDICARE ACUTE|14.25||||||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Managed Medicare|BCBS MEDICARE PPO MA|14.25||||||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Aenta Medicare Advantage|AETNA MEDICARE MA|14.25||||||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|Humana Medicare Advantage|HUMANA MA|14.25||||||| 9526765|ERX|0250|ACETAMINOPHEN 650 MG/20.3|United Medicare Advantage|UHC MEDICARE GOLD MA|14.25||||||| 9526773|ERX|0250|RIVAROXABAN 10 MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|0.64||||||| 9526773|ERX|0250|RIVAROXABAN 10 MG TABLET|Medicare|MEDICARE ACUTE|0.64||||||| 9526773|ERX|0250|RIVAROXABAN 10 MG TABLET|Workers Compensation|WORKERS COMPENSATION OTHER|0.64||||||| 9526781|ERX|0250|HEPARIN 100UNIT/ML 5 ML|Medicare|MEDICARE ACUTE|12.25||||||| 9526831|ERX|0250|TICAGRELOR 90 MG TABLET|Humana Medicare Advantage|HUMANA MA|41.75||||||| 9526872|ERX|0250|SEVELAMER 0.8 G POWDER PK|Humana Medicare Advantage|HUMANA MA|60.25||||||| 9526872|ERX|0250|SEVELAMER 0.8 G POWDER PK|Medicare|MEDICARE ACUTE|60.25||||||| 9526872|ERX|0250|SEVELAMER 0.8 G POWDER PK|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|60.25||||||| 9527060|ERX|0250|PHENYLEPHRINE 60 MG/250 M|Medicare|MEDICARE ACUTE|213.25||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Aetna|AETNA OTHER|19.75||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Aenta Medicare Advantage|AETNA MEDICARE MA|19.75||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|19.75||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Blue Cross PPO Specialty|BCBSTX PPO|19.75||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Medicaid|MEDICAID|19.75||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Managed Medicare|BCBS MEDICARE PPO MA|19.75||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|19.75||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Managed Medicare|HEALTHSPRING MA|19.75||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|United Medicare Advantage|UHC MEDICARE GOLD MA|19.75||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Blue Cross HMO Specialty|BCBSTX HMO|19.75||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|United Medicare Advantage|UHC AARP WELLMED HMO MA|19.75||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Medicare|MEDICARE PART B ONLY IP|19.75||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Medicare|MEDICARE ACUTE|19.75||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Humana Medicare Advantage|HUMANA MA|19.75||||||| 9527078|ERX|0250|ALBUTER 3MG / IPRATR. 0.5|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|19.75||||||| 9527094|ERX|0250|DEXTROMETHORPHAN-QUINIDIN|Medicare|MEDICARE ACUTE|62.50||||||| 9527417|ERX|0250|ROFLUMILAST 500MG TABLET|Humana Medicare Advantage|HUMANA MA|50.50||||||| 9527417|ERX|0250|ROFLUMILAST 500MG TABLET|Medicare|MEDICARE ACUTE|50.50||||||| 9527565|ERX|0250|MAGNESIUM SULFATE 1G/100M|Medicare|MEDICARE ACUTE|107.50||||||| 9527565|ERX|0250|MAGNESIUM SULFATE 1G/100M|United Medicare Advantage|UHC MEDICARE GOLD MA|107.50||||||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Blue Cross PPO Specialty|BCBSTX PPO|43.50||||||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Aetna|AETNA OTHER|43.50||||||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Medicare|MEDICARE ACUTE|43.50||||||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|43.50||||||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|Humana Medicare Advantage|HUMANA MA|43.50||||||| 9527581|ERX|0250|PRAVASTATIN 20 MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|43.50||||||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|257.75||||||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|Medicaid|MEDICAID|257.75||||||| 9527672|ERX|0250|AZTREONAM 1G/100ML NS|Medicare|MEDICARE ACUTE|257.75||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Managed Medicare|HEALTHSPRING MA|146.75||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Blue Cross HMO Specialty|BCBSTX HMO|146.75||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|146.75||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Medicare|MEDICARE ACUTE|146.75||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Humana Medicare Advantage|HUMANA MA|146.75||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|146.75||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|146.75||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Medicare|MEDICARE PART B ONLY IP|146.75||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|United Medicare Advantage|UHC AARP WELLMED HMO MA|146.75||||||| 9527706|ERX|0250|CEFEPIME 1G/100ML NS|Medicaid|MEDICAID|146.75||||||| 9527862|ERX|0250|DILTIAZEM 125MG/100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|107.50||||||| 9527862|ERX|0250|DILTIAZEM 125MG/100ML NS|Medicare|MEDICARE ACUTE|107.50||||||| 9528027|ERX|0250|PANTOPRAZOLE 40MG/100ML N|Medicare|MEDICARE ACUTE|107.50||||||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|Humana Medicare Advantage|HUMANA MA|134.25||||||| 9528142|ERX|0250|ZOSYN 2.25G/100ML NS|Medicare|MEDICARE ACUTE|134.25||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|146.75||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Blue Cross HMO Specialty|BCBSTX HMO|146.75||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|United Medicare Advantage|UHC AARP WELLMED HMO MA|146.75||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|PHCS|HUMANA INSURANCE|146.75||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Workers Compensation|WORKERS COMPENSATION OTHER|146.75||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|146.75||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Texas Workforce Commission|DIS DETER SERV (DDS)|146.75||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Medicaid|MEDICAID|146.75||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|146.75||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|146.75||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Humana Medicare Advantage|HUMANA MA|146.75||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Aenta Medicare Advantage|AETNA MEDICARE MA|146.75||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|146.75||||||| 9528159|ERX|0250|ZOSYN 3.375G/100ML NS|Medicare|MEDICARE ACUTE|146.75||||||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.83||||||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|PHCS|HUMANA INSURANCE|1.83||||||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Medicare|MEDICARE ACUTE|1.83||||||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Humana Medicare Advantage|HUMANA MA|1.83||||||| 9528167|ERX|0250|ZOSYN 4.5G/100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|1.83||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|PHCS|HUMANA INSURANCE|107.75||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|United Medicare Advantage|UHC AARP WELLMED HMO MA|107.75||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Texas Workforce Commission|DIS DETER SERV (DDS)|107.75||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|United Medicare Advantage|UHC MEDICARE GOLD MA|107.75||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|107.75||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Blue Cross HMO Specialty|BCBSTX HMO|107.75||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|107.75||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Blue Cross PPO Specialty|BCBSTX PPO|107.75||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|107.75||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Access