"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" 100|DRG||SEIZURES W MCC|Managed Medicaid|MEDICAID SUPERIOR|20,241.10|5995.86|5995.86|4879.16|||| 100|DRG||SEIZURES W MCC|Medicare|MEDICARE ACUTE|210.37|4879.16|5995.86|4879.16|||| 10060|EAP|0450|I&D ABSCESS SIMP/SNGL|United Healthcare|UNITED HEALTHCARE|||||538.50||| 10060|EAP|0450|I&D ABSCESS SIMP/SNGL|Managed Medicaid|MEDICAID SUPERIOR|||||667.74||| 10060|EAP|0450|I&D ABSCESS SIMP/SNGL|Medicare|MEDICARE ACUTE|||||667.74||| 10060|EAP|0450|I&D ABSCESS SIMP/SNGL|Aetna|AETNA QHP HMO|||||538.50||| 10060|EAP|0450|I&D ABSCESS SIMP/SNGL|Blue Cross PPO Specialty|BCBSTX PPO|||||538.50||| 10060|EAP|0450|I&D ABSCESS SIMP/SNGL|Medicaid|MEDICAID|||||667.74||| 10060|EAP|0450|I&D ABSCESS SIMP/SNGL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||538.50||| 10060|EAP|0450|I&D ABSCESS SIMP/SNGL|Humana Medicare Advantage|HUMANA MA|||||667.74||| 10060|EAP|0450|I&D ABSCESS SIMP/SNGL|United Healthcare|UNITED HEALTHCARE OTHER|||||603.12||| 10060|EAP|0450|I&D ABSCESS SIMP/SNGL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||667.74||| 10060|EAP|0450|I&D ABSCESS SIMP/SNGL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||667.74||| 10080|EAP|0450|I&D PILONIDAL CYST SIMPLE|NON CONTRACTED|COMMERCIAL OTHER 1|||||428.50||| 101|DRG||SEIZURES W/O MCC|Medicare|MEDICARE ACUTE|3,929.60|1644.28|1644.28|188.76|||| 101|DRG||SEIZURES W/O MCC|Workers Compensation|WORKERS COMPENSATION OTHER|32,638.30|188.76|1644.28|188.76|||| 10120|EAP|0450|REM FB SUBQ SIMPLE|Blue Cross HMO Specialty|BCBSTX HMO|||||8.68||| 10120|EAP|0450|REM FB SUBQ SIMPLE|Managed Medicaid|MEDICAID SUPERIOR|||||7.84||| 10120|EAP|0450|REM FB SUBQ SIMPLE|Aetna|AETNA OTHER|||||8.68||| 10120|EAP|0450|REM FB SUBQ SIMPLE|United Healthcare|UNITED HEALTHCARE|||||7.84||| 10120|EAP|0450|REM FB SUBQ SIMPLE|Aetna|AETNA QHP HMO|||||8.68||| 10120|EAP|0450|REM FB SUBQ SIMPLE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||8.68||| 10120|EAP|0450|REM FB SUBQ SIMPLE|Blue Cross PPO Specialty|BCBSTX PPO|||||8.68||| 10120|EAP|0450|REM FB SUBQ SIMPLE|Medicare|MEDICARE ACUTE|||||7.00||| 10120|EAP|0450|REM FB SUBQ SIMPLE|Medicaid|MEDICAID|||||8.68||| 10120|EAP|0450|REM FB SUBQ SIMPLE|Humana Medicare Advantage|HUMANA MA|||||7.00||| 10140|EAP|0450|I&D HEMATOMA SEROMA FLUID|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3,185.25||| 10160|EAP|0450|ASP ABSCESS/HEMA/BUCCA/CY|Blue Cross HMO Specialty|BCBSTX HMO|||||514.60||| 10160|EAP|0450|ASP ABSCESS/HEMA/BUCCA/CY|Blue Cross PPO Specialty|BCBSTX PPO|||||514.60||| 103|DRG||HEADACHES W/O MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|9,356.48|33|33|33|||| 11730|EAP|0450|RMV NAIL PLATE SINGL/SIMP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.61||| 11730|EAP|0450|RMV NAIL PLATE SINGL/SIMP|Medicaid|MEDICAID|||||4.61||| 11730|EAP|0450|RMV NAIL PLATE SINGL/SIMP|United Medicare Advantage|UHC MEDICARE GOLD MA|||||571.64||| 11730|EAP|0450|RMV NAIL PLATE SINGL/SIMP|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.61||| 11730|EAP|0450|RMV NAIL PLATE SINGL/SIMP|Medicare|MEDICARE ACUTE|||||571.64||| 11740|EAP|0450|EVAL SUBUNGUAL HEMATOMA|United Healthcare|UNITED HEALTHCARE OTHER|||||209.25||| 11760|EAP|0450|RPR NAIL BED|Managed Medicaid|MEDICAID SUPERIOR|||||598.92||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Blue Cross PPO Specialty|BCBSTX PPO|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Tricare|TRICARE EAST REGION|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Cigna|CIGNA|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Humana Medicare Advantage|HUMANA MA|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||454.46||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Medicaid|MEDICAID|||||454.46||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Aetna|AETNA OTHER|||||454.46||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Blue Cross PPO Specialty|BCBSTX OTHER|||||454.46||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Aetna|AETNA QHP HMO|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Veterans Affairs|VETERANS ADMINISTRATION|||||410.48||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Blue Cross HMO Specialty|BCBSTX HMO|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|United Healthcare|UNITED HEALTHCARE OTHER|||||454.46||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Managed Medicaid|MEDICAID SUPERIOR|||||454.46||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|United Medicare Advantage|UHC MEDICARE GOLD MA|||||454.46||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|United Healthcare|UNITED HEALTHCARE|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||410.48||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Managed Medicaid|MEDICAID AMERIGROUP|||||410.48||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||454.46||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Medicare|MEDICARE ACUTE|||||454.46||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|NON CONTRACTED|COMMERCIAL OTHER 1|||||366.50||| 12001|EAP|0450|RPR SCLP/NCK/TRUNK/EXT 2.|Workers Compensation|WORKERS COMPENSATION OTHER|||||410.48||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|United Medicare Advantage|UHC MEDICARE GOLD MA|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Workers Compensation|WORKERS COMPENSATION OTHER|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Medicaid|MEDICAID HMO|||||477.09||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|United Healthcare|UNITED HEALTHCARE|||||430.92||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|United Healthcare|UNITED HEALTHCARE OTHER|||||477.09||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|NON CONTRACTED|COMMERCIAL OTHER 1|||||477.09||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Managed Medicaid|MEDICAID AMERIGROUP|||||430.92||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Managed Medicaid|MEDICAID SUPERIOR|||||477.09||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||477.09||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Access Direct Platinum|HEALTHFIRST TPA UMR|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Aetna|AETNA OTHER|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||430.92||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Blue Cross PPO Specialty|BCBSTX PPO|||||477.09||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||477.09||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Cigna|CIGNA|||||477.09||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Medicare|MEDICARE ACUTE|||||477.09||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Humana Medicare Advantage|HUMANA MA|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Medicaid|MEDICAID|||||430.92||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||477.09||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||477.09||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||384.75||| 12002|EAP|0450|RPR LAC SIMPL 2.6-5CM|Veterans Affairs|VETERANS ADMINISTRATION|||||384.75||| 12004|EAP|0450|RPR LAC SIMPL 7.6-12.5CM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||528.24||| 12004|EAP|0450|RPR LAC SIMPL 7.6-12.5CM|Blue Cross PPO Specialty|BCBSTX PPO|||||528.24||| 12004|EAP|0450|RPR LAC SIMPL 7.6-12.5CM|Humana Medicare Advantage|HUMANA MA|||||528.24||| 12004|EAP|0450|RPR LAC SIMPL 7.6-12.5CM|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||4.26||| 12004|EAP|0450|RPR LAC SIMPL 7.6-12.5CM|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||528.24||| 12004|EAP|0450|RPR LAC SIMPL 7.6-12.5CM|Veterans Affairs|VETERANS ADMINISTRATION|||||4.26||| 12004|EAP|0450|RPR LAC SIMPL 7.6-12.5CM|United Healthcare|UNITED HEALTHCARE|||||4.26||| 12004|EAP|0450|RPR LAC SIMPL 7.6-12.5CM|Managed Medicaid|MEDICAID SUPERIOR|||||528.24||| 12004|EAP|0450|RPR LAC SIMPL 7.6-12.5CM|Managed Medicaid|MEDICAID AMERIGROUP|||||528.24||| 12004|EAP|0450|RPR LAC SIMPL 7.6-12.5CM|Medicare|MEDICARE ACUTE|||||4.26||| 12004|EAP|0450|RPR LAC SIMPL 7.6-12.5CM|United Healthcare|UNITED HEALTHCARE|||||528.24||| 12004|EAP|0450|RPR LAC SIMPL 7.6-12.5CM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||528.24||| 12005|EAP|0450|RPR LAC SIMPL 12.6-20CM|Humana Medicare Advantage|HUMANA MA|||||474.50||| 12005|EAP|0450|RPR LAC SIMPL 12.6-20CM|Blue Cross PPO Specialty|BCBSTX PPO|||||588.38||| 12005|EAP|0450|RPR LAC SIMPL 12.6-20CM|United Healthcare|UNITED HEALTHCARE OTHER|||||588.38||| 12005|EAP|0450|RPR LAC SIMPL 12.6-20CM|Medicare|MEDICARE ACUTE|||||474.50||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|United Healthcare|UNITED HEALTHCARE OTHER|||||466.55||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||466.55||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|Blue Cross HMO Specialty|BCBSTX HMO|||||466.55||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|Blue Cross PPO Specialty|BCBSTX PPO|||||466.55||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||376.25||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|Medicare|MEDICARE ACUTE|||||421.40||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|Humana Medicare Advantage|HUMANA MA|||||466.55||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|Cigna|CIGNA|||||376.25||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|Workers Compensation|WORKERS COMPENSATION OTHER|||||421.40||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|Managed Medicare|BCBS MEDICARE PPO MA|||||466.55||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|Managed Medicaid|MEDICAID SUPERIOR|||||466.55||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|United Healthcare|UNITED HEALTHCARE|||||376.25||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|NON CONTRACTED|COMMERCIAL OTHER 1|||||376.25||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|Managed Medicare|HEALTHSPRING MA|||||376.25||| 12011|EAP|0450|RPR LAC SIMPL FACE 2.5CM|Managed Medicaid|MEDICAID AMERIGROUP|||||376.25||| 12013|EAP|0450|RPR LAC SIMPL FACE 2.6-5.|Humana Medicare Advantage|HUMANA MA|||||4.00||| 12013|EAP|0450|RPR LAC SIMPL FACE 2.6-5.|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.00||| 12013|EAP|0450|RPR LAC SIMPL FACE 2.6-5.|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.00||| 12013|EAP|0450|RPR LAC SIMPL FACE 2.6-5.|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.96||| 12013|EAP|0450|RPR LAC SIMPL FACE 2.6-5.|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||4.00||| 12013|EAP|0450|RPR LAC SIMPL FACE 2.6-5.|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.00||| 12013|EAP|0450|RPR LAC SIMPL FACE 2.6-5.|Managed Medicaid|MEDICAID AMERIGROUP|||||4.48||| 12013|EAP|0450|RPR LAC SIMPL FACE 2.6-5.|Medicare|MEDICARE ACUTE|||||4.00||| 12013|EAP|0450|RPR LAC SIMPL FACE 2.6-5.|Managed Medicare|HEALTHSPRING MA|||||4.96||| 12013|EAP|0450|RPR LAC SIMPL FACE 2.6-5.|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||4.00||| 12013|EAP|0450|RPR LAC SIMPL FACE 2.6-5.|United Healthcare|UNITED HEALTHCARE|||||4.96||| 12013|EAP|0450|RPR LAC SIMPL FACE 2.6-5.|Blue Cross PPO Specialty|BCBSTX OTHER|||||4.00||| 12013|EAP|0450|RPR LAC SIMPL FACE 2.6-5.|Blue Cross PPO Specialty|BCBSTX PPO|||||4.96||| 12014|EAP|0450|RPR LAC SIMPL FACE 5.1-7.|Medicare|MEDICARE ACUTE|||||418.50||| 12014|EAP|0450|RPR LAC SIMPL FACE 5.1-7.|Aetna|AETNA QHP HMO|||||518.94||| 12014|EAP|0450|RPR LAC SIMPL FACE 5.1-7.|Managed Medicaid|MEDICAID SUPERIOR|||||468.72||| 12015|EAP|0450|RPR LAC SIMPL FACE 7.6-12|Medicare|MEDICARE ACUTE|||||546.22||| 12015|EAP|0450|RPR LAC SIMPL FACE 7.6-12|Blue Cross PPO Specialty|BCBSTX PPO|||||440.50||| 12031|EAP|0450|RPR LAYER CLOSURE 2.5CM O|Humana Medicare Advantage|HUMANA MA|||||649.76||| 12031|EAP|0450|RPR LAYER CLOSURE 2.5CM O|Medicare|MEDICARE ACUTE|||||649.76||| 12031|EAP|0450|RPR LAYER CLOSURE 2.5CM O|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||649.76||| 12032|EAP|0450|RPR LAYER CLOSURE 2.6-7.5|Workers Compensation|WORKERS COMPENSATION OTHER|||||6.94||| 12032|EAP|0450|RPR LAYER CLOSURE 2.6-7.5|United Medicare Advantage|UHC MEDICARE GOLD MA|||||860.56||| 12032|EAP|0450|RPR LAYER CLOSURE 2.6-7.5|Managed Medicaid|MEDICAID SUPERIOR|||||860.56||| 12032|EAP|0450|RPR LAYER CLOSURE 2.6-7.5|Medicare|MEDICARE ACUTE|||||777.28||| 12032|EAP|0450|RPR LAYER CLOSURE 2.6-7.5|Managed Medicaid|MEDICAID AMERIGROUP|||||860.56||| 12032|EAP|0450|RPR LAYER CLOSURE 2.6-7.5|Blue Cross PPO Specialty|BCBSTX PPO|||||6.94||| 12034|EAP|0450|RPR LAYER CLOSURE 7.6-12.|United Healthcare|UNITED HEALTHCARE OTHER|||||690.06||| 12034|EAP|0450|RPR LAYER CLOSURE 7.6-12.|Managed Medicaid|MEDICAID SUPERIOR|||||690.06||| 12034|EAP|0450|RPR LAYER CLOSURE 7.6-12.|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||690.06||| 12034|EAP|0450|RPR LAYER CLOSURE 7.6-12.|Medicare|MEDICARE ACUTE|||||690.06||| 12034|EAP|0450|RPR LAYER CLOSURE 7.6-12.|Aetna|AETNA OTHER|||||556.50||| 12035|EAP|0450|RPR LAYER CLOSURE 12.6-20|Medicare|MEDICARE ACUTE|||||787.71||| 12035|EAP|0450|RPR LAYER CLOSURE 12.6-20|Humana Medicare Advantage|HUMANA MA|||||787.71||| 12036|EAP|0450|REPAIR WOUNDS 20.1CM-30CM|Medicare|MEDICARE ACUTE|||||7.89||| 12042|EAP|0450|RPR LAYER CLOSURE 2.6-7.5|Medicare|MEDICARE ACUTE|||||4.72||| 12042|EAP|0450|RPR LAYER CLOSURE 2.6-7.5|Blue Cross PPO Specialty|BCBSTX PPO|||||4.72||| 12042|EAP|0450|RPR LAYER CLOSURE 2.6-7.5|United Healthcare|UNITED HEALTHCARE|||||585.28||| 12044|EAP|0450|RPR LAYER CLOSURE 7.6CM-1|Blue Cross PPO Specialty|BCBSTX PPO|||||708.35||| 12045|EAP|0450|REPAIR INTMD WOUND 12.6-2|Workers Compensation|WORKERS COMPENSATION OTHER|||||4.45||| 12052|EAP|0450|REPAIR WOUNDS 2.6-5.0CM|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||586.52||| 12052|EAP|0450|REPAIR WOUNDS 2.6-5.0CM|Managed Medicaid|MEDICAID AMERIGROUP|||||556.78||| 12052|EAP|0450|REPAIR WOUNDS 2.6-5.0CM|Medicare|MEDICARE ACUTE|||||556.78||| 12052|EAP|0450|REPAIR WOUNDS 2.6-5.0CM|Blue Cross PPO Specialty|BCBSTX PPO|||||4.73||| 12053|EAP|0450|REPAIR WOUNDS 5.1-7.5CM|Medicare|MEDICARE ACUTE|||||606.78||| 12054|EAP|0450|INTD WOUND REPAIR FACE|Humana Medicare Advantage|HUMANA MA|||||377.58||| 12054|EAP|0450|INTD WOUND REPAIR FACE|Blue Cross PPO Specialty|BCBSTX PPO|||||556.78||| 124|DRG||OTHER DISORDERS OF THE EYE W MCC|Humana Medicare Advantage|HUMANA MA|28,047.50|64.94|64.94|64.94|||| 13120|EAP|0450|REPAIR COMPLEX ARM/LEG 1.|Medicare|MEDICARE ACUTE|||||828.94||| 13122|EAP|0450|REPAIR COMPLEX ADDITIONAL|Medicare|MEDICARE ACUTE|||||298.84||| 13132|EAP|0450|RPR COMPL FHEAD HND FEET|Medicare|MEDICARE ACUTE|||||767.25||| 13152|EAP|0450|RPR COMPL EYE NOSE EAR LI|Medicare|MEDICARE ACUTE|||||1,346.02||| 152|DRG||OTITIS MEDIA & URI W MCC|Managed Medicaid|MEDICAID SUPERIOR|22,500.15|8484.02|9010.61|2855.72|||| 152|DRG||OTITIS MEDIA & URI W MCC|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|20,951.85|9010.61|9010.61|2855.72|||| 152|DRG||OTITIS MEDIA & URI W MCC|Medicare|MEDICARE ACUTE|5,522.56|2855.72|9010.61|2855.72|||| 157|DRG||DENTAL & ORAL DISEASES W MCC|Medicare|MEDICARE ACUTE|62,046.49|115.5|115.5|115.5|||| 159|DRG||DENTAL & ORAL DISEASES W/O CC/MCC|Medicare|MEDICARE ACUTE|17,960.95|3261.28|3261.28|3261.28|||| 16000|EAP|0450|INTITIAL TREATMENT OF BUR|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.58||| 16000|EAP|0450|INTITIAL TREATMENT OF BUR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||195.92||| 16020|EAP|0450|DEBRIDE BURN PART THICK <|Aetna|AETNA OTHER|||||412.92||| 16020|EAP|0450|DEBRIDE BURN PART THICK <|Workers Compensation|WORKERS COMPENSATION OTHER|||||412.92||| 16020|EAP|0450|DEBRIDE BURN PART THICK <|Blue Cross PPO Specialty|BCBSTX OTHER|||||412.92||| 16020|EAP|0450|DEBRIDE BURN PART THICK <|Blue Cross HMO Specialty|BCBSTX HMO|||||3.33||| 16020|EAP|0450|DEBRIDE BURN PART THICK <|Tricare|TRICARE FOR LIFE|||||412.92||| 16020|EAP|0450|DEBRIDE BURN PART THICK <|Managed Medicaid|MEDICAID SUPERIOR|||||3.33||| 16020|EAP|0450|DEBRIDE BURN PART THICK <|Medicare|MEDICARE ACUTE|||||3.33||| 16020|EAP|0450|DEBRIDE BURN PART THICK <|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||412.92||| 16020|EAP|0450|DEBRIDE BURN PART THICK <|Blue Cross PPO Specialty|BCBSTX PPO|||||3.33||| 16020|EAP|0450|DEBRIDE BURN PART THICK <|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.33||| 16020|EAP|0450|DEBRIDE BURN PART THICK <|United Healthcare|UNITED HEALTHCARE OTHER|||||412.92||| 175|DRG||PULMONARY EMBOLISM W MCC OR ACUTE COR PULMONALE|Medicare|MEDICARE ACUTE|26,865.62|82.5|82.5|82.5|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|100,594.45|24282.28|24282.28|16.5|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|10,761.19|16.5|24282.28|16.5|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Veterans Affairs|VETERANS ADMINISTRATION|21,604.05|4879.16|24282.28|16.5|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Blue Cross PPO Specialty|BCBSTX PPO|10,646.11|46.59|24282.28|16.5|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|44,643.84|19361.03|24282.28|16.5|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|26,059.35|64.68|24282.28|16.5|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Medicare|MEDICARE ACUTE|28,061.67|80.85|24282.28|16.5|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Humana Medicare Advantage|HUMANA MA|18,569.87|33|24282.28|16.5|||| 177|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|43,544.61|7430.7|24282.28|16.5|||| 178|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W CC|Medicaid|MEDICAID|44,866.30|3506.36|3506.36|33|||| 178|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W CC|Medicare|MEDICARE ACUTE|20,387.80|66|3506.36|33|||| 178|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W CC|Blue Cross PPO Specialty|BCBSTX PPO|32,067.80|139.77|3506.36|33|||| 178|DRG||RESPIRATORY INFECTIONS & INFLAMMATIONS W CC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|16,160.82|33|3506.36|33|||| 180|DRG||RESPIRATORY NEOPLASMS W MCC|United Healthcare|UNITED HEALTHCARE|43,032.68|17233.48|17233.48|4056.58|||| 180|DRG||RESPIRATORY NEOPLASMS W MCC|Medicare|MEDICARE ACUTE|15,136.81|4056.58|17233.48|4056.58|||| 183|DRG||MAJOR CHEST TRAUMA W MCC|Humana Medicare Advantage|HUMANA MA|34,750.75|8117.5|8117.5|64.68|||| 183|DRG||MAJOR CHEST TRAUMA W MCC|Medicare|MEDICARE ACUTE|53,675.76|64.68|8117.5|64.68|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Medicare|MEDICARE ACUTE|25,453.94|7625.79|7625.79|139.77|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|25,589.40|4878.28|7625.79|139.77|||| 189|DRG||PULMONARY EDEMA & RESPIRATORY FAILURE|Blue Cross PPO Specialty|BCBSTX PPO|23,879.37|139.77|7625.79|139.77|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Humana Medicare Advantage|HUMANA MA|49,397.80|12968.5|12968.5|44.85|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|27,498.50|4879.16|12968.5|44.85|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Aetna|AETNA PPO|26,787.35|44.85|12968.5|44.85|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Medicaid|MEDICAID|53,607.90|8258.18|12968.5|44.85|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Medicare|MEDICARE ACUTE|25,279.29|66|12968.5|44.85|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|Medicare|MEDICARE PART B ONLY IP|38,778.43|2031.86|12968.5|44.85|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|17,744.64|3264.58|12968.5|44.85|||| 190|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|32,365.83|8099.08|12968.5|44.85|||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|Medicare|MEDICARE ACUTE|7,800.64|33|6097.52|33|||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|Medicaid|MEDICAID|305.98|6097.52|6097.52|33|||| 191|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC|Aenta Medicare Advantage|AETNA MEDICARE MA|18,796.69|2972.28|6097.52|33|||| 192|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC|Medicaid|MEDICAID|25,731.55|4872.16|6482.08|4872.16|||| 192|DRG||CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC|Medicare|MEDICARE ACUTE|24,085.16|6482.08|6482.08|4872.16|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|46,310.73|115.5|35147.7|64.78|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Managed Medicare|HEALTHSPRING MA|27,738.69|6496.16|35147.7|64.78|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|18,903.31|4879.16|35147.7|64.78|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Medicaid|MEDICAID|65,680.45|16423.75|35147.7|64.78|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Humana Medicare Advantage|HUMANA MA|26,657.60|64.78|35147.7|64.78|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Medicare|MEDICARE ACUTE|22,618.15|4879.16|35147.7|64.78|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|32,042.20|8173.77|35147.7|64.78|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|Medicare|MEDICARE PART B ONLY IP|14,255.60|578.49|35147.7|64.78|||| 193|DRG||SIMPLE PNEUMONIA & PLEURISY W MCC|NON CONTRACTED|COMMERCIAL OTHER 1|35,147.70|35147.7|35147.7|64.78|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|43,206.40|14008.27|14008.27|88.78|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|United Healthcare|UNITED HEALTHCARE|23,455.95|88.78|14008.27|88.78|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|Medicaid|MEDICAID|24,162.45|6871.055|14008.27|88.78|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|Medicare|MEDICARE ACUTE|19,697.79|5723.08|14008.27|88.78|||| 194|DRG||SIMPLE PNEUMONIA & PLEURISY W CC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|39,826.82|99|14008.27|88.78|||| 195|DRG||SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC|Medicare|MEDICARE ACUTE|6,303.17|1645.16|1645.16|1645.16|||| 202|DRG||BRONCHITIS & ASTHMA W CC/MCC|Medicare|MEDICARE ACUTE|9,647.77|3262.16|3262.16|3262.16|||| 203|DRG||BRONCHITIS & ASTHMA W/O CC/MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|22,116.70|6585.11|6585.11|6585.11|||| 20526|EAP|0510|THER INJECTION, CARP TUNN|United Medicare Advantage|UHC MEDICARE GOLD MA|||||309.17||| 20550|EAP|0510|INJ TENDON SHEALTH/LIGAME|Medicare|MEDICARE ACUTE|||||276.67||| 20600|EAP|0510|DRAIN/INJ SM JOINT/BURSA|NON CONTRACTED|COMMERCIAL OTHER 1|||||7.42||| 20600|EAP|0510|DRAIN/INJ SM JOINT/BURSA|Medicare|MEDICARE ACUTE|||||7.42||| 20605|EAP|0510|DRAIN/INJ MED JOINT/BURSA|Medicare|MEDICARE ACUTE|||||309.17||| 20605|EAP|0510|DRAIN/INJ MED JOINT/BURSA|United Medicare Advantage|UHC MEDICARE GOLD MA|||||309.17||| 20605|EAP|0510|DRAIN/INJ MED JOINT/BURSA|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||309.17||| 20605|EAP|0510|DRAIN/INJ MED JOINT/BURSA|United Healthcare|UNITED HEALTHCARE|||||309.17||| 20605|EAP|0450|ASP JOINT INTERMEDIATE|Veterans Affairs|VETERANS ADMINISTRATION|||||550.87||| 20610|EAP|0510|DRAIN/INJ MAJOR JOINT/BUR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||309.17||| 20610|EAP|0510|DRAIN/INJ MAJOR JOINT/BUR|United Healthcare|UNITED HEALTHCARE|||||309.17||| 20610|EAP|0510|DRAIN/INJ MAJOR JOINT/BUR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||309.17||| 20610|EAP|0510|DRAIN/INJ MAJOR JOINT/BUR|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||309.17||| 20610|EAP|0510|DRAIN/INJ MAJOR JOINT/BUR|Aetna|AETNA OTHER|||||309.17||| 20610|EAP|0450|ASP JOINT MAJOR|Humana Medicare Advantage|HUMANA MA|||||814.68||| 20610|EAP|0510|DRAIN/INJ MAJOR JOINT/BUR|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||309.17||| 20610|EAP|0450|ASP JOINT MAJOR|Medicare|MEDICARE ACUTE|||||6.57||| 20610|EAP|0510|DRAIN/INJ MAJOR JOINT/BUR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||309.17||| 20610|EAP|0510|DRAIN/INJ MAJOR JOINT/BUR|Humana Medicare Advantage|HUMANA MA|||||309.17||| 20610|EAP|0510|DRAIN/INJ MAJOR JOINT/BUR|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||309.17||| 20610|EAP|0510|DRAIN/INJ MAJOR JOINT/BUR|Blue Cross PPO Specialty|BCBSTX PPO|||||309.17||| 20610|EAP|0510|DRAIN/INJ MAJOR JOINT/BUR|Medicare|MEDICARE ACUTE|||||309.17||| 20610|EAP|0510|DRAIN/INJ MAJOR JOINT/BUR|Tricare|TRICARE EAST REGION|||||309.17||| 20610|EAP|0981|ARTHROCENTESIS LARGE JOIN|Medicare|MEDICARE ACUTE|||||7.07||| 20610|EAP|0510|DRAIN/INJ MAJOR JOINT/BUR|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||309.17||| 20610|EAP|0510|DRAIN/INJ MAJOR JOINT/BUR|NON CONTRACTED|COMMERCIAL OTHER 1|||||309.17||| 20610|EAP|0510|DRAIN/INJ MAJOR JOINT/BUR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||309.17||| 20610|EAP|0450|ASP JOINT MAJOR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||814.68||| 208|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS|United Medicare Advantage|UHC MEDICARE GOLD MA|22,201.35|1624.9|1624.9|33|||| 208|DRG||RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS|Medicare|MEDICARE ACUTE|19,598.32|33|1624.9|33|||| 23650|EAP|0450|TX DISLOC SHLDR W MANIP W|Medicare|MEDICARE ACUTE|||||7.44||| 23650|EAP|0450|TX DISLOC SHLDR W MANIP W|Blue Cross HMO Specialty|BCBSTX HMO|||||6.00||| 23650|EAP|0450|TX DISLOC SHLDR W MANIP W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|6.00||||||| 23650|EAP|0450|TX DISLOC SHLDR W MANIP W|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||7.44||| 23650|EAP|0450|TX DISLOC SHLDR W MANIP W|Humana Medicare Advantage|HUMANA MA|||||6.00||| 24576|EAP|0510|TREAT HUMERUS CONDYLAR FX|Blue Cross PPO Specialty|BCBSTX PPO|||||251.67||| 24600|EAP|0450|TREAT ELBOW DISLOCATION W|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3.44||| 252|DRG||OTHER VASCULAR PROCEDURES W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|102,547.90|35712.5|35712.5|35712.5|||| 25565|EAP|0450|TREAT FRACTURE RADIUS ULN|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1,212.72||| 25600|EAP|0450|TREAT FRACTURE RADIUS/ULN|United Healthcare|UNITED HEALTHCARE OTHER|||||2.87||| 25605|EAP|0450|TX FX RADIUS ULNA W MANIP|Tricare|TRICARE EAST REGION|||||1,208.38||| 25605|EAP|0450|TX FX RADIUS ULNA W MANIP|Cigna|CIGNA|||||1,208.38||| 25605|EAP|0450|TX FX RADIUS ULNA W MANIP|Managed Medicaid|MEDICAID AMERIGROUP|||||974.50||| 25605|EAP|0450|TX FX RADIUS ULNA W MANIP|Humana Medicare Advantage|HUMANA MA|||||974.50||| 26605|EAP|0450|TX FX METACARPAL W MANIP|Cigna|CIGNA|||||784.61||| 26700|EAP|0450|CLSD TRMT METACARPOPHALAN|Medicare|MEDICARE ACUTE|||||448.50||| 26770|EAP|0450|CLSD TRMT JOINT DISLOCATI|Medicare|MEDICARE ACUTE|||||4.27||| 26770|EAP|0450|CLSD TRMT JOINT DISLOCATI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.27||| 27265|EAP|0450|TREAT HIP DISLOCATION WO|Managed Medicare|BCBS MEDICARE PPO MA|||||5.76||| 280|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC|United Healthcare|UNITED HEALTHCARE|50,968.71|16294.32|16294.32|61.48|||| 280|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|28,672.12|11889.12|16294.32|61.48|||| 280|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC|Managed Medicare|HEALTHSPRING MA|29,348.54|66|16294.32|61.48|||| 280|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|30,745.65|97.02|16294.32|61.48|||| 280|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC|Medicare|MEDICARE ACUTE|24,612.59|61.48|16294.32|61.48|||| 280|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC|Humana Medicare Advantage|HUMANA MA|42,743.30|14565.5|16294.32|61.48|||| 281|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC|Humana Medicare Advantage|HUMANA MA|22,500.88|4058.75|18885.34|1631.08|||| 281|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC|Medicare|MEDICARE ACUTE|5,782.70|1631.08|18885.34|1631.08|||| 281|DRG||ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|66,278.45|18885.34|18885.34|1631.08|||| 28190|EAP|0450|RMV FB FOOT SUBQ|Tricare|TRICARE EAST REGION|||||1,424.25||| 28190|EAP|0450|RMV FB FOOT SUBQ|United Healthcare|UNITED HEALTHCARE|||||1,766.07||| 28660|EAP|0450|TX DISLOC TOE JT WO ANEST|Blue Cross PPO Specialty|BCBSTX PPO|||||507.16||| 28660|EAP|0450|TX DISLOC TOE JT WO ANEST|Managed Medicaid|MEDICAID SUPERIOR|||||507.16||| 29065|EAP|0510|APPLICATION OF LONG ARM C|Medicaid|MEDICAID|||||263.33||| 29075|EAP|0510|APPLICATION OF FOREARM CA|Blue Cross HMO Specialty|BCBSTX HMO|||||263.33||| 29075|EAP|0510|APPLICATION OF FOREARM CA|Medicare|MEDICARE ACUTE|||||263.33||| 29075|EAP|0510|APPLICATION OF FOREARM CA|United Medicare Advantage|UHC MEDICARE GOLD MA|||||263.33||| 29075|EAP|0510|APPLICATION OF FOREARM CA|Blue Cross PPO Specialty|BCBSTX PPO|||||263.33||| 291|DRG||HEART FAILURE & SHOCK W MCC|United Healthcare|UNITED HEALTHCARE|47,990.13|13445.89|14310.54|50.64|||| 291|DRG||HEART FAILURE & SHOCK W MCC|NON CONTRACTED|COMMERCIAL OTHER 1|40,188.85|11346.28|14310.54|50.64|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Medicare|MEDICARE ACUTE|23,657.05|64.68|14310.54|50.64|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|41,231.69|14310.54|14310.54|50.64|||| 291|DRG||HEART FAILURE & SHOCK W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|28,956.84|64.94|14310.54|50.64|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|44,860.09|337.68|14310.54|50.64|||| 291|DRG||HEART FAILURE & SHOCK W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|170.09|3262.16|14310.54|50.64|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Humana Medicare Advantage|HUMANA MA|34,413.28|64.86|14310.54|50.64|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Cigna|CIGNA|39,200.66|9270.4|14310.54|50.64|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Medicaid|MEDICAID|40,488.53|6107.26|14310.54|50.64|||| 291|DRG||HEART FAILURE & SHOCK W MCC|Aetna|AETNA PPO|32,326.53|50.64|14310.54|50.64|||| 29105|EAP|0450|APPLY LONG ARM SPLINT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||344.40||| 29105|EAP|0450|APPLY LONG ARM SPLINT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||381.30||| 29105|EAP|0450|APPLY LONG ARM SPLINT|Blue Cross PPO Specialty|BCBSTX PPO|||||344.40||| 29105|EAP|0450|APPLY LONG ARM SPLINT|Medicaid|CRIME VICTIMS COMPENSATION|||||307.50||| 29105|EAP|0450|APPLY LONG ARM SPLINT|Managed Medicaid|MEDICAID SUPERIOR|||||307.50||| 29105|EAP|0450|APPLY LONG ARM SPLINT|Managed Medicaid|MEDICAID AMERIGROUP|||||381.30||| 29105|EAP|0450|APPLY LONG ARM SPLINT|Humana Medicare Advantage|HUMANA MA|||||381.30||| 29105|EAP|0450|APPLY LONG ARM SPLINT|Medicare|MEDICARE ACUTE|||||344.40||| 29105|EAP|0450|APPLY LONG ARM SPLINT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||307.50||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||285.50||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|NON CONTRACTED|COMMERCIAL OTHER 1|||||354.02||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Medicaid|MEDICAID|||||354.02||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||285.50||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Managed Medicaid|MEDICAID SUPERIOR|||||319.76||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Medicaid|MEDICAID HMO|||||285.50||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Managed Medicaid|MEDICAID AMERIGROUP|||||354.02||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Humana Medicare Advantage|HUMANA MA|||||319.76||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||319.76||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||354.02||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Blue Cross PPO Specialty|BCBSTX OTHER|||||285.50||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|United Healthcare|UNITED HEALTHCARE OTHER|||||354.02||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Aenta Medicare Advantage|AETNA MEDICARE MA|||||285.50||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|United Healthcare|UNITED HEALTHCARE|||||285.50||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Blue Cross PPO Specialty|BCBSTX PPO|||||354.02||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||285.50||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Medicare|MEDICARE ACUTE|||||354.02||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Aetna|AETNA OTHER|||||354.02||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||354.02||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||354.02||| 29125|EAP|0510|APPLY FOREARM SPLINT|United Healthcare|UNITED HEALTHCARE|||||119.17||| 29125|EAP|0450|APPLY FOREARM SPLINT STAT|Tricare|TRICARE EAST REGION|||||354.02||| 29130|EAP|0450|APPLY FINGER SPLINT STATI|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||316.51||| 29130|EAP|0450|APPLY FINGER SPLINT STATI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||255.25||| 292|DRG||HEART FAILURE & SHOCK W CC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|7,293.20|3261.28|4856.85|115.5|||| 292|DRG||HEART FAILURE & SHOCK W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|28,368.73|115.5|4856.85|115.5|||| 292|DRG||HEART FAILURE & SHOCK W CC|Blue Cross PPO Specialty|BCBSTX OTHER|19,818.20|4856.85|4856.85|115.5|||| 292|DRG||HEART FAILURE & SHOCK W CC|NON CONTRACTED|COMMERCIAL OTHER 1|23,956.30|1645.16|4856.85|115.5|||| 292|DRG||HEART FAILURE & SHOCK W CC|Medicare|MEDICARE ACUTE|14,315.93|4567.29|4856.85|115.5|||| 293|DRG||HEART FAILURE & SHOCK W/O CC/MCC|Aetna|AETNA OTHER|24,382.06|39.06|39.06|39.06|||| 29405|EAP|0510|APPLY SHORT LEG CAST|Workers Compensation|WORKERS COMPENSATION OTHER|||||263.33||| 29405|EAP|0450|APPLY SHORT LEG CAST BELO|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||277.71||| 29405|EAP|0510|APPLY SHORT LEG CAST|Medicaid|MEDICAID HMO|||||263.33||| 29405|EAP|0510|APPLY SHORT LEG CAST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||263.33||| 29405|EAP|0510|APPLY SHORT LEG CAST|Medicare|MEDICARE ACUTE|||||263.33||| 29405|EAP|0510|APPLY SHORT LEG CAST|Managed Medicaid|MEDICAID AMERIGROUP|||||263.33||| 29505|EAP|0450|APPLY LONG LEG SPLINT|Medicare|MEDICARE ACUTE|||||388.74||| 29505|EAP|0450|APPLY LONG LEG SPLINT|United Healthcare|UNITED HEALTHCARE|||||313.50||| 29505|EAP|0450|APPLY LONG LEG SPLINT|Medicaid|MEDICAID|||||388.74||| 29515|EAP|0450|APPLY SPLINT LOWER LEG|Workers Compensation|WORKERS COMPENSATION OTHER|||||291.50||| 29515|EAP|0450|APPLY SPLINT LOWER LEG|United Medicare Advantage|UHC MEDICARE GOLD MA|||||291.50||| 29515|EAP|0450|APPLY SPLINT LOWER LEG|Humana Medicare Advantage|HUMANA MA|||||326.48||| 29515|EAP|0450|APPLY SPLINT LOWER LEG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||326.48||| 29515|EAP|0450|APPLY SPLINT LOWER LEG|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||291.50||| 29515|EAP|0450|APPLY SPLINT LOWER LEG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||361.46||| 29515|EAP|0450|APPLY SPLINT LOWER LEG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||361.46||| 29515|EAP|0450|APPLY SPLINT LOWER LEG|Blue Cross PPO Specialty|BCBSTX PPO|||||291.50||| 29515|EAP|0450|APPLY SPLINT LOWER LEG|Managed Medicaid|MEDICAID SUPERIOR|||||291.50||| 29515|EAP|0450|APPLY SPLINT LOWER LEG|Medicare|MEDICARE ACUTE|||||291.50||| 29515|EAP|0450|APPLY SPLINT LOWER LEG|Managed Medicaid|MEDICAID AMERIGROUP|||||361.46||| 29515|EAP|0450|APPLY SPLINT LOWER LEG|Tricare|TRICARE EAST REGION|||||291.50||| 29515|EAP|0450|APPLY SPLINT LOWER LEG|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||291.50||| 29515|EAP|0450|APPLY SPLINT LOWER LEG|NON CONTRACTED|COMMERCIAL OTHER 1|||||291.50||| 296|DRG||CARDIAC ARREST, UNEXPLAINED W MCC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|29.31|16.5|16.5|16.5|||| 299|DRG||PERIPHERAL VASCULAR DISORDERS W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|38,016.15|12963.28|12963.28|8214.14|||| 299|DRG||PERIPHERAL VASCULAR DISORDERS W MCC|Medicare|MEDICARE ACUTE|39,949.01|8214.14|12963.28|8214.14|||| 300|DRG||PERIPHERAL VASCULAR DISORDERS W CC|Blue Cross PPO Specialty|BCBSTX PPO|36,220.70|186.36|2453.22|82.5|||| 300|DRG||PERIPHERAL VASCULAR DISORDERS W CC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|37,700.50|82.5|2453.22|82.5|||| 300|DRG||PERIPHERAL VASCULAR DISORDERS W CC|Medicare|MEDICARE ACUTE|14,193.48|2453.22|2453.22|82.5|||| 303|DRG||ATHEROSCLEROSIS W/O MCC|Medicare|MEDICARE ACUTE|3,655.53|1645.16|1645.16|1645.16|||| 30300|EAP|0450|REM FB INTRANASAL|Managed Medicaid|MEDICAID SUPERIOR|||||304.92||| 30300|EAP|0450|REM FB INTRANASAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||272.25||| 304|DRG||HYPERTENSION W MCC|Medicare|MEDICARE ACUTE|12,443.17|3261.28|3261.28|3261.28|||| 305|DRG||HYPERTENSION W/O MCC|Medicare|MEDICARE ACUTE|3,768.55|1644.28|1644.28|1644.28|||| 308|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC|Medicare|MEDICARE ACUTE|11,536.05|4878.28|4878.28|4878.28|||| 309|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC|Medicare|MEDICARE ACUTE|7,761.45|32.34|4872.6|32.34|||| 309|DRG||CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC|Humana Medicare Advantage|HUMANA MA|11,796.14|4872.6|4872.6|32.34|||| 30901|EAP|0450|CONTROL NOSE BLEED ANT/SI|Humana Medicare Advantage|HUMANA MA|||||366.50||| 30901|EAP|0450|CONTROL NOSE BLEED ANT/SI|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||366.50||| 30901|EAP|0450|CONTROL NOSE BLEED ANT/SI|Medicare|MEDICARE ACUTE|||||366.50||| 30903|EAP|0450|CONTROL NOSEBLEED ANT COM|Medicare|MEDICARE ACUTE|||||435.50||| 30905|EAP|0450|CNTRL NOSEBLEED POST W/PA|Blue Cross PPO Specialty|BCBSTX PPO|||||216.50||| 311|DRG||ANGINA PECTORIS|United Medicare Advantage|UHC MEDICARE GOLD MA|11,933.30|1622.2|3264.14|1622.2|||| 311|DRG||ANGINA PECTORIS|Medicare|MEDICARE ACUTE|9,742.39|3264.14|3264.14|1622.2|||| 312|DRG||SYNCOPE & COLLAPSE|Medicare|MEDICARE ACUTE|4,816.20|1645.16|1645.16|32.34|||| 312|DRG||SYNCOPE & COLLAPSE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|13,120.42|32.34|1645.16|32.34|||| 31296|EAP|0360|NSL/SINS NDSC SURG FRNT S|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||147.03||| 31296|EAP|0360|NSL/SINS NDSC SURG FRNT S|Medicare|MEDICARE ACUTE|||||147.03||| 313|DRG||CHEST PAIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|23,270.30|112.56|112.56|112.56|||| 315|DRG||OTHER CIRCULATORY SYSTEM DIAGNOSES W CC|Medicare|MEDICARE ACUTE|21,814.75|4878.28|4878.28|341.79|||| 315|DRG||OTHER CIRCULATORY SYSTEM DIAGNOSES W CC|Medicare|MEDICARE PART B ONLY IP|6,638.08|341.79|4878.28|341.79|||| 31500|EAP|0450|INTUBATION EMERGENCY|Medicare|MEDICARE ACUTE|||||855.51||| 31500|EAP|0450|INTUBATION EMERGENCY|Aetna|AETNA QHP HMO|||||785.26||| 31500|EAP|0450|INTUBATION EMERGENCY|Aenta Medicare Advantage|AETNA MEDICARE MA|||||855.51||| 31500|EAP|0450|INTUBATION EMERGENCY|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||855.51||| 31500|EAP|0450|INTUBATION EMERGENCY|Blue Cross PPO Specialty|BCBSTX PPO|||||7.15||| 31500|EAP|0450|INTUBATION EMERGENCY|United Medicare Advantage|UHC MEDICARE GOLD MA|||||7.15||| 31500|EAP|0450|INTUBATION EMERGENCY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||7.15||| 31500|EAP|0450|INTUBATION EMERGENCY|Medicaid|MEDICAID|||||7.15||| 31500|EAP|0450|INTUBATION EMERGENCY|Managed Medicaid|MEDICAID AMERIGROUP|||||855.51||| 31500|EAP|0450|INTUBATION EMERGENCY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||855.51||| 31500|EAP|0450|INTUBATION EMERGENCY|Humana Medicare Advantage|HUMANA MA|||||7.15||| 31502|EAP|0450|TRACHEOTOMY TUBE CHANGE|Humana Medicare Advantage|HUMANA MA|||||808.17||| 31502|EAP|0450|TRACHEOTOMY TUBE CHANGE|Medicare|MEDICARE ACUTE|||||808.17||| 32421|EAP|0450|THORACENTESIS FOR ASPIRAT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||5.91||| 32551|EAP|0450|CHEST TUBE INSERTION|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1,355.32||| 32551|EAP|0450|CHEST TUBE INSERTION|Medicare|MEDICARE ACUTE|||||10.93||| 32555|EAP|0402|US THORACENTESIS W IMAGIN|Medicare|MEDICARE ACUTE|12.50||||||| 329|DRG||MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|75,057.45|210.21|210.21|210.21|||| 330|DRG||MAJOR SMALL & LARGE BOWEL PROCEDURES W CC|NON CONTRACTED|COMMERCIAL OTHER 1|41,258.55|41258.55|41258.55|132|||| 330|DRG||MAJOR SMALL & LARGE BOWEL PROCEDURES W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|42,408.40|132|41258.55|132|||| 331|DRG||MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC|Cigna|CIGNA|44,112.18|17228.58|17228.58|17228.58|||| 340|DRG||APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC/MCC|NON CONTRACTED|COMMERCIAL OTHER 1|20,470.95|20470.95|20470.95|227.4|||| 340|DRG||APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|31,182.08|227.4|20470.95|227.4|||| 340|DRG||APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC/MCC|Managed Medicaid|MEDICAID SUPERIOR|30,495.10|10560.21|20470.95|227.4|||| 343|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|20,379.25|9333.39|11505.64|93.18|||| 343|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|24,605.90|9795.61|11505.64|93.18|||| 343|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC|United Healthcare|UMR UNITED MEDICAL RESOURCES|28,491.10|11505.64|11505.64|93.18|||| 343|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC|Cigna|CIGNA|24,358.27|2672.23|11505.64|93.18|||| 343|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|25,281.63|93.18|11505.64|93.18|||| 343|DRG||APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC|Managed Medicaid|MEDICAID AMERIGROUP|22,918.14|10560.21|11505.64|93.18|||| 346|DRG||MINOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|11,049.53|93.18|93.18|93.18|||| 36415|EAP|0300|VENIPUNCTURE|Medicaid|MEDICAID|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Workers Compensation|WORKERS COMPENSATION OTHER|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Veterans Affairs|VETERANS ADMINISTRATION|0.82||||0.66||| 36415|EAP|0300|VENIPUNCTURE|NON CONTRACTED|COMMERCIAL OTHER 2|||||42.88||| 36415|EAP|0300|VENIPUNCTURE|Managed Medicare|BCBS MEDICARE PPO MA|0.82||||0.82||| 36415|EAP|0300|VENIPUNCTURE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|United Healthcare|UMR UNITED MEDICAL RESOURCES|0.66||||19.75||| 36415|EAP|0300|VENIPUNCTURE|United Healthcare|UNITED HEALTHCARE|||||19.75||| 36415|EAP|0300|VENIPUNCTURE|NON CONTRACTED|COMMERCIAL OTHER 1|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Medicare|MEDICARE ACUTE|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Medicaid|MEDICAID TEXAS CHILDRENS|||||0.66||| 36415|EAP|0300|VENIPUNCTURE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|United Healthcare|TML GROUP BENEFITS|0.66||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Tricare|TRICARE EAST REGION|0.66||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Medicaid|MEDICAID HMO|||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Medicaid|WOOD COUNTY INDIGENT|||||0.74||| 36415|EAP|0300|VENIPUNCTURE|United Healthcare|UNITED HEALTHCARE|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Medicare|MEDICARE PART B ONLY IP|0.66||||||| 36415|EAP|0300|VENIPUNCTURE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Multiplan|NALC|||||19.75||| 36415|EAP|0300|VENIPUNCTURE|NON CONTRACTED|WOOD COUNTY HOSPITAL DISTRICT|||||0.82||| 36415|EAP|0300|VENIPUNCTURE|United Healthcare|UNITED HEALTHCARE OTHER|||||0.66||| 36415|EAP|0300|VENIPUNCTURE|PHCS|HUMANA INSURANCE|||||0.82||| 36415|EAP|0300|VENIPUNCTURE|Managed Medicare|OTHER INSTITUTIONS|0.66||||0.74||| 36415|EAP|0300|VENIPUNCTURE|Humana Medicare Advantage|HUMANA MA|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|United Healthcare|UNITED HEALTHCARE ERS|||||42.88||| 36415|EAP|0300|VENIPUNCTURE|Tricare|TRICARE FOR LIFE|||||0.82||| 36415|EAP|0300|VENIPUNCTURE|United Healthcare|GEHA|||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Blue Cross PPO Specialty|BCBSTX PPO|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Access Direct Platinum|HEALTHFIRST TPA UMR|0.66||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Managed Medicare|MEDICARE RAILROAD|||||0.74||| 36415|EAP|0300|VENIPUNCTURE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Blue Cross HMO Specialty|BCBSTX HMO|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.66||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Cigna|CIGNA|0.74||||0.66||| 36415|EAP|0300|VENIPUNCTURE|PHCS|GREAT WEST LIFE AND ANNUITY|||||0.82||| 36415|EAP|0300|VENIPUNCTURE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.66||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Veterans Affairs|VETERANS ADMINISTRATION|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Managed Medicaid|MEDICAID SUPERIOR|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Cigna|CIGNA|||||42.88||| 36415|EAP|0300|VENIPUNCTURE|ChampVA|CHAMPVA CENTER|||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Blue Cross PPO Specialty|BCBSTX OTHER|0.66||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Managed Medicare|HEALTHSPRING MA|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|0.66||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Aetna|AETNA PPO|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Managed Medicaid|MEDICAID AMERIGROUP|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Blue Cross PPO Specialty|BLUE SHIELD PHYSICIAN|||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Aenta Medicare Advantage|AETNA MEDICARE MA|0.66||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Aetna|AETNA QHP HMO|||||0.66||| 36415|EAP|0300|VENIPUNCTURE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.82||||19.75||| 36415|EAP|0300|VENIPUNCTURE|Aetna|AETNA OTHER|0.66||||0.66||| 36416|EAP|0300|FINGERSTICK CAPILLARY|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.23||| 36416|EAP|0300|FINGERSTICK CAPILLARY|United Healthcare|TML GROUP BENEFITS|||||0.23||| 36416|EAP|0300|FINGERSTICK CAPILLARY|Tricare|TRICARE EAST REGION|||||0.23||| 36416|EAP|0300|FINGERSTICK CAPILLARY|United Healthcare|UNITED HEALTHCARE ERS|||||0.23||| 36416|EAP|0300|FINGERSTICK CAPILLARY|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.23||| 36416|EAP|0300|FINGERSTICK CAPILLARY|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.23||| 36416|EAP|0300|FINGERSTICK CAPILLARY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.82||||0.23||| 36416|EAP|0300|FINGERSTICK CAPILLARY|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||52.50||| 36416|EAP|0300|FINGERSTICK CAPILLARY|Medicare|MEDICARE ACUTE|0.23||||0.23||| 36416|EAP|0300|FINGERSTICK CAPILLARY|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.23||| 36416|EAP|0300|FINGERSTICK CAPILLARY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.23||| 36416|EAP|0300|FINGERSTICK CAPILLARY|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.23||| 36416|EAP|0300|FINGERSTICK CAPILLARY|Blue Cross HMO Specialty|BCBSTX HMO|0.82||||52.50||| 36416|EAP|0300|FINGERSTICK CAPILLARY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.23||| 36416|EAP|0300|FINGERSTICK CAPILLARY|Humana Medicare Advantage|HUMANA MA|||||0.23||| 36416|EAP|0300|FINGERSTICK CAPILLARY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.82||| 36416|EAP|0300|FINGERSTICK CAPILLARY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.23||||0.23||| 36416|EAP|0300|FINGERSTICK CAPILLARY|Blue Cross PPO Specialty|BCBSTX PPO|||||0.82||| 36416|EAP|0300|FINGERSTICK CAPILLARY|Aetna|AETNA OTHER|||||0.23||| 36416|EAP|0300|FINGERSTICK CAPILLARY|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.23||| 36416|EAP|0300|FINGERSTICK CAPILLARY|United Healthcare|UNITED HEALTHCARE|||||0.82||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|830.49||||830.49||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|United Medicare Advantage|UHC MEDICARE GOLD MA|669.75||||669.75||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||830.49||| 36430|EAP|0391|TRANSFUSION BLOOD|United Healthcare|UNITED HEALTHCARE|||||477.71||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|Medicare|MEDICARE ACUTE|750.12||||830.49||| 36430|EAP|0391|TRANSFUSION BLOOD|Medicare|MEDICARE ACUTE|750.12||||477.71||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|United Healthcare|UNITED HEALTHCARE|||||669.75||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|NON CONTRACTED|COMMERCIAL OTHER 1|669.75||||830.49||| 36430|EAP|0391|TRANSFUSION BLOOD|United Medicare Advantage|AARP UHC WEST COMPLETE MA|830.49||||477.71||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||669.75||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|830.49||||||| 36430|EAP|0391|TRANSFUSION BLOOD|United Healthcare|UNITED HEALTHCARE|||||669.75||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|United Healthcare|UNITED HEALTHCARE|||||830.49||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|Aenta Medicare Advantage|AETNA MEDICARE MA|669.75||||669.75||| 36430|EAP|0391|TRANSFUSION BLOOD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||669.75||| 36430|EAP|0391|TRANSFUSION BLOOD|United Medicare Advantage|UHC MEDICARE GOLD MA|669.75||||669.75||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|Blue Cross HMO Specialty|BCBSTX HMO|830.49||||||| 36430|EAP|0391|TRANSFUSION BLOOD|Humana Medicare Advantage|HUMANA MA|669.75||||385.25||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||830.49||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|Managed Medicaid|MEDICAID SUPERIOR|||||830.49||| 36430|EAP|0391|BLOOD PRODUCT ADMINISTRAT|Humana Medicare Advantage|HUMANA MA|669.75||||830.49||| 36556|EAP|0450|INSERT NON TUNNEL CATH|Medicare|MEDICARE ACUTE|||||2,311.96||| 36556|EAP|0450|INSERT NON TUNNEL CATH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2,064.25||| 36556|EAP|0450|INSERT NON TUNNEL CATH|United Healthcare|UNITED HEALTHCARE|||||2,559.67||| 36569|EAP|0760|INSERT PICC CATH|Managed Medicaid|MEDICAID AMERIGROUP|||||1,593.40||| 372|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC|Humana Medicare Advantage|HUMANA MA|64,501.41|148.5|4122.14|93.18|||| 372|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC|Medicare|MEDICARE ACUTE|16,012.12|4122.14|4122.14|93.18|||| 372|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC|Blue Cross PPO Specialty|BCBSTX PPO|26,215.30|93.18|4122.14|93.18|||| 373|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W/O CC/MCC|Tricare|TRICARE EAST REGION|12,063.35|3399.33|3399.33|39.6|||| 373|DRG||MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W/O CC/MCC|Blue Cross HMO Specialty|BCBSTX HMO|15,628.85|39.6|3399.33|39.6|||| 375|DRG||DIGESTIVE MALIGNANCY W CC|Medicare|MEDICARE ACUTE|25,988.03|6482.08|6482.08|6482.08|||| 377|DRG||G.I. HEMORRHAGE W MCC|Medicare|MEDICARE ACUTE|19,437.95|32.34|32.34|32.34|||| 378|DRG||G.I. HEMORRHAGE W CC|Medicare|MEDICARE ACUTE|26,171.65|6495.28|6495.28|4111.75|||| 378|DRG||G.I. HEMORRHAGE W CC|Humana Medicare Advantage|HUMANA MA|17,999.86|4111.75|6495.28|4111.75|||| 379|DRG||G.I. HEMORRHAGE W/O CC/MCC|Medicare|MEDICARE ACUTE|14,152.05|4878.28|4878.28|4878.28|||| 381|DRG||COMPLICATED PEPTIC ULCER W CC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|28,079.55|81.11|81.11|81.11|||| 388|DRG||G.I. OBSTRUCTION W MCC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|16,757.15|6495.28|6495.28|99|||| 388|DRG||G.I. OBSTRUCTION W MCC|Medicare|MEDICARE ACUTE|45,652.36|99|6495.28|99|||| 389|DRG||G.I. OBSTRUCTION W CC|Veterans Affairs|VETERANS ADMINISTRATION|10,836.66|16.5|33|16.5|||| 389|DRG||G.I. OBSTRUCTION W CC|Medicare|MEDICARE ACUTE|12,221.14|33|33|16.5|||| 390|DRG||G.I. OBSTRUCTION W/O CC/MCC|Medicare|MEDICARE ACUTE|7,499.63|33|1645.16|33|||| 390|DRG||G.I. OBSTRUCTION W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|42.16|1644.28|1645.16|33|||| 390|DRG||G.I. OBSTRUCTION W/O CC/MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|16,000.87|57.75|1645.16|33|||| 390|DRG||G.I. OBSTRUCTION W/O CC/MCC|Veterans Affairs|VETERANS ADMINISTRATION|2,837.75|1645.16|1645.16|33|||| 391|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC|Medicare|MEDICARE ACUTE|23,809.25|80.85|14585.5|80.85|||| 391|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC|Humana Medicare Advantage|HUMANA MA|56,363.85|14585.5|14585.5|80.85|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|20,806.75|48.51|11556.9|31.5|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|15,421.32|49.5|11556.9|31.5|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|15,593.69|139.77|11556.9|31.5|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Cigna|CIGNA|22,466.36|31.5|11556.9|31.5|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Humana Medicare Advantage|HUMANA MA|20,212.45|8117.5|11556.9|31.5|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|United Healthcare|UMR UNITED MEDICAL RESOURCES|25,901.65|7608.15|11556.9|31.5|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|NON CONTRACTED|COMMERCIAL OTHER 1|11,556.90|11556.9|11556.9|31.5|||| 392|DRG||ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC|Medicare|MEDICARE ACUTE|19,969.56|57.75|11556.9|31.5|||| 394|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W CC|Medicare|MEDICARE ACUTE|21,967.50|64.68|8328.09|64.68|||| 394|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W CC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|18,178.70|8328.09|8328.09|64.68|||| 395|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W/O CC/MCC|NON CONTRACTED|COMMERCIAL OTHER 1|33,579.30|33579.3|33579.3|3261.28|||| 395|DRG||OTHER DIGESTIVE SYSTEM DIAGNOSES W/O CC/MCC|Medicare|MEDICARE ACUTE|10,069.85|3261.28|33579.3|3261.28|||| 416|DRG||CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W/O CC/MCC|Blue Cross HMO Specialty|BCBSTX HMO|19,844.37|75.04|107.19|75.04|||| 416|DRG||CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE W/O C.D.E. W/O CC/MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|42,186.30|107.19|107.19|75.04|||| 417|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W MCC|Humana Medicare Advantage|HUMANA MA|31,961.47|66|66|66|||| 418|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC|Medicare|MEDICARE ACUTE|28,031.65|6495.28|6495.28|232.95|||| 418|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC|Blue Cross PPO Specialty|BCBSTX PPO|44,908.41|232.95|6495.28|232.95|||| 419|DRG||LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC|Medicare|MEDICARE ACUTE|342.11|6496.16|6496.16|6496.16|||| 432|DRG||CIRRHOSIS & ALCOHOLIC HEPATITIS W MCC|Humana Medicare Advantage|HUMANA MA|67,523.25|10540.5|10540.5|10540.5|||| 43220|EAP|0750|ESOPHAGOSCOPY BALLOON DIL|Medicare|MEDICARE ACUTE|||||1,951.50||| 43235|EAP|0750|EGD DIAGNOSTIC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,951.50||| 43235|EAP|0750|EGD DIAGNOSTIC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,951.50||| 43235|EAP|0750|EGD DIAGNOSTIC|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,951.50||| 43235|EAP|0750|EGD DIAGNOSTIC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1,951.50||| 43235|EAP|0750|EGD DIAGNOSTIC|Humana Medicare Advantage|HUMANA MA|1,951.50||||1,951.50||| 43235|EAP|0750|EGD DIAGNOSTIC|Blue Cross PPO Specialty|BCBSTX PPO|||||1,951.50||| 43235|EAP|0750|EGD DIAGNOSTIC|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,951.50||| 43235|EAP|0750|EGD DIAGNOSTIC|Medicare|MEDICARE ACUTE|||||1,951.50||| 43235|EAP|0750|EGD DIAGNOSTIC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,951.50||| 43235|EAP|0750|EGD DIAGNOSTIC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Humana Medicare Advantage|HUMANA MA|1,951.50||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Managed Medicare|HEALTHSPRING MA|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Blue Cross PPO Specialty|BCBSTX OTHER|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Blue Cross HMO Specialty|BCBSTX HMO|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1,951.50||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|United Healthcare|TML GROUP BENEFITS|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|United Healthcare|UNITED HEALTHCARE|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Managed Medicare|OTHER INSTITUTIONS|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Medicare|MEDICARE ACUTE|1,951.50||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Blue Cross PPO Specialty|BCBSTX PPO|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,951.50||| 43239|EAP|0750|EGD BIOPSY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,951.50||||1,951.50||| 43244|EAP|0750|EGD VARICES LIGATION|Blue Cross HMO Specialty|BCBSTX HMO|||||1,951.50||| 43246|EAP|0750|EGD PLACE GASTROSTOMY TUB|Medicare|MEDICARE ACUTE|1,951.50||||||| 43246|EAP|0750|EGD PLACE GASTROSTOMY TUB|Blue Cross PPO Specialty|BCBSTX PPO|||||1,951.50||| 43248|EAP|0750|EGD GUIDE WIRE INSERTION|Aetna|AETNA QHP HMO|||||1,951.50||| 43248|EAP|0750|EGD GUIDE WIRE INSERTION|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,951.50||| 43248|EAP|0750|EGD GUIDE WIRE INSERTION|United Healthcare|UNITED HEALTHCARE|||||1,951.50||| 43248|EAP|0750|EGD GUIDE WIRE INSERTION|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,951.50||||1,951.50||| 43248|EAP|0750|EGD GUIDE WIRE INSERTION|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,951.50||| 43248|EAP|0750|EGD GUIDE WIRE INSERTION|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,951.50||| 43248|EAP|0750|EGD GUIDE WIRE INSERTION|Managed Medicare|HEALTHSPRING MA|||||1,951.50||| 43248|EAP|0750|EGD GUIDE WIRE INSERTION|Cigna|CIGNA|||||1,951.50||| 43248|EAP|0750|EGD GUIDE WIRE INSERTION|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,951.50||| 43248|EAP|0750|EGD GUIDE WIRE INSERTION|Humana Medicare Advantage|HUMANA MA|1,951.50||||1,951.50||| 43248|EAP|0750|EGD GUIDE WIRE INSERTION|Medicare|MEDICARE ACUTE|1,951.50||||1,951.50||| 43248|EAP|0750|EGD GUIDE WIRE INSERTION|Blue Cross PPO Specialty|BCBSTX PPO|||||1,951.50||| 43248|EAP|0750|EGD GUIDE WIRE INSERTION|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1,951.50||| 43250|EAP|0750|EGD CAUTERY TUMOR POLYP|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1,951.50||| 43251|EAP|0750|EGD REMOVE LESION SNARE|Medicare|MEDICARE ACUTE|||||1,951.50||| 433|DRG||CIRRHOSIS & ALCOHOLIC HEPATITIS W CC|Medicare|MEDICARE ACUTE|53,503.75|14580.28|14580.28|4879.16|||| 433|DRG||CIRRHOSIS & ALCOHOLIC HEPATITIS W CC|Veterans Affairs|VETERANS ADMINISTRATION|23,243.53|4879.16|14580.28|4879.16|||| 43450|EAP|0750|DILATION OF ESOPHAGUS|Humana Medicare Advantage|HUMANA MA|1,598.37||||||| 43450|EAP|0750|DILATION OF ESOPHAGUS|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,598.37||| 43450|EAP|0750|DILATION OF ESOPHAGUS|Medicare|MEDICARE ACUTE|||||1,440.06||| 43752|EAP|0450|PLCMNT TUBE NASO ORO GAST|Managed Medicaid|MEDICAID SUPERIOR|||||603.26||| 43752|EAP|0450|PLCMNT TUBE NASO ORO GAST|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||603.26||| 43752|EAP|0450|PLCMNT TUBE NASO ORO GAST|Blue Cross PPO Specialty|BCBSTX PPO|||||486.50||| 43752|EAP|0450|PLCMNT TUBE NASO ORO GAST|Humana Medicare Advantage|HUMANA MA|||||486.50||| 43752|EAP|0450|PLCMNT TUBE NASO ORO GAST|Medicare|MEDICARE ACUTE|||||486.50||| 43762|EAP|0450|CHANGE GASTROSTOMY TUBE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||779.24||| 43762|EAP|0450|CHANGE GASTROSTOMY TUBE|Medicare|MEDICARE ACUTE|||||862.73||| 438|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC|Tricare|TRICARE EAST REGION|34,769.66|9797.74|9797.74|9797.74|||| 439|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC|Blue Cross PPO Specialty|BCBSTX PPO|19,502.68|139.77|9730.16|112.56|||| 439|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|30,613.91|9730.16|9730.16|112.56|||| 439|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|25,180.17|112.56|9730.16|112.56|||| 439|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC|Medicare|MEDICARE ACUTE|19,225.98|6495.72|9730.16|112.56|||| 440|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC|Tricare|TRICARE EAST REGION|20,208.97|5694.69|5694.69|16.5|||| 440|DRG||DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC|Medicare|MEDICARE ACUTE|6,362.85|16.5|5694.69|16.5|||| 441|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W MCC|Medicare|MEDICARE ACUTE|20,183.47|49.5|49.5|49.5|||| 442|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W CC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|18,889.30|8572.18|8572.18|48.51|||| 442|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W CC|Humana Medicare Advantage|HUMANA MA|21,633.20|48.51|8572.18|48.51|||| 442|DRG||DISORDERS OF LIVER EXCEPT MALIG, CIRR, ALC HEPA W CC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|16,487.73|4633.61|8572.18|48.51|||| 44394|EAP|0750|COLONOSCOPY W/SNARE|Medicare|MEDICARE ACUTE|||||27.14||| 444|DRG||DISORDERS OF THE BILIARY TRACT W MCC|Humana Medicare Advantage|HUMANA MA|55,998.81|165|165|160.27|||| 444|DRG||DISORDERS OF THE BILIARY TRACT W MCC|Medicare|MEDICARE ACUTE|42,444.09|160.27|165|160.27|||| 445|DRG||DISORDERS OF THE BILIARY TRACT W CC|Medicare|MEDICARE ACUTE|10,765.68|16.5|1131.53|16.5|||| 445|DRG||DISORDERS OF THE BILIARY TRACT W CC|Medicare|MEDICARE PART B ONLY IP|6,286.19|1131.53|1131.53|16.5|||| 45330|EAP|0750|SIGMOIDOSCOPY DIAGNOSTIC|Humana Medicare Advantage|HUMANA MA|||||1,138.50||| 45331|EAP|0750|SIGMOIDOSCOPY W BIOPSY|Medicare|MEDICARE ACUTE|1,138.50||||1,204.75||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|Cigna|CIGNA|||||20.72||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2,192.58||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||20.72||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|20.72||||2,192.58||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2,132.29||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|United Healthcare|UNITED HEALTHCARE|||||2,192.58||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|United Healthcare|UNITED HEALTHCARE|||||20.72||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|Blue Cross PPO Specialty|BCBSTX PPO|||||2,132.29||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|Aetna|AETNA PPO|||||2,192.58||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|Humana Medicare Advantage|HUMANA MA|2,192.58||||20.72||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2,192.58||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||20.72||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|Medicaid|MEDICAID|||||2,192.58||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|NON CONTRACTED|COMMERCIAL OTHER 1|||||20.72||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|Managed Medicare|HEALTHSPRING MA|||||20.72||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|Medicare|MEDICARE ACUTE|||||20.72||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|Managed Medicare|BCBS MEDICARE PPO MA|||||20.72||| 45378|EAP|0750|COLONOSCOPY DIAGNOSTIC|United Healthcare|TML GROUP BENEFITS|||||2,192.58||| 45380|EAP|0750|COLONOSCOPY W BIOPSY|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||20.72||| 45380|EAP|0750|COLONOSCOPY W BIOPSY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2,132.29||| 45380|EAP|0750|COLONOSCOPY W BIOPSY|Blue Cross PPO Specialty|BCBSTX PPO|||||2,192.58||| 45380|EAP|0750|COLONOSCOPY W BIOPSY|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||20.72||| 45380|EAP|0750|COLONOSCOPY W BIOPSY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2,132.29||| 45380|EAP|0750|COLONOSCOPY W BIOPSY|Blue Cross PPO Specialty|BCBSTX OTHER|||||2,192.58||| 45380|EAP|0750|COLONOSCOPY W BIOPSY|Medicare|MEDICARE ACUTE|20.72||||2,192.58||| 45380|EAP|0750|COLONOSCOPY W BIOPSY|NON CONTRACTED|COMMERCIAL OTHER 1|||||2,192.58||| 45380|EAP|0750|COLONOSCOPY W BIOPSY|Aenta Medicare Advantage|AETNA MEDICARE MA|||||20.72||| 45380|EAP|0750|COLONOSCOPY W BIOPSY|Managed Medicare|OTHER INSTITUTIONS|||||20.72||| 45380|EAP|0750|COLONOSCOPY W BIOPSY|Blue Cross HMO Specialty|BCBSTX HMO|||||2,192.58||| 45380|EAP|0750|COLONOSCOPY W BIOPSY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||20.72||| 45380|EAP|0750|COLONOSCOPY W BIOPSY|United Healthcare|UMR UNITED MEDICAL RESOURCES|20.72||||||| 45380|EAP|0750|COLONOSCOPY W BIOPSY|Humana Medicare Advantage|HUMANA MA|2,192.58||||20.72||| 45380|EAP|0750|COLONOSCOPY W BIOPSY|United Healthcare|UNITED HEALTHCARE OTHER|||||20.72||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||20.72||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|United Healthcare|TML GROUP BENEFITS|||||20.72||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2,192.58||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|Blue Cross PPO Specialty|BCBSTX PPO|||||2,192.58||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2,132.29||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||20.72||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|Blue Cross PPO Specialty|BCBSTX OTHER|||||2,192.58||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|Blue Cross HMO Specialty|BCBSTX HMO|||||2,192.58||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||20.72||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|Humana Medicare Advantage|HUMANA MA|||||20.72||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||20.72||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||20.72||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|Tricare|TRICARE EAST REGION|||||20.72||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|Medicare|MEDICARE ACUTE|||||20.72||| 45385|EAP|0750|COLONOSCOPY W LESION REMO|NON CONTRACTED|COMMERCIAL OTHER 1|20.72||||2,192.58||| 45398|EAP|0750|COLONOSCOPY W/HEMORRHOID|Medicare|MEDICARE ACUTE|||||3,710.03||| 468|DRG||REVISION OF HIP OR KNEE REPLACEMENT W/O CC/MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|97,532.55|33|33|33|||| 49082|EAP|0450|PARACENTESIS ABD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||9.68||| 49082|EAP|0450|PARACENTESIS ABD|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||9.68||| 503|DRG||FOOT PROCEDURES W MCC|Medicare|MEDICARE ACUTE|53,453.79|115.5|148.5|115.5|||| 503|DRG||FOOT PROCEDURES W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|51,844.70|148.5|148.5|115.5|||| 504|DRG||FOOT PROCEDURES W CC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|45,213.99|115.5|115.5|115.5|||| 51702|EAP|0450|INSERT FOLEY SIMPL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||343.79||| 51702|EAP|0450|INSERT FOLEY SIMPL|Blue Cross HMO Specialty|BCBSTX HMO|||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|Humana Medicare Advantage|HUMANA MA|||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|Blue Cross PPO Specialty|BCBSTX PPO|||||343.79||| 51702|EAP|0450|INSERT FOLEY SIMPL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|Managed Medicare|HEALTHSPRING MA|||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|NON CONTRACTED|COMMERCIAL OTHER 1|||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|Medicaid|MEDICAID|||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|277.25||||310.52||| 51702|EAP|0450|INSERT FOLEY SIMPL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|343.79||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|United Healthcare|UNITED HEALTHCARE|||||343.79||| 51702|EAP|0450|INSERT FOLEY SIMPL|Managed Medicaid|MEDICAID SUPERIOR|277.25||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|United Healthcare|UNITED HEALTHCARE OTHER|||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|Medicare|MEDICARE ACUTE|343.79||||277.25||| 51702|EAP|0450|INSERT FOLEY SIMPL|Veterans Affairs|VETERANS ADMINISTRATION|||||343.79||| 51702|EAP|0450|INSERT FOLEY SIMPL|Managed Medicaid|MEDICAID AMERIGROUP|||||343.79||| 51702|EAP|0450|INSERT FOLEY SIMPL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||343.79||| 51702|EAP|0450|INSERT FOLEY SIMPL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||310.52||| 51702|EAP|0450|INSERT FOLEY SIMPL|Veterans Affairs|VETERANS ADMINISTRATION|||||310.52||| 535|DRG||FRACTURES OF HIP & PELVIS W MCC|Medicare|MEDICARE ACUTE|18,369.15|48.51|48.51|48.51|||| 536|DRG||FRACTURES OF HIP & PELVIS W/O MCC|Managed Medicare|HEALTHSPRING MA|26,691.25|11347.16|11347.16|66|||| 536|DRG||FRACTURES OF HIP & PELVIS W/O MCC|Medicare|MEDICARE ACUTE|23,152.36|66|11347.16|66|||| 54|DRG||NERVOUS SYSTEM NEOPLASMS W MCC|Blue Cross PPO Specialty|BCBSTX PPO|11,455.35|93.18|93.18|93.18|||| 540|DRG||OSTEOMYELITIS W CC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|34,379.80|101.99|17819.5|101.99|||| 540|DRG||OSTEOMYELITIS W CC|Humana Medicare Advantage|HUMANA MA|67,728.12|17819.5|17819.5|101.99|||| 545|DRG||CONNECTIVE TISSUE DISORDERS W MCC|Medicare|MEDICARE ACUTE|39,347.85|113.19|113.19|113.19|||| 55|DRG||NERVOUS SYSTEM NEOPLASMS W/O MCC|Medicare|MEDICARE ACUTE|11,195.83|32.34|32.34|32.34|||| 551|DRG||MEDICAL BACK PROBLEMS W MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|62,123.75|17657.7|17657.7|8112.28|||| 551|DRG||MEDICAL BACK PROBLEMS W MCC|Medicare|MEDICARE ACUTE|33,497.15|8112.28|17657.7|8112.28|||| 552|DRG||MEDICAL BACK PROBLEMS W/O MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|14,356.10|64.94|4879.16|32.54|||| 552|DRG||MEDICAL BACK PROBLEMS W/O MCC|Medicare|MEDICARE ACUTE|25,299.85|66|4879.16|32.54|||| 552|DRG||MEDICAL BACK PROBLEMS W/O MCC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|14,949.36|4879.16|4879.16|32.54|||| 552|DRG||MEDICAL BACK PROBLEMS W/O MCC|Humana Medicare Advantage|HUMANA MA|10,504.43|32.54|4879.16|32.54|||| 552|DRG||MEDICAL BACK PROBLEMS W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|30,692.83|46.59|4879.16|32.54|||| 554|DRG||BONE DISEASES & ARTHROPATHIES W/O MCC|Medicare|MEDICARE ACUTE|12,440.75|4878.28|36236.5|4878.28|||| 554|DRG||BONE DISEASES & ARTHROPATHIES W/O MCC|NON CONTRACTED|COMMERCIAL OTHER 1|36,236.50|36236.5|36236.5|4878.28|||| 557|DRG||TENDONITIS, MYOSITIS & BURSITIS W MCC|Medicare|MEDICARE ACUTE|7,287.60|1644.28|1644.28|1644.28|||| 558|DRG||TENDONITIS, MYOSITIS & BURSITIS W/O MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|16,587.32|16.5|16.5|16.5|||| 559|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|23,825.50|116.56|11422.88|116.56|||| 559|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC|Medicare|MEDICARE ACUTE|297.70|11422.88|11422.88|116.56|||| 56|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC|Managed Medicare|OTHER INSTITUTIONS|2,620.76|16.5|72.85|16.5|||| 56|DRG||DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC|Medicare|MEDICARE ACUTE|12,259.59|72.85|72.85|16.5|||| 560|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC|United Medicare Advantage|UHC MEDICARE GOLD MA|35,885.24|174.84|174.84|87.42|||| 560|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|21,966.03|87.42|174.84|87.42|||| 560|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC|Medicare|MEDICARE ACUTE|44,766.90|145.7|174.84|87.42|||| 561|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC|Medicare|MEDICARE ACUTE|37,734.62|16551.52|16551.52|5944.56|||| 561|DRG||AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W/O CC/MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|17,627.96|5944.56|16551.52|5944.56|||| 562|DRG||FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W MCC|Medicare|MEDICARE ACUTE|47,259.06|123.75|123.75|123.75|||| 563|DRG||FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W/O MCC|Medicare|MEDICARE ACUTE|19,098.18|5739.58|5739.58|75.04|||| 563|DRG||FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W/O MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|17,559.08|4874.7|5739.58|75.04|||| 563|DRG||FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W/O MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|19,134.60|75.04|5739.58|75.04|||| 571|DRG||SKIN DEBRIDEMENT W CC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|61,004.73|11397.28|37153.5|11397.28|||| 571|DRG||SKIN DEBRIDEMENT W CC|Aenta Medicare Advantage|AETNA MEDICARE MA|83,255.75|37153.5|37153.5|11397.28|||| 57260|EAP|0360|CMBN ANT PST COLPRHY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|115.44||||||| 580|DRG||OTHER SKIN, SUBCUT TISS & BREAST PROC W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|34,837.12|150.08|150.08|150.08|||| 595|DRG||MAJOR SKIN DISORDERS W MCC|Medicare|MEDICARE ACUTE|7,196.01|3262.16|3262.16|3262.16|||| 602|DRG||CELLULITIS W MCC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|25,097.66|82.5|9730.16|66|||| 602|DRG||CELLULITIS W MCC|Medicare|MEDICARE ACUTE|31,183.71|9730.16|9730.16|66|||| 602|DRG||CELLULITIS W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|17,344.27|66|9730.16|66|||| 603|DRG||CELLULITIS W/O MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|73,385.49|225.12|20472.17|48.51|||| 603|DRG||CELLULITIS W/O MCC|Humana Medicare Advantage|HUMANA MA|46,471.33|115.5|20472.17|48.51|||| 603|DRG||CELLULITIS W/O MCC|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|22,368.44|7647.66|20472.17|48.51|||| 603|DRG||CELLULITIS W/O MCC|Managed Medicare|BCBS MEDICARE PPO MA|25,852.62|66|20472.17|48.51|||| 603|DRG||CELLULITIS W/O MCC|NON CONTRACTED|COMMERCIAL OTHER 1|20,472.17|20472.17|20472.17|48.51|||| 603|DRG||CELLULITIS W/O MCC|Medicare|MEDICARE PART B ONLY IP|52,331.19|3038.57|20472.17|48.51|||| 603|DRG||CELLULITIS W/O MCC|Medicare|MEDICARE ACUTE|25,630.27|6496.16|20472.17|48.51|||| 603|DRG||CELLULITIS W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|18,177.95|99.29|20472.17|48.51|||| 603|DRG||CELLULITIS W/O MCC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|33,925.85|9995.02|20472.17|48.51|||| 603|DRG||CELLULITIS W/O MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|15,620.85|48.51|20472.17|48.51|||| 603|DRG||CELLULITIS W/O MCC|Workers Compensation|WORKERS COMPENSATION OTHER|33,523.02|13914.13|20472.17|48.51|||| 605|DRG||TRAUMA TO THE SKIN, SUBCUT TISS & BREAST W/O MCC|Medicare|MEDICARE ACUTE|20,837.73|7290.14|7290.14|7290.14|||| 607|DRG||MINOR SKIN DISORDERS W/O MCC|Medicare|MEDICARE ACUTE|32,061.79|160.27|160.27|160.27|||| 617|DRG||AMPUTAT OF LOWER LIMB FOR ENDOCRINE, NUTRIT, & METABOL DIS W CC|Medicaid|MEDICAID|50,847.50|13334.47|13334.47|13334.47|||| 62270|EAP|0450|SPINAL TAP DX|Managed Medicaid|MEDICAID SUPERIOR|||||758.75||| 62270|EAP|0450|SPINAL TAP DX|United Healthcare|UNITED HEALTHCARE|||||940.85||| 62270|EAP|0450|SPINAL TAP DX|Blue Cross PPO Specialty|BCBSTX PPO|||||758.75||| 637|DRG||DIABETES W MCC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|12,381.76|33|7375.5|33|||| 637|DRG||DIABETES W MCC|Medicare|MEDICARE ACUTE|26,927.23|7375.5|7375.5|33|||| 637|DRG||DIABETES W MCC|Humana Medicare Advantage|HUMANA MA|47,019.65|226.38|7375.5|33|||| 638|DRG||DIABETES W CC|Medicare|MEDICARE ACUTE|23,467.13|49.5|49.5|49.5|||| 639|DRG||DIABETES W/O CC/MCC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|23,038.25|6042.11|16979.65|139.77|||| 639|DRG||DIABETES W/O CC/MCC|Access Direct Platinum|HEALTHFIRST TPA UMR|207.68|6042.11|16979.65|139.77|||| 639|DRG||DIABETES W/O CC/MCC|Blue Cross PPO Specialty|BCBSTX PPO|24,250.71|139.77|16979.65|139.77|||| 639|DRG||DIABETES W/O CC/MCC|NON CONTRACTED|COMMERCIAL OTHER 1|16,979.65|16979.65|16979.65|139.77|||| 64|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC|Medicare|MEDICARE ACUTE|37,706.76|89.76|4879.16|89.76|||| 64|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC|Managed Medicare|OTHER INSTITUTIONS|7,731.30|4879.16|4879.16|89.76|||| 64|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|2,967.60|1427.86|4879.16|89.76|||| 640|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W MCC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|47,628.75|10064.71|10064.71|32.34|||| 640|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W MCC|Medicare|MEDICARE ACUTE|9,291.05|32.34|10064.71|32.34|||| 640|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|37,845.97|115.5|10064.71|32.34|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Blue Cross PPO Specialty|BCBSTX OTHER|25,722.25|139.77|6187.9|33|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|12,077.02|33|6187.9|33|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Medicare|MEDICARE ACUTE|18,715.48|5687.66|6187.9|33|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|16,300.60|6187.9|6187.9|33|||| 641|DRG||MISC DISORDERS OF NUTRITION, METABOLISM, FLUIDS/ELECTROLYTES W/O MCC|Humana Medicare Advantage|HUMANA MA|14,425.01|4085.25|6187.9|33|||| 643|DRG||ENDOCRINE DISORDERS W MCC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|50,434.75|129.36|129.36|129.36|||| 644|DRG||ENDOCRINE DISORDERS W CC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|21,306.05|6495.28|6495.28|6495.28|||| 64415|EAP|0360|INTERSCALENE BLOCK SINGLE|Medicare|MEDICARE ACUTE|||||353.71||| 64416|EAP|0360|INTERSCALENE BLOCK CONTIN|United Healthcare|UNITED HEALTHCARE|||||437.75||| 64416|EAP|0360|INTERSCALENE BLOCK CONTIN|Medicare|MEDICARE ACUTE|||||437.75||| 64447|EAP|0310|FEMORAL BLOCK|United Medicare Advantage|AARP UHC WEST COMPLETE MA|213.59||||213.59||| 64447|EAP|0310|FEMORAL BLOCK|United Medicare Advantage|UHC MEDICARE GOLD MA|213.59||||||| 64447|EAP|0310|FEMORAL BLOCK|Medicare|MEDICARE ACUTE|||||213.59||| 64450|EAP|0361|GANGLION IMPAR BLOCK|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||16.89||| 64450|EAP|0450|INJECTION PERIPHERAL NERV|Medicare|MEDICARE ACUTE|||||315.75||| 64494|EAP|0361|INJ PARAVERT F JNT L/S 2|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1,834.56||| 64495|EAP|0361|INJ PARAVERT F JNT L/S 3|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,687.84||| 64495|EAP|0361|INJ PARAVERT F JNT L/S 3|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||15.07||| 64495|EAP|0361|INJ PARAVERT F JNT L/S 3|Medicare|MEDICARE ACUTE|||||1,687.84||| 64495|EAP|0361|INJ PARAVERT F JNT L/S 3|Humana Medicare Advantage|HUMANA MA|||||1,687.84||| 64495|EAP|0361|INJ PARAVERT F JNT L/S 3|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1,687.84||| 64495|EAP|0361|INJ PARAVERT F JNT L/S 3|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,687.84||| 64495|EAP|0361|INJ PARAVERT F JNT L/S 3|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||15.07||| 64495|EAP|0361|INJ PARAVERT F JNT L/S 3|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,687.84||| 64495|EAP|0361|INJ PARAVERT F JNT L/S 3|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1,597.42||| 645|DRG||ENDOCRINE DISORDERS W/O CC/MCC|Medicare|MEDICARE ACUTE|43,866.23|11432.08|11432.08|11432.08|||| 64633|EAP|0361|DESTROY CERV/THOR FACET J|Humana Medicare Advantage|HUMANA MA|||||39.50||| 64634|EAP|0361|DESTROY C/TH FACET JNT AD|Humana Medicare Advantage|HUMANA MA|||||21.00||| 64635|EAP|0361|DESTROY LUMB/SAC FACET JT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||44.02||| 64635|EAP|0361|DESTROY LUMB/SAC FACET JT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||44.02||| 64635|EAP|0361|DESTROY LUMB/SAC FACET JT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||44.02||| 64635|EAP|0361|DESTROY LUMB/SAC FACET JT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||44.02||| 64636|EAP|0361|DESTROY L/S FACET JNT ADD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||25.20||| 64636|EAP|0361|DESTROY L/S FACET JNT ADD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||25.20||| 64636|EAP|0361|DESTROY L/S FACET JNT ADD|United Medicare Advantage|UHC MEDICARE GOLD MA|||||25.20||| 64636|EAP|0361|DESTROY L/S FACET JNT ADD|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||25.20||| 65|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS|Veterans Affairs|VETERANS ADMINISTRATION|19,700.61|49.5|4861.34|33|||| 65|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS|Medicare|MEDICARE ACUTE|11,518.55|3262.16|4861.34|33|||| 65|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|21,243.84|33|4861.34|33|||| 65|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS|Humana Medicare Advantage|HUMANA MA|19,088.31|4861.34|4861.34|33|||| 65205|EAP|0450|RMV FB EXT EYE SUPERFICIA|Medicare|MEDICARE ACUTE|||||379.44||| 65220|EAP|0450|RMV FB EYE CORNEAL WO SLI|Medicare|MEDICARE ACUTE|||||370.25||| 65220|EAP|0450|RMV FB EYE CORNEAL WO SLI|Managed Medicaid|MEDICAID SUPERIOR|||||459.11||| 65222|EAP|0450|REMOVE FB EXTERNAL EYE|Medicare|MEDICARE ACUTE|||||425.32||| 66|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|8,103.25|1645.16|10162.17|16.5|||| 66|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC|Cigna|CIGNA|32,895.95|10162.17|10162.17|16.5|||| 66|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC|Blue Cross HMO Specialty|BCBSTX HMO|34,019.48|75.04|10162.17|16.5|||| 66|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC|Medicare|MEDICARE ACUTE|24,406.25|49.5|10162.17|16.5|||| 66|DRG||INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC|Humana Medicare Advantage|HUMANA MA|11,988.89|16.5|10162.17|16.5|||| 682|DRG||RENAL FAILURE W MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|35,341.20|10402.98|10402.98|49.5|||| 682|DRG||RENAL FAILURE W MCC|Humana Medicare Advantage|HUMANA MA|43,248.32|82.5|10402.98|49.5|||| 682|DRG||RENAL FAILURE W MCC|Medicare|MEDICARE ACUTE|20,426.40|49.5|10402.98|49.5|||| 682|DRG||RENAL FAILURE W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|26,667.64|5485.5|10402.98|49.5|||| 682|DRG||RENAL FAILURE W MCC|Blue Cross PPO Specialty|BCBSTX PPO|30,552.52|139.77|10402.98|49.5|||| 683|DRG||RENAL FAILURE W CC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|16,426.17|49.5|5883.68|49.5|||| 683|DRG||RENAL FAILURE W CC|Medicare|MEDICARE ACUTE|18,077.94|5725.5|5883.68|49.5|||| 683|DRG||RENAL FAILURE W CC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|27,297.30|112.56|5883.68|49.5|||| 683|DRG||RENAL FAILURE W CC|Humana Medicare Advantage|HUMANA MA|24,306.17|66|5883.68|49.5|||| 683|DRG||RENAL FAILURE W CC|United Medicare Advantage|UHC MEDICARE GOLD MA|32,891.20|66|5883.68|49.5|||| 683|DRG||RENAL FAILURE W CC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|19,343.19|5883.68|5883.68|49.5|||| 683|DRG||RENAL FAILURE W CC|NON CONTRACTED|COMMERCIAL OTHER 1|2,397.75|2397.75|5883.68|49.5|||| 684|DRG||RENAL FAILURE W/O CC/MCC|Medicare|MEDICARE ACUTE|9,329.62|33|33|33|||| 689|DRG||KIDNEY & URINARY TRACT INFECTIONS W MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|28,197.90|6597.7|18562.18|66|||| 689|DRG||KIDNEY & URINARY TRACT INFECTIONS W MCC|Humana Medicare Advantage|HUMANA MA|25,193.85|66|18562.18|66|||| 689|DRG||KIDNEY & URINARY TRACT INFECTIONS W MCC|Medicaid|MEDICAID|39,311.74|11034.27|18562.18|66|||| 689|DRG||KIDNEY & URINARY TRACT INFECTIONS W MCC|Medicare|MEDICARE ACUTE|20,655.83|6481.64|18562.18|66|||| 689|DRG||KIDNEY & URINARY TRACT INFECTIONS W MCC|NON CONTRACTED|COMMERCIAL OTHER 1|34,417.95|8112.28|18562.18|66|||| 689|DRG||KIDNEY & URINARY TRACT INFECTIONS W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|76,481.50|18562.18|18562.18|66|||| 69|DRG||TRANSIENT ISCHEMIA W/O THROMBOLYTIC|Humana Medicare Advantage|HUMANA MA|14,876.25|1623.5|1623.5|1623.5|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|20,127.25|6488.8|7900.88|46.59|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|Blue Cross PPO Specialty|BCBSTX PPO|11,175.61|46.59|7900.88|46.59|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|Humana Medicare Advantage|HUMANA MA|21,627.13|65.47|7900.88|46.59|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|United Healthcare|TML GROUP BENEFITS|16,517.90|7900.88|7900.88|46.59|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|United Healthcare|UNITED HEALTHCARE|36,406.54|7900.88|7900.88|46.59|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|Blue Cross HMO Specialty|BCBSTX HMO|45,502.60|198|7900.88|46.59|||| 690|DRG||KIDNEY & URINARY TRACT INFECTIONS W/O MCC|Medicare|MEDICARE ACUTE|12,953.88|3281.08|7900.88|46.59|||| 69200|EAP|0450|RMV FB EXT AUDITORY CANAL|Medicare|MEDICARE ACUTE|||||271.04||| 69200|EAP|0450|RMV FB EXT AUDITORY CANAL|Managed Medicaid|MEDICAID AMERIGROUP|||||300.08||| 69200|EAP|0450|RMV FB EXT AUDITORY CANAL|Managed Medicaid|MEDICAID SUPERIOR|||||300.08||| 69200|EAP|0450|RMV FB EXT AUDITORY CANAL|Humana Medicare Advantage|HUMANA MA|||||300.08||| 69200|EAP|0450|RMV FB EXT AUDITORY CANAL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.42||| 69209|EAP|0450|REMOVE IMPACTED EAR WAX|Medicare|MEDICARE ACUTE|||||1.37||| 69209|EAP|0450|REMOVE IMPACTED EAR WAX|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||169.88||| 69210|EAP|0450|RMV IMPACTED EAR WAX|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.36||| 69210|EAP|0450|RMV IMPACTED EAR WAX|Medicare|MEDICARE ACUTE|||||292.64||| 694|DRG||URINARY STONES W/O MCC|Medicare|MEDICARE ACUTE|24,415.63|57.75|57.75|57.75|||| 698|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1,076.60|256.09|5353.58|256.09|||| 698|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC|Medicare|MEDICARE ACUTE|17,615.13|5353.58|5353.58|256.09|||| 699|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC|Medicare|MEDICARE ACUTE|32,809.93|97.02|97.02|82.5|||| 699|DRG||OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC|Humana Medicare Advantage|HUMANA MA|23,173.49|82.5|97.02|82.5|||| 70|DRG||NONSPECIFIC CEREBROVASCULAR DISORDERS W MCC|Medicare|MEDICARE ACUTE|25,535.63|8112.28|8112.28|8112.28|||| 70110|EAP|0320|XR MANDIBLE COMPLETE SERI|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.65||| 70110|EAP|0320|XR MANDIBLE COMPLETE SERI|Blue Cross PPO Specialty|BCBSTX PPO|||||3.75||| 70140|EAP|0320|XR FACIAL BONE LESS THAN|Managed Medicaid|MEDICAID SUPERIOR|||||2.15||| 70150|EAP|0320|XR FACIAL BONES COMPLETE|United Healthcare|UNITED HEALTHCARE|||||2.50||| 70160|EAP|0320|XR NOSE 3 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.50||| 70160|EAP|0320|XR NOSE 3 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||3.10||| 70160|EAP|0320|XR NOSE 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||3.10||| 70160|EAP|0320|XR NOSE 3 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||2.50||| 70220|EAP|0320|XR SINUSES PARANASAL COMP|Blue Cross PPO Specialty|BCBSTX PPO|||||3.10||| 70250|EAP|0320|XR SKULL 1 OR 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||266.60||| 70250|EAP|0320|XR SKULL 1 OR 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||266.60||| 70250|EAP|0320|XR SKULL 1 OR 2 VIEWS|Medicare|MEDICARE ACUTE|||||2.15||| 70250|EAP|0320|XR SKULL 1 OR 2 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||266.60||| 70260|EAP|0320|XR SKULL COMPLETE SERIES|Humana Medicare Advantage|HUMANA MA|||||421.80||| 70260|EAP|0320|XR SKULL COMPLETE SERIES|Managed Medicaid|MEDICAID SUPERIOR|||||421.80||| 70260|EAP|0320|XR SKULL COMPLETE SERIES|Cigna|CIGNA|||||421.80||| 70330|EAP|0320|XR T-M TEMPOROMANDIBULAR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||266.60||| 70330|EAP|0320|XR T-M TEMPOROMANDIBULAR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||266.60||| 70330|EAP|0320|XR T-M TEMPOROMANDIBULAR|Humana Medicare Advantage|HUMANA MA|||||266.60||| 70360|EAP|0320|XR NECK SOFT TISSUE|Medicare|MEDICARE ACUTE|||||2.15||| 70360|EAP|0320|XR NECK SOFT TISSUE|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 70360|EAP|0320|XR NECK SOFT TISSUE|Tricare|TRICARE EAST REGION|||||2.15||| 70360|EAP|0320|XR NECK SOFT TISSUE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||266.60||| 70360|EAP|0320|XR NECK SOFT TISSUE|Blue Cross HMO Specialty|BCBSTX HMO|||||2.15||| 70360|EAP|0320|XR NECK SOFT TISSUE|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.15||| 70360|EAP|0320|XR NECK SOFT TISSUE|Humana Medicare Advantage|HUMANA MA|||||266.60||| 70450|EAP|0351|CT HEAD WO CONTRAST|Workers Compensation|WORKERS COMPENSATION OTHER|17.98||||16.24||| 70450|EAP|0351|CT HEAD WO CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|14.50||||14.50||| 70450|EAP|0351|CT HEAD WO CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|14.50||||17.98||| 70450|EAP|0351|CT HEAD WO CONTRAST|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|16.24||||14.50||| 70450|EAP|0351|CT HEAD WO CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|17.98||||17.98||| 70450|EAP|0351|CT HEAD WO CONTRAST|Workers Compensation|UT EMPLOYEE INJURY|||||17.98||| 70450|EAP|0351|CT HEAD WO CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||14.50||| 70450|EAP|0351|CT HEAD WO CONTRAST|Cigna|CIGNA|14.50||||17.98||| 70450|EAP|0351|CT HEAD WO CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|||||17.98||| 70450|EAP|0351|CT HEAD WO CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|16.24||||17.98||| 70450|EAP|0351|CT HEAD WO CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||17.98||| 70450|EAP|0351|CT HEAD WO CONTRAST|Aetna|AETNA OTHER|||||17.98||| 70450|EAP|0351|CT HEAD WO CONTRAST|Blue Cross PPO Specialty|BCBSTX OTHER|||||16.24||| 70450|EAP|0351|CT HEAD WO CONTRAST|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||14.50||| 70450|EAP|0351|CT HEAD WO CONTRAST|Humana Medicare Advantage|HUMANA MA|16.24||||17.98||| 70450|EAP|0351|CT HEAD WO CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||17.98||| 70450|EAP|0351|CT HEAD WO CONTRAST|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||16.24||| 70450|EAP|0351|CT HEAD WO CONTRAST|Cigna|CIGNA|||||17.98||| 70450|EAP|0351|CT HEAD WO CONTRAST|Aetna|AETNA PPO|||||14.50||| 70450|EAP|0351|CT HEAD WO CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|17.98||||17.98||| 70450|EAP|0351|CT HEAD WO CONTRAST|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||16.24||| 70450|EAP|0351|CT HEAD WO CONTRAST|Aetna|AETNA QHP HMO|||||16.24||| 70450|EAP|0351|CT HEAD WO CONTRAST|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||17.98||| 70450|EAP|0351|CT HEAD WO CONTRAST|United Healthcare|UNITED HEALTHCARE|||||17.98||| 70450|EAP|0351|CT HEAD WO CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||14.50||| 70450|EAP|0351|CT HEAD WO CONTRAST|United Healthcare|UNITED HEALTHCARE|||||14.50||| 70450|EAP|0351|CT HEAD WO CONTRAST|Managed Medicare|OTHER INSTITUTIONS|||||17.98||| 70450|EAP|0351|CT HEAD WO CONTRAST|Managed Medicare|BCBS MEDICARE PPO MA|||||17.98||| 70450|EAP|0351|CT HEAD WO CONTRAST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|17.98||||14.50||| 70450|EAP|0351|CT HEAD WO CONTRAST|United Healthcare|UNITED HEALTHCARE OTHER|||||16.24||| 70450|EAP|0351|CT HEAD WO CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|17.98||||17.98||| 70450|EAP|0351|CT HEAD WO CONTRAST|Medicaid|MEDICAID TEXAS CHILDRENS|||||14.50||| 70450|EAP|0351|CT HEAD WO CONTRAST|Tricare|TRICARE EAST REGION|||||16.24||| 70450|EAP|0351|CT HEAD WO CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 1|||||14.50||| 70450|EAP|0351|CT HEAD WO CONTRAST|Managed Medicare|HEALTHSPRING MA|16.24||||14.50||| 70450|EAP|0351|CT HEAD WO CONTRAST|Managed Medicare|MEDICARE RAILROAD|||||17.98||| 70450|EAP|0351|CT HEAD WO CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|14.50||||17.98||| 70450|EAP|0351|CT HEAD WO CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|||||17.98||| 70450|EAP|0351|CT HEAD WO CONTRAST|United Healthcare|TML GROUP BENEFITS|||||14.50||| 70450|EAP|0351|CT HEAD WO CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|14.50||||14.50||| 70450|EAP|0351|CT HEAD WO CONTRAST|Medicare|MEDICARE ACUTE|14.50||||14.50||| 70450|EAP|0351|CT HEAD WO CONTRAST|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||17.98||| 70450|EAP|0351|CT HEAD WO CONTRAST|Medicaid|MEDICAID|||||14.50||| 70460|EAP|0351|CT HEAD W CONTRAST|Managed Medicare|BCBS MEDICARE PPO MA|||||21.08||| 70460|EAP|0351|CT HEAD W CONTRAST|Medicare|MEDICARE ACUTE|||||21.08||| 70460|EAP|0351|CT HEAD W CONTRAST|Humana Medicare Advantage|HUMANA MA|||||17.00||| 70470|EAP|0351|CT HEAD W&WO CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 1|||||22.40||| 70470|EAP|0351|CT HEAD W&WO CONTRAST|Humana Medicare Advantage|HUMANA MA|||||20.00||| 70470|EAP|0351|CT HEAD W&WO CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||20.00||| 70470|EAP|0351|CT HEAD W&WO CONTRAST|Medicare|MEDICARE ACUTE|||||24.80||| 70470|EAP|0351|CT HEAD W&WO CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||20.00||| 70470|EAP|0351|CT HEAD W&WO CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||24.80||| 70480|EAP|0351|XR HEAD IAC/POST FOSSA WO|Blue Cross PPO Specialty|BCBSTX PPO|||||17.98||| 70480|EAP|0351|XR HEAD IAC/POST FOSSA WO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||17.98||| 70480|EAP|0351|XR HEAD IAC/POST FOSSA WO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||14.50||| 70481|EAP|0351|CT HEAD IAC/POST FOSSA W|Humana Medicare Advantage|HUMANA MA|||||21.08||| 70481|EAP|0351|CT HEAD IAC/POST FOSSA W|Tricare|TRICARE EAST REGION|||||17.00||| 70481|EAP|0351|CT HEAD IAC/POST FOSSA W|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||17.00||| 70482|EAP|0351|CT HEAD IAC/POST FOSSA W&|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||24.80||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||14.50||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|||||14.50||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||14.50||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||16.24||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||17.98||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|14.50||||14.50||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|14.50||||17.98||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|Aetna|AETNA QHP HMO|||||17.98||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|Medicaid|MEDICAID|||||14.50||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|||||16.24||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|||||16.24||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||14.50||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|Medicare|MEDICARE ACUTE|16.24||||14.50||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|Humana Medicare Advantage|HUMANA MA|||||17.98||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|United Healthcare|UNITED HEALTHCARE OTHER|||||17.98||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||16.24||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||14.50||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|||||14.50||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|United Healthcare|UNITED HEALTHCARE|||||14.50||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||14.50||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||14.50||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||17.98||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|Tricare|TRICARE EAST REGION|||||17.98||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||17.98||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|Workers Compensation|WORKERS COMPENSATION OTHER|||||17.98||| 70486|EAP|0351|CT FACIAL W/O CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 1|||||14.50||| 70487|EAP|0351|CT FACIAL W CONTRAST|Medicare|MEDICARE ACUTE|||||21.08||| 70487|EAP|0351|CT FACIAL W CONTRAST|Tricare|TRICARE EAST REGION|||||17.00||| 70490|EAP|0350|CT NECK/SOFT TISSUE WO CO|Medicare|MEDICARE ACUTE|||||14.50||| 70490|EAP|0350|CT NECK/SOFT TISSUE WO CO|Managed Medicaid|MEDICAID AMERIGROUP|||||14.50||| 70490|EAP|0350|CT NECK/SOFT TISSUE WO CO|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||14.50||| 70490|EAP|0350|CT NECK/SOFT TISSUE WO CO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||17.98||| 70490|EAP|0350|CT NECK/SOFT TISSUE WO CO|Blue Cross PPO Specialty|BCBSTX PPO|||||14.50||| 70490|EAP|0350|CT NECK/SOFT TISSUE WO CO|United Healthcare|UNITED HEALTHCARE|||||14.50||| 70490|EAP|0350|CT NECK/SOFT TISSUE WO CO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||14.50||| 70490|EAP|0350|CT NECK/SOFT TISSUE WO CO|Veterans Affairs|VETERANS ADMINISTRATION|||||14.50||| 70490|EAP|0350|CT NECK/SOFT TISSUE WO CO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||14.50||| 70490|EAP|0350|CT NECK/SOFT TISSUE WO CO|Aetna|AETNA QHP HMO|||||14.50||| 70490|EAP|0350|CT NECK/SOFT TISSUE WO CO|Humana Medicare Advantage|HUMANA MA|||||14.50||| 70491|EAP|0350|CT NECK/SOFT TISSUE W CON|Medicaid|MEDICAID|||||21.08||| 70491|EAP|0350|CT NECK/SOFT TISSUE W CON|Medicare|MEDICARE ACUTE|17.00||||17.00||| 70491|EAP|0350|CT NECK/SOFT TISSUE W CON|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||19.04||| 70491|EAP|0350|CT NECK/SOFT TISSUE W CON|Managed Medicaid|MEDICAID AMERIGROUP|||||17.00||| 70491|EAP|0350|CT NECK/SOFT TISSUE W CON|NON CONTRACTED|COMMERCIAL OTHER 1|||||17.00||| 70491|EAP|0350|CT NECK/SOFT TISSUE W CON|United Healthcare|UNITED HEALTHCARE OTHER|||||17.00||| 70491|EAP|0350|CT NECK/SOFT TISSUE W CON|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||21.08||| 70491|EAP|0350|CT NECK/SOFT TISSUE W CON|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||21.08||| 70491|EAP|0350|CT NECK/SOFT TISSUE W CON|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||17.00||| 70491|EAP|0350|CT NECK/SOFT TISSUE W CON|Blue Cross PPO Specialty|BCBSTX PPO|||||17.00||| 70491|EAP|0350|CT NECK/SOFT TISSUE W CON|Humana Medicare Advantage|HUMANA MA|||||17.00||| 70491|EAP|0350|CT NECK/SOFT TISSUE W CON|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||17.00||| 70491|EAP|0350|CT NECK/SOFT TISSUE W CON|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||21.08||| 70491|EAP|0350|CT NECK/SOFT TISSUE W CON|Veterans Affairs|VETERANS ADMINISTRATION|||||21.08||| 70496|EAP|0351|CTA HEAD|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||27.90||| 70496|EAP|0351|CTA HEAD|United Medicare Advantage|UHC MEDICARE GOLD MA|||||22.50||| 70496|EAP|0351|CTA HEAD|Veterans Affairs|VETERANS ADMINISTRATION|||||27.90||| 70496|EAP|0351|CTA HEAD|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||27.90||| 70496|EAP|0351|CTA HEAD|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||22.50||| 70496|EAP|0351|CTA HEAD|Aenta Medicare Advantage|AETNA MEDICARE MA|||||27.90||| 70496|EAP|0351|CTA HEAD|Blue Cross PPO Specialty|BCBSTX PPO|||||25.20||| 70496|EAP|0351|CTA HEAD|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||27.90||| 70496|EAP|0351|CTA HEAD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||22.50||| 70496|EAP|0351|CTA HEAD|Blue Cross HMO Specialty|BCBSTX HMO|27.90||||||| 70496|EAP|0351|CTA HEAD|Cigna|CIGNA|||||27.90||| 70496|EAP|0351|CTA HEAD|Humana Medicare Advantage|HUMANA MA|22.50||||27.90||| 70496|EAP|0351|CTA HEAD|Managed Medicaid|MEDICAID SUPERIOR|||||27.90||| 70496|EAP|0351|CTA HEAD|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|27.90||||27.90||| 70496|EAP|0351|CTA HEAD|NON CONTRACTED|COMMERCIAL OTHER 1|||||22.50||| 70496|EAP|0351|CTA HEAD|United Healthcare|UNITED HEALTHCARE ERS|||||27.90||| 70496|EAP|0351|CTA HEAD|Medicare|MEDICARE ACUTE|27.90||||27.90||| 70496|EAP|0351|CTA HEAD|United Healthcare|UNITED HEALTHCARE OTHER|||||22.50||| 70498|EAP|0352|CTA NECK|Managed Medicaid|MEDICAID SUPERIOR|||||27.90||| 70498|EAP|0352|CTA NECK|United Healthcare|UNITED HEALTHCARE OTHER|||||22.50||| 70498|EAP|0352|CTA NECK|NON CONTRACTED|COMMERCIAL OTHER 1|||||22.50||| 70498|EAP|0352|CTA NECK|Cigna|CIGNA|||||27.90||| 70498|EAP|0352|CTA NECK|Blue Cross HMO Specialty|BCBSTX HMO|27.90||||||| 