Direct Platinum|HEALTHFIRST TPA|107.75||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Managed Medicare|BCBS MEDICARE PPO MA|107.75||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|107.75||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Aenta Medicare Advantage|AETNA MEDICARE MA|107.75||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Medicare|MEDICARE ACUTE|107.75||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|107.75||||||| 9528175|ERX|0250|INSULIN,HUMALOG 100UNIT/1|Humana Medicare Advantage|HUMANA MA|107.75||||||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|United Medicare Advantage|UHC MEDICARE GOLD MA|0.62||||||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Medicare|MEDICARE ACUTE|0.62||||||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Cigna|CIGNA OTHER|0.62||||||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Access Direct Platinum|HEALTHFIRST TPA|0.62||||||| 9528183|ERX|0250|INSULIN,HUMULIN R 100UNIT|Humana Medicare Advantage|HUMANA MA|0.62||||||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|Blue Cross PPO Specialty|BCBSTX PPO|0.62||||||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|Medicare|MEDICARE ACUTE|0.62||||||| 9528191|ERX|0250|INSULIN,HUMULIN N 100UNIT|Humana Medicare Advantage|HUMANA MA|0.62||||||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|Blue Cross PPO Specialty|BCBSTX PPO|57.25||||||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|57.25||||||| 9528209|ERX|0250|INSULIN,HUMULIN 70/30 100|Medicare|MEDICARE ACUTE|57.25||||||| 9528258|ERX|0250|CEPACOL LOZENGE|Blue Cross HMO Specialty|BCBSTX HMO|11.50||||||| 9528258|ERX|0250|CEPACOL LOZENGE|Medicare|MEDICARE ACUTE|11.50||||||| 9528258|ERX|0250|CEPACOL LOZENGE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|11.50||||||| 9528258|ERX|0250|CEPACOL LOZENGE|Blue Cross PPO Specialty|BCBSTX PPO|11.50||||||| 9528357|ERX|0250|PHENOBARBITOL UD 20ML/5ML|Workers Compensation|WORKERS COMPENSATION OTHER|11.50||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Blue Cross HMO Specialty|BCBSTX HMO|2.72||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Aetna|AETNA OTHER|2.72||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Medicaid|MEDICAID|2.72||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.72||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Blue Cross PPO Specialty|BCBSTX PPO|2.72||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.72||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Cigna|CIGNA OTHER|2.72||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Medicare|MEDICARE ACUTE|2.72||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Medicare|MEDICARE PART B ONLY IP|2.72||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|Humana Medicare Advantage|HUMANA MA|2.72||||||| 9528431|ERX|0250|CEFEPIME 2G IN 100ML NS|United Medicare Advantage|UHC MEDICARE GOLD MA|2.72||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Humana Medicare Advantage|HUMANA MA|107.50||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Medicare|MEDICARE ACUTE|107.50||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Access Direct Platinum|HEALTHFIRST TPA|107.50||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|United Medicare Advantage|UHC AARP WELLMED HMO MA|107.50||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Blue Cross HMO Specialty|BCBSTX HMO|107.50||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|United Medicare Advantage|UHC MEDICARE GOLD MA|107.50||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Managed Medicaid|MEDICAID UNITED HEALTHCARE|107.50||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Workers Compensation|WORKERS COMPENSATION OTHER|107.50||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|107.50||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Medicaid|MEDICAID|107.50||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|107.50||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Tricare|TRICARE FOR LIFE|107.50||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Cigna|CIGNA OTHER|107.50||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|107.50||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Aenta Medicare Advantage|AETNA MEDICARE MA|107.50||||||| 9528555|ERX|0250|POTASSIUM CHLORIDE 10MEQ/|Blue Cross PPO Specialty|BCBSTX PPO|107.50||||||| 9528654|ERX|0250|ROXANOL 20MG/1ML ORAL SYR|Medicare|MEDICARE ACUTE|11.50||||||| 9528704|ERX|0250|SODIUM CHLORIDE 0.9% IRRI|Medicare|MEDICARE ACUTE|107.50||||||| 9528852|ERX|0250|BUPIVACAINE LIPOSOME 1.3%|Medicare|MEDICARE ACUTE|18.58||||||| 9528860|ERX|0636|MORPHINE 4MG/ML VIAL|Medicare|MEDICARE PART B ONLY IP|0.16||||||| 9528860|ERX|0636|MORPHINE 4MG/ML VIAL|Humana Medicare Advantage|HUMANA MA|0.16||||||| 9528860|ERX|0636|MORPHINE 4MG/ML VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|0.16||||||| 9528860|ERX|0636|MORPHINE 4MG/ML VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|0.16||||||| 9528860|ERX|0636|MORPHINE 4MG/ML VIAL|Medicare|MEDICARE ACUTE|0.16||||||| 9528860|ERX|0636|MORPHINE 4MG/ML VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.16||||||| 9528878|ERX|0250|FENTANYL 2000MCG/100ML NS|Medicare|MEDICARE ACUTE|135.75||||||| 9528878|ERX|0250|FENTANYL 2000MCG/100ML NS|Texas Workforce Commission|DIS DETER SERV (DDS)|135.75||||||| 9528878|ERX|0250|FENTANYL 2000MCG/100ML NS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|135.75||||||| 9528878|ERX|0250|FENTANYL 2000MCG/100ML NS|Humana Medicare Advantage|HUMANA MA|135.75||||||| 9529066|ERX|0250|SODIUM CHLORIDE 7% INH 4M|Aetna|AETNA OTHER|5.75||||||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Access Direct Platinum|HEALTHFIRST TPA|509.75||||||| 9529140|ERX|0250|SUGAMMADEX 200MG/2ML VIAL|Medicare|MEDICARE ACUTE|509.75||||||| 9529157|ERX|0250|LINACLOTIDE 145MCG CAPSUL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.78||||||| 9529157|ERX|0250|LINACLOTIDE 145MCG CAPSUL|Medicare|MEDICARE ACUTE|0.78||||||| 9529256|ERX|0250|NALOXEGOL 25 MG TABLET|Medicare|MEDICARE ACUTE|66.82||||||| 9529389|ERX|0250|MULTIVITAMIN LIQUID, 15 M|Workers Compensation|WORKERS COMPENSATION OTHER|8.80||||||| 9529389|ERX|0250|MULTIVITAMIN LIQUID, 15 M|United Medicare Advantage|UHC MEDICARE GOLD MA|8.80||||||| 9529389|ERX|0250|MULTIVITAMIN LIQUID, 15 M|Managed Medicare|HEALTHSPRING MA|8.80||||||| 9529389|ERX|0250|MULTIVITAMIN LIQUID, 15 M|Blue Cross PPO Specialty|BCBSTX PPO|8.80||||||| 9529389|ERX|0250|MULTIVITAMIN LIQUID, 15 M|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|8.80||||||| 9529389|ERX|0250|MULTIVITAMIN LIQUID, 15 M|Medicare|MEDICARE ACUTE|8.80||||||| 9529389|ERX|0250|MULTIVITAMIN LIQUID, 15 M|Aenta Medicare Advantage|AETNA MEDICARE MA|8.80||||||| 9529397|ERX|0250|SACUBITRIL-VALSARTAN 24-2|Medicare|MEDICARE ACUTE|46.92||||||| 9529421|ERX|0250|MIRABEGRON 25 MG TABLET|Humana Medicare Advantage|HUMANA MA|75.05||||||| 9529421|ERX|0250|MIRABEGRON 25 MG TABLET|Medicare|MEDICARE ACUTE|75.05||||||| 9529587|ERX|0250|MULTIVITAMIN LIQUID 30 ML|Workers Compensation|WORKERS COMPENSATION OTHER|8.80||||||| 9529629|ERX|0250|BUPIVACAINE-EPI 0.5%, 50|Medicare|MEDICARE ACUTE|91.93||||||| 9529660|ERX|0250|BUPIVACAINE LIPOSOME 1.3%|Medicare|MEDICARE ACUTE|877.20||||||| 9529751|ERX|0250|DOLUTEGRAVIR 25 MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|165.75||||||| 957|DRG||OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA W MCC|Medicare|MEDICARE ACUTE|197,820.67|35772.6|35772.6|35772.6|||| 