70498|EAP|0352|CTA NECK|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||27.90||| 70498|EAP|0352|CTA NECK|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||22.50||| 70498|EAP|0352|CTA NECK|Blue Cross PPO Specialty|BCBSTX PPO|||||27.90||| 70498|EAP|0352|CTA NECK|Medicare|MEDICARE ACUTE|27.90||||27.90||| 70498|EAP|0352|CTA NECK|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||22.50||| 70498|EAP|0352|CTA NECK|Aenta Medicare Advantage|AETNA MEDICARE MA|||||27.90||| 70498|EAP|0352|CTA NECK|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||22.50||| 70498|EAP|0352|CTA NECK|Humana Medicare Advantage|HUMANA MA|22.50||||27.90||| 70498|EAP|0352|CTA NECK|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|27.90||||27.90||| 70498|EAP|0352|CTA NECK|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||27.90||| 70498|EAP|0352|CTA NECK|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||27.90||| 70498|EAP|0352|CTA NECK|Veterans Affairs|VETERANS ADMINISTRATION|||||27.90||| 70498|EAP|0352|CTA NECK|United Medicare Advantage|UHC MEDICARE GOLD MA|||||22.50||| 70498|EAP|0352|CTA NECK|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||27.90||| 70543|EAP|0610|MRI ORBIT FACE NECK W/WO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||34.00||| 70543|EAP|0610|MRI ORBIT FACE NECK W/WO|Managed Medicaid|MEDICAID AMERIGROUP|||||34.00||| 70544|EAP|0610|MRA HEAD W/O CONTRAST|United Healthcare|TML GROUP BENEFITS|||||23.00||| 70544|EAP|0610|MRA HEAD W/O CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||23.00||| 70544|EAP|0610|MRA HEAD W/O CONTRAST|Medicare|MEDICARE ACUTE|28.52||||25.76||| 70544|EAP|0610|MRA HEAD W/O CONTRAST|Humana Medicare Advantage|HUMANA MA|28.52||||||| 70544|EAP|0610|MRA HEAD W/O CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|28.52||||||| 70544|EAP|0610|MRA HEAD W/O CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||28.52||| 70547|EAP|0610|MRA NECK W/O CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|28.52||||||| 70547|EAP|0610|MRA NECK W/O CONTRAST|Medicare|MEDICARE ACUTE|28.52||||23.00||| 70547|EAP|0610|MRA NECK W/O CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||23.00||| 70547|EAP|0610|MRA NECK W/O CONTRAST|United Healthcare|TML GROUP BENEFITS|||||23.00||| 70551|EAP|0610|MRI BRAIN W/O|Medicare|MEDICARE ACUTE|23.00||||23.00||| 70551|EAP|0610|MRI BRAIN W/O|Veterans Affairs|VETERANS ADMINISTRATION|28.52||||23.00||| 70551|EAP|0610|MRI BRAIN W/O|Veterans Affairs|VETERANS ADMINISTRATION|28.52||||||| 70551|EAP|0610|MRI BRAIN W/O|United Healthcare|TML GROUP BENEFITS|||||23.00||| 70551|EAP|0610|MRI BRAIN W/O|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||28.52||| 70551|EAP|0610|MRI BRAIN W/O|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||23.00||| 70551|EAP|0610|MRI BRAIN W/O|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||28.52||| 70551|EAP|0610|MRI BRAIN W/O|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|23.00||||28.52||| 70551|EAP|0610|MRI BRAIN W/O|United Healthcare|UNITED HEALTHCARE OTHER|||||25.76||| 70551|EAP|0610|MRI BRAIN W/O|Managed Medicare|BCBS MEDICARE PPO MA|28.52||||||| 70551|EAP|0610|MRI BRAIN W/O|NON CONTRACTED|COMMERCIAL OTHER 1|||||28.52||| 70551|EAP|0610|MRI BRAIN W/O|United Medicare Advantage|UHC MEDICARE GOLD MA|28.52||||23.00||| 70551|EAP|0610|MRI BRAIN W/O|Medicaid|MEDICAID|||||28.52||| 70551|EAP|0610|MRI BRAIN W/O|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||28.52||| 70551|EAP|0610|MRI BRAIN W/O|Managed Medicaid|MEDICAID AMERIGROUP|||||28.52||| 70551|EAP|0610|MRI BRAIN W/O|Aenta Medicare Advantage|AETNA MEDICARE MA|||||23.00||| 70551|EAP|0610|MRI BRAIN W/O|Blue Cross HMO Specialty|BCBSTX HMO|23.00||||||| 70551|EAP|0610|MRI BRAIN W/O|Blue Cross PPO Specialty|BCBSTX PPO|||||28.52||| 70551|EAP|0610|MRI BRAIN W/O|Humana Medicare Advantage|HUMANA MA|23.00||||23.00||| 70551|EAP|0610|MRI BRAIN W/O|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||25.76||| 70551|EAP|0610|MRI BRAIN W/O|Blue Cross PPO Specialty|BCBSTX OTHER|||||23.00||| 70551|EAP|0610|MRI BRAIN W/O|Aetna|AETNA OTHER|||||25.76||| 70551|EAP|0610|MRI BRAIN W/O|Cigna|CIGNA|23.00||||28.52||| 70551|EAP|0610|MRI BRAIN W/O|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||28.52||| 70552|EAP|0610|MRI BRAIN W/CONTRAST|Medicare|MEDICARE ACUTE|27.00||||||| 70553|EAP|0610|MRI BRAIN WO/W|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||38.58||| 70553|EAP|0610|MRI BRAIN WO/W|United Medicare Advantage|UHC MEDICARE GOLD MA|||||43.16||| 70553|EAP|0610|MRI BRAIN WO/W|United Healthcare|UNITED HEALTHCARE|43.16||||43.16||| 70553|EAP|0610|MRI BRAIN WO/W|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|34.00||||||| 70553|EAP|0610|MRI BRAIN WO/W|Blue Cross HMO Specialty|BCBSTX HMO|34.00||||||| 70553|EAP|0610|MRI BRAIN WO/W|Blue Cross PPO Specialty|BCBSTX PPO|||||34.00||| 70553|EAP|0610|MRI BRAIN WO/W|Cigna|CIGNA|34.00||||38.08||| 70553|EAP|0610|MRI BRAIN WO/W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||42.16||| 70553|EAP|0610|MRI BRAIN WO/W|Humana Medicare Advantage|HUMANA MA|||||34.00||| 70553|EAP|0610|MRI BRAIN WO/W|Tricare|TRICARE EAST REGION|||||43.16||| 70553|EAP|0610|MRI BRAIN WO/W|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||42.16||| 70553|EAP|0610|MRI BRAIN WO/W|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||34.00||| 70553|EAP|0610|MRI BRAIN WO/W|Medicare|MEDICARE ACUTE|34.00||||42.16||| 70553|EAP|0610|MRI BRAIN WO/W|NON CONTRACTED|COMMERCIAL OTHER 1|||||34.00||| 70553|EAP|0610|MRI BRAIN WO/W|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||42.16||| 71|DRG||NONSPECIFIC CEREBROVASCULAR DISORDERS W CC|Medicare|MEDICARE ACUTE|10,556.45|3261.28|3261.28|82.5|||| 71|DRG||NONSPECIFIC CEREBROVASCULAR DISORDERS W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|25,882.24|82.5|3261.28|82.5|||| 71045|EAP|0324|XR CHEST 1 VIEW|United Medicare Advantage|AARP UHC WEST COMPLETE MA|241.80||||241.80||| 71045|EAP|0324|XR CHEST 1 VIEW|Veterans Affairs|VETERANS ADMINISTRATION|241.80||||241.80||| 71045|EAP|0324|XR CHEST 1 VIEW|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.95||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|241.80||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|United Medicare Advantage|UHC MEDICARE GOLD MA|241.80||||241.80||| 71045|EAP|0324|XR CHEST 1 VIEW|Humana Medicare Advantage|HUMANA MA|218.40||||218.40||| 71045|EAP|0324|XR CHEST 1 VIEW|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|218.40||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|241.80||||241.80||| 71045|EAP|0324|XR CHEST 1 VIEW|Blue Cross PPO Specialty|BCBSTX PPO|241.80||||241.80||| 71045|EAP|0324|XR CHEST 1 VIEW|Aenta Medicare Advantage|AETNA MEDICARE MA|1.95||||241.80||| 71045|EAP|0324|XR CHEST 1 VIEW|Cigna|CIGNA|||||218.40||| 71045|EAP|0324|XR CHEST 1 VIEW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||241.80||| 71045|EAP|0324|XR CHEST 1 VIEW|Aetna|AETNA PPO|241.80||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|Cigna|CIGNA|241.80||||241.80||| 71045|EAP|0324|XR CHEST 1 VIEW|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.95||||218.40||| 71045|EAP|0324|XR CHEST 1 VIEW|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||218.40||| 71045|EAP|0324|XR CHEST 1 VIEW|United Healthcare|UNITED HEALTHCARE OTHER|||||241.80||| 71045|EAP|0324|XR CHEST 1 VIEW|Blue Cross HMO Specialty|BCBSTX HMO|241.80||||241.80||| 71045|EAP|0324|XR CHEST 1 VIEW|Aetna|AETNA OTHER|241.80||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|Managed Medicare|MEDICARE RAILROAD|||||241.80||| 71045|EAP|0324|XR CHEST 1 VIEW|United Healthcare|UNITED HEALTHCARE|1.95||||241.80||| 71045|EAP|0324|XR CHEST 1 VIEW|United Healthcare|UMR UNITED MEDICAL RESOURCES|1.95||||241.80||| 71045|EAP|0324|XR CHEST 1 VIEW|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||241.80||| 71045|EAP|0324|XR CHEST 1 VIEW|Medicaid|MEDICAID|1.95||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|Medicare|MEDICARE PART B ONLY IP|241.80||||||| 71045|EAP|0324|XR CHEST 1 VIEW|United Healthcare|TML GROUP BENEFITS|||||218.40||| 71045|EAP|0324|XR CHEST 1 VIEW|United Healthcare|GEHA|||||241.80||| 71045|EAP|0324|XR CHEST 1 VIEW|Blue Cross PPO Specialty|BCBSTX OTHER|||||218.40||| 71045|EAP|0324|XR CHEST 1 VIEW|Aetna|AETNA QHP HMO|||||218.40||| 71045|EAP|0324|XR CHEST 1 VIEW|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|241.80||||241.80||| 71045|EAP|0324|XR CHEST 1 VIEW|NON CONTRACTED|WOOD COUNTY HOSPITAL DISTRICT|||||241.80||| 71045|EAP|0324|XR CHEST 1 VIEW|Managed Medicaid|MEDICAID SUPERIOR|1.95||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.95||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||241.80||| 71045|EAP|0324|XR CHEST 1 VIEW|Veterans Affairs|VETERANS ADMINISTRATION|||||241.80||| 71045|EAP|0324|XR CHEST 1 VIEW|Medicaid|WOOD COUNTY INDIGENT|||||241.80||| 71045|EAP|0324|XR CHEST 1 VIEW|Tricare|TRICARE FOR LIFE|||||241.80||| 71045|EAP|0324|XR CHEST 1 VIEW|Managed Medicaid|MEDICAID AMERIGROUP|218.40||||241.80||| 71045|EAP|0324|XR CHEST 1 VIEW|Managed Medicare|BCBS MEDICARE PPO MA|||||241.80||| 71045|EAP|0324|XR CHEST 1 VIEW|Managed Medicare|HEALTHSPRING MA|241.80||||241.80||| 71045|EAP|0324|XR CHEST 1 VIEW|United Healthcare|UNITED HEALTHCARE|||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|Tricare|TRICARE EAST REGION|241.80||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|241.80||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|Managed Medicare|OTHER INSTITUTIONS|||||241.80||| 71045|EAP|0324|XR CHEST 1 VIEW|Medicaid|MEDICAID HMO|||||218.40||| 71045|EAP|0324|XR CHEST 1 VIEW|NON CONTRACTED|COMMERCIAL OTHER 1|1.95||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.95||| 71045|EAP|0324|XR CHEST 1 VIEW|Medicare|MEDICARE ACUTE|218.40||||241.80||| 71046|EAP|0324|XR CHEST 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|2.15||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|United Healthcare|UNITED HEALTHCARE|240.80||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||266.60||| 71046|EAP|0324|XR CHEST 2 VIEWS|Tricare|TRICARE EAST REGION|||||240.80||| 71046|EAP|0324|XR CHEST 2 VIEWS|United Healthcare|TML GROUP BENEFITS|||||240.80||| 71046|EAP|0324|XR CHEST 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Texas Workforce Commission|DEPT OF ASSIST AND REHAB SRVCS|||||266.60||| 71046|EAP|0324|XR CHEST 2 VIEWS|United Healthcare|UNITED HEALTHCARE ERS|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|NON CONTRACTED|WOOD COUNTY HOSPITAL DISTRICT|||||266.60||| 71046|EAP|0324|XR CHEST 2 VIEWS|Medicare|MEDICARE ACUTE|2.15||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Managed Medicare|HEALTHSPRING MA|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Medicaid|WOOD COUNTY INDIGENT|||||266.60||| 71046|EAP|0324|XR CHEST 2 VIEWS|Tricare|TRICARE FOR LIFE|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Medicaid|MEDICAID|2.15||||266.60||| 71046|EAP|0324|XR CHEST 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.15||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Humana Medicare Advantage|HUMANA MA|2.15||||266.60||| 71046|EAP|0324|XR CHEST 2 VIEWS|Cigna|CIGNA|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|240.80||||266.60||| 71046|EAP|0324|XR CHEST 2 VIEWS|Blue Cross PPO Specialty|BCBSTX OTHER|266.60||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|266.60||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UMR|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.15||||266.60||| 71046|EAP|0324|XR CHEST 2 VIEWS|Aetna|AETNA QHP HMO|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.15||||240.80||| 71046|EAP|0324|XR CHEST 2 VIEWS|Cigna|CIGNA|||||240.80||| 71046|EAP|0324|XR CHEST 2 VIEWS|Aetna|AETNA PPO|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|2.15||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|266.60||||266.60||| 71046|EAP|0324|XR CHEST 2 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.15||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|266.60||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|2.15||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|266.60||||266.60||| 71046|EAP|0324|XR CHEST 2 VIEWS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|240.80||||266.60||| 71046|EAP|0324|XR CHEST 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.15||||2.15||| 71046|EAP|0324|XR CHEST 2 VIEWS|Aetna|AETNA OTHER|||||2.15||| 71100|EAP|0320|XR LT RIBS 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||266.60||| 71101|EAP|0320|XR LT RIBS 3 VWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.10||| 71101|EAP|0320|XR LT RIBS 3 VWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3.10||| 71101|EAP|0320|XR RT RIBS 3 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||3.10||| 71101|EAP|0320|XR RT RIBS 3 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||2.50||| 71101|EAP|0320|XR LT RIBS 3 VWS|Veterans Affairs|VETERANS ADMINISTRATION|||||2.50||| 71101|EAP|0320|XR LT RIBS 3 VWS|Veterans Affairs|VETERANS ADMINISTRATION|||||3.10||| 71101|EAP|0320|XR LT RIBS 3 VWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.50||| 71101|EAP|0320|XR RT RIBS 3 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.80||| 71101|EAP|0320|XR LT RIBS 3 VWS|Humana Medicare Advantage|HUMANA MA|||||3.10||| 71101|EAP|0320|XR RT RIBS 3 VIEWS|Cigna|CIGNA|||||3.10||| 71101|EAP|0320|XR LT RIBS 3 VWS|Cigna|CIGNA|||||2.50||| 71101|EAP|0320|XR LT RIBS 3 VWS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||3.10||| 71101|EAP|0320|XR LT RIBS 3 VWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3.10||| 71101|EAP|0320|XR RT RIBS 3 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.10||| 71101|EAP|0320|XR RT RIBS 3 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.10||| 71101|EAP|0320|XR RT RIBS 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||2.80||| 71101|EAP|0320|XR LT RIBS 3 VWS|Blue Cross PPO Specialty|BCBSTX PPO|||||3.10||| 71101|EAP|0320|XR RT RIBS 3 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3.10||| 71101|EAP|0320|XR RT RIBS 3 VIEWS|Cigna|CIGNA|||||2.50||| 71101|EAP|0320|XR LT RIBS 3 VWS|Managed Medicaid|MEDICAID SUPERIOR|||||3.10||| 71101|EAP|0320|XR LT RIBS 3 VWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.50||| 71101|EAP|0320|XR RT RIBS 3 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.50||| 71101|EAP|0320|XR RT RIBS 3 VIEWS|Medicare|MEDICARE ACUTE|||||2.50||| 71101|EAP|0320|XR LT RIBS 3 VWS|Medicaid|MEDICAID|||||2.50||| 71101|EAP|0320|XR RT RIBS 3 VIEWS|Medicaid|MEDICAID|||||2.50||| 71101|EAP|0320|XR RT RIBS 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.50||| 71101|EAP|0320|XR RT RIBS 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||3.10||| 71101|EAP|0320|XR LT RIBS 3 VWS|United Healthcare|UNITED HEALTHCARE OTHER|||||2.50||| 71101|EAP|0320|XR LT RIBS 3 VWS|Medicare|MEDICARE ACUTE|||||2.50||| 71101|EAP|0320|XR RT RIBS 3 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||3.10||| 71101|EAP|0320|XR LT RIBS 3 VWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.50||| 71101|EAP|0320|XR RT RIBS 3 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.80||| 71101|EAP|0320|XR LT RIBS 3 VWS|Medicaid|WOOD COUNTY INDIGENT|||||3.10||| 71101|EAP|0320|XR RT RIBS 3 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.50||| 71101|EAP|0320|XR LT RIBS 3 VWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.50||| 71101|EAP|0320|XR LT RIBS 3 VWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.10||| 71101|EAP|0320|XR RT RIBS 3 VIEWS|Humana Medicare Advantage|HUMANA MA|||||3.10||| 71110|EAP|0320|XR RIBS BILATERAL 3 VIEWS|Medicare|MEDICARE ACUTE|||||3.10||| 71111|EAP|0320|XR RIBS, BOTH SIDES|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.50||| 71111|EAP|0320|XR RIBS, BOTH SIDES|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.50||| 71111|EAP|0320|XR RIBS, BOTH SIDES|Medicare|MEDICARE ACUTE|||||3.10||| 71120|EAP|0320|XR STERNUM 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||2.15||| 71120|EAP|0320|XR STERNUM 2 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||266.60||| 71120|EAP|0320|XR STERNUM 2 VIEWS|Medicare|MEDICARE ACUTE|||||266.60||| 71250|EAP|0352|CT CHEST WO CONTRAST|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|17.98||||14.50||| 71250|EAP|0352|CT CHEST WO CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|14.50||||17.98||| 71250|EAP|0352|CT CHEST WO CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|17.98||||||| 71250|EAP|0352|CT CHEST WO CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|17.98||||17.98||| 71250|EAP|0352|CT CHEST WO CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||17.98||| 71250|EAP|0352|CT CHEST WO CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|17.98||||17.98||| 71250|EAP|0352|CT CHEST WO CONTRAST|Managed Medicare|HEALTHSPRING MA|17.98||||16.24||| 71250|EAP|0352|CT CHEST WO CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|||||16.24||| 71250|EAP|0352|CT CHEST WO CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 1|17.98||||17.98||| 71250|EAP|0352|CT CHEST WO CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|||||17.98||| 71250|EAP|0352|CT CHEST WO CONTRAST|Medicaid|MEDICAID|17.98||||14.50||| 71250|EAP|0352|CT CHEST WO CONTRAST|Tricare|TRICARE EAST REGION|17.98||||16.24||| 71250|EAP|0352|CT CHEST WO CONTRAST|United Healthcare|UNITED HEALTHCARE|16.24||||17.98||| 71250|EAP|0352|CT CHEST WO CONTRAST|Medicare|MEDICARE PART B ONLY IP|17.98||||||| 71250|EAP|0352|CT CHEST WO CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|14.50||||16.24||| 71250|EAP|0352|CT CHEST WO CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|17.98||||17.98||| 71250|EAP|0352|CT CHEST WO CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||17.98||| 71250|EAP|0352|CT CHEST WO CONTRAST|Aetna|AETNA OTHER|||||14.50||| 71250|EAP|0352|CT CHEST WO CONTRAST|Medicare|MEDICARE ACUTE|14.50||||17.98||| 71250|EAP|0352|CT CHEST WO CONTRAST|Aetna|AETNA QHP HMO|||||17.98||| 71250|EAP|0352|CT CHEST WO CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|17.98||||||| 71250|EAP|0352|CT CHEST WO CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|17.98||||14.50||| 71250|EAP|0352|CT CHEST WO CONTRAST|Aetna|AETNA PPO|17.98||||||| 71250|EAP|0352|CT CHEST WO CONTRAST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||16.24||| 71250|EAP|0352|CT CHEST WO CONTRAST|Humana Medicare Advantage|HUMANA MA|14.50||||17.98||| 71250|EAP|0352|CT CHEST WO CONTRAST|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||17.98||| 71250|EAP|0352|CT CHEST WO CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|16.24||||14.50||| 71250|EAP|0352|CT CHEST WO CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|17.98||||17.98||| 71250|EAP|0352|CT CHEST WO CONTRAST|United Healthcare|UNITED HEALTHCARE|||||14.50||| 71260|EAP|0352|CT CHEST W CONTRAST|Aetna|AETNA OTHER|||||21.08||| 71260|EAP|0352|CT CHEST W CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||21.08||| 71260|EAP|0352|CT CHEST W CONTRAST|Humana Medicare Advantage|HUMANA MA|19.04||||17.00||| 71260|EAP|0352|CT CHEST W CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|||||17.00||| 71260|EAP|0352|CT CHEST W CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||17.00||| 71260|EAP|0352|CT CHEST W CONTRAST|Blue Cross PPO Specialty|BCBSTX OTHER|17.00||||19.04||| 71260|EAP|0352|CT CHEST W CONTRAST|Managed Medicare|BCBS MEDICARE PPO MA|||||21.08||| 71260|EAP|0352|CT CHEST W CONTRAST|United Healthcare|UNITED HEALTHCARE|||||17.00||| 71260|EAP|0352|CT CHEST W CONTRAST|Medicare|MEDICARE ACUTE|17.00||||21.08||| 71260|EAP|0352|CT CHEST W CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|||||17.00||| 71260|EAP|0352|CT CHEST W CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||21.08||| 71260|EAP|0352|CT CHEST W CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UMR|||||17.00||| 71260|EAP|0352|CT CHEST W CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|21.08||||21.08||| 71260|EAP|0352|CT CHEST W CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|21.08||||17.00||| 71260|EAP|0352|CT CHEST W CONTRAST|Managed Medicare|OTHER INSTITUTIONS|||||21.08||| 71260|EAP|0352|CT CHEST W CONTRAST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||21.08||| 71260|EAP|0352|CT CHEST W CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 2|||||17.00||| 71260|EAP|0352|CT CHEST W CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|||||21.08||| 71260|EAP|0352|CT CHEST W CONTRAST|Medicaid|MEDICAID|17.00||||19.04||| 71260|EAP|0352|CT CHEST W CONTRAST|United Healthcare|UNITED HEALTHCARE|||||21.08||| 71260|EAP|0352|CT CHEST W CONTRAST|Cigna|CIGNA|||||21.08||| 71260|EAP|0352|CT CHEST W CONTRAST|Managed Medicare|HEALTHSPRING MA|||||17.00||| 71260|EAP|0352|CT CHEST W CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 1|17.00||||19.04||| 71260|EAP|0352|CT CHEST W CONTRAST|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||17.00||| 71260|EAP|0352|CT CHEST W CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|||||17.00||| 71260|EAP|0352|CT CHEST W CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|17.00||||17.00||| 71260|EAP|0352|CT CHEST W CONTRAST|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||21.08||| 71260|EAP|0352|CT CHEST W CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||21.08||| 71260|EAP|0352|CT CHEST W CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||17.00||| 71260|EAP|0352|CT CHEST W CONTRAST|Workers Compensation|WORKERS COMPENSATION OTHER|||||21.08||| 71260|EAP|0352|CT CHEST W CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|||||21.08||| 71260|EAP|0352|CT CHEST W CONTRAST|Tricare|TRICARE EAST REGION|||||17.00||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||27.90||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|United Medicare Advantage|UHC MEDICARE GOLD MA|22.50||||27.90||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|22.50||||27.90||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|United Healthcare|UNITED HEALTHCARE|||||22.50||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|Medicare|MEDICARE PART B ONLY IP|27.90||||||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|27.90||||27.90||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|Medicaid|MEDICAID HMO|||||27.90||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||25.20||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|Medicare|MEDICARE ACUTE|25.20||||27.90||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|Managed Medicare|HEALTHSPRING MA|||||27.90||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|Managed Medicaid|MEDICAID AMERIGROUP|27.90||||25.20||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|22.50||||27.90||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|Veterans Affairs|VETERANS ADMINISTRATION|||||27.90||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||22.50||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|United Healthcare|UNITED HEALTHCARE|22.50||||27.90||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|27.90||||22.50||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|Medicaid|WOOD COUNTY INDIGENT|||||27.90||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|Medicaid|MEDICAID|25.20||||25.20||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|Managed Medicaid|MEDICAID SUPERIOR|||||25.20||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|NON CONTRACTED|COMMERCIAL OTHER 1|22.50||||22.50||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|Managed Medicare|OTHER INSTITUTIONS|||||27.90||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||22.50||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|Cigna|CIGNA|27.90||||||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||22.50||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|Blue Cross PPO Specialty|BCBSTX PPO|27.90||||27.90||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||25.20||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|Aetna|AETNA PPO|27.90||||||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|Blue Cross HMO Specialty|BCBSTX HMO|||||25.20||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|Aenta Medicare Advantage|AETNA MEDICARE MA|27.90||||27.90||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|Humana Medicare Advantage|HUMANA MA|22.50||||27.90||| 71275|EAP|0350|CT CHEST PULMONARY ANGIOG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||27.90||| 71550|EAP|0610|MRI CHEST|Managed Medicaid|MEDICAID AMERIGROUP|||||23.00||| 72|DRG||NONSPECIFIC CEREBROVASCULAR DISORDERS W/O CC/MCC|Medicare|MEDICARE ACUTE|11,917.75|3261.28|3261.28|3261.28|||| 72040|EAP|0320|XR SPINE CERVICAL 2 OR 3|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.15||||2.15||| 72040|EAP|0320|XR SPINE CERVICAL 2 OR 3|Cigna|CIGNA|||||2.15||| 72040|EAP|0320|XR SPINE CERVICAL 2 OR 3|Aenta Medicare Advantage|AETNA MEDICARE MA|||||266.60||| 72040|EAP|0320|XR SPINE CERVICAL 2 OR 3|Medicare|MEDICARE ACUTE|||||2.15||| 72040|EAP|0320|XR SPINE CERVICAL 2 OR 3|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.15||| 72050|EAP|0320|XR SPINE CERVICAL 5 VIEWS|Managed Medicare|HEALTHSPRING MA|||||266.60||| 72050|EAP|0320|XR SPINE CERVICAL 5 VIEWS|United Healthcare|TML GROUP BENEFITS|||||266.60||| 72050|EAP|0320|XR SPINE CERVICAL 5 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||240.80||| 72050|EAP|0320|XR SPINE CERVICAL 5 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||266.60||| 72050|EAP|0320|XR SPINE CERVICAL 5 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.15||| 72050|EAP|0320|XR SPINE CERVICAL 5 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.15||| 72050|EAP|0320|XR SPINE CERVICAL 5 VIEWS|United Healthcare|UNITED HEALTHCARE|||||266.60||| 72050|EAP|0320|XR SPINE CERVICAL 5 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||266.60||| 72050|EAP|0320|XR SPINE CERVICAL 5 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||266.60||| 72050|EAP|0320|XR SPINE CERVICAL 5 VIEWS|Cigna|CIGNA|||||2.15||| 72050|EAP|0320|XR SPINE CERVICAL 5 VIEWS|Humana Medicare Advantage|HUMANA MA|||||2.15||| 72050|EAP|0320|XR SPINE CERVICAL 5 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||2.15||| 72050|EAP|0320|XR SPINE CERVICAL 5 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||266.60||| 72050|EAP|0320|XR SPINE CERVICAL 5 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UMR|||||2.15||| 72050|EAP|0320|XR SPINE CERVICAL 5 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.15||| 72050|EAP|0320|XR SPINE CERVICAL 5 VIEWS|Cigna|CIGNA|||||240.80||| 72050|EAP|0320|XR SPINE CERVICAL 5 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||2.15||| 72050|EAP|0320|XR SPINE CERVICAL 5 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||240.80||| 72050|EAP|0320|XR SPINE CERVICAL 5 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||266.60||| 72050|EAP|0320|XR SPINE CERVICAL 5 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||2.15||| 72050|EAP|0320|XR SPINE CERVICAL 5 VIEWS|Medicare|MEDICARE ACUTE|||||2.15||| 72050|EAP|0320|XR SPINE CERVICAL 5 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.15||| 72050|EAP|0320|XR SPINE CERVICAL 5 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||266.60||| 72052|EAP|0320|XR SPINE CERVICAL COMPLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3.75||| 72052|EAP|0320|XR SPINE CERVICAL COMPLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3.75||| 72052|EAP|0320|XR SPINE CERVICAL COMPLET|Blue Cross PPO Specialty|BCBSTX OTHER|||||3.75||| 72052|EAP|0320|XR SPINE CERVICAL COMPLET|Cigna|CIGNA|||||3.75||| 72052|EAP|0320|XR SPINE CERVICAL COMPLET|Humana Medicare Advantage|HUMANA MA|||||4.65||| 72052|EAP|0320|XR SPINE CERVICAL COMPLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.75||| 72052|EAP|0320|XR SPINE CERVICAL COMPLET|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.75||| 72052|EAP|0320|XR SPINE CERVICAL COMPLET|Medicare|MEDICARE ACUTE|||||3.75||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|Medicare|MEDICARE ACUTE|||||266.60||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||2.15||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.15||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|266.60||||2.15||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.15||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||266.60||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||2.15||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||240.80||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||240.80||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.15||| 72070|EAP|0320|XR SPINE THORACIC 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.15||| 72072|EAP|0320|XR SPINE THORACIC 3 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3.10||| 72072|EAP|0320|XR SPINE THORACIC 3 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.80||| 72072|EAP|0320|XR SPINE THORACIC 3 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.80||| 72072|EAP|0320|XR SPINE THORACIC 3 VIEWS|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.50||| 72072|EAP|0320|XR SPINE THORACIC 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||2.80||| 72072|EAP|0320|XR SPINE THORACIC 3 VIEWS|Cigna|CIGNA|||||2.50||| 72072|EAP|0320|XR SPINE THORACIC 3 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.10||| 72072|EAP|0320|XR SPINE THORACIC 3 VIEWS|Aetna|AETNA QHP HMO|||||3.10||| 72072|EAP|0320|XR SPINE THORACIC 3 VIEWS|Humana Medicare Advantage|HUMANA MA|||||2.50||| 72072|EAP|0320|XR SPINE THORACIC 3 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.80||| 72072|EAP|0320|XR SPINE THORACIC 3 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.50||| 72072|EAP|0320|XR SPINE THORACIC 3 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.10||| 72072|EAP|0320|XR SPINE THORACIC 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.50||| 72072|EAP|0320|XR SPINE THORACIC 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.50||| 72072|EAP|0320|XR SPINE THORACIC 3 VIEWS|Medicaid|MEDICAID|||||2.50||| 72072|EAP|0320|XR SPINE THORACIC 3 VIEWS|Medicare|MEDICARE ACUTE|||||3.10||| 72072|EAP|0320|XR SPINE THORACIC 3 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||2.50||| 72072|EAP|0320|XR SPINE THORACIC 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||3.10||| 72072|EAP|0320|XR SPINE THORACIC 3 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.80||| 72082|EAP|0320|XR ENTIRE SPINE 2 OR 3 VI|Managed Medicaid|MEDICAID SUPERIOR|||||266.60||| 72082|EAP|0320|XR ENTIRE SPINE 2 OR 3 VI|Blue Cross PPO Specialty|BCBSTX PPO|||||2.15||| 72083|EAP|0320|XR ENTIRE SPINE 4 OR 5 VI|Blue Cross PPO Specialty|BCBSTX PPO|||||2.50||| 72083|EAP|0320|XR ENTIRE SPINE 4 OR 5 VI|Managed Medicaid|MEDICAID AMERIGROUP|||||3.10||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.15||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Veterans Affairs|VETERANS ADMINISTRATION|||||240.80||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||266.60||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Veterans Affairs|VETERANS ADMINISTRATION|||||266.60||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.15||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Medicaid|MEDICAID|||||2.15||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||240.80||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Medicare|MEDICARE ACUTE|2.15||||266.60||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.15||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.15||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Managed Medicaid|MEDICAID AMERIGROUP|||||266.60||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|United Healthcare|UNITED HEALTHCARE OTHER|||||240.80||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Managed Medicaid|MEDICAID SUPERIOR|||||266.60||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Tricare|TRICARE FOR LIFE|||||2.15||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|266.60||||2.15||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Texas Workforce Commission|DEPT OF ASSIST AND REHAB SRVCS|||||266.60||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.15||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Managed Medicare|BCBS MEDICARE PPO MA|||||266.60||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|United Healthcare|UNITED HEALTHCARE|||||2.15||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Managed Medicare|HEALTHSPRING MA|||||266.60||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|United Healthcare|TML GROUP BENEFITS|||||266.60||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.15||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Cigna|CIGNA|||||240.80||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Tricare|TRICARE EAST REGION|||||266.60||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||266.60||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Cigna|CIGNA|||||2.15||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Aetna|AETNA QHP HMO|||||266.60||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Humana Medicare Advantage|HUMANA MA|||||2.15||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.15||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||240.80||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Blue Cross PPO Specialty|BCBSTX OTHER|||||240.80||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Aetna|AETNA OTHER|||||266.60||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Aenta Medicare Advantage|AETNA MEDICARE MA|||||266.60||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||266.60||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Blue Cross HMO Specialty|BCBSTX HMO|||||240.80||| 72100|EAP|0320|XR SPINE LUMBAR 2 OR 3 VI|Blue Cross PPO Specialty|BCBSTX PPO|||||266.60||| 72110|EAP|0320|XR SPINE LUMBAR COMPLETE|Blue Cross PPO Specialty|BCBSTX OTHER|||||4.65||| 72110|EAP|0320|XR SPINE LUMBAR COMPLETE|Aetna|AETNA PPO|||||4.65||| 72110|EAP|0320|XR SPINE LUMBAR COMPLETE|Cigna|CIGNA|||||3.75||| 72110|EAP|0320|XR SPINE LUMBAR COMPLETE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.75||| 72110|EAP|0320|XR SPINE LUMBAR COMPLETE|Blue Cross PPO Specialty|BCBSTX PPO|||||4.20||| 72110|EAP|0320|XR SPINE LUMBAR COMPLETE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||3.75||| 72110|EAP|0320|XR SPINE LUMBAR COMPLETE|Humana Medicare Advantage|HUMANA MA|||||3.75||| 72110|EAP|0320|XR SPINE LUMBAR COMPLETE|Blue Cross HMO Specialty|BCBSTX HMO|||||4.65||| 72110|EAP|0320|XR SPINE LUMBAR COMPLETE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.65||| 72110|EAP|0320|XR SPINE LUMBAR COMPLETE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.65||| 72110|EAP|0320|XR SPINE LUMBAR COMPLETE|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.75||| 72110|EAP|0320|XR SPINE LUMBAR COMPLETE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.75||| 72110|EAP|0320|XR SPINE LUMBAR COMPLETE|Managed Medicaid|MEDICAID SUPERIOR|||||3.75||| 72110|EAP|0320|XR SPINE LUMBAR COMPLETE|Medicaid|MEDICAID|||||3.75||| 72110|EAP|0320|XR SPINE LUMBAR COMPLETE|Aetna|AETNA OTHER|||||3.75||| 72110|EAP|0320|XR SPINE LUMBAR COMPLETE|United Healthcare|UNITED HEALTHCARE OTHER|||||4.20||| 72110|EAP|0320|XR SPINE LUMBAR COMPLETE|United Healthcare|UNITED HEALTHCARE|||||4.65||| 72110|EAP|0320|XR SPINE LUMBAR COMPLETE|Managed Medicare|HEALTHSPRING MA|||||4.65||| 72110|EAP|0320|XR SPINE LUMBAR COMPLETE|Medicare|MEDICARE ACUTE|||||4.65||| 72110|EAP|0320|XR SPINE LUMBAR COMPLETE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3.75||| 72110|EAP|0320|XR SPINE LUMBAR COMPLETE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.75||| 72110|EAP|0320|XR SPINE LUMBAR COMPLETE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.65||| 72114|EAP|0320|XR LUMBOSACRAL W/BEND VWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3.75||| 72114|EAP|0320|XR LUMBOSACRAL W/BEND VWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||3.75||| 72114|EAP|0320|XR LUMBOSACRAL W/BEND VWS|Medicare|MEDICARE ACUTE|||||4.65||| 72114|EAP|0320|XR LUMBOSACRAL W/BEND VWS|Blue Cross PPO Specialty|BCBSTX PPO|||||3.75||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Cigna|CIGNA|||||17.98||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Humana Medicare Advantage|HUMANA MA|||||17.98||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||14.50||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|||||17.98||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|||||17.98||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Aetna|AETNA QHP HMO|||||17.98||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||16.24||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||17.98||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||14.50||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Managed Medicare|HEALTHSPRING MA|||||14.50||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||14.50||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Managed Medicaid|MEDICAID SUPERIOR|||||16.24||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|14.50||||14.50||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||17.98||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Medicare|MEDICARE ACUTE|17.98||||14.50||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||14.50||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Aetna|AETNA OTHER|||||14.50||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 1|||||14.50||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Medicaid|MEDICAID|||||14.50||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||17.98||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|United Healthcare|UNITED HEALTHCARE OTHER|||||17.98||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|||||17.98||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Tricare|TRICARE EAST REGION|||||14.50||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|United Healthcare|UNITED HEALTHCARE|||||14.50||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Managed Medicare|BCBS MEDICARE PPO MA|||||17.98||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Managed Medicaid|MEDICAID AMERIGROUP|||||17.98||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|||||14.50||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|||||17.98||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||14.50||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||16.24||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|Workers Compensation|WORKERS COMPENSATION OTHER|||||14.50||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||14.50||| 72125|EAP|0350|CT C-SPINE WO CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||17.98||| 72128|EAP|0350|CT THORACIC SPINE WO CONT|Workers Compensation|WORKERS COMPENSATION OTHER|||||14.50||| 72128|EAP|0350|CT THORACIC SPINE WO CONT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||17.98||| 72128|EAP|0350|CT THORACIC SPINE WO CONT|Medicare|MEDICARE ACUTE|17.98||||16.24||| 72128|EAP|0350|CT THORACIC SPINE WO CONT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|17.98||||14.50||| 72128|EAP|0350|CT THORACIC SPINE WO CONT|Medicaid|MEDICAID|||||14.50||| 72128|EAP|0350|CT THORACIC SPINE WO CONT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||14.50||| 72128|EAP|0350|CT THORACIC SPINE WO CONT|Managed Medicaid|MEDICAID AMERIGROUP|||||17.98||| 72128|EAP|0350|CT THORACIC SPINE WO CONT|United Healthcare|UNITED HEALTHCARE OTHER|||||17.98||| 72128|EAP|0350|CT THORACIC SPINE WO CONT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|17.98||||||| 72128|EAP|0350|CT THORACIC SPINE WO CONT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||16.24||| 72128|EAP|0350|CT THORACIC SPINE WO CONT|Blue Cross PPO Specialty|BCBSTX PPO|||||16.24||| 72128|EAP|0350|CT THORACIC SPINE WO CONT|Humana Medicare Advantage|HUMANA MA|17.98||||16.24||| 72128|EAP|0350|CT THORACIC SPINE WO CONT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||17.98||| 72128|EAP|0350|CT THORACIC SPINE WO CONT|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||16.24||| 72129|EAP|0350|CT THORACIC SPINE W CONTR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||17.00||| 72131|EAP|0350|CT LUMBER SPINE WO CONTRA|United Medicare Advantage|UHC MEDICARE GOLD MA|||||17.98||| 72131|EAP|0350|CT LUMBER SPINE WO CONTRA|Workers Compensation|WORKERS COMPENSATION OTHER|||||14.50||| 72131|EAP|0350|CT LUMBER SPINE WO CONTRA|Tricare|TRICARE EAST REGION|||||17.98||| 72131|EAP|0350|CT LUMBER SPINE WO CONTRA|Medicare|MEDICARE ACUTE|17.98||||17.98||| 72131|EAP|0350|CT LUMBER SPINE WO CONTRA|Managed Medicaid|MEDICAID SUPERIOR|||||17.98||| 72131|EAP|0350|CT LUMBER SPINE WO CONTRA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||14.50||| 72131|EAP|0350|CT LUMBER SPINE WO CONTRA|NON CONTRACTED|COMMERCIAL OTHER 1|||||14.50||| 72131|EAP|0350|CT LUMBER SPINE WO CONTRA|Managed Medicaid|MEDICAID AMERIGROUP|||||17.98||| 72131|EAP|0350|CT LUMBER SPINE WO CONTRA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||14.50||| 72131|EAP|0350|CT LUMBER SPINE WO CONTRA|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|17.98||||16.24||| 72131|EAP|0350|CT LUMBER SPINE WO CONTRA|United Healthcare|TML GROUP BENEFITS|||||17.98||| 72131|EAP|0350|CT LUMBER SPINE WO CONTRA|United Healthcare|UNITED HEALTHCARE|||||17.98||| 72131|EAP|0350|CT LUMBER SPINE WO CONTRA|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||14.50||| 72131|EAP|0350|CT LUMBER SPINE WO CONTRA|Medicaid|MEDICAID|||||14.50||| 72131|EAP|0350|CT LUMBER SPINE WO CONTRA|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|17.98||||17.98||| 72131|EAP|0350|CT LUMBER SPINE WO CONTRA|United Healthcare|UNITED HEALTHCARE OTHER|||||14.50||| 72131|EAP|0350|CT LUMBER SPINE WO CONTRA|Blue Cross PPO Specialty|BCBSTX PPO|||||16.24||| 72131|EAP|0350|CT LUMBER SPINE WO CONTRA|Aenta Medicare Advantage|AETNA MEDICARE MA|||||17.98||| 72131|EAP|0350|CT LUMBER SPINE WO CONTRA|Humana Medicare Advantage|HUMANA MA|||||17.98||| 72131|EAP|0350|CT LUMBER SPINE WO CONTRA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|17.98||||17.98||| 72131|EAP|0350|CT LUMBER SPINE WO CONTRA|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||16.24||| 72131|EAP|0350|CT LUMBER SPINE WO CONTRA|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||16.24||| 72141|EAP|0610|MRI C SPINE|Humana Medicare Advantage|HUMANA MA|||||23.00||| 72141|EAP|0610|MRI C SPINE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||23.00||| 72141|EAP|0610|MRI C SPINE|Blue Cross HMO Specialty|BCBSTX HMO|||||23.00||| 72141|EAP|0610|MRI C SPINE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||28.52||| 72141|EAP|0610|MRI C SPINE|Blue Cross PPO Specialty|BCBSTX PPO|||||23.00||| 72141|EAP|0610|MRI C SPINE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||28.52||| 72141|EAP|0610|MRI C SPINE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||23.00||| 72141|EAP|0610|MRI C SPINE|Managed Medicaid|MEDICAID AMERIGROUP|||||28.52||| 72141|EAP|0610|MRI C SPINE|Medicaid|MEDICAID|||||28.52||| 72141|EAP|0610|MRI C SPINE|Managed Medicare|HEALTHSPRING MA|||||23.00||| 72141|EAP|0610|MRI C SPINE|Medicare|MEDICARE ACUTE|23.00||||28.52||| 72141|EAP|0610|MRI C SPINE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||25.76||| 72141|EAP|0610|MRI C SPINE|NON CONTRACTED|COMMERCIAL OTHER 1|||||23.00||| 72141|EAP|0610|MRI C SPINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||23.00||| 72141|EAP|0610|MRI C SPINE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||23.00||| 72141|EAP|0610|MRI C SPINE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||23.00||| 72141|EAP|0610|MRI C SPINE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||25.76||| 72141|EAP|0610|MRI C SPINE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||23.00||| 72146|EAP|0610|MRI T SPINE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||28.52||| 72146|EAP|0610|MRI T SPINE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||25.76||| 72146|EAP|0610|MRI T SPINE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||28.52||| 72146|EAP|0610|MRI T SPINE|Managed Medicaid|MEDICAID AMERIGROUP|||||23.00||| 72146|EAP|0610|MRI T SPINE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||28.52||| 72146|EAP|0610|MRI T SPINE|Aetna|AETNA PPO|||||23.00||| 72146|EAP|0610|MRI T SPINE|Blue Cross PPO Specialty|BCBSTX PPO|28.52||||28.52||| 72146|EAP|0610|MRI T SPINE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||28.52||| 72146|EAP|0610|MRI T SPINE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||28.52||| 72146|EAP|0610|MRI T SPINE|Medicare|MEDICARE ACUTE|23.00||||25.76||| 72146|EAP|0610|MRI T SPINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|28.52||||||| 72146|EAP|0610|MRI T SPINE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||23.00||| 72146|EAP|0610|MRI T SPINE|Humana Medicare Advantage|HUMANA MA|||||23.00||| 72147|EAP|0610|MRI T-SPINE W/ CONTRAST|Humana Medicare Advantage|HUMANA MA|27.00||||||| 72148|EAP|0610|MRI LUMBAR SPINE WO|United Healthcare|UNITED HEALTHCARE|||||28.52||| 72148|EAP|0610|MRI LUMBAR SPINE WO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||28.52||| 72148|EAP|0610|MRI LUMBAR SPINE WO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||25.76||| 72148|EAP|0610|MRI LUMBAR SPINE WO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO|Workers Compensation|UT EMPLOYEE INJURY|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO|Medicare|MEDICARE ACUTE|23.00||||28.52||| 72148|EAP|0610|MRI LUMBAR SPINE WO|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||28.52||| 72148|EAP|0610|MRI LUMBAR SPINE WO|Managed Medicaid|MEDICAID AMERIGROUP|||||28.52||| 72148|EAP|0610|MRI LUMBAR SPINE WO|NON CONTRACTED|COMMERCIAL OTHER 1|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO|Medicaid|MEDICAID|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|28.52||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||28.52||| 72148|EAP|0610|MRI LUMBAR SPINE WO|Blue Cross PPO Specialty|BCBSTX PPO|28.52||||28.52||| 72148|EAP|0610|MRI LUMBAR SPINE WO|Humana Medicare Advantage|HUMANA MA|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO|Blue Cross PPO Specialty|BCBSTX OTHER|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO|Aetna|AETNA OTHER|||||28.52||| 72148|EAP|0610|MRI LUMBAR SPINE WO|Cigna|CIGNA|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO|Tricare|TRICARE EAST REGION|||||28.52||| 72148|EAP|0610|MRI LUMBAR SPINE WO|Managed Medicare|BCBS MEDICARE PPO MA|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||28.52||| 72148|EAP|0610|MRI LUMBAR SPINE WO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO|Aetna|AETNA PPO|||||25.76||| 72148|EAP|0610|MRI LUMBAR SPINE WO|ChampVA|CHAMPVA CENTER|||||28.52||| 72148|EAP|0610|MRI LUMBAR SPINE WO|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||23.00||| 72148|EAP|0610|MRI LUMBAR SPINE WO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||28.52||| 72149|EAP|0610|MRI L-SPINE W/ CONTRAST|Humana Medicare Advantage|HUMANA MA|27.00||||||| 72156|EAP|0610|MRI C SPINE W W/O|United Medicare Advantage|UHC MEDICARE GOLD MA|||||42.16||| 72156|EAP|0610|MRI C SPINE W W/O|NON CONTRACTED|COMMERCIAL OTHER 1|||||34.00||| 72156|EAP|0610|MRI C SPINE W W/O|Medicare|MEDICARE ACUTE|||||34.00||| 72156|EAP|0610|MRI C SPINE W W/O|Tricare|TRICARE EAST REGION|||||42.16||| 72156|EAP|0610|MRI C SPINE W W/O|Blue Cross PPO Specialty|BCBSTX PPO|||||34.00||| 72156|EAP|0610|MRI C SPINE W W/O|Humana Medicare Advantage|HUMANA MA|||||34.00||| 72157|EAP|0610|MRI T SPINE W W/O|Medicare|MEDICARE ACUTE|||||34.00||| 72157|EAP|0610|MRI T SPINE W W/O|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||42.16||| 72157|EAP|0610|MRI T SPINE W W/O|Blue Cross PPO Specialty|BCBSTX PPO|||||34.00||| 72157|EAP|0610|MRI T SPINE W W/O|Humana Medicare Advantage|HUMANA MA|||||34.00||| 72157|EAP|0610|MRI T SPINE W W/O|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||34.00||| 72157|EAP|0610|MRI T SPINE W W/O|NON CONTRACTED|COMMERCIAL OTHER 1|||||34.00||| 72158|EAP|0610|MRI LUMBAR SPINE W W/O|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||42.16||| 72158|EAP|0610|MRI LUMBAR SPINE W W/O|Medicare|MEDICARE ACUTE|||||38.08||| 72158|EAP|0610|MRI LUMBAR SPINE W W/O|Tricare|TRICARE EAST REGION|||||42.16||| 72158|EAP|0610|MRI LUMBAR SPINE W W/O|NON CONTRACTED|COMMERCIAL OTHER 1|||||34.00||| 72158|EAP|0610|MRI LUMBAR SPINE W W/O|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||34.00||| 72158|EAP|0610|MRI LUMBAR SPINE W W/O|Humana Medicare Advantage|HUMANA MA|||||34.00||| 72158|EAP|0610|MRI LUMBAR SPINE W W/O|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||34.00||| 72170|EAP|0320|XR PELVIS, 1 VIEW|Blue Cross PPO Specialty|BCBSTX PPO|||||218.40||| 72170|EAP|0320|XR PELVIS, 1 VIEW|Cigna|CIGNA|||||241.80||| 72170|EAP|0320|XR PELVIS, 1 VIEW|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||241.80||| 72170|EAP|0320|XR PELVIS, 1 VIEW|Humana Medicare Advantage|HUMANA MA|||||241.80||| 72170|EAP|0320|XR PELVIS, 1 VIEW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|218.40||||1.95||| 72170|EAP|0320|XR PELVIS, 1 VIEW|United Healthcare|UNITED HEALTHCARE OTHER|||||241.80||| 72170|EAP|0320|XR PELVIS, 1 VIEW|Managed Medicaid|MEDICAID SUPERIOR|||||218.40||| 72170|EAP|0320|XR PELVIS, 1 VIEW|Medicare|MEDICARE ACUTE|||||1.95||| 72170|EAP|0320|XR PELVIS, 1 VIEW|Managed Medicare|BCBS MEDICARE PPO MA|||||241.80||| 72170|EAP|0320|XR PELVIS, 1 VIEW|Managed Medicare|OTHER INSTITUTIONS|||||241.80||| 72170|EAP|0320|XR PELVIS, 1 VIEW|Managed Medicaid|MEDICAID AMERIGROUP|||||1.95||| 72170|EAP|0320|XR PELVIS, 1 VIEW|Tricare|TRICARE EAST REGION|||||1.95||| 72170|EAP|0320|XR PELVIS, 1 VIEW|NON CONTRACTED|COMMERCIAL OTHER 1|||||218.40||| 72170|EAP|0320|XR PELVIS, 1 VIEW|Blue Cross HMO Specialty|BCBSTX HMO|||||1.95||| 72170|EAP|0320|XR PELVIS, 1 VIEW|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.95||| 72170|EAP|0320|XR PELVIS, 1 VIEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.95||| 72192|EAP|0352|CT PELVIS WO CONTRAST|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||14.50||| 72192|EAP|0352|CT PELVIS WO CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||14.50||| 72192|EAP|0352|CT PELVIS WO CONTRAST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|14.50||||16.24||| 72192|EAP|0352|CT PELVIS WO CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||14.50||| 72192|EAP|0352|CT PELVIS WO CONTRAST|NON CONTRACTED|WOOD COUNTY HOSPITAL DISTRICT|||||14.50||| 72192|EAP|0352|CT PELVIS WO CONTRAST|Managed Medicare|HEALTHSPRING MA|14.50||||16.24||| 72192|EAP|0352|CT PELVIS WO CONTRAST|Medicaid|WOOD COUNTY INDIGENT|||||14.50||| 72192|EAP|0352|CT PELVIS WO CONTRAST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||14.50||| 72192|EAP|0352|CT PELVIS WO CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|||||17.98||| 72192|EAP|0352|CT PELVIS WO CONTRAST|Humana Medicare Advantage|HUMANA MA|||||14.50||| 72192|EAP|0352|CT PELVIS WO CONTRAST|Aenta Medicare Advantage|AETNA MEDICARE MA|||||14.50||| 72192|EAP|0352|CT PELVIS WO CONTRAST|Blue Cross PPO Specialty|BCBSTX OTHER|||||17.98||| 72192|EAP|0352|CT PELVIS WO CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||14.50||| 72192|EAP|0352|CT PELVIS WO CONTRAST|Medicare|MEDICARE ACUTE|14.50||||17.98||| 72192|EAP|0352|CT PELVIS WO CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||16.24||| 72192|EAP|0352|CT PELVIS WO CONTRAST|Cigna|CIGNA|||||14.50||| 72193|EAP|0352|CT PELVIS W CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|21.08||||||| 72193|EAP|0352|CT PELVIS W CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|||||21.08||| 72193|EAP|0352|CT PELVIS W CONTRAST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||21.08||| 72193|EAP|0352|CT PELVIS W CONTRAST|Medicaid|MEDICAID|||||21.08||| 72193|EAP|0352|CT PELVIS W CONTRAST|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||17.00||| 72195|EAP|0610|MRI PELVIS W/O|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||23.00||| 72195|EAP|0610|MRI PELVIS W/O|Managed Medicaid|MEDICAID SUPERIOR|||||28.52||| 72195|EAP|0610|MRI PELVIS W/O|Medicare|MEDICARE ACUTE|||||23.00||| 72195|EAP|0610|MRI PELVIS W/O|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||28.52||| 72195|EAP|0610|MRI PELVIS W/O|Humana Medicare Advantage|HUMANA MA|||||23.00||| 72195|EAP|0610|MRI PELVIS W/O|Blue Cross PPO Specialty|BCBSTX PPO|||||28.52||| 72195|EAP|0610|MRI PELVIS W/O|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||28.52||| 72197|EAP|0610|MRI PELVIS W/WO CONTRAST|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||34.00||| 72197|EAP|0610|MRI PELVIS W/WO CONTRAST|Medicare|MEDICARE ACUTE|||||38.08||| 72197|EAP|0610|MRI PELVIS W/WO CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||42.16||| 72202|EAP|0320|XR SACRO-ILIAC JOINTS 3|Medicare|MEDICARE ACUTE|||||3.10||| 72202|EAP|0320|XR SACRO-ILIAC JOINTS 3|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.10||| 72202|EAP|0320|XR SACRO-ILIAC JOINTS 3|Blue Cross PPO Specialty|BCBSTX PPO|||||3.10||| 72220|EAP|0320|XR COCCYX 2 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||2.15||| 72220|EAP|0320|XR COCCYX 2 VIEWS|Aetna|AETNA PPO|||||266.60||| 72220|EAP|0320|XR COCCYX 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||266.60||| 72220|EAP|0320|XR COCCYX 2 VIEWS|Medicare|MEDICARE ACUTE|||||266.60||| 72220|EAP|0320|XR COCCYX 2 VIEWS|Managed Medicare|HEALTHSPRING MA|||||266.60||| 73000|EAP|0320|XR RT CLAVICLE 2 VWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||266.60||| 73000|EAP|0320|XR RT CLAVICLE 2 VWS|Veterans Affairs|VETERANS ADMINISTRATION|||||2.15||| 73000|EAP|0320|XR RT CLAVICLE 2 VWS|Medicare|MEDICARE ACUTE|266.60||||266.60||| 73000|EAP|0320|XR RT CLAVICLE 2 VWS|Managed Medicaid|MEDICAID SUPERIOR|||||266.60||| 73000|EAP|0320|XR RT CLAVICLE 2 VWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.15||| 73000|EAP|0320|XR RT CLAVICLE 2 VWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.15||| 73000|EAP|0320|XR RT CLAVICLE 2 VWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73000|EAP|0320|XR RT CLAVICLE 2 VWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.15||| 73000|EAP|0320|XR RT CLAVICLE 2 VWS|United Healthcare|UNITED HEALTHCARE|||||2.15||| 73000|EAP|0320|XR LT CLAVICLE 2 VW|United Healthcare|UNITED HEALTHCARE|||||2.15||| 73000|EAP|0320|XR LT CLAVICLE 2 VW|Blue Cross PPO Specialty|BCBSTX PPO|||||2.15||| 73000|EAP|0320|XR RT CLAVICLE 2 VWS|Blue Cross PPO Specialty|BCBSTX PPO|||||266.60||| 73000|EAP|0320|XR RT CLAVICLE 2 VWS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||266.60||| 73000|EAP|0320|XR RT CLAVICLE 2 VWS|Cigna|CIGNA|||||2.15||| 73000|EAP|0320|XR RT CLAVICLE 2 VWS|Cigna|CIGNA|||||266.60||| 73010|EAP|0320|XR RT SCAPULA 2 VWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73020|EAP|0320|XR LT SHOULDER 1 VW|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||241.80||| 73020|EAP|0320|XR RT SHOULDER 1 VW|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.95||| 73020|EAP|0320|XR RT SHOULDER 1 VW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||241.80||| 73020|EAP|0320|XR RT SHOULDER 1 VW|Humana Medicare Advantage|HUMANA MA|||||218.40||| 73020|EAP|0320|XR RT SHOULDER 1 VW|Medicare|MEDICARE ACUTE|||||241.80||| 73020|EAP|0320|XR RT SHOULDER 1 VW|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||241.80||| 73020|EAP|0320|XR RT SHOULDER 1 VW|Managed Medicaid|MEDICAID AMERIGROUP|||||1.95||| 73020|EAP|0320|XR LT SHOULDER 1 VW|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||241.80||| 73020|EAP|0320|XR LT SHOULDER 1 VW|United Healthcare|UNITED HEALTHCARE|||||241.80||| 73020|EAP|0320|XR LT SHOULDER 1 VW|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.95||| 73020|EAP|0320|XR LT SHOULDER 1 VW|Medicare|MEDICARE ACUTE|||||241.80||| 73020|EAP|0320|XR LT SHOULDER 1 VW|Managed Medicaid|MEDICAID AMERIGROUP|||||1.95||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|United Healthcare|TML GROUP BENEFITS|||||266.60||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|Medicaid|MEDICAID|||||240.80||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|Managed Medicare|BCBS MEDICARE PPO MA|||||266.60||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|Managed Medicare|HEALTHSPRING MA|||||240.80||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|Medicare|MEDICARE ACUTE|240.80||||2.15||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|United Healthcare|UNITED HEALTHCARE|||||266.60||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.15||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|Tricare|TRICARE EAST REGION|||||2.15||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.15||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||240.80||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||266.60||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|Medicaid|WOOD COUNTY INDIGENT|||||266.60||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|Tricare|TRICARE EAST REGION|||||2.15||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|Managed Medicaid|MEDICAID SUPERIOR|||||266.60||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.15||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||266.60||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|United Healthcare|UNITED HEALTHCARE OTHER|||||266.60||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||240.80||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|Medicare|MEDICARE ACUTE|240.80||||266.60||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|United Healthcare|UNITED HEALTHCARE|||||266.60||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||240.80||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|Blue Cross PPO Specialty|BCBSTX PPO|||||266.60||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|Cigna|CIGNA|||||240.80||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|Humana Medicare Advantage|HUMANA MA|266.60||||266.60||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|Blue Cross HMO Specialty|BCBSTX HMO|||||240.80||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.15||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|Cigna|CIGNA|||||2.15||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|Aetna|AETNA OTHER|||||266.60||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|Managed Medicaid|MEDICAID SUPERIOR|||||266.60||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||266.60||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.15||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||266.60||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|Humana Medicare Advantage|HUMANA MA|266.60||||2.15||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||266.60||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||266.60||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|Access Direct Platinum|HEALTHFIRST TPA UMR|||||266.60||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.15||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||240.80||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|United Healthcare|UNITED HEALTHCARE OTHER|||||2.15||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||240.80||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.15||||266.60||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.15||||266.60||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||266.60||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||240.80||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||266.60||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||240.80||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|Cigna|CIGNA|||||266.60||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|Veterans Affairs|VETERANS ADMINISTRATION|||||266.60||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|Aetna|AETNA QHP HMO|||||266.60||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.15||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|266.60||||2.15||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.15||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.15||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|266.60||||266.60||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|Blue Cross HMO Specialty|BCBSTX HMO|||||240.80||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||266.60||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||266.60||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||266.60||| 73030|EAP|0320|XR LT SHOULDER 2 OR 3 VWS|Blue Cross PPO Specialty|BCBSTX PPO|||||266.60||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|Veterans Affairs|VETERANS ADMINISTRATION|||||266.60||| 73030|EAP|0320|XR RT SHOULDER 2 OR 3 VWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||240.80||| 73060|EAP|0320|XR LT HUMERUS 2 VW|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||266.60||| 73060|EAP|0320|XR RT HUMERUS 2 VWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||266.60||| 73060|EAP|0320|XR LT HUMERUS 2 VW|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.15||| 73060|EAP|0320|XR RT HUMERUS 2 VWS|Blue Cross PPO Specialty|BCBSTX PPO|||||266.60||| 73060|EAP|0320|XR LT HUMERUS 2 VW|Blue Cross PPO Specialty|BCBSTX PPO|||||266.60||| 73060|EAP|0320|XR LT HUMERUS 2 VW|Blue Cross HMO Specialty|BCBSTX HMO|||||2.15||| 73060|EAP|0320|XR RT HUMERUS 2 VWS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.15||| 73060|EAP|0320|XR RT HUMERUS 2 VWS|Humana Medicare Advantage|HUMANA MA|||||266.60||| 73060|EAP|0320|XR RT HUMERUS 2 VWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.15||| 73060|EAP|0320|XR RT HUMERUS 2 VWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||266.60||| 73060|EAP|0320|XR LT HUMERUS 2 VW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.15||| 73060|EAP|0320|XR LT HUMERUS 2 VW|Cigna|CIGNA|||||2.15||| 73060|EAP|0320|XR LT HUMERUS 2 VW|Managed Medicaid|MEDICAID SUPERIOR|||||2.15||| 73060|EAP|0320|XR LT HUMERUS 2 VW|Managed Medicaid|MEDICAID AMERIGROUP|||||266.60||| 73060|EAP|0320|XR RT HUMERUS 2 VWS|Cigna|CIGNA|||||266.60||| 73060|EAP|0320|XR RT HUMERUS 2 VWS|Medicare|MEDICARE ACUTE|2.15||||2.15||| 73060|EAP|0320|XR RT HUMERUS 2 VWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.15||| 73060|EAP|0320|XR LT HUMERUS 2 VW|Humana Medicare Advantage|HUMANA MA|||||240.80||| 73060|EAP|0320|XR LT HUMERUS 2 VW|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||266.60||| 73060|EAP|0320|XR RT HUMERUS 2 VWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73060|EAP|0320|XR RT HUMERUS 2 VWS|Managed Medicaid|MEDICAID SUPERIOR|||||266.60||| 73060|EAP|0320|XR LT HUMERUS 2 VW|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.15||| 73060|EAP|0320|XR RT HUMERUS 2 VWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.15||| 73060|EAP|0320|XR LT HUMERUS 2 VW|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.15||| 73060|EAP|0320|XR LT HUMERUS 2 VW|Medicaid|MEDICAID|||||2.15||| 73060|EAP|0320|XR RT HUMERUS 2 VWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.15||| 73060|EAP|0320|XR LT HUMERUS 2 VW|Medicare|MEDICARE ACUTE|2.15||||240.80||| 73060|EAP|0320|XR RT HUMERUS 2 VWS|United Healthcare|UNITED HEALTHCARE|||||266.60||| 73060|EAP|0320|XR LT HUMERUS 2 VW|United Healthcare|UNITED HEALTHCARE|||||266.60||| 73070|EAP|0320|XR LT ELBOW 2 VWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73070|EAP|0320|XR LT ELBOW 2 VWS|Tricare|TRICARE EAST REGION|||||2.15||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||2.15||| 73070|EAP|0320|XR LT ELBOW 2 VWS|Managed Medicaid|MEDICAID SUPERIOR|||||2.15||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|Medicaid|MEDICAID|||||2.15||| 73070|EAP|0320|XR LT ELBOW 2 VWS|Medicaid|MEDICAID|||||2.15||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||266.60||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|United Healthcare|TML GROUP BENEFITS|||||266.60||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||266.60||| 73070|EAP|0320|XR LT ELBOW 2 VWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||240.80||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|Aetna|AETNA QHP HMO|||||266.60||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UMR|||||266.60||| 73070|EAP|0320|XR LT ELBOW 2 VWS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.15||| 73070|EAP|0320|XR LT ELBOW 2 VWS|Blue Cross PPO Specialty|BCBSTX PPO|||||240.80||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||266.60||| 73070|EAP|0320|XR LT ELBOW 2 VWS|Humana Medicare Advantage|HUMANA MA|||||266.60||| 73070|EAP|0320|XR LT ELBOW 2 VWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.15||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||266.60||| 73070|EAP|0320|XR LT ELBOW 2 VWS|Aenta Medicare Advantage|AETNA MEDICARE MA|266.60||||2.15||| 73070|EAP|0320|XR LT ELBOW 2 VWS|Medicare|MEDICARE ACUTE|||||266.60||| 73070|EAP|0320|XR LT ELBOW 2 VWS|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.15||| 73070|EAP|0320|XR LT ELBOW 2 VWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||266.60||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.15||| 73070|EAP|0320|XR LT ELBOW 2 VWS|Aetna|AETNA QHP HMO|||||266.60||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||266.60||| 73070|EAP|0320|XR LT ELBOW 2 VWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||266.60||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||266.60||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|Medicare|MEDICARE ACUTE|||||2.15||| 73070|EAP|0320|XR LT ELBOW 2 VWS|Veterans Affairs|VETERANS ADMINISTRATION|||||266.60||| 73070|EAP|0320|XR LT ELBOW 2 VWS|Veterans Affairs|VETERANS ADMINISTRATION|266.60||||266.60||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||266.60||| 73070|EAP|0320|XR LT ELBOW 2 VWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||266.60||| 73070|EAP|0320|XR LT ELBOW 2 VWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.15||| 73070|EAP|0320|XR LT ELBOW 2 VWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.15||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||240.80||| 73070|EAP|0320|XR LT ELBOW 2 VWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|266.60||||266.60||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.15||| 73070|EAP|0320|XR LT ELBOW 2 VWS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.15||| 73070|EAP|0320|XR RT ELBOW 2 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|266.60||||266.60||| 73080|EAP|0320|XR RT ELBOW 3 VIEWS|Aetna|AETNA OTHER|||||3.10||| 73080|EAP|0320|XR RT ELBOW 3 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.10||| 73080|EAP|0320|XR RT ELBOW 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||2.50||| 73080|EAP|0320|XR LT ELBOW 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||2.50||| 73080|EAP|0320|XR RT ELBOW 3 VIEWS|Humana Medicare Advantage|HUMANA MA|||||3.10||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.15||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.15||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.15||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|United Healthcare|TML GROUP BENEFITS|||||2.15||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Medicare|MEDICARE ACUTE|||||2.15||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||2.15||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||266.60||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Medicare|MEDICARE ACUTE|||||2.15||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.15||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||266.60||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.15||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||266.60||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||2.15||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Medicaid|MEDICAID|||||266.60||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Medicaid|MEDICAID HMO|||||240.80||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||266.60||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||266.60||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Medicaid|CRIME VICTIMS COMPENSATION|||||266.60||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||266.60||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||266.60||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.15||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||266.60||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.15||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Medicaid|MEDICAID|||||266.60||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||266.60||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||240.80||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Aetna|AETNA QHP HMO|||||2.15||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||266.60||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Blue Cross PPO Specialty|BCBSTX OTHER|||||266.60||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||240.80||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||2.15||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Blue Cross PPO Specialty|BCBSTX OTHER|||||240.80||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Cigna|CIGNA|||||266.60||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||266.60||| 73090|EAP|0320|XR RT FOREARM 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.15||| 73090|EAP|0320|XR LT FOREARM 2 VIEWS|Aetna|AETNA OTHER|||||2.15||| 73092|EAP|0320|XR RT EXTREMITY UPPER INF|Managed Medicaid|MEDICAID SUPERIOR|||||266.60||| 73092|EAP|0320|XR LT EXTREMITY UPPER INF|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73100|EAP|0320|XR LT WRIST 1 OR 2 VWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||266.60||| 73100|EAP|0320|XR LT WRIST 1 OR 2 VWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||266.60||| 73100|EAP|0320|XR LT WRIST 1 OR 2 VWS|Blue Cross PPO Specialty|BCBSTX PPO|||||266.60||| 73100|EAP|0320|XR LT WRIST 1 OR 2 VWS|Humana Medicare Advantage|HUMANA MA|||||2.15||| 73100|EAP|0320|XR RT WRIST 1 OR 2 VIEWS|Tricare|TRICARE EAST REGION|||||266.60||| 73100|EAP|0320|XR RT WRIST 1 OR 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73100|EAP|0320|XR LT WRIST 1 OR 2 VWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||266.60||| 73100|EAP|0320|XR LT WRIST 1 OR 2 VWS|Medicaid|MEDICAID|||||266.60||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Multiplan|NALC|||||3.10||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3.10||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||3.10||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Managed Medicare|HEALTHSPRING MA|||||3.10||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||3.10||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.80||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.50||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Medicaid|MEDICAID|||||3.10||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2.50||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||3.10||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Medicaid|MEDICAID|||||2.50||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||2.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.80||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Medicare|MEDICARE ACUTE|2.50||||2.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Managed Medicare|OTHER INSTITUTIONS|||||3.10||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Tricare|TRICARE FOR LIFE|||||3.10||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Medicare|MEDICARE ACUTE|2.50||||2.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.80||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.10||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||2.50||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Cigna|CIGNA|||||3.10||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3.10||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.50||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Managed Medicare|BCBS MEDICARE PPO MA|||||3.10||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Cigna|CIGNA|||||2.80||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.50||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Tricare|TRICARE EAST REGION|||||3.10||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.10||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.10||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Managed Medicare|HEALTHSPRING MA|||||3.10||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Blue Cross PPO Specialty|BCBSTX OTHER|||||3.10||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||3.10||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||2.80||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||3.10||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||3.10||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||3.10||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||3.10||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Humana Medicare Advantage|HUMANA MA|||||3.10||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Cigna|CIGNA|||||2.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||3.10||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Humana Medicare Advantage|HUMANA MA|||||3.10||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Aetna|AETNA OTHER|||||2.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3.10||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||2.50||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.80||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.80||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3.10||| 73110|EAP|0320|XR RT WRIST 3 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3.10||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.50||| 73110|EAP|0320|XR LT WRIST 3 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3.10||| 73120|EAP|0320|XR LT HAND 2 VIEWS|Aetna|AETNA OTHER|||||266.60||| 73120|EAP|0320|XR RT HAND 2 VIEWS|Aetna|AETNA OTHER|||||266.60||| 73120|EAP|0320|XR LT HAND 2 VIEWS|Medicare|MEDICARE ACUTE|||||266.60||| 73120|EAP|0320|XR RT HAND 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||266.60||| 73130|EAP|0320|XR LT HAND 3 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||3.10||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3.10||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||3.10||| 73130|EAP|0320|XR LT HAND 3 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.50||| 73130|EAP|0320|XR LT HAND 3 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||3.10||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||2.50||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.10||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||3.10||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||2.50||| 73130|EAP|0320|XR LT HAND 3 VIEWS|United Healthcare|TML GROUP BENEFITS|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.80||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Medicaid|MEDICAID|||||3.10||| 73130|EAP|0320|XR RT HAND 3 VIEWS|United Healthcare|TML GROUP BENEFITS|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Tricare|TRICARE EAST REGION|||||2.50||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||3.10||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3.10||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Managed Medicare|BCBS MEDICARE PPO MA|||||3.10||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.80||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Medicare|MEDICARE ACUTE|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.10||| 73130|EAP|0320|XR LT HAND 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||3.10||| 73130|EAP|0320|XR RT HAND 3 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||3.10||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Medicare|MEDICARE ACUTE|||||3.10||| 73130|EAP|0320|XR RT HAND 3 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3.10||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Managed Medicare|HEALTHSPRING MA|||||3.10||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||3.10||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Tricare|TRICARE EAST REGION|||||3.10||| 73130|EAP|0320|XR LT HAND 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.10||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.10||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Aetna|AETNA PPO|||||3.10||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.10||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Humana Medicare Advantage|HUMANA MA|3.10||||2.80||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Blue Cross PPO Specialty|BCBSTX OTHER|||||3.10||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||3.10||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Cigna|CIGNA|||||3.10||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Aetna|AETNA PPO|||||3.10||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Aetna|AETNA QHP HMO|||||2.50||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||3.10||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.80||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.50||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Cigna|CIGNA|||||2.50||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Humana Medicare Advantage|HUMANA MA|3.10||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Aetna|AETNA OTHER|||||2.50||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||3.10||| 73130|EAP|0320|XR RT HAND 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||3.10||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||3.10||| 73130|EAP|0320|XR LT HAND 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||2.50||| 73140|EAP|0320|XR RT THUMB 2 OR 3 VWS|PHCS|HUMANA INSURANCE|||||2.15||| 73140|EAP|0320|XR LT THUMB 2 OR 3 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||2.15||| 73140|EAP|0320|XR LT THUMB 2 OR 3 VIEWS|Medicaid|MEDICAID|||||266.60||| 73140|EAP|0320|XR LT THUMB 2 OR 3 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||266.60||| 73140|EAP|0320|XR RT THUMB 2 OR 3 VWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||266.60||| 73140|EAP|0320|XR LT THUMB 2 OR 3 VIEWS|Medicare|MEDICARE ACUTE|||||2.15||| 73140|EAP|0320|XR RT THUMB 2 OR 3 VWS|Medicare|MEDICARE ACUTE|||||266.60||| 73140|EAP|0320|XR LT THUMB 2 OR 3 VIEWS|Tricare|TRICARE EAST REGION|||||2.15||| 73140|EAP|0320|XR LT THUMB 2 OR 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||266.60||| 73140|EAP|0320|XR RT THUMB 2 OR 3 VWS|Tricare|TRICARE EAST REGION|||||240.80||| 73140|EAP|0320|XR RT THUMB 2 OR 3 VWS|United Healthcare|UNITED HEALTHCARE OTHER|||||2.15||| 73140|EAP|0320|XR LT THUMB 2 OR 3 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.15||| 73140|EAP|0320|XR LT THUMB 2 OR 3 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||266.60||| 73140|EAP|0320|XR RT THUMB 2 OR 3 VWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.15||| 73140|EAP|0320|XR RT THUMB 2 OR 3 VWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||266.60||| 73140|EAP|0320|XR LT THUMB 2 OR 3 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.15||| 73140|EAP|0320|XR RT THUMB 2 OR 3 VWS|Veterans Affairs|VETERANS ADMINISTRATION|||||2.15||| 73140|EAP|0320|XR LT THUMB 2 OR 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||266.60||| 73140|EAP|0320|XR RT THUMB 2 OR 3 VWS|Aetna|AETNA PPO|||||2.15||| 73140|EAP|0320|XR RT THUMB 2 OR 3 VWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||240.80||| 73140|EAP|0320|XR RT THUMB 2 OR 3 VWS|ChampVA|CHAMPVA CENTER|||||2.15||| 73140|EAP|0320|XR LT THUMB 2 OR 3 VIEWS|Aetna|AETNA QHP HMO|||||2.15||| 73140|EAP|0320|XR LT THUMB 2 OR 3 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.15||| 73140|EAP|0320|XR RT THUMB 2 OR 3 VWS|Humana Medicare Advantage|HUMANA MA|||||2.15||| 73140|EAP|0320|XR RT THUMB 2 OR 3 VWS|Managed Medicaid|MEDICAID SUPERIOR|||||266.60||| 73140|EAP|0320|XR RT THUMB 2 OR 3 VWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73140|EAP|0320|XR LT THUMB 2 OR 3 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||240.80||| 73200|EAP|0350|CT RT UPPER EXT WO CONTRA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||17.98||| 73200|EAP|0350|CT RT UPPER EXT WO CONTRA|United Medicare Advantage|UHC MEDICARE GOLD MA|||||17.98||| 73200|EAP|0350|CT RT UPPER EXT WO CONTRA|Medicare|MEDICARE ACUTE|||||17.98||| 73200|EAP|0350|CT LT UPPER EXTREMITY WO|Medicare|MEDICARE ACUTE|||||16.24||| 73200|EAP|0350|CT RT UPPER EXT WO CONTRA|United Healthcare|UNITED HEALTHCARE|||||14.50||| 73200|EAP|0350|CT LT UPPER EXTREMITY WO|United Healthcare|UNITED HEALTHCARE OTHER|||||17.98||| 73200|EAP|0350|CT LT UPPER EXTREMITY WO|NON CONTRACTED|COMMERCIAL OTHER 1|||||17.98||| 73200|EAP|0350|CT RT UPPER EXT WO CONTRA|NON CONTRACTED|COMMERCIAL OTHER 1|||||17.98||| 73200|EAP|0350|CT RT UPPER EXT WO CONTRA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||14.50||| 73200|EAP|0350|CT LT UPPER EXTREMITY WO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|14.50||||||| 73200|EAP|0350|CT RT UPPER EXT WO CONTRA|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||17.98||| 73200|EAP|0350|CT RT UPPER EXT WO CONTRA|Humana Medicare Advantage|HUMANA MA|||||17.98||| 73200|EAP|0350|CT LT UPPER EXTREMITY WO|Blue Cross PPO Specialty|BCBSTX PPO|||||16.24||| 73200|EAP|0350|CT LT UPPER EXTREMITY WO|Humana Medicare Advantage|HUMANA MA|||||16.24||| 73200|EAP|0350|CT RT UPPER EXT WO CONTRA|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||14.50||| 73200|EAP|0350|CT RT UPPER EXT WO CONTRA|Aenta Medicare Advantage|AETNA MEDICARE MA|17.98||||17.98||| 73200|EAP|0350|CT LT UPPER EXTREMITY WO|Blue Cross HMO Specialty|BCBSTX HMO|||||17.98||| 73201|EAP|0350|CT LT UPPER EXTREMITY W C|Humana Medicare Advantage|HUMANA MA|||||21.08||| 73201|EAP|0350|CT RT UPPER EXTREMITY W C|Humana Medicare Advantage|HUMANA MA|||||21.08||| 73201|EAP|0350|CT LT UPPER EXTREMITY W C|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||17.00||| 73201|EAP|0350|CT RT UPPER EXTREMITY W C|Managed Medicaid|MEDICAID SUPERIOR|||||21.08||| 73218|EAP|0610|MRI RT UPPER EXT WO CONTR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||28.52||| 73218|EAP|0610|MRI RT UPPER EXT WO CONTR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||23.00||| 73218|EAP|0610|MRI LT UPPER EXT WO CONTR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||23.00||| 73218|EAP|0610|MRI LT UPPER EXT WO CONTR|Medicare|MEDICARE ACUTE|||||23.00||| 73218|EAP|0610|MRI LT UPPER EXT WO CONTR|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||23.00||| 73218|EAP|0610|MRI LT UPPER EXT WO CONTR|Humana Medicare Advantage|HUMANA MA|||||28.52||| 73220|EAP|0610|MRI LT UPPER EXT W/WO CON|Medicare|MEDICARE ACUTE|||||34.00||| 73220|EAP|0610|MRI RT UPPER EXT W/WO CON|Medicare|MEDICARE ACUTE|||||34.00||| 73221|EAP|0610|MRI RT UPPER EXT JOINT WO|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||28.52||| 73221|EAP|0610|MRI RT UPPER EXT JOINT WO|United Healthcare|UNITED HEALTHCARE|||||25.76||| 73221|EAP|0610|MRI RT UPPER EXT JOINT WO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||25.76||| 73221|EAP|0610|3RI LT UPPER EXT JOINT WO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||25.76||| 73221|EAP|0610|MRI RT UPPER EXT JOINT WO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||28.52||| 73221|EAP|0610|3RI LT UPPER EXT JOINT WO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||23.00||| 73221|EAP|0610|MRI RT UPPER EXT JOINT WO|United Healthcare|UNITED HEALTHCARE|||||28.52||| 73221|EAP|0610|MRI RT UPPER EXT JOINT WO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||28.52||| 73221|EAP|0610|3RI LT UPPER EXT JOINT WO|Blue Cross PPO Specialty|BCBSTX PPO|||||23.00||| 73221|EAP|0610|3RI LT UPPER EXT JOINT WO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|23.00||||28.52||| 73221|EAP|0610|3RI LT UPPER EXT JOINT WO|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||28.52||| 73221|EAP|0610|MRI RT UPPER EXT JOINT WO|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||28.52||| 73221|EAP|0610|MRI RT UPPER EXT JOINT WO|Blue Cross PPO Specialty|BCBSTX PPO|||||23.00||| 73221|EAP|0610|MRI RT UPPER EXT JOINT WO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||25.76||| 73221|EAP|0610|MRI RT UPPER EXT JOINT WO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||23.00||| 73221|EAP|0610|3RI LT UPPER EXT JOINT WO|Blue Cross HMO Specialty|BCBSTX HMO|||||23.00||| 73221|EAP|0610|3RI LT UPPER EXT JOINT WO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||23.00||| 73221|EAP|0610|3RI LT UPPER EXT JOINT WO|Humana Medicare Advantage|HUMANA MA|||||23.00||| 73221|EAP|0610|MRI RT UPPER EXT JOINT WO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|23.00||||25.76||| 73221|EAP|0610|MRI RT UPPER EXT JOINT WO|Humana Medicare Advantage|HUMANA MA|||||23.00||| 73221|EAP|0610|3RI LT UPPER EXT JOINT WO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||23.00||| 73221|EAP|0610|MRI RT UPPER EXT JOINT WO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||23.00||| 73221|EAP|0610|MRI RT UPPER EXT JOINT WO|Managed Medicaid|MEDICAID AMERIGROUP|||||23.00||| 73221|EAP|0610|3RI LT UPPER EXT JOINT WO|Medicare|MEDICARE ACUTE|28.52||||23.00||| 73221|EAP|0610|MRI RT UPPER EXT JOINT WO|Managed Medicare|HEALTHSPRING MA|||||23.00||| 73221|EAP|0610|MRI RT UPPER EXT JOINT WO|NON CONTRACTED|COMMERCIAL OTHER 1|||||23.00||| 73221|EAP|0610|MRI RT UPPER EXT JOINT WO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||25.76||| 73221|EAP|0610|MRI RT UPPER EXT JOINT WO|Medicare|MEDICARE ACUTE|28.52||||28.52||| 73221|EAP|0610|3RI LT UPPER EXT JOINT WO|Medicaid|MEDICAID|||||23.00||| 73223|EAP|0610|MRI RT UPPER EXT JOINT W/|Medicare|MEDICARE ACUTE|34.00||||34.00||| 73223|EAP|0610|MRI LT UPPER EXT JOINT W/|Medicare|MEDICARE ACUTE|34.00||||34.00||| 73501|EAP|0320|XR HIPS W/PELVIS UNILATER|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|241.80||||||| 73501|EAP|0320|XR HIPS W/PELVIS UNILATER|Medicare|MEDICARE ACUTE|||||241.80||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||240.80||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|Humana Medicare Advantage|HUMANA MA|266.60||||266.60||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|Blue Cross PPO Specialty|BCBSTX OTHER|||||240.80||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|Blue Cross PPO Specialty|BCBSTX PPO|||||266.60||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|Aetna|AETNA OTHER|||||266.60||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|Blue Cross HMO Specialty|BCBSTX HMO|||||240.80||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|Cigna|CIGNA|||||240.80||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|Aetna|AETNA QHP HMO|||||266.60||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|Aenta Medicare Advantage|AETNA MEDICARE MA|||||240.80||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||240.80||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|Managed Medicaid|MEDICAID SUPERIOR|||||266.60||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.15||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|Managed Medicaid|MEDICAID AMERIGROUP|||||266.60||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|Medicare|MEDICARE ACUTE|266.60||||266.60||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||266.60||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|Managed Medicare|HEALTHSPRING MA|||||266.60||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.15||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||266.60||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|Medicaid|WOOD COUNTY INDIGENT|||||266.60||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|United Healthcare|UNITED HEALTHCARE OTHER|||||266.60||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.15||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|Tricare|TRICARE EAST REGION|||||266.60||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||240.80||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||266.60||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|NON CONTRACTED|COMMERCIAL OTHER 1|||||266.60||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|Managed Medicare|BCBS MEDICARE PPO MA|||||2.15||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|United Healthcare|UNITED HEALTHCARE|||||2.15||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|United Medicare Advantage|UHC MEDICARE GOLD MA|2.15||||2.15||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|Workers Compensation|WORKERS COMPENSATION OTHER|||||266.60||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||266.60||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|266.60||||2.15||| 73502|EAP|0320|XR HIPS W/PELVIS UNILAT 2|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.15||| 73521|EAP|0320|XR HIPS W/PELVIS BILATERA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||266.60||| 73521|EAP|0320|XR HIPS W/PELVIS BILATERA|Medicare|MEDICARE ACUTE|||||266.60||| 73521|EAP|0320|XR HIPS W/PELVIS BILATERA|United Healthcare|UNITED HEALTHCARE|||||266.60||| 73521|EAP|0320|XR HIPS W/PELVIS BILATERA|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.15||| 73521|EAP|0320|XR HIPS W/PELVIS BILATERA|Managed Medicare|HEALTHSPRING MA|||||240.80||| 73521|EAP|0320|XR HIPS W/PELVIS BILATERA|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||266.60||| 73521|EAP|0320|XR HIPS W/PELVIS BILATERA|Humana Medicare Advantage|HUMANA MA|||||266.60||| 73521|EAP|0320|XR HIPS W/PELVIS BILATERA|Blue Cross PPO Specialty|BCBSTX PPO|||||266.60||| 73522|EAP|0320|XR HIPS W/PELVIS BILAT 3|Blue Cross PPO Specialty|BCBSTX PPO|||||2.50||| 73522|EAP|0320|XR HIPS W/PELVIS BILAT 3|Humana Medicare Advantage|HUMANA MA|2.50||||2.50||| 73522|EAP|0320|XR HIPS W/PELVIS BILAT 3|Access Direct Platinum|HEALTHFIRST TPA UMR|||||3.10||| 73522|EAP|0320|XR HIPS W/PELVIS BILAT 3|Cigna|CIGNA|||||2.50||| 73522|EAP|0320|XR HIPS W/PELVIS BILAT 3|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.50||| 73522|EAP|0320|XR HIPS W/PELVIS BILAT 3|Managed Medicaid|MEDICAID SUPERIOR|||||2.50||| 73522|EAP|0320|XR HIPS W/PELVIS BILAT 3|United Healthcare|UNITED HEALTHCARE OTHER|||||2.50||| 73522|EAP|0320|XR HIPS W/PELVIS BILAT 3|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.10||| 73522|EAP|0320|XR HIPS W/PELVIS BILAT 3|Medicare|MEDICARE ACUTE|||||2.50||| 73522|EAP|0320|XR HIPS W/PELVIS BILAT 3|Medicaid|MEDICAID|||||3.10||| 73522|EAP|0320|XR HIPS W/PELVIS BILAT 3|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3.10||| 73522|EAP|0320|XR HIPS W/PELVIS BILAT 3|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.50||| 73522|EAP|0320|XR HIPS W/PELVIS BILAT 3|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.10||| 73551|EAP|0320|XR FEMUR 1 VIEW|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||241.80||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||266.60||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||240.80||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.15||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||266.60||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||240.80||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|Humana Medicare Advantage|HUMANA MA|266.60||||240.80||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||266.60||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||266.60||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||240.80||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.15||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||266.60||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|Medicare|MEDICARE ACUTE|266.60||||266.60||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|Medicaid|MEDICAID|266.60||||2.15||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|United Healthcare|UNITED HEALTHCARE|||||266.60||| 73552|EAP|0320|XR FEMUR 2 OR MORE VIEWS|Tricare|TRICARE EAST REGION|||||2.15||| 73560|EAP|0320|XR LT KNEE 2 VWS|Medicaid|MEDICAID|266.60||||266.60||| 73560|EAP|0320|XR LT KNEE 2 VWS|Medicare|MEDICARE ACUTE|240.80||||266.60||| 73560|EAP|0320|XR LT KNEE 2 VWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.15||| 73560|EAP|0320|XR LT KNEE 2 VWS|Managed Medicare|OTHER INSTITUTIONS|||||266.60||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|Medicare|MEDICARE ACUTE|240.80||||266.60||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|Managed Medicare|OTHER INSTITUTIONS|||||266.60||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73560|EAP|0320|XR LT KNEE 2 VWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.15||| 73560|EAP|0320|XR LT KNEE 2 VWS|Managed Medicaid|MEDICAID SUPERIOR|||||2.15||| 73560|EAP|0320|XR LT KNEE 2 VWS|Managed Medicaid|MEDICAID AMERIGROUP|||||266.60||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.15||| 73560|EAP|0320|XR LT KNEE 2 VWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||266.60||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|PHCS|MULTIPLAN PHCS|||||2.15||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|Tricare|TRICARE EAST REGION|||||2.15||| 73560|EAP|0320|XR LT KNEE 2 VWS|Tricare|TRICARE EAST REGION|||||266.60||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||266.60||| 73560|EAP|0320|XR LT KNEE 2 VWS|United Healthcare|UNITED HEALTHCARE|||||266.60||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||266.60||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||266.60||| 73560|EAP|0320|XR LT KNEE 2 VWS|Managed Medicare|HEALTHSPRING MA|||||266.60||| 73560|EAP|0320|XR LT KNEE 2 VWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||266.60||| 73560|EAP|0320|XR LT KNEE 2 VWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||266.60||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||240.80||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||266.60||| 73560|EAP|0320|XR LT KNEE 2 VWS|Humana Medicare Advantage|HUMANA MA|||||2.15||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.15||| 73560|EAP|0320|XR LT KNEE 2 VWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.15||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||266.60||| 73560|EAP|0320|XR LT KNEE 2 VWS|Blue Cross PPO Specialty|BCBSTX PPO|||||266.60||| 73560|EAP|0320|XR LT KNEE 2 VWS|Aetna|AETNA QHP HMO|||||2.15||| 73560|EAP|0320|XR LT KNEE 2 VWS|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.15||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||266.60||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|Aetna|AETNA OTHER|||||266.60||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||266.60||| 73560|EAP|0320|XR LT KNEE 2 VWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||266.60||| 73560|EAP|0320|XR LT KNEE 2 VWS|Aetna|AETNA OTHER|||||2.15||| 73560|EAP|0320|XR LT KNEE 2 VWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.15||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||266.60||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|Aetna|AETNA PPO|||||2.15||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||266.60||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||266.60||| 73560|EAP|0320|XR LT KNEE 2 VWS|Blue Cross HMO Specialty|BCBSTX HMO|||||266.60||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||266.60||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||266.60||| 73560|EAP|0320|XR LT KNEE 2 VWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|266.60||||266.60||| 73560|EAP|0320|XR LT KNEE 2 VWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||266.60||| 73560|EAP|0320|XR LT KNEE 2 VWS|Veterans Affairs|VETERANS ADMINISTRATION|||||240.80||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|266.60||||2.15||| 73560|EAP|0320|XR LT KNEE 2 VWS|Veterans Affairs|VETERANS ADMINISTRATION|266.60||||||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|266.60||||266.60||| 73560|EAP|0320|XR LT KNEE 2 VWS|United Medicare Advantage|UHC MEDICARE GOLD MA|266.60||||2.15||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.15||| 73560|EAP|0320|XR LT KNEE 2 VWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.15||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.15||| 73560|EAP|0320|XR RT KNEE 2 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|266.60||||||| 73560|EAP|0320|XR LT KNEE 2 VWS|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.15||||2.15||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||3.10||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.50||||2.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.50||| 73562|EAP|0320|XR LT KNEE 3 VW|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||2.50||| 73562|EAP|0320|XR LT KNEE 3 VW|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.50||||2.80||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.80||| 73562|EAP|0320|XR LT KNEE 3 VW|Veterans Affairs|VETERANS ADMINISTRATION|||||2.50||| 73562|EAP|0320|XR LT KNEE 3 VW|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.50||| 73562|EAP|0320|XR LT KNEE 3 VW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.50||| 73562|EAP|0320|XR LT KNEE 3 VW|Cigna|CIGNA|||||2.50||| 73562|EAP|0320|XR LT KNEE 3 VW|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.50||| 73562|EAP|0320|XR LT KNEE 3 VW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.10||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.80||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Cigna|CIGNA|||||3.10||| 73562|EAP|0320|XR LT KNEE 3 VW|Blue Cross PPO Specialty|BCBSTX PPO|||||3.10||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Humana Medicare Advantage|HUMANA MA|||||2.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.10||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||3.10||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.10||| 73562|EAP|0320|XR LT KNEE 3 VW|Humana Medicare Advantage|HUMANA MA|||||2.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||3.10||| 73562|EAP|0320|XR LT KNEE 3 VW|Blue Cross HMO Specialty|BCBSTX HMO|||||3.10||| 73562|EAP|0320|XR LT KNEE 3 VW|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.80||| 73562|EAP|0320|XR LT KNEE 3 VW|Managed Medicaid|MEDICAID AMERIGROUP|||||3.10||| 73562|EAP|0320|XR LT KNEE 3 VW|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3.10||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Medicare|MEDICARE ACUTE|3.10||||2.50||| 73562|EAP|0320|XR LT KNEE 3 VW|Medicare|MEDICARE ACUTE|3.10||||3.10||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||3.10||| 73562|EAP|0320|XR LT KNEE 3 VW|Tricare|TRICARE EAST REGION|||||3.10||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.80||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||3.10||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.10||| 73562|EAP|0320|XR LT KNEE 3 VW|United Healthcare|UNITED HEALTHCARE|||||2.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||3.10||| 73562|EAP|0320|XR LT KNEE 3 VW|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.50||| 73562|EAP|0320|XR LT KNEE 3 VW|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||3.10||| 73562|EAP|0320|XR LT KNEE 3 VW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||2.50||| 73562|EAP|0320|XR LT KNEE 3 VW|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.10||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.10||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||3.10||| 73562|EAP|0320|XR LT KNEE 3 VW|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.80||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.50||| 73562|EAP|0320|XR LT KNEE 3 VW|Managed Medicaid|MEDICAID SUPERIOR|||||2.50||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|PHCS|MULTIPLAN PHCS|||||2.50||| 73562|EAP|0320|XR LT KNEE 3 VW|Texas Workforce Commission|DEPT OF ASSIST AND REHAB SRVCS|||||3.10||| 73562|EAP|0320|XR LT KNEE 3 VW|United Healthcare|UNITED HEALTHCARE|||||3.10||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||3.10||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.80||| 73562|EAP|0320|XR LT KNEE 3 VW|Medicaid|MEDICAID|||||3.10||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.80||| 73562|EAP|0320|XR LT KNEE 3 VW|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||3.10||| 73562|EAP|0320|XR LT KNEE 3 VW|Managed Medicare|HEALTHSPRING MA|||||2.80||| 73562|EAP|0320|XR RT KNEE 3 VIEWS|Tricare|TRICARE EAST REGION|||||3.10||| 73564|EAP|0320|XR LT KNEE 4 VWS|Medicare|MEDICARE ACUTE|||||2.80||| 73564|EAP|0320|XR LT KNEE 4 VWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.50||| 73564|EAP|0320|XR RT KNEE 4 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||3.10||| 73564|EAP|0320|XR LT KNEE 4 VWS|Blue Cross PPO Specialty|BCBSTX PPO|||||3.10||| 73564|EAP|0320|XR LT KNEE 4 VWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.10||| 73565|EAP|0320|XR AP BIL STANDING KNEES|United Medicare Advantage|UHC MEDICARE GOLD MA|||||240.80||| 73565|EAP|0320|XR AP BIL STANDING KNEES|Blue Cross PPO Specialty|BCBSTX PPO|||||2.15||| 73565|EAP|0320|XR AP BIL STANDING KNEES|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||266.60||| 73565|EAP|0320|XR AP BIL STANDING KNEES|Medicare|MEDICARE ACUTE|||||240.80||| 73565|EAP|0320|XR AP BIL STANDING KNEES|Medicaid|MEDICAID|||||240.80||| 73565|EAP|0320|XR AP BIL STANDING KNEES|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.15||| 73565|EAP|0320|XR AP BIL STANDING KNEES|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||240.80||| 73590|EAP|0320|XR RT TIB-FIB 2 VIEWS|Medicare|MEDICARE ACUTE|2.15||||2.15||| 73590|EAP|0320|XR RT TIB-FIB 2 VIEWS|Medicare|MEDICARE PART B ONLY IP|266.60||||||| 73590|EAP|0320|XR RT TIB-FIB 2 VIEWS|Medicaid|MEDICAID|||||2.15||| 73590|EAP|0320|XR RT TIB-FIB 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||266.60||| 73590|EAP|0320|XR RT TIB-FIB 2 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||266.60||| 73590|EAP|0320|XR RT TIB-FIB 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73590|EAP|0320|XR LT TIB-FIB 2 VW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||266.60||| 73590|EAP|0320|XR RT TIB-FIB 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||266.60||| 73590|EAP|0320|XR LT TIB-FIB 2 VW|Medicaid|MEDICAID|||||266.60||| 73590|EAP|0320|XR LT TIB-FIB 2 VW|Managed Medicaid|MEDICAID AMERIGROUP|||||266.60||| 73590|EAP|0320|XR RT TIB-FIB 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.15||| 73590|EAP|0320|XR RT TIB-FIB 2 VIEWS|Medicaid|MEDICAID TEXAS CHILDRENS|||||266.60||| 73590|EAP|0320|XR LT TIB-FIB 2 VW|NON CONTRACTED|COMMERCIAL OTHER 1|||||266.60||| 73590|EAP|0320|XR LT TIB-FIB 2 VW|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.15||| 73590|EAP|0320|XR LT TIB-FIB 2 VW|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||240.80||| 73590|EAP|0320|XR LT TIB-FIB 2 VW|United Healthcare|UNITED HEALTHCARE|||||2.15||| 73590|EAP|0320|XR RT TIB-FIB 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.15||| 73590|EAP|0320|XR LT TIB-FIB 2 VW|United Healthcare|UNITED HEALTHCARE|||||266.60||| 73590|EAP|0320|XR LT TIB-FIB 2 VW|Tricare|TRICARE EAST REGION|||||2.15||| 73590|EAP|0320|XR RT TIB-FIB 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|266.60||||266.60||| 73590|EAP|0320|XR RT TIB-FIB 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||266.60||| 73590|EAP|0320|XR LT TIB-FIB 2 VW|Medicare|MEDICARE ACUTE|2.15||||2.15||| 73590|EAP|0320|XR RT TIB-FIB 2 VIEWS|Cigna|CIGNA|||||2.15||| 73590|EAP|0320|XR RT TIB-FIB 2 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||266.60||| 73590|EAP|0320|XR LT TIB-FIB 2 VW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||266.60||| 73590|EAP|0320|XR RT TIB-FIB 2 VIEWS|Aetna|AETNA PPO|||||2.15||| 73590|EAP|0320|XR LT TIB-FIB 2 VW|Humana Medicare Advantage|HUMANA MA|||||266.60||| 73590|EAP|0320|XR LT TIB-FIB 2 VW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|266.60||||266.60||| 73590|EAP|0320|XR LT TIB-FIB 2 VW|Blue Cross PPO Specialty|BCBSTX PPO|266.60||||266.60||| 73590|EAP|0320|XR RT TIB-FIB 2 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.15||| 73590|EAP|0320|XR LT TIB-FIB 2 VW|Veterans Affairs|VETERANS ADMINISTRATION|||||2.15||| 73590|EAP|0320|XR RT TIB-FIB 2 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||266.60||| 73590|EAP|0320|XR LT TIB-FIB 2 VW|Veterans Affairs|VETERANS ADMINISTRATION|||||266.60||| 73590|EAP|0320|XR RT TIB-FIB 2 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||266.60||| 73590|EAP|0320|XR LT TIB-FIB 2 VW|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||266.60||| 73600|EAP|0320|XR LT ANKLE 2 VW|United Medicare Advantage|UHC MEDICARE GOLD MA|2.15||||266.60||| 73600|EAP|0320|XR LT ANKLE 2 VW|Blue Cross PPO Specialty|BCBSTX PPO|||||266.60||| 73600|EAP|0320|XR RT ANKLE 2 VIEWS|Medicare|MEDICARE ACUTE|2.15||||||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||3.10||| 73610|EAP|0320|XR LT ANKLE 3 VW|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.10||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||2.50||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||2.50||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|Medicare|MEDICARE ACUTE|2.50||||3.10||| 73610|EAP|0320|XR LT ANKLE 3 VW|United Healthcare|UNITED HEALTHCARE|||||3.10||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.50||| 73610|EAP|0320|XR LT ANKLE 3 VW|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.10||| 73610|EAP|0320|XR LT ANKLE 3 VW|Medicare|MEDICARE ACUTE|2.50||||2.50||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.80||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||3.10||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|Tricare|TRICARE EAST REGION|||||3.10||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|Medicaid|MEDICAID|3.10||||2.80||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.50||| 73610|EAP|0320|XR LT ANKLE 3 VW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.50||| 73610|EAP|0320|XR LT ANKLE 3 VW|Managed Medicaid|MEDICAID SUPERIOR|||||3.10||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.50||| 73610|EAP|0320|XR LT ANKLE 3 VW|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.50||| 73610|EAP|0320|XR LT ANKLE 3 VW|Managed Medicare|HEALTHSPRING MA|||||3.10||| 73610|EAP|0320|XR LT ANKLE 3 VW|United Healthcare|UNITED HEALTHCARE OTHER|||||2.50||| 73610|EAP|0320|XR LT ANKLE 3 VW|Medicaid|MEDICAID|3.10||||3.10||| 73610|EAP|0320|XR LT ANKLE 3 VW|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.50||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|Medicaid|MEDICAID HMO|||||3.10||| 73610|EAP|0320|XR LT ANKLE 3 VW|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.50||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.50||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.10||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.50||| 73610|EAP|0320|XR LT ANKLE 3 VW|Managed Medicaid|MEDICAID AMERIGROUP|||||3.10||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|Aetna|AETNA PPO|||||2.50||| 73610|EAP|0320|XR LT ANKLE 3 VW|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.50||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3.10||| 73610|EAP|0320|XR LT ANKLE 3 VW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.80||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||3.10||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||3.10||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|ChampVA|CHAMPVA CENTER|||||3.10||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.50||| 73610|EAP|0320|XR LT ANKLE 3 VW|Blue Cross PPO Specialty|BCBSTX PPO|||||3.10||| 73610|EAP|0320|XR LT ANKLE 3 VW|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||3.10||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|Cigna|CIGNA|||||3.10||| 73610|EAP|0320|XR LT ANKLE 3 VW|Blue Cross HMO Specialty|BCBSTX HMO|||||3.10||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|Humana Medicare Advantage|HUMANA MA|||||2.50||| 73610|EAP|0320|XR LT ANKLE 3 VW|Humana Medicare Advantage|HUMANA MA|||||3.10||| 73610|EAP|0320|XR LT ANKLE 3 VW|Tricare|TRICARE EAST REGION|||||3.10||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||2.50||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||3.10||| 73610|EAP|0320|XR LT ANKLE 3 VW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.10||| 73610|EAP|0320|XR LT ANKLE 3 VW|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.50||| 73610|EAP|0320|XR LT ANKLE 3 VW|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3.10||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.80||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||2.50||| 73610|EAP|0320|XR LT ANKLE 3 VW|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.80||| 73610|EAP|0320|XR LT ANKLE 3 VW|Veterans Affairs|VETERANS ADMINISTRATION|||||2.50||| 73610|EAP|0320|XR LT ANKLE 3 VW|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.80||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||3.10||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3.10||| 73610|EAP|0320|XR LT ANKLE 3 VW|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.50||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||3.10||| 73610|EAP|0320|XR RT ANKLE 3 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.50||| 73620|EAP|0320|XR LT FOOT 2 VW|Veterans Affairs|VETERANS ADMINISTRATION|||||266.60||| 73620|EAP|0320|XR RT FOOT 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||2.15||| 73620|EAP|0320|XR RT FOOT 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||266.60||| 73620|EAP|0320|XR LT FOOT 2 VW|Humana Medicare Advantage|HUMANA MA|||||266.60||| 73620|EAP|0320|XR LT FOOT 2 VW|Blue Cross PPO Specialty|BCBSTX PPO|||||266.60||| 73620|EAP|0320|XR RT FOOT 2 VIEWS|Medicare|MEDICARE ACUTE|266.60||||240.80||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Medicaid|MEDICAID|2.50||||2.80||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||3.10||| 73630|EAP|0320|XR LT FOOT 3 VW|United Healthcare|UNITED HEALTHCARE OTHER|||||2.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||2.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Medicare|MEDICARE ACUTE|3.10||||2.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3.10||| 73630|EAP|0320|XR LT FOOT 3 VW|Medicare|MEDICARE ACUTE|3.10||||2.50||| 73630|EAP|0320|XR LT FOOT 3 VW|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.10||||2.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||2.80||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.80||| 73630|EAP|0320|XR LT FOOT 3 VW|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.50||| 73630|EAP|0320|XR LT FOOT 3 VW|Managed Medicaid|MEDICAID AMERIGROUP|||||3.10||| 73630|EAP|0320|XR LT FOOT 3 VW|Tricare|TRICARE EAST REGION|||||3.10||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|United Healthcare|UNITED HEALTHCARE|||||2.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||3.10||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Medicaid|MEDICAID HMO|||||3.10||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Managed Medicare|HEALTHSPRING MA|||||3.10||| 73630|EAP|0320|XR LT FOOT 3 VW|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.80||| 73630|EAP|0320|XR LT FOOT 3 VW|Managed Medicare|HEALTHSPRING MA|||||3.10||| 73630|EAP|0320|XR LT FOOT 3 VW|Managed Medicaid|MEDICAID SUPERIOR|||||3.10||| 73630|EAP|0320|XR LT FOOT 3 VW|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.10||| 73630|EAP|0320|XR LT FOOT 3 VW|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Humana Medicare Advantage|HUMANA MA|||||2.80||| 73630|EAP|0320|XR LT FOOT 3 VW|Blue Cross PPO Specialty|BCBSTX PPO|3.10||||3.10||| 73630|EAP|0320|XR LT FOOT 3 VW|Aetna|AETNA PPO|||||2.50||| 73630|EAP|0320|XR LT FOOT 3 VW|Medicaid|MEDICAID|2.50||||2.80||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Aetna|AETNA OTHER|||||2.50||| 73630|EAP|0320|XR LT FOOT 3 VW|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.50||| 73630|EAP|0320|XR LT FOOT 3 VW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.10||| 73630|EAP|0320|XR LT FOOT 3 VW|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||3.10||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Tricare|TRICARE EAST REGION|||||2.80||| 73630|EAP|0320|XR LT FOOT 3 VW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.10||||2.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Blue Cross HMO Specialty|BCBSTX HMO|||||2.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|3.10||||3.10||| 73630|EAP|0320|XR LT FOOT 3 VW|ChampVA|CHAMPVA CENTER|||||3.10||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Cigna|CIGNA|||||3.10||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Cigna|CIGNA|||||2.50||| 73630|EAP|0320|XR LT FOOT 3 VW|Humana Medicare Advantage|HUMANA MA|||||3.10||| 73630|EAP|0320|XR LT FOOT 3 VW|Cigna|CIGNA|||||2.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Medicare|MEDICARE PART B ONLY IP|3.10||||||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.80||| 73630|EAP|0320|XR LT FOOT 3 VW|Blue Cross HMO Specialty|BCBSTX HMO|||||3.10||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Blue Cross PPO Specialty|BCBSTX OTHER|||||3.10||| 73630|EAP|0320|XR LT FOOT 3 VW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.10||| 73630|EAP|0320|XR LT FOOT 3 VW|United Healthcare|UNITED HEALTHCARE|||||2.50||| 73630|EAP|0320|XR LT FOOT 3 VW|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.50||||3.10||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|3.10||||3.10||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.10||| 73630|EAP|0320|XR LT FOOT 3 VW|Veterans Affairs|VETERANS ADMINISTRATION|||||3.10||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||2.50||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.50||||3.10||| 73630|EAP|0320|XR LT FOOT 3 VW|Workers Compensation|UT EMPLOYEE INJURY|||||3.10||| 73630|EAP|0320|XR RT FOOT 3 VIEWS|Workers Compensation|WORKERS COMPENSATION OTHER|||||3.10||| 73630|EAP|0320|XR LT FOOT 3 VW|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.50||| 73630|EAP|0320|XR LT FOOT 3 VW|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|3.10||||2.80||| 73630|EAP|0320|XR LT FOOT 3 VW|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.10||| 73650|EAP|0320|XR LT CALCANEUS HEEL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.15||| 73650|EAP|0320|XR RT CALCANEUS (HEEL)|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||266.60||| 73650|EAP|0320|XR RT CALCANEUS (HEEL)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||266.60||| 73650|EAP|0320|XR LT CALCANEUS HEEL|Humana Medicare Advantage|HUMANA MA|||||2.15||| 73650|EAP|0320|XR RT CALCANEUS (HEEL)|Blue Cross HMO Specialty|BCBSTX HMO|||||266.60||| 73650|EAP|0320|XR RT CALCANEUS (HEEL)|ChampVA|CHAMPVA CENTER|||||2.15||| 73650|EAP|0320|XR RT CALCANEUS (HEEL)|Humana Medicare Advantage|HUMANA MA|||||2.15||| 73650|EAP|0320|XR RT CALCANEUS (HEEL)|United Healthcare|UNITED HEALTHCARE|||||2.15||| 73650|EAP|0320|XR RT CALCANEUS (HEEL)|Medicare|MEDICARE ACUTE|||||266.60||| 73650|EAP|0320|XR LT CALCANEUS HEEL|Medicare|MEDICARE ACUTE|||||240.80||| 73650|EAP|0320|XR LT CALCANEUS HEEL|Tricare|TRICARE EAST REGION|||||2.15||| 73660|EAP|0320|XR LT GREAT TOE 1 TO 3 VI|Medicare|MEDICARE ACUTE|||||2.15||| 73660|EAP|0320|XR RT GREAT TOE 1 TO 3 VI|Medicare|MEDICARE ACUTE|||||2.15||| 73660|EAP|0320|XR LT GREAT TOE 1 TO 3 VI|Medicaid|MEDICAID HMO|||||2.15||| 73660|EAP|0320|XR LT GREAT TOE 1 TO 3 VI|Managed Medicaid|MEDICAID SUPERIOR|||||266.60||| 73660|EAP|0320|XR LT GREAT TOE 1 TO 3 VI|Medicaid|MEDICAID TEXAS CHILDRENS|||||266.60||| 73660|EAP|0320|XR RT GREAT TOE 1 TO 3 VI|Medicaid|MEDICAID|||||2.15||| 73660|EAP|0320|XR LT GREAT TOE 1 TO 3 VI|Managed Medicaid|MEDICAID AMERIGROUP|||||2.15||| 73660|EAP|0320|XR RT GREAT TOE 1 TO 3 VI|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||266.60||| 73660|EAP|0320|XR LT GREAT TOE 1 TO 3 VI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.15||| 73660|EAP|0320|XR RT GREAT TOE 1 TO 3 VI|Blue Cross PPO Specialty|BCBSTX PPO|||||266.60||| 73660|EAP|0320|XR RT GREAT TOE 1 TO 3 VI|Aetna|AETNA OTHER|||||266.60||| 73660|EAP|0320|XR RT GREAT TOE 1 TO 3 VI|United Medicare Advantage|UHC MEDICARE GOLD MA|||||266.60||| 73660|EAP|0320|XR RT GREAT TOE 1 TO 3 VI|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||240.80||| 73660|EAP|0320|XR LT GREAT TOE 1 TO 3 VI|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.15||| 73700|EAP|0350|CT LT LOWER EXTREMITY WO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||17.98||| 73700|EAP|0350|CT LT LOWER EXTREMITY WO|Workers Compensation|WORKERS COMPENSATION OTHER|17.98||||14.50||| 73700|EAP|0350|CT LT LOWER EXTREMITY WO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||17.98||| 73700|EAP|0350|CT RT LOWER EXTREMITY WO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||14.50||| 73700|EAP|0350|CT LT LOWER EXTREMITY WO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||17.98||| 73700|EAP|0350|CT RT LOWER EXTREMITY WO|Blue Cross PPO Specialty|BCBSTX PPO|16.24||||17.98||| 73700|EAP|0350|CT RT LOWER EXTREMITY WO|Blue Cross PPO Specialty|BCBSTX OTHER|||||17.98||| 73700|EAP|0350|CT LT LOWER EXTREMITY WO|Humana Medicare Advantage|HUMANA MA|16.24||||17.98||| 73700|EAP|0350|CT LT LOWER EXTREMITY WO|Blue Cross PPO Specialty|BCBSTX OTHER|||||17.98||| 73700|EAP|0350|CT LT LOWER EXTREMITY WO|Blue Cross PPO Specialty|BCBSTX PPO|16.24||||17.98||| 73700|EAP|0350|CT RT LOWER EXTREMITY WO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||14.50||| 73700|EAP|0350|CT LT LOWER EXTREMITY WO|ChampVA|CHAMPVA CENTER|||||14.50||| 73700|EAP|0350|CT LT LOWER EXTREMITY WO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|17.98||||17.98||| 73700|EAP|0350|CT RT LOWER EXTREMITY WO|Humana Medicare Advantage|HUMANA MA|17.98||||16.24||| 73700|EAP|0350|CT RT LOWER EXTREMITY WO|Managed Medicaid|MEDICAID SUPERIOR|||||17.98||| 73700|EAP|0350|CT RT LOWER EXTREMITY WO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|17.98||||14.50||| 73700|EAP|0350|CT LT LOWER EXTREMITY WO|Managed Medicaid|MEDICAID AMERIGROUP|||||17.98||| 73700|EAP|0350|CT LT LOWER EXTREMITY WO|United Healthcare|UNITED HEALTHCARE|||||17.98||| 73700|EAP|0350|CT RT LOWER EXTREMITY WO|Medicare|MEDICARE PART B ONLY IP|17.98||||||| 73700|EAP|0350|CT RT LOWER EXTREMITY WO|Medicare|MEDICARE ACUTE|17.98||||17.98||| 73700|EAP|0350|CT LT LOWER EXTREMITY WO|Medicare|MEDICARE ACUTE|17.98||||17.98||| 73700|EAP|0350|CT RT LOWER EXTREMITY WO|Medicaid|MEDICAID|17.98||||||| 73700|EAP|0350|CT LT LOWER EXTREMITY WO|United Healthcare|UNITED HEALTHCARE|||||14.50||| 73700|EAP|0350|CT RT LOWER EXTREMITY WO|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||17.98||| 73700|EAP|0350|CT LT LOWER EXTREMITY WO|Managed Medicaid|MEDICAID SUPERIOR|||||17.98||| 73701|EAP|0350|CT RT LOWER EXTREMITY W C|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||21.08||| 73701|EAP|0350|CT LT LOWER EXTREMITY W C|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||21.08||| 73701|EAP|0350|CT RT LOWER EXTREMITY W C|Medicare|MEDICARE ACUTE|17.00||||17.00||| 73701|EAP|0350|CT RT LOWER EXTREMITY W C|Humana Medicare Advantage|HUMANA MA|21.08||||||| 73706|EAP|0352|CT ARTERIOGRAM BILATERAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||27.90||| 73706|EAP|0350|CT LOWER EXTREMITY ANGIO|Blue Cross PPO Specialty|BCBSTX PPO|||||27.90||| 73706|EAP|0352|CT ARTERIOGRAM BILATERAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||27.90||| 73706|EAP|0352|CT ARTERIOGRAM BILATERAL|Medicare|MEDICARE ACUTE|||||22.50||| 73706|EAP|0352|CT ARTERIOGRAM BILATERAL|Tricare|TRICARE EAST REGION|||||27.90||| 73706|EAP|0352|CT ARTERIOGRAM BILATERAL|Managed Medicare|HEALTHSPRING MA|||||27.90||| 73718|EAP|0610|MRI LT LOWER EXT NON-JT W|Managed Medicaid|MEDICAID AMERIGROUP|||||23.00||| 73718|EAP|0610|MRI LT LOWER EXT NON-JT W|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||23.00||| 73718|EAP|0610|MRI LT LOWER EXT NON-JT W|Medicaid|MEDICAID|23.00||||||| 73718|EAP|0610|MRI RT LOWER EXT NON-JT W|Medicare|MEDICARE ACUTE|23.00||||25.76||| 73718|EAP|0610|MRI RT LOWER EXT NON-JT W|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||23.00||| 73718|EAP|0610|MRI LT LOWER EXT NON-JT W|Blue Cross HMO Specialty|BCBSTX HMO|||||28.52||| 73718|EAP|0610|MRI RT LOWER EXT NON-JT W|Blue Cross PPO Specialty|BCBSTX OTHER|||||25.76||| 73718|EAP|0610|MRI RT LOWER EXT NON-JT W|Blue Cross PPO Specialty|BCBSTX PPO|28.52||||23.00||| 73718|EAP|0610|MRI LT LOWER EXT NON-JT W|United Healthcare|UNITED HEALTHCARE ERS|||||23.00||| 73718|EAP|0610|MRI LT LOWER EXT NON-JT W|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||23.00||| 73718|EAP|0610|MRI LT LOWER EXT NON-JT W|United Medicare Advantage|AARP UHC WEST COMPLETE MA|25.76||||||| 73720|EAP|0610|MRI LT LOW EXT NON JT W/W|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||42.16||| 73720|EAP|0610|MRI LT LOW EXT NON JT W/W|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||42.16||| 73720|EAP|0610|MRI LT LOW EXT NON JT W/W|Blue Cross PPO Specialty|BCBSTX PPO|||||42.16||| 73720|EAP|0610|MRI LT LOW EXT NON JT W/W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||38.08||| 73720|EAP|0610|MRI LT LOW EXT NON JT W/W|Managed Medicaid|MEDICAID AMERIGROUP|||||42.16||| 73721|EAP|0610|MRI RT LOWER EXT JOINT W/|Managed Medicaid|MEDICAID SUPERIOR|||||25.76||| 73721|EAP|0610|MRI RT LOWER EXT JOINT W/|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||28.52||| 73721|EAP|0610|MRI LT LOWER EXT JOINT W/|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||23.00||| 73721|EAP|0610|MRI LT LOWER EXT JOINT W/|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||25.76||| 73721|EAP|0610|MRI LT LOWER EXT JOINT W/|Managed Medicaid|MEDICAID AMERIGROUP|||||28.52||| 73721|EAP|0610|MRI LT LOWER EXT JOINT W/|NON CONTRACTED|COMMERCIAL OTHER 1|||||28.52||| 73721|EAP|0610|MRI LT LOWER EXT JOINT W/|Medicare|MEDICARE ACUTE|||||23.00||| 73721|EAP|0610|MRI RT LOWER EXT JOINT W/|NON CONTRACTED|COMMERCIAL OTHER 1|||||28.52||| 73721|EAP|0610|MRI RT LOWER EXT JOINT W/|Tricare|TRICARE EAST REGION|||||23.00||| 73721|EAP|0610|MRI LT LOWER EXT JOINT W/|Medicaid|MEDICAID TEXAS CHILDRENS|||||28.52||| 73721|EAP|0610|MRI LT LOWER EXT JOINT W/|Tricare|TRICARE EAST REGION|||||28.52||| 73721|EAP|0610|MRI LT LOWER EXT JOINT W/|Blue Cross PPO Specialty|BCBSTX PPO|||||25.76||| 73721|EAP|0610|MRI LT LOWER EXT JOINT W/|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||23.00||| 73721|EAP|0610|MRI RT LOWER EXT JOINT W/|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||23.00||| 73721|EAP|0610|MRI RT LOWER EXT JOINT W/|Aetna|AETNA OTHER|||||23.00||| 73721|EAP|0610|MRI RT LOWER EXT JOINT W/|Blue Cross PPO Specialty|BCBSTX OTHER|||||28.52||| 73721|EAP|0610|MRI LT LOWER EXT JOINT W/|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||23.00||| 73721|EAP|0610|MRI LT LOWER EXT JOINT W/|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||23.00||| 73721|EAP|0610|MRI RT LOWER EXT JOINT W/|ChampVA|CHAMPVA CENTER|||||28.52||| 73721|EAP|0610|MRI LT LOWER EXT JOINT W/|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||28.52||| 73721|EAP|0610|MRI RT LOWER EXT JOINT W/|Blue Cross PPO Specialty|BCBSTX PPO|||||25.76||| 73721|EAP|0610|MRI RT LOWER EXT JOINT W/|Medicare|MEDICARE ACUTE|||||28.52||| 73721|EAP|0610|MRI RT LOWER EXT JOINT W/|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||28.52||| 73721|EAP|0610|MRI RT LOWER EXT JOINT W/|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||23.00||| 73721|EAP|0610|MRI LT LOWER EXT JOINT W/|Humana Medicare Advantage|HUMANA MA|||||23.00||| 73721|EAP|0610|MRI RT LOWER EXT JOINT W/|United Medicare Advantage|UHC MEDICARE GOLD MA|||||23.00||| 73721|EAP|0610|MRI RT LOWER EXT JOINT W/|United Healthcare|UNITED HEALTHCARE|||||28.52||| 73721|EAP|0610|MRI RT LOWER EXT JOINT W/|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||23.00||| 73721|EAP|0610|MRI RT LOWER EXT JOINT W/|United Healthcare|UNITED HEALTHCARE OTHER|||||23.00||| 73721|EAP|0610|MRI LT LOWER EXT JOINT W/|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||28.52||| 73721|EAP|0610|MRI LT LOWER EXT JOINT W/|Managed Medicaid|MEDICAID SUPERIOR|||||23.00||| 73721|EAP|0610|MRI RT LOWER EXT JOINT W/|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||23.00||| 73721|EAP|0610|MRI LT LOWER EXT JOINT W/|United Healthcare|UNITED HEALTHCARE OTHER|||||23.00||| 73721|EAP|0610|MRI RT LOWER EXT JOINT W/|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||25.76||| 73721|EAP|0610|MRI LT LOWER EXT JOINT W/|United Healthcare|UNITED HEALTHCARE|||||23.00||| 73721|EAP|0610|MRI LT LOWER EXT JOINT W/|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||23.00||| 73721|EAP|0610|MRI LT LOWER EXT JOINT W/|United Medicare Advantage|UHC MEDICARE GOLD MA|||||23.00||| 73721|EAP|0610|MRI RT LOWER EXT JOINT W/|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||25.76||| 73721|EAP|0610|MRI LT LOWER EXT JOINT W/|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||28.52||| 73722|EAP|0610|MRI RT LOWER EXT JOINT W|NON CONTRACTED|COMMERCIAL OTHER 1|27.00||||||| 73723|EAP|0610|MRI LT LOW EXT JOINT W/WO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||34.00||| 74|DRG||CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC|Humana Medicare Advantage|HUMANA MA|26,091.45|8117.5|8117.5|8117.5|||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|United Medicare Advantage|UHC MEDICARE GOLD MA|1.95||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||241.80||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Veterans Affairs|VETERANS ADMINISTRATION|||||241.80||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|United Healthcare|UNITED HEALTHCARE OTHER|||||241.80||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Medicare|MEDICARE ACUTE|1.95||||241.80||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Managed Medicaid|MEDICAID SUPERIOR|||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Managed Medicaid|MEDICAID AMERIGROUP|||||241.80||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Medicaid|MEDICAID|||||241.80||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.95||||218.40||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Managed Medicare|HEALTHSPRING MA|||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Managed Medicare|BCBS MEDICARE PPO MA|241.80||||||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|United Healthcare|UNITED HEALTHCARE|||||241.80||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Tricare|TRICARE EAST REGION|||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|United Healthcare|UNITED HEALTHCARE|||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|United Medicare Advantage|AARP UHC WEST COMPLETE MA|241.80||||218.40||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Aetna|AETNA PPO|||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Aetna|AETNA QHP HMO|||||241.80||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Cigna|CIGNA|||||241.80||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.95||||||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Blue Cross PPO Specialty|BCBSTX PPO|||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Humana Medicare Advantage|HUMANA MA|1.95||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.95||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|241.80||||241.80||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Blue Cross HMO Specialty|BCBSTX HMO|||||218.40||| 74018|EAP|0320|XR ABDOMEN 1 VIEW|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.95||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.15||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|Humana Medicare Advantage|HUMANA MA|||||240.80||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|Aenta Medicare Advantage|AETNA MEDICARE MA|||||266.60||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|Aetna|AETNA PPO|||||266.60||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|Blue Cross PPO Specialty|BCBSTX PPO|||||2.15||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||240.80||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||2.15||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|Medicare|MEDICARE ACUTE|240.80||||266.60||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|United Healthcare|UNITED HEALTHCARE|||||266.60||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|Managed Medicaid|MEDICAID AMERIGROUP|||||266.60||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.15||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|Managed Medicaid|MEDICAID SUPERIOR|||||2.15||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|Tricare|TRICARE EAST REGION|||||266.60||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|Medicaid|MEDICAID|||||2.15||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||266.60||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||240.80||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|United Healthcare|UNITED HEALTHCARE OTHER|||||266.60||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|NON CONTRACTED|COMMERCIAL OTHER 1|||||240.80||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|Veterans Affairs|VETERANS ADMINISTRATION|||||240.80||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.15||| 74019|EAP|0320|XR ABDOMEN 2 VIEWS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||240.80||| 74022|EAP|0320|XR ACUTE ABDOMEN SERIES|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.80||| 74022|EAP|0320|XR ACUTE ABDOMEN SERIES|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3.10||||3.10||| 74022|EAP|0320|XR ACUTE ABDOMEN SERIES|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.50||| 74022|EAP|0320|XR ACUTE ABDOMEN SERIES|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.50||| 74022|EAP|0320|XR ACUTE ABDOMEN SERIES|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.50||| 74022|EAP|0320|XR ACUTE ABDOMEN SERIES|United Healthcare|UNITED HEALTHCARE|||||3.10||| 74022|EAP|0320|XR ACUTE ABDOMEN SERIES|Medicaid|MEDICAID|3.10||||||| 74022|EAP|0320|XR ACUTE ABDOMEN SERIES|Medicare|MEDICARE ACUTE|3.10||||3.10||| 74022|EAP|0320|XR ACUTE ABDOMEN SERIES|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.10||| 74022|EAP|0320|XR ACUTE ABDOMEN SERIES|Veterans Affairs|VETERANS ADMINISTRATION|||||3.10||| 74022|EAP|0320|XR ACUTE ABDOMEN SERIES|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.80||| 74022|EAP|0320|XR ACUTE ABDOMEN SERIES|Managed Medicaid|MEDICAID AMERIGROUP|||||2.80||| 74022|EAP|0320|XR ACUTE ABDOMEN SERIES|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||3.10||| 74022|EAP|0320|XR ACUTE ABDOMEN SERIES|United Healthcare|UNITED HEALTHCARE OTHER|||||2.50||| 74022|EAP|0320|XR ACUTE ABDOMEN SERIES|Managed Medicaid|MEDICAID SUPERIOR|||||3.10||| 74022|EAP|0320|XR ACUTE ABDOMEN SERIES|Blue Cross PPO Specialty|BCBSTX OTHER|||||3.10||| 74022|EAP|0320|XR ACUTE ABDOMEN SERIES|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.50||| 74022|EAP|0320|XR ACUTE ABDOMEN SERIES|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.80||| 74022|EAP|0320|XR ACUTE ABDOMEN SERIES|Humana Medicare Advantage|HUMANA MA|2.80||||3.10||| 74022|EAP|0320|XR ACUTE ABDOMEN SERIES|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.10||| 74022|EAP|0320|XR ACUTE ABDOMEN SERIES|Blue Cross PPO Specialty|BCBSTX PPO|||||2.50||| 74150|EAP|0352|CT ABDOMEN WO CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||17.98||| 74150|EAP|0352|CT ABDOMEN WO CONTRAST|Humana Medicare Advantage|HUMANA MA|14.50||||17.98||| 74150|EAP|0352|CT ABDOMEN WO CONTRAST|Medicare|MEDICARE ACUTE|16.24||||16.24||| 74150|EAP|0352|CT ABDOMEN WO CONTRAST|NON CONTRACTED|COMMERCIAL OTHER 1|||||17.98||| 74150|EAP|0352|CT ABDOMEN WO CONTRAST|United Healthcare|UNITED HEALTHCARE|||||17.98||| 74150|EAP|0352|CT ABDOMEN WO CONTRAST|Veterans Affairs|VETERANS ADMINISTRATION|||||17.98||| 74150|EAP|0352|CT ABDOMEN WO CONTRAST|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||17.98||| 74150|EAP|0352|CT ABDOMEN WO CONTRAST|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||17.98||| 74150|EAP|0352|CT ABDOMEN WO CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||14.50||| 74160|EAP|0352|CT ABDOMEN W CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||17.00||| 74160|EAP|0352|CT ABDOMEN W CONTRAST|Workers Compensation|WORKERS COMPENSATION OTHER|||||21.08||| 74160|EAP|0352|CT ABDOMEN W CONTRAST|Medicare|MEDICARE ACUTE|17.00||||17.00||| 74160|EAP|0352|CT ABDOMEN W CONTRAST|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||21.08||| 74160|EAP|0352|CT ABDOMEN W CONTRAST|United Healthcare|UNITED HEALTHCARE|||||21.08||| 74160|EAP|0352|CT ABDOMEN W CONTRAST|Managed Medicare|OTHER INSTITUTIONS|||||17.00||| 74160|EAP|0352|CT ABDOMEN W CONTRAST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||21.08||| 74160|EAP|0352|CT ABDOMEN W CONTRAST|Blue Cross PPO Specialty|BCBSTX PPO|||||19.04||| 74160|EAP|0352|CT ABDOMEN W CONTRAST|Humana Medicare Advantage|HUMANA MA|||||17.00||| 74160|EAP|0352|CT ABDOMEN W CONTRAST|Blue Cross PPO Specialty|BCBSTX OTHER|17.00||||||| 74160|EAP|0352|CT ABDOMEN W CONTRAST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||21.08||| 74160|EAP|0352|CT ABDOMEN W CONTRAST|Blue Cross HMO Specialty|BCBSTX HMO|||||21.08||| 74170|EAP|0352|CT ABDOMEN W&WO CONTRAST|Medicare|MEDICARE ACUTE|||||20.00||| 74174|EAP|0350|CT ANGIO ABD/PELVIS W AND|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|27.90||||||| 74174|EAP|0350|CT ANGIO ABD/PELVIS W AND|Blue Cross PPO Specialty|BCBSTX PPO|||||22.50||| 74174|EAP|0350|CT ANGIO ABD/PELVIS W AND|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||22.50||| 74174|EAP|0350|CT ANGIO ABD/PELVIS W AND|Medicare|MEDICARE ACUTE|||||27.90||| 74174|EAP|0350|CT ANGIO ABD/PELVIS W AND|NON CONTRACTED|COMMERCIAL OTHER 1|||||22.50||| 74175|EAP|0350|CTA ABDOMEN|Medicare|MEDICARE ACUTE|27.90||||22.50||| 74175|EAP|0350|CTA ABDOMEN|NON CONTRACTED|COMMERCIAL OTHER 1|||||27.90||| 74175|EAP|0350|CTA ABDOMEN|Aetna|AETNA QHP HMO|||||27.90||| 74175|EAP|0350|CTA ABDOMEN|Blue Cross PPO Specialty|BCBSTX PPO|||||27.90||| 74175|EAP|0350|CTA ABDOMEN|Humana Medicare Advantage|HUMANA MA|||||25.20||| 74175|EAP|0350|CTA ABDOMEN|United Medicare Advantage|UHC MEDICARE GOLD MA|||||22.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|17.98||||17.98||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Veterans Affairs|VETERANS ADMINISTRATION|17.98||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||17.98||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|United Medicare Advantage|UHC MEDICARE GOLD MA|17.98||||17.98||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Humana Medicare Advantage|HUMANA MA|16.24||||17.98||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||16.24||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|14.50||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Aetna|AETNA PPO|17.98||||17.98||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Aenta Medicare Advantage|AETNA MEDICARE MA|16.24||||17.98||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Aetna|AETNA QHP HMO|||||17.98||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Cigna|CIGNA|||||17.98||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Blue Cross HMO Specialty|BCBSTX HMO|17.98||||17.98||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Blue Cross PPO Specialty|BCBSTX PPO|17.98||||17.98||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Aetna|AETNA OTHER|||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Blue Cross PPO Specialty|BCBSTX OTHER|17.98||||17.98||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Managed Medicaid|MEDICAID AMERIGROUP|17.98||||17.98||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|14.50||||17.98||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Managed Medicaid|MEDICAID SUPERIOR|||||16.24||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|14.50||||17.98||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|16.24||||17.98||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Medicare|MEDICARE PART B ONLY IP|17.98||||||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Medicare|MEDICARE ACUTE|17.98||||17.98||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Veterans Affairs|VETERANS ADMINISTRATION|||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Managed Medicare|BCBS MEDICARE PPO MA|||||16.24||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|United Healthcare|UNITED HEALTHCARE OTHER|||||17.98||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Tricare|TRICARE FOR LIFE|||||16.24||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|NON CONTRACTED|COMMERCIAL OTHER 1|14.50||||17.98||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Tricare|TRICARE EAST REGION|17.98||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||17.98||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Medicaid|MEDICAID HMO|||||17.98||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|United Healthcare|UNITED HEALTHCARE|||||17.98||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Medicaid|MEDICAID|17.98||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Managed Medicare|HEALTHSPRING MA|||||17.98||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|United Healthcare|TML GROUP BENEFITS|14.50||||||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||14.50||| 74176|EAP|0350|CT ABDOMEN/PELVIS WITHOUT|United Healthcare|UNITED HEALTHCARE|17.98||||17.98||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Managed Medicaid|MEDICAID AMERIGROUP|17.00||||19.04||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Medicare|MEDICARE ACUTE|21.08||||21.08||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|United Healthcare|UNITED HEALTHCARE|||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|United Healthcare|TML GROUP BENEFITS|||||21.08||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Medicaid|MEDICAID|21.08||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||21.08||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|NON CONTRACTED|COMMERCIAL OTHER 1|17.00||||21.08||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|United Healthcare|UMR UNITED MEDICAL RESOURCES|17.00||||21.08||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Tricare|TRICARE EAST REGION|21.08||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||19.04||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Medicaid|WOOD COUNTY INDIGENT|||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|United Healthcare|UNITED HEALTHCARE OTHER|||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Managed Medicare|BCBS MEDICARE PPO MA|||||21.08||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||21.08||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|United Healthcare|UNITED HEALTHCARE|||||21.08||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|17.00||||21.08||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|17.00||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Cigna|CIGNA|21.08||||21.08||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Blue Cross PPO Specialty|BCBSTX OTHER|||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Blue Cross PPO Specialty|BCBSTX PPO|21.08||||21.08||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Aetna|AETNA OTHER|||||21.08||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Managed Medicaid|MEDICAID SUPERIOR|17.00||||21.08||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Humana Medicare Advantage|HUMANA MA|17.00||||21.08||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Aetna|AETNA PPO|21.08||||21.08||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||19.04||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Aetna|AETNA QHP HMO|||||19.04||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Aenta Medicare Advantage|AETNA MEDICARE MA|17.00||||19.04||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|21.08||||21.08||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Blue Cross HMO Specialty|BCBSTX HMO|21.08||||19.04||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||21.08||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||21.08||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Veterans Affairs|VETERANS ADMINISTRATION|||||21.08||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|Veterans Affairs|VETERANS ADMINISTRATION|||||19.04||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||17.00||| 74177|EAP|0350|CT ABDOMEN/PELVIS WITH CO|United Medicare Advantage|UHC MEDICARE GOLD MA|17.00||||17.00||| 74178|EAP|0350|CT ABDOMEN/PELVIS W & WO|Veterans Affairs|VETERANS ADMINISTRATION|||||24.80||| 74178|EAP|0350|CT ABDOMEN/PELVIS W & WO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||24.80||| 74178|EAP|0350|CT ABDOMEN/PELVIS W & WO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||24.80||| 74178|EAP|0350|CT ABDOMEN/PELVIS W & WO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||24.80||| 74178|EAP|0350|CT ABDOMEN/PELVIS W & WO|Humana Medicare Advantage|HUMANA MA|||||24.50||| 74178|EAP|0350|CT ABDOMEN/PELVIS W & WO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||20.00||| 74178|EAP|0350|CT ABDOMEN/PELVIS W & WO|Medicare|MEDICARE ACUTE|||||20.00||| 74181|EAP|0610|MRI ABDOMEN WO CONTRAST|Medicare|MEDICARE ACUTE|23.00||||||| 74181|EAP|0610|MRI ABDOMEN WO CONTRAST|United Medicare Advantage|UHC MEDICARE GOLD MA|23.00||||||| 74181|EAP|0610|MRI ABDOMEN WO CONTRAST|United Healthcare|UNITED HEALTHCARE|||||28.52||| 74183|EAP|0610|MRI ABDOMEN W & W/O|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||34.00||| 74183|EAP|0610|MRI ABDOMEN W & W/O|United Medicare Advantage|UHC MEDICARE GOLD MA|34.00||||||| 74183|EAP|0610|MRI ABDOMEN W & W/O|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||42.16||| 74183|EAP|0610|MRI ABDOMEN W & W/O|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||42.16||| 74183|EAP|0610|MRI ABDOMEN W & W/O|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||38.08||| 74183|EAP|0610|MRI ABDOMEN W & W/O|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||34.00||| 74183|EAP|0610|MRI ABDOMEN W & W/O|Blue Cross PPO Specialty|BCBSTX PPO|||||42.16||| 74183|EAP|0610|MRI ABDOMEN W & W/O|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||34.00||| 74183|EAP|0610|MRI ABDOMEN W & W/O|Medicare|MEDICARE ACUTE|42.16||||38.08||| 74183|EAP|0610|MRI ABDOMEN W & W/O|NON CONTRACTED|COMMERCIAL OTHER 1|42.16||||||| 74183|EAP|0610|MRI ABDOMEN W & W/O|Tricare|TRICARE EAST REGION|||||42.16||| 74230|EAP|0320|XR SWALLOW FUNCTION|Medicare|MEDICARE ACUTE|6.82||||6.82||| 74230|EAP|0320|XR SWALLOW FUNCTION|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||6.82||| 74230|EAP|0320|XR SWALLOW FUNCTION|United Medicare Advantage|UHC MEDICARE GOLD MA|6.82||||||| 74250|EAP|0320|XR SMALL BOWEL SERIES|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.65||||4.65||| 74250|EAP|0320|XR SMALL BOWEL SERIES|Blue Cross PPO Specialty|BCBSTX PPO|||||3.75||| 74250|EAP|0320|XR SMALL BOWEL SERIES|Humana Medicare Advantage|HUMANA MA|3.75||||||| 74250|EAP|0320|XR SMALL BOWEL SERIES|Medicare|MEDICARE ACUTE|4.65||||4.65||| 74250|EAP|0320|XR SMALL BOWEL SERIES|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.65||| 74300|EAP|0320|XR CHOLANGIOGRAM OPERATIV|Medicare|MEDICARE ACUTE|1.95||||||| 74300|EAP|0320|XR CHOLANGIOGRAM OPERATIV|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.95||| 74400|EAP|0320|XR PYELOGREAM IV 5 FILMS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||942.40||| 74400|EAP|0320|XR PYELOGREAM IV 5 FILMS|Blue Cross PPO Specialty|BCBSTX PPO|||||942.40||| 747|DRG||VAGINA, CERVIX & VULVA PROCEDURES W/O CC/MCC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|24,237.80|8266.04|8266.04|8266.04|||| 757|DRG||INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W MCC|Medicare|MEDICARE ACUTE|32,034.69|9730.16|9730.16|9730.16|||| 76000|EAP|0320|XR FLOUROSCOPY < 1 HR|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||4.60||| 76000|EAP|0320|XR FLOUROSCOPY < 1 HR|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.60||| 76000|EAP|0320|XR FLOUROSCOPY < 1 HR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.60||| 76000|EAP|0320|XR FLOUROSCOPY < 1 HR|Blue Cross PPO Specialty|BCBSTX PPO|||||4.60||| 76000|EAP|0320|XR FLOUROSCOPY < 1 HR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.60||| 76000|EAP|0320|XR FLOUROSCOPY < 1 HR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.60||| 76000|EAP|0320|XR FLOUROSCOPY < 1 HR|Blue Cross PPO Specialty|BCBSTX OTHER|||||4.60||| 76000|EAP|0320|XR FLOUROSCOPY < 1 HR|Humana Medicare Advantage|HUMANA MA|||||4.60||| 76000|EAP|0320|XR FLOUROSCOPY < 1 HR|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.60||| 76000|EAP|0320|XR FLOUROSCOPY < 1 HR|Blue Cross HMO Specialty|BCBSTX HMO|||||4.60||| 76000|EAP|0320|XR FLOUROSCOPY < 1 HR|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||4.60||| 76000|EAP|0320|XR FLOUROSCOPY < 1 HR|Managed Medicaid|MEDICAID AMERIGROUP|||||4.60||| 76000|EAP|0320|XR FLOUROSCOPY < 1 HR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.60||| 76000|EAP|0320|XR FLOUROSCOPY < 1 HR|Medicare|MEDICARE ACUTE|||||4.60||| 76000|EAP|0320|XR FLOUROSCOPY < 1 HR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.60||| 76000|EAP|0320|XR FLOUROSCOPY < 1 HR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.60||| 76000|EAP|0320|XR FLOUROSCOPY < 1 HR|United Healthcare|UNITED HEALTHCARE OTHER|||||4.60||| 76000|EAP|0320|XR FLOUROSCOPY < 1 HR|United Healthcare|UNITED HEALTHCARE|||||4.60||| 76010|EAP|0320|XR FOREI BODY CHILD NOSE-|Managed Medicaid|MEDICAID SUPERIOR|||||1.95||| 76010|EAP|0320|XR FOREI BODY CHILD NOSE-|Managed Medicaid|MEDICAID AMERIGROUP|||||1.95||| 76010|EAP|0320|XR FOREI BODY CHILD NOSE-|Cigna|CIGNA|||||241.80||| 76536|EAP|0402|US NECK SOFT TISSUE SONO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||5.45||| 76536|EAP|0402|US NECK SOFT TISSUE SONO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||675.80||| 76536|EAP|0402|US NECK SOFT TISSUE SONO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||675.80||| 76536|EAP|0402|US NECK SOFT TISSUE SONO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||675.80||| 76536|EAP|0402|US NECK SOFT TISSUE SONO|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||5.45||| 76536|EAP|0402|US NECK SOFT TISSUE SONO|Aetna|AETNA QHP HMO|||||675.80||| 76536|EAP|0402|US NECK SOFT TISSUE SONO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||675.80||| 76536|EAP|0402|US NECK SOFT TISSUE SONO|Blue Cross PPO Specialty|BCBSTX OTHER|||||5.45||| 76536|EAP|0402|US NECK SOFT TISSUE SONO|Aetna|AETNA PPO|||||610.40||| 76536|EAP|0402|US NECK SOFT TISSUE SONO|Blue Cross PPO Specialty|BCBSTX PPO|||||5.45||| 76536|EAP|0402|US NECK SOFT TISSUE SONO|Blue Cross HMO Specialty|BCBSTX HMO|||||675.80||| 76536|EAP|0402|US NECK SOFT TISSUE SONO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||5.45||| 76536|EAP|0402|US NECK SOFT TISSUE SONO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||610.40||| 76536|EAP|0402|US NECK SOFT TISSUE SONO|Humana Medicare Advantage|HUMANA MA|675.80||||5.45||| 76536|EAP|0402|US NECK SOFT TISSUE SONO|Cigna|CIGNA|||||5.45||| 76536|EAP|0402|US NECK SOFT TISSUE SONO|Medicare|MEDICARE ACUTE|610.40||||5.45||| 76536|EAP|0402|US NECK SOFT TISSUE SONO|Managed Medicaid|MEDICAID AMERIGROUP|||||5.45||| 76536|EAP|0402|US NECK SOFT TISSUE SONO|NON CONTRACTED|COMMERCIAL OTHER 1|||||675.80||| 76536|EAP|0402|US NECK SOFT TISSUE SONO|United Healthcare|UNITED HEALTHCARE|||||5.45||| 76536|EAP|0402|US NECK SOFT TISSUE SONO|Medicaid|MEDICAID|||||675.80||| 76536|EAP|0402|US NECK SOFT TISSUE SONO|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||5.45||| 76536|EAP|0402|US NECK SOFT TISSUE SONO|Tricare|TRICARE EAST REGION|||||5.45||| 76604|EAP|0402|US ULTRASOUND CHEST|Managed Medicaid|MEDICAID AMERIGROUP|||||540.64||| 76604|EAP|0402|US ULTRASOUND CHEST|Medicare|MEDICARE ACUTE|540.64||||488.32||| 76604|EAP|0402|US ULTRASOUND CHEST|Humana Medicare Advantage|HUMANA MA|||||4.36||| 76604|EAP|0402|US ULTRASOUND CHEST|United Medicare Advantage|UHC MEDICARE GOLD MA|540.64||||||| 76604|EAP|0402|US ULTRASOUND CHEST|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||540.64||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||852.32||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|943.64||||943.64||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|United Medicare Advantage|UHC MEDICARE GOLD MA|943.64||||7.61||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|7.61||||943.64||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||943.64||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|Blue Cross PPO Specialty|BCBSTX PPO|||||943.64||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|Aetna|AETNA PPO|||||852.32||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|Aetna|AETNA OTHER|||||852.32||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|Blue Cross PPO Specialty|BCBSTX OTHER|943.64||||||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||7.61||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|Blue Cross HMO Specialty|BCBSTX HMO|||||852.32||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|Cigna|CIGNA|||||943.64||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|7.61||||7.61||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|Cigna|CIGNA|||||7.61||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|ChampVA|CHAMPVA CENTER|||||7.61||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|Humana Medicare Advantage|HUMANA MA|852.32||||852.32||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|Aenta Medicare Advantage|AETNA MEDICARE MA|||||943.64||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|Medicaid|MEDICAID|||||7.61||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|Access Direct Platinum|HEALTHFIRST TPA UMR|||||943.64||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|Medicare|MEDICARE ACUTE|852.32||||943.64||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||943.64||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||852.32||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||943.64||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|Managed Medicaid|MEDICAID SUPERIOR|||||7.61||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||7.61||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|Managed Medicaid|MEDICAID AMERIGROUP|||||852.32||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|NON CONTRACTED|COMMERCIAL OTHER 1|943.64||||7.61||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|United Healthcare|UNITED HEALTHCARE OTHER|||||943.64||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|United Healthcare|GEHA|||||943.64||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|United Healthcare|UNITED HEALTHCARE|852.32||||943.64||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|Tricare|TRICARE EAST REGION|||||7.61||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||943.64||| 76700|EAP|0402|US ABDOMINAL SONOGRAPHY C|United Healthcare|UNITED HEALTHCARE|||||852.32||| 76705|EAP|0402|US ABDOMINAL SONOGRAPHY L|United Healthcare|UMR UNITED MEDICAL RESOURCES|5.74||||5.74||| 76705|EAP|0402|US ABDOMINAL SONOGRAPHY L|Medicare|MEDICARE ACUTE|711.76||||5.74||| 76705|EAP|0402|US ABD SONOGRAPHY LIMITED|Medicare|MEDICARE ACUTE|5.74||||5.74||| 76705|EAP|0402|US ABDOMINAL SONOGRAPHY L|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||711.76||| 76705|EAP|0402|US ABDOMINAL SONOGRAPHY L|NON CONTRACTED|COMMERCIAL OTHER 1|||||5.74||| 76705|EAP|0402|US ABDOMINAL SONOGRAPHY L|Managed Medicaid|MEDICAID SUPERIOR|||||642.88||| 76705|EAP|0402|US ABD SONOGRAPHY LIMITED|NON CONTRACTED|COMMERCIAL OTHER 1|||||5.74||| 76705|EAP|0402|US ABD SONOGRAPHY LIMITED|Managed Medicaid|MEDICAID SUPERIOR|||||642.88||| 76705|EAP|0402|US ABDOMINAL SONOGRAPHY L|Managed Medicaid|MEDICAID AMERIGROUP|||||642.88||| 76705|EAP|0402|US ABDOMINAL SONOGRAPHY L|United Healthcare|UNITED HEALTHCARE|||||711.76||| 76705|EAP|0402|US ABDOMINAL SONOGRAPHY L|United Healthcare|UNITED HEALTHCARE OTHER|||||711.76||| 76705|EAP|0402|US ABD SONOGRAPHY LIMITED|Tricare|TRICARE EAST REGION|||||711.76||| 76705|EAP|0402|US ABDOMINAL SONOGRAPHY L|United Healthcare|UNITED HEALTHCARE|||||5.74||| 76705|EAP|0402|US ABDOMINAL SONOGRAPHY L|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||5.74||| 76705|EAP|0402|US ABDOMINAL SONOGRAPHY L|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|711.76||||5.74||| 76705|EAP|0402|US ABD SONOGRAPHY LIMITED|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||5.74||| 76705|EAP|0402|US ABDOMINAL SONOGRAPHY L|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||711.76||| 76705|EAP|0402|US ABD SONOGRAPHY LIMITED|Aetna|AETNA OTHER|||||5.74||| 76705|EAP|0402|US ABD SONOGRAPHY LIMITED|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||5.74||| 76705|EAP|0402|US ABDOMINAL SONOGRAPHY L|Humana Medicare Advantage|HUMANA MA|||||711.76||| 76705|EAP|0402|US ABDOMINAL SONOGRAPHY L|Blue Cross PPO Specialty|BCBSTX PPO|711.76||||5.74||| 76705|EAP|0402|US ABDOMINAL SONOGRAPHY L|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|5.74||||5.74||| 76705|EAP|0402|US ABD SONOGRAPHY LIMITED|Humana Medicare Advantage|HUMANA MA|||||711.76||| 76705|EAP|0402|US ABD SONOGRAPHY LIMITED|Blue Cross PPO Specialty|BCBSTX PPO|711.76||||711.76||| 76705|EAP|0402|US ABD SONOGRAPHY LIMITED|Aetna|AETNA QHP HMO|||||5.74||| 76705|EAP|0402|US ABDOMINAL SONOGRAPHY L|United Medicare Advantage|UHC MEDICARE GOLD MA|5.74||||5.74||| 76705|EAP|0402|US ABDOMINAL SONOGRAPHY L|Veterans Affairs|VETERANS ADMINISTRATION|||||5.74||| 76706|EAP|0402|US EXAM AAA SCREEN|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||4.00||| 76706|EAP|0402|US EXAM AAA SCREEN|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.96||| 76706|EAP|0402|US EXAM AAA SCREEN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.48||| 76706|EAP|0402|US EXAM AAA SCREEN|Humana Medicare Advantage|HUMANA MA|||||4.00||| 76706|EAP|0402|US EXAM AAA SCREEN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.96||| 76706|EAP|0402|US EXAM AAA SCREEN|Blue Cross PPO Specialty|BCBSTX PPO|||||4.96||| 76706|EAP|0402|US EXAM AAA SCREEN|Blue Cross PPO Specialty|BCBSTX OTHER|||||4.00||| 76706|EAP|0402|US EXAM AAA SCREEN|Blue Cross HMO Specialty|BCBSTX HMO|||||4.00||| 76706|EAP|0402|US EXAM AAA SCREEN|Medicare|MEDICARE ACUTE|||||4.00||| 76706|EAP|0402|US EXAM AAA SCREEN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.00||| 76706|EAP|0402|US EXAM AAA SCREEN|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.96||| 76706|EAP|0402|US EXAM AAA SCREEN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.00||| 76770|EAP|0402|US RENAL SONO RETROPERITO|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||784.92||| 76770|EAP|0402|US RENAL SONO RETROPERITO|Medicare|MEDICARE PART B ONLY IP|784.92||||||| 76770|EAP|0402|US RENAL SONO RETROPERITO|Managed Medicaid|MEDICAID SUPERIOR|||||784.92||| 76770|EAP|0402|US RENAL SONO RETROPERITO|NON CONTRACTED|COMMERCIAL OTHER 1|||||784.92||| 76770|EAP|0402|US RENAL SONO RETROPERITO|Medicare|MEDICARE ACUTE|784.92||||784.92||| 76770|EAP|0402|US RENAL SONO RETROPERITO|United Healthcare|UNITED HEALTHCARE|||||784.92||| 76770|EAP|0402|US RENAL SONO RETROPERITO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||784.92||| 76770|EAP|0402|US RENAL SONO RETROPERITO|Managed Medicare|HEALTHSPRING MA|||||784.92||| 76770|EAP|0402|US RENAL SONO RETROPERITO|Humana Medicare Advantage|HUMANA MA|784.92||||6.33||| 76770|EAP|0402|US RENAL SONO RETROPERITO|Blue Cross PPO Specialty|BCBSTX PPO|784.92||||784.92||| 76770|EAP|0402|US RENAL SONO RETROPERITO|Aenta Medicare Advantage|AETNA MEDICARE MA|784.92||||784.92||| 76770|EAP|0402|US RENAL SONO RETROPERITO|Aetna|AETNA OTHER|||||6.33||| 76770|EAP|0402|US RENAL SONO RETROPERITO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|784.92||||708.96||| 76770|EAP|0402|US RENAL SONO RETROPERITO|United Medicare Advantage|UHC MEDICARE GOLD MA|6.33||||784.92||| 76770|EAP|0402|US RENAL SONO RETROPERITO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|784.92||||784.92||| 76770|EAP|0402|US RENAL SONO RETROPERITO|Veterans Affairs|VETERANS ADMINISTRATION|||||784.92||| 76770|EAP|0402|US RENAL SONO RETROPERITO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|708.96||||784.92||| 76775|EAP|0402|US RENAL LT|Blue Cross HMO Specialty|BCBSTX HMO|||||5.22||| 76775|EAP|0402|US RENAL RT|Medicare|MEDICARE ACUTE|||||647.28||| 76775|EAP|0402|US RENAL LT|Medicare|MEDICARE ACUTE|||||5.22||| 76775|EAP|0402|US RENAL RT|NON CONTRACTED|COMMERCIAL OTHER 1|||||5.22||| 76801|EAP|0402|US PREGNANCY COMP < 14 WE|NON CONTRACTED|COMMERCIAL OTHER 1|||||5.30||| 76801|EAP|0402|US PREGNANCY COMP < 14 WE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||5.30||| 76801|EAP|0402|US PREGNANCY COMP < 14 WE|Managed Medicaid|MEDICAID SUPERIOR|||||5.30||| 76801|EAP|0402|US PREGNANCY COMP < 14 WE|Managed Medicaid|MEDICAID AMERIGROUP|||||5.30||| 76801|EAP|0402|US PREGNANCY COMP < 14 WE|Medicaid|MEDICAID|||||657.20||| 76801|EAP|0402|US PREGNANCY COMP < 14 WE|Blue Cross PPO Specialty|BCBSTX PPO|||||5.30||| 76801|EAP|0402|US PREGNANCY COMP < 14 WE|Aetna|AETNA OTHER|||||5.30||| 76801|EAP|0402|US PREGNANCY COMP < 14 WE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||5.30||| 76805|EAP|0402|US PREGNANT UTERUS SONO C|Managed Medicaid|MEDICAID SUPERIOR|||||6.47||| 76805|EAP|0402|US PREGNANT UTERUS SONO C|Managed Medicaid|MEDICAID AMERIGROUP|||||802.28||| 76810|EAP|0402|US PREG UTERUS SONO MULT|Medicaid|MEDICAID|||||5.15||| 76817|EAP|0402|US PREGNANCY TRANSVAGINAL|Blue Cross PPO Specialty|BCBSTX PPO|||||519.68||| 76817|EAP|0402|US PREGNANCY TRANSVAGINAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.64||| 76817|EAP|0402|US PREGNANCY TRANSVAGINAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.64||| 76817|EAP|0402|US PREGNANCY TRANSVAGINAL|Medicaid|MEDICAID|||||4.64||| 76830|EAP|0402|US TRANSVAGINAL SONOGRAPH|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||607.04||| 76830|EAP|0402|US TRANSVAGINAL SONOGRAPH|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||672.08||| 76830|EAP|0402|US TRANSVAGINAL SONOGRAPH|NON CONTRACTED|COMMERCIAL OTHER 1|||||672.08||| 76830|EAP|0402|US TRANSVAGINAL SONOGRAPH|Managed Medicaid|MEDICAID SUPERIOR|||||607.04||| 76830|EAP|0402|US TRANSVAGINAL SONOGRAPH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||672.08||| 76830|EAP|0402|US TRANSVAGINAL SONOGRAPH|Managed Medicaid|MEDICAID AMERIGROUP|||||5.42||| 76830|EAP|0402|US TRANSVAGINAL SONOGRAPH|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||672.08||| 76830|EAP|0402|US TRANSVAGINAL SONOGRAPH|United Healthcare|UNITED HEALTHCARE|||||672.08||| 76830|EAP|0402|US TRANSVAGINAL SONOGRAPH|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||672.08||| 76830|EAP|0402|US TRANSVAGINAL SONOGRAPH|Managed Medicare|OTHER INSTITUTIONS|||||5.42||| 76830|EAP|0402|US TRANSVAGINAL SONOGRAPH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||5.42||| 76830|EAP|0402|US TRANSVAGINAL SONOGRAPH|Medicare|MEDICARE ACUTE|||||5.42||| 76830|EAP|0402|US TRANSVAGINAL SONOGRAPH|United Healthcare|UNITED HEALTHCARE OTHER|||||672.08||| 76830|EAP|0402|US TRANSVAGINAL SONOGRAPH|Medicaid|MEDICAID|||||607.04||| 76830|EAP|0402|US TRANSVAGINAL SONOGRAPH|Aetna|AETNA PPO|||||672.08||| 76830|EAP|0402|US TRANSVAGINAL SONOGRAPH|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||672.08||| 76830|EAP|0402|US TRANSVAGINAL SONOGRAPH|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||5.42||| 76830|EAP|0402|US TRANSVAGINAL SONOGRAPH|Blue Cross PPO Specialty|BCBSTX OTHER|||||5.42||| 76830|EAP|0402|US TRANSVAGINAL SONOGRAPH|Aetna|AETNA OTHER|||||5.42||| 76830|EAP|0402|US TRANSVAGINAL SONOGRAPH|Humana Medicare Advantage|HUMANA MA|||||607.04||| 76830|EAP|0402|US TRANSVAGINAL SONOGRAPH|Cigna|CIGNA|||||672.08||| 76830|EAP|0402|US TRANSVAGINAL SONOGRAPH|Blue Cross PPO Specialty|BCBSTX PPO|||||672.08||| 76830|EAP|0402|US TRANSVAGINAL SONOGRAPH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||672.08||| 76830|EAP|0402|US TRANSVAGINAL SONOGRAPH|Blue Cross HMO Specialty|BCBSTX HMO|||||607.04||| 76856|EAP|0402|US PELVIC SONO(NON OB)COM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||6.46||| 76856|EAP|0402|US PELVIC SONO(NON OB)COM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||6.46||| 76856|EAP|0402|US PELVIC SONO(NON OB)COM|Medicare|MEDICARE ACUTE|6.46||||801.04||| 76856|EAP|0402|US PELVIC SONO(NON OB)COM|Managed Medicaid|MEDICAID SUPERIOR|||||6.46||| 76856|EAP|0402|US PELVIC SONO(NON OB)COM|Tricare|TRICARE EAST REGION|||||801.04||| 76856|EAP|0402|US PELVIC SONO(NON OB)COM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||801.04||| 76857|EAP|0402|US PELVIC LIMITED NON OB|United Medicare Advantage|UHC MEDICARE GOLD MA|4.96||||||| 76857|EAP|0402|US PELVIC LIMITED NON OB|United Healthcare|UNITED HEALTHCARE OTHER|||||4.96||| 76857|EAP|0402|US PELVIC LIMITED NON OB|Medicare|MEDICARE ACUTE|4.48||||4.48||| 76857|EAP|0402|US PELVIC LIMITED NON OB|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4.96||| 76857|EAP|0402|US PELVIC LIMITED NON OB|Blue Cross PPO Specialty|BCBSTX PPO|4.00||||||| 76857|EAP|0402|US PELVIC LIMITED NON OB|Humana Medicare Advantage|HUMANA MA|4.48||||||| 76857|EAP|0402|US PELVIC LIMITED NON OB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.00||||||| 76857|EAP|0402|US PELVIC LIMITED NON OB|Aenta Medicare Advantage|AETNA MEDICARE MA|4.96||||||| 76870|EAP|0402|US SCROTUM & CONTENTS SON|Blue Cross PPO Specialty|BCBSTX PPO|||||5.86||| 76870|EAP|0402|US SCROTUM & CONTENTS SON|Aetna|AETNA OTHER|||||726.64||| 76870|EAP|0402|US SCROTUM & CONTENTS SON|Humana Medicare Advantage|HUMANA MA|||||5.86||| 76870|EAP|0402|US SCROTUM & CONTENTS SON|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||5.86||| 76870|EAP|0402|US SCROTUM & CONTENTS SON|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||5.86||| 76870|EAP|0402|US SCROTUM & CONTENTS SON|Medicare|MEDICARE ACUTE|||||5.86||| 76870|EAP|0402|US SCROTUM & CONTENTS SON|United Healthcare|UNITED HEALTHCARE|||||5.86||| 76870|EAP|0402|US SCROTUM & CONTENTS SON|Managed Medicaid|MEDICAID AMERIGROUP|||||656.32||| 76870|EAP|0402|US SCROTUM & CONTENTS SON|United Healthcare|UNITED HEALTHCARE OTHER|||||5.86||| 76870|EAP|0402|US SCROTUM & CONTENTS SON|NON CONTRACTED|COMMERCIAL OTHER 1|||||5.86||| 76870|EAP|0402|US SCROTUM & CONTENTS SON|Medicaid|MEDICAID|||||726.64||| 76870|EAP|0402|US SCROTUM & CONTENTS SON|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||726.64||| 76870|EAP|0402|US SCROTUM & CONTENTS SON|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||5.86||| 76870|EAP|0402|US SCROTUM & CONTENTS SON|Managed Medicaid|MEDICAID SUPERIOR|||||656.32||| 76870|EAP|0402|US SCROTUM & CONTENTS SON|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||726.64||| 76881|EAP|0402|US EXTREMITY SONOGRAPHY N|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||601.40||| 76881|EAP|0402|US EXTREMITY SONOGRAPHY N|Medicare|MEDICARE ACUTE|||||543.20||| 76881|EAP|0402|US EXTREMITY SONOGRAPHY N|Blue Cross PPO Specialty|BCBSTX PPO|||||601.40||| 76881|EAP|0402|US EXTREMITY SONOGRAPHY N|Blue Cross HMO Specialty|BCBSTX HMO|||||543.20||| 76881|EAP|0402|US EXTREMITY SONOGRAPHY N|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.85||| 76881|EAP|0402|US EXTREMITY SONOGRAPHY N|Humana Medicare Advantage|HUMANA MA|601.40||||601.40||| 77|DRG||HYPERTENSIVE ENCEPHALOPATHY W MCC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|151.01|33|33|33|||| 77002|EAP|0320|XR FLUOROGUIDE NEEDLE PLA|Blue Cross PPO Specialty|BCBSTX PPO|||||4.90||| 77002|EAP|0320|XR FLUOROGUIDE NEEDLE PLA|Blue Cross PPO Specialty|BCBSTX OTHER|||||4.90||| 77002|EAP|0320|XR FLUOROGUIDE NEEDLE PLA|Blue Cross HMO Specialty|BCBSTX HMO|||||4.90||| 77002|EAP|0320|XR FLUOROGUIDE NEEDLE PLA|Humana Medicare Advantage|HUMANA MA|||||4.90||| 77002|EAP|0320|XR FLUOROGUIDE NEEDLE PLA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.90||| 77002|EAP|0320|XR FLUOROGUIDE NEEDLE PLA|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||4.90||| 77002|EAP|0320|XR FLUOROGUIDE NEEDLE PLA|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4.90||| 77002|EAP|0320|XR FLUOROGUIDE NEEDLE PLA|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.90||| 77002|EAP|0320|XR FLUOROGUIDE NEEDLE PLA|Medicare|MEDICARE ACUTE|||||4.90||| 77002|EAP|0320|XR FLUOROGUIDE NEEDLE PLA|United Healthcare|UNITED HEALTHCARE|||||4.90||| 77002|EAP|0320|XR FLUOROGUIDE NEEDLE PLA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.90||| 77002|EAP|0320|XR FLUOROGUIDE NEEDLE PLA|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.90||| 77002|EAP|0320|XR FLUOROGUIDE NEEDLE PLA|Managed Medicaid|MEDICAID AMERIGROUP|||||4.90||| 77002|EAP|0320|XR FLUOROGUIDE NEEDLE PLA|United Healthcare|UNITED HEALTHCARE OTHER|||||4.90||| 77002|EAP|0320|XR FLUOROGUIDE NEEDLE PLA|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||4.90||| 77002|EAP|0320|XR FLUOROGUIDE NEEDLE PLA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.90||| 77002|EAP|0320|XR FLUOROGUIDE NEEDLE PLA|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.90||| 77002|EAP|0320|XR FLUOROGUIDE NEEDLE PLA|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.90||| 77075|EAP|0320|XR BONE SURVEY COMPLETE|United Healthcare|UNITED HEALTHCARE|||||3.75||| 77075|EAP|0320|XR BONE SURVEY COMPLETE|Medicare|MEDICARE ACUTE|||||4.65||| 77075|EAP|0320|XR BONE SURVEY COMPLETE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.75||| 77080|EAP|0320|XR BONE DENSITY ONE OR MO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.15||| 77080|EAP|0320|XR BONE DENSITY ONE OR MO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||266.60||| 77080|EAP|0320|XR BONE DENSITY ONE OR MO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||240.80||| 77080|EAP|0320|XR BONE DENSITY ONE OR MO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||240.80||| 77080|EAP|0320|XR BONE DENSITY ONE OR MO|Blue Cross PPO Specialty|BCBSTX PPO|||||2.15||| 77080|EAP|0320|XR BONE DENSITY ONE OR MO|Aetna|AETNA OTHER|||||2.15||| 77080|EAP|0320|XR BONE DENSITY ONE OR MO|Aetna|AETNA QHP HMO|||||266.60||| 77080|EAP|0320|XR BONE DENSITY ONE OR MO|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.15||| 77080|EAP|0320|XR BONE DENSITY ONE OR MO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.15||| 77080|EAP|0320|XR BONE DENSITY ONE OR MO|Blue Cross HMO Specialty|BCBSTX HMO|||||266.60||| 77080|EAP|0320|XR BONE DENSITY ONE OR MO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.15||| 77080|EAP|0320|XR BONE DENSITY ONE OR MO|Humana Medicare Advantage|HUMANA MA|||||2.15||| 77080|EAP|0320|XR BONE DENSITY ONE OR MO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||266.60||| 77080|EAP|0320|XR BONE DENSITY ONE OR MO|Cigna|CIGNA|||||2.15||| 77080|EAP|0320|XR BONE DENSITY ONE OR MO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.15||| 77080|EAP|0320|XR BONE DENSITY ONE OR MO|Medicare|MEDICARE ACUTE|||||2.15||| 77080|EAP|0320|XR BONE DENSITY ONE OR MO|NON CONTRACTED|COMMERCIAL OTHER 1|||||266.60||| 77080|EAP|0320|XR BONE DENSITY ONE OR MO|Tricare|TRICARE EAST REGION|||||240.80||| 77080|EAP|0320|XR BONE DENSITY ONE OR MO|Managed Medicaid|MEDICAID SUPERIOR|||||2.15||| 77080|EAP|0320|XR BONE DENSITY ONE OR MO|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.15||| 77080|EAP|0320|XR BONE DENSITY ONE OR MO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||266.60||| 77080|EAP|0320|XR BONE DENSITY ONE OR MO|Managed Medicare|HEALTHSPRING MA|||||266.60||| 77080|EAP|0320|XR BONE DENSITY ONE OR MO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.15||| 77080|EAP|0320|XR BONE DENSITY ONE OR MO|United Healthcare|UNITED HEALTHCARE|||||2.15||| 77080|EAP|0320|XR BONE DENSITY ONE OR MO|United Healthcare|UNITED HEALTHCARE OTHER|||||266.60||| 78|DRG||HYPERTENSIVE ENCEPHALOPATHY W CC|Medicare|MEDICARE ACUTE|13,676.25|48.51|48.51|48.51|||| 78012|EAP|0341|NM THYROID UPTAKE AND SCA|Blue Cross PPO Specialty|BCBSTX PPO|||||10.00||| 78012|EAP|0341|NM THYROID UPTAKE AND SCA|Medicaid|MEDICAID|||||12.40||| 78070|EAP|0341||Blue Cross PPO Specialty|BCBSTX PPO|||||10.00||| 78227|EAP|0341|NM HEPATOBIL DUCT SYST IM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||5.20||| 78227|EAP|0341|NM HEPATOBIL DUCT SYST IM|United Healthcare|UNITED HEALTHCARE|||||582.40||| 78227|EAP|0341|NM HEPATOBIL DUCT SYST IM|Medicare|MEDICARE ACUTE|||||582.40||| 78227|EAP|0341|NM HEPATOBIL DUCT SYST IM|Managed Medicaid|MEDICAID AMERIGROUP|||||644.80||| 78227|EAP|0341|NM HEPATOBIL DUCT SYST IM|United Healthcare|UNITED HEALTHCARE OTHER|||||5.20||| 78227|EAP|0341|NM HEPATOBIL DUCT SYST IM|Managed Medicaid|MEDICAID SUPERIOR|||||5.20||| 78227|EAP|0341|NM HEPATOBIL DUCT SYST IM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||644.80||| 78227|EAP|0341|NM HEPATOBIL DUCT SYST IM|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||5.20||| 78227|EAP|0341|NM HEPATOBIL DUCT SYST IM|United Medicare Advantage|UHC MEDICARE GOLD MA|5.20||||5.20||| 78227|EAP|0341|NM HEPATOBIL DUCT SYST IM|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||5.20||| 78227|EAP|0341|NM HEPATOBIL DUCT SYST IM|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||582.40||| 78227|EAP|0341|NM HEPATOBIL DUCT SYST IM|Blue Cross PPO Specialty|BCBSTX OTHER|644.80||||||| 78227|EAP|0341|NM HEPATOBIL DUCT SYST IM|Blue Cross HMO Specialty|BCBSTX HMO|||||644.80||| 78227|EAP|0341|NM HEPATOBIL DUCT SYST IM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||5.20||| 78227|EAP|0341|NM HEPATOBIL DUCT SYST IM|Cigna|CIGNA|||||5.20||| 78227|EAP|0341|NM HEPATOBIL DUCT SYST IM|Blue Cross PPO Specialty|BCBSTX PPO|||||5.20||| 78227|EAP|0341|NM HEPATOBIL DUCT SYST IM|Aenta Medicare Advantage|AETNA MEDICARE MA|||||644.80||| 78227|EAP|0341|NM HEPATOBIL DUCT SYST IM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||5.20||| 78227|EAP|0341|NM HEPATOBIL DUCT SYST IM|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||5.20||| 78227|EAP|0341|NM HEPATOBIL DUCT SYST IM|Humana Medicare Advantage|HUMANA MA|644.80||||5.20||| 78264|EAP|0341|NM GASTRIC EMPTYING STUDY|Blue Cross HMO Specialty|BCBSTX HMO|||||12.50||| 78264|EAP|0341|NM GASTRIC EMPTYING STUDY|Blue Cross PPO Specialty|BCBSTX PPO|||||12.50||| 78264|EAP|0341|NM GASTRIC EMPTYING STUDY|Cigna|CIGNA|||||12.50||| 78264|EAP|0341|NM GASTRIC EMPTYING STUDY|United Healthcare|UNITED HEALTHCARE OTHER|||||12.50||| 78264|EAP|0341|NM GASTRIC EMPTYING STUDY|Medicare|MEDICARE ACUTE|||||12.50||| 78264|EAP|0341|NM GASTRIC EMPTYING STUDY|United Healthcare|UNITED HEALTHCARE|||||12.50||| 78306|EAP|0341|NM BONE IMAGING WHOLE BOD|United Medicare Advantage|UHC MEDICARE GOLD MA|||||17.36||| 78306|EAP|0341|NM BONE IMAGING WHOLE BOD|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||17.36||| 78306|EAP|0341|NM BONE IMAGING WHOLE BOD|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||14.00||| 78306|EAP|0341|NM BONE IMAGING WHOLE BOD|Medicare|MEDICARE ACUTE|||||17.36||| 78306|EAP|0341|NM BONE IMAGING WHOLE BOD|Tricare|TRICARE EAST REGION|||||14.00||| 78306|EAP|0341|NM BONE IMAGING WHOLE BOD|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||17.36||| 78306|EAP|0341|NM BONE IMAGING WHOLE BOD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||17.36||| 78306|EAP|0341|NM BONE IMAGING WHOLE BOD|Humana Medicare Advantage|HUMANA MA|||||14.00||| 78315|EAP|0341|NM BONE SCAN-TRIPLE PHASE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,847.60||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|Aenta Medicare Advantage|AETNA MEDICARE MA|3,955.60||||3,955.60||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|Blue Cross PPO Specialty|BCBSTX PPO|3,955.60||||31.90||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3,955.60||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||31.90||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|Aetna|AETNA QHP HMO|||||3,955.60||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|Aetna|AETNA PPO|||||3,955.60||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||31.90||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|Access Direct Platinum|HEALTHFIRST TPA UMR|||||31.90||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||31.90||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|Blue Cross PPO Specialty|BCBSTX OTHER|31.90||||3,572.80||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|Cigna|CIGNA|||||31.90||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|Cigna|CIGNA|||||3,955.60||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|Aetna|AETNA OTHER|||||31.90||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||31.90||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|Humana Medicare Advantage|HUMANA MA|3,955.60||||31.90||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||3,955.60||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|Medicare|MEDICARE ACUTE|31.90||||31.90||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|United Healthcare|UNITED HEALTHCARE|||||3,955.60||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|NON CONTRACTED|COMMERCIAL OTHER 1|31.90||||31.90||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|Managed Medicaid|MEDICAID AMERIGROUP|||||31.90||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|United Healthcare|UNITED HEALTHCARE OTHER|||||3,572.80||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||3,955.60||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|Tricare|TRICARE EAST REGION|||||3,955.60||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||31.90||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||31.90||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|United Healthcare|UNITED HEALTHCARE|3,572.80||||3,955.60||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|31.90||||31.90||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3,955.60||||3,572.80||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|United Medicare Advantage|UHC MEDICARE GOLD MA|31.90||||31.90||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3,572.80||| 78452|EAP|0341|NM MYOCARDIAL PERF SP RES|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||31.90||| 78579|EAP|0341|NM PULMONARY VENTIL IMAG|United Medicare Advantage|UHC MEDICARE GOLD MA|5.20||||644.80||| 78579|EAP|0341|NM PULMONARY VENTIL IMAG|United Medicare Advantage|UHC MEDICARE GOLD MA|954.80||||644.80||| 78579|EAP|0341|NM LUNG PERFUSION SCAN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|954.80||||||| 78579|EAP|0341|NM PULMONARY VENTIL IMAG|Medicare|MEDICARE ACUTE|5.20||||644.80||| 78579|EAP|0341|NM LUNG PERFUSION SCAN|Medicare|MEDICARE ACUTE|954.80||||954.80||| 78579|EAP|0341|NM PULMONARY VENTIL IMAG|United Healthcare|UNITED HEALTHCARE|5.20||||||| 78579|EAP|0341|NM PULMONARY VENTIL IMAG|Humana Medicare Advantage|HUMANA MA|644.80||||||| 78707|EAP|0341|NM KIDNEY IMAGING W/VASCU|Humana Medicare Advantage|HUMANA MA|||||13.20||| 78707|EAP|0341|NM KIDNEY IMAGING W/VASCU|Medicare|MEDICARE ACUTE|||||1,636.80||| 78707|EAP|0341|NM KIDNEY IMAGING W/VASCU|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,636.80||| 80048|EAP|0301|BASIC METABOLIC PANEL|United Medicare Advantage|UHC MEDICARE GOLD MA|2.72||||81.75||| 80048|EAP|0301|BASIC METABOLIC PANEL|Veterans Affairs|VETERANS ADMINISTRATION|337.28||||337.28||| 80048|EAP|0301|BASIC METABOLIC PANEL|Veterans Affairs|VETERANS ADMINISTRATION|304.64||||||| 80048|EAP|0301|BASIC METABOLIC PANEL|Workers Compensation|WORKERS COMPENSATION OTHER|337.28||||81.75||| 80048|EAP|0301|BASIC METABOLIC PANEL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|337.28||||81.75||| 80048|EAP|0301|BASIC METABOLIC PANEL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.72||||337.28||| 80048|EAP|0301|BASIC METABOLIC PANEL|Medicare|MEDICARE PART B ONLY IP|2.72||||||| 80048|EAP|0301|BASIC METABOLIC PANEL|Medicare|MEDICARE ACUTE|2.72||||81.75||| 80048|EAP|0301|BASIC METABOLIC PANEL|Tricare|TRICARE EAST REGION|337.28||||||| 80048|EAP|0301|BASIC METABOLIC PANEL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.72||| 80048|EAP|0301|BASIC METABOLIC PANEL|Medicaid|MEDICAID TEXAS CHILDRENS|||||81.75||| 80048|EAP|0301|BASIC METABOLIC PANEL|Medicaid|MEDICAID|2.72||||2.72||| 80048|EAP|0301|BASIC METABOLIC PANEL|Managed Medicare|HEALTHSPRING MA|337.28||||2.72||| 80048|EAP|0301|BASIC METABOLIC PANEL|Managed Medicare|BCBS MEDICARE PPO MA|337.28||||81.75||| 80048|EAP|0301|BASIC METABOLIC PANEL|United Healthcare|UNITED HEALTHCARE OTHER|||||2.72||| 80048|EAP|0301|BASIC METABOLIC PANEL|United Healthcare|UNITED HEALTHCARE|||||81.75||| 80048|EAP|0301|BASIC METABOLIC PANEL|Managed Medicare|OTHER INSTITUTIONS|304.64||||||| 80048|EAP|0301|BASIC METABOLIC PANEL|Tricare|TRICARE FOR LIFE|||||81.75||| 80048|EAP|0301|BASIC METABOLIC PANEL|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||337.28||| 80048|EAP|0301|BASIC METABOLIC PANEL|NON CONTRACTED|COMMERCIAL OTHER 1|2.72||||2.72||| 80048|EAP|0301|BASIC METABOLIC PANEL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||81.75||| 80048|EAP|0301|BASIC METABOLIC PANEL|United Healthcare|UNITED HEALTHCARE|304.64||||81.75||| 80048|EAP|0301|BASIC METABOLIC PANEL|United Healthcare|TML GROUP BENEFITS|||||81.75||| 80048|EAP|0301|BASIC METABOLIC PANEL|Blue Cross PPO Specialty|BCBSTX PPO|337.28||||81.75||| 80048|EAP|0301|BASIC METABOLIC PANEL|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||81.75||| 80048|EAP|0301|BASIC METABOLIC PANEL|Aetna|AETNA OTHER|337.28||||2.72||| 80048|EAP|0301|BASIC METABOLIC PANEL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|2.72||||81.75||| 80048|EAP|0301|BASIC METABOLIC PANEL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.72||||81.75||| 80048|EAP|0301|BASIC METABOLIC PANEL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.72||||81.75||| 80048|EAP|0301|BASIC METABOLIC PANEL|Access Direct Platinum|HEALTHFIRST TPA UMR|2.72||||81.75||| 80048|EAP|0301|BASIC METABOLIC PANEL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.72||||81.75||| 80048|EAP|0301|BASIC METABOLIC PANEL|Blue Cross HMO Specialty|BCBSTX HMO|337.28||||81.75||| 80048|EAP|0301|BASIC METABOLIC PANEL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|337.28||||81.75||| 80048|EAP|0301|BASIC METABOLIC PANEL|Humana Medicare Advantage|HUMANA MA|2.72||||2.72||| 80048|EAP|0301|BASIC METABOLIC PANEL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|337.28||||81.75||| 80048|EAP|0301|BASIC METABOLIC PANEL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.72||||81.75||| 80048|EAP|0301|BASIC METABOLIC PANEL|Cigna|CIGNA|337.28||||81.75||| 80048|EAP|0301|BASIC METABOLIC PANEL|Managed Medicaid|MEDICAID AMERIGROUP|2.72||||2.72||| 80048|EAP|0301|BASIC METABOLIC PANEL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|337.28||||81.75||| 80048|EAP|0301|BASIC METABOLIC PANEL|Managed Medicaid|MEDICAID SUPERIOR|2.72||||2.72||| 80048|EAP|0301|BASIC METABOLIC PANEL|Cigna|CIGNA|||||81.75||| 80048|EAP|0301|BASIC METABOLIC PANEL|Aenta Medicare Advantage|AETNA MEDICARE MA|2.72||||2.72||| 80048|EAP|0301|BASIC METABOLIC PANEL|Blue Cross PPO Specialty|BCBSTX OTHER|2.72||||176.88||| 80048|EAP|0301|BASIC METABOLIC PANEL|Aetna|AETNA PPO|337.28||||81.75||| 80051|EAP|0301|ELECTROLYTE PANEL|Blue Cross PPO Specialty|BCBSTX PPO|||||67.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Veterans Affairs|VETERANS ADMINISTRATION|||||421.29||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Veterans Affairs|VETERANS ADMINISTRATION|421.29||||421.29||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|421.29||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|United Medicare Advantage|UHC MEDICARE GOLD MA|339.75||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|United Medicare Advantage|AARP UHC WEST COMPLETE MA|421.29||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Workers Compensation|WORKERS COMPENSATION OTHER|421.29||||421.29||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Medicare|MEDICARE PART B ONLY IP|421.29||||||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Managed Medicare|OTHER INSTITUTIONS|||||421.29||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Medicare|MEDICARE ACUTE|421.29||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|United Healthcare|UMR UNITED MEDICAL RESOURCES|339.75||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|United Healthcare|UNITED HEALTHCARE OTHER|||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|PHCS|HUMANA INSURANCE|||||421.29||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Medicaid|MEDICAID TEXAS CHILDRENS|||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Medicaid|WOOD COUNTY INDIGENT|||||421.29||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Medicaid|MEDICAID|339.75||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|United Healthcare|GEHA|||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|421.29||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|United Healthcare|UNITED HEALTHCARE|380.52||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|United Healthcare|TML GROUP BENEFITS|339.75||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Managed Medicare|HEALTHSPRING MA|||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Managed Medicare|BCBS MEDICARE PPO MA|||||220.88||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|PHCS|GREAT WEST LIFE AND ANNUITY|||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Tricare|TRICARE FOR LIFE|||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|United Healthcare|UNITED HEALTHCARE|||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|NON CONTRACTED|WOOD COUNTY HOSPITAL DISTRICT|||||421.29||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|United Healthcare|ZZZZZ UNITED HEALTHCARE|||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Multiplan|NALC|||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|NON CONTRACTED|COMMERCIAL OTHER 1|339.75||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Managed Medicare|MEDICARE RAILROAD|||||421.29||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|NON CONTRACTED|COMMERCIAL OTHER 2|||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|United Healthcare|UNITED HEALTHCARE ERS|||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Blue Cross PPO Specialty|BCBSTX PPO|421.29||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Medicaid|MEDICAID HMO|||||421.29||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Blue Cross PPO Specialty|BCBSTX OTHER|380.52||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Aetna|AETNA OTHER|421.29||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|380.52||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|339.75||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Tricare|TRICARE EAST REGION|421.29||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|339.75||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Access Direct Platinum|HEALTHFIRST TPA UMR|339.75||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Managed Medicaid|MEDICAID UNITED HEALTHCARE|421.29||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|339.75||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|1.02||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Humana Medicare Advantage|HUMANA MA|339.75||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Blue Cross PPO Specialty|BLUE SHIELD PHYSICIAN|||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Aetna|AETNA PPO|421.29||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|421.29||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Blue Cross HMO Specialty|BCBSTX HMO|421.29||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Cigna|CIGNA|||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Aenta Medicare Advantage|AETNA MEDICARE MA|421.29||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Cigna|CIGNA|421.29||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|421.29||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Aetna|AETNA QHP HMO|||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|ChampVA|CHAMPVA CENTER|||||1.02||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Managed Medicaid|MEDICAID SUPERIOR|339.75||||339.75||| 80053|EAP|0301|COMPREHENSIVE METABOLIC P|Managed Medicaid|MEDICAID AMERIGROUP|421.29||||339.75||| 80061|EAP|0301|LIPID PROFILE I|Humana Medicare Advantage|HUMANA MA|533.82||||430.50||| 80061|EAP|0301|LIPID PROFILE I|Blue Cross PPO Specialty|BCBSTX PPO|533.82||||533.82||| 80061|EAP|0301|LIPID PROFILE II|Aetna|AETNA QHP HMO|||||129.25||| 80061|EAP|0301|LIPID PROFILE II|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||129.25||| 80061|EAP|0301|LIPID PROFILE II|ChampVA|CHAMPVA CENTER|||||129.25||| 80061|EAP|0301|LIPID PROFILE II|Aetna|AETNA OTHER|533.82||||129.25||| 80061|EAP|0301|LIPID PROFILE I|Cigna|CIGNA|482.16||||430.50||| 80061|EAP|0301|LIPID PROFILE II|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||129.25||| 80061|EAP|0301|LIPID PROFILE II|Managed Medicaid|MEDICAID AMERIGROUP|||||129.25||| 80061|EAP|0301|LIPID PROFILE II|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||129.25||| 80061|EAP|0301|LIPID PROFILE I|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||430.50||| 80061|EAP|0301|LIPID PROFILE II|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||129.25||| 80061|EAP|0301|LIPID PROFILE II|Blue Cross HMO Specialty|BCBSTX HMO|533.82||||129.25||| 80061|EAP|0301|LIPID PROFILE I|Managed Medicaid|MEDICAID AMERIGROUP|||||430.50||| 80061|EAP|0301|LIPID PROFILE I|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||430.50||| 80061|EAP|0301|LIPID PROFILE II|Blue Cross PPO Specialty|BCBSTX PPO|533.82||||129.25||| 80061|EAP|0301|LIPID PROFILE II|Cigna|CIGNA|482.16||||129.25||| 80061|EAP|0301|LIPID PROFILE II|Aetna|AETNA PPO|533.82||||129.25||| 80061|EAP|0301|LIPID PROFILE I|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|533.82||||430.50||| 80061|EAP|0301|LIPID PROFILE II|Aenta Medicare Advantage|AETNA MEDICARE MA|533.82||||129.25||| 80061|EAP|0301|LIPID PROFILE I|Aenta Medicare Advantage|AETNA MEDICARE MA|533.82||||533.82||| 80061|EAP|0301|LIPID PROFILE II|Humana Medicare Advantage|HUMANA MA|430.50||||129.25||| 80061|EAP|0301|LIPID PROFILE II|Managed Medicaid|MEDICAID UNITED HEALTHCARE|533.82||||129.25||| 80061|EAP|0301|LIPID PROFILE II|Access Direct Platinum|HEALTHFIRST TPA UMR|||||129.25||| 80061|EAP|0301|LIPID PROFILE II|Blue Cross HMO Specialty|BCBSTX HMO|430.50||||129.25||| 80061|EAP|0301|LIPID PROFILE II|Managed Medicaid|MEDICAID SUPERIOR|||||129.25||| 80061|EAP|0301|LIPID PROFILE II|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||129.25||| 80061|EAP|0301|LIPID PROFILE II|Medicare|MEDICARE PART B ONLY IP|430.50||||||| 80061|EAP|0301|LIPID PROFILE II|Medicare|MEDICARE ACUTE|430.50||||129.25||| 80061|EAP|0301|LIPID PROFILE II|Multiplan|NALC|||||129.25||| 80061|EAP|0301|LIPID PROFILE II|NON CONTRACTED|COMMERCIAL OTHER 1|533.82||||129.25||| 80061|EAP|0301|LIPID PROFILE II|United Healthcare|TML GROUP BENEFITS|||||129.25||| 80061|EAP|0301|LIPID PROFILE I|United Healthcare|UNITED HEALTHCARE OTHER|||||533.82||| 80061|EAP|0301|LIPID PROFILE II|Managed Medicare|BCBS MEDICARE PPO MA|533.82||||129.25||| 80061|EAP|0301|LIPID PROFILE II|Medicaid|MEDICAID TEXAS CHILDRENS|||||129.25||| 80061|EAP|0301|LIPID PROFILE I|NON CONTRACTED|COMMERCIAL OTHER 1|533.82||||482.16||| 80061|EAP|0301|LIPID PROFILE II|Cigna|CIGNA|||||129.25||| 80061|EAP|0301|LIPID PROFILE II|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|430.50||||129.25||| 80061|EAP|0301|LIPID PROFILE II|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||129.25||| 80061|EAP|0301|LIPID PROFILE II|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||129.25||| 80061|EAP|0301|LIPID PROFILE II|Medicaid|MEDICAID|430.50||||129.25||| 80061|EAP|0301|LIPID PROFILE II|United Healthcare|GEHA|||||129.25||| 80061|EAP|0301|LIPID PROFILE II|Blue Cross PPO Specialty|BCBSTX OTHER|||||129.25||| 80061|EAP|0301|LIPID PROFILE I|United Healthcare|UNITED HEALTHCARE|533.82||||533.82||| 80061|EAP|0301|LIPID PROFILE II|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|482.16||||129.25||| 80061|EAP|0301|LIPID PROFILE II|United Healthcare|UMR UNITED MEDICAL RESOURCES|430.50||||129.25||| 80061|EAP|0301|LIPID PROFILE II|Tricare|TRICARE FOR LIFE|||||129.25||| 80061|EAP|0301|LIPID PROFILE II|Tricare|TRICARE EAST REGION|533.82||||129.25||| 80061|EAP|0301|LIPID PROFILE I|Medicare|MEDICARE PART B ONLY IP|533.82||||||| 80061|EAP|0301|LIPID PROFILE II|Managed Medicare|HEALTHSPRING MA|533.82||||129.25||| 80061|EAP|0301|LIPID PROFILE I|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|482.16||||430.50||| 80061|EAP|0301|LIPID PROFILE II|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||129.25||| 80061|EAP|0301|LIPID PROFILE I|United Healthcare|UMR UNITED MEDICAL RESOURCES|430.50||||533.82||| 80061|EAP|0301|LIPID PROFILE II|United Healthcare|UNITED HEALTHCARE ERS|||||129.25||| 80061|EAP|0301|LIPID PROFILE II|United Healthcare|ZZZZZ UNITED HEALTHCARE|||||129.25||| 80061|EAP|0301|LIPID PROFILE II|United Healthcare|UNITED HEALTHCARE|||||129.25||| 80061|EAP|0301|LIPID PROFILE I|Aetna|AETNA QHP HMO|||||533.82||| 80061|EAP|0301|LIPID PROFILE II|Blue Cross PPO Specialty|BLUE SHIELD PHYSICIAN|||||129.25||| 80061|EAP|0301|LIPID PROFILE II|United Healthcare|UNITED HEALTHCARE OTHER|||||129.25||| 80061|EAP|0301|LIPID PROFILE I|Medicare|MEDICARE ACUTE|430.50||||533.82||| 80061|EAP|0301|LIPID PROFILE II|United Healthcare|UNITED HEALTHCARE|533.82||||129.25||| 80061|EAP|0301|LIPID PROFILE II|Veterans Affairs|VETERANS ADMINISTRATION|533.82||||||| 80061|EAP|0301|LIPID PROFILE II|Workers Compensation|WORKERS COMPENSATION OTHER|||||129.25||| 80061|EAP|0301|LIPID PROFILE I|Veterans Affairs|VETERANS ADMINISTRATION|533.82||||||| 80061|EAP|0301|LIPID PROFILE I|Veterans Affairs|VETERANS ADMINISTRATION|533.82||||533.82||| 80061|EAP|0301|LIPID PROFILE I|United Medicare Advantage|UHC MEDICARE GOLD MA|430.50||||533.82||| 80061|EAP|0301|LIPID PROFILE II|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||129.25||| 80061|EAP|0301|LIPID PROFILE I|United Medicare Advantage|AARP UHC WEST COMPLETE MA|533.82||||533.82||| 80061|EAP|0301|LIPID PROFILE I|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|533.82||||533.82||| 80061|EAP|0301|LIPID PROFILE II|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|533.82||||129.25||| 80061|EAP|0301|LIPID PROFILE II|United Medicare Advantage|UHC MEDICARE GOLD MA|430.50||||129.25||| 80061|EAP|0301|LIPID PROFILE II|United Medicare Advantage|AARP UHC WEST COMPLETE MA|533.82||||129.25||| 80069|EAP|0300|RENAL FUNCTION PANEL|United Medicare Advantage|UHC MEDICARE GOLD MA|2.79||||83.75||| 80069|EAP|0300|RENAL FUNCTION PANEL|Workers Compensation|WORKERS COMPENSATION OTHER|345.96||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|345.96||||83.75||| 80069|EAP|0300|RENAL FUNCTION PANEL|Veterans Affairs|VETERANS ADMINISTRATION|345.96||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|Managed Medicare|BCBS MEDICARE PPO MA|345.96||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|Medicaid|MEDICAID|345.96||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|United Healthcare|UNITED HEALTHCARE|||||83.75||| 80069|EAP|0300|RENAL FUNCTION PANEL|United Healthcare|UNITED HEALTHCARE|345.96||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|NON CONTRACTED|COMMERCIAL OTHER 1|345.96||||83.75||| 80069|EAP|0300|RENAL FUNCTION PANEL|Managed Medicare|HEALTHSPRING MA|345.96||||345.96||| 80069|EAP|0300|RENAL FUNCTION PANEL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|312.48||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.79||||2.79||| 80069|EAP|0300|RENAL FUNCTION PANEL|Medicare|MEDICARE ACUTE|345.96||||83.75||| 80069|EAP|0300|RENAL FUNCTION PANEL|Blue Cross PPO Specialty|BCBSTX OTHER|345.96||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|Aetna|AETNA PPO|||||83.75||| 80069|EAP|0300|RENAL FUNCTION PANEL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|345.96||||2.79||| 80069|EAP|0300|RENAL FUNCTION PANEL|Cigna|CIGNA|2.79||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|345.96||||83.75||| 80069|EAP|0300|RENAL FUNCTION PANEL|Blue Cross HMO Specialty|BCBSTX HMO|345.96||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|Humana Medicare Advantage|HUMANA MA|345.96||||345.96||| 80069|EAP|0300|RENAL FUNCTION PANEL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|312.48||||||| 80069|EAP|0300|RENAL FUNCTION PANEL|Blue Cross PPO Specialty|BCBSTX PPO|345.96||||83.75||| 80069|EAP|0300|RENAL FUNCTION PANEL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.79||||83.75||| 80069|EAP|0300|RENAL FUNCTION PANEL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||345.96||| 80069|EAP|0300|RENAL FUNCTION PANEL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|345.96||||83.75||| 80069|EAP|0300|RENAL FUNCTION PANEL|Aenta Medicare Advantage|AETNA MEDICARE MA|345.96||||83.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|Humana Medicare Advantage|HUMANA MA|325.50||||78.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|Blue Cross PPO Specialty|BCBSTX PPO|325.50||||78.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|Blue Cross PPO Specialty|BCBSTX OTHER|||||78.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||78.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||78.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||78.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|Access Direct Platinum|HEALTHFIRST TPA UMR|||||78.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|Managed Medicaid|MEDICAID AMERIGROUP|||||78.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|325.50||||78.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|Blue Cross HMO Specialty|BCBSTX HMO|||||78.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||78.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|Aenta Medicare Advantage|AETNA MEDICARE MA|||||78.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||78.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|325.50||||78.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|Medicare|MEDICARE ACUTE|325.50||||78.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|Cigna|CIGNA|||||78.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|United Healthcare|UNITED HEALTHCARE OTHER|||||78.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|United Healthcare|UNITED HEALTHCARE|||||78.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|Medicaid|MEDICAID|||||78.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|Managed Medicare|BCBS MEDICARE PPO MA|||||78.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|NON CONTRACTED|COMMERCIAL OTHER 1|262.50||||||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|Tricare|TRICARE EAST REGION|||||78.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||78.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|Veterans Affairs|VETERANS ADMINISTRATION|325.50||||||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|325.50||||78.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|United Medicare Advantage|AARP UHC WEST COMPLETE MA|325.50||||78.