95700|EAP|0740|EEG CONT REC W/VID EEG TE|Medicaid|MEDICAID|6.84||||||| 95714|EAP|0740|VEEG EA 12-26 HR UNMNTR|Medicaid|MEDICAID|13.12||||||| 95819|EAP|0740|EEG AWAKE AND ASLEEP|Workers Compensation|WORKERS COMPENSATION OTHER|13.78||||||| 95819|EAP|0740|EEG AWAKE Q506675|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|17.21||||||| 95819|EAP|0740|EEG AWAKE AND ASLEEP|Humana Medicare Advantage|HUMANA MA|13.78||||||| 95819|EAP|0740|EEG AWAKE Q506675|Humana Medicare Advantage|HUMANA MA|17.21||||||| 95819|EAP|0740|EEG AWAKE Q506675|Blue Cross HMO Specialty|BCBSTX HMO|17.21||||||| 95819|EAP|0740|EEG AWAKE Q506675|Managed Medicare|HEALTHSPRING MA|17.21||||||| 95819|EAP|0740|EEG AWAKE Q506675|Medicaid|MEDICAID|17.21||||||| 95819|EAP|0740|EEG AWAKE AND ASLEEP|United Medicare Advantage|UHC MEDICARE GOLD MA|13.78||||||| 95819|EAP|0740|EEG AWAKE AND ASLEEP|Medicaid|MEDICAID|13.78||||||| 95819|EAP|0740|EEG AWAKE AND ASLEEP|Blue Cross PPO Specialty|BCBSTX PPO|13.78||||||| 95819|EAP|0740|EEG AWAKE Q506675|Aenta Medicare Advantage|AETNA MEDICARE MA|17.21||||||| 95819|EAP|0740|EEG AWAKE AND ASLEEP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|13.78||||||| 95819|EAP|0740|EEG AWAKE Q506675|Medicare|MEDICARE ACUTE|17.21||||||| 95819|EAP|0740|EEG AWAKE AND ASLEEP|Medicare|MEDICARE ACUTE|13.78||||||| 95822|EAP|0740|EEG ASLEEP|Medicare|MEDICARE ACUTE|21.03||||||| 9582883|ERX|0250|PAPAVERINE 60MG/ 2ML VIAL|Medicare|MEDICARE ACUTE|27.50||||||| 9582933|ERX|0250|AMIODARONE 360MG 200ML DE|Aenta Medicare Advantage|AETNA MEDICARE MA|305.50||||||| 9582933|ERX|0250|AMIODARONE 360MG 200ML DE|Medicare|MEDICARE ACUTE|305.50||||||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|Cigna|CIGNA OTHER|13.50||||||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|United Medicare Advantage|UHC MEDICARE GOLD MA|13.50||||||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|Blue Cross HMO Specialty|BCBSTX HMO|13.50||||||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|Blue Cross PPO Specialty|BCBSTX PPO|13.50||||||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|Medicare|MEDICARE ACUTE|13.50||||||| 9582982|ERX|0250|HYDROMORPHONE 1MG/ML AMPU|Humana Medicare Advantage|HUMANA MA|13.50||||||| 9583071|ERX|0250|GUAIFENESIN-DM 100-10MG/5|Blue Cross HMO Specialty|BCBSTX HMO|10.50||||||| 9583071|ERX|0250|GUAIFENESIN-DM 100-10MG/5|Blue Cross PPO Specialty|BCBSTX PPO|10.50||||||| 9583071|ERX|0250|GUAIFENESIN-DM 100-10MG/5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|10.50||||||| 9583071|ERX|0250|GUAIFENESIN-DM 100-10MG/5|Access Direct Platinum|HEALTHFIRST TPA|10.50||||||| 9583071|ERX|0250|GUAIFENESIN-DM 100-10MG/5|Medicare|MEDICARE ACUTE|10.50||||||| 9583071|ERX|0250|GUAIFENESIN-DM 100-10MG/5|Humana Medicare Advantage|HUMANA MA|10.50||||||| 9583071|ERX|0250|GUAIFENESIN-DM 100-10MG/5|PHCS|HUMANA INSURANCE|10.50||||||| 9583071|ERX|0250|GUAIFENESIN-DM 100-10MG/5|Workers Compensation|WORKERS COMPENSATION OTHER|10.50||||||| 9583691|ERX|0250|HEPARIN 2000 UNITS/1000ML|Medicare|MEDICARE ACUTE|169.50||||||| 9583691|ERX|0250|HEPARIN 2000 UNITS/1000ML|United Medicare Advantage|UHC MEDICARE GOLD MA|169.50||||||| 9583725|ERX|0250|LOPERAMIDE 1MG/ 7.5ML 4OZ|Managed Medicare|HEALTHSPRING MA|23.50||||||| 9583725|ERX|0250|LOPERAMIDE 1MG/ 7.5ML 4OZ|Humana Medicare Advantage|HUMANA MA|23.50||||||| 9583725|ERX|0250|LOPERAMIDE 1MG/ 7.5ML 4OZ|Medicare|MEDICARE ACUTE|23.50||||||| 9583725|ERX|0250|LOPERAMIDE 1MG/ 7.5ML 4OZ|Blue Cross PPO Specialty|BCBSTX PPO|23.50||||||| 9583725|ERX|0250|LOPERAMIDE 1MG/ 7.5ML 4OZ|Blue Cross HMO Specialty|BCBSTX HMO|23.50||||||| 9583725|ERX|0250|LOPERAMIDE 1MG/ 7.5ML 4OZ|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|23.50||||||| 9583766|ERX|0250|LEVALBUTEROL 1.25MG/.05ML|Workers Compensation|WORKERS COMPENSATION OTHER|50.50||||||| 9583766|ERX|0250|LEVALBUTEROL 1.25MG/.05ML|Humana Medicare Advantage|HUMANA MA|50.50||||||| 9583766|ERX|0250|LEVALBUTEROL 1.25MG/.05ML|Medicare|MEDICARE ACUTE|50.50||||||| 9583816|ERX|0250|PROCALAMINE 1000ML BOTTLE|Medicare|MEDICARE ACUTE|7.50||||||| 9583816|ERX|0250|PROCALAMINE 1000ML BOTTLE|Blue Cross PPO Specialty|BCBSTX PPO|7.50||||||| 9583816|ERX|0250|PROCALAMINE 1000ML BOTTLE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|7.50||||||| 9584129|ERX|0250|VALPROATE SOD LIQ 250MG/5|Texas Workforce Commission|DIS DETER SERV (DDS)|10.50||||||| 9584129|ERX|0250|VALPROATE SOD LIQ 250MG/5|Managed Medicare|HEALTHSPRING MA|10.50||||||| 9584459|ERX|0250|CEFTRIAXONE 1G D5W 50ML D|Medicare|MEDICARE ACUTE|99.50||||||| 9584467|ERX|0250|CEFTRIAXONE 2G D5W 50ML D|United Medicare Advantage|UHC MEDICARE GOLD MA|135.75||||||| 9584467|ERX|0250|CEFTRIAXONE 2G D5W 50ML D|Medicare|MEDICARE ACUTE|135.75||||||| 9584467|ERX|0250|CEFTRIAXONE 2G D5W 50ML D|Humana Medicare Advantage|HUMANA MA|135.75||||||| 9584475|ERX|0250|CEFEPIME 1G D5W 50ML DUPL|Blue Cross PPO Specialty|BCBSTX PPO|99.50||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Aetna|AETNA OTHER|10.50||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Blue Cross PPO Specialty|BCBSTX PPO|10.50||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|10.50||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Cigna|CIGNA OTHER|10.50||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Medicare|MEDICARE ACUTE|10.50||||||| 9584558|ERX|0250|CALCIUM CARBONATE 500MG C|Humana Medicare Advantage|HUMANA MA|10.50||||||| 9584624|ERX|0250|DILTIAZEM 100MG IN 100ML|Humana Medicare Advantage|HUMANA MA|99.50||||||| 9584772|ERX|0250|FERROUS SULFATE 300MG/5ML|Blue Cross HMO Specialty|BCBSTX HMO|10.50||||||| 9584772|ERX|0250|FERROUS SULFATE 300MG/5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|10.50||||||| 9584772|ERX|0250|FERROUS SULFATE 300MG/5ML|Managed Medicare|HEALTHSPRING MA|10.50||||||| 9584772|ERX|0250|FERROUS SULFATE 300MG/5ML|Medicaid|MEDICAID|10.50||||||| 9584772|ERX|0250|FERROUS SULFATE 300MG/5ML|Blue Cross PPO Specialty|BCBSTX PPO|10.50||||||| 9584772|ERX|0250|FERROUS SULFATE 300MG/5ML|Aenta Medicare Advantage|AETNA MEDICARE MA|10.50||||||| 9584772|ERX|0250|FERROUS SULFATE 300MG/5ML|United Medicare Advantage|UHC AARP WELLMED HMO MA|10.50||||||| 9584772|ERX|0250|FERROUS SULFATE 300MG/5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|10.50||||||| 9584772|ERX|0250|FERROUS SULFATE 300MG/5ML|Medicare|MEDICARE ACUTE|10.50||||||| 9584772|ERX|0250|FERROUS SULFATE 300MG/5ML|Humana Medicare Advantage|HUMANA MA|10.50||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Managed Medicare|HEALTHSPRING MA|0.28||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.28||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Medicare|MEDICARE ACUTE|0.28||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|Humana Medicare Advantage|HUMANA MA|0.28||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|PHCS|HUMANA INSURANCE|0.28||||||| 9584830|ERX|0250|APIXABAN 5MG TABLET|United Medicare Advantage|UHC MEDICARE GOLD MA|0.28||||||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|Humana Medicare Advantage|HUMANA MA|0.28||||||| 9584848|ERX|0250|APIXABAN 2.5MG TABLET|Medicare|MEDICARE ACUTE|0.28||||||| 9585159|ERX|0250|AZTREONAM 2 G NS MB+|Medicare|MEDICARE ACUTE|407.25||||||| 9585233|ERX|0250|FLUTICASONE 110 MCG INHAL|Blue Cross PPO Specialty|BCBSTX PPO|1,354.25||||||| 9585274|ERX|0250|VANCOMYCIN 750 MG VIAL|Medicare|MEDICARE ACUTE|0.41||||||| 9586348|ERX|0250|LIDO-MAALOX-BENADRYL 30ML|Blue Cross HMO Specialty|BCBSTX HMO|12.50||||||| 9586348|ERX|0250|LIDO-MAALOX-BENADRYL 30ML|Medicare|MEDICARE