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|United Medicare Advantage|UHC MEDICARE GOLD MA|325.50||||78.75||| 80076|EAP|0301|HEPATIC LIVER FUNCTION|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|325.50||||||| 80156|EAP|0301|TEGRETOL LEVEL (CARBAMAZE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||140.50||| 80156|EAP|0301|TEGRETOL LEVEL (CARBAMAZE|Medicare|MEDICARE ACUTE|467.75||||140.50||| 80156|EAP|0301|TEGRETOL LEVEL (CARBAMAZE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||140.50||| 80156|EAP|0301|TEGRETOL LEVEL (CARBAMAZE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||140.50||| 80156|EAP|0301|TEGRETOL LEVEL (CARBAMAZE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||140.50||| 80158|EAP|0300|CYCLOSPORIN|Medicare|MEDICARE ACUTE|527.20||||||| 80162|EAP|0301|DIGOXIN, BLOOD|United Medicare Advantage|UHC MEDICARE GOLD MA|||||426.50||| 80162|EAP|0301|DIGOXIN, BLOOD|United Medicare Advantage|AARP UHC WEST COMPLETE MA|426.50||||426.50||| 80162|EAP|0301|DIGOXIN, BLOOD|Aenta Medicare Advantage|AETNA MEDICARE MA|426.50||||426.50||| 80162|EAP|0301|DIGOXIN, BLOOD|Humana Medicare Advantage|HUMANA MA|426.50||||277.25||| 80162|EAP|0301|DIGOXIN, BLOOD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.28||| 80162|EAP|0301|DIGOXIN, BLOOD|Medicare|MEDICARE ACUTE|426.50||||1.28||| 80162|EAP|0301|DIGOXIN, BLOOD|Medicaid|MEDICAID|426.50||||||| 80162|EAP|0301|DIGOXIN, BLOOD|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.28||| 80164|EAP|0301|VALPORIC ACID-DEPAKENE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||435.25||| 80164|EAP|0301|VALPORIC ACID-DEPAKENE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||130.75||| 80164|EAP|0301|VALPORIC ACID-DEPAKENE|Medicare|MEDICARE ACUTE|435.25||||130.75||| 80164|EAP|0301|VALPORIC ACID-DEPAKENE|Blue Cross PPO Specialty|BCBSTX PPO|||||2.83||| 80164|EAP|0301|VALPORIC ACID-DEPAKENE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||130.75||| 80164|EAP|0301|VALPORIC ACID-DEPAKENE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||130.75||| 80164|EAP|0301|VALPORIC ACID-DEPAKENE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||130.75||| 80164|EAP|0301|VALPORIC ACID-DEPAKENE|Veterans Affairs|VETERANS ADMINISTRATION|435.25||||||| 80164|EAP|0301|VALPORIC ACID-DEPAKENE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||130.75||| 80164|EAP|0301|VALPORIC ACID-DEPAKENE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||130.75||| 80170|EAP|0301|GENTAMYCIN-GARAMYCIN LEVE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.58||| 80170|EAP|0301|GENTAMYCIN-GARAMYCIN LEVE|Humana Medicare Advantage|HUMANA MA|526.50||||||| 80175|EAP|0300|LAMOTRIGINE|Medicaid|WOOD COUNTY INDIGENT|||||3.61||| 80175|EAP|0300|LAMOTRIGINE|Medicare|MEDICARE ACUTE|||||1.32||| 80175|EAP|0300|LAMOTRIGINE|Blue Cross PPO Specialty|BCBSTX PPO|||||1.32||| 80175|EAP|0300|LAMOTRIGINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||404.32||| 80175|EAP|0300|LAMOTRIGINE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.32||| 80175|EAP|0300|LAMOTRIGINE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.32||| 80175|EAP|0300|LAMOTRIGINE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||289.82||| 80178|EAP|0301|LITHIUM (BLOOD)|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||63.75||| 80178|EAP|0301|LITHIUM (BLOOD)|Blue Cross PPO Specialty|BCBSTX PPO|||||63.75||| 80178|EAP|0301|LITHIUM (BLOOD)|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||212.25||| 80178|EAP|0301|LITHIUM (BLOOD)|Cigna|CIGNA|||||63.75||| 80178|EAP|0301|LITHIUM (BLOOD)|Aenta Medicare Advantage|AETNA MEDICARE MA|||||63.75||| 80178|EAP|0301|LITHIUM (BLOOD)|Managed Medicaid|MEDICAID SUPERIOR|||||212.25||| 80178|EAP|0301|LITHIUM (BLOOD)|Medicare|MEDICARE ACUTE|||||63.75||| 80178|EAP|0301|LITHIUM (BLOOD)|NON CONTRACTED|COMMERCIAL OTHER 1|||||63.75||| 80178|EAP|0301|LITHIUM (BLOOD)|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||212.25||| 80178|EAP|0301|LITHIUM (BLOOD)|United Healthcare|UNITED HEALTHCARE OTHER|||||63.75||| 80184|EAP|0301|PHENOBARBITAL LEVEL|Medicare|MEDICARE ACUTE|||||110.50||| 80184|EAP|0301|PHENOBARBITAL LEVEL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||367.75||| 80184|EAP|0301|PHENOBARBITAL LEVEL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|367.75||||110.50||| 80185|EAP|0301|DILANTIN LEVEL|Workers Compensation|WORKERS COMPENSATION OTHER|4.26||||||| 80185|EAP|0301|DILANTIN LEVEL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.28||| 80185|EAP|0301|DILANTIN LEVEL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||4.26||| 80185|EAP|0301|DILANTIN LEVEL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.28||| 80185|EAP|0301|DILANTIN LEVEL|Managed Medicaid|MEDICAID SUPERIOR|||||1.28||| 80185|EAP|0301|DILANTIN LEVEL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.26||| 80185|EAP|0301|DILANTIN LEVEL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.26||| 80185|EAP|0301|DILANTIN LEVEL|Medicare|MEDICARE ACUTE|4.26||||4.26||| 80185|EAP|0301|DILANTIN LEVEL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.28||| 80185|EAP|0301|DILANTIN LEVEL|Medicaid|WOOD COUNTY INDIGENT|||||1.28||| 80185|EAP|0301|DILANTIN LEVEL|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.26||| 80185|EAP|0301|DILANTIN LEVEL|United Healthcare|UNITED HEALTHCARE|4.26||||||| 80198|EAP|0301|AMINOPHYLINE (THEOPHYLLIN|Medicare|MEDICARE ACUTE|454.50||||||| 80198|EAP|0301|AMINOPHYLINE (THEOPHYLLIN|NON CONTRACTED|COMMERCIAL OTHER 1|||||136.50||| 80201|EAP|0300|TOPIRAMATE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||104.50||| 80201|EAP|0300|TOPIRAMATE|Blue Cross PPO Specialty|BCBSTX PPO|||||104.50||| 80202|EAP|0301|VANCOMYCIN SERUM|Medicare|MEDICARE PART B ONLY IP|435.25||||||| 80202|EAP|0301|VANCOMYCIN SERUM|Medicare|MEDICARE ACUTE|435.25||||130.75||| 80202|EAP|0301|VANCOMYCIN SERUM|Medicaid|MEDICAID|435.25||||||| 80202|EAP|0301|VANCOMYCIN SERUM|Blue Cross PPO Specialty|BCBSTX PPO|435.25||||||| 80202|EAP|0301|VANCOMYCIN SERUM|Humana Medicare Advantage|HUMANA MA|435.25||||435.25||| 80202|EAP|0301|VANCOMYCIN SERUM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|435.25||||||| 80202|EAP|0301|VANCOMYCIN SERUM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|435.25||||||| 80202|EAP|0301|VANCOMYCIN SERUM|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|435.25||||||| 80202|EAP|0301|VANCOMYCIN SERUM|Aenta Medicare Advantage|AETNA MEDICARE MA|435.25||||130.75||| 80202|EAP|0301|VANCOMYCIN SERUM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||435.25||| 80202|EAP|0301|VANCOMYCIN SERUM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|435.25||||||| 80202|EAP|0301|VANCOMYCIN SERUM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|435.25||||||| 80202|EAP|0301|VANCOMYCIN SERUM|United Medicare Advantage|UHC MEDICARE GOLD MA|435.25||||||| 80202|EAP|0301|VANCOMYCIN SERUM|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|435.25||||2.83||| 80307|EAP|0301|DRUG SCREEN ER|Veterans Affairs|VETERANS ADMINISTRATION|548.70||||495.60||| 80307|EAP|0301|DRUG SCREEN ER|Workers Compensation|WORKERS COMPENSATION OTHER|||||548.70||| 80307|EAP|0301|DRUG SCREEN ER|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||548.70||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||8.06||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|548.70||||8.06||| 80307|EAP|0301|DRUG SCREEN ER|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||442.50||| 80307|EAP|0301|DRUG SCREEN ER|United Medicare Advantage|UHC MEDICARE GOLD MA|442.50||||548.70||| 80307|EAP|0301|DRUG SCREEN ER|United Medicare Advantage|AARP UHC WEST COMPLETE MA|548.70||||548.70||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||442.50||| 80307|EAP|0301|DRUG SCREEN ER|Managed Medicaid|MEDICAID SUPERIOR|442.50||||442.50||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|Blue Cross PPO Specialty|BCBSTX PPO|548.70||||7.28||| 80307|EAP|0301|DRUG SCREEN ER|Blue Cross PPO Specialty|BCBSTX PPO|548.70||||548.70||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|Blue Cross PPO Specialty|BCBSTX OTHER|548.70||||8.06||| 80307|EAP|0301|DRUG SCREEN ER|Managed Medicaid|MEDICAID AMERIGROUP|||||548.70||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|Managed Medicaid|MEDICAID AMERIGROUP|||||8.06||| 80307|EAP|0301|DRUG SCREEN ER|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|442.50||||442.50||| 80307|EAP|0301|DRUG SCREEN ER|Access Direct Platinum|HEALTHFIRST TPA UMR|||||132.75||| 80307|EAP|0301|DRUG SCREEN, QUALITATIVE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|442.50||||107.25||| 80307|EAP|0301|DRUG SCREEN ER|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||495.60||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|442.50||||7.28||| 80307|EAP|0301|DRUG SCREEN ER|Cigna|CIGNA|||||495.60||| 80307|EAP|0301|DRUG SCREEN ER|Cigna|CIGNA|||||442.50||| 80307|EAP|0301|DRUG SCREEN ER|Blue Cross HMO Specialty|BCBSTX HMO|||||548.70||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|Aetna|AETNA OTHER|||||8.06||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|Cigna|CIGNA|||||8.06||| 80307|EAP|0301|DRUG SCREEN ER|Aenta Medicare Advantage|AETNA MEDICARE MA|442.50||||548.70||| 80307|EAP|0301|DRUG SCREEN ER|Humana Medicare Advantage|HUMANA MA|||||548.70||| 80307|EAP|0301|DRUG SCREEN ER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|442.50||||442.50||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|Aetna|AETNA PPO|||||8.06||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|Aenta Medicare Advantage|AETNA MEDICARE MA|442.50||||624.25||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|6.50||||8.06||| 80307|EAP|0301|DRUG SCREEN ER|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|495.60||||495.60||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|442.50||||6.50||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|Blue Cross HMO Specialty|BCBSTX HMO|||||7.28||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||624.25||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|Humana Medicare Advantage|HUMANA MA|||||6.50||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|Managed Medicaid|MEDICAID SUPERIOR|442.50||||546.25||| 80307|EAP|0301|DRUG SCREEN ER|Aetna|AETNA PPO|||||548.70||| 80307|EAP|0301|DRUG SCREEN ER|Managed Medicaid|MEDICAID UNITED HEALTHCARE|442.50||||548.70||| 80307|EAP|0301|DRUG SCREEN ER|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||132.75||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|Medicare|MEDICARE ACUTE|8.06||||7.28||| 80307|EAP|0301|DRUG SCREEN ER|NON CONTRACTED|COMMERCIAL OTHER 4|||||132.75||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|NON CONTRACTED|COMMERCIAL OTHER 1|||||8.06||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|Medicaid|MEDICAID|||||8.06||| 80307|EAP|0301|DRUG SCREEN ER|Aetna|AETNA OTHER|||||548.70||| 80307|EAP|0301|DRUG SCREEN ER|Medicaid|MEDICAID|||||548.70||| 80307|EAP|0301|DRUG SCREEN ER|Medicaid|MEDICAID TEXAS CHILDRENS|||||495.60||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|Medicaid|MEDICAID TEXAS CHILDRENS|||||624.25||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||8.06||| 80307|EAP|0301|DRUG SCREEN ER|Blue Cross PPO Specialty|BCBSTX OTHER|548.70||||548.70||| 80307|EAP|0301|DRUG SCREEN ER|Medicaid|WOOD COUNTY INDIGENT|||||495.60||| 80307|EAP|0301|DRUG SCREEN ER|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||548.70||| 80307|EAP|0301|DRUG SCREEN ER|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||548.70||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|Tricare|TRICARE EAST REGION|548.70||||8.06||| 80307|EAP|0301|DRUG SCREEN, QUALITATIVE|NON CONTRACTED|COMMERCIAL OTHER 1|||||107.25||| 80307|EAP|0301|DRUG SCREEN ER|Managed Medicare|HEALTHSPRING MA|||||442.50||| 80307|EAP|0301|DRUG SCREEN ER|Managed Medicare|OTHER INSTITUTIONS|||||548.70||| 80307|EAP|0301|DRUG SCREEN ER|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||548.70||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|United Medicare Advantage|UHC MEDICARE GOLD MA|442.50||||6.50||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|Veterans Affairs|VETERANS ADMINISTRATION|548.70||||624.25||| 80307|EAP|0301|DRUG SCREEN ER|Managed Medicare|BCBS MEDICARE PPO MA|||||495.60||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||442.50||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|Managed Medicare|BCBS MEDICARE PPO MA|||||442.50||| 80307|EAP|0301|DRUG SCREEN ER|Tricare|TRICARE EAST REGION|548.70||||548.70||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|United Healthcare|UNITED HEALTHCARE OTHER|||||8.06||| 80307|EAP|0301|DRUG SCREEN ER|United Healthcare|UNITED HEALTHCARE OTHER|||||548.70||| 80307|EAP|0301|DRUG SCREEN ER|United Healthcare|TML GROUP BENEFITS|||||548.70||| 80307|EAP|0301|DRUG SCREEN ER|NON CONTRACTED|COMMERCIAL OTHER 1|||||442.50||| 80307|EAP|0301|DRUG SCREEN ER|United Healthcare|UNITED HEALTHCARE|||||495.60||| 80307|EAP|0301|ACETAMINOPHEN, SERUM|United Healthcare|UNITED HEALTHCARE|||||8.06||| 80307|EAP|0301|DRUG SCREEN ER|Medicare|MEDICARE ACUTE|548.70||||548.70||| 80307|EAP|0301|DRUG SCREEN ER|United Healthcare|UNITED HEALTHCARE|||||548.70||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|Medicare|MEDICARE ACUTE|388.92||||430.59||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|Managed Medicare|HEALTHSPRING MA|||||347.25||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|Medicaid|MEDICAID TEXAS CHILDRENS|||||388.92||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||430.59||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|Managed Medicare|OTHER INSTITUTIONS|||||430.59||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||347.25||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|Tricare|TRICARE EAST REGION|430.59||||430.59||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|United Healthcare|UNITED HEALTHCARE|||||430.59||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|United Healthcare|TML GROUP BENEFITS|||||430.59||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|NON CONTRACTED|COMMERCIAL OTHER 1|||||347.25||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|United Healthcare|UNITED HEALTHCARE OTHER|||||430.59||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|Blue Cross PPO Specialty|BCBSTX PPO|430.59||||430.59||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|Blue Cross PPO Specialty|BCBSTX OTHER|430.59||||430.59||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|347.25||||388.92||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|Aetna|AETNA OTHER|||||430.59||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|Medicaid|MEDICAID|||||347.25||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|347.25||||430.59||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|347.25||||430.59||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|Cigna|CIGNA|||||430.59||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|Cigna|CIGNA|||||347.25||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|Managed Medicare|BCBS MEDICARE PPO MA|||||347.25||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|Managed Medicaid|MEDICAID AMERIGROUP|||||430.59||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||388.92||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|Aenta Medicare Advantage|AETNA MEDICARE MA|||||388.92||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|Managed Medicaid|MEDICAID SUPERIOR|||||347.25||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|Blue Cross HMO Specialty|BCBSTX HMO|||||388.92||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|Humana Medicare Advantage|HUMANA MA|||||430.59||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|Veterans Affairs|VETERANS ADMINISTRATION|430.59||||347.25||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|Veterans Affairs|VETERANS ADMINISTRATION|||||430.59||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||347.25||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|United Medicare Advantage|UHC MEDICARE GOLD MA|||||430.59||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||430.59||| 80320|EAP|0301|ALCOHOL CHEMICAL BLOOD|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||430.59||| 80329|EAP|0301|SALICYLATE|Veterans Affairs|VETERANS ADMINISTRATION|||||2.28||| 80329|EAP|0301|SALICYLATE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.28||| 80329|EAP|0301|SALICYLATE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.28||| 80329|EAP|0301|SALICYLATE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.28||| 80329|EAP|0301|SALICYLATE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.28||| 80329|EAP|0301|SALICYLATE|Blue Cross HMO Specialty|BCBSTX HMO|||||2.28||| 80329|EAP|0301|SALICYLATE|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.28||| 80329|EAP|0301|SALICYLATE|Blue Cross PPO Specialty|BCBSTX PPO|||||2.28||| 80329|EAP|0301|SALICYLATE|Aetna|AETNA OTHER|||||2.28||| 80329|EAP|0301|SALICYLATE|Aetna|AETNA PPO|||||2.28||| 80329|EAP|0301|SALICYLATE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.28||| 80329|EAP|0301|SALICYLATE|Managed Medicaid|MEDICAID AMERIGROUP|||||2.28||| 80329|EAP|0301|SALICYLATE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.28||| 80329|EAP|0301|SALICYLATE|Cigna|CIGNA|||||2.28||| 80329|EAP|0301|SALICYLATE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.28||||68.50||| 80329|EAP|0301|SALICYLATE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.28||| 80329|EAP|0301|SALICYLATE|Humana Medicare Advantage|HUMANA MA|||||2.28||| 80329|EAP|0301|SALICYLATE|Managed Medicaid|MEDICAID SUPERIOR|||||2.28||| 80329|EAP|0301|SALICYLATE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.28||||2.28||| 80329|EAP|0301|SALICYLATE|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.28||| 80329|EAP|0301|SALICYLATE|Medicare|MEDICARE ACUTE|2.28||||2.28||| 80329|EAP|0301|SALICYLATE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.28||| 80329|EAP|0301|SALICYLATE|Medicaid|MEDICAID|||||2.28||| 80329|EAP|0301|SALICYLATE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.28||| 80329|EAP|0301|SALICYLATE|Managed Medicare|BCBS MEDICARE PPO MA|||||2.28||| 80329|EAP|0301|SALICYLATE|Tricare|TRICARE EAST REGION|||||2.28||| 80329|EAP|0301|SALICYLATE|United Healthcare|UNITED HEALTHCARE OTHER|||||2.28||| 80329|EAP|0301|SALICYLATE|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.28||| 80342|EAP|0300|RAPAMMUNE|Medicare|MEDICARE ACUTE|||||1.32||| 809|DRG||MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W CC|United Medicare Advantage|UHC MEDICARE GOLD MA|30,071.85|8112.28|8112.28|3261.28|||| 809|DRG||MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W CC|NON CONTRACTED|COMMERCIAL OTHER 1|17,099.25|3261.28|8112.28|3261.28|||| 81000|EAP|0307|URINE AUTO W/MICRO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.90||||0.90||| 81000|EAP|0307|URINE AUTO W/MICRO|Blue Cross PPO Specialty|BCBSTX OTHER|||||0.90||| 81000|EAP|0307|URINE AUTO W/MICRO|ChampVA|CHAMPVA CENTER|||||0.27||| 81000|EAP|0307|URINE AUTO W/MICRO|Aetna|AETNA OTHER|||||0.90||| 81000|EAP|0307|URINE AUTO W/MICRO|Aetna|AETNA QHP HMO|||||0.90||| 81000|EAP|0307|URINE AUTO W/MICRO|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.90||| 81000|EAP|0307|URINE AUTO W/MICRO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||100.80||| 81000|EAP|0307|URINE AUTO W/MICRO|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.90||| 81000|EAP|0307|URINE AUTO W/MICRO|Blue Cross PPO Specialty|BLUE SHIELD PHYSICIAN|||||0.27||| 81000|EAP|0307|URINE AUTO W/MICRO|Access Direct Platinum|HEALTHFIRST TPA UMR|||||58.50||| 81000|EAP|0307|URINE AUTO W/MICRO|Cigna|CIGNA|||||0.90||| 81000|EAP|0307|URINE AUTO W/MICRO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.90||||0.90||| 81000|EAP|0307|URINE AUTO W/MICRO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.90||| 81000|EAP|0307|URINE AUTO W/MICRO|Cigna|CIGNA|||||0.27||| 81000|EAP|0307|URINE AUTO W/MICRO|Humana Medicare Advantage|HUMANA MA|||||111.60||| 81000|EAP|0307|URINE AUTO W/MICRO|Medicare|MEDICARE ACUTE|||||0.90||| 81000|EAP|0307|URINE AUTO W/MICRO|United Healthcare|UNITED HEALTHCARE|||||111.60||| 81000|EAP|0307|URINE AUTO W/MICRO|Multiplan|NALC|||||0.27||| 81000|EAP|0307|URINE AUTO W/MICRO|United Healthcare|TML GROUP BENEFITS|||||58.50||| 81000|EAP|0307|URINE AUTO W/MICRO|Managed Medicaid|MEDICAID SUPERIOR|||||111.60||| 81000|EAP|0307|URINE AUTO W/MICRO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||111.60||| 81000|EAP|0307|URINE AUTO W/MICRO|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.90||| 81000|EAP|0307|URINE AUTO W/MICRO|Managed Medicaid|MEDICAID AMERIGROUP|||||0.90||| 81000|EAP|0307|URINE AUTO W/MICRO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||111.60||| 81000|EAP|0307|URINE AUTO W/MICRO|United Healthcare|UNITED HEALTHCARE ERS|||||0.27||| 81000|EAP|0307|URINE AUTO W/MICRO|Managed Medicare|HEALTHSPRING MA|||||0.27||| 81000|EAP|0307|URINE AUTO W/MICRO|Medicaid|WOOD COUNTY INDIGENT|||||111.60||| 81000|EAP|0307|URINE AUTO W/MICRO|Blue Cross HMO Specialty|BCBSTX HMO|111.60||||0.90||| 81000|EAP|0307|URINE AUTO W/MICRO|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||111.60||| 81000|EAP|0307|URINE AUTO W/MICRO|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||111.60||| 81000|EAP|0307|URINE AUTO W/MICRO|Medicaid|MEDICAID HMO|||||111.60||| 81000|EAP|0307|URINE AUTO W/MICRO|Medicaid|MEDICAID|||||111.60||| 81000|EAP|0307|URINE AUTO W/MICRO|Aetna|AETNA PPO|||||0.90||| 81000|EAP|0307|URINE AUTO W/MICRO|PHCS|HUMANA INSURANCE|||||111.60||| 81000|EAP|0307|URINE AUTO W/MICRO|Tricare|TRICARE FOR LIFE|||||100.80||| 81000|EAP|0307|URINE AUTO W/MICRO|Tricare|TRICARE EAST REGION|||||0.90||| 81000|EAP|0307|URINE AUTO W/MICRO|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.90||| 81000|EAP|0307|URINE AUTO W/MICRO|Blue Cross PPO Specialty|BCBSTX PPO|0.90||||0.90||| 81000|EAP|0307|URINE AUTO W/MICRO|Managed Medicare|BCBS MEDICARE PPO MA|||||111.60||| 81000|EAP|0307|URINE AUTO W/MICRO|Managed Medicare|OTHER INSTITUTIONS|||||111.60||| 81000|EAP|0307|URINE AUTO W/MICRO|United Healthcare|UMR UNITED MEDICAL RESOURCES|0.90||||0.27||| 81000|EAP|0307|URINE AUTO W/MICRO|United Healthcare|UNITED HEALTHCARE OTHER|||||111.60||| 81000|EAP|0307|URINE AUTO W/MICRO|NON CONTRACTED|WOOD COUNTY HOSPITAL DISTRICT|||||111.60||| 81000|EAP|0307|URINE AUTO W/MICRO|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.90||| 81000|EAP|0307|URINE AUTO W/MICRO|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.90||| 81000|EAP|0307|URINE AUTO W/MICRO|Veterans Affairs|VETERANS ADMINISTRATION|||||111.60||| 81000|EAP|0307|URINE AUTO W/MICRO|United Medicare Advantage|UHC MEDICARE GOLD MA|111.60||||0.90||| 81000|EAP|0307|URINE AUTO W/MICRO|Veterans Affairs|VETERANS ADMINISTRATION|111.60||||111.60||| 81000|EAP|0307|URINE AUTO W/MICRO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||111.60||| 81000|EAP|0307|URINE AUTO W/MICRO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.27||| 81001|EAP|0307||United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.90||||0.90||| 81001|EAP|0307||Veterans Affairs|VETERANS ADMINISTRATION|111.60||||||| 81001|EAP|0307||Veterans Affairs|VETERANS ADMINISTRATION|||||111.60||| 81001|EAP|0307||United Medicare Advantage|UHC MEDICARE GOLD MA|100.80||||0.90||| 81001|EAP|0307||Workers Compensation|WORKERS COMPENSATION OTHER|111.60||||||| 81001|EAP|0307||United Medicare Advantage|AARP UHC WEST COMPLETE MA|111.60||||0.90||| 81001|EAP|0307||Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.90||||0.90||| 81001|EAP|0307||Medicare|MEDICARE ACUTE|111.60||||0.90||| 81001|EAP|0307||United Healthcare|TML GROUP BENEFITS|0.90||||||| 81001|EAP|0307||Managed Medicaid|MEDICAID SUPERIOR|0.90||||0.90||| 81001|EAP|0307||Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.90||| 81001|EAP|0307||Medicaid|MEDICAID HMO|||||111.60||| 81001|EAP|0307||Medicaid|MEDICAID|111.60||||100.80||| 81001|EAP|0307||Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|100.80||||0.90||| 81001|EAP|0307||Managed Medicaid|MEDICAID AMERIGROUP|111.60||||111.60||| 81001|EAP|0307||NON CONTRACTED|COMMERCIAL OTHER 1|0.90||||0.90||| 81001|EAP|0307||Tricare|TRICARE EAST REGION|111.60||||||| 81001|EAP|0307||Medicaid|MEDICAID TEXAS CHILDRENS|||||0.90||| 81001|EAP|0307||Medicare|MEDICARE PART B ONLY IP|111.60||||||| 81001|EAP|0307||Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.90||||0.90||| 81001|EAP|0307||Managed Medicare|HEALTHSPRING MA|||||111.60||| 81001|EAP|0307||United Healthcare|UNITED HEALTHCARE OTHER|||||0.90||| 81001|EAP|0307||United Healthcare|UNITED HEALTHCARE|111.60||||||| 81001|EAP|0307||United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|0.90||||0.90||| 81001|EAP|0307||United Healthcare|UMR UNITED MEDICAL RESOURCES|||||111.60||| 81001|EAP|0307||Managed Medicare|BCBS MEDICARE PPO MA|||||100.80||| 81001|EAP|0307||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|111.60||||||| 81001|EAP|0307||Blue Cross PPO Specialty|BCBSTX OTHER|111.60||||||| 81001|EAP|0307||Blue Cross PPO Specialty|BCBSTX PPO|111.60||||0.27||| 81001|EAP|0307||Aetna|AETNA PPO|111.60||||||| 81001|EAP|0307||Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.90||||0.27||| 81001|EAP|0307||Cigna|CIGNA|111.60||||0.27||| 81001|EAP|0307||Blue Cross HMO Specialty|BCBSTX HMO|111.60||||58.50||| 81001|EAP|0307||Access Direct Platinum|HEALTHFIRST TPA OTHER 1|111.60||||||| 81001|EAP|0307||Access Direct Platinum|HEALTHFIRST TPA UMR|0.90||||||| 81001|EAP|0307||Humana Medicare Advantage|HUMANA MA|0.90||||111.60||| 81001|EAP|0307||Aenta Medicare Advantage|AETNA MEDICARE MA|111.60||||111.60||| 81001|EAP|0307||Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.90||||||| 81002|EAP|0300|URNIALYSIS - DIPSTICK|Blue Cross PPO Specialty|BCBSTX PPO|||||0.30||| 81002|EAP|0307|PROTEIN, URINE QUALITATIV|ChampVA|CHAMPVA CENTER|||||24.75||| 81002|EAP|0307|PROTEIN, URINE QUALITATIV|Blue Cross PPO Specialty|BCBSTX PPO|101.99||||24.75||| 81002|EAP|0307|PROTEIN, URINE QUALITATIV|Humana Medicare Advantage|HUMANA MA|||||82.25||| 81002|EAP|0307|PROTEIN, URINE QUALITATIV|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|82.25||||||| 81002|EAP|0300|URNIALYSIS - DIPSTICK|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.30||| 81002|EAP|0300|URNIALYSIS - DIPSTICK|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.30||| 81002|EAP|0307|PROTEIN, URINE QUALITATIV|Medicare|MEDICARE ACUTE|101.99||||24.75||| 81002|EAP|0300|URNIALYSIS - DIPSTICK|Medicaid|MEDICAID|||||0.30||| 81002|EAP|0300|URNIALYSIS - DIPSTICK|Managed Medicare|HEALTHSPRING MA|||||0.30||| 81002|EAP|0307|PROTEIN, URINE QUALITATIV|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|101.99||||||| 81002|EAP|0307|PROTEIN, URINE QUALITATIV|Medicaid|MEDICAID|101.99||||||| 81002|EAP|0307|PROTEIN, URINE QUALITATIV|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||24.75||| 81002|EAP|0307|PROTEIN, URINE QUALITATIV|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||24.75||| 81002|EAP|0307|PROTEIN, URINE QUALITATIV|United Healthcare|UNITED HEALTHCARE|||||24.75||| 81002|EAP|0300|URNIALYSIS - DIPSTICK|Medicare|MEDICARE ACUTE|||||0.30||| 81002|EAP|0307|PROTEIN, URINE QUALITATIV|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||24.75||| 81002|EAP|0300|URNIALYSIS - DIPSTICK|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.30||| 81002|EAP|0300|URNIALYSIS - DIPSTICK|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.30||| 81002|EAP|0307|PROTEIN, URINE QUALITATIV|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||24.75||| 81002|EAP|0307|PROTEIN, URINE QUALITATIV|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|101.99||||24.75||| 81002|EAP|0307|PROTEIN, URINE QUALITATIV|United Medicare Advantage|UHC MEDICARE GOLD MA|||||24.75||| 81002|EAP|0300|URNIALYSIS - DIPSTICK|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.30||| 81015|EAP|0307|URINE MICRO ONLY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||29.25||| 81015|EAP|0307|URINE MICRO ONLY|Medicare|MEDICARE ACUTE|||||29.25||| 81025|EAP|0300|URINE PREGNANCY|Blue Cross PPO Specialty|BCBSTX PPO|1.72||||1.72||| 81025|EAP|0300|URINE PREGNANCY|Aetna|AETNA PPO|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|Managed Medicaid|MEDICAID AMERIGROUP|1.72||||1.72||| 81025|EAP|0300|URINE PREGNANCY|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|Cigna|CIGNA|1.72||||1.72||| 81025|EAP|0300|URINE PREGNANCY|Aetna|AETNA OTHER|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|Humana Medicare Advantage|HUMANA MA|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|Blue Cross HMO Specialty|BCBSTX HMO|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|Managed Medicaid|MEDICAID SUPERIOR|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|United Healthcare|UNITED HEALTHCARE OTHER|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|United Healthcare|TML GROUP BENEFITS|1.72||||||| 81025|EAP|0300|URINE PREGNANCY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|Medicaid|MEDICAID|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|Medicaid|WOOD COUNTY INDIGENT|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|Medicaid|MEDICAID HMO|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|United Healthcare|UNITED HEALTHCARE|||||1.72||| 81025|EAP|0300|PREGNANCY TEST, URINE|Medicare|MEDICARE ACUTE|||||0.59||| 81025|EAP|0300|URINE PREGNANCY|Medicare|MEDICARE ACUTE|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|Veterans Affairs|VETERANS ADMINISTRATION|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.72||| 81025|EAP|0300|URINE PREGNANCY|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.72||| 811|DRG||RED BLOOD CELL DISORDERS W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|14,573.15|16.5|16.5|16.5|||| 812|DRG||RED BLOOD CELL DISORDERS W/O MCC|Medicare|MEDICARE ACUTE|13,677.55|49.5|49.5|49.5|||| 81240|EAP|0300|F2 GENE|Blue Cross HMO Specialty|BCBSTX HMO|||||4.05||| 81241|EAP|0300|FACTOR V LEIDEN|Medicaid|MEDICAID|||||38.75||| 81241|EAP|0300|FACTOR V LEIDEN|Blue Cross HMO Specialty|BCBSTX HMO|||||38.75||| 81241|EAP|0300|FACTOR V LEIDEN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||38.75||| 81291|EAP|0300|MTHFR GENE|Blue Cross HMO Specialty|BCBSTX HMO|||||3.59||| 813|DRG||COAGULATION DISORDERS|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|47,775.55|129.62|3261.28|129.62|||| 813|DRG||COAGULATION DISORDERS|Medicare|MEDICARE ACUTE|12,441.50|3261.28|3261.28|129.62|||| 815|DRG||RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC|Humana Medicare Advantage|HUMANA MA|22,919.05|4872.6|4872.6|4872.6|||| 82|DRG||TRAUMATIC STUPOR & COMA, COMA >1 HR W MCC|Managed Medicare|OTHER INSTITUTIONS|18,937.42|9730.16|9730.16|9730.16|||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|Veterans Affairs|VETERANS ADMINISTRATION|1.40||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|Veterans Affairs|VETERANS ADMINISTRATION|1.40||||||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|Humana Medicare Advantage|HUMANA MA|||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|Blue Cross PPO Specialty|BCBSTX PPO|1.40||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|Aetna|AETNA PPO|||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|Cigna|CIGNA|||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|Blue Cross HMO Specialty|BCBSTX HMO|1.40||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.40||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|Managed Medicaid|MEDICAID SUPERIOR|||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|Access Direct Platinum|HEALTHFIRST TPA UMR|1.40||||||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.40||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|Workers Compensation|WORKERS COMPENSATION OTHER|1.40||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|Managed Medicaid|MEDICAID AMERIGROUP|||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|Medicare|MEDICARE PART B ONLY IP|1.40||||||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|Tricare|TRICARE EAST REGION|||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|United Healthcare|UNITED HEALTHCARE|||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|United Healthcare|UNITED HEALTHCARE OTHER|||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|Medicaid|MEDICAID|||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|Medicaid|WOOD COUNTY INDIGENT|||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|NON CONTRACTED|COMMERCIAL OTHER 1|1.40||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|United Healthcare|UNITED HEALTHCARE|1.40||||||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.40||| 82009|EAP|0301|ACETONE SERUM QUALITATIVE|Medicare|MEDICARE ACUTE|1.40||||1.40||| 82040|EAP|0301|ALBUMIN, SERUM|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||47.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|United Medicare Advantage|UHC MEDICARE GOLD MA|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Blue Cross PPO Specialty|BCBSTX PPO|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Blue Cross PPO Specialty|BCBSTX OTHER|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Aetna|AETNA QHP HMO|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Aetna|AETNA OTHER|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|178.75||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Cigna|CIGNA|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Humana Medicare Advantage|HUMANA MA|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Aenta Medicare Advantage|AETNA MEDICARE MA|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|ChampVA|CHAMPVA CENTER|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Aetna|AETNA PPO|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Managed Medicaid|MEDICAID AMERIGROUP|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Blue Cross HMO Specialty|BCBSTX HMO|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Managed Medicaid|MEDICAID SUPERIOR|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Blue Cross PPO Specialty|BLUE SHIELD PHYSICIAN|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Medicare|MEDICARE ACUTE|178.75||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|United Healthcare|UNITED HEALTHCARE ERS|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|NON CONTRACTED|COMMERCIAL OTHER 1|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Medicaid|MEDICAID|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Managed Medicare|HEALTHSPRING MA|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Managed Medicare|BCBS MEDICARE PPO MA|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|Tricare|TRICARE EAST REGION|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|United Healthcare|UNITED HEALTHCARE OTHER|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|United Healthcare|TML GROUP BENEFITS|||||53.75||| 82043|EAP|0301|MICROALBUMINURIA URINE QU|United Healthcare|UNITED HEALTHCARE|||||53.75||| 82085|EAP|0300|ALDOLASE|Medicare|MEDICARE ACUTE|||||93.50||| 82085|EAP|0300|ALDOLASE|United Healthcare|UNITED HEALTHCARE|311.75||||||| 82085|EAP|0300|ALDOLASE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||93.50||| 82088|EAP|0301|ALDOSTERONE, SERUM|United Medicare Advantage|UHC MEDICARE GOLD MA|||||392.75||| 82088|EAP|0301|ALDOSTERONE, SERUM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|11.21||||||| 82088|EAP|0301|ALDOSTERONE, SERUM|Medicare|MEDICARE ACUTE|||||392.75||| 82103|EAP|0301|ALPHA 1 ANTITRYPSIN TOTAL|United Healthcare|UNITED HEALTHCARE OTHER|||||129.50||| 82103|EAP|0301|ALPHA 1 ANTITRYPSIN TOTAL|Blue Cross PPO Specialty|BCBSTX PPO|||||129.50||| 82103|EAP|0301|ALPHA 1 ANTITRYPSIN TOTAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||129.50||| 82103|EAP|0301|ALPHA 1 ANTITRYPSIN TOTAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||129.50||| 82105|EAP|0301|ALPHA FETOPROTEIN, SERUM|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||161.75||| 82105|EAP|0301|ALPHA FETOPROTEIN, SERUM|United Medicare Advantage|UHC MEDICARE GOLD MA|||||161.75||| 82105|EAP|0301|ALPHA FETOPROTEIN, SERUM|Medicare|MEDICARE ACUTE|||||161.75||| 82105|EAP|0301|ALPHA FETOPROTEIN, SERUM|Medicaid|MEDICAID|||||161.75||| 82140|EAP|0301|AMMONIA, BLOOD|Blue Cross PPO Specialty|BCBSTX PPO|||||468.25||| 82140|EAP|0301|AMMONIA, BLOOD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|468.25||||468.25||| 82140|EAP|0301|AMMONIA, BLOOD|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|468.25||||140.50||| 82140|EAP|0301|AMMONIA, BLOOD|Humana Medicare Advantage|HUMANA MA|468.25||||468.25||| 82140|EAP|0301|AMMONIA, BLOOD|Aenta Medicare Advantage|AETNA MEDICARE MA|||||468.25||| 82140|EAP|0301|AMMONIA, BLOOD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|468.25||||140.50||| 82140|EAP|0301|AMMONIA, BLOOD|NON CONTRACTED|COMMERCIAL OTHER 1|468.25||||468.25||| 82140|EAP|0301|AMMONIA, BLOOD|Medicare|MEDICARE ACUTE|468.25||||468.25||| 82140|EAP|0301|AMMONIA, BLOOD|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|468.25||||||| 82140|EAP|0301|AMMONIA, BLOOD|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||468.25||| 82140|EAP|0301|AMMONIA, BLOOD|Managed Medicare|HEALTHSPRING MA|468.25||||468.25||| 82140|EAP|0301|AMMONIA, BLOOD|Managed Medicare|BCBS MEDICARE PPO MA|468.25||||||| 82140|EAP|0301|AMMONIA, BLOOD|United Healthcare|UNITED HEALTHCARE|||||468.25||| 82140|EAP|0301|AMMONIA, BLOOD|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||140.50||| 82140|EAP|0301|AMMONIA, BLOOD|United Medicare Advantage|UHC MEDICARE GOLD MA|468.25||||468.25||| 82140|EAP|0301|AMMONIA, BLOOD|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||468.25||| 82140|EAP|0301|AMMONIA, BLOOD|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||140.50||| 82140|EAP|0301|AMMONIA, BLOOD|Veterans Affairs|VETERANS ADMINISTRATION|468.25||||||| 82140|EAP|0301|AMMONIA, BLOOD|Veterans Affairs|VETERANS ADMINISTRATION|468.25||||468.25||| 82150|EAP|0301|AMYLASE, SERUM|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Veterans Affairs|VETERANS ADMINISTRATION|2.08||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Veterans Affairs|VETERANS ADMINISTRATION|||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Medicare|MEDICARE ACUTE|2.08||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|NON CONTRACTED|COMMERCIAL OTHER 1|2.08||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Tricare|TRICARE EAST REGION|2.08||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Medicaid|MEDICAID|2.08||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Managed Medicare|HEALTHSPRING MA|||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Managed Medicare|BCBS MEDICARE PPO MA|||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Tricare|TRICARE FOR LIFE|||||62.50||| 82150|EAP|0301|AMYLASE, SERUM|United Healthcare|UMR UNITED MEDICAL RESOURCES|2.08||||135.25||| 82150|EAP|0301|AMYLASE, SERUM|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|United Healthcare|UNITED HEALTHCARE|||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|United Healthcare|GEHA|||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|United Healthcare|UNITED HEALTHCARE ERS|||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|United Healthcare|TML GROUP BENEFITS|||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Medicaid|MEDICAID HMO|||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|United Healthcare|UNITED HEALTHCARE OTHER|||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.08||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Blue Cross PPO Specialty|BCBSTX PPO|2.08||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Blue Cross PPO Specialty|BCBSTX OTHER|2.08||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Cigna|CIGNA|2.08||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.08||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.08||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.08||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Humana Medicare Advantage|HUMANA MA|2.08||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.08||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Aetna|AETNA QHP HMO|||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Blue Cross HMO Specialty|BCBSTX HMO|2.08||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Aetna|AETNA PPO|2.08||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Managed Medicaid|MEDICAID SUPERIOR|2.08||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.08||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Managed Medicaid|MEDICAID AMERIGROUP|2.08||||2.08||| 82150|EAP|0301|AMYLASE, SERUM|Aetna|AETNA OTHER|||||2.08||| 82164|EAP|0301|ANGIOTENSIN CONVERTING|Medicare|MEDICARE ACUTE|||||140.75||| 82164|EAP|0301|ANGIOTENSIN CONVERTING|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||140.75||| 82175|EAP|0300|ARSENIC LEVEL|Blue Cross PPO Specialty|BCBSTX PPO|||||1.83||| 82175|EAP|0300|ARSENIC LEVEL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.83||| 82175|EAP|0300|ARSENIC LEVEL|Medicare|MEDICARE ACUTE|||||1.83||| 82247|EAP|0301|BILIRUBIN, TOTAL|Medicare|MEDICARE ACUTE|161.25||||||| 82247|EAP|0301|BILIRUBIN, TOTAL|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||48.50||| 82247|EAP|0301|BILIRUBIN, TOTAL|Managed Medicaid|MEDICAID SUPERIOR|||||48.50||| 82248|EAP|0301|BILIRUBIN, DIRECT|Medicare|MEDICARE ACUTE|161.25||||||| 82248|EAP|0301|BILIRUBIN, DIRECT|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||48.50||| 82248|EAP|0301|BILIRUBIN, DIRECT|Tricare|TRICARE FOR LIFE|||||48.50||| 82270|EAP|0301|OCCULT BLOOD FECES 1-3 DE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||104.50||| 82270|EAP|0301|OCCULT BLOOD FECES 1-3 DE|United Medicare Advantage|UHC MEDICARE GOLD MA|104.50||||104.50||| 82270|EAP|0301|OCCULT BLOOD FECES 1-3 DE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|104.50||||104.50||| 82270|EAP|0301|OCCULT BLOOD FECES 1-3 DE|Veterans Affairs|VETERANS ADMINISTRATION|||||104.50||| 82270|EAP|0301|OCCULT BLOOD FECES 1-3 DE|Blue Cross PPO Specialty|BCBSTX OTHER|||||104.50||| 82270|EAP|0301|OCCULT BLOOD FECES 1-3 DE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.68||| 82270|EAP|0301|OCCULT BLOOD FECES 1-3 DE|Humana Medicare Advantage|HUMANA MA|104.50||||104.50||| 82270|EAP|0301|OCCULT BLOOD FECES 1-3 DE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|104.50||||104.50||| 82270|EAP|0301|OCCULT BLOOD FECES 1-3 DE|Aenta Medicare Advantage|AETNA MEDICARE MA|104.50||||104.50||| 82270|EAP|0301|OCCULT BLOOD FECES 1-3 DE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|104.50||||104.50||| 82270|EAP|0301|OCCULT BLOOD FECES 1-3 DE|Blue Cross HMO Specialty|BCBSTX HMO|104.50||||104.50||| 82270|EAP|0301|OCCULT BLOOD FECES 1-3 DE|Cigna|CIGNA|||||0.68||| 82270|EAP|0301|OCCULT BLOOD FECES 1-3 DE|Managed Medicaid|MEDICAID SUPERIOR|||||104.50||| 82270|EAP|0301|OCCULT BLOOD FECES 1-3 DE|Managed Medicaid|MEDICAID AMERIGROUP|||||104.50||| 82270|EAP|0301|OCCULT BLOOD FECES 1-3 DE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|104.50||||104.50||| 82270|EAP|0301|OCCULT BLOOD FECES 1-3 DE|Blue Cross PPO Specialty|BCBSTX PPO|104.50||||104.50||| 82270|EAP|0301|OCCULT BLOOD FECES 1-3 DE|Medicare|MEDICARE ACUTE|104.50||||104.50||| 82270|EAP|0301|OCCULT BLOOD FECES 1-3 DE|Medicaid|MEDICAID|104.50||||104.50||| 82270|EAP|0300|HEMOCCULT PER SLIDE|Medicare|MEDICARE ACUTE|||||104.50||| 82270|EAP|0301|OCCULT BLOOD FECES 1-3 DE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.68||| 82270|EAP|0301|OCCULT BLOOD FECES 1-3 DE|Managed Medicare|HEALTHSPRING MA|||||104.50||| 82270|EAP|0301|OCCULT BLOOD FECES 1-3 DE|Tricare|TRICARE EAST REGION|||||31.50||| 82270|EAP|0301|OCCULT BLOOD FECES 1-3 DE|United Healthcare|UNITED HEALTHCARE|||||31.50||| 82270|EAP|0301|OCCULT BLOOD FECES 1-3 DE|United Healthcare|UMR UNITED MEDICAL RESOURCES|104.50||||||| 82270|EAP|0301|OCCULT BLOOD FECES 1-3 DE|NON CONTRACTED|COMMERCIAL OTHER 1|104.50||||104.50||| 82270|EAP|0301|OCCULT BLOOD FECES 1-3 DE|United Healthcare|UNITED HEALTHCARE|||||104.50||| 82271|EAP|0301|OCCULT BLOOD, OTHER SOURC|Medicare|MEDICARE ACUTE|104.50||||104.50||| 82271|EAP|0301|OCCULT BLOOD, OTHER SOURC|Humana Medicare Advantage|HUMANA MA|104.50||||104.50||| 82271|EAP|0301|OCCULT BLOOD, OTHER SOURC|Blue Cross PPO Specialty|BCBSTX PPO|||||104.50||| 82271|EAP|0301|OCCULT BLOOD, OTHER SOURC|Managed Medicaid|MEDICAID SUPERIOR|||||104.50||| 82271|EAP|0301|OCCULT BLOOD, OTHER SOURC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||104.50||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|United Medicare Advantage|UHC MEDICARE GOLD MA|872.75||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Managed Medicaid|MEDICAID AMERIGROUP|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Blue Cross PPO Specialty|BCBSTX PPO|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Aetna|AETNA QHP HMO|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|ChampVA|CHAMPVA CENTER|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Cigna|CIGNA|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Humana Medicare Advantage|HUMANA MA|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Blue Cross HMO Specialty|BCBSTX HMO|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Aetna|AETNA PPO|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|872.75||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Managed Medicaid|MEDICAID SUPERIOR|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Medicare|MEDICARE ACUTE|872.75||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Managed Medicare|BCBS MEDICARE PPO MA|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Tricare|TRICARE EAST REGION|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Medicaid|MEDICAID|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|United Healthcare|UNITED HEALTHCARE OTHER|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|Managed Medicare|HEALTHSPRING MA|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|United Healthcare|UNITED HEALTHCARE|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|United Healthcare|UNITED HEALTHCARE ERS|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|United Healthcare|GEHA|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.62||| 82306|EAP|0301|25-HYDROX VITAMIN D FROZE|United Healthcare|TML GROUP BENEFITS|||||2.62||| 82310|EAP|0301|CALCIUM, BLOOD|Medicare|MEDICARE ACUTE|||||107.75||| 82310|EAP|0301|CALCIUM, BLOOD|Humana Medicare Advantage|HUMANA MA|||||165.75||| 82310|EAP|0301|CALCIUM, BLOOD|Blue Cross PPO Specialty|BCBSTX PPO|||||165.75||| 82330|EAP|0300|IONIZED CALCIUM|United Medicare Advantage|UHC MEDICARE GOLD MA|||||131.75||| 82330|EAP|0300|IONIZED CALCIUM|Humana Medicare Advantage|HUMANA MA|||||4.39||| 82330|EAP|0300|IONIZED CALCIUM|Medicare|MEDICARE ACUTE|4.39||||||| 82340|EAP|0300|URINE CALCIUM|Medicare|MEDICARE ACUTE|193.75||||||| 82375|EAP|0301|CARBOXYHEMOGLOBIN QUANT|United Healthcare|UNITED HEALTHCARE OTHER|||||3.96||| 82375|EAP|0301|CARBOXYHEMOGLOBIN QUANT|United Healthcare|UNITED HEALTHCARE|||||3.96||| 82378|EAP|0301|CEA|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.83||| 82378|EAP|0301|CEA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||396.25||| 82378|EAP|0301|CEA|Blue Cross PPO Specialty|BCBSTX PPO|||||1.83||| 82378|EAP|0301|CEA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.83||| 82378|EAP|0301|CEA|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.83||| 82378|EAP|0301|CEA|Humana Medicare Advantage|HUMANA MA|609.50||||||| 82378|EAP|0301|CEA|Medicare|MEDICARE ACUTE|609.50||||1.83||| 82378|EAP|0301|CEA|NON CONTRACTED|COMMERCIAL OTHER 1|609.50||||||| 82378|EAP|0301|CEA|United Healthcare|UMR UNITED MEDICAL RESOURCES|609.50||||||| 82384|EAP|0301|CATECHOLAMINES, URINE FRA|Blue Cross PPO Specialty|BCBSTX PPO|||||243.50||| 82390|EAP|0301|CERULOPLASMIN (SERUM)|Blue Cross PPO Specialty|BCBSTX PPO|||||103.50||| 82390|EAP|0301|CERULOPLASMIN (SERUM)|Aenta Medicare Advantage|AETNA MEDICARE MA|||||103.50||| 82390|EAP|0301|CERULOPLASMIN (SERUM)|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||103.50||| 82397|EAP|0300|CHEMILUMINESCENT ASSAY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||136.25||| 82397|EAP|0300|CHEMILUMINESCENT ASSAY|Managed Medicaid|MEDICAID SUPERIOR|||||136.25||| 82436|EAP|0301|CHLORIDE URINE|Medicare|MEDICARE ACUTE|||||161.50||| 82436|EAP|0301|CHLORIDE URINE|United Medicare Advantage|UHC MEDICARE GOLD MA|161.50||||||| 82436|EAP|0301|CHLORIDE URINE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|161.50||||||| 82465|EAP|0301|CHOLESTEROL, SERUM|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.40||||||| 82465|EAP|0301|CHOLESTEROL, SERUM|Medicare|MEDICARE ACUTE|1.40||||||| 82525|EAP|0300|COPPER|Medicare|MEDICARE ACUTE|||||106.50||| 82530|EAP|0301|CORTISOL FREE URINE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||161.25||| 82533|EAP|0301|CORTISOL TOTAL SERUM|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||157.25||| 82533|EAP|0301|CORTISOL TOTAL SERUM|Medicare|MEDICARE ACUTE|523.75||||157.25||| 82533|EAP|0301|CORTISOL TOTAL SERUM|Medicaid|MEDICAID|||||157.25||| 82533|EAP|0301|CORTISOL TOTAL SERUM|United Medicare Advantage|UHC MEDICARE GOLD MA|||||157.25||| 82533|EAP|0301|CORTISOL TOTAL SERUM|NON CONTRACTED|COMMERCIAL OTHER 1|||||157.25||| 82533|EAP|0301|CORTISOL TOTAL SERUM|United Healthcare|UNITED HEALTHCARE|||||157.25||| 82533|EAP|0301|CORTISOL TOTAL SERUM|United Healthcare|UNITED HEALTHCARE OTHER|||||157.25||| 82533|EAP|0301|CORTISOL TOTAL SERUM|Blue Cross PPO Specialty|BCBSTX PPO|||||157.25||| 82533|EAP|0301|CORTISOL TOTAL SERUM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||157.25||| 82533|EAP|0301|CORTISOL TOTAL SERUM|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||157.25||| 82533|EAP|0301|CORTISOL TOTAL SERUM|Humana Medicare Advantage|HUMANA MA|523.75||||523.75||| 82533|EAP|0301|CORTISOL TOTAL SERUM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||157.25||| 82533|EAP|0301|CORTISOL TOTAL SERUM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|523.75||||157.25||| 82533|EAP|0301|CORTISOL TOTAL SERUM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|523.75||||157.25||| 82550|EAP|0301|CPK TOTAL|Aetna|AETNA QHP HMO|||||209.25||| 82550|EAP|0301|CPK TOTAL|Managed Medicaid|MEDICAID SUPERIOR|||||209.25||| 82550|EAP|0301|CPK TOTAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|209.25||||209.25||| 82550|EAP|0301|CPK TOTAL|Managed Medicaid|MEDICAID AMERIGROUP|209.25||||209.25||| 82550|EAP|0301|CPK TOTAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|209.25||||209.25||| 82550|EAP|0301|CPK TOTAL|Medicare|MEDICARE PART B ONLY IP|209.25||||||| 82550|EAP|0301|CPK TOTAL|Medicare|MEDICARE ACUTE|209.25||||209.25||| 82550|EAP|0301|CPK TOTAL|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||209.25||| 82550|EAP|0301|CPK TOTAL|Aetna|AETNA PPO|209.25||||209.25||| 82550|EAP|0301|CPK TOTAL|Medicaid|MEDICAID|209.25||||209.25||| 82550|EAP|0301|CPK TOTAL|NON CONTRACTED|COMMERCIAL OTHER 1|209.25||||209.25||| 82550|EAP|0301|CPK TOTAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|209.25||||209.25||| 82550|EAP|0301|CPK TOTAL|Managed Medicare|HEALTHSPRING MA|209.25||||209.25||| 82550|EAP|0301|CPK TOTAL|United Healthcare|UNITED HEALTHCARE OTHER|||||209.25||| 82550|EAP|0301|CPK TOTAL|United Healthcare|UNITED HEALTHCARE|209.25||||209.25||| 82550|EAP|0301|CPK TOTAL|Aenta Medicare Advantage|AETNA MEDICARE MA|209.25||||209.25||| 82550|EAP|0301|CPK TOTAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||209.25||| 82550|EAP|0301|CPK TOTAL|United Healthcare|UNITED HEALTHCARE|||||209.25||| 82550|EAP|0301|CPK TOTAL|United Medicare Advantage|UHC MEDICARE GOLD MA|209.25||||209.25||| 82550|EAP|0301|CPK TOTAL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|209.25||||209.25||| 82550|EAP|0301|CPK TOTAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|209.25||||209.25||| 82550|EAP|0301|CPK TOTAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|209.25||||209.25||| 82550|EAP|0301|CPK TOTAL|Veterans Affairs|VETERANS ADMINISTRATION|209.25||||209.25||| 82550|EAP|0301|CPK TOTAL|Workers Compensation|WORKERS COMPENSATION OTHER|||||209.25||| 82550|EAP|0301|CPK TOTAL|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|62.75||||209.25||| 82550|EAP|0301|CPK TOTAL|Aetna|AETNA OTHER|209.25||||209.25||| 82550|EAP|0301|CPK TOTAL|Blue Cross HMO Specialty|BCBSTX HMO|209.25||||||| 82550|EAP|0301|CPK TOTAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||209.25||| 82550|EAP|0301|CPK TOTAL|Humana Medicare Advantage|HUMANA MA|209.25||||209.25||| 82550|EAP|0301|CPK TOTAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||209.25||| 82550|EAP|0301|CPK TOTAL|Cigna|CIGNA|209.25||||209.25||| 82550|EAP|0301|CPK TOTAL|Blue Cross PPO Specialty|BCBSTX PPO|209.25||||209.25||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|United Healthcare|UNITED HEALTHCARE|||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|Aetna|AETNA PPO|197.50||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|Aenta Medicare Advantage|AETNA MEDICARE MA|197.50||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|Managed Medicare|HEALTHSPRING MA|197.50||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|197.50||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|Medicare|MEDICARE PART B ONLY IP|197.50||||||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|59.25||||128.38||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|United Healthcare|UNITED HEALTHCARE|197.50||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|Cigna|CIGNA|||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|Aetna|AETNA OTHER|197.50||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|Aetna|AETNA QHP HMO|||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|Blue Cross PPO Specialty|BCBSTX PPO|197.50||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|197.50||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|United Healthcare|UNITED HEALTHCARE OTHER|||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|Medicaid|MEDICAID|197.50||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|Veterans Affairs|VETERANS ADMINISTRATION|||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|Medicare|MEDICARE ACUTE|197.50||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|Managed Medicaid|MEDICAID AMERIGROUP|||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|Blue Cross HMO Specialty|BCBSTX HMO|197.50||||||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|197.50||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|NON CONTRACTED|COMMERCIAL OTHER 1|197.50||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|Humana Medicare Advantage|HUMANA MA|197.50||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|197.50||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|United Medicare Advantage|UHC MEDICARE GOLD MA|197.50||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|197.50||||197.50||| 82553|EAP|0301|CPK-ISOENZYME MB FRACT|Veterans Affairs|VETERANS ADMINISTRATION|197.50||||197.50||| 82565|EAP|0301|CREATININE, BLOOD|Tricare|TRICARE EAST REGION|||||1.07||| 82565|EAP|0301|CREATININE, BLOOD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||49.50||| 82565|EAP|0301|CREATININE, BLOOD|Medicare|MEDICARE ACUTE|164.50||||49.50||| 82565|EAP|0301|CREATININE, BLOOD|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||49.50||| 82565|EAP|0301|CREATININE, BLOOD|Managed Medicare|BCBS MEDICARE PPO MA|||||49.50||| 82565|EAP|0301|CREATININE, BLOOD|Blue Cross PPO Specialty|BCBSTX OTHER|||||49.50||| 82565|EAP|0301|CREATININE, BLOOD|Aetna|AETNA OTHER|||||49.50||| 82565|EAP|0301|CREATININE, BLOOD|Medicaid|MEDICAID|164.50||||49.50||| 82565|EAP|0301|CREATININE, BLOOD|Aenta Medicare Advantage|AETNA MEDICARE MA|||||49.50||| 82565|EAP|0301|CREATININE, BLOOD|Managed Medicaid|MEDICAID SUPERIOR|||||49.50||| 82565|EAP|0301|CREATININE, BLOOD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||49.50||| 82565|EAP|0301|CREATININE, BLOOD|United Healthcare|UNITED HEALTHCARE|||||49.50||| 82565|EAP|0301|CREATININE, BLOOD|Managed Medicaid|MEDICAID AMERIGROUP|164.50||||||| 82565|EAP|0301|CREATININE, BLOOD|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||49.50||| 82565|EAP|0301|CREATININE, BLOOD|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||49.50||| 82565|EAP|0301|CREATININE, BLOOD|NON CONTRACTED|COMMERCIAL OTHER 2|||||49.50||| 82565|EAP|0301|CREATININE, BLOOD|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||49.50||| 82565|EAP|0301|CREATININE, BLOOD|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|164.50||||1.07||| 82565|EAP|0301|CREATININE, BLOOD|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|164.50||||49.50||| 82565|EAP|0301|CREATININE, BLOOD|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||49.50||| 82565|EAP|0301|CREATININE, BLOOD|Humana Medicare Advantage|HUMANA MA|||||49.50||| 82565|EAP|0301|CREATININE, BLOOD|Aetna|AETNA PPO|||||49.50||| 82565|EAP|0301|CREATININE, BLOOD|Managed Medicare|HEALTHSPRING MA|||||49.50||| 82565|EAP|0301|CREATININE, BLOOD|Blue Cross PPO Specialty|BCBSTX PPO|||||49.50||| 82565|EAP|0301|CREATININE, BLOOD|Blue Cross HMO Specialty|BCBSTX HMO|||||49.50||| 82565|EAP|0301|CREATININE, BLOOD|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||49.50||| 82565|EAP|0301|CREATININE, BLOOD|NON CONTRACTED|COMMERCIAL OTHER 1|||||49.50||| 82565|EAP|0301|CREATININE, BLOOD|United Medicare Advantage|UHC MEDICARE GOLD MA|||||49.50||| 82565|EAP|0301|CREATININE, BLOOD|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||49.50||| 82570|EAP|0300|STONE RISK CREATININE|Medicaid|MEDICAID|166.25||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|Managed Medicare|HEALTHSPRING MA|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|United Healthcare|UNITED HEALTHCARE|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|166.25||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|Managed Medicare|BCBS MEDICARE PPO MA|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|166.25||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|Tricare|TRICARE EAST REGION|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|ChampVA|CHAMPVA CENTER|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|Aetna|AETNA QHP HMO|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|Managed Medicaid|MEDICAID AMERIGROUP|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|Blue Cross PPO Specialty|BCBSTX OTHER|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|United Healthcare|UNITED HEALTHCARE ERS|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|United Healthcare|UNITED HEALTHCARE OTHER|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|Blue Cross PPO Specialty|BCBSTX PPO|166.25||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|United Healthcare|TML GROUP BENEFITS|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|Humana Medicare Advantage|HUMANA MA|166.25||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|Aetna|AETNA PPO|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|Aenta Medicare Advantage|AETNA MEDICARE MA|166.25||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|Cigna|CIGNA|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|Blue Cross PPO Specialty|BLUE SHIELD PHYSICIAN|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|Medicare|MEDICARE ACUTE|166.25||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|Blue Cross HMO Specialty|BCBSTX HMO|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|Aetna|AETNA OTHER|||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|166.25||||0.50||| 82570|EAP|0300|STONE RISK CREATININE|Managed Medicaid|MEDICAID SUPERIOR|||||0.50||| 82575|EAP|0300|CREATININE CL (URINE/BODY|Medicare|MEDICARE ACUTE|||||0.91||| 82607|EAP|0301|VITAMIN B-12|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|484.25||||145.25||| 82607|EAP|0301|VITAMIN B-12|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||145.25||| 82607|EAP|0301|VITAMIN B-12|Humana Medicare Advantage|HUMANA MA|484.25||||484.25||| 82607|EAP|0301|VITAMIN B-12|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||145.25||| 82607|EAP|0301|VITAMIN B-12|Medicaid|MEDICAID|484.25||||145.25||| 82607|EAP|0301|VITAMIN B-12|Aenta Medicare Advantage|AETNA MEDICARE MA|484.25||||145.25||| 82607|EAP|0301|VITAMIN B-12|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||145.25||| 82607|EAP|0301|VITAMIN B-12|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||145.25||| 82607|EAP|0301|VITAMIN B-12|Medicare|MEDICARE ACUTE|484.25||||145.25||| 82607|EAP|0301|VITAMIN B-12|NON CONTRACTED|COMMERCIAL OTHER 1|484.25||||145.25||| 82607|EAP|0301|VITAMIN B-12|United Healthcare|UNITED HEALTHCARE|484.25||||145.25||| 82607|EAP|0301|VITAMIN B-12|Access Direct Platinum|HEALTHFIRST TPA UMR|||||145.25||| 82607|EAP|0301|VITAMIN B-12|Tricare|TRICARE EAST REGION|||||145.25||| 82607|EAP|0301|VITAMIN B-12|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|484.25||||145.25||| 82607|EAP|0301|VITAMIN B-12|United Healthcare|UNITED HEALTHCARE|||||145.25||| 82607|EAP|0301|VITAMIN B-12|Managed Medicaid|MEDICAID UNITED HEALTHCARE|484.25||||145.25||| 82607|EAP|0301|VITAMIN B-12|ChampVA|CHAMPVA CENTER|||||145.25||| 82607|EAP|0301|VITAMIN B-12|United Healthcare|UNITED HEALTHCARE OTHER|||||145.25||| 82607|EAP|0301|VITAMIN B-12|PHCS|GREAT WEST LIFE AND ANNUITY|||||145.25||| 82607|EAP|0301|VITAMIN B-12|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||145.25||| 82607|EAP|0301|VITAMIN B-12|United Medicare Advantage|UHC MEDICARE GOLD MA|484.25||||145.25||| 82607|EAP|0301|VITAMIN B-12|Managed Medicare|HEALTHSPRING MA|||||145.25||| 82607|EAP|0301|VITAMIN B-12|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|484.25||||145.25||| 82607|EAP|0301|VITAMIN B-12|Blue Cross PPO Specialty|BCBSTX OTHER|484.25||||145.25||| 82607|EAP|0301|VITAMIN B-12|Aetna|AETNA PPO|||||145.25||| 82607|EAP|0301|VITAMIN B-12|Cigna|CIGNA|||||145.25||| 82607|EAP|0301|VITAMIN B-12|United Medicare Advantage|AARP UHC WEST COMPLETE MA|484.25||||145.25||| 82607|EAP|0301|VITAMIN B-12|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||145.25||| 82607|EAP|0301|VITAMIN B-12|Managed Medicaid|MEDICAID AMERIGROUP|||||145.25||| 82607|EAP|0301|VITAMIN B-12|Managed Medicaid|MEDICAID SUPERIOR|||||145.25||| 82607|EAP|0301|VITAMIN B-12|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|484.25||||145.25||| 82607|EAP|0301|VITAMIN B-12|Blue Cross HMO Specialty|BCBSTX HMO|484.25||||145.25||| 82607|EAP|0301|VITAMIN B-12|Blue Cross PPO Specialty|BCBSTX PPO|||||145.25||| 82626|EAP|0300|DHEA (DEHYDROEPIANDROSTER|United Healthcare|UNITED HEALTHCARE|||||243.50||| 82626|EAP|0300|DHEA (DEHYDROEPIANDROSTER|United Medicare Advantage|UHC MEDICARE GOLD MA|||||243.50||| 82626|EAP|0300|DHEA (DEHYDROEPIANDROSTER|Blue Cross PPO Specialty|BCBSTX PPO|||||243.50||| 82626|EAP|0300|DHEA (DEHYDROEPIANDROSTER|Cigna|CIGNA|||||243.50||| 82626|EAP|0300|DHEA (DEHYDROEPIANDROSTER|NON CONTRACTED|COMMERCIAL OTHER 1|||||243.50||| 82626|EAP|0300|DHEA (DEHYDROEPIANDROSTER|Managed Medicaid|MEDICAID SUPERIOR|||||243.50||| 82626|EAP|0300|DHEA (DEHYDROEPIANDROSTER|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||243.50||| 82626|EAP|0300|DHEA (DEHYDROEPIANDROSTER|Medicare|MEDICARE ACUTE|||||243.50||| 82626|EAP|0300|DHEA (DEHYDROEPIANDROSTER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||243.50||| 82626|EAP|0300|DHEA (DEHYDROEPIANDROSTER|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||243.50||| 82626|EAP|0300|DHEA (DEHYDROEPIANDROSTER|Blue Cross HMO Specialty|BCBSTX HMO|||||243.50||| 82626|EAP|0300|DHEA (DEHYDROEPIANDROSTER|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||243.50||| 82627|EAP|0300|DEHYDROEPIANDROSTERONE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.82||| 82627|EAP|0300|DEHYDROEPIANDROSTERONE|Blue Cross PPO Specialty|BCBSTX PPO|||||1.82||| 82627|EAP|0300|DEHYDROEPIANDROSTERONE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.82||| 82652|EAP|0301|1.25 VITAMIN D DIHYDROXY|United Medicare Advantage|UHC MEDICARE GOLD MA|1,113.75||||||| 82652|EAP|0301|1.25 VITAMIN D DIHYDROXY|Humana Medicare Advantage|HUMANA MA|||||3.71||| 82652|EAP|0301|1.25 VITAMIN D DIHYDROXY|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3.71||| 82652|EAP|0301|1.25 VITAMIN D DIHYDROXY|Medicare|MEDICARE ACUTE|1,113.75||||3.71||| 82652|EAP|0301|1.25 VITAMIN D DIHYDROXY|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3.71||| 82652|EAP|0301|1.25 VITAMIN D DIHYDROXY|United Healthcare|UNITED HEALTHCARE|||||3.71||| 82652|EAP|0301|1.25 VITAMIN D DIHYDROXY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1,113.75||||3.71||| 82668|EAP|0301|ERYTHROPOIETIN SERUM|Access Direct Platinum|HEALTHFIRST TPA UMR|||||181.25||| 82670|EAP|0301|ESTRADIOL LEVEL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||269.25||| 82670|EAP|0301|ESTRADIOL LEVEL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||269.25||| 82670|EAP|0301|ESTRADIOL LEVEL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||269.25||| 82670|EAP|0301|ESTRADIOL LEVEL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||269.25||| 82670|EAP|0301|ESTRADIOL LEVEL|NON CONTRACTED|COMMERCIAL OTHER 1|||||269.25||| 82670|EAP|0301|ESTRADIOL LEVEL|Blue Cross PPO Specialty|BCBSTX OTHER|||||269.25||| 82670|EAP|0301|ESTRADIOL LEVEL|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||269.25||| 82670|EAP|0301|ESTRADIOL LEVEL|United Healthcare|UNITED HEALTHCARE OTHER|||||269.25||| 82670|EAP|0301|ESTRADIOL LEVEL|Humana Medicare Advantage|HUMANA MA|||||269.25||| 82670|EAP|0301|ESTRADIOL LEVEL|Medicaid|MEDICAID TEXAS CHILDRENS|||||269.25||| 82670|EAP|0301|ESTRADIOL LEVEL|Managed Medicaid|MEDICAID AMERIGROUP|||||269.25||| 82670|EAP|0301|ESTRADIOL LEVEL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||269.25||| 82670|EAP|0301|ESTRADIOL LEVEL|Blue Cross HMO Specialty|BCBSTX HMO|||||269.25||| 82670|EAP|0301|ESTRADIOL LEVEL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||269.25||| 82670|EAP|0301|ESTRADIOL LEVEL|Aetna|AETNA PPO|||||269.25||| 82670|EAP|0301|ESTRADIOL LEVEL|Blue Cross PPO Specialty|BCBSTX PPO|||||269.25||| 82670|EAP|0301|ESTRADIOL LEVEL|Cigna|CIGNA|||||269.25||| 82670|EAP|0301|ESTRADIOL LEVEL|Medicare|MEDICARE ACUTE|||||269.25||| 82670|EAP|0301|ESTRADIOL LEVEL|Managed Medicaid|MEDICAID SUPERIOR|||||269.25||| 82670|EAP|0301|ESTRADIOL LEVEL|Medicaid|MEDICAID|||||269.25||| 82670|EAP|0301|ESTRADIOL LEVEL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||269.25||| 82670|EAP|0301|ESTRADIOL LEVEL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||269.25||| 82670|EAP|0301|ESTRADIOL LEVEL|United Healthcare|UNITED HEALTHCARE|||||269.25||| 82670|EAP|0301|ESTRADIOL LEVEL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||269.25||| 82677|EAP|0300|ASSAY OF ESTRIOL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.99||| 82677|EAP|0300|ASSAY OF ESTRIOL|Medicare|MEDICARE ACUTE|||||1.99||| 82677|EAP|0300|ASSAY OF ESTRIOL|Blue Cross PPO Specialty|BCBSTX PPO|||||1.99||| 82705|EAP|0301|FECAL FAT, QUALITATIVE|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.49||| 82728|EAP|0301|FERRITIN (RIA)|Access Direct Platinum|HEALTHFIRST TPA UMR|||||131.25||| 82728|EAP|0301|FERRITIN (RIA)|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|437.50||||131.25||| 82728|EAP|0301|FERRITIN (RIA)|United Medicare Advantage|UHC MEDICARE GOLD MA|437.50||||131.25||| 82728|EAP|0301|FERRITIN (RIA)|Veterans Affairs|VETERANS ADMINISTRATION|||||437.50||| 82728|EAP|0301|FERRITIN (RIA)|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||437.50||| 82728|EAP|0301|FERRITIN (RIA)|Cigna|CIGNA|||||131.25||| 82728|EAP|0301|FERRITIN (RIA)|United Medicare Advantage|AARP UHC WEST COMPLETE MA|437.50||||131.25||| 82728|EAP|0301|FERRITIN (RIA)|Blue Cross HMO Specialty|BCBSTX HMO|||||131.25||| 82728|EAP|0301|FERRITIN (RIA)|Blue Cross PPO Specialty|BLUE SHIELD PHYSICIAN|||||131.25||| 82728|EAP|0301|FERRITIN (RIA)|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||131.25||| 82728|EAP|0301|FERRITIN (RIA)|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|437.50||||131.25||| 82728|EAP|0301|FERRITIN (RIA)|Blue Cross PPO Specialty|BCBSTX PPO|||||131.25||| 82728|EAP|0301|FERRITIN (RIA)|Managed Medicaid|MEDICAID UNITED HEALTHCARE|437.50||||131.25||| 82728|EAP|0301|FERRITIN (RIA)|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||437.50||| 82728|EAP|0301|FERRITIN (RIA)|Managed Medicare|HEALTHSPRING MA|||||131.25||| 82728|EAP|0301|FERRITIN (RIA)|Medicare|MEDICARE ACUTE|437.50||||131.25||| 82728|EAP|0301|FERRITIN (RIA)|Managed Medicaid|MEDICAID AMERIGROUP|437.50||||131.25||| 82728|EAP|0301|FERRITIN (RIA)|United Healthcare|TML GROUP BENEFITS|437.50||||||| 82728|EAP|0301|FERRITIN (RIA)|Aenta Medicare Advantage|AETNA MEDICARE MA|437.50||||131.25||| 82728|EAP|0301|FERRITIN (RIA)|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||131.25||| 82728|EAP|0301|FERRITIN (RIA)|Humana Medicare Advantage|HUMANA MA|437.50||||437.50||| 82728|EAP|0301|FERRITIN (RIA)|Managed Medicaid|MEDICAID SUPERIOR|||||131.25||| 82728|EAP|0301|FERRITIN (RIA)|Tricare|TRICARE EAST REGION|||||131.25||| 82728|EAP|0301|FERRITIN (RIA)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||131.25||| 82728|EAP|0301|FERRITIN (RIA)|United Healthcare|UNITED HEALTHCARE|||||284.38||| 82728|EAP|0301|FERRITIN (RIA)|Aetna|AETNA OTHER|||||437.50||| 82728|EAP|0301|FERRITIN (RIA)|United Healthcare|UNITED HEALTHCARE|||||131.25||| 82728|EAP|0301|FERRITIN (RIA)|NON CONTRACTED|COMMERCIAL OTHER 1|437.50||||131.25||| 82728|EAP|0301|FERRITIN (RIA)|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|437.50||||131.25||| 82728|EAP|0301|FERRITIN (RIA)|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||131.25||| 82728|EAP|0301|FERRITIN (RIA)|United Healthcare|UNITED HEALTHCARE OTHER|||||131.25||| 82728|EAP|0301|FERRITIN (RIA)|Medicaid|MEDICAID|437.50||||131.25||| 82746|EAP|0301|FOLATE-FOLIC ACID (BLOOD)|Blue Cross PPO Specialty|BCBSTX PPO|||||141.75||| 82746|EAP|0301|FOLATE-FOLIC ACID (BLOOD)|Tricare|TRICARE EAST REGION|||||141.75||| 82746|EAP|0301|FOLATE-FOLIC ACID (BLOOD)|Medicare|MEDICARE ACUTE|472.25||||141.75||| 82746|EAP|0301|FOLATE-FOLIC ACID (BLOOD)|Medicaid|MEDICAID|||||3.07||| 82746|EAP|0301|FOLATE-FOLIC ACID (BLOOD)|United Healthcare|UNITED HEALTHCARE|472.25||||141.75||| 82746|EAP|0301|FOLATE-FOLIC ACID (BLOOD)|NON CONTRACTED|COMMERCIAL OTHER 1|472.25||||141.75||| 82746|EAP|0301|FOLATE-FOLIC ACID (BLOOD)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||141.75||| 82746|EAP|0301|FOLATE-FOLIC ACID (BLOOD)|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||141.75||| 82746|EAP|0301|FOLATE-FOLIC ACID (BLOOD)|Managed Medicare|HEALTHSPRING MA|||||141.75||| 82746|EAP|0301|FOLATE-FOLIC ACID (BLOOD)|Managed Medicaid|MEDICAID AMERIGROUP|||||141.75||| 82746|EAP|0301|FOLATE-FOLIC ACID (BLOOD)|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|472.25||||141.75||| 82746|EAP|0301|FOLATE-FOLIC ACID (BLOOD)|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||141.75||| 82746|EAP|0301|FOLATE-FOLIC ACID (BLOOD)|Cigna|CIGNA|||||141.75||| 82746|EAP|0301|FOLATE-FOLIC ACID (BLOOD)|United Medicare Advantage|UHC MEDICARE GOLD MA|472.25||||141.75||| 82746|EAP|0301|FOLATE-FOLIC ACID (BLOOD)|Managed Medicaid|MEDICAID SUPERIOR|||||141.75||| 82746|EAP|0301|FOLATE-FOLIC ACID (BLOOD)|Humana Medicare Advantage|HUMANA MA|472.25||||472.25||| 82746|EAP|0301|FOLATE-FOLIC ACID (BLOOD)|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||141.75||| 82746|EAP|0301|FOLATE-FOLIC ACID (BLOOD)|United Healthcare|UNITED HEALTHCARE OTHER|||||141.75||| 82746|EAP|0301|FOLATE-FOLIC ACID (BLOOD)|Blue Cross HMO Specialty|BCBSTX HMO|472.25||||141.75||| 82746|EAP|0301|FOLATE-FOLIC ACID (BLOOD)|Blue Cross PPO Specialty|BCBSTX OTHER|||||141.75||| 82746|EAP|0301|FOLATE-FOLIC ACID (BLOOD)|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|472.25||||||| 82746|EAP|0301|FOLATE-FOLIC ACID (BLOOD)|Managed Medicaid|MEDICAID UNITED HEALTHCARE|472.25||||141.75||| 82746|EAP|0301|FOLATE-FOLIC ACID (BLOOD)|Aenta Medicare Advantage|AETNA MEDICARE MA|472.25||||||| 82746|EAP|0301|FOLATE-FOLIC ACID (BLOOD)|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|472.25||||141.75||| 82746|EAP|0301|FOLATE-FOLIC ACID (BLOOD)|United Medicare Advantage|AARP UHC WEST COMPLETE MA|472.25||||141.75||| 82784|EAP|0300|IMMUNOGLOBULIN PANEL II G|Aenta Medicare Advantage|AETNA MEDICARE MA|||||89.75||| 82784|EAP|0300|IMMUNOGLOBULIN PANEL II G|Managed Medicaid|MEDICAID AMERIGROUP|||||89.75||| 82784|EAP|0300|IMMUNOGLOBULIN M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||89.75||| 82784|EAP|0300|IMMUNOGLOBULIN M|United Healthcare|UNITED HEALTHCARE OTHER|||||89.75||| 82784|EAP|0300|IMMUNOGLOBULIN PANEL II G|Medicare|MEDICARE ACUTE|||||89.75||| 82784|EAP|0300|IMMUNOGLOBULIN PANEL II G|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||89.75||| 82784|EAP|0300|IMMUNOGLOBULIN PANEL II G|United Healthcare|UNITED HEALTHCARE OTHER|||||89.75||| 82784|EAP|0300|IMMUNOGLOBULIN M|Medicare|MEDICARE ACUTE|||||89.75||| 82784|EAP|0300|IMMUNOGLOBULIN PANEL II G|Blue Cross PPO Specialty|BCBSTX PPO|||||89.75||| 82784|EAP|0300|IMMUNOGLOBULIN M|United Medicare Advantage|UHC MEDICARE GOLD MA|||||89.75||| 82784|EAP|0300|IMMUNOGLOBULIN PANEL II G|United Medicare Advantage|UHC MEDICARE GOLD MA|||||89.75||| 82784|EAP|0300|IMMUNOGLOBULIN PANEL II G|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|89.75||||89.75||| 82784|EAP|0300|IMMUNOGLOBULIN PANEL II G|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||89.75||| 82784|EAP|0300|IMMUNOGLOBULIN M|Blue Cross PPO Specialty|BCBSTX PPO|||||89.75||| 82784|EAP|0300|IMMUNOGLOBULIN PANEL II G|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|298.75||||||| 82784|EAP|0300|IMMUNOGLOBULIN M|Managed Medicaid|MEDICAID AMERIGROUP|||||298.75||| 82785|EAP|0300|IMMUNOGLOBULIN E|Blue Cross PPO Specialty|BCBSTX OTHER|||||158.75||| 82785|EAP|0300|IMMUNOGLOBULIN E|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||158.75||| 82785|EAP|0300|IMMUNOGLOBULIN E|Medicare|MEDICARE ACUTE|||||158.75||| 82785|EAP|0300|IMMUNOGLOBULIN E|United Healthcare|UNITED HEALTHCARE OTHER|||||158.75||| 82785|EAP|0300|IMMUNOGLOBULIN E|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||158.75||| 82785|EAP|0300|IMMUNOGLOBULIN E|United Medicare Advantage|UHC MEDICARE GOLD MA|||||158.75||| 82785|EAP|0300|IMMUNOGLOBULIN E|Managed Medicaid|MEDICAID SUPERIOR|||||158.75||| 82785|EAP|0300|IMMUNOGLOBULIN E|Managed Medicaid|MEDICAID AMERIGROUP|||||158.75||| 82785|EAP|0300|IMMUNOGLOBULIN E|Aetna|AETNA QHP HMO|||||158.75||| 82785|EAP|0300|IMMUNOGLOBULIN E|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||158.75||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Aenta Medicare Advantage|AETNA MEDICARE MA|911.50||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|United Medicare Advantage|AARP UHC WEST COMPLETE MA|911.50||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Veterans Affairs|VETERANS ADMINISTRATION|||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|911.50||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Veterans Affairs|VETERANS ADMINISTRATION|911.50||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|911.50||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|United Medicare Advantage|UHC MEDICARE GOLD MA|911.50||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|911.50||||||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Aetna|AETNA QHP HMO|||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Managed Medicare|HEALTHSPRING MA|||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Blue Cross PPO Specialty|BCBSTX OTHER|||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Aetna|AETNA PPO|911.50||||||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|911.50||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Managed Medicaid|MEDICAID SUPERIOR|911.50||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Cigna|CIGNA|||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Cigna|CIGNA|911.50||||||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Managed Medicaid|MEDICAID UNITED HEALTHCARE|911.50||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Blue Cross PPO Specialty|BCBSTX PPO|911.50||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Humana Medicare Advantage|HUMANA MA|911.50||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Medicaid|WOOD COUNTY INDIGENT|||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Managed Medicaid|MEDICAID AMERIGROUP|911.50||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|911.50||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|United Healthcare|UNITED HEALTHCARE OTHER|||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|NON CONTRACTED|COMMERCIAL OTHER 1|911.50||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Medicare|MEDICARE PART B ONLY IP|911.50||||||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Medicare|MEDICARE ACUTE|911.50||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|911.50||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Medicaid|MEDICAID|911.50||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Blue Cross HMO Specialty|BCBSTX HMO|||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|United Healthcare|UNITED HEALTHCARE|||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|United Healthcare|UNITED HEALTHCARE|911.50||||911.50||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Access Direct Platinum|HEALTHFIRST TPA UMR|911.50||||||| 82805|EAP|0300|ARTERIAL BLOOD STUDIES (C|Managed Medicare|OTHER INSTITUTIONS|||||911.50||| 82945|EAP|0301|GLUCOSE (SERUM, CSF, FLUI|United Medicare Advantage|UHC MEDICARE GOLD MA|1.26||||||| 82945|EAP|0301|GLUCOSE (SERUM, CSF, FLUI|Managed Medicaid|MEDICAID SUPERIOR|||||1.26||| 82945|EAP|0301|GLUCOSE (SERUM, CSF, FLUI|Medicare|MEDICARE ACUTE|1.26||||||| 82945|EAP|0301|GLUCOSE (SERUM, CSF, FLUI|Blue Cross PPO Specialty|BCBSTX PPO|||||1.26||| 82947|EAP|0301|GLUCOSE BLOOD STICK|Blue Cross HMO Specialty|BCBSTX HMO|1.26||||||| 82947|EAP|0301|GLUCOSE BLOOD STICK|United Medicare Advantage|UHC MEDICARE GOLD MA|1.26||||1.26||| 82947|EAP|0301|GLUCOSE BLOOD STICK|Humana Medicare Advantage|HUMANA MA|1.26||||||| 82947|EAP|0301|GLUCOSE BLOOD STICK|Aetna|AETNA PPO|||||0.38||| 82947|EAP|0301|GLUCOSE BLOOD STICK|Blue Cross PPO Specialty|BCBSTX PPO|1.26||||0.38||| 82947|EAP|0301|GLUCOSE BLOOD STICK|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.26||| 82947|EAP|0301|GLUCOSE BLOOD STICK|Aenta Medicare Advantage|AETNA MEDICARE MA|1.26||||||| 82947|EAP|0301|GLUCOSE BLOOD STICK|United Healthcare|UNITED HEALTHCARE|1.26||||||| 82947|EAP|0301|GLUCOSE BLOOD STICK|Medicaid|MEDICAID|1.26||||||| 82947|EAP|0301|GLUCOSE BLOOD STICK|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.38||| 82947|EAP|0301|GLUCOSE BLOOD STICK|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.26||||||| 82947|EAP|0301|GLUCOSE BLOOD STICK|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.26||||||| 82947|EAP|0301|GLUCOSE BLOOD STICK|Medicare|MEDICARE ACUTE|1.26||||1.26||| 82947|EAP|0301|GLUCOSE BLOOD STICK|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.26||| 82951|EAP|0301|GLUCOSE TOLERANCE, 3 TEST|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||124.25||| 82952|EAP|0301|GLUCOSE TEST 5 HR MAX|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||37.75||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.64||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Veterans Affairs|VETERANS ADMINISTRATION|0.64||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|PHCS|HUMANA INSURANCE|||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Medicaid|MEDICAID HMO|||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|United Medicare Advantage|UHC MEDICARE GOLD MA|0.64||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|0.64||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Managed Medicare|OTHER INSTITUTIONS|0.64||||||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Managed Medicare|HEALTHSPRING MA|0.64||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|0.64||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|United Healthcare|UNITED HEALTHCARE|||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|United Healthcare|UNITED HEALTHCARE|0.64||||||| 82962|EAP|0300|BLOOD SUGAR-FINGER|Medicaid|MEDICAID|0.64||||0.30||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|United Healthcare|UNITED HEALTHCARE ERS|||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Medicaid|MEDICAID|0.64||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Tricare|TRICARE EAST REGION|0.64||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Medicaid|WOOD COUNTY INDIGENT|||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|NON CONTRACTED|COMMERCIAL OTHER 1|0.64||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Medicare|MEDICARE ACUTE|0.64||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|United Healthcare|TML GROUP BENEFITS|||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.64||| 82962|EAP|0300|BLOOD SUGAR-FINGER|Medicare|MEDICARE ACUTE|0.64||||0.30||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.64||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Medicare|MEDICARE PART B ONLY IP|0.64||||||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Aetna|AETNA PPO|0.64||||||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Blue Cross PPO Specialty|BCBSTX OTHER|||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Humana Medicare Advantage|HUMANA MA|0.64||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.64||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|0.64||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Aenta Medicare Advantage|AETNA MEDICARE MA|0.64||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.64||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.64||||||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Managed Medicaid|MEDICAID SUPERIOR|0.64||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Cigna|CIGNA|0.64||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Access Direct Platinum|HEALTHFIRST TPA UMR|0.64||||||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Managed Medicaid|MEDICAID AMERIGROUP|||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Aetna|AETNA OTHER|0.64||||||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Aetna|AETNA QHP HMO|||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.64||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|United Healthcare|UNITED HEALTHCARE OTHER|||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Blue Cross PPO Specialty|BCBSTX PPO|0.64||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Blue Cross HMO Specialty|BCBSTX HMO|0.64||||0.64||| 82962|EAP|0300|GLUCOSE POC (GLUCOMETER)|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.64||||0.64||| 82977|EAP|0301|GGT GAMMA GT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||69.50||| 82977|EAP|0301|GGT GAMMA GT|Managed Medicaid|MEDICAID AMERIGROUP|||||69.50||| 82977|EAP|0301|GGT GAMMA GT|Blue Cross PPO Specialty|BCBSTX PPO|||||69.50||| 82977|EAP|0301|GGT GAMMA GT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||69.50||| 82977|EAP|0301|GGT GAMMA GT|Medicare|MEDICARE ACUTE|||||69.50||| 82977|EAP|0301|GGT GAMMA GT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||69.50||| 82977|EAP|0301|GGT GAMMA GT|Aenta Medicare Advantage|AETNA MEDICARE MA|||||69.50||| 83|DRG||TRAUMATIC STUPOR & COMA, COMA >1 HR W CC|Veterans Affairs|VETERANS ADMINISTRATION|19,445.58|49.5|49.5|49.5|||| 83001|EAP|0301|FSH|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||179.25||| 83001|EAP|0301|FSH|Medicare|MEDICARE ACUTE|||||179.25||| 83001|EAP|0301|FSH|NON CONTRACTED|COMMERCIAL OTHER 1|||||179.25||| 83001|EAP|0301|FSH|Medicaid|MEDICAID TEXAS CHILDRENS|||||179.25||| 83001|EAP|0301|FSH|Medicaid|MEDICAID|||||179.25||| 83001|EAP|0301|FSH|United Healthcare|UNITED HEALTHCARE OTHER|||||179.25||| 83001|EAP|0301|FSH|United Healthcare|UNITED HEALTHCARE|||||179.25||| 83001|EAP|0301|FSH|Blue Cross PPO Specialty|BCBSTX PPO|||||179.25||| 83001|EAP|0301|FSH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||179.25||| 83001|EAP|0301|FSH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||179.25||| 83001|EAP|0301|FSH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||179.25||| 83001|EAP|0301|FSH|Managed Medicaid|MEDICAID AMERIGROUP|||||179.25||| 83001|EAP|0301|FSH|Managed Medicaid|MEDICAID SUPERIOR|||||179.25||| 83001|EAP|0301|FSH|Humana Medicare Advantage|HUMANA MA|||||179.25||| 83001|EAP|0301|FSH|Cigna|CIGNA|||||179.25||| 83001|EAP|0301|FSH|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||179.25||| 83001|EAP|0301|FSH|Aetna|AETNA PPO|||||179.25||| 83001|EAP|0301|FSH|United Medicare Advantage|UHC MEDICARE GOLD MA|||||179.25||| 83001|EAP|0301|FSH|Blue Cross HMO Specialty|BCBSTX HMO|||||179.25||| 83001|EAP|0301|FSH|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||179.25||| 83002|EAP|0301|LUTEINEZING HORMONE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||178.50||| 83002|EAP|0301|LUTEINEZING HORMONE|Blue Cross HMO Specialty|BCBSTX HMO|||||178.50||| 83002|EAP|0301|LUTEINEZING HORMONE|Blue Cross PPO Specialty|BCBSTX PPO|||||178.50||| 83002|EAP|0301|LUTEINEZING HORMONE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||178.50||| 83002|EAP|0301|LUTEINEZING HORMONE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||178.50||| 83002|EAP|0301|LUTEINEZING HORMONE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||178.50||| 83002|EAP|0301|LUTEINEZING HORMONE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||178.50||| 83002|EAP|0301|LUTEINEZING HORMONE|Cigna|CIGNA|||||178.50||| 83002|EAP|0301|LUTEINEZING HORMONE|Aetna|AETNA PPO|||||178.50||| 83002|EAP|0301|LUTEINEZING HORMONE|Humana Medicare Advantage|HUMANA MA|||||178.50||| 83002|EAP|0301|LUTEINEZING HORMONE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||178.50||| 83002|EAP|0301|LUTEINEZING HORMONE|United Healthcare|UNITED HEALTHCARE OTHER|||||178.50||| 83002|EAP|0301|LUTEINEZING HORMONE|Medicare|MEDICARE ACUTE|||||178.50||| 83002|EAP|0301|LUTEINEZING HORMONE|NON CONTRACTED|COMMERCIAL OTHER 1|||||178.50||| 83002|EAP|0301|LUTEINEZING HORMONE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||178.50||| 83002|EAP|0301|LUTEINEZING HORMONE|United Healthcare|UNITED HEALTHCARE|||||178.50||| 83002|EAP|0301|LUTEINEZING HORMONE|Managed Medicaid|MEDICAID SUPERIOR|||||178.50||| 83002|EAP|0301|LUTEINEZING HORMONE|Managed Medicaid|MEDICAID AMERIGROUP|||||178.50||| 83002|EAP|0301|LUTEINEZING HORMONE|Medicaid|MEDICAID TEXAS CHILDRENS|||||178.50||| 83002|EAP|0301|LUTEINEZING HORMONE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||178.50||| 83002|EAP|0301|LUTEINEZING HORMONE|Medicaid|MEDICAID|||||178.50||| 83010|EAP|0301|HAPTOGLOBIN QUANT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||121.25||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|311.75||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Workers Compensation|WORKERS COMPENSATION OTHER|||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|United Medicare Advantage|UHC MEDICARE GOLD MA|311.75||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Veterans Affairs|VETERANS ADMINISTRATION|311.75||||||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Medicare|MEDICARE ACUTE|311.75||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|United Healthcare|GEHA|||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|United Medicare Advantage|AARP UHC WEST COMPLETE MA|311.75||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Tricare|TRICARE EAST REGION|||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|PHCS|GREAT WEST LIFE AND ANNUITY|||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|311.75||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Medicaid|MEDICAID TEXAS CHILDRENS|||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|United Healthcare|UNITED HEALTHCARE ERS|||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|United Healthcare|ZZZZZ UNITED HEALTHCARE|||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Managed Medicare|HEALTHSPRING MA|311.75||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Managed Medicare|BCBS MEDICARE PPO MA|||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Medicaid|MEDICAID|311.75||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Blue Cross PPO Specialty|BCBSTX PPO|311.75||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|United Healthcare|UNITED HEALTHCARE|||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Aetna|AETNA OTHER|311.75||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Blue Cross PPO Specialty|BLUE SHIELD PHYSICIAN|||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Aetna|AETNA PPO|311.75||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|United Healthcare|UNITED HEALTHCARE OTHER|||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Tricare|TRICARE FOR LIFE|||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Blue Cross PPO Specialty|BCBSTX OTHER|||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|311.75||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Blue Cross HMO Specialty|BCBSTX HMO|311.75||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|NON CONTRACTED|COMMERCIAL OTHER 1|311.75||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|United Healthcare|TML GROUP BENEFITS|||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|ChampVA|CHAMPVA CENTER|||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Access Direct Platinum|HEALTHFIRST TPA UMR|311.75||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Cigna|CIGNA|311.75||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Aenta Medicare Advantage|AETNA MEDICARE MA|311.75||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|311.75||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Medicare|MEDICARE PART B ONLY IP|311.75||||||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Humana Medicare Advantage|HUMANA MA|311.75||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Aetna|AETNA QHP HMO|||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|United Healthcare|UNITED HEALTHCARE|311.75||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Cigna|CIGNA|||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Managed Medicaid|MEDICAID AMERIGROUP|||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|311.75||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Managed Medicaid|MEDICAID SUPERIOR|||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||93.50||| 83036|EAP|0301|GLYCOHEMOGLOBIN ELECTROPH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|311.75||||93.50||| 83090|EAP|0301|HOMOCYSTEINE|Medicare|MEDICARE ACUTE|||||162.75||| 83090|EAP|0301|HOMOCYSTEINE|Medicaid|MEDICAID|||||162.75||| 83497|EAP|0301|5-HIAA|Medicare|MEDICARE ACUTE|149.50||||||| 83516|EAP|0300|TISSUE TRANSGLUTAMASE AB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||111.25||| 83516|EAP|0301|ANTITRANSYLUTIMINASE|Aetna|AETNA PPO|||||111.25||| 83516|EAP|0301|ANTITRANSYLUTIMINASE|Blue Cross PPO Specialty|BCBSTX PPO|||||111.25||| 83516|EAP|0300|TISSUE TRANSGLUTAMASE AB|NON CONTRACTED|COMMERCIAL OTHER 1|||||111.25||| 83516|EAP|0300|TISSUE TRANSGLUTAMASE AB|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||111.25||| 83516|EAP|0301|ANTITRANSYLUTIMINASE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||111.25||| 83516|EAP|0301|ANTITRANSYLUTIMINASE|Managed Medicaid|MEDICAID AMERIGROUP|||||111.25||| 83516|EAP|0301|ANTITRANSYLUTIMINASE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||111.25||| 83520|EAP|0300|IMMUNOASSAY QUANT NOS|Blue Cross HMO Specialty|BCBSTX HMO|||||106.80||| 83525|EAP|0301|INSULIN TOTAL SERUM FASTI|Managed Medicaid|MEDICAID AMERIGROUP|||||110.25||| 83525|EAP|0301|INSULIN TOTAL SERUM FASTI|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||367.25||| 83525|EAP|0301|INSULIN TOTAL SERUM FASTI|Blue Cross PPO Specialty|BCBSTX PPO|||||110.25||| 83540|EAP|0301|IRON (SERUM)|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.08||||||| 83540|EAP|0301|IRON (SERUM)|United Healthcare|UNITED HEALTHCARE|||||135.25||| 83540|EAP|0301|IRON (SERUM)|NON CONTRACTED|COMMERCIAL OTHER 1|2.08||||2.08||| 83540|EAP|0301|IRON (SERUM)|Blue Cross HMO Specialty|BCBSTX HMO|2.08||||||| 83540|EAP|0301|IRON (SERUM)|Aenta Medicare Advantage|AETNA MEDICARE MA|2.08||||||| 83540|EAP|0301|IRON (SERUM)|United Healthcare|UNITED HEALTHCARE|2.08||||62.50||| 83540|EAP|0301|IRON (SERUM)|Medicare|MEDICARE ACUTE|2.08||||2.08||| 83540|EAP|0301|IRON (SERUM)|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.08||||2.08||| 83540|EAP|0301|IRON (SERUM)|United Healthcare|TML GROUP BENEFITS|2.08||||||| 83540|EAP|0301|IRON (SERUM)|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.08||||2.08||| 83540|EAP|0301|IRON (SERUM)|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.08||||62.50||| 83540|EAP|0301|IRON (SERUM)|Veterans Affairs|VETERANS ADMINISTRATION|||||2.08||| 83540|EAP|0301|IRON (SERUM)|Access Direct Platinum|HEALTHFIRST TPA UMR|||||62.50||| 83540|EAP|0301|IRON (SERUM)|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.08||||62.50||| 83540|EAP|0301|IRON (SERUM)|United Medicare Advantage|UHC MEDICARE GOLD MA|2.08||||||| 83540|EAP|0301|IRON (SERUM)|Managed Medicare|HEALTHSPRING MA|||||62.50||| 83540|EAP|0301|IRON (SERUM)|Humana Medicare Advantage|HUMANA MA|2.08||||2.08||| 83540|EAP|0301|IRON (SERUM)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||62.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|NON CONTRACTED|COMMERCIAL OTHER 1|2.81||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|Tricare|TRICARE EAST REGION|||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|Blue Cross HMO Specialty|BCBSTX HMO|2.81||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.81||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|Managed Medicare|HEALTHSPRING MA|||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|United Healthcare|TML GROUP BENEFITS|2.81||||||| 83550|EAP|0301|IRON BINDING TEST, SERUM|Medicaid|MEDICAID|2.81||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|United Healthcare|UNITED HEALTHCARE|||||2.81||| 83550|EAP|0301|IRON BINDING TEST, SERUM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.81||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|United Medicare Advantage|UHC MEDICARE GOLD MA|2.81||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|Blue Cross PPO Specialty|BCBSTX PPO|||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|Aenta Medicare Advantage|AETNA MEDICARE MA|2.81||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|Managed Medicaid|MEDICAID AMERIGROUP|||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|Humana Medicare Advantage|HUMANA MA|2.81||||2.81||| 83550|EAP|0301|IRON BINDING TEST, SERUM|Blue Cross PPO Specialty|BLUE SHIELD PHYSICIAN|||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|Access Direct Platinum|HEALTHFIRST TPA UMR|||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|Cigna|CIGNA|||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|Veterans Affairs|VETERANS ADMINISTRATION|||||2.81||| 83550|EAP|0301|IRON BINDING TEST, SERUM|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|Managed Medicaid|MEDICAID SUPERIOR|||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.81||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|Blue Cross PPO Specialty|BCBSTX OTHER|||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.81||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.81||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|United Healthcare|UNITED HEALTHCARE OTHER|||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|Medicare|MEDICARE ACUTE|2.81||||84.50||| 83550|EAP|0301|IRON BINDING TEST, SERUM|United Healthcare|UNITED HEALTHCARE|2.81||||84.50||| 83605|EAP|0301|LACTIC ACID|Medicare|MEDICARE PART B ONLY IP|3.43||||||| 83605|EAP|0301|LACTIC ACID|United Healthcare|TML GROUP BENEFITS|||||3.43||| 83605|EAP|0301|LACTIC ACID|NON CONTRACTED|COMMERCIAL OTHER 1|3.43||||3.43||| 83605|EAP|0301|LACTIC ACID|Medicaid|MEDICAID|3.43||||3.43||| 83605|EAP|0301|LACTIC ACID|Tricare|TRICARE EAST REGION|3.43||||3.43||| 83605|EAP|0301|LACTIC ACID|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|3.43||||3.43||| 83605|EAP|0301|LACTIC ACID|Managed Medicare|HEALTHSPRING MA|||||3.43||| 83605|EAP|0301|LACTIC ACID|United Healthcare|UNITED HEALTHCARE|3.43||||3.43||| 83605|EAP|0301|LACTIC ACID|United Healthcare|UNITED HEALTHCARE OTHER|||||3.43||| 83605|EAP|0301|LACTIC ACID|Aetna|AETNA OTHER|||||3.43||| 83605|EAP|0301|LACTIC ACID|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.43||||3.43||| 83605|EAP|0301|LACTIC ACID|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||3.43||| 83605|EAP|0301|LACTIC ACID|Managed Medicaid|MEDICAID AMERIGROUP|3.43||||3.43||| 83605|EAP|0301|LACTIC ACID|Aenta Medicare Advantage|AETNA MEDICARE MA|3.43||||3.43||| 83605|EAP|0301|LACTIC ACID|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|3.43||||3.43||| 83605|EAP|0301|LACTIC ACID|Blue Cross HMO Specialty|BCBSTX HMO|3.43||||3.43||| 83605|EAP|0301|LACTIC ACID|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|3.43||||3.43||| 83605|EAP|0301|LACTIC ACID|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|3.43||||3.43||| 83605|EAP|0301|LACTIC ACID|Managed Medicaid|MEDICAID SUPERIOR|||||3.43||| 83605|EAP|0301|LACTIC ACID|Veterans Affairs|VETERANS ADMINISTRATION|||||3.43||| 83605|EAP|0301|LACTIC ACID|Cigna|CIGNA|3.43||||3.43||| 83605|EAP|0301|LACTIC ACID|Aetna|AETNA PPO|3.43||||3.43||| 83605|EAP|0301|LACTIC ACID|United Medicare Advantage|UHC MEDICARE GOLD MA|3.43||||3.43||| 83605|EAP|0301|LACTIC ACID|Medicare|MEDICARE ACUTE|3.43||||3.43||| 83605|EAP|0301|LACTIC ACID|Blue Cross PPO Specialty|BCBSTX PPO|3.43||||3.43||| 83605|EAP|0301|LACTIC ACID|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3.43||||3.43||| 83605|EAP|0301|LACTIC ACID|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|3.43||||3.43||| 83605|EAP|0301|LACTIC ACID|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.43||||3.43||| 83605|EAP|0301|LACTIC ACID|Blue Cross PPO Specialty|BCBSTX OTHER|||||3.43||| 83605|EAP|0301|LACTIC ACID|Workers Compensation|WORKERS COMPENSATION OTHER|3.43||||3.43||| 83605|EAP|0301|LACTIC ACID|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3.43||||3.43||| 83605|EAP|0301|LACTIC ACID|Humana Medicare Advantage|HUMANA MA|3.43||||3.43||| 83615|EAP|0301|LDH BLOOD|United Medicare Advantage|UHC MEDICARE GOLD MA|193.75||||193.75||| 83615|EAP|0301|LDH BLOOD|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||193.75||| 83615|EAP|0301|LDH BLOOD|Veterans Affairs|VETERANS ADMINISTRATION|||||193.75||| 83615|EAP|0301|LDH BLOOD|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||193.75||| 83615|EAP|0301|LDH BLOOD|Blue Cross PPO Specialty|BCBSTX PPO|193.75||||193.75||| 83615|EAP|0301|LDH BLOOD|Managed Medicaid|MEDICAID AMERIGROUP|193.75||||193.75||| 83615|EAP|0301|LDH BLOOD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|193.75||||193.75||| 83615|EAP|0301|LDH BLOOD|Humana Medicare Advantage|HUMANA MA|193.75||||193.75||| 83615|EAP|0301|LDH BLOOD|Aenta Medicare Advantage|AETNA MEDICARE MA|||||58.25||| 83615|EAP|0301|LDH BLOOD|United Medicare Advantage|AARP UHC WEST COMPLETE MA|193.75||||193.75||| 83615|EAP|0301|LDH BLOOD|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|193.75||||193.75||| 83615|EAP|0301|LDH BLOOD|Medicare|MEDICARE ACUTE|193.75||||193.75||| 83615|EAP|0301|LDH BLOOD|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|193.75||||193.75||| 83615|EAP|0301|LDH BLOOD|Medicaid|MEDICAID|||||193.75||| 83615|EAP|0301|LDH BLOOD|NON CONTRACTED|COMMERCIAL OTHER 1|193.75||||193.75||| 83615|EAP|0301|LDH BLOOD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.26||| 83615|EAP|0301|LDH BLOOD|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||193.75||| 83615|EAP|0301|LDH BLOOD|Managed Medicare|HEALTHSPRING MA|||||193.75||| 83615|EAP|0301|LDH BLOOD|United Healthcare|UNITED HEALTHCARE|||||1.26||| 83630|EAP|0300|LACTOFERRIN FECAL QUAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.60||| 83630|EAP|0300|LACTOFERRIN FECAL QUAL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.60||| 83655|EAP|0301|LEAD BLOOD QUANTITATIVE|Blue Cross PPO Specialty|BCBSTX PPO|||||116.75||| 83655|EAP|0301|LEAD BLOOD QUANTITATIVE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||116.75||| 83655|EAP|0301|LEAD BLOOD QUANTITATIVE|Medicaid|MEDICAID|||||116.75||| 83655|EAP|0301|LEAD BLOOD QUANTITATIVE|Tricare|TRICARE EAST REGION|||||116.75||| 83655|EAP|0301|LEAD BLOOD QUANTITATIVE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||116.75||| 83655|EAP|0301|LEAD BLOOD QUANTITATIVE|Managed Medicaid|MEDICAID SUPERIOR|||||116.75||| 83655|EAP|0301|LEAD BLOOD QUANTITATIVE|Medicare|MEDICARE ACUTE|||||116.75||| 83655|EAP|0301|LEAD BLOOD QUANTITATIVE|Managed Medicaid|MEDICAID AMERIGROUP|||||116.75||| 83690|EAP|0301|LIPASE BLOOD|Workers Compensation|WORKERS COMPENSATION OTHER|||||221.25||| 83690|EAP|0301|LIPASE BLOOD|United Medicare Advantage|UHC MEDICARE GOLD MA|221.25||||221.25||| 83690|EAP|0301|LIPASE BLOOD|United Medicare Advantage|AARP UHC WEST COMPLETE MA|221.25||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Veterans Affairs|VETERANS ADMINISTRATION|||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Tricare|TRICARE FOR LIFE|||||66.50||| 83690|EAP|0301|LIPASE BLOOD|Medicaid|MEDICAID HMO|||||221.25||| 83690|EAP|0301|LIPASE BLOOD|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||221.25||| 83690|EAP|0301|LIPASE BLOOD|NON CONTRACTED|COMMERCIAL OTHER 1|221.25||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Tricare|TRICARE EAST REGION|221.25||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Managed Medicare|HEALTHSPRING MA|||||221.25||| 83690|EAP|0301|LIPASE BLOOD|United Healthcare|TML GROUP BENEFITS|||||221.25||| 83690|EAP|0301|LIPASE BLOOD|United Healthcare|UNITED HEALTHCARE ERS|||||221.25||| 83690|EAP|0301|LIPASE BLOOD|United Healthcare|UNITED HEALTHCARE OTHER|||||221.25||| 83690|EAP|0301|LIPASE BLOOD|United Healthcare|UMR UNITED MEDICAL RESOURCES|221.25||||143.88||| 83690|EAP|0301|LIPASE BLOOD|United Healthcare|UNITED HEALTHCARE|||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Managed Medicare|BCBS MEDICARE PPO MA|||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Blue Cross HMO Specialty|BCBSTX HMO|221.25||||221.25||| 83690|EAP|0301|LIPASE BLOOD|United Healthcare|GEHA|||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Blue Cross PPO Specialty|BCBSTX PPO|221.25||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Blue Cross PPO Specialty|BCBSTX OTHER|221.25||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Aetna|AETNA OTHER|||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Medicare|MEDICARE ACUTE|221.25||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Access Direct Platinum|HEALTHFIRST TPA UMR|||||66.50||| 83690|EAP|0301|LIPASE BLOOD|Managed Medicaid|MEDICAID AMERIGROUP|221.25||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||221.25||| 83690|EAP|0301|LIPASE BLOOD|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Medicaid|MEDICAID|221.25||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Veterans Affairs|VETERANS ADMINISTRATION|221.25||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Cigna|CIGNA|221.25||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Aenta Medicare Advantage|AETNA MEDICARE MA|||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|221.25||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|221.25||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Aetna|AETNA PPO|221.25||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|221.25||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Managed Medicaid|MEDICAID SUPERIOR|221.25||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Humana Medicare Advantage|HUMANA MA|221.25||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|221.25||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Cigna|CIGNA|||||66.50||| 83690|EAP|0301|LIPASE BLOOD|Aetna|AETNA QHP HMO|||||221.25||| 83690|EAP|0301|LIPASE BLOOD|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||221.25||| 83718|EAP|0301|HDL CHOLESTEROL, SERUM|Medicare|MEDICARE ACUTE|2.63||||||| 83718|EAP|0301|HDL CHOLESTEROL, SERUM|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.63||||||| 83721|EAP|0300|ASSAY OF BLOOD LIPOPROTEI|Medicare|MEDICARE ACUTE|2.60||||||| 83721|EAP|0300|ASSAY OF BLOOD LIPOPROTEI|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.60||||||| 83735|EAP|0301|MAGNESIUM, BLOOD|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.40||| 83735|EAP|0301|MAGNESIUM, BLOOD|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|215.25||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|215.25||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|Aetna|AETNA PPO|215.25||||215.25||| 83735|EAP|0301|MAGNESIUM, BLOOD|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|Blue Cross HMO Specialty|BCBSTX HMO|215.25||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|Access Direct Platinum|HEALTHFIRST TPA UMR|215.25||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|Medicare|MEDICARE PART B ONLY IP|215.25||||||| 83735|EAP|0301|MAGNESIUM, BLOOD|Cigna|CIGNA|215.25||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|Aenta Medicare Advantage|AETNA MEDICARE MA|215.25||||215.25||| 83735|EAP|0301|MAGNESIUM, BLOOD|Managed Medicaid|MEDICAID SUPERIOR|215.25||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|215.25||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|215.25||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|Managed Medicaid|MEDICAID AMERIGROUP|215.25||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|Humana Medicare Advantage|HUMANA MA|215.25||||215.25||| 83735|EAP|0301|MAGNESIUM, BLOOD|Cigna|CIGNA|||||215.25||| 83735|EAP|0301|MAGNESIUM, BLOOD|United Healthcare|UNITED HEALTHCARE ERS|||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|Medicaid|MEDICAID|215.25||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.40||| 83735|EAP|0301|MAGNESIUM, BLOOD|Medicaid|MEDICAID TEXAS CHILDRENS|||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|Medicaid|WOOD COUNTY INDIGENT|||||215.25||| 83735|EAP|0301|MAGNESIUM, BLOOD|Medicaid|MEDICAID HMO|||||215.25||| 83735|EAP|0301|MAGNESIUM, BLOOD|NON CONTRACTED|WOOD COUNTY HOSPITAL DISTRICT|||||215.25||| 83735|EAP|0301|MAGNESIUM, BLOOD|ChampVA|CHAMPVA CENTER|||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|215.25||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|NON CONTRACTED|COMMERCIAL OTHER 1|215.25||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|215.25||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|United Healthcare|UNITED HEALTHCARE|215.25||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|Tricare|TRICARE FOR LIFE|||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|Tricare|TRICARE EAST REGION|215.25||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|Managed Medicare|OTHER INSTITUTIONS|215.25||||215.25||| 83735|EAP|0301|MAGNESIUM, BLOOD|Managed Medicare|MEDICARE RAILROAD|||||215.25||| 83735|EAP|0301|MAGNESIUM, BLOOD|Managed Medicare|HEALTHSPRING MA|215.25||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|Managed Medicare|BCBS MEDICARE PPO MA|215.25||||215.25||| 83735|EAP|0301|MAGNESIUM, BLOOD|United Healthcare|UNITED HEALTHCARE|||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|NON CONTRACTED|COMMERCIAL OTHER 2|||||215.25||| 83735|EAP|0301|MAGNESIUM, BLOOD|Aetna|AETNA OTHER|215.25||||215.25||| 83735|EAP|0301|MAGNESIUM, BLOOD|Aetna|AETNA QHP HMO|||||215.25||| 83735|EAP|0301|MAGNESIUM, BLOOD|United Medicare Advantage|UHC MEDICARE GOLD MA|215.25||||215.25||| 83735|EAP|0301|MAGNESIUM, BLOOD|United Healthcare|UMR UNITED MEDICAL RESOURCES|215.25||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|Blue Cross PPO Specialty|BCBSTX PPO|215.25||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|215.25||||215.25||| 83735|EAP|0301|MAGNESIUM, BLOOD|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|215.25||||215.25||| 83735|EAP|0301|MAGNESIUM, BLOOD|United Healthcare|UNITED HEALTHCARE OTHER|||||215.25||| 83735|EAP|0301|MAGNESIUM, BLOOD|United Medicare Advantage|AARP UHC WEST COMPLETE MA|215.25||||215.25||| 83735|EAP|0301|MAGNESIUM, BLOOD|Medicare|MEDICARE ACUTE|215.25||||215.25||| 83735|EAP|0301|MAGNESIUM, BLOOD|United Healthcare|GEHA|||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|Veterans Affairs|VETERANS ADMINISTRATION|215.25||||215.25||| 83735|EAP|0301|MAGNESIUM, BLOOD|United Healthcare|TML GROUP BENEFITS|||||64.75||| 83735|EAP|0301|MAGNESIUM, BLOOD|Workers Compensation|WORKERS COMPENSATION OTHER|215.25||||215.25||| 83735|EAP|0301|MAGNESIUM, BLOOD|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|215.25||||215.25||| 83825|EAP|0300|MERCURY LEVEL|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 83825|EAP|0300|MERCURY LEVEL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.25||| 83825|EAP|0300|MERCURY LEVEL|Medicare|MEDICARE ACUTE|||||1.25||| 83835|EAP|0301|METANEPHRINES TOTAL URINE|Blue Cross PPO Specialty|BCBSTX PPO|||||163.25||| 83835|EAP|0301|METANEPHRINES TOTAL URINE|Managed Medicaid|MEDICAID AMERIGROUP|||||544.25||| 83835|EAP|0301|METANEPHRINES TOTAL URINE|Humana Medicare Advantage|HUMANA MA|544.25||||||| 83874|EAP|0301|MYOGLOBIN DIFF SERUM|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.15||| 83874|EAP|0301|MYOGLOBIN DIFF SERUM|Medicare|MEDICARE ACUTE|||||4.15||| 83874|EAP|0301|MYOGLOBIN DIFF SERUM|Aetna|AETNA PPO|||||4.15||| 83874|EAP|0301|MYOGLOBIN DIFF SERUM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.15||| 83880|EAP|0300|BNP|Humana Medicare Advantage|HUMANA MA|10.99||||10.99||| 83880|EAP|0300|BNP|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|10.99||||10.99||| 83880|EAP|0300|BNP|Blue Cross PPO Specialty|BCBSTX PPO|10.99||||10.99||| 83880|EAP|0300|BNP|Managed Medicaid|MEDICAID UNITED HEALTHCARE|10.99||||10.99||| 83880|EAP|0300|BNP|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||10.99||| 83880|EAP|0300|BNP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|10.99||||10.99||| 83880|EAP|0300|BNP|Cigna|CIGNA|||||10.99||| 83880|EAP|0300|BNP|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|10.99||||10.99||| 83880|EAP|0300|BNP|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|327.25||||327.25||| 83880|EAP|0300|BNP|Managed Medicaid|MEDICAID SUPERIOR|10.99||||10.99||| 83880|EAP|0300|BNP|Blue Cross HMO Specialty|BCBSTX HMO|||||10.99||| 83880|EAP|0300|BNP|Managed Medicaid|MEDICAID AMERIGROUP|10.99||||10.99||| 83880|EAP|0300|BNP|Aetna|AETNA PPO|10.99||||10.99||| 83880|EAP|0300|BNP|Blue Cross PPO Specialty|BCBSTX OTHER|||||10.99||| 83880|EAP|0300|BNP|Managed Medicare|BCBS MEDICARE PPO MA|||||10.99||| 83880|EAP|0300|BNP|Medicaid|MEDICAID TEXAS CHILDRENS|||||327.25||| 83880|EAP|0300|BNP|Aetna|AETNA OTHER|10.99||||10.99||| 83880|EAP|0300|BNP|Cigna|CIGNA|10.99||||10.99||| 83880|EAP|0300|BNP|Aetna|AETNA QHP HMO|||||10.99||| 83880|EAP|0300|BNP|Medicaid|MEDICAID|10.99||||10.99||| 83880|EAP|0300|BNP|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||10.99||| 83880|EAP|0300|BNP|Aenta Medicare Advantage|AETNA MEDICARE MA|10.99||||10.99||| 83880|EAP|0300|BNP|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||10.99||| 83880|EAP|0300|BNP|United Healthcare|UNITED HEALTHCARE|10.99||||10.99||| 83880|EAP|0300|BNP|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||10.99||| 83880|EAP|0300|BNP|NON CONTRACTED|COMMERCIAL OTHER 1|10.99||||10.99||| 83880|EAP|0300|BNP|United Healthcare|UNITED HEALTHCARE|||||713.13||| 83880|EAP|0300|BNP|Medicaid|WOOD COUNTY INDIGENT|||||10.99||| 83880|EAP|0300|BNP|United Healthcare|TML GROUP BENEFITS|||||10.99||| 83880|EAP|0300|BNP|United Healthcare|UNITED HEALTHCARE OTHER|||||10.99||| 83880|EAP|0300|BNP|Tricare|TRICARE EAST REGION|||||10.99||| 83880|EAP|0300|BNP|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||10.99||| 83880|EAP|0300|BNP|United Healthcare|GEHA|||||10.99||| 83880|EAP|0300|BNP|NON CONTRACTED|COMMERCIAL OTHER 2|||||10.99||| 83880|EAP|0300|BNP|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|10.99||||10.99||| 83880|EAP|0300|BNP|Managed Medicare|HEALTHSPRING MA|10.99||||10.99||| 83880|EAP|0300|BNP|United Medicare Advantage|AARP UHC WEST COMPLETE MA|10.99||||10.99||| 83880|EAP|0300|BNP|Medicare|MEDICARE PART B ONLY IP|10.99||||||| 83880|EAP|0300|BNP|Medicare|MEDICARE ACUTE|10.99||||10.99||| 83880|EAP|0300|BNP|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|10.99||||10.99||| 83880|EAP|0300|BNP|Veterans Affairs|VETERANS ADMINISTRATION|10.99||||10.99||| 83880|EAP|0300|BNP|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||10.99||| 83880|EAP|0300|BNP|Managed Medicare|OTHER INSTITUTIONS|||||10.99||| 83880|EAP|0300|BNP|United Medicare Advantage|UHC MEDICARE GOLD MA|10.99||||10.99||| 83918|EAP|0301|METHYLONALONIC ACID EA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||158.75||| 83930|EAP|0301|OSMOLALITY SERUM|United Medicare Advantage|UHC MEDICARE GOLD MA|158.25||||||| 83930|EAP|0301|OSMOLALITY SERUM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|158.25||||||| 83930|EAP|0301|OSMOLALITY SERUM|Medicare|MEDICARE ACUTE|158.25||||158.25||| 83930|EAP|0301|OSMOLALITY SERUM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|158.25||||||| 83930|EAP|0301|OSMOLALITY SERUM|Humana Medicare Advantage|HUMANA MA|158.25||||||| 83935|EAP|0301|OSMOLALITY, URINE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|158.25||||||| 83935|EAP|0301|OSMOLALITY, URINE|United Medicare Advantage|UHC MEDICARE GOLD MA|158.25||||158.25||| 83935|EAP|0301|OSMOLALITY, URINE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|158.25||||||| 83935|EAP|0301|OSMOLALITY, URINE|Humana Medicare Advantage|HUMANA MA|158.25||||158.25||| 83935|EAP|0301|OSMOLALITY, URINE|Medicare|MEDICARE ACUTE|158.25||||158.25||| 83970|EAP|0300|PARATHYROID HORMONE INTAC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||3.98||| 83970|EAP|0300|PARATHYROID HORMONE INTAC|Aetna|AETNA PPO|||||3.98||| 83970|EAP|0300|PARATHYROID HORMONE INTAC|United Healthcare|UNITED HEALTHCARE|||||3.98||| 83970|EAP|0300|PARATHYROID HORMONE INTAC|ChampVA|CHAMPVA CENTER|||||3.98||| 83970|EAP|0300|PARATHYROID HORMONE INTAC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.98||| 83970|EAP|0300|PARATHYROID HORMONE INTAC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.98||| 83970|EAP|0300|PARATHYROID HORMONE INTAC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3.98||| 83970|EAP|0300|PARATHYROID HORMONE INTAC|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.98||| 83970|EAP|0300|PARATHYROID HORMONE INTAC|United Medicare Advantage|UHC MEDICARE GOLD MA|1,122.50||||3.98||| 83970|EAP|0300|PARATHYROID HORMONE INTAC|Medicare|MEDICARE ACUTE|1,122.50||||3.98||| 83970|EAP|0300|PARATHYROID HORMONE INTAC|Humana Medicare Advantage|HUMANA MA|||||1,122.50||| 83970|EAP|0300|PARATHYROID HORMONE INTAC|Blue Cross PPO Specialty|BCBSTX PPO|||||3.98||| 83970|EAP|0300|PARATHYROID HORMONE INTAC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3.98||| 83986|EAP|0300|STONE RISK PH NON BLOOD|Medicare|MEDICARE ACUTE|114.75||||||| 83986|EAP|0300|STONE RISK PH NON BLOOD|United Medicare Advantage|AARP UHC WEST COMPLETE MA|114.75||||||| 840|DRG||LYMPHOMA & NON-ACUTE LEUKEMIA W MCC|Medicare|MEDICARE ACUTE|44,327.43|57.42|57.42|57.42|||| 84030|EAP|0309|BLOOD COLLECTION (STATE P|Aetna|AETNA PPO|||||53.25||| 84030|EAP|0309|BLOOD COLLECTION (STATE P|Managed Medicaid|MEDICAID AMERIGROUP|||||53.25||| 84030|EAP|0309|BLOOD COLLECTION (STATE P|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||53.25||| 84030|EAP|0309|BLOOD COLLECTION (STATE P|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||53.25||| 84030|EAP|0309|BLOOD COLLECTION (STATE P|Access Direct Platinum|HEALTHFIRST TPA UMR|||||53.25||| 84030|EAP|0309|BLOOD COLLECTION (STATE P|Medicaid|MEDICAID|||||53.25||| 84030|EAP|0309|BLOOD COLLECTION (STATE P|Managed Medicaid|MEDICAID SUPERIOR|||||53.25||| 841|DRG||LYMPHOMA & NON-ACUTE LEUKEMIA W CC|Blue Cross PPO Specialty|BCBSTX PPO|24,312.88|93.18|93.18|93.18|||| 84100|EAP|0301|PHOSPHORUS, BLOOD|United Medicare Advantage|AARP UHC WEST COMPLETE MA|152.50||||99.13||| 84100|EAP|0301|PHOSPHORUS, BLOOD|Medicare|MEDICARE PART B ONLY IP|152.50||||||| 84100|EAP|0301|PHOSPHORUS, BLOOD|United Medicare Advantage|UHC MEDICARE GOLD MA|152.50||||45.75||| 84100|EAP|0301|PHOSPHORUS, BLOOD|Tricare|TRICARE FOR LIFE|||||45.75||| 84100|EAP|0301|PHOSPHORUS, BLOOD|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|152.50||||152.50||| 84100|EAP|0301|PHOSPHORUS, BLOOD|Medicare|MEDICARE ACUTE|152.50||||45.75||| 84100|EAP|0301|PHOSPHORUS, BLOOD|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|152.50||||||| 84100|EAP|0301|PHOSPHORUS, BLOOD|United Healthcare|UNITED HEALTHCARE|152.50||||||| 84100|EAP|0301|PHOSPHORUS, BLOOD|NON CONTRACTED|COMMERCIAL OTHER 1|152.50||||45.75||| 84100|EAP|0301|PHOSPHORUS, BLOOD|Medicaid|MEDICAID|152.50||||||| 84100|EAP|0301|PHOSPHORUS, BLOOD|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|152.50||||45.75||| 84100|EAP|0301|PHOSPHORUS, BLOOD|Access Direct Platinum|HEALTHFIRST TPA UMR|||||45.75||| 84100|EAP|0301|PHOSPHORUS, BLOOD|Blue Cross PPO Specialty|BCBSTX PPO|152.50||||45.75||| 84100|EAP|0301|PHOSPHORUS, BLOOD|Aetna|AETNA OTHER|||||152.50||| 84100|EAP|0301|PHOSPHORUS, BLOOD|Veterans Affairs|VETERANS ADMINISTRATION|152.50||||||| 84100|EAP|0301|PHOSPHORUS, BLOOD|Aenta Medicare Advantage|AETNA MEDICARE MA|152.50||||||| 84100|EAP|0301|PHOSPHORUS, BLOOD|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|152.50||||45.75||| 84100|EAP|0301|PHOSPHORUS, BLOOD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|152.50||||45.75||| 84100|EAP|0301|PHOSPHORUS, BLOOD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|152.50||||45.75||| 84100|EAP|0301|PHOSPHORUS, BLOOD|ChampVA|CHAMPVA CENTER|||||45.75||| 84100|EAP|0301|PHOSPHORUS, BLOOD|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||45.75||| 84100|EAP|0301|PHOSPHORUS, BLOOD|Humana Medicare Advantage|HUMANA MA|152.50||||152.50||| 84100|EAP|0301|PHOSPHORUS, BLOOD|Managed Medicaid|MEDICAID SUPERIOR|152.50||||||| 84132|EAP|0301|POTASSIUM, BLOOD|Blue Cross HMO Specialty|BCBSTX HMO|147.50||||||| 84132|EAP|0301|POTASSIUM, BLOOD|Blue Cross PPO Specialty|BCBSTX PPO|147.50||||147.50||| 84132|EAP|0301|POTASSIUM, BLOOD|Managed Medicaid|MEDICAID AMERIGROUP|147.50||||||| 84132|EAP|0301|POTASSIUM, BLOOD|Aenta Medicare Advantage|AETNA MEDICARE MA|147.50||||||| 84132|EAP|0301|POTASSIUM, BLOOD|Humana Medicare Advantage|HUMANA MA|147.50||||147.50||| 84132|EAP|0301|POTASSIUM, BLOOD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|147.50||||44.25||| 84132|EAP|0301|POTASSIUM, BLOOD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|147.50||||147.50||| 84132|EAP|0301|POTASSIUM, BLOOD|Aetna|AETNA OTHER|147.50||||||| 84132|EAP|0301|POTASSIUM, BLOOD|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|147.50||||44.25||| 84132|EAP|0301|POTASSIUM, BLOOD|Cigna|CIGNA|147.50||||147.50||| 84132|EAP|0301|POTASSIUM, BLOOD|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|147.50||||||| 84132|EAP|0301|POTASSIUM, BLOOD|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|147.50||||44.25||| 84132|EAP|0301|POTASSIUM, BLOOD|Medicare|MEDICARE PART B ONLY IP|147.50||||||| 84132|EAP|0301|POTASSIUM, BLOOD|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||44.25||| 84132|EAP|0301|POTASSIUM, BLOOD|Medicare|MEDICARE ACUTE|147.50||||147.50||| 84132|EAP|0301|POTASSIUM, BLOOD|United Healthcare|UNITED HEALTHCARE|||||44.25||| 84132|EAP|0301|POTASSIUM, BLOOD|United Healthcare|UNITED HEALTHCARE|147.50||||||| 84132|EAP|0301|POTASSIUM, BLOOD|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|147.50||||147.50||| 84132|EAP|0301|POTASSIUM, BLOOD|Managed Medicare|HEALTHSPRING MA|147.50||||147.50||| 84132|EAP|0301|POTASSIUM, BLOOD|United Medicare Advantage|AARP UHC WEST COMPLETE MA|147.50||||147.50||| 84132|EAP|0301|POTASSIUM, BLOOD|Medicaid|MEDICAID|147.50||||147.50||| 84132|EAP|0301|POTASSIUM, BLOOD|United Medicare Advantage|UHC MEDICARE GOLD MA|147.50||||147.50||| 84132|EAP|0301|POTASSIUM, BLOOD|Tricare|TRICARE EAST REGION|147.50||||||| 84132|EAP|0301|POTASSIUM, BLOOD|NON CONTRACTED|COMMERCIAL OTHER 1|147.50||||147.50||| 84132|EAP|0301|POTASSIUM, BLOOD|Managed Medicare|BCBS MEDICARE PPO MA|147.50||||||| 84133|EAP|0300|STONE RISK POTASSIUM|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|138.25||||||| 84133|EAP|0300|STONE RISK POTASSIUM|Medicaid|MEDICAID|138.25||||||| 84134|EAP|0301|PREALBUMIN|Blue Cross PPO Specialty|BCBSTX PPO|||||81.50||| 84134|EAP|0301|PREALBUMIN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.71||||||| 84134|EAP|0301|PREALBUMIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.71||||81.50||| 84134|EAP|0301|PREALBUMIN|Humana Medicare Advantage|HUMANA MA|2.71||||176.25||| 84134|EAP|0301|PREALBUMIN|Medicaid|MEDICAID|2.71||||||| 84134|EAP|0301|PREALBUMIN|Medicare|MEDICARE ACUTE|2.71||||81.50||| 84134|EAP|0301|PREALBUMIN|Workers Compensation|WORKERS COMPENSATION OTHER|||||81.50||| 84134|EAP|0301|PREALBUMIN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.71||||81.50||| 84134|EAP|0301|PREALBUMIN|NON CONTRACTED|COMMERCIAL OTHER 1|2.71||||||| 84134|EAP|0301|PREALBUMIN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||81.50||| 84134|EAP|0301|PREALBUMIN|Blue Cross HMO Specialty|BCBSTX HMO|2.71||||||| 84134|EAP|0301|PREALBUMIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.71||||||| 84134|EAP|0301|PREALBUMIN|Aenta Medicare Advantage|AETNA MEDICARE MA|2.71||||2.71||| 84134|EAP|0301|PREALBUMIN|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.71||||||| 84134|EAP|0301|PREALBUMIN|United Medicare Advantage|UHC MEDICARE GOLD MA|2.71||||2.71||| 84144|EAP|0301||Cigna|CIGNA|||||201.25||| 84144|EAP|0301||United Medicare Advantage|UHC MEDICARE GOLD MA|||||201.25||| 84144|EAP|0301||Medicare|MEDICARE ACUTE|||||201.25||| 84144|EAP|0301||Medicaid|MEDICAID|||||201.25||| 84144|EAP|0301||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||201.25||| 84144|EAP|0301||United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||201.25||| 84144|EAP|0301||Managed Medicaid|MEDICAID SUPERIOR|||||201.25||| 84144|EAP|0301||Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||201.25||| 84144|EAP|0301||Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||201.25||| 84144|EAP|0301||Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||201.25||| 84144|EAP|0301||Managed Medicaid|MEDICAID AMERIGROUP|||||201.25||| 84146|EAP|0301|PROLACTIN (FROZEN)|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||186.75||| 84146|EAP|0301|PROLACTIN (FROZEN)|Managed Medicaid|MEDICAID AMERIGROUP|||||186.75||| 84146|EAP|0301|PROLACTIN (FROZEN)|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||186.75||| 84146|EAP|0301|PROLACTIN (FROZEN)|Medicaid|MEDICAID|||||186.75||| 84146|EAP|0301|PROLACTIN (FROZEN)|Medicare|MEDICARE ACUTE|||||186.75||| 84146|EAP|0301|PROLACTIN (FROZEN)|United Healthcare|UNITED HEALTHCARE|||||186.75||| 84146|EAP|0301|PROLACTIN (FROZEN)|United Medicare Advantage|UHC MEDICARE GOLD MA|||||186.75||| 84146|EAP|0301|PROLACTIN (FROZEN)|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||186.75||| 84146|EAP|0301|PROLACTIN (FROZEN)|NON CONTRACTED|COMMERCIAL OTHER 1|||||186.75||| 84146|EAP|0301|PROLACTIN (FROZEN)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||186.75||| 84146|EAP|0301|PROLACTIN (FROZEN)|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||186.75||| 84146|EAP|0301|PROLACTIN (FROZEN)|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||186.75||| 84146|EAP|0301|PROLACTIN (FROZEN)|Managed Medicaid|MEDICAID SUPERIOR|||||186.75||| 84146|EAP|0301|PROLACTIN (FROZEN)|Blue Cross PPO Specialty|BCBSTX PPO|||||186.75||| 84153|EAP|0301||Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||177.25||| 84153|EAP|0301||United Medicare Advantage|UHC MEDICARE GOLD MA|||||177.25||| 84153|EAP|0301||Medicaid|MOLINA HEALTHCARE OF TEXAS|||||177.25||| 84153|EAP|0301||United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||177.25||| 84153|EAP|0301||Medicaid|MEDICAID|||||177.25||| 84153|EAP|0301||Managed Medicare|BCBS MEDICARE PPO MA|||||177.25||| 84153|EAP|0301||Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||177.25||| 84153|EAP|0301||United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||177.25||| 84153|EAP|0301||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|590.75||||||| 84153|EAP|0301||Humana Medicare Advantage|HUMANA MA|||||177.25||| 84153|EAP|0301||Blue Cross PPO Specialty|BCBSTX PPO|||||177.25||| 84153|EAP|0301||United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||177.25||| 84153|EAP|0301||Managed Medicaid|MEDICAID AMERIGROUP|||||177.25||| 84153|EAP|0301||Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||177.25||| 84153|EAP|0301||Managed Medicare|HEALTHSPRING MA|||||177.25||| 84153|EAP|0301||Medicare|MEDICARE ACUTE|||||177.25||| 84153|EAP|0301||Managed Medicaid|MEDICAID SUPERIOR|||||177.25||| 84155|EAP|0301|PROTEIN, TOTAL, SERUM|Humana Medicare Advantage|HUMANA MA|117.75||||117.75||| 84155|EAP|0301|PROTEIN, TOTAL, SERUM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||35.25||| 84155|EAP|0301|PROTEIN, TOTAL, SERUM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||35.25||| 84155|EAP|0301|PROTEIN, TOTAL, SERUM|Aetna|AETNA PPO|||||35.25||| 84155|EAP|0301|PROTEIN, TOTAL, SERUM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||35.25||| 84155|EAP|0301|PROTEIN, TOTAL, SERUM|Medicare|MEDICARE ACUTE|117.75||||35.25||| 84156|EAP|0301|PROTEIN URINE 24 HR|NON CONTRACTED|COMMERCIAL OTHER 1|||||117.75||| 84156|EAP|0301|PROTEIN URINE 24 HR|Medicare|MEDICARE ACUTE|||||35.25||| 84156|EAP|0301|PROTEIN URINE 24 HR|Humana Medicare Advantage|HUMANA MA|117.75||||||| 84156|EAP|0301|PROTEIN URINE 24 HR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||35.25||| 84156|EAP|0301|PROTEIN URINE 24 HR|Managed Medicaid|MEDICAID AMERIGROUP|||||35.25||| 84157|EAP|0301|PROTEIN OTHER SOURCES|United Medicare Advantage|UHC MEDICARE GOLD MA|119.25||||||| 84157|EAP|0301|PROTEIN, SPINAL FLUID|Blue Cross PPO Specialty|BCBSTX PPO|||||119.25||| 84157|EAP|0301|PROTEIN, SPINAL FLUID|Managed Medicaid|MEDICAID SUPERIOR|||||119.25||| 84157|EAP|0301|PROTEIN, SPINAL FLUID|Medicare|MEDICARE ACUTE|119.25||||||| 84157|EAP|0301|PROTEIN OTHER SOURCES|Medicare|MEDICARE ACUTE|119.25||||||| 84165|EAP|0301|PROTEIN ELECTROPHORESIS S|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||103.50||| 84165|EAP|0301|PROTEIN ELECTROPHORESIS S|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||103.50||| 84165|EAP|0301|PROTEIN ELECTROPHORESIS S|Humana Medicare Advantage|HUMANA MA|3.45||||3.45||| 84165|EAP|0301|PROTEIN ELECTROPHORESIS S|Medicare|MEDICARE ACUTE|3.45||||103.50||| 84165|EAP|0301|PROTEIN ELECTROPHORESIS S|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||103.50||| 84165|EAP|0301|PROTEIN ELECTROPHORESIS S|Aetna|AETNA PPO|||||103.50||| 84166|EAP|0300|PROTEIN ELECTROPHORESIS O|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.72||| 84166|EAP|0300|PROTEIN ELECTROPHORESIS O|Medicare|MEDICARE ACUTE|||||1.72||| 84207|EAP|0300|ASSAY OF VITAMIN B-6|Medicare|MEDICARE ACUTE|||||2.46||| 84207|EAP|0300|ASSAY OF VITAMIN B-6|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.46||| 84234|EAP|0301|PROGESTERONE LEVEL|Blue Cross HMO Specialty|BCBSTX HMO|||||201.25||| 84234|EAP|0301|PROGESTERONE LEVEL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||201.25||| 84234|EAP|0301|PROGESTERONE LEVEL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||201.25||| 84234|EAP|0301|PROGESTERONE LEVEL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||201.25||| 84234|EAP|0301|PROGESTERONE LEVEL|Blue Cross PPO Specialty|BCBSTX OTHER|||||201.25||| 84234|EAP|0301|PROGESTERONE LEVEL|Blue Cross PPO Specialty|BCBSTX PPO|||||201.25||| 84234|EAP|0301|PROGESTERONE LEVEL|Cigna|CIGNA|||||201.25||| 84234|EAP|0301|PROGESTERONE LEVEL|NON CONTRACTED|COMMERCIAL OTHER 1|||||201.25||| 84234|EAP|0301|PROGESTERONE LEVEL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||201.25||| 84234|EAP|0301|PROGESTERONE LEVEL|United Healthcare|UNITED HEALTHCARE|||||201.25||| 84234|EAP|0301|PROGESTERONE LEVEL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||201.25||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|615.60||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|NON CONTRACTED|COMMERCIAL OTHER 1|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|Managed Medicare|HEALTHSPRING MA|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|United Healthcare|TML GROUP BENEFITS|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|United Healthcare|UNITED HEALTHCARE OTHER|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|United Healthcare|UNITED HEALTHCARE|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|Tricare|TRICARE EAST REGION|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|Medicare|MEDICARE ACUTE|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|Blue Cross PPO Specialty|BCBSTX PPO|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|Blue Cross PPO Specialty|BCBSTX OTHER|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|Medicaid|MEDICAID|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|Blue Cross HMO Specialty|BCBSTX HMO|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|United Medicare Advantage|UHC MEDICARE GOLD MA|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|Managed Medicaid|MEDICAID SUPERIOR|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|Medicaid|MEDICAID TEXAS CHILDRENS|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|Managed Medicaid|MEDICAID AMERIGROUP|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|Access Direct Platinum|HEALTHFIRST TPA UMR|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|Cigna|CIGNA|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||185.60||| 84270|EAP|0300|ASSAY SEX HORMONE GLOBULI|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||185.60||| 84295|EAP|0301|SODIUM, BLOOD|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||46.50||| 84295|EAP|0301|SODIUM, BLOOD|Medicare|MEDICARE ACUTE|||||46.50||| 84300|EAP|0301|SODIUM, URINE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|156.25||||156.25||| 84300|EAP|0301|SODIUM, URINE|United Medicare Advantage|UHC MEDICARE GOLD MA|156.25||||156.25||| 84300|EAP|0301|SODIUM, URINE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|156.25||||||| 84300|EAP|0301|SODIUM, URINE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||156.25||| 84300|EAP|0301|SODIUM, URINE|Aenta Medicare Advantage|AETNA MEDICARE MA|156.25||||||| 84300|EAP|0301|SODIUM, URINE|Humana Medicare Advantage|HUMANA MA|156.25||||156.25||| 84300|EAP|0301|SODIUM, URINE|Veterans Affairs|VETERANS ADMINISTRATION|||||156.25||| 84300|EAP|0301|SODIUM, URINE|Medicare|MEDICARE ACUTE|156.25||||156.25||| 84300|EAP|0301|SODIUM, URINE|Blue Cross PPO Specialty|BCBSTX PPO|156.25||||0.47||| 84300|EAP|0301|SODIUM, URINE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|156.25||||||| 84300|EAP|0301|SODIUM, URINE|Medicaid|MEDICAID|156.25||||||| 84300|EAP|0301|SODIUM, URINE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|156.25||||||| 84300|EAP|0301|SODIUM, URINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|156.25||||156.25||| 84305|EAP|0300|ASSAY OF SOMATOMEDIN|Managed Medicaid|MEDICAID SUPERIOR|||||173.60||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|829.50||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|United Healthcare|TML GROUP BENEFITS|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|Medicare|MEDICARE ACUTE|829.50||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|Medicaid|MEDICAID|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|Managed Medicare|HEALTHSPRING MA|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|Tricare|TRICARE EAST REGION|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|Access Direct Platinum|HEALTHFIRST TPA UMR|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|United Healthcare|UNITED HEALTHCARE|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|Aetna|AETNA PPO|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|Humana Medicare Advantage|HUMANA MA|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|Managed Medicaid|MEDICAID AMERIGROUP|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|Cigna|CIGNA|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|Managed Medicaid|MEDICAID SUPERIOR|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|United Healthcare|UNITED HEALTHCARE OTHER|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|Blue Cross HMO Specialty|BCBSTX HMO|||||2.49||| 84403|EAP|0301|TESTOSTERONE LEVEL TOTAL|Blue Cross PPO Specialty|BCBSTX PPO|||||2.49||| 84432|EAP|0301|THYROGLOBULIN, SERUM|Medicare|MEDICARE ACUTE|||||81.75||| 84432|EAP|0301|THYROGLOBULIN, SERUM|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||81.75||| 84436|EAP|0301|T4 THYROXINE|Blue Cross PPO Specialty|BCBSTX PPO|||||66.25||| 84436|EAP|0301|T4 THYROXINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||66.25||| 84436|EAP|0301|T4 THYROXINE|Cigna|CIGNA|||||143.50||| 84436|EAP|0301|T4 THYROXINE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||66.25||| 84436|EAP|0301|T4 THYROXINE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||66.25||| 84436|EAP|0301|T4 THYROXINE|Humana Medicare Advantage|HUMANA MA|220.75||||||| 84436|EAP|0301|T4 THYROXINE|Managed Medicaid|MEDICAID SUPERIOR|||||66.25||| 84436|EAP|0301|T4 THYROXINE|Managed Medicaid|MEDICAID AMERIGROUP|||||66.25||| 84436|EAP|0301|T4 THYROXINE|Medicare|MEDICARE ACUTE|220.75||||66.25||| 84436|EAP|0301|T4 THYROXINE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||66.25||| 84436|EAP|0301|T4 THYROXINE|Managed Medicare|BCBS MEDICARE PPO MA|220.75||||||| 84436|EAP|0301|T4 THYROXINE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||66.25||| 84436|EAP|0301|T4 THYROXINE|NON CONTRACTED|COMMERCIAL OTHER 1|||||66.25||| 84436|EAP|0301|T4 THYROXINE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||220.75||| 84436|EAP|0301|T4 THYROXINE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||66.25||| 84436|EAP|0301|T4 THYROXINE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|220.75||||66.25||| 84436|EAP|0301|T4 THYROXINE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||66.25||| 84439|EAP|0301|T4 FREE THYROXINE|United Healthcare|UNITED HEALTHCARE OTHER|||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Medicaid|MEDICAID|289.75||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Medicaid|MEDICAID TEXAS CHILDRENS|||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Tricare|TRICARE EAST REGION|||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Managed Medicare|HEALTHSPRING MA|289.75||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Managed Medicare|BCBS MEDICARE PPO MA|||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|United Healthcare|UNITED HEALTHCARE|289.75||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|United Healthcare|GEHA|||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|United Healthcare|TML GROUP BENEFITS|||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|NON CONTRACTED|COMMERCIAL OTHER 1|289.75||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|289.75||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|United Healthcare|UNITED HEALTHCARE|||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Blue Cross PPO Specialty|BCBSTX OTHER|||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Aetna|AETNA QHP HMO|||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Aetna|AETNA PPO|289.75||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Managed Medicaid|MEDICAID SUPERIOR|||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Cigna|CIGNA|||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Humana Medicare Advantage|HUMANA MA|289.75||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Aenta Medicare Advantage|AETNA MEDICARE MA|289.75||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Medicare|MEDICARE ACUTE|289.75||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Blue Cross HMO Specialty|BCBSTX HMO|||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Managed Medicaid|MEDICAID AMERIGROUP|||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Blue Cross PPO Specialty|BCBSTX PPO|||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|289.75||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|289.75||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|289.75||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|United Medicare Advantage|UHC MEDICARE GOLD MA|289.75||||0.87||| 84439|EAP|0301|T4 FREE THYROXINE|Workers Compensation|WORKERS COMPENSATION OTHER|289.75||||||| 84439|EAP|0301|T4 FREE THYROXINE|Veterans Affairs|VETERANS ADMINISTRATION|289.75||||||| 84443|EAP|0301|TSH|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|539.75||||1.62||| 84443|EAP|0301|TSH|Workers Compensation|WORKERS COMPENSATION OTHER|539.75||||||| 84443|EAP|0301|TSH|United Medicare Advantage|UHC MEDICARE GOLD MA|539.75||||1.62||| 84443|EAP|0301|TSH|Veterans Affairs|VETERANS ADMINISTRATION|539.75||||539.75||| 84443|EAP|0301|TSH|Cigna|CIGNA|539.75||||1.62||| 84443|EAP|0301|TSH|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|539.75||||1.62||| 84443|EAP|0301|TSH|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||1.62||| 84443|EAP|0301|TSH|Blue Cross PPO Specialty|BCBSTX OTHER|539.75||||1.62||| 84443|EAP|0301|TSH|Blue Cross PPO Specialty|BCBSTX PPO|539.75||||1.62||| 84443|EAP|0301|TSH|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|539.75||||1.62||| 84443|EAP|0301|TSH|Access Direct Platinum|HEALTHFIRST TPA UMR|||||1.62||| 84443|EAP|0301|TSH|Aetna|AETNA OTHER|539.75||||||| 84443|EAP|0301|TSH|Aetna|AETNA PPO|539.75||||1.62||| 84443|EAP|0301|TSH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|539.75||||1.62||| 84443|EAP|0301|TSH|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1.62||| 84443|EAP|0301|TSH|Blue Cross PPO Specialty|BLUE SHIELD PHYSICIAN|||||1.62||| 84443|EAP|0301|TSH|Cigna|CIGNA|||||1.62||| 84443|EAP|0301|TSH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.62||| 84443|EAP|0301|TSH|Humana Medicare Advantage|HUMANA MA|539.75||||1.62||| 84443|EAP|0301|TSH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|539.75||||1.62||| 84443|EAP|0301|TSH|Aenta Medicare Advantage|AETNA MEDICARE MA|539.75||||1.62||| 84443|EAP|0301|TSH|Managed Medicaid|MEDICAID AMERIGROUP|||||1.62||| 84443|EAP|0301|TSH|Managed Medicaid|MEDICAID SUPERIOR|||||1.62||| 84443|EAP|0301|TSH|Blue Cross HMO Specialty|BCBSTX HMO|539.75||||1.62||| 84443|EAP|0301|TSH|Medicare|MEDICARE PART B ONLY IP|539.75||||||| 84443|EAP|0301|TSH|Medicare|MEDICARE ACUTE|539.75||||1.62||| 84443|EAP|0301|TSH|ChampVA|CHAMPVA CENTER|||||1.62||| 84443|EAP|0301|TSH|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|539.75||||1.62||| 84443|EAP|0301|TSH|Aetna|AETNA QHP HMO|||||539.75||| 84443|EAP|0301|TSH|United Healthcare|UNITED HEALTHCARE|||||1.62||| 84443|EAP|0301|TSH|United Healthcare|UNITED HEALTHCARE ERS|||||1.62||| 84443|EAP|0301|TSH|Multiplan|NALC|||||1.62||| 84443|EAP|0301|TSH|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||1.62||| 84443|EAP|0301|TSH|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|539.75||||1.62||| 84443|EAP|0301|TSH|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.62||| 84443|EAP|0301|TSH|Medicaid|MEDICAID HMO|||||1.62||| 84443|EAP|0301|TSH|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.62||| 84443|EAP|0301|TSH|Medicaid|MEDICAID|539.75||||1.62||| 84443|EAP|0301|TSH|United Medicare Advantage|AARP UHC WEST COMPLETE MA|539.75||||1.62||| 84443|EAP|0301|TSH|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||350.88||| 84443|EAP|0301|TSH|Tricare|TRICARE FOR LIFE|||||1.62||| 84443|EAP|0301|TSH|Managed Medicare|HEALTHSPRING MA|539.75||||1.62||| 84443|EAP|0301|TSH|PHCS|GREAT WEST LIFE AND ANNUITY|||||1.62||| 84443|EAP|0301|TSH|Managed Medicare|BCBS MEDICARE PPO MA|539.75||||1.62||| 84443|EAP|0301|TSH|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|539.75||||1.62||| 84443|EAP|0301|TSH|NON CONTRACTED|COMMERCIAL OTHER 1|539.75||||1.62||| 84443|EAP|0301|TSH|United Healthcare|GEHA|||||1.62||| 84443|EAP|0301|TSH|United Healthcare|UNITED HEALTHCARE OTHER|||||1.62||| 84443|EAP|0301|TSH|United Healthcare|UNITED HEALTHCARE|539.75||||1.62||| 84443|EAP|0301|TSH|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.62||| 84443|EAP|0301|TSH|United Healthcare|TML GROUP BENEFITS|||||1.62||| 84443|EAP|0301|TSH|Tricare|TRICARE EAST REGION|539.75||||1.62||| 84450|EAP|0301|SGOT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.50||| 84450|EAP|0301|SGOT|Aetna|AETNA QHP HMO|||||0.50||| 84460|EAP|0301|SGPT|Aetna|AETNA QHP HMO|||||0.51||| 84460|EAP|0301|SGPT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.51||| 84466|EAP|0301|TRANSFERRIN|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||88.75||| 84466|EAP|0301|TRANSFERRIN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||88.75||| 84466|EAP|0301|TRANSFERRIN|Medicare|MEDICARE ACUTE|||||88.75||| 84466|EAP|0301|TRANSFERRIN|Tricare|TRICARE EAST REGION|||||88.75||| 84466|EAP|0301|TRANSFERRIN|Managed Medicare|HEALTHSPRING MA|||||88.75||| 84466|EAP|0301|TRANSFERRIN|NON CONTRACTED|COMMERCIAL OTHER 1|||||88.75||| 84466|EAP|0301|TRANSFERRIN|United Healthcare|UNITED HEALTHCARE|||||88.75||| 84466|EAP|0301|TRANSFERRIN|Blue Cross PPO Specialty|BCBSTX PPO|||||88.75||| 84466|EAP|0301|TRANSFERRIN|Blue Cross HMO Specialty|BCBSTX HMO|||||88.75||| 84466|EAP|0301|TRANSFERRIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||88.75||| 84466|EAP|0301|TRANSFERRIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||88.75||| 84478|EAP|0301|TRIGLYCERIDES, BLOOD|Blue Cross PPO Specialty|BCBSTX PPO|184.75||||||| 84478|EAP|0301|TRIGLYCERIDES, BLOOD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|184.75||||||| 84478|EAP|0301|TRIGLYCERIDES, BLOOD|United Medicare Advantage|AARP UHC WEST COMPLETE MA|184.75||||||| 84478|EAP|0301|TRIGLYCERIDES, BLOOD|Medicare|MEDICARE ACUTE|184.75||||184.75||| 84479|EAP|0301|T3 UPTAKE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||62.50||| 84479|EAP|0301|T3 UPTAKE|Medicare|MEDICARE ACUTE|2.08||||62.50||| 84479|EAP|0301|T3 UPTAKE|Blue Cross PPO Specialty|BCBSTX PPO|||||62.50||| 84479|EAP|0301|T3 UPTAKE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||62.50||| 84479|EAP|0301|T3 UPTAKE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||62.50||| 84479|EAP|0301|T3 UPTAKE|Cigna|CIGNA|||||2.08||| 84480|EAP|0301|T3 BY RIA|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||62.50||| 84480|EAP|0300|TOTAL T3|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3.86||| 84480|EAP|0300|TOTAL T3|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||3.86||| 84480|EAP|0300|TOTAL T3|Blue Cross HMO Specialty|BCBSTX HMO|||||3.86||| 84480|EAP|0300|TOTAL T3|Managed Medicaid|MEDICAID AMERIGROUP|||||3.86||| 84480|EAP|0300|TOTAL T3|Blue Cross PPO Specialty|BCBSTX PPO|||||3.86||| 84480|EAP|0300|TOTAL T3|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.86||| 84480|EAP|0300|TOTAL T3|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.86||| 84480|EAP|0300|TOTAL T3|Cigna|CIGNA|||||3.86||| 84480|EAP|0300|TOTAL T3|Access Direct Platinum|HEALTHFIRST TPA UMR|||||3.86||| 84480|EAP|0300|TOTAL T3|Tricare|TRICARE EAST REGION|||||3.86||| 84480|EAP|0300|TOTAL T3|Medicare|MEDICARE ACUTE|3.86||||3.86||| 84480|EAP|0300|TOTAL T3|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3.86||| 84480|EAP|0300|TOTAL T3|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.86||| 84481|EAP|0300|FREE T3|Workers Compensation|WORKERS COMPENSATION OTHER|544.25||||||| 84481|EAP|0300|FREE T3|United Medicare Advantage|UHC MEDICARE GOLD MA|544.25||||163.50||| 84481|EAP|0300|FREE T3|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||163.50||| 84481|EAP|0300|FREE T3|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||163.50||| 84481|EAP|0300|FREE T3|Managed Medicare|HEALTHSPRING MA|544.25||||||| 84481|EAP|0300|FREE T3|NON CONTRACTED|COMMERCIAL OTHER 1|||||163.50||| 84481|EAP|0300|FREE T3|Tricare|TRICARE EAST REGION|||||163.50||| 84481|EAP|0300|FREE T3|Medicare|MEDICARE ACUTE|544.25||||163.50||| 84481|EAP|0300|FREE T3|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||163.50||| 84481|EAP|0300|FREE T3|United Healthcare|UNITED HEALTHCARE|||||163.50||| 84481|EAP|0300|FREE T3|Medicaid|MEDICAID|||||163.50||| 84481|EAP|0300|FREE T3|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|544.25||||||| 84481|EAP|0300|FREE T3|Tricare|TRICARE FOR LIFE|||||163.50||| 84481|EAP|0300|FREE T3|Blue Cross PPO Specialty|BCBSTX PPO|||||163.50||| 84481|EAP|0300|FREE T3|Aetna|AETNA PPO|544.25||||163.50||| 84481|EAP|0300|FREE T3|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||163.50||| 84481|EAP|0300|FREE T3|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||163.50||| 84481|EAP|0300|FREE T3|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||163.50||| 84481|EAP|0300|FREE T3|Humana Medicare Advantage|HUMANA MA|544.25||||544.25||| 84481|EAP|0300|FREE T3|Blue Cross HMO Specialty|BCBSTX HMO|||||163.50||| 84481|EAP|0300|FREE T3|Managed Medicaid|MEDICAID AMERIGROUP|||||163.50||| 84481|EAP|0300|FREE T3|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||163.50||| 84484|EAP|0301||Blue Cross PPO Specialty|BCBSTX OTHER|2.68||||2.68||| 84484|EAP|0301||Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.68||| 84484|EAP|0301||Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.68||| 84484|EAP|0301||Aetna|AETNA OTHER|2.68||||||| 84484|EAP|0301||Humana Medicare Advantage|HUMANA MA|2.68||||2.68||| 84484|EAP|0301||Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|0.95||||0.95||| 84484|EAP|0301||Blue Cross PPO Specialty|BCBSTX PPO|2.68||||2.68||| 84484|EAP|0301||Cigna|CIGNA|2.68||||||| 84484|EAP|0301||Managed Medicaid|MEDICAID AMERIGROUP|2.68||||2.68||| 84484|EAP|0301||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.68||||2.68||| 84484|EAP|0301||Aenta Medicare Advantage|AETNA MEDICARE MA|2.68||||2.68||| 84484|EAP|0301||Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.68||||2.68||| 84484|EAP|0301||Managed Medicaid|MEDICAID SUPERIOR|2.68||||2.68||| 84484|EAP|0301||Medicare|MEDICARE PART B ONLY IP|2.68||||||| 84484|EAP|0301||Access Direct Platinum|HEALTHFIRST TPA UMR|2.68||||||| 84484|EAP|0301||Medicaid|MEDICAID TEXAS CHILDRENS|||||0.95||| 84484|EAP|0301||Blue Cross HMO Specialty|BCBSTX HMO|2.68||||2.68||| 84484|EAP|0301||Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.68||||2.68||| 84484|EAP|0301||Medicaid|MEDICAID|2.68||||2.68||| 84484|EAP|0301||Medicare|MEDICARE ACUTE|2.68||||2.68||| 84484|EAP|0301||NON CONTRACTED|COMMERCIAL OTHER 1|2.68||||2.68||| 84484|EAP|0301||Tricare|TRICARE EAST REGION|2.68||||||| 84484|EAP|0301||Managed Medicare|MEDICARE RAILROAD|||||2.68||| 84484|EAP|0301||Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.68||||2.68||| 84484|EAP|0301||Managed Medicare|HEALTHSPRING MA|2.68||||2.68||| 84484|EAP|0301||Managed Medicare|BCBS MEDICARE PPO MA|||||2.68||| 84484|EAP|0301||United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.68||||2.68||| 84484|EAP|0301||United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.68||||2.68||| 84484|EAP|0301||Aetna|AETNA PPO|2.68||||||| 84484|EAP|0301||Veterans Affairs|VETERANS ADMINISTRATION|2.68||||||| 84484|EAP|0301||Veterans Affairs|VETERANS ADMINISTRATION|2.68||||2.68||| 84484|EAP|0301||United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.68||||2.68||| 84484|EAP|0301||United Medicare Advantage|UHC MEDICARE GOLD MA|2.68||||2.68||| 84484|EAP|0301||United Healthcare|UNITED HEALTHCARE|2.68||||||| 84484|EAP|0301||United Healthcare|UMR UNITED MEDICAL RESOURCES|2.68||||||| 84512|EAP|0301|TROPONIN QUAN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Veterans Affairs|VETERANS ADMINISTRATION|2.68||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Veterans Affairs|VETERANS ADMINISTRATION|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Medicare|MEDICARE ACUTE|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|NON CONTRACTED|COMMERCIAL OTHER 1|2.68||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Medicaid|MEDICAID|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Managed Medicare|OTHER INSTITUTIONS|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Managed Medicare|BCBS MEDICARE PPO MA|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|NON CONTRACTED|WOOD COUNTY HOSPITAL DISTRICT|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Managed Medicare|HEALTHSPRING MA|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|United Healthcare|TML GROUP BENEFITS|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|United Healthcare|UNITED HEALTHCARE|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|United Healthcare|UNITED HEALTHCARE OTHER|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|United Healthcare|UNITED HEALTHCARE|2.68||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|United Healthcare|GEHA|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Tricare|TRICARE EAST REGION|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Cigna|CIGNA|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Medicaid|WOOD COUNTY INDIGENT|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Blue Cross PPO Specialty|BCBSTX PPO|2.68||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Aetna|AETNA OTHER|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Aetna|AETNA PPO|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Blue Cross HMO Specialty|BCBSTX HMO|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Humana Medicare Advantage|HUMANA MA|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.68||| 84512|EAP|0301|TROPONIN QUAN|Aetna|AETNA QHP HMO|||||2.68||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|Managed Medicaid|MEDICAID AMERIGROUP|126.75||||||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|Aetna|AETNA PPO|||||0.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|Aetna|AETNA OTHER|||||0.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|Humana Medicare Advantage|HUMANA MA|126.75||||0.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|Blue Cross HMO Specialty|BCBSTX HMO|||||0.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|Blue Cross PPO Specialty|BCBSTX PPO|||||0.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|126.75||||82.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|Medicare|MEDICARE ACUTE|126.75||||0.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|NON CONTRACTED|COMMERCIAL OTHER 2|||||0.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|Managed Medicare|HEALTHSPRING MA|||||0.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|Blue Cross PPO Specialty|BCBSTX OTHER|||||0.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|Managed Medicare|BCBS MEDICARE PPO MA|||||0.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|United Healthcare|UNITED HEALTHCARE|||||0.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|Medicaid|MEDICAID|126.75||||0.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|Tricare|TRICARE EAST REGION|||||82.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|Managed Medicaid|MEDICAID SUPERIOR|||||0.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.38||| 84520|EAP|0301|BUN, UREA NITROGEN BLOOD|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.38||| 84550|EAP|0301|URIC ACID, BLOOD|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|United Medicare Advantage|UHC MEDICARE GOLD MA|1.45||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|Medicare|MEDICARE ACUTE|1.45||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|NON CONTRACTED|COMMERCIAL OTHER 1|||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|Tricare|TRICARE FOR LIFE|||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|Tricare|TRICARE EAST REGION|||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|Managed Medicare|HEALTHSPRING MA|||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|Managed Medicare|BCBS MEDICARE PPO MA|1.45||||94.25||| 84550|EAP|0301|URIC ACID, BLOOD|United Healthcare|UNITED HEALTHCARE|||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|Medicaid|MEDICAID|||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|United Healthcare|UNITED HEALTHCARE OTHER|||||94.25||| 84550|EAP|0301|URIC ACID, BLOOD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|United Healthcare|TML GROUP BENEFITS|||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|Blue Cross PPO Specialty|BCBSTX OTHER|||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|Blue Cross PPO Specialty|BCBSTX PPO|||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|Aetna|AETNA PPO|||||94.25||| 84550|EAP|0301|URIC ACID, BLOOD|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.45||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|Aetna|AETNA OTHER|||||1.45||| 84550|EAP|0301|URIC ACID, BLOOD|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.45||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|Access Direct Platinum|HEALTHFIRST TPA UMR|||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.45||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|Blue Cross HMO Specialty|BCBSTX HMO|||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|Managed Medicaid|MEDICAID SUPERIOR|||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|Cigna|CIGNA|||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|Managed Medicaid|MEDICAID AMERIGROUP|||||94.25||| 84550|EAP|0301|URIC ACID, BLOOD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||43.50||| 84550|EAP|0301|URIC ACID, BLOOD|Humana Medicare Advantage|HUMANA MA|1.45||||1.45||| 84590|EAP|0300|ASSAY OF VITAMIN A|Medicare|MEDICARE ACUTE|||||95.70||| 84681|EAP|0301|C-PEPTIDE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||200.50||| 84681|EAP|0301|C-PEPTIDE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||200.50||| 84681|EAP|0301|C-PEPTIDE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||200.50||| 84681|EAP|0301|C-PEPTIDE|Blue Cross PPO Specialty|BCBSTX PPO|||||200.50||| 84681|EAP|0301|C-PEPTIDE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||200.50||| 84681|EAP|0301|C-PEPTIDE|Blue Cross HMO Specialty|BCBSTX HMO|||||200.50||| 84681|EAP|0301|C-PEPTIDE|Medicare|MEDICARE ACUTE|||||200.50||| 84681|EAP|0301|C-PEPTIDE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||200.50||| 84681|EAP|0301|C-PEPTIDE|United Healthcare|UNITED HEALTHCARE|||||200.50||| 84681|EAP|0301|C-PEPTIDE|United Healthcare|TML GROUP BENEFITS|||||200.50||| 84702|EAP|0301|HCG QUANT|NON CONTRACTED|COMMERCIAL OTHER 1|||||280.50||| 84702|EAP|0301|HCG QUANT|Medicaid|MEDICAID|||||280.50||| 84702|EAP|0301|HCG QUANT|United Healthcare|UNITED HEALTHCARE|||||280.50||| 84702|EAP|0301|HCG QUANT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||182.38||| 84702|EAP|0301|HCG QUANT|United Healthcare|UNITED HEALTHCARE OTHER|||||280.50||| 84702|EAP|0301|HCG QUANT|Blue Cross PPO Specialty|BCBSTX PPO|||||280.50||| 84702|EAP|0301|HCG QUANT|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||84.25||| 84702|EAP|0301|HCG QUANT|Tricare|TRICARE EAST REGION|||||84.25||| 84702|EAP|0301|HCG QUANT|Aetna|AETNA OTHER|||||280.50||| 84702|EAP|0301|HCG QUANT|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||280.50||| 84702|EAP|0301|HCG QUANT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||182.38||| 84702|EAP|0301|HCG QUANT|Cigna|CIGNA|||||280.50||| 84702|EAP|0301|HCG QUANT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||280.50||| 84702|EAP|0301|HCG QUANT|Managed Medicaid|MEDICAID SUPERIOR|||||280.50||| 84702|EAP|0301|HCG QUANT|Managed Medicaid|MEDICAID AMERIGROUP|280.50||||280.50||| 84703|EAP|0301|HCG QUALITATIVE|Veterans Affairs|VETERANS ADMINISTRATION|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|Blue Cross PPO Specialty|BCBSTX OTHER|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|Aetna|AETNA OTHER|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|Aetna|AETNA PPO|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|Access Direct Platinum|HEALTHFIRST TPA UMR|241.25||||||| 84703|EAP|0301|HCG QUALITATIVE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|Cigna|CIGNA|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|Humana Medicare Advantage|HUMANA MA|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||72.50||| 84703|EAP|0301|HCG QUALITATIVE|Managed Medicaid|MEDICAID AMERIGROUP|241.25||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|Blue Cross HMO Specialty|BCBSTX HMO|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|Blue Cross PPO Specialty|BCBSTX PPO|241.25||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|Managed Medicaid|MEDICAID SUPERIOR|241.25||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|Medicare|MEDICARE ACUTE|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|Medicaid|MEDICAID TEXAS CHILDRENS|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|Medicaid|MEDICAID HMO|||||72.50||| 84703|EAP|0301|HCG QUALITATIVE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|Medicaid|MEDICAID|241.25||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|Tricare|TRICARE EAST REGION|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|NON CONTRACTED|COMMERCIAL OTHER 1|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|United Healthcare|UNITED HEALTHCARE|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|United Healthcare|UNITED HEALTHCARE OTHER|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|United Healthcare|UNITED HEALTHCARE ERS|||||241.25||| 84703|EAP|0301|HCG QUALITATIVE|United Healthcare|UMR UNITED MEDICAL RESOURCES|241.25||||241.25||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Managed Medicare|OTHER INSTITUTIONS|||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Medicare|MEDICARE PART B ONLY IP|110.50||||||| 85007|EAP|0305|MANUAL DIFFERENTIAL|United Healthcare|UNITED HEALTHCARE|110.50||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Tricare|TRICARE EAST REGION|110.50||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|NON CONTRACTED|WOOD COUNTY HOSPITAL DISTRICT|||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Medicaid|MEDICAID HMO|||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Medicaid|WOOD COUNTY INDIGENT|||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||71.88||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Medicaid|MEDICAID|110.50||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|United Healthcare|UNITED HEALTHCARE|||||71.88||| 85007|EAP|0305|MANUAL DIFFERENTIAL|United Healthcare|UNITED HEALTHCARE OTHER|||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|110.50||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Managed Medicare|BCBS MEDICARE PPO MA|||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|110.50||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Blue Cross PPO Specialty|BCBSTX PPO|110.50||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Blue Cross PPO Specialty|BCBSTX OTHER|||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Managed Medicare|HEALTHSPRING MA|110.50||||71.88||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Aetna|AETNA OTHER|||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Cigna|CIGNA|||||33.25||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Aetna|AETNA PPO|110.50||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Aetna|AETNA QHP HMO|||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|110.50||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Managed Medicaid|MEDICAID AMERIGROUP|110.50||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Managed Medicaid|MEDICAID SUPERIOR|110.50||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||33.25||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|110.50||||33.25||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Access Direct Platinum|HEALTHFIRST TPA UMR|110.50||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|NON CONTRACTED|COMMERCIAL OTHER 1|110.50||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|110.50||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|110.50||||33.25||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Cigna|CIGNA|110.50||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Medicare|MEDICARE ACUTE|110.50||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|110.50||||33.25||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Humana Medicare Advantage|HUMANA MA|110.50||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|110.50||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Blue Cross HMO Specialty|BCBSTX HMO|110.50||||33.25||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|110.50||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Workers Compensation|WORKERS COMPENSATION OTHER|110.50||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|110.50||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|110.50||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|110.50||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|110.50||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Veterans Affairs|VETERANS ADMINISTRATION|||||110.50||| 85007|EAP|0305|MANUAL DIFFERENTIAL|Veterans Affairs|VETERANS ADMINISTRATION|110.50||||110.50||| 85014|EAP|0305|HCT (HEMATOCRIT)|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.76||||0.76||| 85014|EAP|0305|HCT (HEMATOCRIT)|United Medicare Advantage|UHC MEDICARE GOLD MA|0.76||||0.76||| 85014|EAP|0305|HCT (HEMATOCRIT)|Aenta Medicare Advantage|AETNA MEDICARE MA|0.76||||||| 85014|EAP|0305|HCT (HEMATOCRIT)|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.76||| 85014|EAP|0305|HCT (HEMATOCRIT)|Managed Medicaid|MEDICAID SUPERIOR|||||0.23||| 85014|EAP|0305|HCT (HEMATOCRIT)|Medicare|MEDICARE ACUTE|0.76||||0.76||| 85014|EAP|0305|HCT (HEMATOCRIT)|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.76||| 85014|EAP|0305|HCT (HEMATOCRIT)|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.23||| 85014|EAP|0305|HCT (HEMATOCRIT)|Managed Medicaid|MEDICAID AMERIGROUP|||||0.23||| 85014|EAP|0305|HCT (HEMATOCRIT)|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.76||||0.76||| 85014|EAP|0305|HCT (HEMATOCRIT)|Humana Medicare Advantage|HUMANA MA|0.76||||0.76||| 85014|EAP|0305|HCT (HEMATOCRIT)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.76||| 85014|EAP|0305|HCT (HEMATOCRIT)|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.76||| 85018|EAP|0305|HEMOGLOBIN|Medicare|MEDICARE ACUTE|0.76||||0.76||| 85018|EAP|0305|HEMOGLOBIN|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.23||| 85018|EAP|0305|HEMOGLOBIN|Medicaid|MEDICAID|||||0.23||| 85018|EAP|0305|HEMOGLOBIN|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.76||| 85018|EAP|0305|HEMOGLOBIN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.76||| 85018|EAP|0305|HEMOGLOBIN|Blue Cross PPO Specialty|BCBSTX PPO|||||0.76||| 85018|EAP|0305|HEMOGLOBIN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.76||| 85018|EAP|0305|HEMOGLOBIN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.76||| 85018|EAP|0305|HEMOGLOBIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.76||| 85018|EAP|0305|HEMOGLOBIN|Humana Medicare Advantage|HUMANA MA|0.76||||0.76||| 85018|EAP|0305|HEMOGLOBIN|Aenta Medicare Advantage|AETNA MEDICARE MA|0.76||||||| 85018|EAP|0305|HEMOGLOBIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.76||||0.76||| 85018|EAP|0305|HEMOGLOBIN|Managed Medicaid|MEDICAID AMERIGROUP|||||0.23||| 85018|EAP|0305|HEMOGLOBIN|Managed Medicaid|MEDICAID SUPERIOR|||||0.23||| 85018|EAP|0305|HEMOGLOBIN|United Medicare Advantage|UHC MEDICARE GOLD MA|0.76||||0.76||| 85018|EAP|0305|HEMOGLOBIN|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|0.76||||||| 85018|EAP|0305|HEMOGLOBIN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.76||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|249.75||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Veterans Affairs|VETERANS ADMINISTRATION|249.75||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|United Medicare Advantage|AARP UHC WEST COMPLETE MA|249.75||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Workers Compensation|WORKERS COMPENSATION OTHER|249.75||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|249.75||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Blue Cross PPO Specialty|BCBSTX PPO|249.75||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Aetna|AETNA QHP HMO|||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Aetna|AETNA OTHER|249.75||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Blue Cross PPO Specialty|BLUE SHIELD PHYSICIAN|||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Aetna|AETNA PPO|249.75||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|0.75||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|ChampVA|CHAMPVA CENTER|||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|249.75||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|249.75||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|249.75||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|United Medicare Advantage|UHC MEDICARE GOLD MA|249.75||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Access Direct Platinum|HEALTHFIRST TPA UMR|249.75||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Cigna|CIGNA|||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|249.75||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Aenta Medicare Advantage|AETNA MEDICARE MA|249.75||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Managed Medicaid|MEDICAID UNITED HEALTHCARE|249.75||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Managed Medicaid|MEDICAID SUPERIOR|249.75||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Medicare|MEDICARE ACUTE|249.75||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Blue Cross HMO Specialty|BCBSTX HMO|249.75||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Managed Medicare|BCBS MEDICARE PPO MA|249.75||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|NON CONTRACTED|WOOD COUNTY HOSPITAL DISTRICT|||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Medicaid|WOOD COUNTY INDIGENT|||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Medicaid|MEDICAID TEXAS CHILDRENS|||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Cigna|CIGNA|249.75||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|249.75||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Blue Cross PPO Specialty|BCBSTX OTHER|249.75||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Managed Medicaid|MEDICAID AMERIGROUP|249.75||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Humana Medicare Advantage|HUMANA MA|249.75||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Medicaid|MEDICAID|249.75||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Medicare|MEDICARE PART B ONLY IP|249.75||||||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Medicaid|MEDICAID HMO|||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|249.75||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Multiplan|NALC|||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|PHCS|HUMANA INSURANCE|||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|PHCS|GREAT WEST LIFE AND ANNUITY|||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Tricare|TRICARE EAST REGION|249.75||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Tricare|TRICARE FOR LIFE|||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Managed Medicare|HEALTHSPRING MA|249.75||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|United Healthcare|GEHA|||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|NON CONTRACTED|COMMERCIAL OTHER 2|||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|United Healthcare|UNITED HEALTHCARE OTHER|||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|United Healthcare|UNITED HEALTHCARE ERS|||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|United Healthcare|UNITED HEALTHCARE|||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|United Healthcare|UMR UNITED MEDICAL RESOURCES|249.75||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|United Healthcare|UNITED HEALTHCARE|249.75||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|NON CONTRACTED|COMMERCIAL OTHER 1|249.75||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|United Healthcare|ZZZZZ UNITED HEALTHCARE|||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|United Healthcare|TML GROUP BENEFITS|249.75||||0.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Managed Medicare|MEDICARE RAILROAD|||||249.75||| 85025|EAP|0305|CBC/DIFF AUTO W/DIFF|Managed Medicare|OTHER INSTITUTIONS|249.75||||249.75||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Medicare|MEDICARE PART B ONLY IP|1.76||||||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Medicare|MEDICARE ACUTE|1.76||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Medicaid|WOOD COUNTY INDIGENT|||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||31.20||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Medicaid|MEDICAID HMO|||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||31.20||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Tricare|TRICARE EAST REGION|1.76||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Managed Medicare|HEALTHSPRING MA|1.76||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|United Healthcare|UNITED HEALTHCARE OTHER|||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Managed Medicare|OTHER INSTITUTIONS|||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|United Healthcare|UMR UNITED MEDICAL RESOURCES|1.76||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|United Healthcare|UNITED HEALTHCARE|||||31.20||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|NON CONTRACTED|COMMERCIAL OTHER 1|1.76||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|United Healthcare|UNITED HEALTHCARE|1.76||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Managed Medicare|BCBS MEDICARE PPO MA|||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.76||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|NON CONTRACTED|WOOD COUNTY HOSPITAL DISTRICT|||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Blue Cross PPO Specialty|BCBSTX PPO|1.76||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Managed Medicaid|MEDICAID SUPERIOR|1.76||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Aetna|AETNA QHP HMO|||||103.60||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Aetna|AETNA PPO|1.76||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||31.20||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Aetna|AETNA OTHER|||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|ChampVA|CHAMPVA CENTER|||||31.20||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.76||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.76||||31.20||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Medicaid|MEDICAID|1.76||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.76||||31.20||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Access Direct Platinum|HEALTHFIRST TPA UMR|1.76||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Cigna|CIGNA|1.76||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.76||||31.20||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Humana Medicare Advantage|HUMANA MA|1.76||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Managed Medicaid|MEDICAID AMERIGROUP|1.76||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Aenta Medicare Advantage|AETNA MEDICARE MA|1.76||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Cigna|CIGNA|||||103.60||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.76||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Blue Cross HMO Specialty|BCBSTX HMO|1.76||||31.20||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.76||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.76||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.76||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Veterans Affairs|VETERANS ADMINISTRATION|1.76||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Workers Compensation|WORKERS COMPENSATION OTHER|1.76||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.76||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|Veterans Affairs|VETERANS ADMINISTRATION|||||1.76||| 85027|EAP|0305|CBC AUTO COMPLETE W/O DIF|United Medicare Advantage|UHC MEDICARE GOLD MA|1.76||||1.76||| 85044|EAP|0305|RETICULOCYTE COUNT BLOOD|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|138.25||||41.50||| 85044|EAP|0305|RETICULOCYTE COUNT BLOOD|Veterans Affairs|VETERANS ADMINISTRATION|||||138.25||| 85044|EAP|0305|RETICULOCYTE COUNT BLOOD|United Medicare Advantage|UHC MEDICARE GOLD MA|138.25||||41.50||| 85044|EAP|0305|RETICULOCYTE COUNT BLOOD|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||41.50||| 85044|EAP|0305|RETICULOCYTE COUNT BLOOD|Access Direct Platinum|HEALTHFIRST TPA UMR|||||41.50||| 85044|EAP|0305|RETICULOCYTE COUNT BLOOD|Humana Medicare Advantage|HUMANA MA|||||138.25||| 85044|EAP|0305|RETICULOCYTE COUNT BLOOD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||41.50||| 85044|EAP|0305|RETICULOCYTE COUNT BLOOD|Aenta Medicare Advantage|AETNA MEDICARE MA|138.25||||||| 85044|EAP|0305|RETICULOCYTE COUNT BLOOD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|138.25||||41.50||| 85044|EAP|0305|RETICULOCYTE COUNT BLOOD|Blue Cross PPO Specialty|BCBSTX PPO|||||41.50||| 85044|EAP|0305|RETICULOCYTE COUNT BLOOD|United Medicare Advantage|AARP UHC WEST COMPLETE MA|138.25||||41.50||| 85044|EAP|0305|RETICULOCYTE COUNT BLOOD|Blue Cross HMO Specialty|BCBSTX HMO|||||41.50||| 85044|EAP|0305|RETICULOCYTE COUNT BLOOD|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|138.25||||41.50||| 85044|EAP|0305|RETICULOCYTE COUNT BLOOD|Medicare|MEDICARE ACUTE|138.25||||41.50||| 85044|EAP|0305|RETICULOCYTE COUNT BLOOD|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||41.50||| 85044|EAP|0305|RETICULOCYTE COUNT BLOOD|Medicaid|MEDICAID|138.25||||41.50||| 85044|EAP|0305|RETICULOCYTE COUNT BLOOD|Managed Medicare|HEALTHSPRING MA|||||41.50||| 85044|EAP|0305|RETICULOCYTE COUNT BLOOD|NON CONTRACTED|COMMERCIAL OTHER 1|138.25||||41.50||| 85044|EAP|0305|RETICULOCYTE COUNT BLOOD|Cigna|CIGNA|||||41.50||| 85044|EAP|0305|RETICULOCYTE COUNT BLOOD|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||41.50||| 85044|EAP|0305|RETICULOCYTE COUNT BLOOD|United Healthcare|UNITED HEALTHCARE OTHER|||||41.50||| 85044|EAP|0305|RETICULOCYTE COUNT BLOOD|United Healthcare|UNITED HEALTHCARE|||||138.25||| 85044|EAP|0305|RETICULOCYTE COUNT BLOOD|United Healthcare|UNITED HEALTHCARE|||||41.50||| 85045|EAP|0300|RETIC COUNT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.35||| 85303|EAP|0305|PROTEIN C LEVEL, PLASMA|Medicare|MEDICARE ACUTE|444.25||||||| 85303|EAP|0305|PROTEIN C LEVEL, PLASMA|Aenta Medicare Advantage|AETNA MEDICARE MA|444.25||||||| 85378|EAP|0305||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||151.25||| 85378|EAP|0305||Veterans Affairs|VETERANS ADMINISTRATION|||||151.25||| 85378|EAP|0305||Blue Cross PPO Specialty|BCBSTX PPO|||||151.25||| 85378|EAP|0305||Aetna|AETNA QHP HMO|||||151.25||| 85378|EAP|0305||Aetna|AETNA PPO|||||151.25||| 85378|EAP|0305||Aetna|AETNA OTHER|||||151.25||| 85378|EAP|0305||Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||45.40||| 85378|EAP|0305||Cigna|CIGNA|||||151.25||| 85378|EAP|0305||Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||151.25||| 85378|EAP|0305||Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||151.25||| 85378|EAP|0305||Humana Medicare Advantage|HUMANA MA|||||151.25||| 85378|EAP|0305||Aenta Medicare Advantage|AETNA MEDICARE MA|||||151.25||| 85378|EAP|0305||Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||45.40||| 85378|EAP|0305||Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||151.25||| 85378|EAP|0305||Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||151.25||| 85378|EAP|0305||Blue Cross HMO Specialty|BCBSTX HMO|||||151.25||| 85378|EAP|0305||Blue Cross PPO Specialty|BCBSTX OTHER|||||151.25||| 85378|EAP|0305||Medicare|MEDICARE ACUTE|||||151.25||| 85378|EAP|0305||NON CONTRACTED|COMMERCIAL OTHER 1|||||151.25||| 85378|EAP|0305||Medicaid|WOOD COUNTY INDIGENT|||||151.25||| 85378|EAP|0305||Medicaid|MOLINA HEALTHCARE OF TEXAS|||||151.25||| 85378|EAP|0305||Medicaid|MEDICAID|||||151.25||| 85378|EAP|0305||United Healthcare|UNITED HEALTHCARE OTHER|||||151.25||| 85378|EAP|0305||Tricare|TRICARE EAST REGION|||||151.25||| 85378|EAP|0305||Managed Medicare|OTHER INSTITUTIONS|||||151.25||| 85378|EAP|0305||Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||151.25||| 85378|EAP|0305||United Healthcare|GEHA|||||151.25||| 85378|EAP|0305||United Healthcare|UNITED HEALTHCARE|||||151.25||| 85378|EAP|0305||United Healthcare|UMR UNITED MEDICAL RESOURCES|||||151.25||| 85379|EAP|0305|D-DIMER QUAN|Medicare|MEDICARE ACUTE|151.25||||151.25||| 85379|EAP|0305|D-DIMER QUAN|Medicaid|MEDICAID|151.25||||151.25||| 85379|EAP|0305|D-DIMER QUAN|Medicaid|MEDICAID HMO|||||151.25||| 85379|EAP|0305|D-DIMER QUAN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||151.25||| 85379|EAP|0305|D-DIMER QUAN|NON CONTRACTED|COMMERCIAL OTHER 1|151.25||||||| 85379|EAP|0305|D-DIMER QUAN|Managed Medicare|HEALTHSPRING MA|||||151.25||| 85379|EAP|0305|D-DIMER QUAN|Managed Medicare|BCBS MEDICARE PPO MA|||||151.25||| 85379|EAP|0305|D-DIMER QUAN|United Healthcare|UNITED HEALTHCARE|151.25||||||| 85379|EAP|0305|D-DIMER QUAN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||151.25||| 85379|EAP|0305|D-DIMER QUAN|Blue Cross PPO Specialty|BCBSTX PPO|151.25||||151.25||| 85379|EAP|0305|D-DIMER QUAN|Blue Cross PPO Specialty|BCBSTX OTHER|||||151.25||| 85379|EAP|0305|D-DIMER QUAN|Aetna|AETNA PPO|151.25||||||| 85379|EAP|0305|D-DIMER QUAN|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|45.40||||45.40||| 85379|EAP|0305|D-DIMER QUAN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|151.25||||151.25||| 85379|EAP|0305|D-DIMER QUAN|Blue Cross HMO Specialty|BCBSTX HMO|151.25||||||| 85379|EAP|0305|D-DIMER QUAN|United Medicare Advantage|UHC MEDICARE GOLD MA|||||151.25||| 85379|EAP|0305|D-DIMER QUAN|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|151.25||||151.25||| 85379|EAP|0305|D-DIMER QUAN|Medicaid|MEDICAID TEXAS CHILDRENS|||||45.40||| 85379|EAP|0305|D-DIMER QUAN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|151.25||||151.25||| 85379|EAP|0305|D-DIMER QUAN|Veterans Affairs|VETERANS ADMINISTRATION|||||151.25||| 85379|EAP|0305|D-DIMER QUAN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||151.25||| 85379|EAP|0305|D-DIMER QUAN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|151.25||||151.25||| 85379|EAP|0305|D-DIMER QUAN|Managed Medicaid|MEDICAID AMERIGROUP|151.25||||151.25||| 85379|EAP|0305|D-DIMER QUAN|Aenta Medicare Advantage|AETNA MEDICARE MA|151.25||||151.25||| 85379|EAP|0305|D-DIMER QUAN|Humana Medicare Advantage|HUMANA MA|151.25||||151.25||| 85379|EAP|0305|D-DIMER QUAN|Cigna|CIGNA|151.25||||||| 85379|EAP|0305|D-DIMER QUAN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|151.25||||||| 85379|EAP|0305|D-DIMER QUAN|Medicare|MEDICARE PART B ONLY IP|151.25||||||| 85379|EAP|0305|D-DIMER QUAN|Managed Medicaid|MEDICAID SUPERIOR|||||151.25||| 85384|EAP|0305|FIBRINOGEN LEVEL|United Medicare Advantage|UHC MEDICARE GOLD MA|272.75||||||| 85384|EAP|0305|FIBRINOGEN LEVEL|Medicare|MEDICARE ACUTE|272.75||||||| 854|DRG||INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC|Aetna|AETNA PPO|26,754.45|30.39|30.39|30.39|||| 85610|EAP|0305|PROTHROMBIN TIME|United Medicare Advantage|AARP UHC WEST COMPLETE MA|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|United Medicare Advantage|UHC MEDICARE GOLD MA|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Medicare|MEDICARE PART B ONLY IP|126.25||||||| 85610|EAP|0305|PROTHROMBIN TIME|United Healthcare|UNITED HEALTHCARE|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Medicaid|WOOD COUNTY INDIGENT|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Medicaid|MEDICAID HMO|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Medicaid|MEDICAID TEXAS CHILDRENS|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Medicaid|MEDICAID|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Tricare|TRICARE EAST REGION|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|NON CONTRACTED|WOOD COUNTY HOSPITAL DISTRICT|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Managed Medicare|OTHER INSTITUTIONS|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Managed Medicare|HEALTHSPRING MA|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Managed Medicare|BCBS MEDICARE PPO MA|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Workers Compensation|WORKERS COMPENSATION OTHER|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Managed Medicare|MEDICARE RAILROAD|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|United Healthcare|UNITED HEALTHCARE OTHER|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|United Healthcare|UMR UNITED MEDICAL RESOURCES|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|United Healthcare|TML GROUP BENEFITS|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|United Healthcare|GEHA|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|United Healthcare|UNITED HEALTHCARE|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|NON CONTRACTED|COMMERCIAL OTHER 1|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Blue Cross PPO Specialty|BCBSTX PPO|126.25||||126.25||| 85610|EAP|0300|PROTHROMBIN TIME|Medicare|MEDICARE ACUTE|||||0.42||| 85610|EAP|0305|PROTHROMBIN TIME|Aetna|AETNA PPO|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Aetna|AETNA OTHER|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Aetna|AETNA QHP HMO|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Veterans Affairs|VETERANS ADMINISTRATION|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Medicare|MEDICARE ACUTE|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Managed Medicaid|MEDICAID UNITED HEALTHCARE|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|ChampVA|CHAMPVA CENTER|||||0.38||| 85610|EAP|0305|PROTHROMBIN TIME|Cigna|CIGNA|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Cigna|CIGNA|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Veterans Affairs|VETERANS ADMINISTRATION|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Access Direct Platinum|HEALTHFIRST TPA UMR|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Blue Cross PPO Specialty|BCBSTX OTHER|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Humana Medicare Advantage|HUMANA MA|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Aenta Medicare Advantage|AETNA MEDICARE MA|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Blue Cross HMO Specialty|BCBSTX HMO|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Managed Medicaid|MEDICAID AMERIGROUP|||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Managed Medicaid|MEDICAID SUPERIOR|126.25||||126.25||| 85610|EAP|0305|PROTHROMBIN TIME|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|126.25||||126.25||| 85613|EAP|0300|LUPUS ANTICOAGULANT ASSAY|Blue Cross PPO Specialty|BCBSTX OTHER|||||67.50||| 85613|EAP|0300|LUPUS ANTICOAGULANT ASSAY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||67.50||| 85613|EAP|0300|LUPUS ANTICOAGULANT ASSAY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||67.50||| 85613|EAP|0300|LUPUS ANTICOAGULANT ASSAY|Medicare|MEDICARE ACUTE|||||67.50||| 85613|EAP|0300|LUPUS ANTICOAGULANT ASSAY|United Healthcare|UNITED HEALTHCARE OTHER|||||67.50||| 85613|EAP|0300|LUPUS ANTICOAGULANT ASSAY|United Healthcare|UNITED HEALTHCARE|||||67.50||| 85613|EAP|0300|LUPUS ANTICOAGULANT ASSAY|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||67.50||| 85651|EAP|0305|SEDIMENTATION RATE|Workers Compensation|WORKERS COMPENSATION OTHER|1.14||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.14||||74.13||| 85651|EAP|0305|SEDIMENTATION RATE|Veterans Affairs|VETERANS ADMINISTRATION|1.14||||1.14||| 85651|EAP|0305|SEDIMENTATION RATE|Medicare|MEDICARE PART B ONLY IP|1.14||||||| 85651|EAP|0305|SEDIMENTATION RATE|Medicare|MEDICARE ACUTE|1.14||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.14||| 85651|EAP|0305|SEDIMENTATION RATE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|Medicaid|MEDICAID|1.14||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.14||||1.14||| 85651|EAP|0305|SEDIMENTATION RATE|Managed Medicare|HEALTHSPRING MA|||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.14||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|Managed Medicare|BCBS MEDICARE PPO MA|1.14||||||| 85651|EAP|0305|SEDIMENTATION RATE|United Healthcare|UMR UNITED MEDICAL RESOURCES|1.14||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|United Healthcare|TML GROUP BENEFITS|1.14||||||| 85651|EAP|0305|SEDIMENTATION RATE|United Healthcare|UNITED HEALTHCARE|1.14||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|United Healthcare|UNITED HEALTHCARE OTHER|||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.14||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|Blue Cross PPO Specialty|BCBSTX PPO|1.14||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|Blue Cross PPO Specialty|BCBSTX OTHER|||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|Medicaid|MEDICAID TEXAS CHILDRENS|||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|Tricare|TRICARE EAST REGION|||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|Aetna|AETNA PPO|1.14||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|United Healthcare|UNITED HEALTHCARE|||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|Aetna|AETNA OTHER|||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|NON CONTRACTED|COMMERCIAL OTHER 1|1.14||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|Aetna|AETNA QHP HMO|||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|United Medicare Advantage|UHC MEDICARE GOLD MA|1.14||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|Humana Medicare Advantage|HUMANA MA|1.14||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|ChampVA|CHAMPVA CENTER|||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|Managed Medicaid|MEDICAID SUPERIOR|||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|Cigna|CIGNA|1.14||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|1.14||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|1.14||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.14||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|Aenta Medicare Advantage|AETNA MEDICARE MA|1.14||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|Cigna|CIGNA|||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|Blue Cross HMO Specialty|BCBSTX HMO|1.14||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.14||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|Managed Medicaid|MEDICAID AMERIGROUP|1.14||||34.25||| 85651|EAP|0305|SEDIMENTATION RATE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.14||||34.25||| 85730|EAP|0305|PTT|Managed Medicaid|MEDICAID SUPERIOR|192.75||||192.75||| 85730|EAP|0305|PTT|Managed Medicaid|MEDICAID AMERIGROUP|||||192.75||| 85730|EAP|0305|PTT|Blue Cross PPO Specialty|BCBSTX OTHER|192.75||||192.75||| 85730|EAP|0305|PTT|Aetna|AETNA OTHER|192.75||||192.75||| 85730|EAP|0305|PTT|Aetna|AETNA PPO|192.75||||192.75||| 85730|EAP|0305|PTT|Aenta Medicare Advantage|AETNA MEDICARE MA|192.75||||192.75||| 85730|EAP|0305|PTT|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||192.75||| 85730|EAP|0305|PTT|Cigna|CIGNA|192.75||||192.75||| 85730|EAP|0305|PTT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||192.75||| 85730|EAP|0305|PTT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||192.75||| 85730|EAP|0305|PTT|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|192.75||||192.75||| 85730|EAP|0305|PTT|Humana Medicare Advantage|HUMANA MA|192.75||||192.75||| 85730|EAP|0305|PTT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|192.75||||192.75||| 85730|EAP|0305|PTT|Cigna|CIGNA|||||192.75||| 85730|EAP|0305|PTT|United Healthcare|TML GROUP BENEFITS|||||192.75||| 85730|EAP|0305|PTT|Medicare|MEDICARE ACUTE|192.75||||192.75||| 85730|EAP|0305|PTT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|192.75||||192.75||| 85730|EAP|0305|PTT|NON CONTRACTED|WOOD COUNTY HOSPITAL DISTRICT|||||192.75||| 85730|EAP|0305|PTT|Medicaid|WOOD COUNTY INDIGENT|||||192.75||| 85730|EAP|0305|PTT|Medicare|MEDICARE PART B ONLY IP|192.75||||||| 85730|EAP|0305|PTT|Access Direct Platinum|HEALTHFIRST TPA UMR|||||192.75||| 85730|EAP|0305|PTT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|192.75||||192.75||| 85730|EAP|0305|PTT|Blue Cross HMO Specialty|BCBSTX HMO|192.75||||192.75||| 85730|EAP|0305|PTT|Medicaid|MEDICAID TEXAS CHILDRENS|||||192.75||| 85730|EAP|0305|PTT|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||192.75||| 85730|EAP|0305|PTT|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||192.75||| 85730|EAP|0305|PTT|Medicaid|MEDICAID HMO|||||192.75||| 85730|EAP|0305|PTT|Medicaid|MEDICAID|192.75||||192.75||| 85730|EAP|0305|PTT|Tricare|TRICARE EAST REGION|192.75||||192.75||| 85730|EAP|0305|PTT|Managed Medicare|OTHER INSTITUTIONS|||||192.75||| 85730|EAP|0305|PTT|Managed Medicare|MEDICARE RAILROAD|||||192.75||| 85730|EAP|0305|PTT|Managed Medicare|HEALTHSPRING MA|||||192.75||| 85730|EAP|0305|PTT|United Healthcare|UNITED HEALTHCARE|||||192.75||| 85730|EAP|0305|PTT|Aetna|AETNA QHP HMO|||||192.75||| 85730|EAP|0305|PTT|United Healthcare|UMR UNITED MEDICAL RESOURCES|192.75||||192.75||| 85730|EAP|0305|PTT|Managed Medicare|BCBS MEDICARE PPO MA|||||192.75||| 85730|EAP|0305|PTT|United Healthcare|UNITED HEALTHCARE OTHER|||||192.75||| 85730|EAP|0305|PTT|Blue Cross PPO Specialty|BCBSTX PPO|192.75||||192.75||| 85730|EAP|0305|PTT|United Healthcare|GEHA|||||192.75||| 85730|EAP|0305|PTT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|192.75||||192.75||| 85730|EAP|0305|PTT|United Healthcare|UNITED HEALTHCARE|192.75||||192.75||| 85730|EAP|0305|PTT|NON CONTRACTED|COMMERCIAL OTHER 1|192.75||||192.75||| 85730|EAP|0305|PTT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|192.75||||192.75||| 85730|EAP|0305|PTT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|192.75||||192.75||| 85730|EAP|0305|PTT|Workers Compensation|WORKERS COMPENSATION OTHER|192.75||||192.75||| 85730|EAP|0305|PTT|Veterans Affairs|VETERANS ADMINISTRATION|192.75||||192.75||| 85730|EAP|0305|PTT|Veterans Affairs|VETERANS ADMINISTRATION|||||192.75||| 85730|EAP|0305|PTT|United Medicare Advantage|UHC MEDICARE GOLD MA|192.75||||192.75||| 85730|EAP|0305|PTT|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|192.75||||192.75||| 86003|EAP|0302|ALLERGEN PROFILE IGE PANE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||39.42||| 86003|EAP|0302|ALLERGEN PROFILE IGE PANE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||39.42||| 86003|EAP|0302|ALLERGEN PROFILE IGE PANE|NON CONTRACTED|COMMERCIAL OTHER 1|||||39.42||| 86003|EAP|0302|ALLERGEN PROFILE IGE PANE|United Healthcare|UNITED HEALTHCARE|||||39.42||| 86003|EAP|0302|ALLERGEN PROFILE IGE PANE|Medicare|MEDICARE ACUTE|||||39.42||| 86003|EAP|0302|ALLERGEN PROFILE IGE PANE|United Healthcare|UNITED HEALTHCARE OTHER|||||39.42||| 86003|EAP|0302|ALLERGEN PROFILE IGE PANE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||39.42||| 86003|EAP|0302|ALLERGEN PROFILE IGE PANE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||39.42||| 86003|EAP|0302|ALLERGEN PROFILE IGE PANE|Blue Cross PPO Specialty|BCBSTX OTHER|||||39.42||| 86003|EAP|0302|ALLERGEN PROFILE IGE PANE|Blue Cross PPO Specialty|BCBSTX PPO|||||39.42||| 86003|EAP|0302|ALLERGEN PROFILE IGE PANE|Cigna|CIGNA|||||39.42||| 86003|EAP|0302|ALLERGEN PROFILE IGE PANE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||39.42||| 86003|EAP|0302|ALLERGEN PROFILE IGE PANE|Blue Cross HMO Specialty|BCBSTX HMO|||||39.42||| 86003|EAP|0302|ALLERGEN PROFILE IGE PANE|Managed Medicaid|MEDICAID SUPERIOR|||||39.42||| 86003|EAP|0302|ALLERGEN PROFILE IGE PANE|Aetna|AETNA QHP HMO|||||39.42||| 86003|EAP|0302|ALLERGEN PROFILE IGE PANE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||39.42||| 86003|EAP|0302|ALLERGEN PROFILE IGE PANE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||39.42||| 86022|EAP|0300|HEPARIN INDUCED PLATELET|Humana Medicare Advantage|HUMANA MA|314.50||||||| 86038|EAP|0300|ANA|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.06||| 86038|EAP|0300|ANA|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.06||| 86038|EAP|0300|ANA|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1.06||| 86038|EAP|0300|ANA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3.29||||1.06||| 86038|EAP|0300|ANA|Medicare|MEDICARE ACUTE|3.29||||1.06||| 86038|EAP|0300|ANA|Managed Medicare|HEALTHSPRING MA|||||1.06||| 86038|EAP|0300|ANA|United Healthcare|UNITED HEALTHCARE OTHER|||||1.06||| 86038|EAP|0300|ANA|United Healthcare|UNITED HEALTHCARE|||||1.06||| 86038|EAP|0300|ANA|Tricare|TRICARE EAST REGION|||||1.06||| 86038|EAP|0300|ANA|United Healthcare|UMR UNITED MEDICAL RESOURCES|3.29||||1.06||| 86038|EAP|0300|ANA|United Healthcare|UNITED HEALTHCARE|3.29||||1.06||| 86038|EAP|0300|ANA|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.06||| 86038|EAP|0300|ANA|Blue Cross PPO Specialty|BCBSTX PPO|||||1.06||| 86038|EAP|0300|ANA|Aetna|AETNA PPO|||||1.06||| 86038|EAP|0300|ANA|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.06||| 86038|EAP|0300|ANA|Medicaid|MEDICAID|||||1.06||| 86038|EAP|0300|ANA|Cigna|CIGNA|||||1.06||| 86038|EAP|0300|ANA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.06||| 86038|EAP|0300|ANA|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.06||| 86038|EAP|0300|ANA|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.06||| 86038|EAP|0300|ANA|Blue Cross HMO Specialty|BCBSTX HMO|||||1.06||| 86038|EAP|0300|ANA|Managed Medicaid|MEDICAID AMERIGROUP|||||1.06||| 86038|EAP|0300|ANA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.06||| 86038|EAP|0300|ANA|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.06||| 86038|EAP|0300|ANA|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.06||| 86038|EAP|0300|ANA|Managed Medicaid|MEDICAID SUPERIOR|||||1.06||| 86038|EAP|0300|ANA|Humana Medicare Advantage|HUMANA MA|||||1.06||| 86038|EAP|0300|ANA|Access Direct Platinum|HEALTHFIRST TPA UMR|||||1.06||| 86060|EAP|0302|ASO TITER|Medicare|MEDICARE ACUTE|||||70.50||| 86060|EAP|0302|ASO TITER|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||70.