ACUTE|12.50||||||| 9586348|ERX|0250|LIDO-MAALOX-BENADRYL 30ML|Humana Medicare Advantage|HUMANA MA|12.50||||||| 9587098|ERX|0250|RITONAVIR 100 MG TABLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|42.98||||||| 9587114|ERX|0250|LABETALOL 20 MG/4 ML SYRI|Medicare|MEDICARE ACUTE|98.02||||||| 9587130|ERX|0250|SELENIUM 200 MCG TABLET|United Medicare Advantage|UHC AARP WELLMED HMO MA|8.80||||||| 9587130|ERX|0250|SELENIUM 200 MCG TABLET|Humana Medicare Advantage|HUMANA MA|8.80||||||| 9587130|ERX|0250|SELENIUM 200 MCG TABLET|Medicare|MEDICARE ACUTE|8.80||||||| 9587288|ERX|0250|MULTITRACE-5 CONC 1ML VIA|Cigna|CIGNA OTHER|0.63||||||| 9587288|ERX|0250|MULTITRACE-5 CONC 1ML VIA|Medicare|MEDICARE ACUTE|0.63||||||| 9587288|ERX|0250|MULTITRACE-5 CONC 1ML VIA|Access Direct Platinum|HEALTHFIRST TPA|0.63||||||| 9587338|ERX|0250|REMDESIVIR 100 MG VIAL-PO|Medicare|MEDICARE ACUTE|6.50||||||| 9587338|ERX|0250|REMDESIVIR 100 MG VIAL-PO|Humana Medicare Advantage|HUMANA MA|6.50||||||| 9589193|ERX|0250|HYDROC-ACET 2.5-108MG/5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|25.50||||||| 9589193|ERX|0250|HYDROC-ACET 2.5-108MG/5ML|United Medicare Advantage|UHC AARP WELLMED HMO MA|25.50||||||| 9589193|ERX|0250|HYDROC-ACET 2.5-108MG/5ML|Blue Cross HMO Specialty|BCBSTX HMO|25.50||||||| 9589193|ERX|0250|HYDROC-ACET 2.5-108MG/5ML|Aetna|AETNA OTHER|25.50||||||| 9589193|ERX|0250|HYDROC-ACET 2.5-108MG/5ML|Managed Medicare|HEALTHSPRING MA|25.50||||||| 9589193|ERX|0250|HYDROC-ACET 2.5-108MG/5ML|Medicaid|MEDICAID|25.50||||||| 9589193|ERX|0250|HYDROC-ACET 2.5-108MG/5ML|Aenta Medicare Advantage|AETNA MEDICARE MA|25.50||||||| 9589193|ERX|0250|HYDROC-ACET 2.5-108MG/5ML|Medicare|MEDICARE ACUTE|25.50||||||| 9589193|ERX|0250|HYDROC-ACET 2.5-108MG/5ML|Humana Medicare Advantage|HUMANA MA|25.50||||||| 9589508|ERX|0636|MICAFUNGIN 100 MG IN 100|Humana Medicare Advantage|HUMANA MA|1,085.50||||||| 9589508|ERX|0636|MICAFUNGIN 100 MG IN 100|Blue Cross HMO Specialty|BCBSTX HMO|1,085.50||||||| 9589508|ERX|0636|MICAFUNGIN 100 MG IN 100|Managed Medicare|BCBS MEDICARE PPO MA|1,085.50||||||| 9589508|ERX|0636|MICAFUNGIN 100 MG IN 100|Medicare|MEDICARE ACUTE|1,085.50||||||| 9589508|ERX|0636|MICAFUNGIN 100 MG IN 100|United Medicare Advantage|UHC MEDICARE GOLD MA|1,085.50||||||| 9589540|ERX|0250|LEVETIRACETAM 500MG/5ML U|Workers Compensation|WORKERS COMPENSATION OTHER|21.50||||||| 9589540|ERX|0250|LEVETIRACETAM 500MG/5ML U|Medicaid|MEDICAID|21.50||||||| 9589540|ERX|0250|LEVETIRACETAM 500MG/5ML U|Blue Cross PPO Specialty|BCBSTX PPO|21.50||||||| 9589540|ERX|0250|LEVETIRACETAM 500MG/5ML U|Medicare|MEDICARE ACUTE|21.50||||||| 9589565|ERX|0636|MICAFUNGIN 100 MG VIAL|Medicare|MEDICARE ACUTE|1,085.50||||||| 9589565|ERX|0636|MICAFUNGIN 100 MG VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|1,085.50||||||| 9590084|ERX|0250|LURASIDONE 20 MG TABLET|Medicare|MEDICARE ACUTE|151.25||||||| 9590142|ERX|0250|BENZOCAINE ORAL SPRAY 0.5|Medicare|MEDICARE ACUTE|73.25||||||| 9590241|ERX|0250|RIBAVIRIN 200MG CAPSULE|Medicare|MEDICARE ACUTE|62.25||||||| 9590407|ERX|0250|HEPARIN LOCK 10 UNIT/ML 5|Medicare|MEDICARE ACUTE|27.25||||||| 9590449|ERX|0250|EMPAGLIFLOZIN(JARDIANCE)2|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.86||||||| 9590449|ERX|0250|EMPAGLIFLOZIN(JARDIANCE)2|Medicare|MEDICARE ACUTE|0.86||||||| 9590449|ERX|0250|EMPAGLIFLOZIN(JARDIANCE)2|Humana Medicare Advantage|HUMANA MA|0.86||||||| 9590456|ERX|0250|LINAGLIPTIN(TRADJENTA) 5M|Medicare|MEDICARE ACUTE|0.83||||||| 9590456|ERX|0250|LINAGLIPTIN(TRADJENTA) 5M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.83||||||| 9590456|ERX|0250|LINAGLIPTIN(TRADJENTA) 5M|Blue Cross PPO Specialty|BCBSTX PPO|0.83||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|United Medicare Advantage|UHC AARP WELLMED HMO MA|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Aetna|AETNA OTHER|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Managed Medicare|HEALTHSPRING MA|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Aenta Medicare Advantage|AETNA MEDICARE MA|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Medicare|MEDICARE ACUTE|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Humana Medicare Advantage|HUMANA MA|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Blue Cross HMO Specialty|BCBSTX HMO|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Blue Cross PPO Specialty|BCBSTX PPO|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|United Medicare Advantage|UHC MEDICARE GOLD MA|202.75||||||| 9590498|ERX|0250|VENELEX OINTMENT 60GM TUB|Texas Workforce Commission|DIS DETER SERV (DDS)|202.75||||||| 9590522|ERX|0250|DEXMEDETOMIDINE 200MCG/50|Humana Medicare Advantage|HUMANA MA|360.50||||||| 9590522|ERX|0250|DEXMEDETOMIDINE 200MCG/50|Texas Workforce Commission|DIS DETER SERV (DDS)|360.50||||||| 9590522|ERX|0250|DEXMEDETOMIDINE 200MCG/50|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|360.50||||||| 9590522|ERX|0250|DEXMEDETOMIDINE 200MCG/50|Medicare|MEDICARE ACUTE|360.50||||||| 9590571|ERX|0250|PHYTONADIONE 1MG TABLET|Medicare|MEDICARE ACUTE|0.02||||||| 9590605|ERX|0636|NEOSTIGMINE 3MG/3ML SYRIN|Medicare|MEDICARE ACUTE|1.77||||||| 9590639|ERX|0250|PHENYLEPH-SHARK LIVER-CCB|Medicare|MEDICARE ACUTE|9.25||||||| 9590779|ERX|0250|SULFAMETH-TRIMET 800-160M|Medicare|MEDICARE ACUTE|0.36||||||| 9590910|ERX|0250|MINERAL OIL, STERILE, 10M|Blue Cross PPO Specialty|BCBSTX PPO|101.62||||||| 9590910|ERX|0250|MINERAL OIL, STERILE, 10M|Medicare|MEDICARE ACUTE|101.62||||||| 9591066|ERX|0250|MIDAZOLAM 100 MG/100 ML N|Texas Workforce Commission|DIS DETER SERV (DDS)|0.85||||||| 9591066|ERX|0250|MIDAZOLAM 100 MG/100 ML N|Blue Cross PPO Specialty|BCBSTX PPO|0.85||||||| 9591066|ERX|0250|MIDAZOLAM 100 MG/100 ML N|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.85||||||| 9591066|ERX|0250|MIDAZOLAM 100 MG/100 ML N|Medicare|MEDICARE ACUTE|0.85||||||| 9591074|ERX|0250|NOREPINEPHRINE 8 MG/250 M|Aenta Medicare Advantage|AETNA MEDICARE MA|101.50||||||| 9591074|ERX|0250|NOREPINEPHRINE 8 MG/250 M|Medicare|MEDICARE ACUTE|101.50||||||| 9591074|ERX|0250|NOREPINEPHRINE 8 MG/250 M|Humana Medicare Advantage|HUMANA MA|101.50||||||| 97|DRG||NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W MCC|Medicare|MEDICARE ACUTE|421,789.15|39831.55|39831.55|39831.55|||| 97110|EAP|0420|THERAPEUTIC EXERCISE, IND|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||213.75||| 97161|EAP|0420|PHYSICAL THERAPY EVAL/LOW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.96||| 97162|EAP|0420|EVAL INIT/DIS|United Medicare Advantage|UHC MEDICARE GOLD MA|6.87||||||| 97162|EAP|0420|EVAL INIT/DIS|United Medicare Advantage|UHC AARP WELLMED HMO MA|6.87||||||| 97162|EAP|0420|EVAL INIT/DIS|Tricare|TRICARE FOR LIFE|6.87||||||| 97162|EAP|0420|EVAL INIT/DIS|PHCS|HUMANA INSURANCE|6.87||||||| 97162|EAP|0420|EVAL INIT/DIS|United Healthcare|UNITED HEALTHCARE OTHER|6.87||||||| 97162|EAP|0420|EVAL INIT/DIS|Texas Workforce Commission|DIS DETER SERV (DDS)|6.87||||||| 97162|EAP|0420|EVAL INIT/DIS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|6.87||||||| 97162|EAP|0420|EVAL INIT/DIS|Aetna|AETNA OTHER|6.87||||||| 97162|EAP|0420|EVAL INIT/DIS|Humana Medicare Advantage|HUMANA MA|6.87||||||| 97162|EAP|0420|EVAL INIT/DIS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|6.87||||||| 97162|EAP|0420|EVAL INIT/DIS|Managed Medicare|HEALTHSPRING MA|6.87||||||| 97162|EAP|0420|EVAL INIT/DIS|Managed Medicare|BCBS MEDICARE PPO MA|6.87||||||| 97162|EAP|0420|EVAL INIT/DIS|Medicaid|MEDICAID|6.87||||||| 97162|EAP|0420|EVAL