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|Blue Cross PPO Specialty|BCBSTX PPO|166.25||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|166.25||||166.25||| 86140|EAP|0302|C-REACTIVE PROTIEN|United Medicare Advantage|UHC MEDICARE GOLD MA|166.25||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|166.25||||108.13||| 86140|EAP|0302|C-REACTIVE PROTIEN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|Workers Compensation|WORKERS COMPENSATION OTHER|166.25||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|Blue Cross PPO Specialty|BCBSTX OTHER|||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|Aetna|AETNA PPO|166.25||||||| 86140|EAP|0302|C-REACTIVE PROTIEN|Aetna|AETNA OTHER|||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|Access Direct Platinum|HEALTHFIRST TPA UMR|||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|166.25||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|166.25||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|Cigna|CIGNA|166.25||||||| 86140|EAP|0302|C-REACTIVE PROTIEN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|166.25||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|166.25||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|Humana Medicare Advantage|HUMANA MA|166.25||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|Aenta Medicare Advantage|AETNA MEDICARE MA|166.25||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|Blue Cross HMO Specialty|BCBSTX HMO|166.25||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|Aetna|AETNA QHP HMO|||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|Managed Medicaid|MEDICAID AMERIGROUP|166.25||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|166.25||||166.25||| 86140|EAP|0302|C-REACTIVE PROTIEN|Managed Medicaid|MEDICAID SUPERIOR|||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|Medicare|MEDICARE PART B ONLY IP|166.25||||||| 86140|EAP|0302|C-REACTIVE PROTIEN|Medicare|MEDICARE ACUTE|166.25||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||166.25||| 86140|EAP|0302|C-REACTIVE PROTIEN|Medicaid|MEDICAID|166.25||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|Medicaid|MEDICAID TEXAS CHILDRENS|||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|Managed Medicare|BCBS MEDICARE PPO MA|166.25||||||| 86140|EAP|0302|C-REACTIVE PROTIEN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|166.25||||166.25||| 86140|EAP|0302|C-REACTIVE PROTIEN|Tricare|TRICARE FOR LIFE|||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|Managed Medicare|HEALTHSPRING MA|||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|United Healthcare|UNITED HEALTHCARE|166.25||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|United Healthcare|UMR UNITED MEDICAL RESOURCES|166.25||||0.50||| 86140|EAP|0302|C-REACTIVE PROTIEN|United Healthcare|UNITED HEALTHCARE|||||0.50||| 86147|EAP|0302|ANTI-CARDIOLIPIN AB (SERU|Medicaid|MEDICAID|||||75.75||| 86147|EAP|0302|ANTI-CARDIOLIPIN AB (SERU|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||75.75||| 86147|EAP|0302|ANTI-CARDIOLIPIN AB (SERU|Medicare|MEDICARE ACUTE|||||75.75||| 86160|EAP|0302|COMPLIMENT 3 OR 4 ANTIGEN|Aetna|AETNA PPO|||||115.75||| 86160|EAP|0302|COMPLIMENT 3 OR 4 ANTIGEN|Medicare|MEDICARE ACUTE|||||115.75||| 86160|EAP|0302|COMPLIMENT 3 OR 4 ANTIGEN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||115.75||| 86160|EAP|0302|COMPLIMENT 3 OR 4 ANTIGEN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||115.75||| 86160|EAP|0302|COMPLIMENT 3 OR 4 ANTIGEN|Blue Cross PPO Specialty|BCBSTX PPO|||||115.75||| 86160|EAP|0302|COMPLIMENT 3 OR 4 ANTIGEN|Managed Medicaid|MEDICAID AMERIGROUP|||||115.75||| 86171|EAP|0302|COMPLIMENT FIXATION, EACH|Aetna|AETNA QHP HMO|||||0.62||| 86200|EAP|0300|CCP ANTIBODY|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.25||| 86200|EAP|0300|CCP ANTIBODY|Medicare|MEDICARE ACUTE|||||1.25||| 86200|EAP|0300|CCP ANTIBODY|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.25||| 86200|EAP|0300|CCP ANTIBODY|Blue Cross PPO Specialty|BCBSTX PPO|||||1.25||| 86200|EAP|0300|CCP ANTIBODY|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.25||| 86200|EAP|0300|CCP ANTIBODY|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.25||| 86200|EAP|0300|CCP ANTIBODY|Managed Medicaid|MEDICAID SUPERIOR|||||1.25||| 86200|EAP|0300|CCP ANTIBODY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| 86225|EAP|0302|ANTI DNA AB DOUBLE STRAND|Blue Cross PPO Specialty|BCBSTX PPO|||||132.50||| 86225|EAP|0302|ANTI DNA AB DOUBLE STRAND|Aetna|AETNA PPO|||||132.50||| 86225|EAP|0302|ANTI DNA AB DOUBLE STRAND|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||132.50||| 86225|EAP|0302|ANTI DNA AB DOUBLE STRAND|Medicare|MEDICARE ACUTE|||||132.50||| 86225|EAP|0302|ANTI DNA AB DOUBLE STRAND|United Healthcare|UNITED HEALTHCARE|441.25||||||| 86225|EAP|0302|ANTI DNA AB DOUBLE STRAND|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||132.50||| 86235|EAP|0300|SJORGENS B ANTIBODY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.57||| 86235|EAP|0300|CENTROMERE AB|United Healthcare|UNITED HEALTHCARE|4.89||||||| 86235|EAP|0300|SJORGENS B ANTIBODY|United Healthcare|UNITED HEALTHCARE|523.60||||||| 86235|EAP|0300|SJORGENS B ANTIBODY|Medicare|MEDICARE ACUTE|||||1.57||| 86235|EAP|0300|SJORGENS A ANTIBODY|Blue Cross PPO Specialty|BCBSTX PPO|||||1.57||| 86235|EAP|0300|SJORGENS A ANTIBODY|Aetna|AETNA QHP HMO|||||1.57||| 86235|EAP|0300|CENTROMERE AB|Blue Cross PPO Specialty|BCBSTX PPO|||||1.57||| 86235|EAP|0300|SJORGENS B ANTIBODY|Aetna|AETNA QHP HMO|||||1.57||| 86235|EAP|0300|SJORGENS B ANTIBODY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.57||| 86235|EAP|0300|SJORGENS A ANTIBODY|United Healthcare|UNITED HEALTHCARE|523.60||||||| 86235|EAP|0300|SJORGENS A ANTIBODY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.57||| 86235|EAP|0300|CENTROMERE AB|Medicare|MEDICARE ACUTE|||||1.57||| 86235|EAP|0300|SJORGENS A ANTIBODY|Medicare|MEDICARE ACUTE|||||1.57||| 86235|EAP|0300|CENTROMERE AB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.57||| 86235|EAP|0300|SJORGENS B ANTIBODY|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.57||| 86235|EAP|0300|SJORGENS A ANTIBODY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.57||| 86235|EAP|0300|CENTROMERE AB|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.57||| 86235|EAP|0300|SJORGENS A ANTIBODY|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.57||| 86255|EAP|0300|ACETYCHOLINE BINDING ANTI|Aetna|AETNA PPO|||||116.25||| 86255|EAP|0302|ANTI-MITOCHONDRIAL ANTIBO|Blue Cross PPO Specialty|BCBSTX PPO|||||116.25||| 86255|EAP|0300|ACETYCHOLINE BINDING ANTI|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||116.25||| 86255|EAP|0300|ANTI SMOOTH MUSCLE AB|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||116.25||| 86255|EAP|0302|ANTI-MITOCHONDRIAL ANTIBO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||116.25||| 86255|EAP|0300|ACETYCHOLINE BINDING ANTI|Managed Medicaid|MEDICAID AMERIGROUP|||||116.25||| 86255|EAP|0300|ACETYCHOLINE BINDING ANTI|United Healthcare|UNITED HEALTHCARE|387.25||||||| 86255|EAP|0300|ACETYCHOLINE BINDING ANTI|Medicare|MEDICARE ACUTE|||||116.25||| 86255|EAP|0300|ANTI SMOOTH MUSCLE AB|Medicare|MEDICARE ACUTE|||||116.25||| 86255|EAP|0300|ACETYCHOLINE BINDING ANTI|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||116.25||| 86255|EAP|0300|ACETYCHOLINE BINDING ANTI|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||116.25||| 86255|EAP|0300|ANTI SMOOTH MUSCLE AB|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||116.25||| 863|DRG||POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W/O MCC|Medicare|MEDICARE ACUTE|6,176.60|16.17|16.17|16.17|||| 86300|EAP|0300|CA 15-3|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||200.50||| 86300|EAP|0300|CA 15-3|Medicare|MEDICARE ACUTE|||||200.50||| 86308|EAP|0302|MONO (SPOT) SCREEN|United Healthcare|TML GROUP BENEFITS|||||166.25||| 86308|EAP|0302|MONO (SPOT) SCREEN|Blue Cross PPO Specialty|BCBSTX PPO|||||0.50||| 86308|EAP|0302|MONO (SPOT) SCREEN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.50||| 86308|EAP|0302|MONO (SPOT) SCREEN|Managed Medicaid|MEDICAID SUPERIOR|||||108.13||| 86308|EAP|0302|MONO (SPOT) SCREEN|Cigna|CIGNA|||||0.50||| 86308|EAP|0302|MONO (SPOT) SCREEN|Managed Medicaid|MEDICAID AMERIGROUP|||||166.25||| 86308|EAP|0302|MONO (SPOT) SCREEN|Blue Cross HMO Specialty|BCBSTX HMO|||||0.50||| 86308|EAP|0302|MONO (SPOT) SCREEN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||166.25||| 86308|EAP|0302|MONO (SPOT) SCREEN|United Healthcare|UNITED HEALTHCARE|||||166.25||| 86308|EAP|0302|MONO (SPOT) SCREEN|United Healthcare|UNITED HEALTHCARE OTHER|||||0.50||| 86308|EAP|0302|MONO (SPOT) SCREEN|Medicare|MEDICARE ACUTE|||||0.50||| 86308|EAP|0302|MONO (SPOT) SCREEN|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.50||| 86316|EAP|0302|CA125|United Medicare Advantage|AARP UHC WEST COMPLETE MA|668.25||||||| 86316|EAP|0302|CA125|United Medicare Advantage|UHC MEDICARE GOLD MA|||||200.50||| 86316|EAP|0302|CA125|Blue Cross PPO Specialty|BCBSTX PPO|||||200.50||| 86316|EAP|0302|CA19-9 FREEZE|Blue Cross PPO Specialty|BCBSTX PPO|||||200.50||| 86316|EAP|0302|CA125|Blue Cross PPO Specialty|BCBSTX OTHER|||||200.50||| 86316|EAP|0302|CA125|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||200.50||| 86316|EAP|0302|CA125|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||200.50||| 86316|EAP|0302|CA19-9 FREEZE|Medicare|MEDICARE ACUTE|||||200.50||| 86316|EAP|0302|CA19-9 FREEZE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||200.50||| 86316|EAP|0302|CA125|Medicare|MEDICARE ACUTE|||||200.50||| 86334|EAP|0302|IFE SERUM|Aetna|AETNA PPO|||||215.50||| 86334|EAP|0302|IFE SERUM|Medicare|MEDICARE ACUTE|||||215.50||| 86334|EAP|0302|IFE SERUM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||215.50||| 86334|EAP|0302|IFE SERUM|Humana Medicare Advantage|HUMANA MA|717.75||||||| 86334|EAP|0302|IFE SERUM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||215.50||| 86335|EAP|0300|IMMUNFIX E PHORSIS/URINE/|Medicare|MEDICARE ACUTE|||||282.75||| 86359|EAP|0300|T CELLS TOTAL COUNT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3.08||| 86360|EAP|0300|TCELL ABSOLUTE CD4 AND CD|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|13.72||||411.50||| 86361|EAP|0300|CD4 COUNT|Blue Cross HMO Specialty|BCBSTX HMO|||||234.50||| 86361|EAP|0300|CD4 COUNT|Blue Cross PPO Specialty|BCBSTX PPO|||||781.80||| 86376|EAP|0302|MICROSOMAL ANTIBODIES EA|United Medicare Advantage|UHC MEDICARE GOLD MA|||||140.25||| 86376|EAP|0300|MICRO ANTIBODY THYROID/LI|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||140.25||| 86376|EAP|0300|MICRO ANTIBODY THYROID/LI|Medicare|MEDICARE ACUTE|||||140.25||| 86376|EAP|0300|MICRO ANTIBODY THYROID/LI|United Healthcare|UNITED HEALTHCARE|||||140.25||| 86376|EAP|0300|MICRO ANTIBODY THYROID/LI|Medicaid|MEDICAID|||||140.25||| 86376|EAP|0300|MICRO ANTIBODY THYROID/LI|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||140.25||| 86376|EAP|0300|MICRO ANTIBODY THYROID/LI|Blue Cross PPO Specialty|BCBSTX PPO|||||140.25||| 86376|EAP|0300|MICRO ANTIBODY THYROID/LI|Aetna|AETNA PPO|||||140.25||| 86376|EAP|0300|MICRO ANTIBODY THYROID/LI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||140.25||| 86376|EAP|0300|MICRO ANTIBODY THYROID/LI|Aenta Medicare Advantage|AETNA MEDICARE MA|||||140.25||| 86376|EAP|0300|MICRO ANTIBODY THYROID/LI|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||140.25||| 86376|EAP|0300|MICRO ANTIBODY THYROID/LI|Blue Cross HMO Specialty|BCBSTX HMO|||||140.25||| 86376|EAP|0300|MICRO ANTIBODY THYROID/LI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||140.25||| 86376|EAP|0300|MICRO ANTIBODY THYROID/LI|Managed Medicaid|MEDICAID AMERIGROUP|||||140.25||| 86403|EAP|0306|BACTERIAL ANTIGEN EACH|Medicare|MEDICARE ACUTE|327.25||||||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|United Medicare Advantage|UHC MEDICARE GOLD MA|||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|Blue Cross PPO Specialty|BCBSTX PPO|||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|Blue Cross PPO Specialty|BCBSTX OTHER|||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|Aetna|AETNA PPO|||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|Access Direct Platinum|HEALTHFIRST TPA UMR|||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|Managed Medicaid|MEDICAID SUPERIOR|||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|Managed Medicaid|MEDICAID AMERIGROUP|||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|Blue Cross HMO Specialty|BCBSTX HMO|||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|Cigna|CIGNA|||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|Medicare|MEDICARE ACUTE|||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|Medicaid|MEDICAID|||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|NON CONTRACTED|COMMERCIAL OTHER 1|||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|Tricare|TRICARE EAST REGION|||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|Managed Medicare|HEALTHSPRING MA|||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|United Healthcare|UNITED HEALTHCARE|182.50||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|United Healthcare|UNITED HEALTHCARE OTHER|||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|United Healthcare|UNITED HEALTHCARE|||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||54.75||| 86430|EAP|0302|RHEUMATOID FACTOR LATEX Q|Humana Medicare Advantage|HUMANA MA|||||54.75||| 86480|EAP|0300|TB TEST CELL IMMUN MEASUR|United Healthcare|UNITED HEALTHCARE OTHER|||||5.07||| 86480|EAP|0300|TB TEST CELL IMMUN MEASUR|Medicare|MEDICARE ACUTE|||||5.07||| 86480|EAP|0300|TB TEST CELL IMMUN MEASUR|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||5.07||| 86480|EAP|0300|TB TEST CELL IMMUN MEASUR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||5.07||| 86480|EAP|0300|TB TEST CELL IMMUN MEASUR|Managed Medicaid|MEDICAID AMERIGROUP|||||5.07||| 86592|EAP|0302|RPR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||41.25||| 86592|EAP|0302|RPR|Blue Cross PPO Specialty|BCBSTX PPO|||||41.25||| 86592|EAP|0302|RPR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||41.25||| 86592|EAP|0302|RPR|Managed Medicaid|MEDICAID SUPERIOR|||||41.25||| 86592|EAP|0302|RPR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||41.25||| 86592|EAP|0302|RPR|Medicare|MEDICARE ACUTE|1.37||||41.25||| 86592|EAP|0302|RPR|NON CONTRACTED|COMMERCIAL OTHER 1|||||41.25||| 86592|EAP|0302|RPR|Medicaid|MEDICAID|||||41.25||| 86592|EAP|0302|RPR|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||41.25||| 86592|EAP|0302|RPR|United Healthcare|UNITED HEALTHCARE|||||41.25||| 86592|EAP|0302|RPR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||41.25||| 86592|EAP|0302|RPR|Blue Cross HMO Specialty|BCBSTX HMO|||||41.25||| 86592|EAP|0302|RPR|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||41.25||| 86592|EAP|0302|RPR|United Healthcare|UNITED HEALTHCARE OTHER|||||41.25||| 86609|EAP|0300|ANTIBODY BACTERIUM|Managed Medicaid|MEDICAID SUPERIOR|||||71.75||| 86611|EAP|0302|BARTONELLA TITER|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.79||| 86618|EAP|0302|LYME DISEASE TITER|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||164.25||| 86618|EAP|0302|LYME DISEASE TITER|United Medicare Advantage|UHC MEDICARE GOLD MA|547.25||||164.25||| 86618|EAP|0302|LYME DISEASE TITER|Blue Cross PPO Specialty|BCBSTX OTHER|||||164.25||| 86618|EAP|0302|LYME DISEASE TITER|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||164.25||| 86631|EAP|0302|CHLAMYDIA AB PANEL|Medicare|MEDICARE ACUTE|262.75||||||| 86631|EAP|0302|CHLAMYDIA AB PANEL|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.79||| 86631|EAP|0302|CHLAMYDIA AB PANEL|Managed Medicaid|MEDICAID SUPERIOR|||||0.79||| 86631|EAP|0302|CHLAMYDIA AB PANEL|United Medicare Advantage|UHC MEDICARE GOLD MA|262.75||||||| 86632|EAP|0300|CHLAMYDIA IGM ANTIBODY|United Medicare Advantage|UHC MEDICARE GOLD MA|224.80||||||| 86632|EAP|0300|CHLAMYDIA IGM ANTIBODY|Managed Medicaid|MEDICAID SUPERIOR|||||67.50||| 86632|EAP|0300|CHLAMYDIA IGM ANTIBODY|Medicare|MEDICARE ACUTE|224.80||||||| 86632|EAP|0300|CHLAMYDIA IGM ANTIBODY|NON CONTRACTED|COMMERCIAL OTHER 1|||||67.50||| 86663|EAP|0302|EPSTEIN-BARR ANTIBODY|Blue Cross PPO Specialty|BCBSTX PPO|||||107.20||| 86663|EAP|0302|EPSTEIN-BARR ANTIBODY|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||107.20||| 86663|EAP|0302|EPSTEIN-BARR ANTIBODY|United Medicare Advantage|UHC MEDICARE GOLD MA|||||107.20||| 86664|EAP|0302|ESPTEIN-BARR NUCLEAR ANTI|Blue Cross PPO Specialty|BCBSTX PPO|||||124.90||| 86664|EAP|0302|ESPTEIN-BARR NUCLEAR ANTI|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||124.90||| 86665|EAP|0302|EPSTEIN-BARR CAPSID VCA|Blue Cross PPO Specialty|BCBSTX PPO|||||174.75||| 86665|EAP|0302|EPSTEIN-BARR CAPSID VCA|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||174.75||| 86677|EAP|0302|H PYLORI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.79||| 86689|EAP|0302|HTLV/HIV ANTIBODY|Veterans Affairs|VETERANS ADMINISTRATION|440.50||||||| 86689|EAP|0302|HTLV/HIV ANTIBODY|Workers Compensation|WORKERS COMPENSATION OTHER|||||286.38||| 86689|EAP|0302|HTLV/HIV ANTIBODY|Medicaid|MEDICAID|||||440.50||| 86689|EAP|0302|HTLV/HIV ANTIBODY|NON CONTRACTED|COMMERCIAL OTHER 1|||||132.25||| 86689|EAP|0302|HTLV/HIV ANTIBODY|United Healthcare|UNITED HEALTHCARE|||||132.25||| 86689|EAP|0302|HTLV/HIV ANTIBODY|United Healthcare|UNITED HEALTHCARE OTHER|||||132.25||| 86689|EAP|0302|HTLV/HIV ANTIBODY|Blue Cross PPO Specialty|BCBSTX PPO|||||132.25||| 86689|EAP|0302|HTLV/HIV ANTIBODY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||132.25||| 86689|EAP|0302|HTLV/HIV ANTIBODY|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||132.25||| 86689|EAP|0302|HTLV/HIV ANTIBODY|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||132.25||| 86689|EAP|0302|HTLV/HIV ANTIBODY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||132.25||| 86694|EAP|0302|HERPES SIMPLEX|Blue Cross PPO Specialty|BCBSTX PPO|||||138.75||| 86694|EAP|0302|HERPES SIMPLEX|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||138.75||| 86694|EAP|0302|HERPES SIMPLEX|Blue Cross HMO Specialty|BCBSTX HMO|||||138.75||| 86694|EAP|0302|HERPES SIMPLEX|Managed Medicaid|MEDICAID SUPERIOR|||||138.75||| 86694|EAP|0302|HERPES SIMPLEX|Medicare|MEDICARE ACUTE|||||138.75||| 86694|EAP|0302|HERPES SIMPLEX|NON CONTRACTED|COMMERCIAL OTHER 1|||||138.75||| 86694|EAP|0302|HERPES SIMPLEX|United Healthcare|UNITED HEALTHCARE OTHER|||||138.75||| 86694|EAP|0302|HERPES SIMPLEX|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||138.75||| 86695|EAP|0300|HERPES SIMPLEX TYPE 1|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.27||| 86695|EAP|0300|HERPES SIMPLEX TYPE 1|Medicare|MEDICARE ACUTE|||||1.27||| 86695|EAP|0300|HERPES SIMPLEX TYPE 1|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.27||| 86695|EAP|0300|HERPES SIMPLEX TYPE 1|United Healthcare|UNITED HEALTHCARE OTHER|||||1.27||| 86695|EAP|0300|HERPES SIMPLEX TYPE 1|Blue Cross PPO Specialty|BCBSTX PPO|||||1.27||| 86695|EAP|0300|HERPES SIMPLEX TYPE 1|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.27||| 86695|EAP|0300|HERPES SIMPLEX TYPE 1|Blue Cross HMO Specialty|BCBSTX HMO|||||1.27||| 86695|EAP|0300|HERPES SIMPLEX TYPE 1|Managed Medicaid|MEDICAID SUPERIOR|||||1.27||| 86696|EAP|0300|HERPES SIMPLEX TYPE 2|Blue Cross PPO Specialty|BCBSTX PPO|||||186.50||| 86696|EAP|0300|HERPES SIMPLEX TYPE 2|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||186.50||| 86696|EAP|0300|HERPES SIMPLEX TYPE 2|Blue Cross HMO Specialty|BCBSTX HMO|||||186.50||| 86696|EAP|0300|HERPES SIMPLEX TYPE 2|Managed Medicaid|MEDICAID SUPERIOR|||||186.50||| 86696|EAP|0300|HERPES SIMPLEX TYPE 2|United Healthcare|UNITED HEALTHCARE OTHER|||||186.50||| 86696|EAP|0300|HERPES SIMPLEX TYPE 2|NON CONTRACTED|COMMERCIAL OTHER 1|||||186.50||| 86696|EAP|0300|HERPES SIMPLEX TYPE 2|Medicare|MEDICARE ACUTE|||||186.50||| 86696|EAP|0300|HERPES SIMPLEX TYPE 2|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||186.50||| 86703|EAP|0302||United Medicare Advantage|UHC MEDICARE GOLD MA|440.50||||132.25||| 86703|EAP|0302||United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||132.25||| 86703|EAP|0302||Medicare|MEDICARE ACUTE|440.50||||132.25||| 86703|EAP|0302||Medicaid|MEDICAID|440.50||||132.25||| 86703|EAP|0302||NON CONTRACTED|COMMERCIAL OTHER 1|440.50||||||| 86703|EAP|0302||Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||132.25||| 86703|EAP|0302||Managed Medicaid|MEDICAID SUPERIOR|||||132.25||| 86703|EAP|0302||Humana Medicare Advantage|HUMANA MA|440.50||||||| 86703|EAP|0302||Managed Medicaid|MEDICAID UNITED HEALTHCARE|440.50||||132.25||| 86703|EAP|0302||Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||132.25||| 86705|EAP|0300|HEPATITIS B CORE ANTIBODY|Blue Cross PPO Specialty|BCBSTX PPO|||||113.50||| 86705|EAP|0300|HEPATITIS B CORE ANTIBODY|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||113.50||| 86705|EAP|0300|HEPATITIS B CORE ANTIBODY|Cigna|CIGNA|||||113.50||| 86705|EAP|0300|HEPATITIS B CORE ANTIBODY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.78||||113.50||| 86705|EAP|0300|HEPATITIS B CORE ANTIBODY|Humana Medicare Advantage|HUMANA MA|3.78||||||| 86705|EAP|0300|HEPATITIS B CORE ANTIBODY|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||113.50||| 86705|EAP|0300|HEPATITIS B CORE ANTIBODY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.78||||113.50||| 86705|EAP|0300|HEPATITIS B CORE ANTIBODY|Managed Medicaid|MEDICAID AMERIGROUP|||||3.78||| 86705|EAP|0300|HEPATITIS B CORE ANTIBODY|Aetna|AETNA PPO|||||113.50||| 86705|EAP|0300|HEPATITIS B CORE ANTIBODY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||113.50||| 86705|EAP|0300|HEPATITIS B CORE ANTIBODY|Medicaid|MEDICAID|3.78||||113.50||| 86705|EAP|0300|HEPATITIS B CORE ANTIBODY|NON CONTRACTED|COMMERCIAL OTHER 1|3.78||||||| 86705|EAP|0300|HEPATITIS B CORE ANTIBODY|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||113.50||| 86705|EAP|0300|HEPATITIS B CORE ANTIBODY|United Healthcare|UNITED HEALTHCARE|3.78||||||| 86705|EAP|0300|HEPATITIS B CORE ANTIBODY|Medicare|MEDICARE ACUTE|3.78||||113.50||| 86705|EAP|0300|HEPATITIS B CORE ANTIBODY|United Healthcare|UNITED HEALTHCARE|||||113.50||| 86705|EAP|0300|HEPATITIS B CORE ANTIBODY|Veterans Affairs|VETERANS ADMINISTRATION|3.78||||||| 86705|EAP|0300|HEPATITIS B CORE ANTIBODY|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|3.78||||113.50||| 86705|EAP|0300|HEPATITIS B CORE ANTIBODY|United Medicare Advantage|UHC MEDICARE GOLD MA|3.78||||113.50||| 86706|EAP|0302|HEPATITIS B SURFACE ANTIG|United Medicare Advantage|UHC MEDICARE GOLD MA|3.45||||103.50||| 86706|EAP|0302|HEPATITIS B SURFACE ANTIG|Veterans Affairs|VETERANS ADMINISTRATION|3.45||||||| 86706|EAP|0302|HEPATITIS B SURFACE ANTIG|Workers Compensation|WORKERS COMPENSATION OTHER|||||103.50||| 86706|EAP|0302|HEPATITIS B SURFACE ANTIG|Medicare|MEDICARE ACUTE|3.45||||103.50||| 86706|EAP|0302|HEPATITIS B SURFACE ANTIG|NON CONTRACTED|COMMERCIAL OTHER 1|3.45||||||| 86706|EAP|0302|HEPATITIS B SURFACE ANTIG|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||103.50||| 86706|EAP|0302|HEPATITIS B SURFACE ANTIG|Medicaid|MEDICAID|3.45||||103.50||| 86706|EAP|0302|HEPATITIS B SURFACE ANTIG|United Healthcare|UNITED HEALTHCARE|||||103.50||| 86706|EAP|0302|HEPATITIS B SURFACE ANTIG|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||103.50||| 86706|EAP|0302|HEPATITIS B SURFACE ANTIG|United Healthcare|UNITED HEALTHCARE|3.45||||||| 86706|EAP|0302|HEPATITIS B SURFACE ANTIG|Blue Cross PPO Specialty|BCBSTX PPO|||||103.50||| 86706|EAP|0302|HEPATITIS B SURFACE ANTIG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||103.50||| 86706|EAP|0302|HEPATITIS B SURFACE ANTIG|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|3.45||||103.50||| 86706|EAP|0302|HEPATITIS B SURFACE ANTIG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||103.50||| 86706|EAP|0302|HEPATITIS B SURFACE ANTIG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||103.50||| 86706|EAP|0302|HEPATITIS B SURFACE ANTIG|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||103.50||| 86706|EAP|0302|HEPATITIS B SURFACE ANTIG|Cigna|CIGNA|||||103.50||| 86706|EAP|0302|HEPATITIS B SURFACE ANTIG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.45||||103.50||| 86706|EAP|0302|HEPATITIS B SURFACE ANTIG|Aenta Medicare Advantage|AETNA MEDICARE MA|||||103.50||| 86706|EAP|0302|HEPATITIS B SURFACE ANTIG|Humana Medicare Advantage|HUMANA MA|3.45||||||| 86706|EAP|0302|HEPATITIS B SURFACE ANTIG|Managed Medicaid|MEDICAID AMERIGROUP|||||3.45||| 86706|EAP|0302|HEPATITIS B SURFACE ANTIG|Managed Medicaid|MEDICAID SUPERIOR|||||103.50||| 86706|EAP|0302|HEPATITIS B SURFACE ANTIG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.45||||103.50||| 86706|EAP|0302|HEPATITIS B SURFACE ANTIG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||103.50||| 86708|EAP|0300|HEPATITIS A ANTIBODY|Blue Cross PPO Specialty|BCBSTX PPO|||||119.50||| 86708|EAP|0300|HEPATITIS A ANTIBODY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.98||||119.50||| 86708|EAP|0300|HEPATITIS A ANTIBODY|Cigna|CIGNA|||||119.50||| 86708|EAP|0300|HEPATITIS A ANTIBODY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.98||||119.50||| 86708|EAP|0300|HEPATITIS A ANTIBODY|Humana Medicare Advantage|HUMANA MA|3.98||||||| 86708|EAP|0300|HEPATITIS A ANTIBODY|Aenta Medicare Advantage|AETNA MEDICARE MA|||||119.50||| 86708|EAP|0300|HEPATITIS A ANTIBODY|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||119.50||| 86708|EAP|0300|HEPATITIS A ANTIBODY|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||119.50||| 86708|EAP|0300|HEPATITIS A ANTIBODY|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||119.50||| 86708|EAP|0300|HEPATITIS A ANTIBODY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||119.50||| 86708|EAP|0300|HEPATITIS A ANTIBODY|Managed Medicaid|MEDICAID AMERIGROUP|||||3.98||| 86708|EAP|0300|HEPATITIS A ANTIBODY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||119.50||| 86708|EAP|0300|HEPATITIS A ANTIBODY|Medicaid|MEDICAID|3.98||||119.50||| 86708|EAP|0300|HEPATITIS A ANTIBODY|NON CONTRACTED|COMMERCIAL OTHER 1|3.98||||||| 86708|EAP|0300|HEPATITIS A ANTIBODY|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||119.50||| 86708|EAP|0300|HEPATITIS A ANTIBODY|United Healthcare|UNITED HEALTHCARE|||||119.50||| 86708|EAP|0300|HEPATITIS A ANTIBODY|Medicare|MEDICARE ACUTE|3.98||||119.50||| 86708|EAP|0300|HEPATITIS A ANTIBODY|United Healthcare|UNITED HEALTHCARE|3.98||||||| 86708|EAP|0300|HEPATITIS A ANTIBODY|Veterans Affairs|VETERANS ADMINISTRATION|3.98||||||| 86708|EAP|0300|HEPATITIS A ANTIBODY|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|3.98||||119.50||| 86708|EAP|0300|HEPATITIS A ANTIBODY|United Medicare Advantage|UHC MEDICARE GOLD MA|3.98||||119.50||| 86710|EAP|0300|FLU A & B|Managed Medicaid|MEDICAID SUPERIOR|||||435.50||| 86735|EAP|0302|MUMPS VIRUS ANTIBODY IGG,|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||1.26||| 86735|EAP|0302|MUMPS VIRUS ANTIBODY IGG,|Blue Cross PPO Specialty|BCBSTX PPO|||||1.26||| 86735|EAP|0302|MUMPS VIRUS ANTIBODY IGG,|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.26||| 86735|EAP|0302|MUMPS VIRUS ANTIBODY IGG,|Cigna|CIGNA|||||1.26||| 86735|EAP|0302|MUMPS VIRUS ANTIBODY IGG,|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.26||| 86735|EAP|0302|MUMPS VIRUS ANTIBODY IGG,|Managed Medicaid|MEDICAID AMERIGROUP|||||419.25||| 86738|EAP|0302|MYCOPLASM PNEUMONIA AB|United Medicare Advantage|UHC MEDICARE GOLD MA|425.50||||||| 86738|EAP|0302|MYCOPLASM PNEUMONIA AB|United Medicare Advantage|AARP UHC WEST COMPLETE MA|425.50||||||| 86738|EAP|0302|MYCOPLASM PNEUMONIA AB|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|425.50||||||| 86738|EAP|0302|MYCOPLASM PNEUMONIA AB|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||127.75||| 86738|EAP|0302|MYCOPLASM PNEUMONIA AB|Medicare|MEDICARE ACUTE|425.50||||||| 86738|EAP|0302|MYCOPLASM PNEUMONIA AB|United Healthcare|UNITED HEALTHCARE|425.50||||||| 86762|EAP|0302|RUBELLA QUALITATIVE|Medicaid|MEDICAID|||||138.75||| 86762|EAP|0302|RUBELLA QUALITATIVE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||138.75||| 86762|EAP|0302|RUBELLA QUALITATIVE|Blue Cross PPO Specialty|BCBSTX PPO|||||138.75||| 86762|EAP|0302|RUBELLA QUALITATIVE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||138.75||| 86762|EAP|0302|RUBELLA QUALITATIVE|Cigna|CIGNA|||||138.75||| 86762|EAP|0302|RUBELLA QUALITATIVE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||138.75||| 86762|EAP|0302|RUBELLA QUALITATIVE|Managed Medicaid|MEDICAID SUPERIOR|||||138.75||| 86765|EAP|0302|RUBEOLA TITER SERUM|Blue Cross PPO Specialty|BCBSTX PPO|||||124.25||| 86765|EAP|0302|RUBEOLA TITER SERUM|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||124.25||| 86765|EAP|0302|RUBEOLA TITER SERUM|Cigna|CIGNA|||||124.25||| 86765|EAP|0302|RUBEOLA TITER SERUM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||124.25||| 86765|EAP|0302|RUBEOLA TITER SERUM|Managed Medicaid|MEDICAID SUPERIOR|||||124.25||| 86765|EAP|0302|RUBEOLA TITER SERUM|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||124.25||| 86769|EAP|0300|SARS/COVID-19,IGG/IGM/IGA|United Medicare Advantage|UHC MEDICARE GOLD MA|||||84.26||| 86769|EAP|0300|SARS/COVID-19,IGG/IGM/IGA|Medicare|MEDICARE ACUTE|||||84.26||| 86769|EAP|0300|SARS/COVID-19,IGG/IGM/IGA|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||84.26||| 86769|EAP|0300|SARS/COVID-19,IGG/IGM/IGA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||84.26||| 86787|EAP|0302|VARICELLA ZOSTER ANTIBODY|Managed Medicaid|MEDICAID AMERIGROUP|||||0.79||| 86787|EAP|0302|VARICELLA ZOSTER AB IGG|Blue Cross PPO Specialty|BCBSTX PPO|||||0.79||| 86787|EAP|0302|VARICELLA ZOSTER AB IGG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.79||| 86787|EAP|0302|VARICELLA ZOSTER AB IGG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.79||| 86787|EAP|0302|VARICELLA ZOSTER AB IGG|Cigna|CIGNA|||||0.79||| 86787|EAP|0302|VARICELLA ZOSTER AB IGG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.79||| 86787|EAP|0302|VARICELLA ZOSTER AB IGG|Managed Medicaid|MEDICAID AMERIGROUP|||||0.79||| 86787|EAP|0302|VARICELLA ZOSTER AB IGG|Managed Medicaid|MEDICAID SUPERIOR|||||0.79||| 86787|EAP|0302|VARICELLA ZOSTER AB IGG|Medicare|MEDICARE ACUTE|262.75||||||| 86787|EAP|0302|VARICELLA ZOSTER AB IGG|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.79||| 86787|EAP|0302|VARICELLA ZOSTER AB IGG|Medicaid|MEDICAID|||||0.79||| 86790|EAP|0302|WEST NILE VIRUS TITER|Medicare|MEDICARE ACUTE|262.75||||||| 86800|EAP|0300|THYROGLOBULIN ANTIBODY|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||139.25||| 86800|EAP|0300|THYROGLOBULIN ANTIBODY|Blue Cross PPO Specialty|BCBSTX PPO|||||139.25||| 86800|EAP|0300|THYROGLOBULIN ANTIBODY|Aetna|AETNA QHP HMO|||||139.25||| 86800|EAP|0300|THYROGLOBULIN ANTIBODY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||139.25||| 86800|EAP|0300|THYROGLOBULIN ANTIBODY|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||139.25||| 86800|EAP|0300|THYROGLOBULIN ANTIBODY|Blue Cross HMO Specialty|BCBSTX HMO|||||139.25||| 86800|EAP|0300|THYROGLOBULIN ANTIBODY|Managed Medicaid|MEDICAID AMERIGROUP|||||139.25||| 86800|EAP|0300|THYROGLOBULIN ANTIBODY|Medicaid|MEDICAID|||||139.25||| 86800|EAP|0300|THYROGLOBULIN ANTIBODY|Medicare|MEDICARE ACUTE|||||139.25||| 86800|EAP|0300|THYROGLOBULIN ANTIBODY|United Healthcare|UNITED HEALTHCARE|||||139.25||| 86800|EAP|0300|THYROGLOBULIN ANTIBODY|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||139.25||| 86803|EAP|0302|HEPATITIS C ANTIBODY|United Healthcare|TML GROUP BENEFITS|||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|Medicare|MEDICARE ACUTE|458.50||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|NON CONTRACTED|COMMERCIAL OTHER 1|458.50||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|Tricare|TRICARE EAST REGION|||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|Managed Medicare|HEALTHSPRING MA|||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|United Healthcare|UNITED HEALTHCARE|||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|United Healthcare|UNITED HEALTHCARE OTHER|||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|Blue Cross PPO Specialty|BCBSTX PPO|||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|Blue Cross PPO Specialty|BCBSTX OTHER|||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|Aetna|AETNA PPO|||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|United Healthcare|UNITED HEALTHCARE|458.50||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|Cigna|CIGNA|||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|458.50||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|Medicaid|MEDICAID|458.50||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|Humana Medicare Advantage|HUMANA MA|458.50||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|Aenta Medicare Advantage|AETNA MEDICARE MA|||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|Blue Cross HMO Specialty|BCBSTX HMO|||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|Managed Medicaid|MEDICAID SUPERIOR|||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|Managed Medicaid|MEDICAID AMERIGROUP|||||2.98||| 86803|EAP|0302|HEPATITIS C ANTIBODY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|458.50||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|United Medicare Advantage|UHC MEDICARE GOLD MA|458.50||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|458.50||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|458.50||||137.50||| 86803|EAP|0302|HEPATITIS C ANTIBODY|Veterans Affairs|VETERANS ADMINISTRATION|458.50||||||| 86803|EAP|0302|HEPATITIS C ANTIBODY|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.98||| 86812|EAP|0302|HLA-B27 (SERUM)|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||248.75||| 86812|EAP|0302|HLA-B27 (SERUM)|Managed Medicaid|MEDICAID AMERIGROUP|||||248.75||| 86870|EAP|0300|ANTIBODY PANEL, BLOOD BAN|Medicare|MEDICARE ACUTE|288.30||||||| 86870|EAP|0300|ANTIBODY PANEL, BLOOD BAN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||288.30||| 86880|EAP|0302|DIRECT COOMBS|Veterans Affairs|VETERANS ADMINISTRATION|||||172.50||| 86880|EAP|0302|DIRECT COOMBS|Humana Medicare Advantage|HUMANA MA|||||213.90||| 86880|EAP|0302|DIRECT COOMBS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||172.50||| 86880|EAP|0302|DIRECT COOMBS|Medicare|MEDICARE ACUTE|||||193.20||| 86885|EAP|0300|INDIRECT COOMBS|United Healthcare|UNITED HEALTHCARE|||||227.85||| 86885|EAP|0300|INDIRECT COOMBS|Medicaid|MEDICAID|||||183.75||| 86885|EAP|0300|BLOOD TYPE & SCREEN|Medicaid|MEDICAID|||||205.80||| 86885|EAP|0300|INDIRECT COOMBS|NON CONTRACTED|COMMERCIAL OTHER 1|183.75||||227.85||| 86885|EAP|0300|BLOOD TYPE & SCREEN|Managed Medicare|OTHER INSTITUTIONS|||||227.85||| 86885|EAP|0300|INDIRECT COOMBS|Medicare|MEDICARE ACUTE|227.85||||227.85||| 86885|EAP|0300|BLOOD TYPE & SCREEN|United Healthcare|UNITED HEALTHCARE|||||183.75||| 86885|EAP|0300|BLOOD TYPE & SCREEN|Blue Cross PPO Specialty|BCBSTX PPO|||||227.85||| 86885|EAP|0300|BLOOD TYPE & SCREEN|Managed Medicaid|MEDICAID SUPERIOR|||||205.80||| 86885|EAP|0300|BLOOD TYPE & SCREEN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||227.85||| 86885|EAP|0300|INDIRECT COOMBS|Humana Medicare Advantage|HUMANA MA|183.75||||227.85||| 86885|EAP|0300|BLOOD TYPE & SCREEN|Medicare|MEDICARE ACUTE|183.75||||227.85||| 86885|EAP|0300|BLOOD TYPE & SCREEN|Aenta Medicare Advantage|AETNA MEDICARE MA|183.75||||183.75||| 86885|EAP|0300|INDIRECT COOMBS|Blue Cross HMO Specialty|BCBSTX HMO|227.85||||||| 86885|EAP|0300|BLOOD TYPE & SCREEN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||183.75||| 86885|EAP|0300|INDIRECT COOMBS|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||227.85||| 86885|EAP|0300|BLOOD TYPE & SCREEN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|227.85||||||| 86885|EAP|0300|INDIRECT COOMBS|Managed Medicaid|MEDICAID SUPERIOR|||||183.75||| 86885|EAP|0300|BLOOD TYPE & SCREEN|Humana Medicare Advantage|HUMANA MA|227.85||||227.85||| 86885|EAP|0300|INDIRECT COOMBS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|227.85||||227.85||| 86885|EAP|0300|BLOOD TYPE & SCREEN|United Medicare Advantage|UHC MEDICARE GOLD MA|183.75||||183.75||| 86885|EAP|0300|INDIRECT COOMBS|United Medicare Advantage|UHC MEDICARE GOLD MA|183.75||||227.85||| 86885|EAP|0300|BLOOD TYPE & SCREEN|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|183.75||||227.85||| 86885|EAP|0300|BLOOD TYPE & SCREEN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|227.85||||227.85||| 86885|EAP|0300|INDIRECT COOMBS|Veterans Affairs|VETERANS ADMINISTRATION|||||183.75||| 86900|EAP|0300|BLOOD TYPING ABO|United Medicare Advantage|UHC MEDICARE GOLD MA|95.75||||118.73||| 86900|EAP|0300|BLOOD TYPING ABO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|95.75||||||| 86900|EAP|0300|BLOOD TYPING ABO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||118.73||| 86900|EAP|0300|BLOOD TYPING ABO|Blue Cross PPO Specialty|BCBSTX PPO|||||28.75||| 86900|EAP|0300|BLOOD TYPING ABO|Humana Medicare Advantage|HUMANA MA|95.75||||118.73||| 86900|EAP|0300|BLOOD TYPING ABO|Blue Cross HMO Specialty|BCBSTX HMO|118.73||||||| 86900|EAP|0300|BLOOD TYPING ABO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||118.73||| 86900|EAP|0300|BLOOD TYPING ABO|Managed Medicaid|MEDICAID SUPERIOR|||||95.75||| 86900|EAP|0300|BLOOD TYPING ABO|Managed Medicaid|MEDICAID AMERIGROUP|||||95.75||| 86900|EAP|0300|BLOOD TYPING ABO|Medicare|MEDICARE ACUTE|118.73||||95.75||| 86900|EAP|0300|BLOOD TYPING ABO|Medicaid|MEDICAID|||||95.75||| 86900|EAP|0300|BLOOD TYPING ABO|NON CONTRACTED|COMMERCIAL OTHER 1|||||118.73||| 86900|EAP|0300|BLOOD TYPING ABO|United Healthcare|UNITED HEALTHCARE|||||118.73||| 86901|EAP|0300|BLOOD TYPING RH|Medicare|MEDICARE ACUTE|118.73||||118.73||| 86901|EAP|0300|BLOOD TYPING RH|United Healthcare|UNITED HEALTHCARE|||||118.73||| 86901|EAP|0300|BLOOD TYPE/RH FACTOR DONO|Medicare|MEDICARE ACUTE|118.73||||118.73||| 86901|EAP|0300|BLOOD TYPING RH|NON CONTRACTED|COMMERCIAL OTHER 1|95.75||||95.75||| 86901|EAP|0300|BLOOD TYPE/RH FACTOR DONO|NON CONTRACTED|COMMERCIAL OTHER 1|95.75||||118.73||| 86901|EAP|0300|BLOOD TYPE/RH FACTOR DONO|United Healthcare|UNITED HEALTHCARE|||||118.73||| 86901|EAP|0300|BLOOD TYPE/RH FACTOR DONO|United Healthcare|UNITED HEALTHCARE|||||95.75||| 86901|EAP|0300|BLOOD TYPING RH|Blue Cross PPO Specialty|BCBSTX PPO|||||95.75||| 86901|EAP|0300|BLOOD TYPING RH|Aetna|AETNA OTHER|||||95.75||| 86901|EAP|0300|BLOOD TYPE/RH FACTOR DONO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||118.73||| 86901|EAP|0300|BLOOD TYPING RH|Managed Medicaid|MEDICAID SUPERIOR|||||107.24||| 86901|EAP|0300|BLOOD TYPING RH|Humana Medicare Advantage|HUMANA MA|95.75||||118.73||| 86901|EAP|0300|BLOOD TYPE/RH FACTOR DONO|Aenta Medicare Advantage|AETNA MEDICARE MA|95.75||||95.75||| 86901|EAP|0300|BLOOD TYPE/RH FACTOR DONO|Humana Medicare Advantage|HUMANA MA|95.75||||118.73||| 86901|EAP|0300|BLOOD TYPE/RH FACTOR DONO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||95.75||| 86901|EAP|0300|BLOOD TYPING RH|Medicaid|MEDICAID|||||107.24||| 86901|EAP|0300|BLOOD TYPE/RH FACTOR DONO|Blue Cross HMO Specialty|BCBSTX HMO|118.73||||||| 86901|EAP|0300|BLOOD TYPING RH|Blue Cross HMO Specialty|BCBSTX HMO|118.73||||||| 86901|EAP|0300|BLOOD TYPING RH|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||107.24||| 86901|EAP|0300|BLOOD TYPING RH|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||95.75||| 86901|EAP|0300|BLOOD TYPE/RH FACTOR DONO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|118.73||||||| 86901|EAP|0300|BLOOD TYPING RH|Managed Medicaid|MEDICAID AMERIGROUP|||||95.75||| 86901|EAP|0300|BLOOD TYPE/RH FACTOR DONO|Managed Medicaid|MEDICAID SUPERIOR|||||118.73||| 86901|EAP|0300|BLOOD TYPING RH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||107.24||| 86901|EAP|0300|BLOOD TYPING RH|United Medicare Advantage|UHC MEDICARE GOLD MA|95.75||||118.73||| 86901|EAP|0300|BLOOD TYPING RH|United Medicare Advantage|AARP UHC WEST COMPLETE MA|118.73||||118.73||| 86901|EAP|0300|BLOOD TYPE/RH FACTOR DONO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|95.75||||118.73||| 86901|EAP|0300|BLOOD TYPE/RH FACTOR DONO|United Medicare Advantage|UHC MEDICARE GOLD MA|95.75||||95.75||| 86901|EAP|0300|BLOOD TYPE/RH FACTOR DONO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|118.73||||118.73||| 86904|EAP|0300|ANTIGEN SCREEN, PATIENT S|Humana Medicare Advantage|HUMANA MA|55.25||||||| 86904|EAP|0300|ANTIGEN SCREEN, PATIENT S|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||68.51||| 86904|EAP|0300|ANTIGEN SCREEN, PATIENT S|Medicare|MEDICARE ACUTE|61.88||||55.25||| 86905|EAP|0300|ANTIGEN SCREEN, PER UNIT|Medicare|MEDICARE ACUTE|107.57||||||| 86905|EAP|0300|ANTIGEN SCREEN, PER UNIT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||107.57||| 86922|EAP|0302|CROSSMATCH|United Medicare Advantage|UHC MEDICARE GOLD MA|166.75||||166.75||| 86922|EAP|0302|CROSSMATCH|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|166.75||||206.77||| 86922|EAP|0302|CROSSMATCH|United Medicare Advantage|AARP UHC WEST COMPLETE MA|206.77||||206.77||| 86922|EAP|0302|CROSSMATCH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||166.75||| 86922|EAP|0302|CROSSMATCH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|206.77||||||| 86922|EAP|0302|CROSSMATCH|Managed Medicaid|MEDICAID SUPERIOR|||||166.75||| 86922|EAP|0302|CROSSMATCH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||206.77||| 86922|EAP|0302|CROSSMATCH|Humana Medicare Advantage|HUMANA MA|186.76||||206.77||| 86922|EAP|0302|CROSSMATCH|Aenta Medicare Advantage|AETNA MEDICARE MA|166.75||||166.75||| 86922|EAP|0302|CROSSMATCH|Blue Cross HMO Specialty|BCBSTX HMO|206.77||||||| 86922|EAP|0302|CROSSMATCH|Medicare|MEDICARE ACUTE|206.77||||206.77||| 86922|EAP|0302|CROSSMATCH|NON CONTRACTED|COMMERCIAL OTHER 1|166.75||||206.77||| 86922|EAP|0302|CROSSMATCH|Managed Medicare|OTHER INSTITUTIONS|||||206.77||| 86922|EAP|0302|CROSSMATCH|United Healthcare|UNITED HEALTHCARE|||||206.77||| 86922|EAP|0302|CROSSMATCH|United Healthcare|UNITED HEALTHCARE|||||166.75||| 86927|EAP|0300|FRESH FROZEN PLASMA THAWI|Medicare|MEDICARE ACUTE|0.27||||||| 86927|EAP|0300|FRESH FROZEN PLASMA THAWI|United Medicare Advantage|UHC MEDICARE GOLD MA|0.27||||||| 87040|EAP|0306|CULTURE BLOOD|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||331.50||| 87040|EAP|0306|CULTURE BLOOD|United Medicare Advantage|UHC MEDICARE GOLD MA|331.50||||331.50||| 87040|EAP|0306|CULTURE BLOOD|United Medicare Advantage|AARP UHC WEST COMPLETE MA|331.50||||331.50||| 87040|EAP|0306|CULTURE BLOOD|Veterans Affairs|VETERANS ADMINISTRATION|||||331.50||| 87040|EAP|0306|CULTURE BLOOD|Workers Compensation|WORKERS COMPENSATION OTHER|331.50||||||| 87040|EAP|0306|CULTURE BLOOD|Blue Cross PPO Specialty|BCBSTX OTHER|||||331.50||| 87040|EAP|0306|CULTURE BLOOD|Blue Cross PPO Specialty|BCBSTX PPO|331.50||||331.50||| 87040|EAP|0306|CULTURE BLOOD|Aetna|AETNA QHP HMO|||||331.50||| 87040|EAP|0306|CULTURE BLOOD|Aetna|AETNA PPO|331.50||||||| 87040|EAP|0306|CULTURE BLOOD|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||331.50||| 87040|EAP|0306|CULTURE BLOOD|Cigna|CIGNA|331.50||||331.50||| 87040|EAP|0306|CULTURE BLOOD|Cigna|CIGNA|||||331.50||| 87040|EAP|0306|CULTURE BLOOD|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|331.50||||331.50||| 87040|EAP|0306|CULTURE BLOOD|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|331.50||||99.50||| 87040|EAP|0306|CULTURE BLOOD|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|331.50||||||| 87040|EAP|0306|CULTURE BLOOD|Humana Medicare Advantage|HUMANA MA|331.50||||331.50||| 87040|EAP|0306|CULTURE BLOOD|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|331.50||||331.50||| 87040|EAP|0306|CULTURE BLOOD|Aenta Medicare Advantage|AETNA MEDICARE MA|331.50||||331.50||| 87040|EAP|0306|CULTURE BLOOD|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|331.50||||331.50||| 87040|EAP|0306|CULTURE BLOOD|Blue Cross HMO Specialty|BCBSTX HMO|331.50||||331.50||| 87040|EAP|0306|CULTURE BLOOD|Managed Medicaid|MEDICAID SUPERIOR|||||331.50||| 87040|EAP|0306|CULTURE BLOOD|Managed Medicaid|MEDICAID UNITED HEALTHCARE|331.50||||331.50||| 87040|EAP|0306|CULTURE BLOOD|Managed Medicaid|MEDICAID AMERIGROUP|331.50||||331.50||| 87040|EAP|0306|CULTURE BLOOD|NON CONTRACTED|COMMERCIAL OTHER 1|331.50||||331.50||| 87040|EAP|0306|CULTURE BLOOD|Medicare|MEDICARE PART B ONLY IP|331.50||||||| 87040|EAP|0306|CULTURE BLOOD|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|331.50||||331.50||| 87040|EAP|0306|CULTURE BLOOD|Medicare|MEDICARE ACUTE|331.50||||331.50||| 87040|EAP|0306|CULTURE BLOOD|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||331.50||| 87040|EAP|0306|CULTURE BLOOD|Medicaid|MEDICAID|331.50||||331.50||| 87040|EAP|0306|CULTURE BLOOD|Medicaid|MEDICAID TEXAS CHILDRENS|||||331.50||| 87040|EAP|0306|CULTURE BLOOD|Tricare|TRICARE EAST REGION|331.50||||||| 87040|EAP|0306|CULTURE BLOOD|United Healthcare|UNITED HEALTHCARE|331.50||||331.50||| 87040|EAP|0306|CULTURE BLOOD|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||331.50||| 87040|EAP|0306|CULTURE BLOOD|Managed Medicare|HEALTHSPRING MA|||||331.50||| 87040|EAP|0306|CULTURE BLOOD|Managed Medicare|BCBS MEDICARE PPO MA|||||331.50||| 87040|EAP|0306|CULTURE BLOOD|United Healthcare|UNITED HEALTHCARE OTHER|||||331.50||| 87040|EAP|0306|CULTURE BLOOD|United Healthcare|UNITED HEALTHCARE|||||331.50||| 87040|EAP|0306|CULTURE BLOOD|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||331.50||| 87045|EAP|0306|CULTURE STOOL|Managed Medicaid|MEDICAID AMERIGROUP|||||0.91||| 87045|EAP|0306|CULTURE STOOL|United Healthcare|UNITED HEALTHCARE|||||0.91||| 87045|EAP|0306|CULTURE STOOL|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.03||| 87045|EAP|0306|CULTURE STOOL|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.91||| 87045|EAP|0306|CULTURE STOOL|Medicaid|MEDICAID|||||3.03||| 87045|EAP|0306|CULTURE STOOL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|3.03||||0.91||| 87045|EAP|0306|CULTURE STOOL|United Healthcare|UMR UNITED MEDICAL RESOURCES|3.03||||||| 87045|EAP|0306|CULTURE STOOL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.03||||||| 87045|EAP|0306|CULTURE STOOL|Tricare|TRICARE EAST REGION|||||0.91||| 87045|EAP|0306|CULTURE STOOL|Medicare|MEDICARE ACUTE|3.03||||3.03||| 87045|EAP|0306|CULTURE STOOL|Blue Cross PPO Specialty|BCBSTX PPO|3.03||||0.91||| 87045|EAP|0306|CULTURE STOOL|Blue Cross PPO Specialty|BCBSTX OTHER|||||3.03||| 87045|EAP|0306|CULTURE STOOL|Aetna|AETNA PPO|||||0.91||| 87045|EAP|0306|CULTURE STOOL|Cigna|CIGNA|||||1.97||| 87045|EAP|0306|CULTURE STOOL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.91||| 87045|EAP|0306|CULTURE STOOL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.03||| 87045|EAP|0306|CULTURE STOOL|Humana Medicare Advantage|HUMANA MA|3.03||||3.03||| 87045|EAP|0306|CULTURE STOOL|Blue Cross HMO Specialty|BCBSTX HMO|||||0.91||| 87045|EAP|0306|CULTURE STOOL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.91||| 87045|EAP|0306|CULTURE STOOL|Managed Medicaid|MEDICAID SUPERIOR|||||3.03||| 87045|EAP|0306|CULTURE STOOL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||3.03||| 87045|EAP|0306|CULTURE STOOL|United Medicare Advantage|UHC MEDICARE GOLD MA|3.03||||3.03||| 87045|EAP|0306|CULTURE STOOL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.97||| 87045|EAP|0306|CULTURE STOOL|Veterans Affairs|VETERANS ADMINISTRATION|||||3.03||| 87070|EAP|0306|CULTURE CSF|United Medicare Advantage|AARP UHC WEST COMPLETE MA|276.50||||276.50||| 87070|EAP|0306|CULTURE GENITAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|276.50||||276.50||| 87070|EAP|0306||United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|276.50||||276.50||| 87070|EAP|0306||United Medicare Advantage|UHC MEDICARE GOLD MA|276.50||||276.50||| 87070|EAP|0306||United Medicare Advantage|AARP UHC WEST COMPLETE MA|276.50||||276.50||| 87070|EAP|0306||Workers Compensation|WORKERS COMPENSATION OTHER|276.50||||||| 87070|EAP|0306|CULTURE GENITAL|Blue Cross PPO Specialty|BCBSTX PPO|276.50||||276.50||| 87070|EAP|0306|CULTURE CSF|Blue Cross PPO Specialty|BCBSTX PPO|276.50||||276.50||| 87070|EAP|0306|CULTURE CSF|Humana Medicare Advantage|HUMANA MA|276.50||||276.50||| 87070|EAP|0306||Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|276.50||||||| 87070|EAP|0306|CULTURE CSF|United Medicare Advantage|UHC MEDICARE GOLD MA|276.50||||276.50||| 87070|EAP|0306||Cigna|CIGNA|276.50||||||| 87070|EAP|0306||Access Direct Platinum|HEALTHFIRST TPA OTHER 1|276.50||||||| 87070|EAP|0306||Humana Medicare Advantage|HUMANA MA|276.50||||276.50||| 87070|EAP|0306||Aenta Medicare Advantage|AETNA MEDICARE MA|276.50||||||| 87070|EAP|0306|CULTURE CSF|Aenta Medicare Advantage|AETNA MEDICARE MA|276.50||||||| 87070|EAP|0306||Managed Medicaid|MEDICAID AMERIGROUP|||||276.50||| 87070|EAP|0306||Managed Medicaid|MEDICAID SUPERIOR|276.50||||276.50||| 87070|EAP|0306||Medicare|MEDICARE ACUTE|276.50||||276.50||| 87070|EAP|0306|CULTURE CSF|Medicare|MEDICARE ACUTE|276.50||||276.50||| 87070|EAP|0306||Medicare|MEDICARE PART B ONLY IP|276.50||||||| 87070|EAP|0306|CULTURE CSF|Managed Medicaid|MEDICAID SUPERIOR|276.50||||276.50||| 87070|EAP|0306||Medicaid|MEDICAID|276.50||||||| 87070|EAP|0306||Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|276.50||||276.50||| 87070|EAP|0306|CULTURE GENITAL|Managed Medicaid|MEDICAID AMERIGROUP|||||0.83||| 87071|EAP|0306|CULTURE NOSE/THROAT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|119.25||||||| 87071|EAP|0306|CULTURE NOSE/THROAT|Medicare|MEDICARE ACUTE|119.25||||35.80||| 87071|EAP|0306|CULTURE NOSE/THROAT|Medicare|MEDICARE PART B ONLY IP|119.25||||||| 87071|EAP|0306|CULTURE NOSE/THROAT|NON CONTRACTED|COMMERCIAL OTHER 1|||||35.80||| 87071|EAP|0306|CULTURE NOSE/THROAT|Medicaid|MEDICAID|119.25||||119.25||| 87071|EAP|0306|CULTURE NOSE/THROAT|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||35.80||| 87071|EAP|0306|CULTURE NOSE/THROAT|Managed Medicaid|MEDICAID AMERIGROUP|119.25||||||| 87071|EAP|0306|CULTURE NOSE/THROAT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|119.25||||||| 87071|EAP|0306|CULTURE NOSE/THROAT|Managed Medicaid|MEDICAID SUPERIOR|||||119.25||| 87071|EAP|0306|CULTURE NOSE/THROAT|United Healthcare|TML GROUP BENEFITS|||||119.25||| 87071|EAP|0306|CULTURE NOSE/THROAT|Blue Cross PPO Specialty|BCBSTX PPO|119.25||||35.80||| 87071|EAP|0306|CULTURE NOSE/THROAT|Cigna|CIGNA|119.25||||||| 87071|EAP|0306|CULTURE NOSE/THROAT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||77.53||| 87071|EAP|0306|CULTURE NOSE/THROAT|Humana Medicare Advantage|HUMANA MA|119.25||||119.25||| 87071|EAP|0306|CULTURE NOSE/THROAT|Aenta Medicare Advantage|AETNA MEDICARE MA|119.25||||||| 87071|EAP|0306|CULTURE NOSE/THROAT|Blue Cross HMO Specialty|BCBSTX HMO|119.25||||||| 87071|EAP|0306|CULTURE NOSE/THROAT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|119.25||||||| 87071|EAP|0306|CULTURE NOSE/THROAT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|119.25||||119.25||| 87071|EAP|0306|CULTURE NOSE/THROAT|United Medicare Advantage|UHC MEDICARE GOLD MA|119.25||||35.80||| 87071|EAP|0306|CULTURE NOSE/THROAT|Veterans Affairs|VETERANS ADMINISTRATION|119.25||||||| 87075|EAP|0300|ANAEROBIC CULTURE|United Medicare Advantage|UHC MEDICARE GOLD MA|2.58||||||| 87075|EAP|0300|ANAEROBIC CULTURE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.58||||||| 87075|EAP|0306|CULTURE AEROBIC|Blue Cross PPO Specialty|BCBSTX PPO|||||276.50||| 87075|EAP|0306|CULTURE AEROBIC|Aetna|AETNA QHP HMO|||||276.50||| 87075|EAP|0300|ANAEROBIC CULTURE|Managed Medicaid|MEDICAID AMERIGROUP|||||2.58||| 87075|EAP|0306|CULTURE AEROBIC|Blue Cross HMO Specialty|BCBSTX HMO|||||0.83||| 87075|EAP|0306|CULTURE AEROBIC|NON CONTRACTED|COMMERCIAL OTHER 1|||||276.50||| 87075|EAP|0306|CULTURE AEROBIC|Medicaid|WOOD COUNTY INDIGENT|||||276.50||| 87076|EAP|0300|ANAEROBIC IDENTIFICATION|Medicare|MEDICARE ACUTE|2.20||||||| 87076|EAP|0300|ANAEROBIC IDENTIFICATION|Managed Medicaid|MEDICAID AMERIGROUP|||||2.20||| 87076|EAP|0300|ANAEROBIC IDENTIFICATION|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Veterans Affairs|VETERANS ADMINISTRATION|||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Veterans Affairs|VETERANS ADMINISTRATION|2.20||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||68.70||| 87077|EAP|0300|AEROBIC IDENTIFICATION|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.20||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.20||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Workers Compensation|WORKERS COMPENSATION OTHER|2.20||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Blue Cross PPO Specialty|BCBSTX OTHER|2.20||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Aetna|AETNA QHP HMO|||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Aetna|AETNA OTHER|2.20||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Cigna|CIGNA|||||68.70||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Cigna|CIGNA|||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.20||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Humana Medicare Advantage|HUMANA MA|2.20||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Aenta Medicare Advantage|AETNA MEDICARE MA|2.20||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Blue Cross HMO Specialty|BCBSTX HMO|2.20||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|2.20||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.20||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Blue Cross PPO Specialty|BCBSTX PPO|2.20||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Managed Medicaid|MEDICAID SUPERIOR|2.20||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Managed Medicaid|MEDICAID AMERIGROUP|||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.20||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||68.70||| 87077|EAP|0300|AEROBIC IDENTIFICATION|United Medicare Advantage|UHC MEDICARE GOLD MA|2.20||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.20||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Medicaid|WOOD COUNTY INDIGENT|||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Medicaid|MEDICAID|2.20||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Managed Medicare|BCBS MEDICARE PPO MA|||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Managed Medicare|HEALTHSPRING MA|||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.20||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Tricare|TRICARE EAST REGION|||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|United Healthcare|UNITED HEALTHCARE|||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|United Healthcare|UNITED HEALTHCARE OTHER|||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Medicare|MEDICARE ACUTE|2.20||||2.20||| 87077|EAP|0300|AEROBIC IDENTIFICATION|Medicare|MEDICARE PART B ONLY IP|2.20||||||| 87081|EAP|0306|PERTUSSIS CULTURE|Medicare|MEDICARE ACUTE|||||0.64||| 87086|EAP|0306|CULTURE URINE|Veterans Affairs|VETERANS ADMINISTRATION|||||259.50||| 87086|EAP|0306|CULTURE URINE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|259.50||||259.50||| 87086|EAP|0306|CULTURE URINE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|259.50||||259.50||| 87086|EAP|0306|CULTURE URINE|United Medicare Advantage|UHC MEDICARE GOLD MA|259.50||||259.50||| 87086|EAP|0306|CULTURE URINE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|259.50||||259.50||| 87086|EAP|0306|CULTURE URINE|Blue Cross PPO Specialty|BCBSTX PPO|259.50||||259.50||| 87086|EAP|0306|CULTURE URINE|Blue Cross PPO Specialty|BCBSTX OTHER|259.50||||259.50||| 87086|EAP|0306|CULTURE URINE|Aetna|AETNA OTHER|||||259.50||| 87086|EAP|0306|CULTURE URINE|Aetna|AETNA PPO|||||259.50||| 87086|EAP|0306|CULTURE URINE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.78||| 87086|EAP|0306|CULTURE URINE|Cigna|CIGNA|259.50||||259.50||| 87086|EAP|0306|CULTURE URINE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|259.50||||259.50||| 87086|EAP|0306|CULTURE URINE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||259.50||| 87086|EAP|0306|CULTURE URINE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|259.50||||0.78||| 87086|EAP|0306|CULTURE URINE|Humana Medicare Advantage|HUMANA MA|259.50||||259.50||| 87086|EAP|0306|CULTURE URINE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|259.50||||0.78||| 87086|EAP|0306|CULTURE URINE|Cigna|CIGNA|||||0.78||| 87086|EAP|0306|CULTURE URINE|Aenta Medicare Advantage|AETNA MEDICARE MA|259.50||||259.50||| 87086|EAP|0306|CULTURE URINE|Blue Cross HMO Specialty|BCBSTX HMO|259.50||||0.78||| 87086|EAP|0306|CULTURE URINE|Medicare|MEDICARE ACUTE|259.50||||259.50||| 87086|EAP|0306|CULTURE URINE|Managed Medicaid|MEDICAID AMERIGROUP|||||259.50||| 87086|EAP|0306|CULTURE URINE|United Healthcare|TML GROUP BENEFITS|259.50||||259.50||| 87086|EAP|0306|CULTURE URINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|259.50||||259.50||| 87086|EAP|0306|CULTURE URINE|Aetna|AETNA QHP HMO|||||259.50||| 87086|EAP|0306|CULTURE URINE|Medicaid|MEDICAID TEXAS CHILDRENS|||||259.50||| 87086|EAP|0306|CULTURE URINE|Medicaid|MEDICAID HMO|||||259.50||| 87086|EAP|0306|CULTURE URINE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||259.50||| 87086|EAP|0306|CULTURE URINE|Medicaid|MEDICAID|259.50||||259.50||| 87086|EAP|0306|CULTURE URINE|Workers Compensation|WORKERS COMPENSATION OTHER|||||259.50||| 87086|EAP|0306|CULTURE URINE|NON CONTRACTED|COMMERCIAL OTHER 1|259.50||||259.50||| 87086|EAP|0306|CULTURE URINE|Managed Medicaid|MEDICAID SUPERIOR|||||259.50||| 87086|EAP|0306|CULTURE URINE|Tricare|TRICARE FOR LIFE|||||259.50||| 87086|EAP|0306|CULTURE URINE|Tricare|TRICARE EAST REGION|||||259.50||| 87086|EAP|0306|CULTURE URINE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|259.50||||259.50||| 87086|EAP|0306|CULTURE URINE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||259.50||| 87086|EAP|0306|CULTURE URINE|Managed Medicare|HEALTHSPRING MA|||||259.50||| 87086|EAP|0306|CULTURE URINE|Managed Medicare|BCBS MEDICARE PPO MA|||||259.50||| 87086|EAP|0306|CULTURE URINE|United Healthcare|UNITED HEALTHCARE OTHER|||||168.75||| 87086|EAP|0306|CULTURE URINE|United Healthcare|UNITED HEALTHCARE|259.50||||259.50||| 87086|EAP|0306|CULTURE URINE|United Healthcare|UNITED HEALTHCARE|||||259.50||| 87086|EAP|0306|CULTURE URINE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||259.50||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|5,538.35|1645.16|17981.01|16.5|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|NON CONTRACTED|COMMERCIAL OTHER 1|415.71|12963.28|17981.01|16.5|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Medicare|MEDICARE ACUTE|29,558.23|80.85|17981.01|16.5|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Managed Medicare|OTHER INSTITUTIONS|2,834.48|1644.72|17981.01|16.5|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Aetna|AETNA OTHER|50,595.25|17981.01|17981.01|16.5|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|62,678.20|10740.42|17981.01|16.5|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Humana Medicare Advantage|HUMANA MA|32,710.28|9718.25|17981.01|16.5|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|44,908.90|11889.12|17981.01|16.5|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Managed Medicaid|MEDICAID AMERIGROUP|23,436.32|17257.72|17981.01|16.5|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Blue Cross PPO Specialty|BCBSTX PPO|84,235.82|512.49|17981.01|16.5|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|32,009.85|6495.28|17981.01|16.5|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|15,775.99|4056.58|17981.01|16.5|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|Veterans Affairs|VETERANS ADMINISTRATION|14,581.40|16.5|17981.01|16.5|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|296.85|8113.16|17981.01|16.5|||| 871|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|4,994.03|16.5|17981.01|16.5|||| 87102|EAP|0306|CULTURE FUNGAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.81||| 87102|EAP|0306|CULTURE FUNGAL|Blue Cross PPO Specialty|BCBSTX PPO|||||0.81||| 87102|EAP|0306|CULTURE FUNGAL|Medicare|MEDICARE ACUTE|||||0.81||| 87116|EAP|0306|CULTURE ACID FAST|Medicare|MEDICARE ACUTE|||||104.25||| 87116|EAP|0306|CULTURE ACID FAST|Blue Cross PPO Specialty|BCBSTX PPO|||||104.25||| 87116|EAP|0306|CULTURE ACID FAST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||104.25||| 87147|EAP|0300|SALMONELLA TYPE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.14||| 87147|EAP|0300|SALMONELLA TYPE|Medicare|MEDICARE ACUTE|||||0.14||| 87177|EAP|0306|OVA & PARASITES|United Medicare Advantage|UHC MEDICARE GOLD MA|2.81||||84.50||| 87177|EAP|0306|OVA & PARASITES|Humana Medicare Advantage|HUMANA MA|2.81||||84.50||| 87177|EAP|0306|OVA & PARASITES|Blue Cross PPO Specialty|BCBSTX PPO|||||84.50||| 87177|EAP|0306|OVA & PARASITES|Aetna|AETNA PPO|||||84.50||| 87177|EAP|0306|OVA & PARASITES|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||84.50||| 87177|EAP|0306|OVA & PARASITES|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||182.75||| 87177|EAP|0306|OVA & PARASITES|Aenta Medicare Advantage|AETNA MEDICARE MA|||||84.50||| 87177|EAP|0306|OVA & PARASITES|Blue Cross HMO Specialty|BCBSTX HMO|||||84.50||| 87177|EAP|0306|OVA & PARASITES|Managed Medicaid|MEDICAID SUPERIOR|||||84.50||| 87177|EAP|0306|OVA & PARASITES|Medicare|MEDICARE ACUTE|2.81||||84.50||| 87177|EAP|0306|OVA & PARASITES|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.81||||||| 87177|EAP|0306|OVA & PARASITES|United Healthcare|UNITED HEALTHCARE|||||84.50||| 87177|EAP|0306|OVA & PARASITES|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||84.50||| 87177|EAP|0306|OVA & PARASITES|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||84.50||| 87177|EAP|0306|OVA & PARASITES|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||84.50||| 87177|EAP|0306|OVA & PARASITES|Managed Medicaid|MEDICAID AMERIGROUP|||||84.50||| 87177|EAP|0300|WET MOUNT KOH|Medicare|MEDICARE ACUTE|||||0.69||| 87184|EAP|0300|KIRBY BAUER ANTIMICROBIAL|Medicare|MEDICARE ACUTE|||||0.56||| 87184|EAP|0300|KIRBY BAUER ANTIMICROBIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.88||| 87186|EAP|0306|SENSITIVITY, EACH|United Medicare Advantage|UHC MEDICARE GOLD MA|277.75||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||180.63||| 87186|EAP|0306|SENSITIVITY, EACH|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|277.75||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|United Medicare Advantage|AARP UHC WEST COMPLETE MA|277.75||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|Veterans Affairs|VETERANS ADMINISTRATION|277.75||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|Veterans Affairs|VETERANS ADMINISTRATION|||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|Blue Cross PPO Specialty|BCBSTX PPO|277.75||||83.50||| 87186|EAP|0306|SENSITIVITY, EACH|Blue Cross PPO Specialty|BCBSTX OTHER|277.75||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|Aetna|AETNA OTHER|277.75||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|Cigna|CIGNA|||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|Cigna|CIGNA|||||83.50||| 87186|EAP|0306|SENSITIVITY, EACH|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||83.50||| 87186|EAP|0306|SENSITIVITY, EACH|Aetna|AETNA QHP HMO|||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|277.75||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|277.75||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|277.75||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|Humana Medicare Advantage|HUMANA MA|277.75||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|Aenta Medicare Advantage|AETNA MEDICARE MA|277.75||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|Blue Cross HMO Specialty|BCBSTX HMO|277.75||||83.50||| 87186|EAP|0306|SENSITIVITY, EACH|Medicare|MEDICARE PART B ONLY IP|277.75||||||| 87186|EAP|0306|SENSITIVITY, EACH|Medicare|MEDICARE ACUTE|277.75||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|Workers Compensation|WORKERS COMPENSATION OTHER|277.75||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|Managed Medicaid|MEDICAID SUPERIOR|277.75||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|277.75||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|277.75||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|Managed Medicaid|MEDICAID AMERIGROUP|||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|NON CONTRACTED|COMMERCIAL OTHER 1|||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|Medicaid|MEDICAID|277.75||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|Medicaid|MEDICAID TEXAS CHILDRENS|||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|Medicaid|WOOD COUNTY INDIGENT|||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|277.75||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|Managed Medicare|HEALTHSPRING MA|||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|Managed Medicare|BCBS MEDICARE PPO MA|||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|United Healthcare|UNITED HEALTHCARE OTHER|||||277.75||| 87186|EAP|0306|SENSITIVITY, EACH|United Healthcare|UNITED HEALTHCARE|||||277.75||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Medicaid|MEDICAID|37,817.32|6754.98|22076.4|43.71|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|16,310.40|4879.16|22076.4|43.71|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|NON CONTRACTED|COMMERCIAL OTHER 1|22,076.40|22076.4|22076.4|43.71|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Medicare|MEDICARE PART B ONLY IP|33,790.65|2692.56|22076.4|43.71|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Medicare|MEDICARE ACUTE|16,530.09|43.71|22076.4|43.71|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|30,299.60|9012.7|22076.4|43.71|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|27,078.29|150.08|22076.4|43.71|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Aenta Medicare Advantage|AETNA MEDICARE MA|36,746.36|10402.98|22076.4|43.71|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|Humana Medicare Advantage|HUMANA MA|39,587.22|115.5|22076.4|43.71|||| 872|DRG||SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|25,512.07|6499.2|22076.4|43.71|||| 87205|EAP|0306|GRAM STAIN|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.37||| 87205|EAP|0306|GRAM STAIN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.37||| 87205|EAP|0306|GRAM STAIN|Humana Medicare Advantage|HUMANA MA|||||1.37||| 87205|EAP|0306|GRAM STAIN|Medicare|MEDICARE ACUTE|1.37||||1.37||| 87205|EAP|0306|GRAM STAIN|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.37||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||148.25||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||148.25||| 87209|EAP|0300|SMEAR COMPLEX STAIN|United Healthcare|UNITED HEALTHCARE|||||148.25||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Medicare|MEDICARE ACUTE|494.20||||148.25||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Blue Cross PPO Specialty|BCBSTX PPO|||||148.25||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Aetna|AETNA PPO|||||148.25||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||321.23||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Humana Medicare Advantage|HUMANA MA|494.20||||148.25||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Aenta Medicare Advantage|AETNA MEDICARE MA|||||148.25||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Blue Cross HMO Specialty|BCBSTX HMO|||||148.25||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|494.20||||||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||148.25||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Managed Medicaid|MEDICAID AMERIGROUP|||||148.25||| 87209|EAP|0300|SMEAR COMPLEX STAIN|Managed Medicaid|MEDICAID SUPERIOR|||||148.25||| 87209|EAP|0300|SMEAR COMPLEX STAIN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||148.25||| 87209|EAP|0300|SMEAR COMPLEX STAIN|United Medicare Advantage|UHC MEDICARE GOLD MA|494.20||||148.25||| 87210|EAP|0306|SMEAR, WET MOUNT|Aetna|AETNA OTHER|||||1.37||| 87210|EAP|0306|SMEAR, WET MOUNT|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.37||| 87210|EAP|0306|SMEAR, WET MOUNT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||41.25||| 87210|EAP|0306|SMEAR, WET MOUNT|Medicare|MEDICARE ACUTE|||||1.37||| 87210|EAP|0306|SMEAR, WET MOUNT|United Healthcare|UNITED HEALTHCARE|||||41.25||| 87210|EAP|0306|SMEAR, WET MOUNT|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.37||| 87210|EAP|0306|SMEAR, WET MOUNT|Managed Medicaid|MEDICAID SUPERIOR|||||1.37||| 87210|EAP|0306|SMEAR, WET MOUNT|Managed Medicaid|MEDICAID AMERIGROUP|||||89.13||| 87210|EAP|0306|SMEAR, WET MOUNT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.37||| 87252|EAP|0306|CULTURE VIRUS|United Medicare Advantage|UHC MEDICARE GOLD MA|837.25||||||| 87252|EAP|0306|CULTURE VIRUS|Managed Medicaid|MEDICAID SUPERIOR|||||837.25||| 87324|EAP|0306|CLOSTRIDIUM DIFF TOXIN|Blue Cross PPO Specialty|BCBSTX PPO|634.25||||190.25||| 87324|EAP|0306|CLOSTRIDIUM DIFF TOXIN|Aetna|AETNA PPO|||||190.25||| 87324|EAP|0306|CLOSTRIDIUM DIFF TOXIN|Cigna|CIGNA|||||634.25||| 87324|EAP|0306|CLOSTRIDIUM DIFF TOXIN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||634.25||| 87324|EAP|0306|CLOSTRIDIUM DIFF TOXIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|634.25||||||| 87324|EAP|0306|CLOSTRIDIUM DIFF TOXIN|Humana Medicare Advantage|HUMANA MA|634.25||||634.25||| 87324|EAP|0306|CLOSTRIDIUM DIFF TOXIN|Blue Cross HMO Specialty|BCBSTX HMO|||||190.25||| 87324|EAP|0306|CLOSTRIDIUM DIFF TOXIN|Medicare|MEDICARE ACUTE|634.25||||634.25||| 87324|EAP|0306|CLOSTRIDIUM DIFF TOXIN|NON CONTRACTED|COMMERCIAL OTHER 1|||||412.25||| 87324|EAP|0306|CLOSTRIDIUM DIFF TOXIN|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||190.25||| 87324|EAP|0306|CLOSTRIDIUM DIFF TOXIN|Tricare|TRICARE EAST REGION|634.25||||||| 87324|EAP|0306|CLOSTRIDIUM DIFF TOXIN|Blue Cross PPO Specialty|BCBSTX OTHER|||||634.25||| 87324|EAP|0306|CLOSTRIDIUM DIFF TOXIN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||634.25||| 87324|EAP|0306|CLOSTRIDIUM DIFF TOXIN|Managed Medicaid|MEDICAID SUPERIOR|||||634.25||| 87324|EAP|0306|CLOSTRIDIUM DIFF TOXIN|Managed Medicaid|MEDICAID AMERIGROUP|||||190.25||| 87324|EAP|0306|CLOSTRIDIUM DIFF TOXIN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|634.25||||190.25||| 87324|EAP|0306|CLOSTRIDIUM DIFF TOXIN|Managed Medicare|BCBS MEDICARE PPO MA|634.25||||||| 87324|EAP|0306|CLOSTRIDIUM DIFF TOXIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|634.25||||||| 87324|EAP|0306|CLOSTRIDIUM DIFF TOXIN|United Healthcare|UNITED HEALTHCARE|||||190.25||| 87324|EAP|0306|CLOSTRIDIUM DIFF TOXIN|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||634.25||| 87324|EAP|0306|CLOSTRIDIUM DIFF TOXIN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||634.25||| 87324|EAP|0306|CLOSTRIDIUM DIFF TOXIN|United Medicare Advantage|UHC MEDICARE GOLD MA|634.25||||634.25||| 87324|EAP|0306|CLOSTRIDIUM DIFF TOXIN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|634.25||||190.25||| 87324|EAP|0306|CLOSTRIDIUM DIFF TOXIN|Veterans Affairs|VETERANS ADMINISTRATION|||||634.25||| 87328|EAP|0300|CRYPTOSPORIDIUM AG IA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.98||| 87329|EAP|0300|GIARDIA AG IA|Medicare|MEDICARE ACUTE|3.27||||||| 87338|EAP|0300|H PYLORI STOOL|United Healthcare|UNITED HEALTHCARE|||||3.92||| 87340|EAP|0302|HEPATITIS B SURFACE ANTIG|United Medicare Advantage|UHC MEDICARE GOLD MA|331.75||||99.50||| 87340|EAP|0302|HEPATITIS B SURFACE ANTIG|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|331.75||||99.50||| 87340|EAP|0302|HEPATITIS B SURFACE ANTIG|Blue Cross PPO Specialty|BCBSTX PPO|||||99.50||| 87340|EAP|0302|HEPATITIS B SURFACE ANTIG|Managed Medicaid|MEDICAID AMERIGROUP|||||331.75||| 87340|EAP|0302|HEPATITIS B SURFACE ANTIG|Aetna|AETNA PPO|||||99.50||| 87340|EAP|0302|HEPATITIS B SURFACE ANTIG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|331.75||||99.50||| 87340|EAP|0302|HEPATITIS B SURFACE ANTIG|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||99.50||| 87340|EAP|0302|HEPATITIS B SURFACE ANTIG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||99.50||| 87340|EAP|0302|HEPATITIS B SURFACE ANTIG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||99.50||| 87340|EAP|0302|HEPATITIS B SURFACE ANTIG|Veterans Affairs|VETERANS ADMINISTRATION|331.75||||||| 87340|EAP|0302|HEPATITIS B SURFACE ANTIG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||99.50||| 87340|EAP|0302|HEPATITIS B SURFACE ANTIG|Cigna|CIGNA|||||99.50||| 87340|EAP|0302|HEPATITIS B SURFACE ANTIG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|331.75||||99.50||| 87340|EAP|0302|HEPATITIS B SURFACE ANTIG|Humana Medicare Advantage|HUMANA MA|331.75||||||| 87340|EAP|0302|HEPATITIS B SURFACE ANTIG|Aenta Medicare Advantage|AETNA MEDICARE MA|||||99.50||| 87340|EAP|0302|HEPATITIS B SURFACE ANTIG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||99.50||| 87340|EAP|0302|HEPATITIS B SURFACE ANTIG|Medicare|MEDICARE ACUTE|331.75||||99.50||| 87340|EAP|0302|HEPATITIS B SURFACE ANTIG|NON CONTRACTED|COMMERCIAL OTHER 1|331.75||||||| 87340|EAP|0302|HEPATITIS B SURFACE ANTIG|Medicaid|MEDICAID|331.75||||99.50||| 87340|EAP|0302|HEPATITIS B SURFACE ANTIG|United Healthcare|UNITED HEALTHCARE OTHER|||||99.50||| 87340|EAP|0302|HEPATITIS B SURFACE ANTIG|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||99.50||| 87340|EAP|0302|HEPATITIS B SURFACE ANTIG|United Healthcare|UNITED HEALTHCARE|||||99.50||| 87340|EAP|0302|HEPATITIS B SURFACE ANTIG|United Healthcare|UNITED HEALTHCARE|331.75||||||| 87420|EAP|0306|RESPIRATORY SYNCYTIAL VIR|NON CONTRACTED|COMMERCIAL OTHER 1|||||385.50||| 87420|EAP|0306|RESPIRATORY SYNCYTIAL VIR|Medicaid|MEDICAID|||||385.50||| 87420|EAP|0306|RESPIRATORY SYNCYTIAL VIR|Medicaid|MEDICAID TEXAS CHILDRENS|||||385.50||| 87420|EAP|0306|RESPIRATORY SYNCYTIAL VIR|Medicare|MEDICARE ACUTE|||||385.50||| 87420|EAP|0306|RESPIRATORY SYNCYTIAL VIR|Tricare|TRICARE EAST REGION|||||385.50||| 87420|EAP|0306|RESPIRATORY SYNCYTIAL VIR|United Healthcare|UNITED HEALTHCARE|||||385.50||| 87420|EAP|0306|RESPIRATORY SYNCYTIAL VIR|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||385.50||| 87420|EAP|0306|RESPIRATORY SYNCYTIAL VIR|Managed Medicaid|MEDICAID SUPERIOR|||||385.50||| 87420|EAP|0306|RESPIRATORY SYNCYTIAL VIR|Managed Medicaid|MEDICAID AMERIGROUP|||||385.50||| 87420|EAP|0306|RESPIRATORY SYNCYTIAL VIR|Blue Cross PPO Specialty|BCBSTX PPO|||||385.50||| 87420|EAP|0306|RESPIRATORY SYNCYTIAL VIR|Aetna|AETNA OTHER|||||385.50||| 87420|EAP|0306|RESPIRATORY SYNCYTIAL VIR|Cigna|CIGNA|385.50||||||| 87420|EAP|0306|RESPIRATORY SYNCYTIAL VIR|Cigna|CIGNA|||||385.50||| 87420|EAP|0306|RESPIRATORY SYNCYTIAL VIR|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|United Medicare Advantage|UHC MEDICARE GOLD MA|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Veterans Affairs|VETERANS ADMINISTRATION|||||385.50||| 87430|EAP|0300|STREP SCREEN (DIRECT SCRE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.57||| 87430|EAP|0306|STREP SCREEN LATEX|Blue Cross PPO Specialty|BCBSTX PPO|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Blue Cross PPO Specialty|BCBSTX OTHER|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Aetna|AETNA OTHER|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Aetna|AETNA QHP HMO|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Aetna|AETNA PPO|385.50||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Cigna|CIGNA|385.50||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Humana Medicare Advantage|HUMANA MA|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Aenta Medicare Advantage|AETNA MEDICARE MA|385.50||||385.50||| 87430|EAP|0300|STREP SCREEN (DIRECT SCRE|Managed Medicaid|MEDICAID AMERIGROUP|||||0.57||| 87430|EAP|0306|STREP SCREEN LATEX|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|385.50||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Cigna|CIGNA|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Blue Cross HMO Specialty|BCBSTX HMO|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Managed Medicaid|MEDICAID AMERIGROUP|385.50||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Managed Medicaid|MEDICAID UNITED HEALTHCARE|385.50||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Medicare|MEDICARE ACUTE|385.50||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||385.50||| 87430|EAP|0300|STREP SCREEN (DIRECT SCRE|Medicaid|MEDICAID HMO|||||0.57||| 87430|EAP|0300|STREP SCREEN (DIRECT SCRE|Medicaid|MEDICAID|||||0.57||| 87430|EAP|0300|STREP SCREEN (DIRECT SCRE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.57||| 87430|EAP|0306|STREP SCREEN LATEX|NON CONTRACTED|COMMERCIAL OTHER 1|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Medicaid|MEDICAID TEXAS CHILDRENS|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Medicaid|MEDICAID HMO|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Medicaid|MEDICAID|385.50||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Tricare|TRICARE FOR LIFE|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Tricare|TRICARE EAST REGION|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Managed Medicare|HEALTHSPRING MA|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|United Healthcare|TML GROUP BENEFITS|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|United Healthcare|UNITED HEALTHCARE|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|United Healthcare|UNITED HEALTHCARE OTHER|||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|United Healthcare|UNITED HEALTHCARE|385.50||||385.50||| 87430|EAP|0306|STREP SCREEN LATEX|Managed Medicaid|MEDICAID SUPERIOR|||||385.50||| 87430|EAP|0300|STREP SCREEN (DIRECT SCRE|Medicare|MEDICARE ACUTE|||||0.57||| 87449|EAP|0300|AG DETECT NOS EIA MULTI|Medicaid|MEDICAID|339.80||||||| 87449|EAP|0300|AG DETECT NOS EIA MULTI|NON CONTRACTED|COMMERCIAL OTHER 1|339.80||||||| 87449|EAP|0300|AG DETECT NOS EIA MULTI|Managed Medicare|HEALTHSPRING MA|339.80||||||| 87449|EAP|0300|AG DETECT NOS EIA MULTI|United Healthcare|UNITED HEALTHCARE|339.80||||||| 87449|EAP|0300|AG DETECT NOS EIA MULTI|Medicare|MEDICARE PART B ONLY IP|339.80||||||| 87449|EAP|0300|AG DETECT NOS EIA MULTI|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|339.80||||||| 87449|EAP|0300|AG DETECT NOS EIA MULTI|Medicare|MEDICARE ACUTE|339.80||||339.80||| 87449|EAP|0300|AG DETECT NOS EIA MULTI|Blue Cross PPO Specialty|BCBSTX PPO|339.80||||||| 87449|EAP|0300|AG DETECT NOS EIA MULTI|Aetna|AETNA PPO|339.80||||||| 87449|EAP|0300|AG DETECT NOS EIA MULTI|Cigna|CIGNA|339.80||||||| 87449|EAP|0300|AG DETECT NOS EIA MULTI|Humana Medicare Advantage|HUMANA MA|339.80||||339.80||| 87449|EAP|0300|AG DETECT NOS EIA MULTI|Aenta Medicare Advantage|AETNA MEDICARE MA|339.80||||||| 87449|EAP|0300|AG DETECT NOS EIA MULTI|Blue Cross HMO Specialty|BCBSTX HMO|339.80||||||| 87449|EAP|0300|AG DETECT NOS EIA MULTI|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|339.80||||||| 87449|EAP|0300|AG DETECT NOS EIA MULTI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|339.80||||||| 87449|EAP|0300|AG DETECT NOS EIA MULTI|United Medicare Advantage|UHC MEDICARE GOLD MA|339.80||||||| 87449|EAP|0300|AG DETECT NOS EIA MULTI|United Medicare Advantage|AARP UHC WEST COMPLETE MA|339.80||||339.80||| 87449|EAP|0300|AG DETECT NOS EIA MULTI|Veterans Affairs|VETERANS ADMINISTRATION|339.80||||||| 87449|EAP|0300|AG DETECT NOS EIA MULTI|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|339.80||||||| 87449|EAP|0300|AG DETECT NOS EIA MULTI|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|339.80||||||| 87490|EAP|0306|CHLAMYDIA BY DNA|Blue Cross PPO Specialty|BCBSTX PPO|||||6.44||| 87490|EAP|0306|CHLAMYDIA BY DNA|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||193.25||| 87490|EAP|0306|CHLAMYDIA BY DNA|Cigna|CIGNA|||||6.44||| 87490|EAP|0306|CHLAMYDIA BY DNA|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||193.25||| 87490|EAP|0306|CHLAMYDIA BY DNA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||193.25||| 87490|EAP|0306|CHLAMYDIA BY DNA|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||193.25||| 87490|EAP|0306|CHLAMYDIA BY DNA|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||6.44||| 87490|EAP|0306|CHLAMYDIA BY DNA|Blue Cross HMO Specialty|BCBSTX HMO|||||193.25||| 87490|EAP|0306|CHLAMYDIA BY DNA|Medicare|MEDICARE ACUTE|||||193.25||| 87490|EAP|0306|CHLAMYDIA BY DNA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||418.63||| 87490|EAP|0306|CHLAMYDIA BY DNA|Aetna|AETNA OTHER|||||6.44||| 87490|EAP|0306|CHLAMYDIA BY DNA|Managed Medicaid|MEDICAID AMERIGROUP|||||418.63||| 87490|EAP|0306|CHLAMYDIA BY DNA|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||6.44||| 87490|EAP|0306|CHLAMYDIA BY DNA|Managed Medicaid|MEDICAID SUPERIOR|||||418.63||| 87490|EAP|0306|CHLAMYDIA BY DNA|NON CONTRACTED|COMMERCIAL OTHER 1|||||418.63||| 87490|EAP|0306|CHLAMYDIA BY DNA|Medicaid|MEDICAID|||||193.25||| 87490|EAP|0306|CHLAMYDIA BY DNA|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||6.44||| 87490|EAP|0306|CHLAMYDIA BY DNA|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||6.44||| 87490|EAP|0306|CHLAMYDIA BY DNA|Tricare|TRICARE EAST REGION|||||193.25||| 87490|EAP|0306|CHLAMYDIA BY DNA|United Healthcare|UNITED HEALTHCARE|||||418.63||| 87490|EAP|0306|CHLAMYDIA BY DNA|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||6.44||| 87490|EAP|0306|CHLAMYDIA BY DNA|United Healthcare|UNITED HEALTHCARE OTHER|||||193.25||| 87490|EAP|0306|CHLAMYDIA BY DNA|United Healthcare|UNITED HEALTHCARE|||||193.25||| 87493|EAP|0300|C DIFF BY PCR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||286.60||| 87493|EAP|0300|C DIFF BY PCR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||955.20||| 87493|EAP|0300|C DIFF BY PCR|Tricare|TRICARE EAST REGION|||||286.60||| 87493|EAP|0300|C DIFF BY PCR|Medicare|MEDICARE ACUTE|955.20||||286.60||| 87493|EAP|0300|C DIFF BY PCR|Blue Cross PPO Specialty|BCBSTX PPO|955.20||||||| 87493|EAP|0300|C DIFF BY PCR|Blue Cross PPO Specialty|BCBSTX OTHER|||||955.20||| 87493|EAP|0300|C DIFF BY PCR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||286.60||| 87493|EAP|0300|C DIFF BY PCR|Humana Medicare Advantage|HUMANA MA|955.20||||955.20||| 87493|EAP|0300|C DIFF BY PCR|Blue Cross HMO Specialty|BCBSTX HMO|||||286.60||| 87493|EAP|0300|C DIFF BY PCR|Managed Medicaid|MEDICAID SUPERIOR|||||286.60||| 87493|EAP|0300|C DIFF BY PCR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||286.60||| 87493|EAP|0300|C DIFF BY PCR|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||286.60||| 87497|EAP|0300|INFECTIOUS AGENT ANTIGEN|Medicare|MEDICARE ACUTE|||||2.32||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Veterans Affairs|VETERANS ADMINISTRATION|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Workers Compensation|WORKERS COMPENSATION OTHER|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Blue Cross PPO Specialty|BCBSTX PPO|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Blue Cross PPO Specialty|BCBSTX OTHER|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Aetna|AETNA QHP HMO|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Aetna|AETNA PPO|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Cigna|CIGNA|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Cigna|CIGNA|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Humana Medicare Advantage|HUMANA MA|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Aenta Medicare Advantage|AETNA MEDICARE MA|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Blue Cross HMO Specialty|BCBSTX HMO|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Managed Medicaid|MEDICAID AMERIGROUP|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Managed Medicaid|MEDICAID SUPERIOR|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Aetna|AETNA OTHER|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Medicaid|MEDICAID|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Medicaid|MEDICAID HMO|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Medicaid|MEDICAID TEXAS CHILDRENS|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|NON CONTRACTED|COMMERCIAL OTHER 2|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|NON CONTRACTED|COMMERCIAL OTHER 1|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|United Medicare Advantage|UHC MEDICARE GOLD MA|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Managed Medicare|HEALTHSPRING MA|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Tricare|TRICARE EAST REGION|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|United Healthcare|UNITED HEALTHCARE|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|United Healthcare|TML GROUP BENEFITS|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|United Healthcare|UNITED HEALTHCARE|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|United Healthcare|UNITED HEALTHCARE OTHER|||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Medicare|MEDICARE ACUTE|13.90||||13.90||| 87502|EAP|0300|INFLUENZA DNA AMP PROBE|Medicare|MEDICARE PART B ONLY IP|13.90||||||| 87522|EAP|0306|HEP C RNA/PCR QUAN|Medicare|MEDICARE ACUTE|911.50||||273.50||| 87522|EAP|0306|HEP C RNA/PCR QUAN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||273.50||| 87522|EAP|0306|HEP C RNA/PCR QUAN|Managed Medicaid|MEDICAID AMERIGROUP|||||273.50||| 87522|EAP|0306|HEP C RNA/PCR QUAN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||273.50||| 87522|EAP|0306|HEP C RNA/PCR QUAN|NON CONTRACTED|COMMERCIAL OTHER 1|||||273.50||| 87522|EAP|0306|HEP C RNA/PCR QUAN|Medicaid|MEDICAID|911.50||||273.50||| 87522|EAP|0306|HEP C RNA/PCR QUAN|United Healthcare|UNITED HEALTHCARE OTHER|||||273.50||| 87522|EAP|0306|HEP C RNA/PCR QUAN|Blue Cross PPO Specialty|BCBSTX PPO|||||273.50||| 87522|EAP|0306|HEP C RNA/PCR QUAN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||273.50||| 87522|EAP|0306|HEP C RNA/PCR QUAN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||273.50||| 87522|EAP|0306|HEP C RNA/PCR QUAN|United Medicare Advantage|UHC MEDICARE GOLD MA|||||273.50||| 87522|EAP|0306|HEP C RNA/PCR QUAN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|911.50||||||| 87536|EAP|0300|HIV 1 DNA QUANT|Blue Cross PPO Specialty|BCBSTX PPO|||||2,484.80||| 87536|EAP|0300|HIV 1 DNA QUANT|Blue Cross HMO Specialty|BCBSTX HMO|||||745.50||| 87536|EAP|0300|HIV 1 DNA QUANT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2,484.80||||745.50||| 87536|EAP|0300|HIV 1 DNA QUANT|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||745.50||| 87536|EAP|0300|HIV 1 DNA QUANT|Medicare|MEDICARE ACUTE|||||745.50||| 87590|EAP|0300|GC BY DNA|United Healthcare|UNITED HEALTHCARE OTHER|||||193.25||| 87590|EAP|0300|GC BY DNA|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||6.44||| 87590|EAP|0300|GC BY DNA|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||6.44||| 87590|EAP|0300|GC BY DNA|NON CONTRACTED|COMMERCIAL OTHER 1|||||6.44||| 87590|EAP|0300|GC BY DNA|Tricare|TRICARE EAST REGION|||||193.25||| 87590|EAP|0300|GC BY DNA|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||6.44||| 87590|EAP|0300|GC BY DNA|United Healthcare|UNITED HEALTHCARE|||||418.63||| 87590|EAP|0300|GC BY DNA|United Healthcare|UNITED HEALTHCARE|||||193.25||| 87590|EAP|0300|GC BY DNA|Medicare|MEDICARE ACUTE|||||193.25||| 87590|EAP|0300|GC BY DNA|Blue Cross PPO Specialty|BCBSTX PPO|||||6.44||| 87590|EAP|0300|GC BY DNA|Medicaid|MEDICAID|||||193.25||| 87590|EAP|0300|GC BY DNA|Aetna|AETNA OTHER|||||6.44||| 87590|EAP|0300|GC BY DNA|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||193.25||| 87590|EAP|0300|GC BY DNA|Cigna|CIGNA|||||6.44||| 87590|EAP|0300|GC BY DNA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||193.25||| 87590|EAP|0300|GC BY DNA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||418.63||| 87590|EAP|0300|GC BY DNA|Blue Cross HMO Specialty|BCBSTX HMO|||||193.25||| 87590|EAP|0300|GC BY DNA|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||6.44||| 87590|EAP|0300|GC BY DNA|Managed Medicaid|MEDICAID SUPERIOR|||||418.63||| 87590|EAP|0300|GC BY DNA|Managed Medicaid|MEDICAID AMERIGROUP|||||418.63||| 87590|EAP|0300|GC BY DNA|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||6.44||| 87590|EAP|0300|GC BY DNA|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||193.25||| 87590|EAP|0300|GC BY DNA|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||193.25||| 87804|EAP|0300|FLU STAT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||326.50||| 87804|EAP|0300|FLU STAT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||326.50||| 87804|EAP|0300|FLU STAT|Blue Cross PPO Specialty|BCBSTX PPO|||||326.50||| 87804|EAP|0300|FLU STAT|Medicaid|MEDICAID|||||326.50||| 87804|EAP|0300|FLU STAT|Medicaid|MEDICAID HMO|||||326.50||| 87804|EAP|0300|FLU STAT|Medicare|MEDICARE ACUTE|||||326.50||| 87807|EAP|0300|RSV|Medicare|MEDICARE ACUTE|||||0.80||| 87899|EAP|0300|STREP PNEUMONIA SERO TYPE|United Medicare Advantage|UHC MEDICARE GOLD MA|350.40||||||| 87899|EAP|0300|STREP PNEUMONIA SERO TYPE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|350.40||||||| 87899|EAP|0300|STREP PNEUMONIA SERO TYPE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|350.40||||350.40||| 87899|EAP|0300|STREP PNEUMONIA SERO TYPE|Blue Cross PPO Specialty|BCBSTX PPO|350.40||||||| 87899|EAP|0300|STREP PNEUMONIA SERO TYPE|Aetna|AETNA PPO|350.40||||||| 87899|EAP|0300|STREP PNEUMONIA SERO TYPE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|350.40||||||| 87899|EAP|0300|STREP PNEUMONIA SERO TYPE|Cigna|CIGNA|350.40||||||| 87899|EAP|0300|STREP PNEUMONIA SERO TYPE|Humana Medicare Advantage|HUMANA MA|350.40||||350.40||| 87899|EAP|0300|STREP PNEUMONIA SERO TYPE|Aenta Medicare Advantage|AETNA MEDICARE MA|350.40||||||| 87899|EAP|0300|STREP PNEUMONIA SERO TYPE|Blue Cross HMO Specialty|BCBSTX HMO|350.40||||||| 87899|EAP|0300|STREP PNEUMONIA SERO TYPE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|350.40||||||| 87899|EAP|0300|STREP PNEUMONIA SERO TYPE|Medicaid|MEDICAID|350.40||||||| 87899|EAP|0300|STREP PNEUMONIA SERO TYPE|NON CONTRACTED|COMMERCIAL OTHER 1|350.40||||||| 87899|EAP|0300|STREP PNEUMONIA SERO TYPE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|350.40||||||| 87899|EAP|0300|STREP PNEUMONIA SERO TYPE|Managed Medicare|HEALTHSPRING MA|350.40||||||| 87899|EAP|0300|STREP PNEUMONIA SERO TYPE|United Healthcare|UNITED HEALTHCARE|350.40||||||| 87899|EAP|0300|STREP PNEUMONIA SERO TYPE|Medicare|MEDICARE ACUTE|350.40||||350.40||| 87899|EAP|0300|STREP PNEUMONIA SERO TYPE|Medicare|MEDICARE PART B ONLY IP|350.40||||||| 87902|EAP|0300|HEPATITIS C GENOTYPE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||4.04||| 87902|EAP|0300|HEPATITIS C GENOTYPE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.04||| 87902|EAP|0300|HEPATITIS C GENOTYPE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.04||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|United Medicare Advantage|UHC MEDICARE GOLD MA|736.80||||||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|United Medicare Advantage|AARP UHC WEST COMPLETE MA|736.80||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Medicare|MEDICARE ACUTE|736.80||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Medicaid|MEDICAID|736.80||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Medicaid|WOOD COUNTY INDIGENT|||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|NON CONTRACTED|COMMERCIAL OTHER 1|736.80||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|United Healthcare|UNITED HEALTHCARE OTHER|||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|United Healthcare|UMR UNITED MEDICAL RESOURCES|736.80||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|United Healthcare|UNITED HEALTHCARE|||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|736.80||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Blue Cross PPO Specialty|BCBSTX PPO|736.80||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Medicaid|MEDICAID TEXAS CHILDRENS|||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Veterans Affairs|VETERANS ADMINISTRATION|||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Aetna|AETNA OTHER|||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Aetna|AETNA PPO|736.80||||||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Cigna|CIGNA|736.80||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|736.80||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Humana Medicare Advantage|HUMANA MA|736.80||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Blue Cross HMO Specialty|BCBSTX HMO|736.80||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Managed Medicaid|MEDICAID AMERIGROUP|736.80||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Managed Medicaid|MEDICAID SUPERIOR|736.80||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||736.80||| 88304|EAP|0300|GROSS AND MICROSCOPIC LEV|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|736.80||||736.80||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Access Direct Platinum|HEALTHFIRST TPA UMR|||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|Access Direct Platinum|HEALTHFIRST TPA UMR|||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|77.25||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Blue Cross PPO Specialty|BCBSTX PPO|77.25||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|Blue Cross PPO Specialty|BCBSTX OTHER|||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Blue Cross PPO Specialty|BCBSTX OTHER|||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|77.25||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|Aetna|AETNA PPO|77.25||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Aetna|AETNA PPO|77.25||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||736.80||| 88305|EAP|0300|SURGICAL PATHOLOGY|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|77.25||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|Cigna|CIGNA|77.25||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Cigna|CIGNA|77.25||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|77.25||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|77.25||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|Humana Medicare Advantage|HUMANA MA|77.25||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Humana Medicare Advantage|HUMANA MA|77.25||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|Aenta Medicare Advantage|AETNA MEDICARE MA|||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|Blue Cross HMO Specialty|BCBSTX HMO|77.25||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Blue Cross HMO Specialty|BCBSTX HMO|77.25||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||407.03||| 88305|EAP|0300|SURGICAL PATHOLOGY|Managed Medicaid|MEDICAID AMERIGROUP|77.25||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Managed Medicaid|MEDICAID SUPERIOR|77.25||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Medicare|MEDICARE ACUTE|77.25||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|Medicare|MEDICARE ACUTE|77.25||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Managed Medicaid|MEDICAID AMERIGROUP|77.25||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|Medicaid|MEDICAID|77.25||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|Medicaid|MEDICAID TEXAS CHILDRENS|||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Medicaid|MEDICAID|77.25||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|Managed Medicaid|MEDICAID SUPERIOR|77.25||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Aenta Medicare Advantage|AETNA MEDICARE MA|||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|Medicaid|WOOD COUNTY INDIGENT|||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|NON CONTRACTED|COMMERCIAL OTHER 1|736.80||||736.80||| 88305|EAP|0300|SURGICAL PATHOLOGY|NON CONTRACTED|COMMERCIAL OTHER 1|77.25||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|NON CONTRACTED|WOOD COUNTY HOSPITAL DISTRICT|||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|NON CONTRACTED|WOOD COUNTY HOSPITAL DISTRICT|||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|United Healthcare|UMR UNITED MEDICAL RESOURCES|77.25||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|Managed Medicare|OTHER INSTITUTIONS|||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|Managed Medicare|HEALTHSPRING MA|||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Managed Medicare|OTHER INSTITUTIONS|||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|Aetna|AETNA OTHER|||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Managed Medicare|HEALTHSPRING MA|||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|Tricare|TRICARE EAST REGION|||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|Tricare|TRICARE EAST REGION|||||407.03||| 88305|EAP|0300|SURGICAL PATHOLOGY|Blue Cross PPO Specialty|BCBSTX PPO|77.25||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|United Healthcare|UNITED HEALTHCARE|||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|United Healthcare|UNITED HEALTHCARE OTHER|||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|United Healthcare|TML GROUP BENEFITS|||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|United Healthcare|TML GROUP BENEFITS|||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|United Healthcare|UMR UNITED MEDICAL RESOURCES|77.25||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|United Healthcare|UNITED HEALTHCARE|||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|United Healthcare|UNITED HEALTHCARE OTHER|||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|Veterans Affairs|VETERANS ADMINISTRATION|||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|United Medicare Advantage|UHC MEDICARE GOLD MA|77.25||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|United Medicare Advantage|UHC MEDICARE GOLD MA|77.25||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|77.25||||77.25||| 88305|EAP|0300|SURGICAL PATHOLOGY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|77.25||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|407.03||||77.25||| 88305|EAP|0300|GROSS AND MICROSCOPIC LEV|United Medicare Advantage|AARP UHC WEST COMPLETE MA|77.25||||77.25||| 88307|EAP|0300|GROSS AND MICROSCOPIC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||12.09||| 88307|EAP|0300|GROSS AND MICROSCOPIC|United Medicare Advantage|UHC MEDICARE GOLD MA|||||12.09||| 88307|EAP|0300|GROSS AND MICROSCOPIC|Medicare|MEDICARE ACUTE|12.09||||12.09||| 88307|EAP|0300|GROSS AND MICROSCOPIC|NON CONTRACTED|COMMERCIAL OTHER 1|12.09||||||| 88307|EAP|0300|GROSS AND MICROSCOPIC|Blue Cross PPO Specialty|BCBSTX PPO|||||12.09||| 88307|EAP|0300|GROSS AND MICROSCOPIC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||12.09||| 88307|EAP|0300|GROSS AND MICROSCOPIC|Humana Medicare Advantage|HUMANA MA|12.09||||||| 88307|EAP|0300|GROSS AND MICROSCOPIC|Blue Cross HMO Specialty|BCBSTX HMO|||||12.09||| 88307|EAP|0300|GROSS AND MICROSCOPIC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||12.09||| 88342|EAP|0300|IMMUNOHISTOCHEMISTRY|Blue Cross PPO Specialty|BCBSTX PPO|||||736.80||| 88342|EAP|0300|IMMUNOHISTOCHEMISTRY|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||736.80||| 88342|EAP|0300|IMMUNOHISTOCHEMISTRY|Humana Medicare Advantage|HUMANA MA|||||736.80||| 88342|EAP|0300|IMMUNOHISTOCHEMISTRY|Medicare|MEDICARE ACUTE|||||736.80||| 884|DRG||ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY|Medicare|MEDICARE ACUTE|16,896.78|3281.08|3281.08|3281.08|||| 885|DRG||PSYCHOSES|United Medicare Advantage|UHC MEDICARE GOLD MA|14,187.95|64.68|64.68|64.68|||| 89051|EAP|0309|CELL COUNT W/DIFF CSF/JOI|Blue Cross PPO Specialty|BCBSTX PPO|||||1.77||| 89051|EAP|0309|CELL COUNT W/DIFF CSF/JOI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.77||| 89051|EAP|0309|CELL COUNT W/DIFF CSF/JOI|Medicare|MEDICARE ACUTE|1.77||||||| 89051|EAP|0309|CELL COUNT W/DIFF CSF/JOI|Managed Medicaid|MEDICAID SUPERIOR|||||1.77||| 89051|EAP|0309|CELL COUNT W/DIFF CSF/JOI|United Medicare Advantage|UHC MEDICARE GOLD MA|1.77||||||| 89051|EAP|0309|CELL COUNT W/DIFF CSF/JOI|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.77||||1.77||| 89055|EAP|0300|FECAL LEUKOCYTES PREP|United Medicare Advantage|UHC MEDICARE GOLD MA|202.25||||202.25||| 89055|EAP|0300|FECAL LEUKOCYTES PREP|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||202.25||| 89055|EAP|0300|FECAL LEUKOCYTES PREP|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||147.25||| 89055|EAP|0300|FECAL LEUKOCYTES PREP|Medicare|MEDICARE ACUTE|202.25||||202.25||| 89055|EAP|0300|FECAL LEUKOCYTES PREP|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||147.25||| 89055|EAP|0300|FECAL LEUKOCYTES PREP|Veterans Affairs|VETERANS ADMINISTRATION|||||202.25||| 89055|EAP|0300|FECAL LEUKOCYTES PREP|NON CONTRACTED|COMMERCIAL OTHER 1|||||174.75||| 89055|EAP|0300|FECAL LEUKOCYTES PREP|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|202.25||||||| 89055|EAP|0300|FECAL LEUKOCYTES PREP|Tricare|TRICARE EAST REGION|||||147.25||| 89055|EAP|0300|FECAL LEUKOCYTES PREP|United Healthcare|UNITED HEALTHCARE|||||202.25||| 89055|EAP|0300|FECAL LEUKOCYTES PREP|United Healthcare|UNITED HEALTHCARE|||||147.25||| 89055|EAP|0300|FECAL LEUKOCYTES PREP|Blue Cross PPO Specialty|BCBSTX PPO|202.25||||202.25||| 89055|EAP|0300|FECAL LEUKOCYTES PREP|Blue Cross PPO Specialty|BCBSTX OTHER|||||202.25||| 89055|EAP|0300|FECAL LEUKOCYTES PREP|Cigna|CIGNA|||||202.25||| 89055|EAP|0300|FECAL LEUKOCYTES PREP|Humana Medicare Advantage|HUMANA MA|202.25||||202.25||| 89055|EAP|0300|FECAL LEUKOCYTES PREP|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||202.25||| 89055|EAP|0300|FECAL LEUKOCYTES PREP|Managed Medicaid|MEDICAID SUPERIOR|||||202.25||| 89060|EAP|0300|CRYSTALS, BODY FLUID|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.95||| 89060|EAP|0300|CRYSTALS, BODY FLUID|Medicare|MEDICARE ACUTE|||||1.95||| 89060|EAP|0300|CRYSTALS, BODY FLUID|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.95||| 89190|EAP|0309|EOSINOPHIL COUNT NASAL|United Medicare Advantage|UHC MEDICARE GOLD MA|152.50||||||| 89190|EAP|0309|EOSINOPHIL COUNT NASAL|Medicare|MEDICARE ACUTE|||||45.75||| 894|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE, LEFT AMA|Humana Medicare Advantage|HUMANA MA|3,062.01|16.5|16.5|16.5|||| 896|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W MCC|Medicare|MEDICARE ACUTE|44,221.85|11347.16|11347.16|11347.16|||| 897|DRG||ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC|NON CONTRACTED|COMMERCIAL OTHER 1|32,877.26|32877.26|32877.26|32877.26|||| 90375|EAP|0636|RABIES IMMUNE GLOB 300 UN|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,134.41||| 90375|EAP|0636|RABIES IMMUNE GLOB 300 UN|Medicare|MEDICARE ACUTE|||||1,134.41||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.91||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Blue Cross PPO Specialty|BCBSTX OTHER|||||100.75||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Blue Cross PPO Specialty|BCBSTX PPO|||||100.75||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Aetna|AETNA OTHER|||||100.75||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Aetna|AETNA QHP HMO|||||81.25||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||100.75||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Cigna|CIGNA|||||100.75||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||100.75||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Aenta Medicare Advantage|AETNA MEDICARE MA|||||81.25||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Blue Cross HMO Specialty|BCBSTX HMO|||||100.75||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||100.75||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Managed Medicare|HEALTHSPRING MA|||||100.75||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Medicare|MEDICARE ACUTE|||||100.75||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|NON CONTRACTED|COMMERCIAL OTHER 1|||||100.75||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|PHCS|HUMANA INSURANCE|||||100.75||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Humana Medicare Advantage|HUMANA MA|||||100.75||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Tricare|TRICARE FOR LIFE|||||100.75||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Tricare|TRICARE EAST REGION|||||0.91||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||100.75||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|United Healthcare|UNITED HEALTHCARE|||||100.75||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Medicaid|MEDICAID|||||100.75||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Managed Medicaid|MEDICAID SUPERIOR|||||100.75||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||81.25||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||81.25||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|100.75||||||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Managed Medicaid|MEDICAID AMERIGROUP|||||100.75||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|United Healthcare|UNITED HEALTHCARE|||||81.25||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||100.75||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|United Healthcare|UNITED HEALTHCARE OTHER|||||100.75||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||81.25||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||81.25||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||100.75||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Veterans Affairs|VETERANS ADMINISTRATION|||||0.91||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Workers Compensation|WORKERS COMPENSATION OTHER|||||100.75||| 90471|EAP|0450|IMM ADMIN ONE VACCINE|Workers Compensation|UT EMPLOYEE INJURY|||||100.75||| 90675|EAP|0636|RABIES VACCINE,PCEC 2.5 U|Medicare|MEDICARE ACUTE|||||1,688.87||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|United Healthcare|UNITED HEALTHCARE OTHER|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Veterans Affairs|VETERANS ADMINISTRATION|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Workers Compensation|UT EMPLOYEE INJURY|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Workers Compensation|WORKERS COMPENSATION OTHER|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Blue Cross PPO Specialty|BCBSTX OTHER|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Blue Cross PPO Specialty|BCBSTX PPO|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Aetna|AETNA OTHER|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Aetna|AETNA QHP HMO|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|195.84||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Cigna|CIGNA|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Humana Medicare Advantage|HUMANA MA|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Aenta Medicare Advantage|AETNA MEDICARE MA|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Blue Cross HMO Specialty|BCBSTX HMO|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Managed Medicaid|MEDICAID SUPERIOR|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Managed Medicaid|MEDICAID AMERIGROUP|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|United Healthcare|UNITED HEALTHCARE|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Managed Medicare|HEALTHSPRING MA|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Medicare|MEDICARE ACUTE|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|NON CONTRACTED|COMMERCIAL OTHER 1|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|PHCS|HUMANA INSURANCE|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Tricare|TRICARE FOR LIFE|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Tricare|TRICARE EAST REGION|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Medicaid|MEDICAID|||||195.84||| 90714|EAP|0636|TETANUS-DIPTHE TOX (ADULT|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||195.84||| 90732|EAP|0636|PNEUMOCOCCAL VACC 25MCG/0|Medicare|MEDICARE ACUTE|278.25||||278.25||| 90732|EAP|0636|PNEUMOCOCCAL VACC 25MCG/0|Medicaid|MEDICAID|278.25||||||| 90732|EAP|0636|PNEUMOCOCCAL VACC 25MCG/0|Blue Cross PPO Specialty|BCBSTX PPO|278.25||||||| 90732|EAP|0636|PNEUMOCOCCAL VACC 25MCG/0|Humana Medicare Advantage|HUMANA MA|278.25||||||| 90732|EAP|0636|PNEUMOCOCCAL VACC 25MCG/0|Aenta Medicare Advantage|AETNA MEDICARE MA|278.25||||||| 90732|EAP|0636|PNEUMOCOCCAL VACC 25MCG/0|United Medicare Advantage|AARP UHC WEST COMPLETE MA|278.25||||||| 91|DRG||OTHER DISORDERS OF NERVOUS SYSTEM W MCC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|37,520.30|11346.28|14585.5|4878.28|||| 91|DRG||OTHER DISORDERS OF NERVOUS SYSTEM W MCC|Humana Medicare Advantage|HUMANA MA|491.30|14585.5|14585.5|4878.28|||| 91|DRG||OTHER DISORDERS OF NERVOUS SYSTEM W MCC|Medicare|MEDICARE ACUTE|17,396.90|4878.28|14585.5|4878.28|||| 917|DRG||POISONING & TOXIC EFFECTS OF DRUGS W MCC|Medicare|MEDICARE ACUTE|76,612.29|148.5|148.5|148.5|||| 92|DRG||OTHER DISORDERS OF NERVOUS SYSTEM W CC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|5,133.83|16.17|99|16.17|||| 92|DRG||OTHER DISORDERS OF NERVOUS SYSTEM W CC|Medicare|MEDICARE ACUTE|26,853.17|99|99|16.17|||| 920|DRG||COMPLICATIONS OF TREATMENT W CC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|17,378.10|4878.28|4878.28|4878.28|||| 92507|EAP|0440|SLP SPEECH THX 60MIN|Blue Cross HMO Specialty|BCBSTX HMO|218.75||||||| 92507|EAP|0440|SLP SPEECH THX 45MIN|Medicare|MEDICARE ACUTE|218.75||||||| 92522|EAP|0444|SLP EVALUATION OF SPEECH|United Medicare Advantage|UHC MEDICARE GOLD MA|5.08||||||| 92522|EAP|0444|SLP EVALUATION OF SPEECH|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|5.08||||||| 92522|EAP|0444|SLP EVALUATION OF SPEECH|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||5.08||| 92522|EAP|0444|SLP EVALUATION OF SPEECH|Medicare|MEDICARE ACUTE|5.08||||||| 92522|EAP|0444|SLP EVALUATION OF SPEECH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|5.08||||||| 92522|EAP|0444|SLP EVALUATION OF SPEECH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|5.08||||||| 92522|EAP|0444|SLP EVALUATION OF SPEECH|Humana Medicare Advantage|HUMANA MA|5.08||||5.08||| 92522|EAP|0444|SLP EVALUATION OF SPEECH|Blue Cross HMO Specialty|BCBSTX HMO|5.08||||||| 92526|EAP|0440|SLP TREAT OF SWALLOW DYSF|Medicare|MEDICARE ACUTE|282.75||||||| 92526|EAP|0440|SLP TREAT OF SWALLOW DYSF|United Medicare Advantage|UHC MEDICARE GOLD MA|282.75||||||| 92610|EAP|0444|SLP EVAL SWALLOW FUNC ORA|United Medicare Advantage|UHC MEDICARE GOLD MA|4.18||||4.18||| 92610|EAP|0444|SLP EVAL SWALLOW FUNC ORA|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|4.18||||||| 92610|EAP|0444|SLP EVAL SWALLOW FUNC ORA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.18||||4.18||| 92610|EAP|0444|SLP EVAL SWALLOW FUNC ORA|Veterans Affairs|VETERANS ADMINISTRATION|4.18||||||| 92610|EAP|0444|SLP EVAL SWALLOW FUNC ORA|Workers Compensation|WORKERS COMPENSATION OTHER|4.18||||||| 92610|EAP|0444|SLP EVAL SWALLOW FUNC ORA|Humana Medicare Advantage|HUMANA MA|4.18||||||| 92610|EAP|0444|SLP EVAL SWALLOW FUNC ORA|Aenta Medicare Advantage|AETNA MEDICARE MA|4.18||||||| 92610|EAP|0444|SLP EVAL SWALLOW FUNC ORA|Blue Cross HMO Specialty|BCBSTX HMO|4.18||||||| 92610|EAP|0444|SLP EVAL SWALLOW FUNC ORA|Medicare|MEDICARE ACUTE|4.18||||||| 92610|EAP|0444|SLP EVAL SWALLOW FUNC ORA|NON CONTRACTED|COMMERCIAL OTHER 1|4.18||||||| 92610|EAP|0444|SLP EVAL SWALLOW FUNC ORA|Medicaid|MEDICAID|4.18||||||| 92611|EAP|0444|SLP EVAL SWALLOW FUNC FLU|Medicare|MEDICARE ACUTE|289.50||||||| 92611|EAP|0444|SLP EVAL SWALLOW FUNC FLU|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||289.50||| 92612|EAP|0444|SLP EVAL SWALLOW FUNC END|Medicare|MEDICARE ACUTE|4.18||||||| 92950|EAP|0450|CPR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||7.98||| 92950|EAP|0450|CPR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||989.52||| 92950|EAP|0450|CPR|Blue Cross PPO Specialty|BCBSTX PPO|||||7.98||| 92950|EAP|0450|CPR|Aetna|AETNA QHP HMO|||||7.98||| 92950|EAP|0450|CPR|Humana Medicare Advantage|HUMANA MA|||||7.98||| 92950|EAP|0450|CPR|Aenta Medicare Advantage|AETNA MEDICARE MA|||||989.52||| 92950|EAP|0450|CPR|Medicare|MEDICARE ACUTE|||||989.52||| 92950|EAP|0450|CPR|United Healthcare|UNITED HEALTHCARE OTHER|||||989.52||| 92950|EAP|0450|CPR|Medicaid|MEDICAID|||||7.98||| 92950|EAP|0450|CPR|United Healthcare|UNITED HEALTHCARE|||||989.52||| 92977|EAP|0480|THROMBOLYSIS CORONARY INF|Medicare|MEDICARE ACUTE|||||923.25||| 92977|EAP|0480|THROMBOLYSIS CORONARY INF|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,144.83||| 92977|EAP|0480|THROMBOLYSIS CORONARY INF|NON CONTRACTED|COMMERCIAL OTHER 1|||||923.25||| 93005|EAP|0730|EKG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.25||||2.25||| 93005|EAP|0730|EKG|United Medicare Advantage|UHC MEDICARE GOLD MA|2.25||||2.79||| 93005|EAP|0730|EKG|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.79||||2.52||| 93005|EAP|0730|EKG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.79||||2.79||| 93005|EAP|0730|EKG|Veterans Affairs|VETERANS ADMINISTRATION|2.79||||2.79||| 93005|EAP|0730|EKG|United Healthcare|UNITED HEALTHCARE|2.79||||2.79||| 93005|EAP|0730|EKG|United Healthcare|UNITED HEALTHCARE OTHER|||||2.79||| 93005|EAP|0730|EKG|United Healthcare|UNITED HEALTHCARE|||||2.25||| 93005|EAP|0730|EKG|United Healthcare|GEHA|||||2.79||| 93005|EAP|0730|EKG|United Healthcare|UMR UNITED MEDICAL RESOURCES|2.25||||2.25||| 93005|EAP|0730|EKG|United Healthcare|TML GROUP BENEFITS|||||2.79||| 93005|EAP|0730|EKG|Blue Cross PPO Specialty|BCBSTX OTHER|2.79||||2.52||| 93005|EAP|0730|EKG|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2.25||| 93005|EAP|0730|EKG|Aetna|AETNA QHP HMO|||||2.25||| 93005|EAP|0730|EKG|Aetna|AETNA PPO|2.79||||2.25||| 93005|EAP|0730|EKG|Aetna|AETNA OTHER|2.79||||2.25||| 93005|EAP|0730|EKG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.25||||2.79||| 93005|EAP|0730|EKG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.25||||2.25||| 93005|EAP|0730|EKG|Access Direct Platinum|HEALTHFIRST TPA UMR|2.25||||2.25||| 93005|EAP|0730|EKG|Cigna|CIGNA|2.79||||2.79||| 93005|EAP|0730|EKG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|2.52||||2.79||| 93005|EAP|0730|EKG|Cigna|CIGNA|||||2.79||| 93005|EAP|0730|EKG|Humana Medicare Advantage|HUMANA MA|2.25||||2.79||| 93005|EAP|0730|EKG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.52||||2.79||| 93005|EAP|0730|EKG|Blue Cross HMO Specialty|BCBSTX HMO|2.79||||2.79||| 93005|EAP|0730|EKG|Aenta Medicare Advantage|AETNA MEDICARE MA|2.25||||2.79||| 93005|EAP|0730|EKG|Aenta Medicare Advantage|AETNA MEDICARE MA|2.25||||130.20||| 93005|EAP|0730|EKG|Blue Cross PPO Specialty|BCBSTX PPO|2.79||||2.79||| 93005|EAP|0730|EKG|Managed Medicare|OTHER INSTITUTIONS|||||2.79||| 93005|EAP|0730|EKG|Managed Medicare|MEDICARE RAILROAD|||||2.79||| 93005|EAP|0730|EKG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.25||| 93005|EAP|0730|EKG|Managed Medicare|HEALTHSPRING MA|2.79||||2.79||| 93005|EAP|0730|EKG|United Healthcare|UNITED HEALTHCARE ERS|||||2.25||| 93005|EAP|0730|EKG|Managed Medicare|BCBS MEDICARE PPO MA|||||2.79||| 93005|EAP|0730|EKG|Managed Medicaid|MEDICAID SUPERIOR|2.25||||2.25||| 93005|EAP|0730|EKG|Managed Medicaid|MEDICAID AMERIGROUP|2.52||||130.20||| 93005|EAP|0730|EKG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.79||||2.25||| 93005|EAP|0730|EKG|Workers Compensation|WORKERS COMPENSATION OTHER|2.79||||2.52||| 93005|EAP|0730|EKG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.79||||2.25||| 93005|EAP|0730|EKG|Managed Medicaid|MEDICAID AMERIGROUP|2.52||||2.79||| 93005|EAP|0730|EKG|Medicare|MEDICARE ACUTE|2.25||||2.25||| 93005|EAP|0730|EKG|Medicare|MEDICARE ACUTE|2.25||||130.20||| 93005|EAP|0730|EKG|Medicare|MEDICARE PART B ONLY IP|2.52||||||| 93005|EAP|0730|EKG|NON CONTRACTED|COMMERCIAL OTHER 1|2.25||||2.25||| 93005|EAP|0730|EKG|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.25||| 93005|EAP|0730|EKG|NON CONTRACTED|WOOD COUNTY HOSPITAL DISTRICT|||||2.79||| 93005|EAP|0730|EKG|PHCS|HUMANA INSURANCE|||||2.79||| 93005|EAP|0730|EKG|Tricare|TRICARE EAST REGION|2.79||||2.25||| 93005|EAP|0730|EKG|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.79||| 93005|EAP|0730|EKG|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||2.52||| 93005|EAP|0730|EKG|Medicaid|WOOD COUNTY INDIGENT|||||2.79||| 93005|EAP|0730|EKG|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.25||| 93005|EAP|0730|EKG|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2.79||| 93005|EAP|0730|EKG|Medicaid|MEDICAID|2.25||||2.25||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Managed Medicare|BCBS MEDICARE PPO MA|||||1,133.36||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Medicare|MEDICARE ACUTE|9.14||||9.14||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Managed Medicaid|MEDICAID AMERIGROUP|||||9.14||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|NON CONTRACTED|COMMERCIAL OTHER 1|9.14||||9.14||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Tricare|TRICARE EAST REGION|||||1,133.36||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|9.14||||9.14||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||9.14||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Blue Cross PPO Specialty|BCBSTX PPO|1,133.36||||1,133.36||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1,133.36||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||9.14||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Access Direct Platinum|HEALTHFIRST TPA UMR|||||1,023.68||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Blue Cross PPO Specialty|BCBSTX OTHER|9.14||||1,023.68||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||9.14||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Aetna|AETNA QHP HMO|||||1,133.36||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||1,133.36||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Aetna|AETNA PPO|||||1,133.36||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||9.14||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Cigna|CIGNA|||||1,133.36||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Cigna|CIGNA|||||9.14||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||9.14||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Humana Medicare Advantage|HUMANA MA|1,133.36||||9.14||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Aenta Medicare Advantage|AETNA MEDICARE MA|1,133.36||||1,133.36||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|Blue Cross HMO Specialty|BCBSTX HMO|||||1,133.36||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1,133.36||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|United Healthcare|UNITED HEALTHCARE|1,023.68||||9.14||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|United Healthcare|UNITED HEALTHCARE|||||1,133.36||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|United Healthcare|UNITED HEALTHCARE OTHER|||||1,133.36||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||9.14||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|United Medicare Advantage|UHC MEDICARE GOLD MA|9.14||||9.14||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1,023.68||| 93017|EAP|0482|NM TREADMILL FOR CARDIOVA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,133.36||||1,133.36||| 93225|EAP|0731|HOLTER MONITOR HOOK UP FE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||5.04||| 93225|EAP|0731|HOLTER MONITOR HOOK UP FE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4.50||| 93225|EAP|0731|HOLTER MONITOR HOOK UP FE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||4.50||| 93225|EAP|0731|HOLTER MONITOR HOOK UP FE|Humana Medicare Advantage|HUMANA MA|||||5.04||| 93225|EAP|0731|HOLTER MONITOR HOOK UP FE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||5.04||| 93225|EAP|0731|HOLTER MONITOR HOOK UP FE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.50||| 93225|EAP|0731|HOLTER MONITOR HOOK UP FE|Medicare|MEDICARE ACUTE|||||5.04||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|16.81||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Managed Medicare|HEALTHSPRING MA|2,084.44||||2,084.44||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Managed Medicare|BCBS MEDICARE PPO MA|2,084.44||||1,882.72||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Medicare|MEDICARE PART B ONLY IP|16.81||||||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Medicare|MEDICARE ACUTE|16.81||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Multiplan|NALC|||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|NON CONTRACTED|COMMERCIAL OTHER 1|16.81||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Tricare|TRICARE EAST REGION|||||2,084.44||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2,084.44||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2,084.44||||2,084.44||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Managed Medicaid|MEDICAID SUPERIOR|||||2,084.44||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2,084.44||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Blue Cross PPO Specialty|BCBSTX OTHER|16.81||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Blue Cross PPO Specialty|BCBSTX PPO|2,084.44||||1,882.72||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2,084.44||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Access Direct Platinum|HEALTHFIRST TPA UMR|||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2,084.44||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Aetna|AETNA OTHER|2,084.44||||1,882.72||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Managed Medicaid|MEDICAID AMERIGROUP|||||1,882.72||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Medicaid|MEDICAID|2,084.44||||||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Aetna|AETNA QHP HMO|||||2,084.44||| 93306|EAP|0483||Aetna|AETNA PPO|1,882.72||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Cigna|CIGNA|1,882.72||||1,882.72||| 93306|EAP|0483||NON CONTRACTED|COMMERCIAL OTHER 1|16.81||||27.68||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Cigna|CIGNA|||||2,084.44||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2,084.44||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Humana Medicare Advantage|HUMANA MA|16.81||||2,084.44||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Aenta Medicare Advantage|AETNA MEDICARE MA|2,084.44||||2,084.44||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Blue Cross HMO Specialty|BCBSTX HMO|1,882.72||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2,084.44||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|United Healthcare|UNITED HEALTHCARE OTHER|||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|United Healthcare|UNITED HEALTHCARE|2,084.44||||2,084.44||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|16.81||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|United Medicare Advantage|UHC MEDICARE GOLD MA|27.68||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|United Medicare Advantage|UHC MEDICARE GOLD MA|16.81||||16.81||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1,882.72||||2,084.44||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2,084.44||||2,084.44||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|United Medicare Advantage|AARP UHC WEST COMPLETE MA|16.81||||2,084.44||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Veterans Affairs|VETERANS ADMINISTRATION|2,084.44||||2,084.44||| 93306|EAP|0483|US ECHO 2D M MODE COMPLET|Veterans Affairs|VETERANS ADMINISTRATION|1,882.72||||||| 93308|EAP|0483|US ECHO TRANSTHORACIC LIM|Blue Cross PPO Specialty|BCBSTX PPO|||||6.08||| 93350|EAP|0480|STRESS OR DOBUTAMINE ECHO|Cigna|CIGNA|||||13.35||| 93351|EAP|0483|US ECHO STRESS|United Medicare Advantage|UHC MEDICARE GOLD MA|||||15.50||| 93351|EAP|0483|US ECHO STRESS|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||15.50||| 93351|EAP|0483|US ECHO STRESS|United Healthcare|UNITED HEALTHCARE OTHER|||||15.50||| 93351|EAP|0483|US ECHO STRESS|United Healthcare|UNITED HEALTHCARE|||||12.50||| 93351|EAP|0483|US ECHO STRESS|United Healthcare|UNITED HEALTHCARE|||||15.50||| 93351|EAP|0483|US ECHO STRESS|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||12.50||| 93351|EAP|0483|US ECHO STRESS|Medicare|MEDICARE ACUTE|16.81||||12.50||| 93351|EAP|0483|US ECHO STRESS|NON CONTRACTED|COMMERCIAL OTHER 1|||||15.50||| 93351|EAP|0483|US ECHO STRESS|Blue Cross PPO Specialty|BCBSTX PPO|||||15.50||| 93351|EAP|0483|US ECHO STRESS|Access Direct Platinum|HEALTHFIRST TPA UMR|||||15.50||| 93351|EAP|0483|US ECHO STRESS|Cigna|CIGNA|||||12.50||| 93351|EAP|0483|US ECHO STRESS|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||14.00||| 934|DRG||FULL THICKNESS BURN W/O SKIN GRAFT OR INHAL INJ|Medicare|MEDICARE ACUTE|24,961.98|66|66|66|||| 93798|EAP|0943|CARDIAC REHAB PHASE 2 - E|United Healthcare|UNITED HEALTHCARE|||||264.12||| 93798|EAP|0943|CARDIAC REHAB PHASE 2 - E|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.13||| 93798|EAP|0943|CARDIAC REHAB PHASE 2 - E|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.13||| 93798|EAP|0943|CARDIAC REHAB PHASE 2 - E|Blue Cross PPO Specialty|BCBSTX PPO|||||2.13||| 93798|EAP|0943|CARDIAC REHAB PHASE 2 - E|Blue Cross PPO Specialty|BCBSTX OTHER|||||264.12||| 93798|EAP|0943|CARDIAC REHAB PHASE 2 - E|Aetna|AETNA OTHER|||||264.12||| 93798|EAP|0943|CARDIAC REHAB PHASE 2 - E|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.13||| 93798|EAP|0943|CARDIAC REHAB PHASE 2 - E|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.13||| 93798|EAP|0943|CARDIAC REHAB PHASE 2 - E|Humana Medicare Advantage|HUMANA MA|||||2.13||| 93798|EAP|0943|CARDIAC REHAB PHASE 2 - E|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.13||| 93798|EAP|0943|CARDIAC REHAB PHASE 2 - E|Blue Cross HMO Specialty|BCBSTX HMO|||||2.13||| 93798|EAP|0943|CARDIAC REHAB PHASE 2 - E|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.13||| 93798|EAP|0943|CARDIAC REHAB PHASE 2 - E|Medicare|MEDICARE ACUTE|||||2.13||| 93798|EAP|0943|CARDIAC REHAB PHASE 2 - E|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.13||| 93880|EAP|0921|US EXTRACRANIAL ARTERY DU|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||9.00||| 93880|EAP|0921|US EXTRACRANIAL ARTERY DU|Managed Medicaid|MEDICAID SUPERIOR|||||11.16||| 93880|EAP|0921|US EXTRACRANIAL ARTERY DU|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||11.16||| 93880|EAP|0921|US EXTRACRANIAL ARTERY DU|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||11.16||| 93880|EAP|0921|US EXTRACRANIAL ARTERY DU|Medicare|MEDICARE ACUTE|9.00||||9.00||| 93880|EAP|0921|US EXTRACRANIAL ARTERY DU|NON CONTRACTED|COMMERCIAL OTHER 1|11.16||||9.00||| 93880|EAP|0921|US EXTRACRANIAL ARTERY DU|Blue Cross PPO Specialty|BCBSTX PPO|11.16||||9.00||| 93880|EAP|0921|US EXTRACRANIAL ARTERY DU|Aetna|AETNA PPO|||||11.16||| 93880|EAP|0921|US EXTRACRANIAL ARTERY DU|Managed Medicare|BCBS MEDICARE PPO MA|11.16||||||| 93880|EAP|0921|US EXTRACRANIAL ARTERY DU|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||9.00||| 93880|EAP|0921|US EXTRACRANIAL ARTERY DU|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||11.16||| 93880|EAP|0921|US EXTRACRANIAL ARTERY DU|Cigna|CIGNA|9.00||||||| 93880|EAP|0921|US EXTRACRANIAL ARTERY DU|Humana Medicare Advantage|HUMANA MA|9.00||||11.16||| 93880|EAP|0921|US EXTRACRANIAL ARTERY DU|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||9.00||| 93880|EAP|0921|US EXTRACRANIAL ARTERY DU|Blue Cross HMO Specialty|BCBSTX HMO|9.00||||11.16||| 93880|EAP|0921|US EXTRACRANIAL ARTERY DU|Aenta Medicare Advantage|AETNA MEDICARE MA|||||9.00||| 93880|EAP|0921|US EXTRACRANIAL ARTERY DU|United Healthcare|UNITED HEALTHCARE OTHER|||||10.08||| 93880|EAP|0921|US EXTRACRANIAL ARTERY DU|United Medicare Advantage|AARP UHC WEST COMPLETE MA|10.08||||10.08||| 93880|EAP|0921|US EXTRACRANIAL ARTERY DU|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||10.08||| 93880|EAP|0921|US EXTRACRANIAL ARTERY DU|United Medicare Advantage|UHC MEDICARE GOLD MA|9.00||||11.16||| 93880|EAP|0921|US EXTRACRANIAL ARTERY DU|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|11.16||||11.16||| 93880|EAP|0921|US EXTRACRANIAL ARTERY DU|Veterans Affairs|VETERANS ADMINISTRATION|11.16||||||| 93922|EAP|0921|US ANKLE BRACHIAL INDICES|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||505.92||| 93922|EAP|0921|US ANKLE BRACHIAL INDICES|Humana Medicare Advantage|HUMANA MA|||||4.08||| 93922|EAP|0921|US ANKLE BRACHIAL INDICES|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||505.92||| 93922|EAP|0921|US ANKLE BRACHIAL INDICES|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.08||| 93922|EAP|0921|US ANKLE BRACHIAL INDICES|Managed Medicare|BCBS MEDICARE PPO MA|||||505.92||| 93922|EAP|0921|US ANKLE BRACHIAL INDICES|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||505.92||| 93922|EAP|0921|US ANKLE BRACHIAL INDICES|Medicare|MEDICARE ACUTE|505.92||||4.08||| 93922|EAP|0921|US ANKLE BRACHIAL INDICES|Medicare|MEDICARE PART B ONLY IP|505.92||||||| 93922|EAP|0921|US ANKLE BRACHIAL INDICES|NON CONTRACTED|COMMERCIAL OTHER 1|||||456.96||| 93925|EAP|0921|US LOWER EXT ARTERY COMPL|Managed Medicare|OTHER INSTITUTIONS|||||1,061.44||| 93925|EAP|0921|US LOWER EXT ARTERY COMPL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,061.44||| 93925|EAP|0921|US LOWER EXT ARTERY COMPL|Managed Medicaid|MEDICAID SUPERIOR|||||8.56||| 93925|EAP|0921|US LOWER EXT ARTERY COMPL|Medicare|MEDICARE ACUTE|8.56||||8.56||| 93925|EAP|0921|US LOWER EXT ARTERY COMPL|NON CONTRACTED|COMMERCIAL OTHER 1|||||8.56||| 93925|EAP|0921|US LOWER EXT ARTERY COMPL|Blue Cross PPO Specialty|BCBSTX PPO|8.56||||8.56||| 93925|EAP|0921|US LOWER EXT ARTERY COMPL|Aetna|AETNA PPO|||||1,061.44||| 93925|EAP|0921|US LOWER EXT ARTERY COMPL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||8.56||| 93925|EAP|0921|US LOWER EXT ARTERY COMPL|Cigna|CIGNA|||||8.56||| 93925|EAP|0921|US LOWER EXT ARTERY COMPL|Humana Medicare Advantage|HUMANA MA|8.56||||8.56||| 93925|EAP|0921|US LOWER EXT ARTERY COMPL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,061.44||||958.72||| 93925|EAP|0921|US LOWER EXT ARTERY COMPL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1,061.44||| 93925|EAP|0921|US LOWER EXT ARTERY COMPL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|958.72||||1,061.44||| 93925|EAP|0921|US LOWER EXT ARTERY COMPL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||8.56||| 93925|EAP|0921|US LOWER EXT ARTERY COMPL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|8.56||||1,061.44||| 93926|EAP|0921|US RT LOWER EXT ART UNILA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||742.76||| 93926|EAP|0921|US LT LOWER EXT ART UNILA|United Medicare Advantage|UHC MEDICARE GOLD MA|||||742.76||| 93926|EAP|0921|US LT LOWER EXT ART UNILA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||742.76||| 93926|EAP|0921|US RT LOWER EXT ART UNILA|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||5.99||| 93926|EAP|0921|US RT LOWER EXT ART UNILA|Blue Cross PPO Specialty|BCBSTX PPO|||||5.99||| 93926|EAP|0921|US LT LOWER EXT ART UNILA|Blue Cross PPO Specialty|BCBSTX PPO|||||742.76||| 93926|EAP|0921|US LT LOWER EXT ART UNILA|Humana Medicare Advantage|HUMANA MA|742.76||||742.76||| 93926|EAP|0921|US RT LOWER EXT ART UNILA|Humana Medicare Advantage|HUMANA MA|742.76||||742.76||| 93926|EAP|0921|US RT LOWER EXT ART UNILA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||5.99||| 93926|EAP|0921|US LT LOWER EXT ART UNILA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||742.76||| 93926|EAP|0921|US LT LOWER EXT ART UNILA|Blue Cross HMO Specialty|BCBSTX HMO|||||5.99||| 93926|EAP|0921|US LT LOWER EXT ART UNILA|Managed Medicare|HEALTHSPRING MA|||||742.76||| 93926|EAP|0921|US RT LOWER EXT ART UNILA|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||5.99||| 93926|EAP|0921|US RT LOWER EXT ART UNILA|Medicare|MEDICARE ACUTE|5.99||||742.76||| 93926|EAP|0921|US LT LOWER EXT ART UNILA|Medicare|MEDICARE ACUTE|5.99||||5.99||| 93931|EAP|0921|US LT UPPER EXT ART UNILA|Medicare|MEDICARE ACUTE|||||714.24||| 93931|EAP|0921|US RT UPPER EXT ART UNILA|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||714.24||| 93931|EAP|0921|US LT UPPER EXT ART UNILA|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||5.76||| 93970|EAP|0921|US EXT VEINS SCAN BILAT L|United Healthcare|UNITED HEALTHCARE|9.42||||||| 93970|EAP|0921|US EXT VEINS SCAN BILAT L|United Medicare Advantage|UHC MEDICARE GOLD MA|9.42||||9.42||| 93970|EAP|0921|US EXT VEINS SCAN BILAT L|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1,055.04||||1,168.08||| 93970|EAP|0921|US EXT VEINS SCAN BILAT L|Blue Cross PPO Specialty|BCBSTX PPO|9.42||||1,168.08||| 93970|EAP|0921|US EXT VEINS SCAN BILAT L|Aetna|AETNA PPO|||||1,168.08||| 93970|EAP|0921|US EXT VEINS SCAN BILAT L|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||9.42||| 93970|EAP|0921|US EXT VEINS SCAN BILAT L|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||9.42||| 93970|EAP|0921|US EXT VEINS SCAN BILAT L|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|9.42||||||| 93970|EAP|0921|US EXT VEINS SCAN BILAT L|Humana Medicare Advantage|HUMANA MA|9.42||||1,168.08||| 93970|EAP|0921|US EXT VEINS SCAN BILAT L|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,168.08||| 93970|EAP|0921|US EXT VEINS SCAN BILAT L|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||9.42||| 93970|EAP|0921|US EXT VEINS SCAN BILAT L|Blue Cross HMO Specialty|BCBSTX HMO|||||1,168.08||| 93970|EAP|0921|US EXT VEINS SCAN BILAT L|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1,168.08||| 93970|EAP|0921|US EXT VEINS SCAN BILAT L|Managed Medicare|OTHER INSTITUTIONS|||||1,055.04||| 93970|EAP|0921|US EXT VEINS SCAN BILAT L|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|9.42||||||| 93970|EAP|0921|US EXT VEINS SCAN BILAT L|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1,168.08||||1,168.08||| 93970|EAP|0921|US EXT VEINS SCAN BILAT L|Managed Medicaid|MEDICAID SUPERIOR|||||9.42||| 93970|EAP|0921|US EXT VEINS SCAN BILAT L|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1,168.08||| 93970|EAP|0921|US EXT VEINS SCAN BILAT L|Managed Medicaid|MEDICAID AMERIGROUP|||||9.42||| 93970|EAP|0921|US EXT VEINS SCAN BILAT L|Medicare|MEDICARE PART B ONLY IP|1,168.08||||||| 93970|EAP|0921|US EXT VEINS SCAN BILAT L|Medicare|MEDICARE ACUTE|9.42||||1,168.08||| 93970|EAP|0921|US EXT VEINS SCAN BILAT U|Medicare|MEDICARE ACUTE|9.42||||1,168.08||| 93970|EAP|0921|US EXT VEINS SCAN BILAT L|NON CONTRACTED|COMMERCIAL OTHER 1|9.42||||9.42||| 93970|EAP|0921|US EXT VEINS SCAN BILAT L|Medicaid|MEDICAID|9.42||||1,168.08||| 93971|EAP|0921|US RT EXT VEINS SCAN UNIL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|501.04||||||| 93971|EAP|0921|US LT EXT VEINS SCAN UNIL|Managed Medicare|MEDICARE RAILROAD|||||801.04||| 93971|EAP|0921|US LT EXT VEINS SCAN UNIL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|6.46||||||| 93971|EAP|0921|US RT EXT VEINS SCAN UNIL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|501.04||||6.46||| 93971|EAP|0921|US LT EXT VEINS SCAN UNIL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|501.04||||6.46||| 93971|EAP|0921|US LT EXT VEINS SCAN UNIL|Managed Medicaid|MEDICAID AMERIGROUP|||||801.04||| 93971|EAP|0921|US LT EXT VEINS SCAN UNIL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||801.04||| 93971|EAP|0921|US LT EXT VEINS SCAN UNIL|Medicare|MEDICARE ACUTE|6.46||||6.46||| 93971|EAP|0921|US RT EXT VEINS SCAN UNIL|Medicare|MEDICARE ACUTE|6.46||||801.04||| 93971|EAP|0921|US RT EXT VEINS SCAN UNIL|Medicare|MEDICARE ACUTE|6.46||||6.46||| 93971|EAP|0921|US LT EXT VEINS SCAN UNIL|NON CONTRACTED|COMMERCIAL OTHER 1|6.46||||801.04||| 93971|EAP|0921|US RT EXT VEINS SCAN UNIL|NON CONTRACTED|COMMERCIAL OTHER 1|6.46||||651.04||| 93971|EAP|0921|US RT EXT VEINS SCAN UNIL|Tricare|TRICARE EAST REGION|||||501.04||| 93971|EAP|0921|US RT EXT VEINS SCAN UNIL|Medicaid|MEDICAID|||||501.04||| 93971|EAP|0921|US RT EXT VEINS SCAN UNIL|Blue Cross PPO Specialty|BCBSTX PPO|||||6.46||| 93971|EAP|0921|US LT EXT VEINS SCAN UNIL|Blue Cross PPO Specialty|BCBSTX PPO|||||801.04||| 93971|EAP|0921|US LT EXT VEINS SCAN UNIL|Cigna|CIGNA|||||6.46||| 93971|EAP|0921|US RT EXT VEINS SCAN UNIL|Aetna|AETNA QHP HMO|||||501.04||| 93971|EAP|0921|US RT EXT VEINS SCAN UNIL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||6.46||| 93971|EAP|0921|US RT EXT VEINS SCAN UNIL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||6.46||| 93971|EAP|0921|US RT EXT VEINS SCAN UNIL|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||6.46||| 93971|EAP|0921|US LT EXT VEINS SCAN UNIL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||801.04||| 93971|EAP|0921|US LT EXT VEINS SCAN UNIL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||6.46||| 93971|EAP|0921|US LT EXT VEINS SCAN UNIL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||6.46||| 93971|EAP|0921|US LT EXT VEINS SCAN UNIL|Tricare|TRICARE EAST REGION|||||801.04||| 93971|EAP|0921|US LT EXT VEINS SCAN UNIL|Medicare|MEDICARE ACUTE|6.46||||801.04||| 93971|EAP|0921|US LT EXT VEINS SCAN UNIL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||801.04||| 93971|EAP|0921|US LT EXT VEINS SCAN UNIL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||6.46||| 93971|EAP|0921|US LT EXT VEINS SCAN UNIL|Humana Medicare Advantage|HUMANA MA|||||6.46||| 93971|EAP|0921|US RT EXT VEINS SCAN UNIL|Humana Medicare Advantage|HUMANA MA|||||6.46||| 93971|EAP|0921|US RT EXT VEINS SCAN UNIL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|801.04||||6.46||| 93971|EAP|0921|US LT EXT VEINS SCAN UNIL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|801.04||||6.46||| 93971|EAP|0921|US RT EXT VEINS SCAN UNIL|Aenta Medicare Advantage|AETNA MEDICARE MA|801.04||||573.52||| 93971|EAP|0921|US LT EXT VEINS SCAN UNIL|Aenta Medicare Advantage|AETNA MEDICARE MA|801.04||||6.46||| 93971|EAP|0921|US LT EXT VEINS SCAN UNIL|Managed Medicare|HEALTHSPRING MA|||||801.04||| 93971|EAP|0921|US LT EXT VEINS SCAN UNIL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|801.04||||801.04||| 93971|EAP|0921|US RT EXT VEINS SCAN UNIL|United Healthcare|UNITED HEALTHCARE|||||501.04||| 93971|EAP|0921|US RT EXT VEINS SCAN UNIL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||801.04||| 93971|EAP|0921|US RT EXT VEINS SCAN UNIL|United Medicare Advantage|UHC MEDICARE GOLD MA|6.46||||801.04||| 93971|EAP|0921|US RT EXT VEINS SCAN UNIL|United Medicare Advantage|UHC MEDICARE GOLD MA|6.46||||501.04||| 93971|EAP|0921|US RT EXT VEINS SCAN UNIL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|801.04||||723.52||| 93971|EAP|0921|US RT EXT VEINS SCAN UNIL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|801.04||||6.46||| 93971|EAP|0921|US RT EXT VEINS SCAN UNIL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|501.04||||501.04||| 93971|EAP|0921|US LT EXT VEINS SCAN UNIL|United Medicare Advantage|UHC MEDICARE GOLD MA|6.46||||6.46||| 93971|EAP|0921|US LT EXT VEINS SCAN UNIL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|801.04||||723.52||| 93971|EAP|0921|US LT EXT VEINS SCAN UNIL|Veterans Affairs|VETERANS ADMINISTRATION|||||6.46||| 93971|EAP|0921|US RT EXT VEINS SCAN UNIL|Workers Compensation|WORKERS COMPENSATION OTHER|||||573.52||| 93971|EAP|0921|US LT EXT VEINS SCAN UNIL|Workers Compensation|WORKERS COMPENSATION OTHER|||||801.04||| 93975|EAP|0921|US ARTER INFLOW VENOUS OU|United Healthcare|UNITED HEALTHCARE OTHER|||||8.88||| 93975|EAP|0921|US ARTER INFLOW VENOUS OU|United Healthcare|UNITED HEALTHCARE|||||994.56||| 93975|EAP|0921|US ARTER INFLOW VENOUS OU|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1,101.12||| 93975|EAP|0921|US ARTER INFLOW VENOUS OU|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1,101.12||| 93975|EAP|0921|US ARTER INFLOW VENOUS OU|Blue Cross PPO Specialty|BCBSTX PPO|||||8.88||| 93975|EAP|0921|US ARTER INFLOW VENOUS OU|Aetna|AETNA OTHER|||||1,101.12||| 93975|EAP|0921|US ARTER INFLOW VENOUS OU|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1,101.12||| 93975|EAP|0921|US ARTER INFLOW VENOUS OU|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||8.88||| 93975|EAP|0921|US ARTER INFLOW VENOUS OU|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||8.88||| 93975|EAP|0921|US ARTER INFLOW VENOUS OU|Humana Medicare Advantage|HUMANA MA|1,101.12||||8.88||| 93975|EAP|0921|US ARTER INFLOW VENOUS OU|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||8.88||| 93975|EAP|0921|US ARTER INFLOW VENOUS OU|Managed Medicaid|MEDICAID AMERIGROUP|||||8.88||| 93975|EAP|0921|US ARTER INFLOW VENOUS OU|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,101.12||| 93975|EAP|0921|US ARTER INFLOW VENOUS OU|Managed Medicaid|MEDICAID SUPERIOR|||||994.56||| 93975|EAP|0921|US ARTER INFLOW VENOUS OU|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||8.88||| 93975|EAP|0921|US ARTER INFLOW VENOUS OU|Medicare|MEDICARE ACUTE|8.88||||8.88||| 93975|EAP|0921|US ARTER INFLOW VENOUS OU|NON CONTRACTED|COMMERCIAL OTHER 1|||||8.88||| 93975|EAP|0921|US ARTER INFLOW VENOUS OU|Tricare|TRICARE EAST REGION|||||1,101.12||| 93975|EAP|0921|US ARTER INFLOW VENOUS OU|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1,101.12||| 93975|EAP|0921|US ARTER INFLOW VENOUS OU|Medicaid|MEDICAID|||||1,101.12||| 93978|EAP|0921|US AORTA IVC DUPLEX COMPL|Medicare|MEDICARE ACUTE|||||7.49||| 93978|EAP|0921|US AORTA IVC DUPLEX COMPL|NON CONTRACTED|COMMERCIAL OTHER 1|||||7.49||| 93978|EAP|0921|US AORTA IVC DUPLEX COMPL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||7.49||| 93978|EAP|0921|US AORTA IVC DUPLEX COMPL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||928.76||| 94002|EAP|0410|VOLUME VENTILATOR, 4HR MI|United Medicare Advantage|UHC MEDICARE GOLD MA|262.25||||||| 94002|EAP|0410|VOLUME VENTILATOR, 4HR MI|Aenta Medicare Advantage|AETNA MEDICARE MA|||||262.25||| 94003|EAP|0410|CPAP/BIPAP SUBSEQ DAY|Medicare|MEDICARE ACUTE|876.75||||||| 94003|EAP|0410|CPAP/BIPAP SUBSEQ DAY|Managed Medicaid|MEDICAID SUPERIOR|876.75||||||| 94003|EAP|0410|CPAP/BIPAP SUBSEQ DAY|Medicaid|MEDICAID|876.75||||||| 94003|EAP|0410|CPAP/BIPAP SUBSEQ DAY|Blue Cross PPO Specialty|BCBSTX PPO|876.75||||||| 94003|EAP|0410|CPAP/BIPAP SUBSEQ DAY|Cigna|CIGNA|876.75||||||| 94003|EAP|0410|CPAP/BIPAP SUBSEQ DAY|Humana Medicare Advantage|HUMANA MA|876.75||||||| 94003|EAP|0410|CPAP/BIPAP SUBSEQ DAY|Aenta Medicare Advantage|AETNA MEDICARE MA|876.75||||876.75||| 94003|EAP|0410|CPAP/BIPAP SUBSEQ DAY|United Medicare Advantage|UHC MEDICARE GOLD MA|876.75||||876.75||| 94003|EAP|0410|CPAP/BIPAP SUBSEQ DAY|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|876.75||||||| 94003|EAP|0410|CPAP/BIPAP SUBSEQ DAY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|876.75||||||| 94010|EAP|0460|BREATHING EXERCISE PER TR|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|324.88||||||| 94010|EAP|0460|BREATHING EXERCISE PER TR|United Medicare Advantage|UHC MEDICARE GOLD MA|2.62||||2.62||| 94010|EAP|0460|BREATHING EXERCISE PER TR|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|324.88||||2.62||| 94010|EAP|0460|BREATHING EXERCISE PER TR|Veterans Affairs|VETERANS ADMINISTRATION|2.62||||||| 94010|EAP|0460|BREATHING EXERCISE PER TR|Veterans Affairs|VETERANS ADMINISTRATION|||||324.88||| 94010|EAP|0460|BREATHING EXERCISE PER TR|United Healthcare|UNITED HEALTHCARE|2.62||||||| 94010|EAP|0460|PULMONARY FUNCTION BASIC|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.62||| 94010|EAP|0460|BREATHING EXERCISE PER TR|Blue Cross PPO Specialty|BCBSTX PPO|324.88||||324.88||| 94010|EAP|0460|PULMONARY FUNCTION BASIC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.62||| 94010|EAP|0460|BREATHING EXERCISE PER TR|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|324.88||||||| 94010|EAP|0460|BREATHING EXERCISE PER TR|Cigna|CIGNA|324.88||||||| 94010|EAP|0460|BREATHING EXERCISE PER TR|Humana Medicare Advantage|HUMANA MA|324.88||||2.62||| 94010|EAP|0460|PULMONARY FUNCTION BASIC|Humana Medicare Advantage|HUMANA MA|324.88||||2.62||| 94010|EAP|0460|PULMONARY FUNCTION BASIC|Blue Cross PPO Specialty|BCBSTX PPO|324.88||||2.62||| 94010|EAP|0460|BREATHING EXERCISE PER TR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|324.88||||||| 94010|EAP|0460|BREATHING EXERCISE PER TR|Aenta Medicare Advantage|AETNA MEDICARE MA|324.88||||324.88||| 94010|EAP|0460|BREATHING EXERCISE PER TR|Blue Cross HMO Specialty|BCBSTX HMO|324.88||||||| 94010|EAP|0460|BREATHING EXERCISE PER TR|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.62||||324.88||| 94010|EAP|0460|BREATHING EXERCISE PER TR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|324.88||||2.62||| 94010|EAP|0460|BREATHING EXERCISE PER TR|Managed Medicare|HEALTHSPRING MA|2.62||||||| 94010|EAP|0460|BREATHING EXERCISE PER TR|Medicare|MEDICARE ACUTE|2.62||||324.88||| 94010|EAP|0460|BREATHING EXERCISE PER TR|Medicare|MEDICARE PART B ONLY IP|2.62||||||| 94010|EAP|0460|PULMONARY FUNCTION BASIC|Medicare|MEDICARE ACUTE|2.62||||2.62||| 94010|EAP|0460|PULMONARY FUNCTION BASIC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|324.88||||2.62||| 94010|EAP|0460|BREATHING EXERCISE PER TR|NON CONTRACTED|COMMERCIAL OTHER 1|2.62||||||| 94010|EAP|0460|PULMONARY FUNCTION BASIC|Tricare|TRICARE EAST REGION|||||2.62||| 94010|EAP|0460|BREATHING EXERCISE PER TR|Medicaid|MEDICAID|2.62||||||| 94010|EAP|0460|PULMONARY FUNCTION BASIC|Managed Medicaid|MEDICAID AMERIGROUP|324.88||||2.62||| 94010|EAP|0460|BREATHING EXERCISE PER TR|Managed Medicaid|MEDICAID SUPERIOR|2.62||||||| 94010|EAP|0460|BREATHING EXERCISE PER TR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|324.88||||324.88||| 94010|EAP|0460|BREATHING EXERCISE PER TR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|324.88||||2.62||| 94010|EAP|0460|PULMONARY FUNCTION BASIC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|324.88||||74.75||| 94010|EAP|0460|BREATHING EXERCISE PER TR|Managed Medicaid|MEDICAID AMERIGROUP|324.88||||324.88||| 94060|EAP|0460|PULMONARY FUNCTION B&A BR|Medicare|MEDICARE ACUTE|4.76||||590.24||| 94060|EAP|0460|PULMONARY FUNCTION B&A BR|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.76||| 94060|EAP|0460|PULMONARY FUNCTION B&A BR|Managed Medicaid|MEDICAID SUPERIOR|||||4.76||| 94060|EAP|0460|PULMONARY FUNCTION B&A BR|Managed Medicaid|MEDICAID AMERIGROUP|||||590.24||| 94060|EAP|0460|PULMONARY FUNCTION B&A BR|Aetna|AETNA QHP HMO|||||590.24||| 94060|EAP|0460|PULMONARY FUNCTION B&A BR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||533.12||| 941|DRG||O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W/O CC/MCC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|91,679.74|33|148.5|33|||| 941|DRG||O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W/O CC/MCC|Medicare|MEDICARE ACUTE|35,679.66|148.5|148.5|33|||| 94640|EAP|0410|UPDRAFT NEBULIZER PER TRE|Blue Cross PPO Specialty|BCBSTX PPO|147.87||||147.87||| 94640|EAP|0410|UPDRAFT NEBULIZER PER TRE|Aetna|AETNA PPO|119.25||||||| 94640|EAP|0410|UPDRAFT NEBULIZER PER TRE|Cigna|CIGNA|||||119.25||| 94640|EAP|0410|UPDRAFT NEBULIZER PER TRE|Humana Medicare Advantage|HUMANA MA|119.25||||119.25||| 94640|EAP|0410|UPDRAFT NEBULIZER PER TRE|Aenta Medicare Advantage|AETNA MEDICARE MA|119.25||||119.25||| 94640|EAP|0410|UPDRAFT NEBULIZER PER TRE|Medicare|MEDICARE PART B ONLY IP|119.25||||||| 94640|EAP|0410|UPDRAFT NEBULIZER PER TRE|Medicare|MEDICARE ACUTE|119.25||||119.25||| 94640|EAP|0410|UPDRAFT NEBULIZER PER TRE|Managed Medicare|HEALTHSPRING MA|147.87||||119.25||| 94640|EAP|0410|UPDRAFT NEBULIZER PER TRE|United Healthcare|GEHA|||||119.25||| 94640|EAP|0410|UPDRAFT NEBULIZER PER TRE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|133.56||||147.87||| 94640|EAP|0410|UPDRAFT NEBULIZER PER TRE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|147.87||||147.87||| 94640|EAP|0410|UPDRAFT NEBULIZER PER TRE|Managed Medicaid|MEDICAID SUPERIOR|119.25||||119.25||| 94640|EAP|0410|UPDRAFT NEBULIZER PER TRE|NON CONTRACTED|COMMERCIAL OTHER 1|119.25||||119.25||| 94640|EAP|0410|UPDRAFT NEBULIZER PER TRE|Tricare|TRICARE EAST REGION|147.87||||||| 94640|EAP|0410|UPDRAFT NEBULIZER PER TRE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|147.87||||147.87||| 94640|EAP|0410|UPDRAFT NEBULIZER PER TRE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|119.25||||147.87||| 94640|EAP|0410|UPDRAFT NEBULIZER PER TRE|Medicaid|MEDICAID|119.25||||119.25||| 94640|EAP|0410|UPDRAFT NEBULIZER PER TRE|United Healthcare|UNITED HEALTHCARE|119.25||||||| 94640|EAP|0410|UPDRAFT NEBULIZER PER TRE|Managed Medicare|OTHER INSTITUTIONS|119.25||||||| 94640|EAP|0410|UPDRAFT NEBULIZER PER TRE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|119.25||||147.87||| 94640|EAP|0410|UPDRAFT NEBULIZER PER TRE|United Medicare Advantage|UHC MEDICARE GOLD MA|119.25||||119.25||| 94640|EAP|0410|UPDRAFT NEBULIZER PER TRE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|119.25||||119.25||| 94640|EAP|0410|UPDRAFT NEBULIZER PER TRE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|147.87||||147.87||| 94640|EAP|0410|UPDRAFT NEBULIZER PER TRE|Veterans Affairs|VETERANS ADMINISTRATION|119.25||||119.25||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|5.30||||||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|United Medicare Advantage|AARP UHC WEST COMPLETE MA|5.30||||||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|United Medicare Advantage|UHC MEDICARE GOLD MA|5.30||||||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|Veterans Affairs|VETERANS ADMINISTRATION|5.30||||||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|Medicare|MEDICARE ACUTE|5.30||||5.30||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|Managed Medicaid|MEDICAID SUPERIOR|5.30||||||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|Medicaid|MEDICAID|5.30||||||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|Blue Cross PPO Specialty|BCBSTX PPO|5.30||||||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|Cigna|CIGNA|5.30||||||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|Humana Medicare Advantage|HUMANA MA|5.30||||||| 94660|EAP|0410|CPAP/BIPAP FIRST DAY|Aenta Medicare Advantage|AETNA MEDICARE MA|5.30||||||| 94667|EAP|0410|PERCUSSION INITIAL|Blue Cross PPO Specialty|BCBSTX PPO|168.64||||||| 94667|EAP|0410|PERCUSSION INITIAL|Humana Medicare Advantage|HUMANA MA|1.36||||1.36||| 94667|EAP|0410|PERCUSSION INITIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|1.36||||||| 94667|EAP|0410|PERCUSSION INITIAL|Medicare|MEDICARE ACUTE|1.36||||||| 94667|EAP|0410|PERCUSSION INITIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|152.32||||||| 94667|EAP|0410|PERCUSSION INITIAL|Medicaid|MEDICAID|1.36||||||| 94667|EAP|0410|PERCUSSION INITIAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|1.36||||||| 94667|EAP|0410|PERCUSSION INITIAL|United Healthcare|UNITED HEALTHCARE|152.32||||||| 94667|EAP|0410|PERCUSSION INITIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|1.36||||||| 94667|EAP|0410|PERCUSSION INITIAL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1.36||||||| 94667|EAP|0410|PERCUSSION INITIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|168.64||||||| 94667|EAP|0410|PERCUSSION INITIAL|Veterans Affairs|VETERANS ADMINISTRATION|1.36||||||| 94668|EAP|0410|PERCUSSION SUBSEQUENT|United Medicare Advantage|UHC MEDICARE GOLD MA|102.75||||||| 94668|EAP|0410|PERCUSSION SUBSEQUENT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|102.75||||||| 94668|EAP|0410|PERCUSSION SUBSEQUENT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|127.41||||||| 94668|EAP|0410|PERCUSSION SUBSEQUENT|Veterans Affairs|VETERANS ADMINISTRATION|102.75||||||| 94668|EAP|0410|PERCUSSION SUBSEQUENT|Medicare|MEDICARE ACUTE|102.75||||||| 94668|EAP|0410|PERCUSSION SUBSEQUENT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|127.41||||||| 94668|EAP|0410|PERCUSSION SUBSEQUENT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|102.75||||||| 94668|EAP|0410|PERCUSSION SUBSEQUENT|Medicaid|MEDICAID|102.75||||||| 94668|EAP|0410|PERCUSSION SUBSEQUENT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|102.75||||||| 94668|EAP|0410|PERCUSSION SUBSEQUENT|United Healthcare|UNITED HEALTHCARE|102.75||||||| 94668|EAP|0410|PERCUSSION SUBSEQUENT|Blue Cross PPO Specialty|BCBSTX PPO|127.41||||||| 94668|EAP|0410|PERCUSSION SUBSEQUENT|Humana Medicare Advantage|HUMANA MA|102.75||||102.75||| 94668|EAP|0410|PERCUSSION SUBSEQUENT|Aenta Medicare Advantage|AETNA MEDICARE MA|102.75||||||| 94761|EAP|0460|PULSE OXIMETER|Blue Cross PPO Specialty|BCBSTX PPO|192.32||||192.32||| 94761|EAP|0460|PULSE OXIMETER|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|155.10||||||| 94761|EAP|0460|PULSE OXIMETER|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|155.10||||||| 94761|EAP|0460|PULSE OXIMETER|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|155.10||||192.32||| 94761|EAP|0460|PULSE OXIMETER|Aetna|AETNA QHP HMO|||||192.32||| 94761|EAP|0460|PULSE OXIMETER|Aetna|AETNA PPO|155.10||||192.32||| 94761|EAP|0460|PULSE OXIMETER|Aetna|AETNA OTHER|173.71||||155.10||| 94761|EAP|0460|PULSE OXIMETER|Cigna|CIGNA|192.32||||||| 94761|EAP|0460|PULSE OXIMETER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|192.32||||155.10||| 94761|EAP|0460|PULSE OXIMETER|Humana Medicare Advantage|HUMANA MA|155.10||||155.10||| 94761|EAP|0460|PULSE OXIMETER|Aenta Medicare Advantage|AETNA MEDICARE MA|192.32||||192.32||| 94761|EAP|0460|PULSE OXIMETER|Managed Medicare|OTHER INSTITUTIONS|155.10||||||| 94761|EAP|0460|PULSE OXIMETER|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|155.10||||192.32||| 94761|EAP|0460|PULSE OXIMETER|Managed Medicare|HEALTHSPRING MA|192.32||||173.71||| 94761|EAP|0460|PULSE OXIMETER|Blue Cross HMO Specialty|BCBSTX HMO|192.32||||||| 94761|EAP|0460|PULSE OXIMETER|Cigna|CIGNA|||||192.32||| 94761|EAP|0460|PULSE OXIMETER|Managed Medicare|BCBS MEDICARE PPO MA|192.32||||||| 94761|EAP|0460|PULSE OXIMETER|Medicare|MEDICARE PART B ONLY IP|155.10||||||| 94761|EAP|0460|PULSE OXIMETER|Medicare|MEDICARE ACUTE|155.10||||192.32||| 94761|EAP|0460|PULSE OXIMETER|NON CONTRACTED|COMMERCIAL OTHER 1|155.10||||155.10||| 94761|EAP|0460|PULSE OXIMETER|Tricare|TRICARE EAST REGION|192.32||||||| 94761|EAP|0460|PULSE OXIMETER|Managed Medicaid|MEDICAID AMERIGROUP|192.32||||192.32||| 94761|EAP|0460|PULSE OXIMETER|Managed Medicaid|MEDICAID UNITED HEALTHCARE|192.32||||192.32||| 94761|EAP|0460|PULSE OXIMETER|Medicaid|MEDICAID|155.10||||||| 94761|EAP|0460|PULSE OXIMETER|Blue Cross PPO Specialty|BCBSTX OTHER|155.10||||||| 94761|EAP|0460|PULSE OXIMETER|Managed Medicaid|MEDICAID SUPERIOR|155.10||||||| 94761|EAP|0460|PULSE OXIMETER|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|192.32||||192.32||| 94761|EAP|0460|PULSE OXIMETER|United Healthcare|UMR UNITED MEDICAL RESOURCES|155.10||||192.32||| 94761|EAP|0460|PULSE OXIMETER|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|155.10||||||| 94761|EAP|0460|PULSE OXIMETER|United Medicare Advantage|UHC MEDICARE GOLD MA|155.10||||155.10||| 94761|EAP|0460|PULSE OXIMETER|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|155.10||||155.10||| 94761|EAP|0460|PULSE OXIMETER|United Medicare Advantage|AARP UHC WEST COMPLETE MA|192.32||||155.10||| 94761|EAP|0460|PULSE OXIMETER|Veterans Affairs|VETERANS ADMINISTRATION|192.32||||192.32||| 94761|EAP|0460|PULSE OXIMETER|Veterans Affairs|VETERANS ADMINISTRATION|192.32||||155.10||| 94761|EAP|0460|PULSE OXIMETER|United Healthcare|UNITED HEALTHCARE|192.32||||192.32||| 94761|EAP|0460|PULSE OXIMETER|United Healthcare|UNITED HEALTHCARE OTHER|||||192.32||| 94761|EAP|0460|PULSE OXIMETER|Workers Compensation|WORKERS COMPENSATION OTHER|192.32||||||| 948|DRG||SIGNS & SYMPTOMS W/O MCC|Medicare|MEDICARE ACUTE|4,629.67|16.5|16.5|16.5|||| 949|DRG||AFTERCARE W CC/MCC|Medicaid|MEDICAID|74,226.68||||||| 949|DRG||AFTERCARE W CC/MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|6,982.30|4283.58|4283.58|97.02|||| 949|DRG||AFTERCARE W CC/MCC|Humana Medicare Advantage|HUMANA MA|27,174.27|97.02|4283.58|97.02|||| 949|DRG||AFTERCARE W CC/MCC|Medicare|MEDICARE ACUTE|42,404.95|189.41|4283.58|97.02|||| 95|DRG||BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM W CC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|71,874.29|29985.06|29985.06|29985.06|||| 950|DRG||AFTERCARE W/O CC/MCC|Medicare|MEDICARE ACUTE|31,832.32|160.27|160.27|160.27|||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||4,742.75||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|United Medicare Advantage|UHC MEDICARE GOLD MA|||||5,881.01||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|United Healthcare|UNITED HEALTHCARE OTHER|||||5,881.01||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||5,881.01||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Blue Cross PPO Specialty|BCBSTX PPO|||||4,742.75||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||5,881.01||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||5,881.01||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||4,742.75||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||5,881.01||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Humana Medicare Advantage|HUMANA MA|||||5,311.88||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||5,311.88||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Blue Cross HMO Specialty|BCBSTX HMO|||||4,742.75||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Aenta Medicare Advantage|AETNA MEDICARE MA|||||5,881.01||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4,742.75||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Managed Medicaid|MEDICAID SUPERIOR|||||5,311.88||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Medicare|MEDICARE ACUTE|||||5,881.01||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|NON CONTRACTED|COMMERCIAL OTHER 1|||||4,742.75||| 95810|EAP|0740|POLYSOMNOGRAM DIAGNOSTIC|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||5,881.01||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|Managed Medicaid|MEDICAID SUPERIOR|||||5,138.75||| 95811|EAP|0740|POLYSOMNOGRAM SPLIT NIGHT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||6,372.05||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|Medicare|MEDICARE ACUTE|||||5,138.75||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|NON CONTRACTED|COMMERCIAL OTHER 1|||||5,138.75||| 95811|EAP|0740|POLYSOMNOGRAM SPLIT NIGHT|NON CONTRACTED|COMMERCIAL OTHER 1|||||5,755.40||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|Tricare|TRICARE EAST REGION|||||5,138.75||| 95811|EAP|0740|POLYSOMNOGRAM SPLIT NIGHT|Medicaid|MEDICAID|||||6,372.05||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|Blue Cross PPO Specialty|BCBSTX PPO|||||5,755.40||| 95811|EAP|0740|POLYSOMNOGRAM SPLIT NIGHT|Blue Cross PPO Specialty|BCBSTX PPO|||||6,372.05||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||5,755.40||| 95811|EAP|0740|POLYSOMNOGRAM SPLIT NIGHT|Medicare|MEDICARE ACUTE|||||5,755.40||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||5,138.75||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|Access Direct Platinum|HEALTHFIRST TPA UMR|||||5,138.75||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||5,138.75||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||5,755.40||| 95811|EAP|0740|POLYSOMNOGRAM SPLIT NIGHT|Humana Medicare Advantage|HUMANA MA|||||6,372.05||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|Humana Medicare Advantage|HUMANA MA|||||6,372.05||| 95811|EAP|0740|POLYSOMNOGRAM SPLIT NIGHT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||6,372.05||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|United Medicare Advantage|UHC MEDICARE GOLD MA|||||6,372.05||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||6,372.05||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||5,755.40||| 95811|EAP|0740|POLYSOMNOGRAM SPLIT NIGHT|United Medicare Advantage|UHC MEDICARE GOLD MA|||||6,372.05||| 95811|EAP|0740|POLYSOMNOGRAM SPLIT NIGHT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||6,372.05||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|United Healthcare|UNITED HEALTHCARE|||||5,138.75||| 95811|EAP|0740|POLYSOMNOGRAM THERAPEUTIC|United Healthcare|UNITED HEALTHCARE OTHER|||||6,372.05||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Workers Compensation|UT EMPLOYEE INJURY|||||518.63||| 96360|EAP|0260|IV INFUSION FOR HYDRATION|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||330.46||| 96360|EAP|0260|IV INFUSION FOR HYDRATION|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||330.46||| 96360|EAP|0450|IV INFUSION HYDRATION UP|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||418.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|United Medicare Advantage|UHC MEDICARE GOLD MA|||||518.63||| 96360|EAP|0450|IV INFUSION HYDRATION UP|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||418.25||| 96360|EAP|0260|IV INFUSION FOR HYDRATION|Veterans Affairs|VETERANS ADMINISTRATION|330.46||||||| 96360|EAP|0260|IV INFUSION FOR HYDRATION|Veterans Affairs|VETERANS ADMINISTRATION|||||330.46||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Veterans Affairs|VETERANS ADMINISTRATION|||||518.63||| 96360|EAP|0260|IV INFUSION FOR HYDRATION|Blue Cross PPO Specialty|BCBSTX OTHER|||||330.46||| 96360|EAP|0260|IV INFUSION FOR HYDRATION|Blue Cross PPO Specialty|BCBSTX PPO|330.46||||330.46||| 96360|EAP|0260|IV INFUSION FOR HYDRATION|Aetna|AETNA PPO|||||330.46||| 96360|EAP|0260|IV INFUSION FOR HYDRATION|Aetna|AETNA OTHER|||||266.50||| 96360|EAP|0260|IV INFUSION FOR HYDRATION|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||374.36||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||518.63||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||518.63||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Blue Cross PPO Specialty|BCBSTX PPO|518.63||||518.63||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Blue Cross PPO Specialty|BCBSTX OTHER|||||518.63||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Aetna|AETNA PPO|||||518.63||| 96360|EAP|0260|IV INFUSION FOR HYDRATION|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||418.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Humana Medicare Advantage|HUMANA MA|||||518.63||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||418.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Aetna|AETNA OTHER|||||468.44||| 96360|EAP|0260|IV INFUSION FOR HYDRATION|Cigna|CIGNA|||||330.46||| 96360|EAP|0260|IV INFUSION FOR HYDRATION|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|266.50||||418.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||468.44||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Cigna|CIGNA|||||468.44||| 96360|EAP|0260|IV INFUSION FOR HYDRATION|Humana Medicare Advantage|HUMANA MA|418.25||||330.46||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||418.25||| 96360|EAP|0260|IV INFUSION FOR HYDRATION|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||266.50||| 96360|EAP|0260|IV INFUSION FOR HYDRATION|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|266.50||||||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Aenta Medicare Advantage|AETNA MEDICARE MA|||||468.44||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Workers Compensation|WORKERS COMPENSATION OTHER|||||468.44||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Blue Cross HMO Specialty|BCBSTX HMO|||||518.63||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|418.25||||418.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Managed Medicare|HEALTHSPRING MA|||||518.63||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Managed Medicare|BCBS MEDICARE PPO MA|||||518.63||| 96360|EAP|0450|IV INFUSION HYDRATION UP|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||518.63||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Medicare|MEDICARE ACUTE|468.44||||518.63||| 96360|EAP|0260|IV INFUSION FOR HYDRATION|NON CONTRACTED|COMMERCIAL OTHER 1|330.46||||418.25||| 96360|EAP|0260|IV INFUSION FOR HYDRATION|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|418.25||||330.46||| 96360|EAP|0450|IV INFUSION HYDRATION UP|NON CONTRACTED|COMMERCIAL OTHER 1|||||518.63||| 96360|EAP|0260|IV INFUSION FOR HYDRATION|United Medicare Advantage|UHC MEDICARE GOLD MA|||||418.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Tricare|TRICARE EAST REGION|||||518.63||| 96360|EAP|0260|IV INFUSION FOR HYDRATION|United Healthcare|UMR UNITED MEDICAL RESOURCES|418.25||||266.50||| 96360|EAP|0260|IV INFUSION FOR HYDRATION|United Healthcare|UNITED HEALTHCARE OTHER|||||330.46||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Medicaid|MEDICAID|||||468.44||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||518.63||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Managed Medicaid|MEDICAID AMERIGROUP|||||418.25||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||518.63||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Managed Medicaid|MEDICAID SUPERIOR|||||518.63||| 96360|EAP|0450|IV INFUSION HYDRATION UP|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||518.63||| 96360|EAP|0260|IV INFUSION FOR HYDRATION|Medicare|MEDICARE ACUTE|330.46||||330.46||| 96360|EAP|0450|IV INFUSION HYDRATION UP|United Healthcare|UNITED HEALTHCARE|||||518.63||| 96360|EAP|0450|IV INFUSION HYDRATION UP|United Healthcare|UNITED HEALTHCARE|518.63||||518.63||| 96360|EAP|0450|IV INFUSION HYDRATION UP|United Healthcare|UNITED HEALTHCARE OTHER|||||418.25||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Managed Medicare|OTHER INSTITUTIONS|||||224.44||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||224.44||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Managed Medicare|HEALTHSPRING MA|||||224.44||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Managed Medicare|BCBS MEDICARE PPO MA|||||224.44||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Medicare|MEDICARE ACUTE|224.44||||1.81||| 96361|EAP|0260|1V INFUSION HYDRATION EAC|NON CONTRACTED|COMMERCIAL OTHER 1|197.78||||159.50||| 96361|EAP|0260|1V INFUSION HYDRATION EAC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|159.50||||197.78||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Tricare|TRICARE FOR LIFE|||||159.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Tricare|TRICARE EAST REGION|224.44||||191.97||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Healthcare|UMR UNITED MEDICAL RESOURCES|159.50||||1.81||| 96361|EAP|0260|1V INFUSION HYDRATION EAC|United Healthcare|UMR UNITED MEDICAL RESOURCES|159.50||||159.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Medicaid|MEDICAID TEXAS CHILDRENS|||||159.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Medicaid|WOOD COUNTY INDIGENT|||||224.44||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||224.44||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Medicaid|MEDICAID|191.97||||202.72||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||191.97||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Managed Medicaid|MEDICAID UNITED HEALTHCARE|224.44||||224.44||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.81||||1.81||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Managed Medicaid|MEDICAID SUPERIOR|||||1.81||| 96361|EAP|0260|1V INFUSION HYDRATION EAC|Medicare|MEDICARE ACUTE|178.64||||197.78||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Healthcare|UNITED HEALTHCARE|224.44||||224.44||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Healthcare|UNITED HEALTHCARE ERS|||||159.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Healthcare|GEHA|||||224.44||| 96361|EAP|0260|1V INFUSION HYDRATION EAC|Blue Cross PPO Specialty|BCBSTX OTHER|||||197.78||| 96361|EAP|0260|1V INFUSION HYDRATION EAC|Blue Cross PPO Specialty|BCBSTX PPO|197.78||||197.78||| 96361|EAP|0260|1V INFUSION HYDRATION EAC|Aetna|AETNA OTHER|||||159.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Healthcare|UNITED HEALTHCARE OTHER|||||224.44||| 96361|EAP|0260|1V INFUSION HYDRATION EAC|Aetna|AETNA PPO|||||197.78||| 96361|EAP|0260|1V INFUSION HYDRATION EAC|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||178.64||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|159.50||||224.44||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|1.81||||1.81||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Healthcare|TML GROUP BENEFITS|||||224.44||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Managed Medicaid|MEDICAID AMERIGROUP|224.44||||224.44||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Access Direct Platinum|HEALTHFIRST TPA UMR|159.50||||1.81||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||224.44||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Blue Cross PPO Specialty|BCBSTX PPO|224.44||||224.44||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Blue Cross PPO Specialty|BCBSTX OTHER|224.44||||224.44||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Aetna|AETNA QHP HMO|||||191.97||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Aetna|AETNA PPO|224.44||||224.44||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Aetna|AETNA OTHER|||||224.44||| 96361|EAP|0260|1V INFUSION HYDRATION EAC|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||159.50||| 96361|EAP|0260|1V INFUSION HYDRATION EAC|United Healthcare|UNITED HEALTHCARE OTHER|||||159.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||159.50||| 96361|EAP|0260|1V INFUSION HYDRATION EAC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||159.50||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Cigna|CIGNA|1.81||||1.81||| 96361|EAP|0260|1V INFUSION HYDRATION EAC|Humana Medicare Advantage|HUMANA MA|159.50||||197.78||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|NON CONTRACTED|COMMERCIAL OTHER 1|1.81||||1.81||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|170.25||||224.44||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Humana Medicare Advantage|HUMANA MA|||||224.44||| 96361|EAP|0260|1V INFUSION HYDRATION EAC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||159.50||| 96361|EAP|0260|1V INFUSION HYDRATION EAC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|159.50||||||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Healthcare|UNITED HEALTHCARE|||||224.44||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Aenta Medicare Advantage|AETNA MEDICARE MA|||||224.44||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Blue Cross HMO Specialty|BCBSTX HMO|224.44||||224.44||| 96361|EAP|0260|1V INFUSION HYDRATION EAC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||197.78||| 96361|EAP|0260|1V INFUSION HYDRATION EAC|United Medicare Advantage|UHC MEDICARE GOLD MA|||||159.50||| 96361|EAP|0260|1V INFUSION HYDRATION EAC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||197.78||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||224.44||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.81||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||224.44||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||224.44||| 96361|EAP|0260|1V INFUSION HYDRATION EAC|Veterans Affairs|VETERANS ADMINISTRATION|197.78||||||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Veterans Affairs|VETERANS ADMINISTRATION|224.44||||224.44||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Veterans Affairs|VETERANS ADMINISTRATION|||||224.44||| 96361|EAP|0450|IV INF HYDRATION EA ADL H|Workers Compensation|WORKERS COMPENSATION OTHER|||||224.44||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.12||| 96365|EAP|0450|IV INF THER PROPH DX UP T|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||4.12||| 96365|EAP|0450|IV INF THER PROPH DX UP T|United Medicare Advantage|UHC MEDICARE GOLD MA|||||510.88||| 96365|EAP|0450|IV INF THER PROPH DX UP T|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||510.88||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Veterans Affairs|VETERANS ADMINISTRATION|||||376.96||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Veterans Affairs|VETERANS ADMINISTRATION|||||510.88||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Veterans Affairs|VETERANS ADMINISTRATION|||||4.12||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Blue Cross PPO Specialty|BCBSTX PPO|||||376.96||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Aetna|AETNA QHP HMO|||||3.04||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||376.96||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||376.96||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|4.12||||4.12||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||510.88||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3.58||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Blue Cross PPO Specialty|BCBSTX OTHER|510.88||||510.88||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Aetna|AETNA PPO|4.12||||||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Aetna|AETNA QHP HMO|||||4.12||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||510.88||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Cigna|CIGNA|||||376.96||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|3.04||||376.96||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Cigna|CIGNA|510.88||||510.88||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Humana Medicare Advantage|HUMANA MA|376.96||||376.96||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Aenta Medicare Advantage|AETNA MEDICARE MA|||||376.96||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||510.88||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Aetna|AETNA OTHER|510.88||||510.88||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Humana Medicare Advantage|HUMANA MA|||||4.12||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|3.04||||376.96||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Managed Medicaid|MEDICAID AMERIGROUP|||||376.96||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.04||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Blue Cross PPO Specialty|BCBSTX PPO|461.44||||510.88||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Aenta Medicare Advantage|AETNA MEDICARE MA|||||4.12||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Blue Cross HMO Specialty|BCBSTX HMO|461.44||||4.12||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||4.12||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Managed Medicare|HEALTHSPRING MA|||||510.88||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|4.12||||461.44||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Managed Medicare|BCBS MEDICARE PPO MA|||||510.88||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Medicare|MEDICARE PART B ONLY IP|510.88||||||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Medicare|MEDICARE ACUTE|4.12||||4.12||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Managed Medicare|OTHER INSTITUTIONS|||||376.96||| 96365|EAP|0450|IV INF THER PROPH DX UP T|NON CONTRACTED|COMMERCIAL OTHER 1|4.12||||4.12||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Tricare|TRICARE FOR LIFE|||||510.88||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|United Healthcare|UMR UNITED MEDICAL RESOURCES|4.12||||||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Medicaid|WOOD COUNTY INDIGENT|||||461.44||| 96365|EAP|0450|IV INF THER PROPH DX UP T|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||510.88||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||376.96||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Medicaid|MEDICAID|461.44||||4.12||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Medicaid|MEDICAID TEXAS CHILDRENS|||||4.12||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|4.12||||510.88||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Managed Medicaid|MEDICAID AMERIGROUP|461.44||||461.44||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Managed Medicaid|MEDICAID SUPERIOR|4.12||||4.12||| 96365|EAP|0450|IV INF THER PROPH DX UP T|Managed Medicaid|MEDICAID UNITED HEALTHCARE|461.44||||4.12||| 96365|EAP|0450|IV INF THER PROPH DX UP T|United Healthcare|TML GROUP BENEFITS|4.12||||||| 96365|EAP|0260|IV INFUSION INITIAL HOUR|Medicare|MEDICARE ACUTE|394.48||||376.96||| 96365|EAP|0450|IV INF THER PROPH DX UP T|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||4.12||| 96365|EAP|0450|IV INF THER PROPH DX UP T|United Healthcare|UNITED HEALTHCARE|4.12||||510.88||| 96365|EAP|0450|IV INF THER PROPH DX UP T|United Healthcare|UNITED HEALTHCARE OTHER|||||4.12||| 96365|EAP|0450|IV INF THER PROPH DX UP T|United Healthcare|UNITED HEALTHCARE|||||510.88||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||282.10||| 96366|EAP|0260|IV INFUSION EACH ADDIT HR|Managed Medicare|OTHER INSTITUTIONS|||||217.93||| 96366|EAP|0450|IV INF THER PROPH DX EA A|NON CONTRACTED|COMMERCIAL OTHER 1|||||175.75||| 96366|EAP|0260|IV INFUSION EACH ADDIT HR|United Healthcare|UMR UNITED MEDICAL RESOURCES|175.75||||||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Managed Medicaid|MEDICAID AMERIGROUP|||||175.75||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|227.50||||||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Managed Medicaid|MEDICAID UNITED HEALTHCARE|282.10||||282.10||| 96366|EAP|0450|IV INF THER PROPH DX EA A|United Healthcare|UNITED HEALTHCARE|||||282.10||| 96366|EAP|0260|IV INFUSION EACH ADDIT HR|Blue Cross PPO Specialty|BCBSTX PPO|||||217.93||| 96366|EAP|0260|IV INFUSION EACH ADDIT HR|Aetna|AETNA QHP HMO|||||175.75||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|175.75||||||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||282.10||| 96366|EAP|0260|IV INFUSION EACH ADDIT HR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||217.93||| 96366|EAP|0260|IV INFUSION EACH ADDIT HR|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||175.75||| 96366|EAP|0260|IV INFUSION EACH ADDIT HR|Medicare|MEDICARE ACUTE|217.93||||217.93||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Blue Cross PPO Specialty|BCBSTX PPO|||||282.10||| 96366|EAP|0260|IV INFUSION EACH ADDIT HR|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||175.75||| 96366|EAP|0260|IV INFUSION EACH ADDIT HR|Cigna|CIGNA|||||217.93||| 96366|EAP|0260|IV INFUSION EACH ADDIT HR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|175.75||||217.93||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Medicaid|MEDICAID|||||228.93||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Cigna|CIGNA|||||175.75||| 96366|EAP|0260|IV INFUSION EACH ADDIT HR|Humana Medicare Advantage|HUMANA MA|217.93||||217.93||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||282.10||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Humana Medicare Advantage|HUMANA MA|||||282.10||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Medicare|MEDICARE ACUTE|175.75||||227.50||| 96366|EAP|0260|IV INFUSION EACH ADDIT HR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|175.75||||||| 96366|EAP|0260|IV INFUSION EACH ADDIT HR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||175.75||| 96366|EAP|0260|IV INFUSION EACH ADDIT HR|Managed Medicaid|MEDICAID AMERIGROUP|||||217.93||| 96366|EAP|0450|IV INF THER PROPH DX EA A|Aenta Medicare Advantage|AETNA MEDICARE MA|||||227.50||| 96366|EAP|0260|IV INFUSION EACH ADDIT HR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||175.75||| 96366|EAP|0260|IV INFUSION EACH ADDIT HR|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||175.75||| 96366|EAP|0450|IV INF THER PROPH DX EA A|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||282.10||| 96366|EAP|0450|IV INF THER PROPH DX EA A|United Medicare Advantage|UHC MEDICARE GOLD MA|||||175.75||| 96366|EAP|0450|IV INF THER PROPH DX EA A|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||175.75||| 96366|EAP|0450|IV INF THER PROPH DX EA A|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||282.10||| 96366|EAP|0260|IV INFUSION EACH ADDIT HR|Veterans Affairs|VETERANS ADMINISTRATION|||||217.93||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||217.75||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|United Medicare Advantage|UHC MEDICARE GOLD MA|||||270.01||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||217.75||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||270.01||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Veterans Affairs|VETERANS ADMINISTRATION|||||270.01||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|217.75||||||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Blue Cross PPO Specialty|BCBSTX PPO|||||217.75||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||270.01||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Cigna|CIGNA|270.01||||270.01||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||270.01||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Humana Medicare Advantage|HUMANA MA|||||270.01||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Aenta Medicare Advantage|AETNA MEDICARE MA|||||217.75||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||243.88||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Medicare|MEDICARE ACUTE|217.75||||217.75||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|NON CONTRACTED|COMMERCIAL OTHER 1|||||217.75||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Medicaid|MEDICAID|||||217.75||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Medicaid|WOOD COUNTY INDIGENT|||||217.75||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Managed Medicaid|MEDICAID AMERIGROUP|||||243.88||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||270.01||| 96367|EAP|0450|IV INF TX DX ADDL SEQ UP|Managed Medicaid|MEDICAID UNITED HEALTHCARE|217.75||||217.75||| 96372|EAP|0450|INJ SUBQ/IM|Managed Medicare|HEALTHSPRING MA|||||146.94||| 96372|EAP|0450|INJ SUBQ/IM|Managed Medicare|BCBS MEDICARE PPO MA|||||146.94||| 96372|EAP|0450|INJ SUBQ/IM|Medicare|MEDICARE ACUTE|||||118.50||| 96372|EAP|0450|INJ SUBQ/IM|Multiplan|NALC|||||146.94||| 96372|EAP|0450|INJ SUBQ/IM|United Healthcare|GEHA|||||132.72||| 96372|EAP|0260|INJ ADM THERP OR DIAGNOST|NON CONTRACTED|COMMERCIAL OTHER 1|118.50||||118.50||| 96372|EAP|0450|INJ SUBQ/IM|NON CONTRACTED|COMMERCIAL OTHER 1|||||146.94||| 96372|EAP|0450|INJ SUBQ/IM|Tricare|TRICARE EAST REGION|||||118.50||| 96372|EAP|0450|INJ SUBQ/IM|United Healthcare|UNITED HEALTHCARE ERS|||||146.94||| 96372|EAP|0260|INJ ADM THERP OR DIAGNOST|United Healthcare|UNITED HEALTHCARE|118.50||||||| 96372|EAP|0260|INJ ADM THERP OR DIAGNOST|United Healthcare|UNITED HEALTHCARE OTHER|||||55.25||| 96372|EAP|0450|INJ SUBQ/IM|Medicaid|MEDICAID|||||146.94||| 96372|EAP|0450|INJ SUBQ/IM|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||118.50||| 96372|EAP|0450|INJ SUBQ/IM|Managed Medicaid|MEDICAID AMERIGROUP|||||146.94||| 96372|EAP|0450|INJ SUBQ/IM|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||118.50||| 96372|EAP|0450|INJ SUBQ/IM|Managed Medicaid|MEDICAID SUPERIOR|||||118.50||| 96372|EAP|0450|INJ SUBQ/IM|United Healthcare|TML GROUP BENEFITS|||||146.94||| 96372|EAP|0450|INJ SUBQ/IM|United Healthcare|UMR UNITED MEDICAL RESOURCES|118.50||||146.94||| 96372|EAP|0450|INJ SUBQ/IM|United Healthcare|UNITED HEALTHCARE|||||118.50||| 96372|EAP|0450|INJ SUBQ/IM|United Healthcare|UNITED HEALTHCARE OTHER|||||146.94||| 96372|EAP|0260|INJ ADM THERP OR DIAGNOST|Blue Cross PPO Specialty|BCBSTX PPO|||||93.51||| 96372|EAP|0450|INJ SUBQ/IM|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||146.94||| 96372|EAP|0450|INJ SUBQ/IM|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||118.50||| 96372|EAP|0450|INJ SUBQ/IM|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||118.50||| 96372|EAP|0450|INJ SUBQ/IM|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||146.94||| 96372|EAP|0450|INJ SUBQ/IM|Blue Cross PPO Specialty|BCBSTX PPO|146.94||||146.94||| 96372|EAP|0450|INJ SUBQ/IM|United Healthcare|UNITED HEALTHCARE|||||132.72||| 96372|EAP|0260|INJ ADM THERP OR DIAGNOST|Medicare|MEDICARE ACUTE|93.51||||68.51||| 96372|EAP|0450|INJ SUBQ/IM|Blue Cross PPO Specialty|BCBSTX OTHER|||||132.72||| 96372|EAP|0450|INJ SUBQ/IM|Aetna|AETNA OTHER|||||132.72||| 96372|EAP|0260|INJ ADM THERP OR DIAGNOST|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||68.51||| 96372|EAP|0450|INJ SUBQ/IM|Aetna|AETNA PPO|146.94||||118.50||| 96372|EAP|0450|INJ SUBQ/IM|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||118.50||| 96372|EAP|0450|INJ SUBQ/IM|Aetna|AETNA QHP HMO|||||132.72||| 96372|EAP|0450|INJ SUBQ/IM|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||118.50||| 96372|EAP|0260|INJ ADM THERP OR DIAGNOST|Cigna|CIGNA|||||118.50||| 96372|EAP|0260|INJ ADM THERP OR DIAGNOST|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|55.25||||118.50||| 96372|EAP|0450|INJ SUBQ/IM|Cigna|CIGNA|||||132.72||| 96372|EAP|0450|INJ SUBQ/IM|Cigna|CIGNA|||||118.50||| 96372|EAP|0260|INJ ADM THERP OR DIAGNOST|Humana Medicare Advantage|HUMANA MA|||||55.25||| 96372|EAP|0450|INJ SUBQ/IM|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|146.94||||118.50||| 96372|EAP|0450|INJ SUBQ/IM|Humana Medicare Advantage|HUMANA MA|||||118.50||| 96372|EAP|0260|INJ ADM THERP OR DIAGNOST|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|55.25||||||| 96372|EAP|0260|INJ ADM THERP OR DIAGNOST|Managed Medicaid|MEDICAID AMERIGROUP|||||118.50||| 96372|EAP|0450|INJ SUBQ/IM|Aenta Medicare Advantage|AETNA MEDICARE MA|||||118.50||| 96372|EAP|0260|INJ ADM THERP OR DIAGNOST|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|118.50||||68.51||| 96372|EAP|0450|INJ SUBQ/IM|Multiplan|AMERICAN MEDICAL SECURITY|||||146.94||| 96372|EAP|0450|INJ SUBQ/IM|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||146.94||| 96372|EAP|0450|INJ SUBQ/IM|Blue Cross HMO Specialty|BCBSTX HMO|||||118.50||| 96372|EAP|0260|INJ ADM THERP OR DIAGNOST|United Medicare Advantage|UHC MEDICARE GOLD MA|||||68.51||| 96372|EAP|0260|INJ ADM THERP OR DIAGNOST|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||68.51||| 96372|EAP|0450|INJ SUBQ/IM|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||118.50||| 96372|EAP|0450|INJ SUBQ/IM|United Medicare Advantage|UHC MEDICARE GOLD MA|||||118.50||| 96372|EAP|0450|INJ SUBQ/IM|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||146.94||| 96372|EAP|0450|INJ SUBQ/IM|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||146.94||| 96372|EAP|0260|INJ ADM THERP OR DIAGNOST|Veterans Affairs|VETERANS ADMINISTRATION|||||68.51||| 96372|EAP|0450|INJ SUBQ/IM|Veterans Affairs|VETERANS ADMINISTRATION|||||132.72||| 96372|EAP|0450|INJ SUBQ/IM|Veterans Affairs|VETERANS ADMINISTRATION|||||146.94||| 96372|EAP|0450|INJ SUBQ/IM|Workers Compensation|WORKERS COMPENSATION OTHER|||||132.72||| 96373|EAP|0260|INJ INTRA ARTERIAL|Medicare|MEDICARE ACUTE|||||300.29||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Healthcare|UNITED HEALTHCARE OTHER|||||225.12||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicare|MEDICARE ACUTE|249.24||||2.01||| 96374|EAP|0260|IVP THERAP/DIAGNOSTIC INI|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|NON CONTRACTED|COMMERCIAL OTHER 1|2.01||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|NON CONTRACTED|COMMERCIAL OTHER 2|||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|PHCS|HUMANA INSURANCE|||||249.24||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Tricare|TRICARE EAST REGION|249.24||||2.01||| 96374|EAP|0260|IVP THERAP/DIAGNOSTIC INI|United Healthcare|UNITED HEALTHCARE|2.01||||||| 96374|EAP|0260|IVP THERAP/DIAGNOSTIC INI|United Healthcare|UNITED HEALTHCARE OTHER|||||214.76||| 96374|EAP|0260|IVP THERAP/DIAGNOSTIC INI|United Healthcare|UMR UNITED MEDICAL RESOURCES|2.01||||191.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicaid|MEDICAID|2.01||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Tricare|TRICARE FOR LIFE|||||249.24||| 96374|EAP|0260|IVP THERAP/DIAGNOSTIC INI|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.01||||237.77||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicaid|MEDICAID HMO|||||249.24||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicaid|WOOD COUNTY INDIGENT|||||249.24||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||249.24||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||225.12||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicare|BCBS MEDICARE PPO MA|||||225.12||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Healthcare|UNITED HEALTHCARE|||||249.24||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicaid|MEDICAID SUPERIOR|2.01||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicaid|MEDICAID AMERIGROUP|249.24||||249.24||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|249.24||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.01||||2.01||| 96374|EAP|0260|IVP THERAP/DIAGNOSTIC INI|Medicare|MEDICARE ACUTE|2.01||||237.77||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Healthcare|TML GROUP BENEFITS|||||249.24||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Healthcare|GEHA|||||225.12||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Healthcare|UNITED HEALTHCARE|225.12||||249.24||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Healthcare|UNITED HEALTHCARE ERS|||||225.12||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Healthcare|UMR UNITED MEDICAL RESOURCES|2.01||||249.24||| 96374|EAP|0260|IVP THERAP/DIAGNOSTIC INI|Cigna|CIGNA|||||237.77||| 96374|EAP|0260|IVP THERAP/DIAGNOSTIC INI|Veterans Affairs|VETERANS ADMINISTRATION|||||237.77||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|2.01||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicare|OTHER INSTITUTIONS|||||249.24||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Veterans Affairs|VETERANS ADMINISTRATION|||||249.24||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Aetna|AETNA QHP HMO|||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Workers Compensation|WORKERS COMPENSATION OTHER|249.24||||249.24||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||249.24||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.01||| 96374|EAP|0260|IVP THERAP/DIAGNOSTIC INI|Managed Medicaid|MEDICAID AMERIGROUP|||||219.39||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Cigna|CIGNA|||||249.24||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Aetna|AETNA OTHER|||||2.01||| 96374|EAP|0260|IVP THERAP/DIAGNOSTIC INI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||191.75||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Humana Medicare Advantage|HUMANA MA|||||249.24||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Aetna|AETNA PPO|249.24||||2.01||| 96374|EAP|0260|IVP THERAP/DIAGNOSTIC INI|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||219.39||| 96374|EAP|0260|IVP THERAP/DIAGNOSTIC INI|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Access Direct Platinum|HEALTHFIRST TPA UMR|2.01||||2.01||| 96374|EAP|0260|IVP THERAP/DIAGNOSTIC INI|Blue Cross PPO Specialty|BCBSTX PPO|237.77||||237.77||| 96374|EAP|0260|IVP THERAP/DIAGNOSTIC INI|Blue Cross PPO Specialty|BCBSTX OTHER|||||237.77||| 96374|EAP|0260|IVP THERAP/DIAGNOSTIC INI|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.01||| 96374|EAP|0260|IVP THERAP/DIAGNOSTIC INI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|191.75||||196.38||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||225.12||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Cigna|CIGNA|225.12||||2.01||| 96374|EAP|0260|IVP THERAP/DIAGNOSTIC INI|Veterans Affairs|VETERANS ADMINISTRATION|237.77||||||| 96374|EAP|0260|IVP THERAP/DIAGNOSTIC INI|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|191.75||||||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicare|MEDICARE RAILROAD|||||249.24||| 96374|EAP|0260|IVP THERAP/DIAGNOSTIC INI|Humana Medicare Advantage|HUMANA MA|2.01||||2.01||| 96374|EAP|0260|IVP THERAP/DIAGNOSTIC INI|Cigna|CIGNA|||||2.01||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||249.24||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Blue Cross PPO Specialty|BCBSTX PPO|249.24||||249.24||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Blue Cross HMO Specialty|BCBSTX HMO|249.24||||2.01||| 96374|EAP|0260|IVP THERAP/DIAGNOSTIC INI|United Medicare Advantage|UHC MEDICARE GOLD MA|||||237.77||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Aenta Medicare Advantage|AETNA MEDICARE MA|||||249.24||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Managed Medicare|HEALTHSPRING MA|||||249.24||| 96374|EAP|0260|IVP THERAP/DIAGNOSTIC INI|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||237.77||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||249.24||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|249.24||||249.24||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.01||||249.24||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|Veterans Affairs|VETERANS ADMINISTRATION|249.24||||249.24||| 96374|EAP|0450|INJ IV PUSH INITIAL DRUG|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.01||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Humana Medicare Advantage|HUMANA MA|||||190.65||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EA|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||118.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicare|BCBS MEDICARE PPO MA|||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicare|HEALTHSPRING MA|||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Blue Cross HMO Specialty|BCBSTX HMO|190.65||||153.75||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EA|Veterans Affairs|VETERANS ADMINISTRATION|||||147.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||190.65||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||153.75||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EA|Managed Medicaid|MEDICAID AMERIGROUP|||||150.50||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Medicare|MEDICARE ACUTE|190.65||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|190.65||||190.65||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EA|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||150.50||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||190.65||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Tricare|TRICARE FOR LIFE|||||190.65||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||190.65||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicare|OTHER INSTITUTIONS|||||190.65||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Medicaid|MEDICAID HMO|||||190.65||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EA|United Healthcare|UNITED HEALTHCARE|153.75||||||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|153.75||||190.65||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Medicaid|MEDICAID|153.75||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Medicare Advantage|UHC MEDICARE GOLD MA|||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Tricare|TRICARE EAST REGION|190.65||||190.65||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EA|Cigna|CIGNA|||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Healthcare|UNITED HEALTHCARE|||||190.65||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||190.65||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EA|United Medicare Advantage|UHC MEDICARE GOLD MA|||||147.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|NON CONTRACTED|COMMERCIAL OTHER 1|153.75||||153.75||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EA|Medicare|MEDICARE ACUTE|147.25||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Access Direct Platinum|HEALTHFIRST TPA UMR|153.75||||||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|153.75||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Healthcare|UNITED HEALTHCARE|153.75||||190.65||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EA|NON CONTRACTED|COMMERCIAL OTHER 1|||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicaid|MEDICAID AMERIGROUP|172.20||||190.65||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicaid|MEDICAID SUPERIOR|153.75||||153.75||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EA|Humana Medicare Advantage|HUMANA MA|153.75||||147.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Healthcare|UNITED HEALTHCARE OTHER|||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Workers Compensation|WORKERS COMPENSATION OTHER|190.65||||190.65||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||147.25||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EA|Blue Cross PPO Specialty|BCBSTX PPO|118.75||||147.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Medicaid|WOOD COUNTY INDIGENT|||||172.20||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EA|Blue Cross PPO Specialty|BCBSTX OTHER|||||147.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Medicaid|MEDICAID TEXAS CHILDRENS|||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|190.65||||190.65||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EA|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||147.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Healthcare|UMR UNITED MEDICAL RESOURCES|153.75||||190.65||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|190.65||||190.65||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Aetna|AETNA QHP HMO|||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Aetna|AETNA PPO|190.65||||153.75||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EA|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||153.75||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EA|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||147.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Healthcare|UNITED HEALTHCARE ERS|||||172.20||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|PHCS|HUMANA INSURANCE|||||190.65||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Cigna|CIGNA|190.65||||190.65||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Medicare|MEDICARE PART B ONLY IP|190.65||||||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EA|United Healthcare|UMR UNITED MEDICAL RESOURCES|153.75||||||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EA|Cigna|CIGNA|||||147.25||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||190.65||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Managed Medicaid|MEDICAID UNITED HEALTHCARE|190.65||||172.20||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Aetna|AETNA OTHER|190.65||||153.