INIT/DIS|Blue Cross PPO Specialty|BCBSTX PPO|6.87||||||| 97162|EAP|0420|EVAL INIT/DIS|Cigna|CIGNA OTHER|6.87||||||| 97162|EAP|0420|EVAL INIT/DIS|Access Direct Platinum|HEALTHFIRST TPA|6.87||||||| 97162|EAP|0420|EVAL INIT/DIS|Blue Cross HMO Specialty|BCBSTX HMO|6.87||||||| 97162|EAP|0420|EVAL INIT/DIS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|6.87||||||| 97162|EAP|0420|EVAL INIT/DIS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|6.87||||||| 97162|EAP|0420|EVAL INIT/DIS|Aenta Medicare Advantage|AETNA MEDICARE MA|6.87||||||| 97162|EAP|0420|EVAL INIT/DIS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|6.87||||||| 97162|EAP|0420|EVAL INIT/DIS|Medicare|MEDICARE PART B ONLY IP|6.87||||||| 97162|EAP|0420|EVAL INIT/DIS|Medicare|MEDICARE ACUTE|6.87||||||| 97164|EAP|0420|RE-EVALUATION OF PHYSICAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.20||| 981|DRG||EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W MCC|Medicare|MEDICARE ACUTE|513,060.12|63081.405|63081.405|63081.405|||| 987|DRG||NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W MCC|Blue Cross PPO Specialty|BCBSTX PPO|185,193.30|144|388963.49|144|||| 987|DRG||NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W MCC|Medicare|MEDICARE ACUTE|159,733.35|23010.97|388963.49|144|||| 987|DRG||NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W MCC|Humana Medicare Advantage|HUMANA MA|3,928,245.25|388963.49|388963.49|144|||| 988|DRG||NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W CC|Medicare|MEDICARE ACUTE|69,092.75|10120.88|10120.88|10120.88|||| A4216|ERX|0250|WATER FOR INJ.,STERILE 10|Medicare|MEDICARE ACUTE|0.13||||||| A9502|EAP|0343|TC99M MYOVIEW PER STUDY|Aetna|AETNA OTHER|520.50||||||| A9537|EAP|0255|CHOLETEC RX|Medicare|MEDICARE ACUTE|391.50||||||| A9576|EAP|0255|PROHANCE 20ML NDC0270-111|Blue Cross PPO Specialty|BCBSTX PPO|9.24||||||| A9576|EAP|0255|PROHANCE 20ML NDC0270-111|Aenta Medicare Advantage|AETNA MEDICARE MA|9.24||||||| A9576|EAP|0255|PROHANCE 20ML NDC0270-111|Cigna|CIGNA OTHER|9.24||||||| A9576|EAP|0255|PROHANCE 20ML NDC0270-111|Medicare|MEDICARE ACUTE|9.24||||||| A9576|EAP|0255|PROHANCE 15ML VIAL/ML NDC|Medicare|MEDICARE ACUTE|9.87||||||| A9576|EAP|0255|PROHANCE 20ML NDC0270-111|Humana Medicare Advantage|HUMANA MA|9.24||||||| C1725|EAP|0272|BALLOON ANGIOPLASTY CATHE|Medicare|MEDICARE ACUTE|1,396.50||||||| C1769|EAP|0270|GUIDE WIRE|Medicare|MEDICARE ACUTE|241.50||||||| C1769|EAP|0272|GUIDEWIRE JAGTOME RX44|Medicare|MEDICARE ACUTE|2,047.50||||||| H5300|EAP|0430|PHYSICAL MEDICINE 60 MINU|United Medicare Advantage|UHC MEDICARE GOLD MA|1,127.50||||||| H5300|EAP|0430|PHYSICAL MEDICINE 45 MINU|United Medicare Advantage|UHC MEDICARE GOLD MA|838.25||||||| H5300|EAP|0430|PHYSICAL MEDICINE 45 MINU|United Medicare Advantage|UHC AARP WELLMED HMO MA|838.25||||||| H5300|EAP|0430|PHYS MED 3O MIN|United Medicare Advantage|UHC MEDICARE GOLD MA|651.25||||||| H5300|EAP|0430|PHYS MED 15 MIN|United Medicare Advantage|UHC MEDICARE GOLD MA|3.40||||||| H5300|EAP|0430|PHYS MED 15 MIN|United Medicare Advantage|UHC AARP WELLMED HMO MA|3.40||||||| H5300|EAP|0430|PHYSICAL MEDICINE 45 MINU|Tricare|TRICARE FOR LIFE|838.25||||||| H5300|EAP|0430|PHYS MED 15 MIN|Tricare|TRICARE FOR LIFE|3.40||||||| H5300|EAP|0430|PHYSICAL MEDICINE 60 MINU|PHCS|HUMANA INSURANCE|1,127.50||||||| H5300|EAP|0430|PHYS MED 15 MIN|PHCS|HUMANA INSURANCE|3.40||||||| H5300|EAP|0430|PHYSICAL MEDICINE 45 MINU|PHCS|HUMANA INSURANCE|838.25||||||| H5300|EAP|0430|PHYSICAL MEDICINE 45 MINU|United Healthcare|UNITED HEALTHCARE OTHER|838.25||||||| H5300|EAP|0430|PHYS MED 3O MIN|United Healthcare|UNITED HEALTHCARE OTHER|651.25||||||| H5300|EAP|0430|PHYS MED 15 MIN|United Healthcare|UNITED HEALTHCARE OTHER|3.40||||||| H5300|EAP|0430|PHYS MED 15 MIN|Texas Workforce Commission|DIS DETER SERV (DDS)|3.40||||||| H5300|EAP|0430|PHYS MED 3O MIN|Texas Workforce Commission|DIS DETER SERV (DDS)|651.25||||||| H5300|EAP|0430|PHYS MED 15 MIN|Humana Medicare Advantage|HUMANA MA|3.40||||||| H5300|EAP|0430|PHYSICAL MEDICINE 45 MINU|Humana Medicare Advantage|HUMANA MA|838.25||||||| H5300|EAP|0430|PHYS MED 3O MIN|Humana Medicare Advantage|HUMANA MA|651.25||||||| H5300|EAP|0430|PHYSICAL MEDICINE 60 MINU|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1,127.50||||||| H5300|EAP|0430|PHYSICAL MEDICINE 45 MINU|Managed Medicaid|MEDICAID UNITED HEALTHCARE|838.25||||||| H5300|EAP|0430|PHYS MED 3O MIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|651.25||||||| H5300|EAP|0430|PHYSICAL MEDICINE 60 MINU|Blue Cross HMO Specialty|BCBSTX HMO|1,127.50||||||| H5300|EAP|0430|PHYS MED 3O MIN|Blue Cross HMO Specialty|BCBSTX HMO|651.25||||||| H5300|EAP|0430|PHYS MED 15 MIN|Blue Cross HMO Specialty|BCBSTX HMO|3.40||||||| H5300|EAP|0430|PHYSICAL MEDICINE 45 MINU|Aetna|AETNA OTHER|838.25||||||| H5300|EAP|0430|PHYS MED 15 MIN|Aetna|AETNA OTHER|3.40||||||| H5300|EAP|0430|PHYS MED 3O MIN|Aetna|AETNA OTHER|651.25||||||| H5300|EAP|0430|PHYSICAL MEDICINE 45 MINU|Managed Medicare|HEALTHSPRING MA|838.25||||||| H5300|EAP|0430|PHYS MED 3O MIN|Managed Medicare|HEALTHSPRING MA|651.25||||||| H5300|EAP|0430|PHYS MED 15 MIN|Managed Medicare|HEALTHSPRING MA|3.40||||||| H5300|EAP|0430|PHYS MED 15 MIN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|3.40||||||| H5300|EAP|0430|PHYS MED 15 MIN|Managed Medicare|BCBS MEDICARE PPO MA|3.40||||||| H5300|EAP|0430|PHYSICAL MEDICINE 60 MINU|Medicaid|MEDICAID|1,127.50||||||| H5300|EAP|0430|PHYSICAL MEDICINE 45 MINU|Medicaid|MEDICAID|838.25||||||| H5300|EAP|0430|PHYS MED 3O MIN|Medicaid|MEDICAID|651.25||||||| H5300|EAP|0430|PHYS MED 15 MIN|Medicaid|MEDICAID|3.40||||||| H5300|EAP|0430|PHYSICAL MEDICINE 60 MINU|Blue Cross PPO Specialty|BCBSTX PPO|1,127.50||||||| H5300|EAP|0430|PHYSICAL MEDICINE 45 MINU|Blue Cross HMO Specialty|BCBSTX HMO|838.25||||||| H5300|EAP|0430|PHYSICAL MEDICINE 45 MINU|Blue Cross PPO Specialty|BCBSTX PPO|838.25||||||| H5300|EAP|0430|PHYS MED 3O MIN|Blue Cross PPO Specialty|BCBSTX PPO|651.25||||||| H5300|EAP|0430|PHYS MED 15 MIN|Blue Cross PPO Specialty|BCBSTX PPO|3.40||||||| H5300|EAP|0430|PHYSICAL MEDICINE 45 MINU|Cigna|CIGNA OTHER|838.25||||||| H5300|EAP|0430|PHYSICAL MEDICINE 45 MINU|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|838.25||||||| H5300|EAP|0430|PHYS MED 3O MIN|Cigna|CIGNA OTHER|651.25||||||| H5300|EAP|0430|PHYS MED 15 MIN|Cigna|CIGNA OTHER|3.40||||||| H5300|EAP|0430|PHYS MED 15 MIN|Aenta Medicare Advantage|AETNA MEDICARE MA|3.40||||||| H5300|EAP|0430|PHYSICAL MEDICINE 45 MINU|Aenta Medicare Advantage|AETNA MEDICARE MA|838.25||||||| H5300|EAP|0430|PHYSICAL MEDICINE 60 MINU|Humana Medicare Advantage|HUMANA MA|1,127.50||||||| H5300|EAP|0430|PHYS MED 3O MIN|Aenta Medicare Advantage|AETNA MEDICARE MA|651.25||||||| H5300|EAP|0430|PHYSICAL MEDICINE 45 MINU|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|838.25||||||| H5300|EAP|0430|PHYSICAL MEDICINE 45 MINU|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|838.25||||||| H5300|EAP|0430|PHYSICAL MEDICINE 60 MINU|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,127.50||||||| H5300|EAP|0430|PHYSICAL MEDICINE 45 MINU|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|838.25||||||| H5300|EAP|0430|PHYS MED 3O MIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|651.25||||||| H5300|EAP|0430|PHYS MED 15 MIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.40||||||| H5300|EAP|0430|PHYSICAL MEDICINE 60 MINU|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1,127.50||||||| H5300|EAP|0430|PHYS MED 3O MIN|PHCS|HUMANA INSURANCE|651.25||||||| H5300|EAP|0430|PHYS MED 3O MIN|Tricare|TRICARE FOR LIFE|651.25||||||| H5300|EAP|0430|PHYS MED 15 MIN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|3.40||||||| H5300|EAP|0430|PHYSICAL MEDICINE 60 MINU|Access Direct Platinum|HEALTHFIRST TPA|1,127.50||||||| H5300|EAP|0430|PHYS MED 3O MIN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|651.25||||||| H5300|EAP|0430|PHYSICAL MEDICINE 45 MINU|Access Direct Platinum|HEALTHFIRST TPA|838.25||||||| H5300|EAP|0430|PHYS MED 15 MIN|Access Direct Platinum|HEALTHFIRST TPA|3.40||||||| H5300|EAP|0430|PHYS MED 15 MIN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|3.40||||||| H5300|EAP|0430|PHYSICAL MEDICINE 60 MINU|Medicare|MEDICARE ACUTE|1,127.50||||||| H5300|EAP|0430|PHYSICAL MEDICINE 45 MINU|Medicare|MEDICARE PART B ONLY IP|838.25||||||| H5300|EAP|0430|PHYS MED 3O MIN|United Medicare Advantage|UHC AARP WELLMED HMO MA|651.25||||||| H5300|EAP|0430|PHYSICAL MEDICINE 45 MINU|Medicare|MEDICARE ACUTE|838.25||||||| H5300|EAP|0430|PHYS MED 3O MIN|Medicare|MEDICARE PART B ONLY IP|651.25||||||| H5300|EAP|0430|PHYS MED 3O MIN|Medicare|MEDICARE ACUTE|651.25||||||| H5300|EAP|0430|PHYSICAL MEDICINE 60 MINU|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1,127.50||||||| H5300|EAP|0430|PHYS MED 15 MIN|Medicare|MEDICARE PART B ONLY IP|3.40||||||| H5300|EAP|0430|PHYS MED 15 MIN|Medicare|MEDICARE ACUTE|3.40||||||| H5300|EAP|0430|PHYS MED 3O MIN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|651.25||||||| H5300|EAP|0430|PHYS MED 3O MIN|Access Direct Platinum|HEALTHFIRST TPA|651.25||||||| J0289|ERX|0250|AMPHOTERICIN B LIPOSOME 5|Medicare|MEDICARE ACUTE|322.50||||||| J0289|ERX|0250|AMPHOTERICIN B LIPOSOME 5|Humana Medicare Advantage|HUMANA MA|322.50||||||| J0690|ERX|0636|CEFAZOLIN 2GM 50ML D5W|Medicare|MEDICARE ACUTE|99.50||||||| J0690|ERX|0636|CEFAZOLIN 2GM 50ML D5W|Humana Medicare Advantage|HUMANA MA|99.50||||||| J0690|ERX|0636|CEFAZOLIN 2GM 50ML D5W|Blue Cross HMO Specialty|BCBSTX HMO|99.50||||||| J0690|ERX|0636|CEFAZOLIN 2GM 50ML D5W|Medicaid|MEDICAID|99.50||||||| J0690|ERX|0636|CEFAZOLIN 2GM 50ML D5W|Blue Cross PPO Specialty|BCBSTX PPO|99.50||||||| J0690|ERX|0636|CEFAZOLIN 2GM 50ML D5W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|99.50||||||| J0714|ERX|0636|CEFTAZIDIME-AVIBACTAM 2.5|Medicare|MEDICARE ACUTE|422.71||||||| J0878|ERX|0636|DAPTOMYCIN 500MG VIAL|Humana Medicare Advantage|HUMANA MA|3.81||||||| J0878|ERX|0636|DAPTOMYCIN 500MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|3.81||||||| J0878|ERX|0636|DAPTOMYCIN 500MG VIAL|Medicare|MEDICARE ACUTE|3.81||||||| J1160|ERX|0636|DIGOXIN 250MCG 1ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|38.28||||||| J1160|ERX|0636|DIGOXIN 250MCG 1ML|Humana Medicare Advantage|HUMANA MA|38.28||||||| J1160|ERX|0636|DIGOXIN 250MCG 1ML|Medicare|MEDICARE ACUTE|38.28||||||| J1447|ERX|0636|TBO-FILGRASTIM 300MCG/0.5|Medicare|MEDICARE ACUTE|4.62||||||| J1447|ERX|0636|TBO-FILGRASTIM 480MCG/0.8|Medicare|MEDICARE ACUTE|4.63||||||| J1568|ERX|0636|OCTAGAM (5%) 10 GM/200 ML|Aenta Medicare Advantage|AETNA MEDICARE MA|301.70||||||| J1568|ERX|0636|OCTAGAM (5%) GM/100 ML VI|Aenta Medicare Advantage|AETNA MEDICARE MA|340.20||||||| J1568|ERX|0636|OCTAGAM (5%) 10 GM/200 ML|Medicare|MEDICARE ACUTE|301.70||||||| J1610|ERX|0250|GLUCAGON 1MG VIAL|Medicare|MEDICARE ACUTE|891.50||||||| J1750|ERX|0636|IRON DEXTRAN 50MG/ML, 2ML|Humana Medicare Advantage|HUMANA MA|193.63||||||| J1756|ERX|0636|IRON SUCROSE COMPL. 100/M|Humana Medicare Advantage|HUMANA MA|635.50||||||| J1756|ERX|0636|IRON SUCROSE COMPL. 100/M|Medicare|MEDICARE ACUTE|635.50||||||| J1953|ERX|0636|LEVETIRACETAM 500MG IN 10|Medicare|MEDICARE ACUTE|271.50||||||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|United Medicare Advantage|UHC AARP WELLMED HMO MA|4.80||||||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|Humana Medicare Advantage|HUMANA MA|4.80||||||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|Blue Cross PPO Specialty|BCBSTX PPO|4.80||||||| J2020|ERX|0636|LINEZOLID 600MG/300ML D5W|Medicare|MEDICARE ACUTE|4.80||||||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Access Direct Platinum|HEALTHFIRST TPA|0.16||||||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Humana Medicare Advantage|HUMANA MA|0.16||||||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.16||||||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.16||||||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Blue Cross HMO Specialty|BCBSTX HMO|0.16||||||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Aetna|AETNA OTHER|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|HEALTHSPRING MA|0.16||||||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|0.16||||||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Medicaid|MEDICAID|0.16||||||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Blue Cross PPO Specialty|BCBSTX PPO|0.16||||||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Aenta Medicare Advantage|AETNA MEDICARE MA|0.16||||||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.16||||||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|Medicare|MEDICARE ACUTE|0.16||||||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.16||||||| J2270|ERX|0636|MORPHINE 2MG/ML SYRINGE|United Medicare Advantage|UHC AARP WELLMED HMO MA|0.16||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Access Direct Platinum|HEALTHFIRST TPA|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Humana Medicare Advantage|HUMANA MA|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Blue Cross HMO Specialty|BCBSTX HMO|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Aetna|AETNA OTHER|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Managed Medicare|HEALTHSPRING MA|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Medicaid|MEDICAID|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Cigna|CIGNA OTHER|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Aenta Medicare Advantage|AETNA MEDICARE MA|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Medicare|MEDICARE PART B ONLY IP|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Medicare|MEDICARE ACUTE|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|United Medicare Advantage|UHC AARP WELLMED HMO MA|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|Tricare|TRICARE FOR LIFE|16.80||||||| J2405|ERX|0636|ONDANSETRON 4MG/2ML|United Healthcare|UNITED HEALTHCARE OTHER|16.80||||||| J2785|EAP|0361|LEXISCAN 0.4MG INJECTION|Aetna|AETNA OTHER|1,650.50||||||| J2800|ERX|0636|METHOCARBAMOL 100MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|5.00||||||| J2800|ERX|0636|METHOCARBAMOL 100MG/1ML|Medicare|MEDICARE ACUTE|5.00||||||| J2997|ERX|0636|ALTEPLASE 1 MG/1 ML SYRIN|Access Direct Platinum|HEALTHFIRST TPA|329.08||||||| J2997|ERX|0636|ALTEPLASE 1 MG/1 ML SYRIN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|329.08||||||| J2997|ERX|0636|ALTEPLASE 1 MG/1 ML SYRIN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|329.08||||||| J2997|ERX|0636|ALTEPLASE 1 MG/1 ML SYRIN|Humana Medicare Advantage|HUMANA MA|329.08||||||| J2997|ERX|0636|ALTEPLASE 1 MG/1 ML SYRIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|329.08||||||| J2997|ERX|0636|ALTEPLASE 1 MG/1 ML SYRIN|Blue Cross HMO Specialty|BCBSTX HMO|329.08||||||| J2997|ERX|0636|ALTEPLASE 1 MG/1 ML SYRIN|Blue Cross PPO Specialty|BCBSTX PPO|329.08||||||| J2997|ERX|0250|ALTEPLASE 2MG VIAL|Medicare|MEDICARE ACUTE|329.08||||||| J2997|ERX|0250|ALTEPLASE 5MG|Medicare|MEDICARE ACUTE|252.50||||||| J2997|ERX|0636|ALTEPLASE 1 MG/1 ML SYRIN|Aenta Medicare Advantage|AETNA MEDICARE MA|329.08||||||| J2997|ERX|0636|ALTEPLASE 1 MG/1 ML SYRIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|329.08||||||| J2997|ERX|0250|ALTEPLASE 5MG|Humana Medicare Advantage|HUMANA MA|252.50||||||| J2997|ERX|0636|ALTEPLASE 1 MG/1 ML SYRIN|Medicare|MEDICARE ACUTE|329.08||||||| J2997|ERX|0636|ALTEPLASE 1 MG/1 ML SYRIN|Tricare|TRICARE FOR LIFE|329.08||||||| J3262|ERX|0636|TOCILIZUMAB 400 MG/20 ML|Medicare|MEDICARE ACUTE|19.92||||||| J3465|ERX|0636|VORICONAZOLE 200MG VIAL|Medicare|MEDICARE ACUTE|524.90||||||| J3490|ERX|0250|LIDOCAINE AMPS 1.5% 20ML|Medicare|MEDICARE ACUTE|105.50||||||| J7503|ERX|0636|TACROLIMUS XR 1 MG TABLET|Medicare|MEDICARE ACUTE|29.35||||||| J7682|ERX|0636|TOBRAMYCIN 300 MG/5 ML NE|Workers Compensation|WORKERS COMPENSATION OTHER|553.71||||||| J7682|ERX|0636|TOBRAMYCIN 300 MG/5 ML NE|Humana Medicare Advantage|HUMANA MA|553.71||||||| J7682|ERX|0636|TOBRAMYCIN 300 MG/5 ML NE|Managed Medicare|BCBS MEDICARE PPO MA|553.71||||||| J7682|ERX|0636|TOBRAMYCIN 300 MG/5 ML NE|Medicaid|MEDICAID|553.71||||||| J7682|ERX|0636|TOBRAMYCIN 300 MG/5 ML NE|Medicare|MEDICARE ACUTE|553.71||||||| L8501|EAP|0274|TRACHEOSTOMY SPEAKING VAL|Medicare|MEDICARE ACUTE|719.50||||||| P9016|EAP|0390|BLOOD LEUKOREDUCED EACH|United Medicare Advantage|UHC MEDICARE GOLD MA|6.53||||||| P9016|EAP|0390|BLOOD LEUKOREDUCED EACH|United Medicare Advantage|UHC AARP WELLMED HMO MA|6.53||||||| P9016|EAP|0390|BLOOD LEUKOREDUCED EACH|Humana Medicare Advantage|HUMANA MA|6.53||||||| P9016|EAP|0390|BLOOD LEUKOREDUCED EACH|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|6.53||||||| P9016|EAP|0390|BLOOD LEUKOREDUCED EACH|Medicaid|MEDICAID|6.53||||||| P9016|EAP|0390|BLOOD LEUKOREDUCED EACH|Blue Cross PPO Specialty|BCBSTX PPO|6.53||||||| P9016|EAP|0390|BLOOD LEUKOREDUCED EACH|Access Direct Platinum|HEALTHFIRST TPA|6.53||||||| P9016|EAP|0390|BLOOD LEUKOREDUCED EACH|Aenta Medicare Advantage|AETNA MEDICARE MA|6.53||||||| P9016|EAP|0390|BLOOD LEUKOREDUCED EACH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|6.53||||||| P9016|EAP|0390|BLOOD LEUKOREDUCED EACH|Medicare|MEDICARE ACUTE|6.53||||||| P9040|EAP|0390|BLOOD LEUKOREDUCED IRRADI|Humana Medicare Advantage|HUMANA MA|9.81||||||| P9040|EAP|0390|BLOOD LEUKOREDUCED IRRADI|Blue Cross HMO Specialty|BCBSTX HMO|9.81||||||| P9040|EAP|0390|BLOOD LEUKOREDUCED IRRADI|Aenta Medicare Advantage|AETNA MEDICARE MA|9.81||||||| P9040|EAP|0390|BLOOD LEUKOREDUCED IRRADI|Medicare|MEDICARE ACUTE|9.81||||||| P9040|EAP|0390|BLOOD LEUKOREDUCED IRRADI|United Healthcare|UNITED HEALTHCARE OTHER|9.81||||||| P9045|ERX|0636|ALBUMIN 5% 12.5 G 250ML|United Medicare Advantage|UHC MEDICARE GOLD MA|821.75||||||| P9045|ERX|0636|ALBUMIN 5% 12.5 G 250ML|Humana Medicare Advantage|HUMANA MA|821.75||||||| P9045|ERX|0636|ALBUMIN 5% 12.5 G 250ML|Medicaid|MEDICAID|821.75||||||| P9045|ERX|0636|ALBUMIN 5% 12.5 G 250ML|Blue Cross PPO Specialty|BCBSTX PPO|821.75||||||| P9045|ERX|0636|ALBUMIN 5% 12.5 G 250ML|Aenta Medicare Advantage|AETNA MEDICARE MA|821.75||||||| P9045|ERX|0636|ALBUMIN 5% 12.5 G 250ML|Medicare|MEDICARE ACUTE|821.75||||||| P9045|ERX|0636|ALBUMIN 5% 12.5 G 250ML|Medicare|MEDICARE PART B ONLY IP|821.75||||||| P9047|ERX|0636|ALBUMIN 25% 12.5G/50ML|Humana Medicare Advantage|HUMANA MA|1,155.75||||||| P9047|ERX|0636|ALBUMIN 25% 12.5G/50ML|Blue Cross PPO Specialty|BCBSTX PPO|1,155.75||||||| P9047|ERX|0636|ALBUMIN 25% 12.5G/50ML|Aenta Medicare Advantage|AETNA MEDICARE MA|1,155.75||||||| P9047|ERX|0636|ALBUMIN 25% 12.5G/50ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,155.75||||||| P9047|ERX|0636|ALBUMIN 25% 12.5G/50ML|Medicare|MEDICARE ACUTE|1,155.75||||||| P9047|ERX|0636|ALBUMIN 25% 12.5G/50ML|United Medicare Advantage|UHC MEDICARE GOLD MA|1,155.75||||||| P9059|EAP|0390|FROZEN PLASMA|Medicare|MEDICARE ACUTE|2.74||||||| Q0086|EAP|0420|PHYS THER EX III|United Medicare Advantage|UHC MEDICARE GOLD MA|838.25||||||| Q0086|EAP|0420|PHYS THER EX II|United Medicare Advantage|UHC MEDICARE GOLD MA|651.25||||||| Q0086|EAP|0420|PHYS THER EX II|United Medicare Advantage|UHC AARP WELLMED HMO MA|651.25||||||| Q0086|EAP|0420|PHYS THER EX I|United Medicare Advantage|UHC MEDICARE GOLD MA|3.40||||||| Q0086|EAP|0420|PHYS THER EA ADDL 15MIN|United Medicare Advantage|UHC MEDICARE GOLD MA|214.25||||||| Q0086|EAP|0420|PHYS THER EA ADDL 15MIN|United Medicare Advantage|UHC AARP WELLMED HMO MA|214.25||||||| Q0086|EAP|0420|PHYS THER EX II|Tricare|TRICARE FOR LIFE|651.25||||||| Q0086|EAP|0420|PHYS THER EX I|Tricare|TRICARE FOR LIFE|3.40||||||| Q0086|EAP|0420|PHYS THER EA ADDL 15MIN|Tricare|TRICARE FOR LIFE|214.25||||||| Q0086|EAP|0420|PHYS THER EX IV|PHCS|HUMANA INSURANCE|1,127.50||||||| Q0086|EAP|0420|PHYS THER EX II|PHCS|HUMANA INSURANCE|651.25||||||| Q0086|EAP|0420|PHYS THER EX III|PHCS|HUMANA INSURANCE|838.25||||||| Q0086|EAP|0420|PHYS THER EX II|United Healthcare|UNITED HEALTHCARE OTHER|651.25||||||| Q0086|EAP|0420|PHYS THER EX I|United Healthcare|UNITED HEALTHCARE OTHER|3.40||||||| Q0086|EAP|0420|PHYS THER EA ADDL 15MIN|United Healthcare|UNITED HEALTHCARE OTHER|214.25||||||| Q0086|EAP|0420|PHYS THER EX III|Texas Workforce Commission|DIS DETER SERV (DDS)|838.25||||||| Q0086|EAP|0420|PHYS THER EX II|Texas Workforce Commission|DIS DETER SERV (DDS)|651.25||||||| Q0086|EAP|0420|PHYS THER EX I|Humana Medicare Advantage|HUMANA MA|3.40||||||| Q0086|EAP|0420|PHYS THER EX IV|Humana Medicare Advantage|HUMANA MA|1,127.50||||||| Q0086|EAP|0420|PHYS THER EX III|Humana Medicare Advantage|HUMANA MA|838.25||||||| Q0086|EAP|0420|PHYS THER EA ADDL 15MIN|Humana Medicare Advantage|HUMANA MA|214.25||||||| Q0086|EAP|0420|PHYS THER EX III|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|838.25||||||| Q0086|EAP|0420|PHYS THER EX II|Managed Medicaid|MEDICAID UNITED HEALTHCARE|651.25||||||| Q0086|EAP|0420|PHYS THER EX II|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|651.25||||||| Q0086|EAP|0420|PHYS THER EA ADDL 15MIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|214.25||||||| Q0086|EAP|0420|PHYS THER EX IV|Blue Cross HMO Specialty|BCBSTX HMO|1,127.50||||||| Q0086|EAP|0420|PHYS THER EX III|Blue Cross HMO Specialty|BCBSTX HMO|838.25||||||| Q0086|EAP|0420|PHYS THER EX I|Blue Cross HMO Specialty|BCBSTX HMO|3.40||||||| Q0086|EAP|0420|PHYS THER EA ADDL 15MIN|Blue Cross HMO Specialty|BCBSTX HMO|214.25||||||| Q0086|EAP|0420|PHYS THER EX II|Aetna|AETNA OTHER|651.25||||||| Q0086|EAP|0420|PHYS THER EX III|Managed Medicare|HEALTHSPRING MA|838.25||||||| Q0086|EAP|0420|PHYS THER EX II|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|651.25||||||| Q0086|EAP|0420|PHYS THER EX II|Managed Medicare|HEALTHSPRING MA|651.25||||||| Q0086|EAP|0420|PHYS THER EX II|Managed Medicare|BCBS MEDICARE PPO MA|651.25||||||| Q0086|EAP|0420|PHYS THER EX I|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|3.40||||||| Q0086|EAP|0420|PHYS THER EX I|Managed Medicare|HEALTHSPRING MA|3.40||||||| Q0086|EAP|0420|PHYS THER EX I|Managed Medicare|BCBS MEDICARE PPO MA|3.40||||||| Q0086|EAP|0420|PHYS THER EX I|Aetna|AETNA OTHER|3.40||||||| Q0086|EAP|0420|PHYS THER EX II|Blue Cross HMO Specialty|BCBSTX HMO|651.25||||||| Q0086|EAP|0420|PHYS THER EA ADDL 15MIN|Managed Medicare|HEALTHSPRING MA|214.25||||||| Q0086|EAP|0420|PHYS THER EX III|Medicaid|MEDICAID|838.25||||||| Q0086|EAP|0420|PHYS THER EX II|Medicaid|MEDICAID|651.25||||||| Q0086|EAP|0420|PHYS THER EX I|Medicaid|MEDICAID|3.40||||||| Q0086|EAP|0420|PHYS THER EX I|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.40||||||| Q0086|EAP|0420|PHYS THER EA ADDL 15MIN|Medicaid|MEDICAID|214.25||||||| Q0086|EAP|0420|PHYS THER EX IV|Blue Cross PPO Specialty|BCBSTX PPO|1,127.50||||||| Q0086|EAP|0420|PHYS THER EX III|Blue Cross PPO Specialty|BCBSTX PPO|838.25||||||| Q0086|EAP|0420|PHYS THER EX II|Blue Cross PPO Specialty|BCBSTX PPO|651.25||||||| Q0086|EAP|0420|PHYS THER EX I|Blue Cross PPO Specialty|BCBSTX PPO|3.40||||||| Q0086|EAP|0420|PHYS THER EA ADDL 15MIN|Blue Cross PPO Specialty|BCBSTX PPO|214.25||||||| Q0086|EAP|0420|PHYS THER EX II|Humana Medicare Advantage|HUMANA MA|651.25||||||| Q0086|EAP|0420|PHYS THER EX II|Cigna|CIGNA OTHER|651.25||||||| Q0086|EAP|0420|PHYS THER EX I|Cigna|CIGNA OTHER|3.40||||||| Q0086|EAP|0420|PHYS THER EX II|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|651.25||||||| Q0086|EAP|0420|PHYS THER EX II|Access Direct Platinum|HEALTHFIRST TPA|651.25||||||| Q0086|EAP|0420|PHYS THER EX I|Aenta Medicare Advantage|AETNA MEDICARE MA|3.40||||||| Q0086|EAP|0420|PHYS THER EX I|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|3.40||||||| Q0086|EAP|0420|PHYS THER EX I|Texas Workforce Commission|DIS DETER SERV (DDS)|3.40||||||| Q0086|EAP|0420|PHYS THER EX I|PHCS|HUMANA INSURANCE|3.40||||||| Q0086|EAP|0420|PHYS THER EX II|Aenta Medicare Advantage|AETNA MEDICARE MA|651.25||||||| Q0086|EAP|0420|PHYS THER EX III|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|838.25||||||| Q0086|EAP|0420|PHYS THER EA ADDL 15MIN|Aenta Medicare Advantage|AETNA MEDICARE MA|214.25||||||| Q0086|EAP|0420|PHYS THER EX III|Access Direct Platinum|HEALTHFIRST TPA|838.25||||||| Q0086|EAP|0420|PHYS THER EX IV|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1,127.50||||||| Q0086|EAP|0420|PHYS THER EX I|Access Direct Platinum|HEALTHFIRST TPA|3.40||||||| Q0086|EAP|0420|PHYS THER EX IV|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,127.50||||||| Q0086|EAP|0420|PHYS THER EX III|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|838.25||||||| Q0086|EAP|0420|PHYS THER EX I|United Medicare Advantage|UHC AARP WELLMED HMO MA|3.40||||||| Q0086|EAP|0420|PHYS THER EX II|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|651.25||||||| Q0086|EAP|0420|PHYS THER EX I|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.40||||||| Q0086|EAP|0420|PHYS THER EX III|United Medicare Advantage|UHC AARP WELLMED HMO MA|838.25||||||| Q0086|EAP|0420|PHYS THER EA ADDL 15MIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|214.25||||||| Q0086|EAP|0420|PHYS THER EX IV|Medicare|MEDICARE ACUTE|1,127.50||||||| Q0086|EAP|0420|PHYS THER EX III|Medicare|MEDICARE PART B ONLY IP|838.25||||||| Q0086|EAP|0420|PHYS THER EX III|Medicare|MEDICARE ACUTE|838.25||||||| Q0086|EAP|0420|PHYS THER EX II|Medicare|MEDICARE PART B ONLY IP|651.25||||||| Q0086|EAP|0420|PHYS THER EX II|Medicare|MEDICARE ACUTE|651.25||||||| Q0086|EAP|0420|PHYS THER EX I|Medicare|MEDICARE PART B ONLY IP|3.40||||||| Q0086|EAP|0420|PHYS THER EX I|Medicare|MEDICARE ACUTE|3.40||||||| Q0086|EAP|0420|PHYS THER EA ADDL 15MIN|Medicare|MEDICARE PART B ONLY IP|214.25||||||| Q0086|EAP|0420|PHYS THER EA ADDL 15MIN|Medicare|MEDICARE ACUTE|214.25||||||| Q2009|ERX|0636|FOSPHENYTOIN 500MG/10ML V|Blue Cross HMO Specialty|BCBSTX HMO|1.16||||||| Q2009|ERX|0636|FOSPHENYTOIN 100MG/2ML VI|Blue Cross HMO Specialty|BCBSTX HMO|33.60||||||| Q2009|ERX|0636|FOSPHENYTOIN 100MG/2ML VI|Medicaid|MEDICAID|33.60||||||| Q2009|ERX|0636|FOSPHENYTOIN 100MG/2ML VI|Medicare|MEDICARE ACUTE|33.60||||||| Q2037|ERX|0250||Blue Cross HMO Specialty|BCBSTX HMO|158.25||||||| Q2037|ERX|0250||Medicaid|MEDICAID|158.25||||||| Q2037|ERX|0250||Blue Cross PPO Specialty|BCBSTX PPO|158.25||||||| Q2037|ERX|0250||Medicare|MEDICARE ACUTE|158.25||||||| Q2037|ERX|0250||Humana Medicare Advantage|HUMANA MA|158.25||||||| Q5105|ERX|0636|RETACRIT 4000 UNIT/1ML (E|Access Direct Platinum|HEALTHFIRST TPA|5.52||||||| Q5105|ERX|0636|RETACRIT 4000 UNIT/1ML (E|Humana Medicare Advantage|HUMANA MA|5.52||||||| Q5105|ERX|0636|RETACRIT 10000 UNIT/1ML (|Humana Medicare Advantage|HUMANA MA|4.74||||||| Q5105|ERX|0636|RETACRIT 4000 UNIT/1ML (E|Blue Cross PPO Specialty|BCBSTX PPO|5.52||||||| Q5105|ERX|0636|RETACRIT 10000 UNIT/1ML (|Blue Cross PPO Specialty|BCBSTX PPO|4.74||||||| Q5105|ERX|0636|RETACRIT 4000 UNIT/1ML (E|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.52||||||| Q5105|ERX|0636|RETACRIT 10000 UNIT/1ML (|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.74||||||| Q5105|ERX|0636|RETACRIT 4000 UNIT/1ML (E|Medicare|MEDICARE ACUTE|5.52||||||| Q5105|ERX|0636|RETACRIT 4000 UNIT/1ML (E|Medicare|MEDICARE PART B ONLY IP|5.52||||||| Q5105|ERX|0636|RETACRIT 10000 UNIT/1ML (|Medicare|MEDICARE ACUTE|4.74||||||| Q5105|ERX|0636|RETACRIT 10000 UNIT/1ML (|Medicare|MEDICARE PART B ONLY IP|4.74||||||| Q5106|ERX|0636|RETACRIT 10000 UNIT/1ML (|United Medicare Advantage|UHC AARP WELLMED HMO MA|47.43||||||| Q5106|ERX|0636|RETACRIT 10000 UNIT/1ML (|Humana Medicare Advantage|HUMANA MA|47.43||||||| Q5106|ERX|0636|RETACRIT 10000 UNIT/1ML (|Blue Cross HMO Specialty|BCBSTX HMO|47.43||||||| Q5106|ERX|0636|RETACRIT 10000 UNIT/1ML (|Blue Cross PPO Specialty|BCBSTX PPO|47.43||||||| Q5106|ERX|0636|RETACRIT 10000 UNIT/1ML (|Aenta Medicare Advantage|AETNA MEDICARE MA|47.43||||||| Q5106|ERX|0636|RETACRIT 10000 UNIT/1ML (|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|47.43||||||| Q5106|ERX|0636|RETACRIT 40000 UNIT/1ML (|Medicare|MEDICARE PART B ONLY IP|47.43||||||| Q5106|ERX|0636|RETACRIT 10000 UNIT/1ML (|Medicare|MEDICARE ACUTE|47.43||||||| Q5106|ERX|0636|RETACRIT 4000 UNIT/1ML (N|Medicare|MEDICARE ACUTE|55.15||||||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Medicare|MEDICARE ACUTE|4.35||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|United Medicare Advantage|UHC MEDICARE GOLD MA|2.75||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|United Medicare Advantage|UHC AARP WELLMED HMO MA|2.75||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|Blue Cross HMO Specialty|BCBSTX HMO|2.75||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.75||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|Managed Medicare|HEALTHSPRING MA|2.75||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|Medicaid|MEDICAID|2.75||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|Blue Cross PPO Specialty|BCBSTX PPO|2.75||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.75||||||| Q9967|EAP|0255|ISOVUE 300 50/ML NDC 0270|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.75||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|Medicare|MEDICARE ACUTE|2.75||||||| Q9967|EAP|0255|ISOVUE 300 50/ML NDC 0270|Medicare|MEDICARE ACUTE|2.75||||||| Q9967|EAP|0255|ISOVUE 300 100/ML NDC 027|Medicare|MEDICARE ACUTE|2.75||||||| Q9967|EAP|0255|ISOVUE 300|Medicare|MEDICARE ACUTE|2.75||||||| Q9967|EAP|0255|ISOVUE 200M 20ML NDC 0270|Medicare|MEDICARE ACUTE|0.12||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|Access Direct Platinum|HEALTHFIRST TPA|2.75||||||| Q9967|EAP|0255|ISOVUE 370 500/ML NDC 027|Humana Medicare Advantage|HUMANA MA|2.75||||||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Humana Medicare Advantage|HUMANA MA|1.54||||||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Blue Cross HMO Specialty|BCBSTX HMO|1.54||||||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Blue Cross PPO Specialty|BCBSTX PPO|1.54||||||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Aenta Medicare Advantage|AETNA MEDICARE MA|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|Medicare|MEDICARE ACUTE|1.54|||||||