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Blue Cross PPO Specialty|BCBSTX PPO|190.65||||190.65||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Aenta Medicare Advantage|AETNA MEDICARE MA|||||190.65||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Veterans Affairs|VETERANS ADMINISTRATION|||||190.65||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||153.75||| 96375|EAP|0260|IVP THERAP/DIAGNOSTIC EA|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|118.75||||118.75||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|Blue Cross PPO Specialty|BCBSTX OTHER|190.65||||190.65||| 96375|EAP|0450|INJ IV PUSH ADDL SEQ NEW|United Healthcare|TML GROUP BENEFITS|153.75||||190.65||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Aenta Medicare Advantage|AETNA MEDICARE MA|||||30.25||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||37.51||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||37.51||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Medicare|MEDICARE ACUTE|37.51||||30.25||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Tricare|TRICARE FOR LIFE|||||30.25||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Humana Medicare Advantage|HUMANA MA|||||37.51||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Managed Medicare|BCBS MEDICARE PPO MA|||||30.25||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||33.88||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||33.88||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Managed Medicaid|MEDICAID SUPERIOR|||||30.25||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|37.51||||37.51||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Managed Medicaid|MEDICAID AMERIGROUP|||||33.88||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|United Healthcare|UNITED HEALTHCARE ERS|||||33.88||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|United Healthcare|UNITED HEALTHCARE|||||37.51||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|NON CONTRACTED|COMMERCIAL OTHER 1|||||37.51||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Managed Medicare|OTHER INSTITUTIONS|||||37.51||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|United Healthcare|UNITED HEALTHCARE OTHER|||||30.25||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Medicaid|MEDICAID|37.51||||33.88||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Blue Cross HMO Specialty|BCBSTX HMO|||||30.25||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||30.25||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Access Direct Platinum|HEALTHFIRST TPA UMR|30.25||||||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Veterans Affairs|VETERANS ADMINISTRATION|||||30.25||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||30.25||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|United Medicare Advantage|UHC MEDICARE GOLD MA|||||30.25||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Blue Cross PPO Specialty|BCBSTX PPO|33.88||||37.51||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|30.25||||30.25||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Workers Compensation|WORKERS COMPENSATION OTHER|||||37.51||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Cigna|CIGNA|30.25||||30.25||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Aetna|AETNA PPO|37.51||||||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||37.51||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Veterans Affairs|VETERANS ADMINISTRATION|||||33.88||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Aetna|AETNA QHP HMO|||||30.25||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|Blue Cross PPO Specialty|BCBSTX OTHER|||||37.51||| 96376|EAP|0450|INJ THERAPEUTIC/DIAGNOSTI|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||30.25||| 96523|EAP|0260|IRRIG DRUG DELIVERY DEVIC|Blue Cross PPO Specialty|BCBSTX PPO|||||71.50||| 96523|EAP|0260|IRRIG DRUG DELIVERY DEVIC|Managed Medicaid|MEDICAID AMERIGROUP|||||88.66||| 96523|EAP|0260|IRRIG DRUG DELIVERY DEVIC|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||71.50||| 96523|EAP|0260|IRRIG DRUG DELIVERY DEVIC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||71.50||| 96523|EAP|0260|IRRIG DRUG DELIVERY DEVIC|United Medicare Advantage|UHC MEDICARE GOLD MA|||||88.66||| 96523|EAP|0260|IRRIG DRUG DELIVERY DEVIC|Medicaid|MEDICAID|||||88.66||| 96523|EAP|0260|IRRIG DRUG DELIVERY DEVIC|Medicare|MEDICARE ACUTE|||||88.66||| 97|DRG||NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W MCC|Medicare|MEDICARE ACUTE|137,375.88|346.5|346.5|118.8|||| 97|DRG||NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W MCC|Blue Cross HMO Specialty|BCBSTX HMO|34,105.90|118.8|346.5|118.8|||| 97110|EAP|0420|EXERCISE UNIT|United Medicare Advantage|UHC MEDICARE GOLD MA|151.75||||||| 97110|EAP|0420|EXERCISE UNIT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|151.75||||||| 97110|EAP|0420|EXERCISE UNIT|Cigna|CIGNA|151.75||||||| 97110|EAP|0430|OT THERAPEUTIC EXERCISES|United Medicare Advantage|AARP UHC WEST COMPLETE MA|151.75||||||| 97110|EAP|0430|OT THERAPEUTIC EXERCISES|United Medicare Advantage|UHC MEDICARE GOLD MA|151.75||||||| 97110|EAP|0430|OT THERAPEUTIC EXERCISES|Workers Compensation|WORKERS COMPENSATION OTHER|151.75||||||| 97110|EAP|0420|EXERCISE UNIT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|151.75||||||| 97110|EAP|0430|OT THERAPEUTIC EXERCISES|Medicare|MEDICARE ACUTE|151.75||||||| 97110|EAP|0430|OT THERAPEUTIC EXERCISES|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|151.75||||||| 97110|EAP|0430|OT THERAPEUTIC EXERCISES|Veterans Affairs|VETERANS ADMINISTRATION|151.75||||||| 97110|EAP|0430|OT THERAPEUTIC EXERCISES|NON CONTRACTED|COMMERCIAL OTHER 1|151.75||||||| 97110|EAP|0420|EXERCISE UNIT|Humana Medicare Advantage|HUMANA MA|151.75||||||| 97110|EAP|0430|OT THERAPEUTIC EXERCISES|United Healthcare|UNITED HEALTHCARE|151.75||||||| 97110|EAP|0420|EXERCISE UNIT|Medicaid|MEDICAID|151.75||||||| 97110|EAP|0430|OT THERAPEUTIC EXERCISES|Medicaid|MEDICAID|151.75||||||| 97110|EAP|0420|EXERCISE UNIT|United Healthcare|UNITED HEALTHCARE|151.75||||||| 97110|EAP|0430|OT THERAPEUTIC EXERCISES|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|151.75||||151.75||| 97110|EAP|0430|OT THERAPEUTIC EXERCISES|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|151.75||||||| 97110|EAP|0430|OT THERAPEUTIC EXERCISES|Blue Cross PPO Specialty|BCBSTX PPO|151.75||||||| 97110|EAP|0420|EXERCISE UNIT|Medicare|MEDICARE ACUTE|151.75||||151.75||| 97110|EAP|0430|OT THERAPEUTIC EXERCISES|Managed Medicare|BCBS MEDICARE PPO MA|151.75||||||| 97110|EAP|0430|OT THERAPEUTIC EXERCISES|Aetna|AETNA PPO|151.75||||||| 97110|EAP|0420|EXERCISE UNIT|Aenta Medicare Advantage|AETNA MEDICARE MA|151.75||||||| 97110|EAP|0420|EXERCISE UNIT|Workers Compensation|WORKERS COMPENSATION OTHER|151.75||||||| 97110|EAP|0420|EXERCISE UNIT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|151.75||||||| 97110|EAP|0430|OT THERAPEUTIC EXERCISES|Aenta Medicare Advantage|AETNA MEDICARE MA|151.75||||||| 97110|EAP|0420|EXERCISE UNIT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|151.75||||||| 97110|EAP|0420|EXERCISE UNIT|Managed Medicare|HEALTHSPRING MA|151.75||||||| 97110|EAP|0430|OT THERAPEUTIC EXERCISES|Humana Medicare Advantage|HUMANA MA|151.75||||151.75||| 97110|EAP|0430|OT THERAPEUTIC EXERCISES|Managed Medicare|HEALTHSPRING MA|151.75||||||| 97110|EAP|0420|EXERCISE UNIT|Veterans Affairs|VETERANS ADMINISTRATION|151.75||||||| 97110|EAP|0430|OT THERAPEUTIC EXERCISES|Managed Medicaid|MEDICAID UNITED HEALTHCARE|151.75||||||| 97112|EAP|0430|OT NEUROMUSCULAR REEDUCAT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|151.75||||||| 97112|EAP|0430|OT NEUROMUSCULAR REEDUCAT|Humana Medicare Advantage|HUMANA MA|151.75||||||| 97112|EAP|0430|OT NEUROMUSCULAR REEDUCAT|Veterans Affairs|VETERANS ADMINISTRATION|151.75||||||| 97112|EAP|0430|OT NEUROMUSCULAR REEDUCAT|Medicare|MEDICARE ACUTE|151.75||||||| 97116|EAP|0420|GAIT TRAINING|Humana Medicare Advantage|HUMANA MA|182.50||||||| 97116|EAP|0420|GAIT TRAINING|United Medicare Advantage|AARP UHC WEST COMPLETE MA|182.50||||||| 97116|EAP|0420|GAIT TRAINING|Cigna|CIGNA|182.50||||||| 97116|EAP|0420|GAIT TRAINING|Veterans Affairs|VETERANS ADMINISTRATION|182.50||||||| 97116|EAP|0420|GAIT TRAINING|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|182.50||||||| 97116|EAP|0420|GAIT TRAINING|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|182.50||||||| 97116|EAP|0420|GAIT TRAINING|Managed Medicare|BCBS MEDICARE PPO MA|182.50||||||| 97116|EAP|0420|GAIT TRAINING|Medicare|MEDICARE ACUTE|182.50||||182.50||| 97116|EAP|0420|GAIT TRAINING|Managed Medicaid|MEDICAID UNITED HEALTHCARE|182.50||||||| 97116|EAP|0420|GAIT TRAINING|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|182.50||||||| 97116|EAP|0420|GAIT TRAINING|Aenta Medicare Advantage|AETNA MEDICARE MA|182.50||||||| 97116|EAP|0420|GAIT TRAINING|United Medicare Advantage|UHC MEDICARE GOLD MA|182.50||||182.50||| 97116|EAP|0420|GAIT TRAINING|United Healthcare|UNITED HEALTHCARE|182.50||||||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|Humana Medicare Advantage|HUMANA MA|2.73||||2.73||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|Medicare|MEDICARE ACUTE|2.73||||2.73||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|Aetna|AETNA OTHER|2.73||||||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|Medicare|MEDICARE PART B ONLY IP|2.73||||||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|Aenta Medicare Advantage|AETNA MEDICARE MA|2.73||||||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|United Medicare Advantage|UHC MEDICARE GOLD MA|2.73||||||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|United Healthcare|UNITED HEALTHCARE|2.73||||||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|Managed Medicare|HEALTHSPRING MA|2.73||||2.73||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.73||||||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|Medicaid|MEDICAID|2.73||||||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|Cigna|CIGNA|2.73||||||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.73||||||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.73||||2.73||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.73||| 97161|EAP|0424|PHYSICAL THERAPY EVALUATI|Veterans Affairs|VETERANS ADMINISTRATION|2.73||||||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|Blue Cross PPO Specialty|BCBSTX PPO|3.48||||||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|Managed Medicare|BCBS MEDICARE PPO MA|3.48||||||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|Medicare|MEDICARE PART B ONLY IP|3.48||||||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|3.48||||||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|United Medicare Advantage|UHC MEDICARE GOLD MA|3.48||||3.48||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|Workers Compensation|WORKERS COMPENSATION OTHER|3.48||||||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|Medicaid|MEDICAID|3.48||||||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|Managed Medicaid|MEDICAID SUPERIOR|3.48||||||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|3.48||||3.48||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|3.48||||||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|United Healthcare|UMR UNITED MEDICAL RESOURCES|3.48||||||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|United Healthcare|UNITED HEALTHCARE|3.48||||||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|Medicare|MEDICARE ACUTE|3.48||||3.48||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|Managed Medicaid|MEDICAID UNITED HEALTHCARE|3.48||||||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|United Medicare Advantage|AARP UHC WEST COMPLETE MA|3.48||||3.48||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|NON CONTRACTED|COMMERCIAL OTHER 1|3.48||||||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|Humana Medicare Advantage|HUMANA MA|3.48||||3.48||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|Aenta Medicare Advantage|AETNA MEDICARE MA|3.48||||3.48||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|Cigna|CIGNA|3.48||||||| 97162|EAP|0424|PHYSICAL THERAPY EVALUATI|Managed Medicare|HEALTHSPRING MA|3.48||||||| 97163|EAP|0424|PHYSICAL THERAPY EVALUATI|Medicare|MEDICARE ACUTE|4.25||||4.25||| 97163|EAP|0424|PHYSICAL THERAPY EVALUATI|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.25||||||| 97163|EAP|0424|PHYSICAL THERAPY EVALUATI|Veterans Affairs|VETERANS ADMINISTRATION|4.25||||||| 97163|EAP|0424|PHYSICAL THERAPY EVALUATI|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|4.25||||4.25||| 97163|EAP|0424|PHYSICAL THERAPY EVALUATI|United Medicare Advantage|UHC MEDICARE GOLD MA|4.25||||||| 97163|EAP|0424|PHYSICAL THERAPY EVALUATI|Humana Medicare Advantage|HUMANA MA|4.25||||||| 97163|EAP|0424|PHYSICAL THERAPY EVALUATI|Blue Cross HMO Specialty|BCBSTX HMO|4.25||||||| 97163|EAP|0424|PHYSICAL THERAPY EVALUATI|Blue Cross PPO Specialty|BCBSTX PPO|4.25||||||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|Managed Medicare|HEALTHSPRING MA|2.88||||2.88||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|Aetna|AETNA OTHER|2.88||||||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|Aenta Medicare Advantage|AETNA MEDICARE MA|2.88||||2.88||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|Humana Medicare Advantage|HUMANA MA|2.88||||2.88||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|Cigna|CIGNA|2.88||||||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|Aetna|AETNA PPO|2.88||||||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|United Healthcare|UNITED HEALTHCARE|2.88||||||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.88||||||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|Managed Medicare|BCBS MEDICARE PPO MA|2.88||||||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|Blue Cross PPO Specialty|BCBSTX PPO|2.88||||||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|Medicaid|MEDICAID|2.88||||||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|NON CONTRACTED|COMMERCIAL OTHER 1|2.88||||||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|Veterans Affairs|VETERANS ADMINISTRATION|2.88||||||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|2.88||||2.88||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|2.88||||||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|United Medicare Advantage|UHC MEDICARE GOLD MA|2.88||||2.88||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.88||||||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.88||||||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|2.88||||2.88||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|Medicare|MEDICARE ACUTE|2.88||||2.88||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|Workers Compensation|WORKERS COMPENSATION OTHER|2.88||||||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|Medicare|MEDICARE PART B ONLY IP|2.88||||||| 97166|EAP|0434|OCCUPATIONAL THERAPY EVAL|Managed Medicaid|MEDICAID SUPERIOR|2.88||||||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES IN|Humana Medicare Advantage|HUMANA MA|165.50||||||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES IN|Aenta Medicare Advantage|AETNA MEDICARE MA|165.50||||||| 97530|EAP|0430|OT THERAPEUTIC ACTIVITIES|Humana Medicare Advantage|HUMANA MA|165.50||||||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES IN|Blue Cross PPO Specialty|BCBSTX PPO|165.50||||||| 97530|EAP|0430|OT THERAPEUTIC ACTIVITIES|Aetna|AETNA PPO|165.50||||||| 97530|EAP|0430|OT THERAPEUTIC ACTIVITIES|Aenta Medicare Advantage|AETNA MEDICARE MA|165.50||||165.50||| 97530|EAP|0430|OT THERAPEUTIC ACTIVITIES|Medicare|MEDICARE ACUTE|165.50||||||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES IN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|165.50||||||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES IN|NON CONTRACTED|COMMERCIAL OTHER 1|165.50||||||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES IN|Medicaid|MEDICAID|165.50||||||| 97530|EAP|0430|OT THERAPEUTIC ACTIVITIES|Medicaid|MEDICAID|165.50||||||| 97530|EAP|0430|OT THERAPEUTIC ACTIVITIES|United Healthcare|UNITED HEALTHCARE|165.50||||||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES IN|Managed Medicare|HEALTHSPRING MA|165.50||||||| 97530|EAP|0430|OT THERAPEUTIC ACTIVITIES|NON CONTRACTED|COMMERCIAL OTHER 1|165.50||||||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES IN|United Healthcare|UNITED HEALTHCARE|165.50||||||| 97530|EAP|0430|OT THERAPEUTIC ACTIVITIES|Managed Medicaid|MEDICAID UNITED HEALTHCARE|165.50||||||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES IN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|165.50||||||| 97530|EAP|0430|OT THERAPEUTIC ACTIVITIES|Managed Medicare|BCBS MEDICARE PPO MA|165.50||||||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES IN|United Medicare Advantage|UHC MEDICARE GOLD MA|165.50||||165.50||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES IN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|165.50||||||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES IN|Medicare|MEDICARE ACUTE|165.50||||165.50||| 97530|EAP|0430|OT THERAPEUTIC ACTIVITIES|Medicare|MEDICARE PART B ONLY IP|165.50||||||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES IN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|165.50||||||| 97530|EAP|0430|OT THERAPEUTIC ACTIVITIES|United Medicare Advantage|UHC MEDICARE GOLD MA|165.50||||||| 97530|EAP|0430|OT THERAPEUTIC ACTIVITIES|United Medicare Advantage|AARP UHC WEST COMPLETE MA|165.50||||||| 97530|EAP|0430|OT THERAPEUTIC ACTIVITIES|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|165.50||||165.50||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES IN|Veterans Affairs|VETERANS ADMINISTRATION|165.50||||||| 97530|EAP|0430|OT THERAPEUTIC ACTIVITIES|Workers Compensation|WORKERS COMPENSATION OTHER|165.50||||||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES IN|Workers Compensation|WORKERS COMPENSATION OTHER|165.50||||||| 97530|EAP|0420|THERAPEUTIC ACTIVITIES IN|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|165.50||||||| 97535|EAP|0430|OT SELF CARE MGMT TRAININ|United Medicare Advantage|UHC MEDICARE GOLD MA|167.25||||167.25||| 97535|EAP|0430|OT SELF CARE MGMT TRAININ|United Medicare Advantage|AARP UHC WEST COMPLETE MA|167.25||||167.25||| 97535|EAP|0430|OT SELF CARE MGMT TRAININ|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|167.25||||||| 97535|EAP|0430|OT SELF CARE MGMT TRAININ|Workers Compensation|WORKERS COMPENSATION OTHER|167.25||||||| 97535|EAP|0430|OT SELF CARE MGMT TRAININ|Medicare|MEDICARE PART B ONLY IP|167.25||||||| 97535|EAP|0430|OT SELF CARE MGMT TRAININ|United Healthcare|UNITED HEALTHCARE|167.25||||||| 97535|EAP|0430|OT SELF CARE MGMT TRAININ|NON CONTRACTED|COMMERCIAL OTHER 1|167.25||||||| 97535|EAP|0430|OT SELF CARE MGMT TRAININ|Aenta Medicare Advantage|AETNA MEDICARE MA|167.25||||167.25||| 97535|EAP|0430|OT SELF CARE MGMT TRAININ|Humana Medicare Advantage|HUMANA MA|167.25||||167.25||| 97535|EAP|0430|OT SELF CARE MGMT TRAININ|Blue Cross PPO Specialty|BCBSTX PPO|167.25||||||| 97535|EAP|0430|OT SELF CARE MGMT TRAININ|Managed Medicare|HEALTHSPRING MA|167.25||||167.25||| 97535|EAP|0430|OT SELF CARE MGMT TRAININ|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|167.25||||||| 97535|EAP|0430|OT SELF CARE MGMT TRAININ|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|167.25||||||| 97535|EAP|0430|OT SELF CARE MGMT TRAININ|Managed Medicaid|MEDICAID UNITED HEALTHCARE|167.25||||||| 97535|EAP|0430|OT SELF CARE MGMT TRAININ|Managed Medicaid|MEDICAID SUPERIOR|167.25||||||| 97535|EAP|0430|OT SELF CARE MGMT TRAININ|Aetna|AETNA OTHER|167.25||||||| 97535|EAP|0430|OT SELF CARE MGMT TRAININ|Managed Medicare|BCBS MEDICARE PPO MA|167.25||||||| 97535|EAP|0430|OT SELF CARE MGMT TRAININ|Medicare|MEDICARE ACUTE|167.25||||167.25||| 97535|EAP|0430|OT SELF CARE MGMT TRAININ|Medicaid|MEDICAID|167.25||||||| 97535|EAP|0430|OT SELF CARE MGMT TRAININ|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|167.25||||167.25||| 97597|EAP|0450|DEBRIDE SKIN PARTIAL THIC|NON CONTRACTED|COMMERCIAL OTHER 1|||||538.78||| 97597|EAP|0450|DEBRIDE SKIN PARTIAL THIC|Medicare|MEDICARE ACUTE|||||538.78||| 97597|EAP|0450|DEBRIDE SKIN PARTIAL THIC|Humana Medicare Advantage|HUMANA MA|||||538.78||| 97597|EAP|0450|DEBRIDE SKIN PARTIAL THIC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||538.78||| 989|DRG||NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC|United Medicare Advantage|UHC MEDICARE GOLD MA|40,334.75|11352.78|11352.78|11352.78|||| 99001|EAP|0300|PATH REFERENCE|Blue Cross PPO Specialty|BCBSTX PPO|0.25||||||| 99001|EAP|0300|PATH REFERENCE|United Healthcare|UNITED HEALTHCARE|||||0.25||| 99001|EAP|0300|PATH REFERENCE|NON CONTRACTED|COMMERCIAL OTHER 1|||||0.25||| 99001|EAP|0300|PATH REFERENCE|Blue Cross HMO Specialty|BCBSTX HMO|||||0.25||| 99001|EAP|0300|PATH REFERENCE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||0.25||| 99001|EAP|0300|PATH REFERENCE|Humana Medicare Advantage|HUMANA MA|||||0.25||| 99001|EAP|0300|PATH REFERENCE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.25||| 99001|EAP|0300|PATH REFERENCE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.25||| 99001|EAP|0300|PATH REFERENCE|Medicare|MEDICARE ACUTE|0.25||||0.25||| 99001|EAP|0300|PATH REFERENCE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.25||| 99001|EAP|0300|PATH REFERENCE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.25||||||| 99141|EAP|0450|CONSCIOUS SEDATE IV/IM|Managed Medicaid|MEDICAID AMERIGROUP|||||5.11||| 99281|EAP|0450|ER VISIT LEVEL 1|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Blue Cross PPO Specialty|BCBSTX PPO|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Aetna|AETNA OTHER|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Cigna|CIGNA|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Humana Medicare Advantage|HUMANA MA|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Managed Medicare|BCBS MEDICARE PPO MA|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1 WITH PRO|Medicare|MEDICARE ACUTE|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Medicare|MEDICARE ACUTE|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|United Healthcare|UNITED HEALTHCARE OTHER|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Tricare|TRICARE EAST REGION|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|PHCS|MULTIPLAN PHCS OTHER|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Managed Medicaid|MEDICAID SUPERIOR|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Managed Medicaid|MEDICAID AMERIGROUP|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|United Healthcare|UNITED HEALTHCARE|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Workers Compensation|UT EMPLOYEE INJURY|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Blue Cross HMO Specialty|BCBSTX HMO|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Medicaid|MEDICAID TEXAS CHILDRENS|||||2.30||| 99281|EAP|0450|ER VISIT LEVEL 1|Medicaid|MEDICAID|||||2.30||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Medicare|MEDICARE ACUTE|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Humana Medicare Advantage|HUMANA MA|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|PHCS|MULTIPLAN PHCS OTHER|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|PHCS|HUMANA INSURANCE|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Tricare|TRICARE EAST REGION|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Tricare|TRICARE EAST REGION|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|NON CONTRACTED|COMMERCIAL OTHER 1|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Medicaid|MEDICAID|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Managed Medicaid|MEDICAID AMERIGROUP|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Medicare|MEDICARE ACUTE|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Managed Medicaid|MEDICAID SUPERIOR|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Managed Medicaid|MEDICAID SUPERIOR|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|United Healthcare|UNITED HEALTHCARE|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|United Healthcare|UNITED HEALTHCARE|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|United Healthcare|UNITED HEALTHCARE OTHER|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Blue Cross PPO Specialty|BCBSTX PPO|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Cigna|CIGNA|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Aetna|AETNA QHP HMO|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Cigna|CIGNA|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Managed Medicaid|MEDICAID AMERIGROUP|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|PHCS|HUMANA INSURANCE|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Access Direct Platinum|HEALTHFIRST TPA UMR|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|United Healthcare|UNITED HEALTHCARE OTHER|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Medicaid|MEDICAID|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Aetna|AETNA QHP HMO|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Humana Medicare Advantage|HUMANA MA|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Blue Cross PPO Specialty|BCBSTX PPO|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Blue Cross HMO Specialty|BCBSTX HMO|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Blue Cross PPO Specialty|BCBSTX OTHER|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|United Medicare Advantage|UHC MEDICARE GOLD MA|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Veterans Affairs|VETERANS ADMINISTRATION|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2|Workers Compensation|WORKERS COMPENSATION OTHER|||||3.98||| 99282|EAP|0450|ER VISIT LEVEL 2 WITH PRO|Workers Compensation|WORKERS COMPENSATION OTHER|||||3.98||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Veterans Affairs|VETERANS ADMINISTRATION|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|United Healthcare|UNITED HEALTHCARE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Veterans Affairs|VETERANS ADMINISTRATION|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Workers Compensation|WORKERS COMPENSATION OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Workers Compensation|UT EMPLOYEE INJURY|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Access Direct Platinum|HEALTHFIRST TPA UMR|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Blue Cross PPO Specialty|BCBSTX OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Blue Cross PPO Specialty|BCBSTX PPO|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Blue Cross PPO Specialty|BCBSTX PPO|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Aetna|AETNA PPO|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Aetna|AETNA QHP HMO|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Aetna|AETNA QHP HMO|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Aetna|AETNA OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Aetna|AETNA OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|ChampVA|CHAMPVA CENTER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|ChampVA|CHAMPVA CENTER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Cigna|CIGNA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Humana Medicare Advantage|HUMANA MA|11.00||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Aenta Medicare Advantage|AETNA MEDICARE MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Blue Cross HMO Specialty|BCBSTX HMO|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Managed Medicare|OTHER INSTITUTIONS|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Managed Medicare|OTHER INSTITUTIONS|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Blue Cross HMO Specialty|BCBSTX HMO|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Managed Medicare|HEALTHSPRING MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Managed Medicare|TEXAS COMMUNITY CARE MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|NON CONTRACTED|COMMERCIAL OTHER 1|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|NON CONTRACTED|COMMERCIAL OTHER 1|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Medicare|MEDICARE ACUTE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Medicaid|MEDICAID TEXAS CHILDRENS|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Humana Medicare Advantage|HUMANA MA|11.00||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|NON CONTRACTED|WOOD COUNTY HOSPITAL DISTRICT|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Tricare|TRICARE FOR LIFE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Cigna|CIGNA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Tricare|TRICARE EAST REGION|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Medicare|MEDICARE ACUTE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Managed Medicare|BCBS MEDICARE PPO MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Tricare|TRICARE EAST REGION|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Medicaid|MEDICAID HMO|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Aetna|AETNA PPO|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|PHCS|MULTIPLAN PHCS|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Medicaid|MEDICAID|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Medicaid|CRIME VICTIMS COMPENSATION|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Medicaid|MEDICAID HMO|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Blue Cross PPO Specialty|BCBSTX OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Medicaid|WOOD COUNTY INDIGENT|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Medicaid|MEDICAID TEXAS CHILDRENS|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Managed Medicare|HEALTHSPRING MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Tricare|TRICARE FOR LIFE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Medicaid|MEDICAID BCBSTX|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|PHCS|HUMANA INSURANCE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Managed Medicaid|MEDICAID AMERIGROUP|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Medicaid|MEDICAID|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Managed Medicaid|MEDICAID SUPERIOR|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Workers Compensation|WORKERS COMPENSATION OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|United Healthcare|TML GROUP BENEFITS|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|United Healthcare|ZZZZZ UNITED HEALTHCARE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Medicaid|CRIME VICTIMS COMPENSATION|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|United Healthcare|UNITED HEALTHCARE OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|United Healthcare|UNITED HEALTHCARE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|United Healthcare|UNITED HEALTHCARE ERS|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Managed Medicaid|MEDICAID SUPERIOR|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|Managed Medicaid|MEDICAID AMERIGROUP|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|United Healthcare|UNITED HEALTHCARE OTHER|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|United Healthcare|TML GROUP BENEFITS|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3 WITH PRO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|United Medicare Advantage|UHC MEDICARE GOLD MA|||||11.00||| 99283|EAP|0450|ER VISIT LEVEL 3|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||11.00||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|NON CONTRACTED|COMMERCIAL OTHER 2|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Managed Medicare|MEDICARE RAILROAD|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Managed Medicare|BCBS MEDICARE PPO MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Managed Medicare|HEALTHSPRING MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Medicare|MEDICARE ACUTE|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Managed Medicare|OTHER INSTITUTIONS|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Medicare|MEDICARE ACUTE|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Multiplan|AMERICAN MEDICAL SECURITY|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|NON CONTRACTED|COMMERCIAL OTHER 1|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|NON CONTRACTED|COMMERCIAL OTHER 1|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|PHCS|HUMANA INSURANCE|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Tricare|TRICARE FOR LIFE|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Tricare|TRICARE EAST REGION|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Tricare|TRICARE EAST REGION|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Medicaid|WOOD COUNTY INDIGENT|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Medicaid|MEDICAID TEXAS CHILDRENS|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Medicaid|MEDICAID HMO|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Medicaid|COUNTY INDIGENT HEALTH OTHER|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Medicaid|WOOD COUNTY INDIGENT|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Managed Medicaid|MEDICAID SUPERIOR|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Managed Medicaid|MEDICAID SUPERIOR|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Managed Medicaid|MEDICAID AMERIGROUP|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Blue Cross PPO Specialty|BCBSTX OTHER|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Blue Cross PPO Specialty|BCBSTX OTHER|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Blue Cross PPO Specialty|BCBSTX PPO|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Blue Cross PPO Specialty|BCBSTX PPO|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Access Direct Platinum|HEALTHFIRST TPA UMR|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Access Direct Platinum|HEALTHFIRST TPA UMR|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Access Direct Platinum|HEALTHFIRST TPA OTHER 2|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Aetna|AETNA OTHER|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Aetna|AETNA PPO|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Aetna|AETNA QHP HMO|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Aetna|AETNA PPO|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Managed Medicaid|MEDICAID AMERIGROUP|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Aetna|AETNA QHP HMO|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Aetna|AETNA OTHER|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Cigna|CIGNA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Cigna|CIGNA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Medicaid|MEDICAID|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Humana Medicare Advantage|HUMANA MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Humana Medicare Advantage|HUMANA MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Blue Cross HMO Specialty|BCBSTX HMO|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Blue Cross HMO Specialty|BCBSTX HMO|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Medicaid|MEDICAID|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|United Healthcare|GEHA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|United Healthcare|UNITED HEALTHCARE ERS|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|United Healthcare|UNITED HEALTHCARE|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|United Medicare Advantage|UHC MEDICARE GOLD MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|United Healthcare|GEHA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|United Healthcare|UNITED HEALTHCARE ERS|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Managed Medicare|HEALTHSPRING MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Managed Medicare|BCBS MEDICARE PPO MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Veterans Affairs|VETERANS ADMINISTRATION|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Veterans Affairs|VETERANS ADMINISTRATION|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|United Healthcare|UNITED HEALTHCARE|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|United Healthcare|TML GROUP BENEFITS|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Workers Compensation|WORKERS COMPENSATION OTHER|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|Workers Compensation|UT EMPLOYEE INJURY|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|United Healthcare|UNITED HEALTHCARE OTHER|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Workers Compensation|WORKERS COMPENSATION OTHER|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|United Healthcare|TML GROUP BENEFITS|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|United Healthcare|UNITED HEALTHCARE OTHER|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4 WITH PRO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||23.80||| 99284|EAP|0450|ER VISIT LEVEL 4|Aenta Medicare Advantage|AETNA MEDICARE MA|||||23.80||| 99285|EAP|0450|ER VISIT LEVEL 5|United Healthcare|UNITED HEALTHCARE|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|United Healthcare|TML GROUP BENEFITS|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|United Healthcare|UMR UNITED MEDICAL RESOURCES|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|United Medicare Advantage|UHC MEDICARE GOLD MA|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|United Medicare Advantage|UHC MEDICARE GOLD MA|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|15.35||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|15.35||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|United Healthcare|UNITED HEALTHCARE|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|United Healthcare|UNITED HEALTHCARE|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|United Healthcare|UNITED HEALTHCARE OTHER|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|United Healthcare|UMR UNITED MEDICAL RESOURCES|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Veterans Affairs|VETERANS ADMINISTRATION|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|United Healthcare|UNITED HEALTHCARE OTHER|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Workers Compensation|WORKERS COMPENSATION OTHER|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Blue Cross PPO Specialty|BCBSTX PPO|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Blue Cross PPO Specialty|BCBSTX OTHER|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Aetna|AETNA OTHER|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Aetna|AETNA PPO|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Blue Cross PPO Specialty|BCBSTX OTHER|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Aetna|AETNA QHP HMO|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Aetna|AETNA OTHER|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Cigna|CIGNA|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Cigna|CIGNA|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Humana Medicare Advantage|HUMANA MA|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Blue Cross HMO Specialty|BCBSTX HMO|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Managed Medicare|HEALTHSPRING MA|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Blue Cross HMO Specialty|BCBSTX HMO|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Managed Medicare|MEDICARE RAILROAD|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|United Healthcare|TML GROUP BENEFITS|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Aetna|AETNA QHP HMO|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Veterans Affairs|VETERANS ADMINISTRATION|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Aetna|AETNA PPO|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Managed Medicare|BCBS MEDICARE PPO MA|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Workers Compensation|WORKERS COMPENSATION OTHER|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Blue Cross PPO Specialty|BCBSTX PPO|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Aenta Medicare Advantage|AETNA MEDICARE MA|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Aenta Medicare Advantage|AETNA MEDICARE MA|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Managed Medicare|BCBS MEDICARE PPO MA|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Medicare|MEDICARE ACUTE|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Medicare|MEDICARE PART B ONLY IP|37.40||||||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Humana Medicare Advantage|HUMANA MA|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Medicare|MEDICARE ACUTE|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Managed Medicare|OTHER INSTITUTIONS|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Multiplan|NALC|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|NON CONTRACTED|COMMERCIAL OTHER 1|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|NON CONTRACTED|COMMERCIAL OTHER 1|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Tricare|TRICARE FOR LIFE|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Tricare|TRICARE EAST REGION|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Tricare|TRICARE EAST REGION|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Medicaid|MEDICAID TEXAS CHILDRENS|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Veterans Affairs|VETERANS ADMINISTRATION|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Medicaid|MEDICAID TEXAS CHILDRENS|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Managed Medicaid|MEDICAID SUPERIOR|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Managed Medicaid|MEDICAID SUPERIOR|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Managed Medicaid|MEDICAID UNITED HEALTHCARE|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Managed Medicaid|MEDICAID AMERIGROUP|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Managed Medicaid|MEDICAID AMERIGROUP|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Managed Medicaid|MEDICAID UNITED HEALTHCARE|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Medicaid|MEDICAID|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Medicaid|MEDICAID|37.40||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Medicaid|MEDICAID HMO|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|United Healthcare|UNITED HEALTHCARE ERS|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||37.40||| 99285|EAP|0450|ER VISIT LEVEL 5 WITH PRO|Medicaid|WOOD COUNTY INDIGENT|||||37.40||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Medicare|MEDICARE ACUTE|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Managed Medicare|HEALTHSPRING MA|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|NON CONTRACTED|COMMERCIAL OTHER 1|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Managed Medicaid|MEDICAID AMERIGROUP|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Managed Medicaid|MEDICAID SUPERIOR|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|22.65||||||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Blue Cross PPO Specialty|BCBSTX PPO|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|22.65||||||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Access Direct Platinum|HEALTHFIRST TPA UMR|22.65||||||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Medicaid|MEDICAID|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Aetna|AETNA OTHER|22.65||||||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Aetna|AETNA QHP HMO|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Humana Medicare Advantage|HUMANA MA|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Aenta Medicare Advantage|AETNA MEDICARE MA|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Veterans Affairs|VETERANS ADMINISTRATION|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|United Healthcare|UNITED HEALTHCARE|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||22.65||| 99291|EAP|0450|CRITICAL CARE FIRST HOUR|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||22.65||| 99292|EAP|0450|CRITICAL CARE EACH ADD 30|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||822.25||| 99292|EAP|0450|CRITICAL CARE EACH ADD 30|Medicare|MEDICARE ACUTE|||||822.25||| A4216|EAP|0250|WATER FOR INJ.,STERILE 10|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2.25||| A4216|EAP|0250|WATER FOR INJ.,STERILE 10|Humana Medicare Advantage|HUMANA MA|2.25||||2.25||| A4216|EAP|0250|WATER FOR INJ.,STERILE 10|Aenta Medicare Advantage|AETNA MEDICARE MA|||||2.25||| A4216|EAP|0250|WATER FOR INJ.,STERILE 10|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.25||| A4216|EAP|0250|WATER FOR INJ.,STERILE 10|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.25||||2.25||| A4216|EAP|0250|WATER FOR INJ.,STERILE 10|Managed Medicaid|MEDICAID SUPERIOR|||||2.25||| A4216|EAP|0250|WATER FOR INJ.,STERILE 10|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2.25||| A4216|EAP|0250|WATER FOR INJ.,STERILE 10|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.25||| A4216|EAP|0250|WATER FOR INJ.,STERILE 10|Managed Medicaid|MEDICAID AMERIGROUP|||||2.25||| A4216|EAP|0250|WATER FOR INJ.,STERILE 10|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|2.25||||2.25||| A4216|EAP|0250|WATER FOR INJ.,STERILE 10|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.25||| A4216|EAP|0250|WATER FOR INJ.,STERILE 10|Blue Cross HMO Specialty|BCBSTX HMO|||||2.25||| A4216|EAP|0250|WATER FOR INJ.,STERILE 10|Blue Cross PPO Specialty|BCBSTX OTHER|2.25||||||| A4216|EAP|0250|WATER FOR INJ.,STERILE 10|Blue Cross PPO Specialty|BCBSTX PPO|||||2.25||| A4216|EAP|0250|WATER FOR INJ.,STERILE 10|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.25||| A4216|EAP|0250|WATER FOR INJ.,STERILE 10|United Healthcare|UNITED HEALTHCARE|||||2.25||| A4216|EAP|0250|WATER FOR INJ.,STERILE 10|Medicare|MEDICARE ACUTE|2.25||||2.25||| A4216|EAP|0250|WATER FOR INJ.,STERILE 10|NON CONTRACTED|COMMERCIAL OTHER 1|||||2.25||| A4216|EAP|0250|WATER FOR INJ.,STERILE 10|Veterans Affairs|VETERANS ADMINISTRATION|||||2.25||| A4216|EAP|0250|WATER FOR INJ.,STERILE 10|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.25||| A4216|EAP|0250|WATER FOR INJ.,STERILE 10|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.25||| A4216|EAP|0250|WATER FOR INJ.,STERILE 10|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.25||| A4216|EAP|0250|WATER FOR INJ.,STERILE 10|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.25||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 10ML|United Healthcare|UNITED HEALTHCARE|||||0.63||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.45||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 10ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.45||||0.63||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 10ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|0.45||||0.63||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|United Medicare Advantage|UHC MEDICARE GOLD MA|0.45||||0.45||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|0.45||||0.45||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.45||||0.45||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 10ML|Veterans Affairs|VETERANS ADMINISTRATION|||||0.63||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|Veterans Affairs|VETERANS ADMINISTRATION|||||0.45||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 10ML|Managed Medicaid|MEDICAID SUPERIOR|||||0.63||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 10ML|Managed Medicaid|MEDICAID AMERIGROUP|||||0.63||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 10ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.45||||0.63||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.45||||0.45||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.45||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|Managed Medicaid|MEDICAID AMERIGROUP|||||0.45||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|Medicare|MEDICARE ACUTE|0.45||||0.45||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 10ML|Medicare|MEDICARE ACUTE|0.45||||0.63||| A4218|EAP|0258|SODIUM CHLORIDE 0.9% 50ML|NON CONTRACTED|COMMERCIAL OTHER 1|||||140.25||| A4218|EAP|0258|SODIUM CHLORIDE 0.9% 50ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||140.25||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 10ML|NON CONTRACTED|COMMERCIAL OTHER 1|0.45||||0.63||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|NON CONTRACTED|COMMERCIAL OTHER 1|0.45||||0.45||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|Medicaid|WOOD COUNTY INDIGENT|||||0.45||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.45||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 10ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||0.63||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|Managed Medicaid|MEDICAID SUPERIOR|||||0.45||| A4218|EAP|0258|SODIUM CHLORIDE 0.9% 50ML|Medicare|MEDICARE ACUTE|140.25||||140.25||| A4218|EAP|0258|SODIUM CHLORIDE 0.9% 50ML|Blue Cross PPO Specialty|BCBSTX PPO|||||140.25||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 10ML|Blue Cross PPO Specialty|BCBSTX PPO|0.63||||0.63||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|Blue Cross PPO Specialty|BCBSTX PPO|0.45||||0.45||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|Blue Cross PPO Specialty|BCBSTX OTHER|0.45||||||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|Aetna|AETNA QHP HMO|||||0.45||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|Aetna|AETNA OTHER|||||0.45||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 10ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.63||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 10ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.63||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|Workers Compensation|WORKERS COMPENSATION OTHER|0.45||||||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.45||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.45||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.45||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|Cigna|CIGNA|0.45||||0.45||| A4218|EAP|0258|SODIUM CHLORIDE 0.9% 50ML|Humana Medicare Advantage|HUMANA MA|||||140.25||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|United Healthcare|UNITED HEALTHCARE|||||0.45||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|United Healthcare|UNITED HEALTHCARE OTHER|||||0.45||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 10ML|Humana Medicare Advantage|HUMANA MA|0.63||||0.63||| A4218|EAP|0258|SODIUM CHLORIDE 0.9% 50ML|Medicaid|MEDICAID|140.25||||||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|Humana Medicare Advantage|HUMANA MA|0.45||||0.45||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.45||| A4218|EAP|0258|SODIUM CHLORIDE 0.9% 50ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||140.25||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 10ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.63||| A4218|EAP|0258|SODIUM CHLORIDE 0.9% 50ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||140.25||| A4218|EAP|0258|SODIUM CHLORIDE 0.9% 50ML|Managed Medicaid|MEDICAID SUPERIOR|||||140.25||| A4218|EAP|0258|SODIUM CHLORIDE 0.9% 50ML|Managed Medicaid|MEDICAID AMERIGROUP|||||140.25||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|Aenta Medicare Advantage|AETNA MEDICARE MA|||||0.45||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 10ML|Blue Cross HMO Specialty|BCBSTX HMO|0.63||||0.45||| A4218|EAP|0636|SODIUM CHLORIDE 0.9% 100M|Blue Cross HMO Specialty|BCBSTX HMO|0.45||||0.45||| A4570|EAP|0270|SPLINT FINGER|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||5.50||| A4615|EAP|0270||Medicaid|MEDICAID TEXAS CHILDRENS|||||4.75||| A4615|EAP|0270||Medicaid|MEDICAID|||||4.75||| A4615|EAP|0270||United Healthcare|UNITED HEALTHCARE OTHER|||||4.75||| A4615|EAP|0270||Managed Medicaid|MEDICAID SUPERIOR|||||4.75||| A4615|EAP|0270||Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||4.75||| A4615|EAP|0270||Managed Medicaid|MEDICAID AMERIGROUP|||||4.75||| A4615|EAP|0270||Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||4.75||| A4616|EAP|0270||United Medicare Advantage|UHC MEDICARE GOLD MA|||||4.75||| A4616|EAP|0270||Humana Medicare Advantage|HUMANA MA|||||4.75||| A6402|EAP|0272||Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||4.75||| A6402|EAP|0272||Workers Compensation|WORKERS COMPENSATION OTHER|||||4.75||| A6449|EAP|0270|BANDAGE ACE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.05||| A6449|EAP|0270|BANDAGE ACE|PHCS|MULTIPLAN PHCS|||||0.05||| A6449|EAP|0270|BANDAGE ACE|Medicare|MEDICARE ACUTE|||||0.05||| A6450|EAP|0270|"BANDAGE ACE 6"" X 5 YDS"|Medicare|MEDICARE ACUTE|||||6.75||| A9502|EAP|0343|NM TC99M TETROFOSMIN|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||3.40||| A9502|EAP|0343|NM TC99M TETROFOSMIN|United Medicare Advantage|UHC MEDICARE GOLD MA|3.40||||3.40||| A9502|EAP|0343|NM TC99M TETROFOSMIN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|421.60||||380.80||| A9502|EAP|0343|NM TC99M TETROFOSMIN|Blue Cross PPO Specialty|BCBSTX PPO|421.60||||3.40||| A9502|EAP|0343|NM TC99M TETROFOSMIN|Blue Cross PPO Specialty|BCBSTX OTHER|3.40||||380.80||| A9502|EAP|0343|NM TC99M TETROFOSMIN|Aetna|AETNA PPO|||||421.60||| A9502|EAP|0343|NM TC99M TETROFOSMIN|Aetna|AETNA OTHER|||||3.40||| A9502|EAP|0343|NM TC99M TETROFOSMIN|Aetna|AETNA QHP HMO|||||421.60||| A9502|EAP|0343|NM TC99M TETROFOSMIN|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||3.40||| A9502|EAP|0343|NM TC99M TETROFOSMIN|Cigna|CIGNA|||||3.40||| A9502|EAP|0343|NM TC99M TETROFOSMIN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3.40||| A9502|EAP|0343|NM TC99M TETROFOSMIN|Humana Medicare Advantage|HUMANA MA|421.60||||3.40||| A9502|EAP|0343|NM TC99M TETROFOSMIN|Cigna|CIGNA|||||421.60||| A9502|EAP|0343|NM TC99M TETROFOSMIN|Aenta Medicare Advantage|AETNA MEDICARE MA|421.60||||421.60||| A9502|EAP|0343|NM TC99M TETROFOSMIN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||3.40||| A9502|EAP|0343|NM TC99M TETROFOSMIN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||421.60||| A9502|EAP|0343|NM TC99M TETROFOSMIN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||3.40||| A9502|EAP|0343|NM TC99M TETROFOSMIN|Access Direct Platinum|HEALTHFIRST TPA UMR|||||3.40||| A9502|EAP|0343|NM TC99M TETROFOSMIN|Medicare|MEDICARE ACUTE|3.40||||3.40||| A9502|EAP|0343|NM TC99M TETROFOSMIN|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||380.80||| A9502|EAP|0343|NM TC99M TETROFOSMIN|NON CONTRACTED|COMMERCIAL OTHER 1|3.40||||3.40||| A9502|EAP|0343|NM TC99M TETROFOSMIN|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||421.60||| A9502|EAP|0343|NM TC99M TETROFOSMIN|Tricare|TRICARE EAST REGION|||||421.60||| A9502|EAP|0343|NM TC99M TETROFOSMIN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||3.40||| A9502|EAP|0343|NM TC99M TETROFOSMIN|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|3.40||||3.40||| A9502|EAP|0343|NM TC99M TETROFOSMIN|Managed Medicaid|MEDICAID AMERIGROUP|||||3.40||| A9502|EAP|0343|NM TC99M TETROFOSMIN|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||3.40||| A9502|EAP|0343|NM TC99M TETROFOSMIN|United Healthcare|UNITED HEALTHCARE|||||421.60||| A9502|EAP|0343|NM TC99M TETROFOSMIN|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||421.60||| A9502|EAP|0343|NM TC99M TETROFOSMIN|United Healthcare|UNITED HEALTHCARE OTHER|||||380.80||| A9502|EAP|0343|NM TC99M TETROFOSMIN|United Healthcare|UNITED HEALTHCARE|380.80||||421.60||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|NON CONTRACTED|COMMERCIAL OTHER 1|9.24||||9.24||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||9.87||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|Tricare|TRICARE EAST REGION|||||9.24||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|Tricare|TRICARE EAST REGION|||||9.87||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|United Healthcare|UNITED HEALTHCARE|9.24||||9.24||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|Medicare|MEDICARE ACUTE|9.24||||9.24||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|Medicare|MEDICARE ACUTE|9.24||||9.87||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|Blue Cross PPO Specialty|BCBSTX PPO|||||9.24||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|Cigna|CIGNA|||||9.24||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||9.24||| A9576|EAP|0255|PROHANCE 10 ML NDC 0270-0|Humana Medicare Advantage|HUMANA MA|||||9.24||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|Humana Medicare Advantage|HUMANA MA|||||9.24||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||9.24||| A9576|EAP|0255|PROHANCE 10 ML NDC 0270-0|Medicare|MEDICARE ACUTE|9.87||||9.24||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|Managed Medicaid|MEDICAID AMERIGROUP|||||9.87||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||9.24||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|Managed Medicaid|MEDICAID AMERIGROUP|||||9.24||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||9.24||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||9.87||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||9.87||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|NON CONTRACTED|COMMERCIAL OTHER 1|9.87||||9.87||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||9.87||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|Humana Medicare Advantage|HUMANA MA|||||9.87||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|United Medicare Advantage|UHC MEDICARE GOLD MA|||||9.87||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||9.87||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|United Medicare Advantage|UHC MEDICARE GOLD MA|||||9.24||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|9.24||||9.24||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||9.24||| A9576|EAP|0255|PROHANCE 20 ML NDC 0270-1|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||9.24||| A9576|EAP|0255|PROHANCE 15ML VL/ML NDC 0|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||9.87||| C1713|EAP|0278|IMPLANTABLE ANCHOR OR SCR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|55,577.95||||479.69||| C1713|EAP|0278|IMPLANTABLE ANCHOR OR SCR|United Medicare Advantage|UHC MEDICARE GOLD MA|66,582.95||||||| C1713|EAP|0278|IMPLANTABLE ANCHOR OR SCR|Medicare|MEDICARE ACUTE|||||15.00||| C1713|EAP|0278|IMPLANTABLE ANCHOR OR SCR|United Healthcare|UNITED HEALTHCARE|||||13.75||| C1713|EAP|0278|IMPLANTABLE ANCHOR OR SCR|NON CONTRACTED|COMMERCIAL OTHER 1|||||1,527.50||| C1713|EAP|0278|IMPLANTABLE ANCHOR OR SCR|Workers Compensation|WORKERS COMPENSATION OTHER|||||0.78||| C1781|EAP|0278|MESH (IMPLANTABLE)|Blue Cross PPO Specialty|BCBSTX PPO|||||981.17||| C1781|EAP|0278|MESH PERFIX PLUG|Blue Cross PPO Specialty|BCBSTX PPO|||||6.53||| C1781|EAP|0278|MESH PERFIX PLUG|Humana Medicare Advantage|HUMANA MA|||||6.53||| C1781|EAP|0278|MESH (IMPLANTABLE)|Managed Medicaid|MEDICAID SUPERIOR|||||1,062.33||| C1781|EAP|0278|MESH PERFIX PLUG|NON CONTRACTED|WOOD COUNTY HOSPITAL DISTRICT|||||6.53||| C1781|EAP|0278|MESH PERFIX PLUG|Medicare|MEDICARE ACUTE|||||6.53||| C1781|EAP|0278|MESH (IMPLANTABLE)|Medicare|MEDICARE ACUTE|||||8.63||| C1788|EAP|0278|IMPLANT PORT (BARD)|Managed Medicaid|MEDICAID UNITED HEALTHCARE|9.90||||||| C1788|EAP|0278|IMPLANT PORT (BARD)|United Medicare Advantage|UHC MEDICARE GOLD MA|9.90||||9.90||| C1788|EAP|0278|IMPLANT PORT (BARD)|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||9.90||| C1889|EAP|0278|LATERA ABSORBABLE NASAL I|Tricare|TRICARE EAST REGION|||||53.25||| C1889|EAP|0278|LATERA ABSORBABLE NASAL I|United Healthcare|UNITED HEALTHCARE|||||53.25||| C1889|EAP|0278|LATERA ABSORBABLE NASAL I|Medicare|MEDICARE ACUTE|||||53.25||| C1889|EAP|0278|LATERA ABSORBABLE NASAL I|Humana Medicare Advantage|HUMANA MA|||||53.25||| C1889|EAP|0278|LATERA ABSORBABLE NASAL I|Managed Medicaid|MEDICAID SUPERIOR|||||53.25||| C1889|EAP|0278|LATERA ABSORBABLE NASAL I|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||53.25||| C5025|EAP|0305||Medicare|MEDICARE ACUTE|||||0.75||| C8929|EAP|0483|US ECHOCARDIO 2DM DOPLR M|Humana Medicare Advantage|HUMANA MA|||||3,432.32||| C8929|EAP|0483|US ECHOCARDIO 2DM DOPLR M|Medicare|MEDICARE ACUTE|||||16.81||| C9359|EAP|0278|BONE FILLER VOID 10CC 20C|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4,252.50||||||| C9359|EAP|0278|BONE FILLER VOID 10CC 20C|United Medicare Advantage|UHC MEDICARE GOLD MA|4,252.50||||||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|Medicare|MEDICARE ACUTE|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|NON CONTRACTED|COMMERCIAL OTHER 1|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|Medicaid|MEDICAID|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|Tricare|TRICARE EAST REGION|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|Managed Medicare|HEALTHSPRING MA|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|Managed Medicare|BCBS MEDICARE PPO MA|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|United Healthcare|UNITED HEALTHCARE ERS|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|United Healthcare|UNITED HEALTHCARE|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|United Healthcare|TML GROUP BENEFITS|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|United Healthcare|UNITED HEALTHCARE OTHER|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|Blue Cross PPO Specialty|BCBSTX PPO|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|Blue Cross PPO Specialty|BCBSTX OTHER|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|United Healthcare|ZZZZZ UNITED HEALTHCARE|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|Medicaid|WOOD COUNTY INDIGENT|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|Humana Medicare Advantage|HUMANA MA|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|Blue Cross HMO Specialty|BCBSTX HMO|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|Cigna|CIGNA|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|Managed Medicaid|MEDICAID SUPERIOR|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|Aetna|AETNA PPO|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||177.25||| G0103|EAP|0301|PROSTATE-SPECIFIC ANTIGEN|Access Direct Platinum|HEALTHFIRST TPA UMR|||||177.25||| G0104|EAP|0750|COLORECTAL CANCER SCREENI|Humana Medicare Advantage|HUMANA MA|||||2,115.33||| G0104|EAP|0750|COLORECTAL CANCER SCREENI|Medicare|MEDICARE ACUTE|||||2,115.33||| G0105|EAP|0750|COLONOSCOPY SCREENING|United Healthcare|TML GROUP BENEFITS|||||20.72||| G0105|EAP|0750|COLONOSCOPY SCREENING|United Healthcare|UNITED HEALTHCARE|||||2,192.58||| G0105|EAP|0750|COLONOSCOPY SCREENING|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2,192.58||| G0105|EAP|0750|COLONOSCOPY SCREENING|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||20.72||| G0105|EAP|0750|COLONOSCOPY SCREENING|Managed Medicare|BCBS MEDICARE PPO MA|||||20.72||| G0105|EAP|0750|COLONOSCOPY SCREENING|Managed Medicaid|MEDICAID SUPERIOR|||||20.72||| G0105|EAP|0750|COLONOSCOPY SCREENING|Medicare|MEDICARE ACUTE|||||20.72||| G0105|EAP|0750|COLONOSCOPY SCREENING|Tricare|TRICARE EAST REGION|||||20.72||| G0105|EAP|0750|COLONOSCOPY SCREENING|Blue Cross PPO Specialty|BCBSTX PPO|||||2,192.58||| G0105|EAP|0750|COLONOSCOPY SCREENING|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||2,192.58||| G0105|EAP|0750|COLONOSCOPY SCREENING|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||20.72||| G0105|EAP|0750|COLONOSCOPY SCREENING|Humana Medicare Advantage|HUMANA MA|||||20.72||| G0105|EAP|0750|COLONOSCOPY SCREENING|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||20.72||| G0105|EAP|0750|COLONOSCOPY SCREENING|Blue Cross HMO Specialty|BCBSTX HMO|||||2,132.29||| G0121|EAP|0750|COLONOSCOPY SCREENING|Blue Cross PPO Specialty|BCBSTX PPO|||||2,115.33||| G0121|EAP|0750|COLONOSCOPY SCREENING|Aetna|AETNA PPO|||||19.99||| G0121|EAP|0750|COLONOSCOPY SCREENING|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||19.99||| G0121|EAP|0750|COLONOSCOPY SCREENING|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||19.99||| G0121|EAP|0750|COLONOSCOPY SCREENING|Humana Medicare Advantage|HUMANA MA|||||19.99||| G0121|EAP|0750|COLONOSCOPY SCREENING|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2,115.33||| G0121|EAP|0750|COLONOSCOPY SCREENING|Blue Cross HMO Specialty|BCBSTX HMO|||||2,057.17||| G0121|EAP|0750|COLONOSCOPY SCREENING|Cigna|CIGNA|||||2,115.33||| G0121|EAP|0750|COLONOSCOPY SCREENING|Managed Medicare|BCBS MEDICARE PPO MA|||||19.99||| G0121|EAP|0750|COLONOSCOPY SCREENING|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2,115.33||| G0121|EAP|0750|COLONOSCOPY SCREENING|Medicare|MEDICARE ACUTE|||||2,115.33||| G0121|EAP|0750|COLONOSCOPY SCREENING|NON CONTRACTED|COMMERCIAL OTHER 1|||||19.99||| G0121|EAP|0750|COLONOSCOPY SCREENING|Tricare|TRICARE EAST REGION|||||2,057.17||| G0121|EAP|0750|COLONOSCOPY SCREENING|United Healthcare|UNITED HEALTHCARE ERS|||||2,057.17||| G0121|EAP|0750|COLONOSCOPY SCREENING|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2,057.17||| G0121|EAP|0750|COLONOSCOPY SCREENING|United Healthcare|UNITED HEALTHCARE|||||2,057.17||| G0121|EAP|0750|COLONOSCOPY SCREENING|United Healthcare|UNITED HEALTHCARE|||||2,115.33||| G0121|EAP|0750|COLONOSCOPY SCREENING|United Healthcare|TML GROUP BENEFITS|||||2,115.33||| G0121|EAP|0750|COLONOSCOPY SCREENING|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||19.99||| G0121|EAP|0750|COLONOSCOPY SCREENING|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2,115.33||| G0121|EAP|0750|COLONOSCOPY SCREENING|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2,115.33||| G0237|EAP|0410|THERAPEUTIC PROCEDURE EXE|United Medicare Advantage|UHC MEDICARE GOLD MA|||||76.57||| G0237|EAP|0410|THERAPEUTIC PROCEDURE EXE|Medicare|MEDICARE ACUTE|||||61.75||| G0237|EAP|0410|THERAPEUTIC PROCEDURE EXE|NON CONTRACTED|COMMERCIAL OTHER 1|||||61.75||| G0237|EAP|0410|THERAPEUTIC PROCEDURE EXE|Blue Cross PPO Specialty|BCBSTX PPO|||||76.57||| G0237|EAP|0410|THERAPEUTIC PROCEDURE EXE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||76.57||| G0237|EAP|0410|THERAPEUTIC PROCEDURE EXE|Humana Medicare Advantage|HUMANA MA|||||61.75||| G0238|EAP|0410|THERAPEUTIC PROCEDURE EDU|Blue Cross PPO Specialty|BCBSTX PPO|||||76.57||| G0238|EAP|0410|THERAPEUTIC PROCEDURE EDU|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||76.57||| G0238|EAP|0410|THERAPEUTIC PROCEDURE EDU|Humana Medicare Advantage|HUMANA MA|||||61.75||| G0238|EAP|0410|THERAPEUTIC PROCEDURE EDU|Medicare|MEDICARE ACUTE|||||61.75||| G0238|EAP|0410|THERAPEUTIC PROCEDURE EDU|NON CONTRACTED|COMMERCIAL OTHER 1|||||61.75||| G0238|EAP|0410|THERAPEUTIC PROCEDURE EDU|United Medicare Advantage|UHC MEDICARE GOLD MA|||||76.57||| G0239|EAP|0410|THERAPEUTIC PROCEDURE GRO|United Medicare Advantage|UHC MEDICARE GOLD MA|||||103.23||| G0239|EAP|0410|THERAPEUTIC PROCEDURE GRO|Medicare|MEDICARE ACUTE|||||83.25||| G0239|EAP|0410|THERAPEUTIC PROCEDURE GRO|Blue Cross PPO Specialty|BCBSTX PPO|||||103.23||| G0239|EAP|0410|THERAPEUTIC PROCEDURE GRO|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||103.23||| G0297|EAP|0350|CT SCREENING LUNG|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.86||| G0297|EAP|0350|CT SCREENING LUNG|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.86||| G0297|EAP|0350|CT SCREENING LUNG|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.86||| G0297|EAP|0350|CT SCREENING LUNG|Blue Cross PPO Specialty|BCBSTX PPO|||||1.86||| G0297|EAP|0350|CT SCREENING LUNG|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.86||| G0297|EAP|0350|CT SCREENING LUNG|Humana Medicare Advantage|HUMANA MA|||||1.50||| G0297|EAP|0350|CT SCREENING LUNG|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.86||| G0297|EAP|0350|CT SCREENING LUNG|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.50||| G0297|EAP|0350|CT SCREENING LUNG|Medicare|MEDICARE ACUTE|||||1.50||| G0297|EAP|0350|CT SCREENING LUNG|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.50||| G0297|EAP|0350|CT SCREENING LUNG|Tricare|TRICARE FOR LIFE|||||1.86||| G0297|EAP|0350|CT SCREENING LUNG|United Healthcare|UNITED HEALTHCARE OTHER|||||1.86||| G0297|EAP|0350|CT SCREENING LUNG|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1.50||| G0297|EAP|0350|CT SCREENING LUNG|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.50||| G0297|EAP|0350|CT SCREENING LUNG|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.86||| G0297|EAP|0350|CT SCREENING LUNG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.86||| G0378|EAP|0762|OBSERVATION SERVICES PER|United Healthcare|UNITED HEALTHCARE OTHER|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|1.25||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Managed Medicare|HEALTHSPRING MA|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Managed Medicaid|MEDICAID AMERIGROUP|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.25||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Medicare|MEDICARE ACUTE|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Medicare|MEDICARE PART B ONLY IP|1.25||||||| G0378|EAP|0762|OBSERVATION SERVICES PER|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Medicaid|MEDICAID|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Blue Cross PPO Specialty|BCBSTX PPO|1.25||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Aetna|AETNA OTHER|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Cigna|CIGNA|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Humana Medicare Advantage|HUMANA MA|||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.25||||1.25||| G0378|EAP|0762|OBSERVATION SERVICES PER|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.25||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||2.00||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT,|United Healthcare|UNITED HEALTHCARE|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|United Healthcare|UNITED HEALTHCARE|||||2.00||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Blue Cross PPO Specialty|BCBSTX PPO|||||2.00||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Blue Cross PPO Specialty|BCBSTX PPO|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT,|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Aetna|AETNA OTHER|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT,|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT,|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.75||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.00||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT,|Humana Medicare Advantage|HUMANA MA|||||2.00||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT,|Humana Medicare Advantage|HUMANA MA|||||1.75||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Humana Medicare Advantage|HUMANA MA|||||2.00||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT,|Blue Cross HMO Specialty|BCBSTX HMO|||||1.75||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Blue Cross HMO Specialty|BCBSTX HMO|||||2.00||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Blue Cross HMO Specialty|BCBSTX HMO|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.00||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT,|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.75||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Managed Medicare|OTHER INSTITUTIONS|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||2.00||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Managed Medicaid|MEDICAID AMERIGROUP|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Managed Medicare|HEALTHSPRING MA|||||2.00||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Managed Medicare|OTHER INSTITUTIONS|||||2.00||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Medicare|MEDICARE ACUTE|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT,|Medicare|MEDICARE ACUTE|||||2.00||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT,|Medicare|MEDICARE ACUTE|||||1.75||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Medicare|MEDICARE ACUTE|||||2.00||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT,|Medicare|MEDICARE ACUTE|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Humana Medicare Advantage|HUMANA MA|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Tricare|TRICARE EAST REGION|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT,|Medicaid|MEDICAID HMO|||||1.75||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT,|Medicaid|MEDICAID|||||1.75||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2.00||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Medicaid|MEDICAID HMO|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|Medicaid|MEDICAID|||||2.00||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT,|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1.75||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT,|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.75||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT,|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.00||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT,|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.75||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|United Medicare Advantage|UHC MEDICARE GOLD MA|||||2.00||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT,|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.00||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.00||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.00||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.50||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT,|United Healthcare|UNITED HEALTHCARE|||||1.75||| G0463|EAP|0510|OFFICE/OUTPATIENT VISIT N|United Healthcare|UNITED HEALTHCARE|||||1.50||| J0131|EAP|0250|ACETAMINOPHEN INJ 100ML B|Veterans Affairs|VETERANS ADMINISTRATION|||||68.75||| J0131|EAP|0250|ACETAMINOPHEN INJ 100ML B|United Medicare Advantage|UHC MEDICARE GOLD MA|||||68.75||| J0131|EAP|0250|ACETAMINOPHEN INJ 100ML B|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||68.75||| J0131|EAP|0250|ACETAMINOPHEN INJ 100ML B|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||68.75||| J0131|EAP|0250|ACETAMINOPHEN INJ 100ML B|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||68.75||| J0131|EAP|0250|ACETAMINOPHEN INJ 100ML B|Medicaid|WOOD COUNTY INDIGENT|||||68.75||| J0131|EAP|0250|ACETAMINOPHEN INJ 100ML B|Medicaid|MEDICAID|||||68.75||| J0131|EAP|0250|ACETAMINOPHEN INJ 100ML B|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||68.75||| J0131|EAP|0250|ACETAMINOPHEN INJ 100ML B|NON CONTRACTED|COMMERCIAL OTHER 1|||||68.75||| J0131|EAP|0250|ACETAMINOPHEN INJ 100ML B|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||68.75||| J0131|EAP|0250|ACETAMINOPHEN INJ 100ML B|United Healthcare|UNITED HEALTHCARE OTHER|||||68.75||| J0131|EAP|0250|ACETAMINOPHEN INJ 100ML B|United Healthcare|UNITED HEALTHCARE|||||68.75||| J0131|EAP|0250|ACETAMINOPHEN INJ 100ML B|Medicare|MEDICARE ACUTE|||||68.75||| J0131|EAP|0250|ACETAMINOPHEN INJ 100ML B|Cigna|CIGNA|||||68.75||| J0131|EAP|0250|ACETAMINOPHEN INJ 100ML B|Humana Medicare Advantage|HUMANA MA|||||68.75||| J0131|EAP|0250|ACETAMINOPHEN INJ 100ML B|Aenta Medicare Advantage|AETNA MEDICARE MA|||||68.75||| J0131|EAP|0250|ACETAMINOPHEN INJ 100ML B|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||68.75||| J0131|EAP|0250|ACETAMINOPHEN INJ 100ML B|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||68.75||| J0131|EAP|0250|ACETAMINOPHEN INJ 100ML B|Managed Medicaid|MEDICAID AMERIGROUP|||||68.75||| J0131|EAP|0250|ACETAMINOPHEN INJ 100ML B|Managed Medicaid|MEDICAID SUPERIOR|||||68.75||| J0131|EAP|0250|ACETAMINOPHEN INJ 100ML B|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||68.75||| J0132|EAP|0636|ACETYLCYSTEINE 20%, 30ML|Blue Cross PPO Specialty|BCBSTX PPO|||||1,315.20||| J0132|EAP|0636|ACETYLCYSTEINE 20%, 30ML|Humana Medicare Advantage|HUMANA MA|1,315.20||||||| J0132|EAP|0636|ACETYLCYSTEINE 20%, 30ML|Medicare|MEDICARE ACUTE|1,315.20||||1,315.20||| J0132|EAP|0636|ACETYLCYSTEINE 20%, 30ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1,315.20||| J0153|EAP|0636|ADENOSINE 3MG/ML, 2ML VIA|United Medicare Advantage|UHC MEDICARE GOLD MA|||||120.50||| J0153|EAP|0636|ADENOSINE 3MG/ML, 2ML VIA|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||120.50||| J0153|EAP|0636|ADENOSINE 3MG/ML, 2ML VIA|Veterans Affairs|VETERANS ADMINISTRATION|||||120.50||| J0153|EAP|0636|ADENOSINE 3MG/ML, 2ML VIA|Medicare|MEDICARE ACUTE|||||120.50||| J0153|EAP|0636|ADENOSINE 3MG/ML, 2ML VIA|Blue Cross PPO Specialty|BCBSTX PPO|||||120.50||| J0153|EAP|0636|ADENOSINE 3MG/ML, 2ML VIA|Blue Cross PPO Specialty|BCBSTX OTHER|||||120.50||| J0153|EAP|0636|ADENOSINE 3MG/ML, 2ML VIA|Humana Medicare Advantage|HUMANA MA|||||120.50||| J0561|EAP|0636|PENICILLIN G BENZ 600000|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||50.29||| J0561|EAP|0636|PENICILLIN G BENZ 600000|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||50.29||| J0561|EAP|0636|PENICILLIN G BENZ 600000|Managed Medicaid|MEDICAID AMERIGROUP|||||50.29||| J0561|EAP|0636|PENICILLIN G BENZ 600000|Medicare|MEDICARE ACUTE|||||50.29||| J0561|EAP|0636|PENICILLIN G BENZATHINE 1|Medicare|MEDICARE ACUTE|||||42.79||| J0561|EAP|0636|PENICILLIN G BENZATHINE 1|Medicaid|MEDICAID|||||42.79||| J0561|EAP|0636|PENICILLIN G BENZATHINE 1|Veterans Affairs|VETERANS ADMINISTRATION|||||42.79||| J0690|EAP|0636||Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||72.25||| J0690|EAP|0636||Medicare|MEDICARE ACUTE|||||72.25||| J0690|EAP|0250||Medicare|MEDICARE ACUTE|||||72.25||| J0840|EAP|0636|ANTIVENIN,CROTALIDAE 1 VI|Blue Cross PPO Specialty|BCBSTX PPO|||||12,912.75||| J0885|EAP|0636|EPOETIN 20000 UNIT/1ML|Medicare|MEDICARE ACUTE|||||133.90||| J0897|EAP|0636|DENOSUMAB 60 MG/ML SYRING|Medicare|MEDICARE ACUTE|||||73.35||| J1160|EAP|0636|DIGOXIN 250MCG 1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||38.28||| J1160|EAP|0636|DIGOXIN 250MCG 1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|38.28||||38.28||| J1160|EAP|0636|DIGOXIN 250MCG 1ML|Aetna|AETNA PPO|38.28||||||| J1160|EAP|0636|DIGOXIN 250MCG 1ML|Humana Medicare Advantage|HUMANA MA|38.28||||38.28||| J1160|EAP|0636|DIGOXIN 250MCG 1ML|Aenta Medicare Advantage|AETNA MEDICARE MA|38.28||||||| J1160|EAP|0636|DIGOXIN 250MCG 1ML|Managed Medicare|HEALTHSPRING MA|38.28||||||| J1160|EAP|0636|DIGOXIN 250MCG 1ML|Medicare|MEDICARE ACUTE|38.28||||38.28||| J1301|EAP|0636|EDARAVONE 30 MG/100 ML BA|Medicare|MEDICARE ACUTE|||||71.67||| J1439|EAP|0636|FERRIC CARBOXYMALTOSE 750|Medicare|MEDICARE ACUTE|||||5.28||| J1568|EAP|0636|OCTAGAM (5%) 10 GM/200 ML|Medicare|MEDICARE ACUTE|||||301.70||| J1568|EAP|0636|OCTAGAM (5%) 5 GM/100 ML|Medicare|MEDICARE ACUTE|||||340.20||| J1610|EAP|0250|GLUCAGON 1MG VIAL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||891.50||| J1610|EAP|0250|GLUCAGON 1MG VIAL|Cigna|CIGNA|||||891.50||| J1610|EAP|0250|GLUCAGON 1MG VIAL|Humana Medicare Advantage|HUMANA MA|||||891.50||| J1610|EAP|0250|GLUCAGON 1MG VIAL|United Healthcare|UNITED HEALTHCARE OTHER|||||891.50||| J1610|EAP|0250|GLUCAGON 1MG VIAL|United Healthcare|GEHA|||||891.50||| J1610|EAP|0250|GLUCAGON 1MG VIAL|Medicare|MEDICARE ACUTE|||||891.50||| J1670|EAP|0250|TETANUS IMMUNE GLOB 250 U|Humana Medicare Advantage|HUMANA MA|||||1,167.50||| J1670|EAP|0250|TETANUS IMMUNE GLOB 250 U|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1,167.50||| J1745|EAP|0636|INFLIXIMAB 100MG VIAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||508.65||| J1745|EAP|0636|INFLIXIMAB 100MG VIAL|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||508.65||| J1756|EAP|0636|IRON SUCROSE COMPL. 100/M|United Medicare Advantage|UHC MEDICARE GOLD MA|427.50||||||| J1756|EAP|0636|IRON SUCROSE COMPL. 100/M|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|427.50||||||| J1756|EAP|0636|IRON SUCROSE COMPL. 100/M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||427.50||| J1756|EAP|0636|IRON SUCROSE COMPL. 100/M|Medicare|MEDICARE ACUTE|427.50||||427.50||| J1756|EAP|0636|IRON SUCROSE COMPL. 100/M|NON CONTRACTED|COMMERCIAL OTHER 1|427.50||||||| J1756|EAP|0636|IRON SUCROSE COMPL. 100/M|Humana Medicare Advantage|HUMANA MA|427.50||||427.50||| J1756|EAP|0636|IRON SUCROSE COMPL. 100/M|Aenta Medicare Advantage|AETNA MEDICARE MA|427.50||||||| J1756|EAP|0636|IRON SUCROSE COMPL. 100/M|Blue Cross HMO Specialty|BCBSTX HMO|427.50||||||| J1953|EAP|0636|LEVETIRACETAM 1000MG IN 1|Aetna|AETNA OTHER|||||394.50||| J1953|EAP|0636|LEVETIRACETAM 1000MG IN 1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||394.50||| J1953|EAP|0636|LEVETIRACETAM 1000MG IN 1|Medicare|MEDICARE ACUTE|197.25||||394.50||| J1953|EAP|0636|LEVETIRACETAM 500MG IN 10|Medicaid|MEDICAID|197.25||||||| J1953|EAP|0636|LEVETIRACETAM 1000MG IN 1|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||394.50||| J1953|EAP|0636|LEVETIRACETAM 1000MG IN 1|Veterans Affairs|VETERANS ADMINISTRATION|||||394.50||| J1953|EAP|0636|LEVETIRACETAM 1000MG IN 1|Workers Compensation|WORKERS COMPENSATION OTHER|||||394.50||| J2020|EAP|0636|LINEZOLID 600MG/300ML D5W|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|4.80||||||| J2020|EAP|0636|LINEZOLID 600MG/300ML D5W|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|4.80||||||| J2020|EAP|0636|LINEZOLID 600MG/300ML D5W|Medicare|MEDICARE PART B ONLY IP|4.80||||||| J2020|EAP|0636|LINEZOLID 600MG/300ML D5W|Medicare|MEDICARE ACUTE|4.80||||4.80||| J2020|EAP|0636|LINEZOLID 600MG/300ML D5W|Blue Cross PPO Specialty|BCBSTX PPO|4.80||||||| J2020|EAP|0636|LINEZOLID 600MG/300ML D5W|Aetna|AETNA OTHER|4.80||||||| J2020|EAP|0636|LINEZOLID 600MG/300ML D5W|Humana Medicare Advantage|HUMANA MA|4.80||||||| J2020|EAP|0636|LINEZOLID 600MG/300ML D5W|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|4.80||||||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Blue Cross PPO Specialty|BCBSTX OTHER|||||0.16||| J2270|EAP|0636|MORPHINE 10MG/1ML|Blue Cross PPO Specialty|BCBSTX PPO|17.50||||17.50||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Blue Cross PPO Specialty|BCBSTX PPO|0.16||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Aetna|AETNA OTHER|||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Aetna|AETNA OTHER|||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Aetna|AETNA PPO|0.16||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|17.50||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.16||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|0.16||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|0.16||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|0.16||||0.16||| J2270|EAP|0636|MORPHINE 8MG/1ML SYRINGE|Cigna|CIGNA|0.16||||44.25||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Cigna|CIGNA|0.16||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Cigna|CIGNA|0.16||||0.16||| J2270|EAP|0636|MORPHINE 8MG/1ML SYRINGE|Humana Medicare Advantage|HUMANA MA|0.16||||44.25||| J2270|EAP|0636|MORPHINE 10MG/1ML|Humana Medicare Advantage|HUMANA MA|0.16||||17.50||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Humana Medicare Advantage|HUMANA MA|0.16||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.16||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.16||||0.16||| J2270|EAP|0636|MORPHINE 10MG/1ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.16||||17.50||| J2270|EAP|0636|MORPHINE 8MG/1ML SYRINGE|Aenta Medicare Advantage|AETNA MEDICARE MA|0.16||||44.25||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Aenta Medicare Advantage|AETNA MEDICARE MA|0.16||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Blue Cross HMO Specialty|BCBSTX HMO|0.16||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Blue Cross HMO Specialty|BCBSTX HMO|0.16||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.16||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Managed Medicare|HEALTHSPRING MA|||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.16||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Managed Medicare|BCBS MEDICARE PPO MA|||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|0.16||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Managed Medicaid|MEDICAID SUPERIOR|0.16||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicare|HEALTHSPRING MA|||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.16||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicare|OTHER INSTITUTIONS|0.16||||||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Managed Medicaid|MEDICAID AMERIGROUP|0.16||||0.16||| J2270|EAP|0636|MORPHINE 10MG/1ML|Managed Medicaid|MEDICAID AMERIGROUP|0.16||||17.50||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicaid|MEDICAID SUPERIOR|0.16||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.16||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicaid|MEDICAID AMERIGROUP|0.16||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicare|BCBS MEDICARE PPO MA|||||0.16||| J2270|EAP|0636|MORPHINE 10MG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.16||||17.50||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.16||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Medicare|MEDICARE ACUTE|0.16||||0.16||| J2270|EAP|0636|MORPHINE 10MG/1ML|Medicare|MEDICARE ACUTE|17.50||||17.50||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Medicare|MEDICARE PART B ONLY IP|0.16||||||| J2270|EAP|0636|MORPHINE 8MG/1ML SYRINGE|Medicare|MEDICARE ACUTE|44.25||||44.25||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Medicare|MEDICARE ACUTE|0.16||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Multiplan|NALC|||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Managed Medicare|OTHER INSTITUTIONS|0.16||||||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Aenta Medicare Advantage|AETNA MEDICARE MA|0.16||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|NON CONTRACTED|COMMERCIAL OTHER 1|0.16||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|NON CONTRACTED|WOOD COUNTY HOSPITAL DISTRICT|||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|NON CONTRACTED|COMMERCIAL OTHER 1|0.16||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Tricare|TRICARE FOR LIFE|||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Humana Medicare Advantage|HUMANA MA|0.16||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Tricare|TRICARE EAST REGION|0.16||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Tricare|TRICARE EAST REGION|0.16||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Medicaid|MEDICAID HMO|||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Medicaid|MEDICAID|||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Medicaid|WOOD COUNTY INDIGENT|||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.16||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Medicaid|MEDICAID TEXAS CHILDRENS|||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Medicaid|MEDICAID|||||0.16||| J2270|EAP|0636|MORPHINE 10MG/1ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|0.16||||17.50||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|United Healthcare|UMR UNITED MEDICAL RESOURCES|0.16||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|0.16||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Aetna|AETNA QHP HMO|||||0.16||| J2270|EAP|0636|MORPHINE 8MG/1ML SYRINGE|United Healthcare|UNITED HEALTHCARE OTHER|||||44.25||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|United Healthcare|UNITED HEALTHCARE OTHER|||||0.16||| J2270|EAP|0636|MORPHINE 8MG/1ML SYRINGE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.16||||44.25||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|0.16||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|United Medicare Advantage|UHC MEDICARE GOLD MA|0.16||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.16||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|United Healthcare|UMR UNITED MEDICAL RESOURCES|0.16||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Blue Cross PPO Specialty|BCBSTX PPO|0.16||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.16||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|0.16||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.16||||0.16||| J2270|EAP|0636|MORPHINE 10MG/1ML|United Medicare Advantage|UHC MEDICARE GOLD MA|0.16||||17.50||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|United Healthcare|UNITED HEALTHCARE|||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|United Healthcare|UNITED HEALTHCARE|||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|United Healthcare|UNITED HEALTHCARE OTHER|||||0.16||| J2270|EAP|0636|MORPHINE 2MG/ML SYRINGE|Veterans Affairs|VETERANS ADMINISTRATION|0.16||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Veterans Affairs|VETERANS ADMINISTRATION|0.16||||0.16||| J2270|EAP|0636|MORPHINE 4MG/ML CARPUJECT|Workers Compensation|WORKERS COMPENSATION OTHER|0.16||||0.16||| J2354|EAP|0636|OCTREOTIDE 100MCG/1ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||166.50||| J2354|EAP|0636|OCTREOTIDE 100MCG/1ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||166.50||| J2354|EAP|0636|OCTREOTIDE 100MCG/1ML|Medicare|MEDICARE ACUTE|||||166.50||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Blue Cross PPO Specialty|BCBSTX OTHER|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Aetna|AETNA QHP HMO|||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Aetna|AETNA OTHER|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Aetna|AETNA PPO|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Cigna|CIGNA|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Humana Medicare Advantage|HUMANA MA|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Aenta Medicare Advantage|AETNA MEDICARE MA|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Blue Cross HMO Specialty|BCBSTX HMO|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Managed Medicare|HEALTHSPRING MA|||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Managed Medicare|BCBS MEDICARE PPO MA|||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Managed Medicaid|MEDICAID SUPERIOR|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Managed Medicaid|MEDICAID AMERIGROUP|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Medicare|MEDICARE PART B ONLY IP|16.80||||||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Medicare|MEDICARE ACUTE|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|NON CONTRACTED|WOOD COUNTY HOSPITAL DISTRICT|||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|NON CONTRACTED|COMMERCIAL OTHER 1|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Tricare|TRICARE FOR LIFE|||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Tricare|TRICARE EAST REGION|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Access Direct Platinum|HEALTHFIRST TPA UMR|||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Medicaid|WOOD COUNTY INDIGENT|||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Medicaid|MEDICAID|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|United Medicare Advantage|UHC MEDICARE GOLD MA|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Blue Cross PPO Specialty|BCBSTX PPO|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|United Healthcare|UNITED HEALTHCARE ERS|||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|United Healthcare|UNITED HEALTHCARE|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|United Healthcare|UNITED HEALTHCARE OTHER|||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|United Healthcare|UNITED HEALTHCARE|||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|United Healthcare|TML GROUP BENEFITS|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Veterans Affairs|VETERANS ADMINISTRATION|16.80||||16.80||| J2405|EAP|0636|ONDANSETRON 4MG/2ML|Workers Compensation|WORKERS COMPENSATION OTHER|16.80||||16.80||| J2704|EAP|0636|PROPOFOL 200MG/20ML|United Medicare Advantage|UHC MEDICARE GOLD MA|66.75||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|66.75||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|66.75||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|United Healthcare|UNITED HEALTHCARE OTHER|||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|United Healthcare|UNITED HEALTHCARE ERS|||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|66.75||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|United Healthcare|TML GROUP BENEFITS|||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Veterans Affairs|VETERANS ADMINISTRATION|||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Managed Medicare|OTHER INSTITUTIONS|||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Managed Medicare|HEALTHSPRING MA|||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Managed Medicare|BCBS MEDICARE PPO MA|||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|66.75||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Managed Medicaid|MEDICAID AMERIGROUP|66.75||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Medicare|MEDICARE ACUTE|66.75||||66.75||| J2704|EAP|0636|PROPOFOL 1000MG/100ML|Medicare|MEDICARE ACUTE|1.27||||1.27||| J2704|EAP|0636|PROPOFOL 200MG/20ML|NON CONTRACTED|WOOD COUNTY HOSPITAL DISTRICT|||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|NON CONTRACTED|COMMERCIAL OTHER 1|66.75||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Tricare|TRICARE FOR LIFE|||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Managed Medicaid|MEDICAID SUPERIOR|66.75||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Tricare|TRICARE EAST REGION|||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Medicaid|WOOD COUNTY INDIGENT|||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Medicaid|MEDICAID|||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Blue Cross PPO Specialty|BCBSTX PPO|66.75||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Blue Cross PPO Specialty|BCBSTX OTHER|||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|United Healthcare|UNITED HEALTHCARE|||||66.75||| J2704|EAP|0636|PROPOFOL 1000MG/100ML|Aetna|AETNA QHP HMO|||||1.27||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Aetna|AETNA QHP HMO|||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Aetna|AETNA PPO|66.75||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Aetna|AETNA OTHER|||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|66.75||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|66.75||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Access Direct Platinum|HEALTHFIRST TPA UMR|||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|66.75||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Cigna|CIGNA|66.75||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Cigna|CIGNA|||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Humana Medicare Advantage|HUMANA MA|66.75||||66.75||| J2704|EAP|0636|PROPOFOL 1000MG/100ML|Humana Medicare Advantage|HUMANA MA|66.75||||1.27||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|66.75||||66.75||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||66.75||| J2704|EAP|0636|PROPOFOL 1000MG/100ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.27||| J2704|EAP|0636|PROPOFOL 200MG/20ML|Blue Cross HMO Specialty|BCBSTX HMO|66.75||||66.75||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|Blue Cross PPO Specialty|BCBSTX PPO|1,009.50||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|Blue Cross PPO Specialty|BCBSTX OTHER|1,009.50||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|Aetna|AETNA OTHER|||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|Aetna|AETNA PPO|||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|Humana Medicare Advantage|HUMANA MA|1,009.50||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|Aenta Medicare Advantage|AETNA MEDICARE MA|1,009.50||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|Cigna|CIGNA|||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|Aetna|AETNA QHP HMO|||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|Blue Cross HMO Specialty|BCBSTX HMO|||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1,009.50||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|Managed Medicaid|MEDICAID AMERIGROUP|||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|Medicare|MEDICARE ACUTE|1,009.50||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|NON CONTRACTED|COMMERCIAL OTHER 1|1,009.50||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|United Medicare Advantage|UHC MEDICARE GOLD MA|1,009.50||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,009.50||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|United Healthcare|UNITED HEALTHCARE|||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|United Healthcare|UNITED HEALTHCARE OTHER|||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|United Healthcare|UNITED HEALTHCARE|1,009.50||||1,009.50||| J2785|EAP|0636|REGADENOSON 0.4MG 5ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1,009.50||| J2790|EAP|0636|HYPERRHO IMMUNE GLOBULIN|Managed Medicaid|MEDICAID SUPERIOR|||||282.25||| J2790|EAP|0636|HYPERRHO IMMUNE GLOBULIN|Medicaid|MEDICAID|||||282.25||| J2790|EAP|0636|HYPERRHO IMMUNE GLOBULIN|Blue Cross PPO Specialty|BCBSTX PPO|||||282.25||| J2790|EAP|0636|HYPERRHO IMMUNE GLOBULIN|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||282.25||| J2805|EAP|0636|SINCALIDE 5MCG VIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||453.25||| J2805|EAP|0636|SINCALIDE 5MCG VIAL|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||453.25||| J2805|EAP|0636|SINCALIDE 5MCG VIAL|United Healthcare|UNITED HEALTHCARE OTHER|||||453.25||| J2805|EAP|0636|SINCALIDE 5MCG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|||||453.25||| J2805|EAP|0636|SINCALIDE 5MCG VIAL|United Healthcare|UNITED HEALTHCARE|||||453.25||| J2805|EAP|0636|SINCALIDE 5MCG VIAL|Blue Cross PPO Specialty|BCBSTX OTHER|453.25||||||| J2805|EAP|0636|SINCALIDE 5MCG VIAL|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||453.25||| J2805|EAP|0636|SINCALIDE 5MCG VIAL|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||453.25||| J2805|EAP|0636|SINCALIDE 5MCG VIAL|Cigna|CIGNA|||||453.25||| J2805|EAP|0636|SINCALIDE 5MCG VIAL|Humana Medicare Advantage|HUMANA MA|453.25||||453.25||| J2805|EAP|0636|SINCALIDE 5MCG VIAL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||453.25||| J2805|EAP|0636|SINCALIDE 5MCG VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|453.25||||453.25||| J2805|EAP|0636|SINCALIDE 5MCG VIAL|Blue Cross HMO Specialty|BCBSTX HMO|||||453.25||| J2805|EAP|0636|SINCALIDE 5MCG VIAL|Aenta Medicare Advantage|AETNA MEDICARE MA|||||453.25||| J2805|EAP|0636|SINCALIDE 5MCG VIAL|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||453.25||| J2805|EAP|0636|SINCALIDE 5MCG VIAL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||453.25||| J2805|EAP|0636|SINCALIDE 5MCG VIAL|Managed Medicaid|MEDICAID SUPERIOR|||||453.25||| J2805|EAP|0636|SINCALIDE 5MCG VIAL|Managed Medicaid|MEDICAID AMERIGROUP|||||453.25||| J2805|EAP|0636|SINCALIDE 5MCG VIAL|Medicare|MEDICARE ACUTE|453.25||||453.25||| J2997|EAP|0636|ALTEPLASE 100MG IN 100ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||254.49||| J2997|EAP|0636|ALTEPLASE 100MG IN 100ML|Medicare|MEDICARE ACUTE|||||254.49||| J2997|EAP|0636|ALTEPLASE 100MG VIAL|Medicare|MEDICARE ACUTE|||||281.61||| J2997|EAP|0250|ALTEPLASE 2MG VIAL|Medicare|MEDICARE ACUTE|||||329.08||| J2997|EAP|0636|ALTEPLASE 100MG IN 100ML|Blue Cross PPO Specialty|BCBSTX PPO|||||254.49||| J2997|EAP|0636|ALTEPLASE 100MG VIAL|Blue Cross PPO Specialty|BCBSTX PPO|||||281.61||| J2997|EAP|0636|ALTEPLASE 100MG IN 100ML|Cigna|CIGNA|||||254.49||| J2997|EAP|0636|ALTEPLASE 100MG VIAL|Humana Medicare Advantage|HUMANA MA|||||281.61||| J2997|EAP|0636|ALTEPLASE 100MG VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|||||281.61||| J2997|EAP|0636|ALTEPLASE 100MG VIAL|Veterans Affairs|VETERANS ADMINISTRATION|||||281.61||| J3101|EAP|0636|TENECTEPLASE 50MG 1 KIT|Blue Cross PPO Specialty|BCBSTX PPO|||||413.02||| J3101|EAP|0636|TENECTEPLASE 50MG 1 KIT|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||413.02||| J3101|EAP|0636|TENECTEPLASE 50MG 1 KIT|Medicare|MEDICARE ACUTE|||||413.02||| J3411|EAP|0250|THIAMINE 100 MG IN 100 ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.85||| J3411|EAP|0250|THIAMINE 100 MG IN 100 ML|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.85||| J3411|EAP|0250|THIAMINE 100 MG IN 100 ML|NON CONTRACTED|COMMERCIAL OTHER 1|0.85||||||| J3411|EAP|0250|THIAMINE 100 MG IN 100 ML|Tricare|TRICARE EAST REGION|0.85||||||| J3411|EAP|0250|THIAMINE 100 MG IN 100 ML|Medicare|MEDICARE PART B ONLY IP|0.85||||||| J3411|EAP|0250|THIAMINE 100 MG IN 100 ML|Medicare|MEDICARE ACUTE|0.85||||0.85||| J3411|EAP|0250|THIAMINE 100 MG IN 100 ML|Cigna|CIGNA|||||0.85||| J3411|EAP|0250|THIAMINE 100 MG IN 100 ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.85||||||| J3411|EAP|0250|THIAMINE 100 MG IN 100 ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|0.85||||||| J3411|EAP|0250|THIAMINE 100 MG IN 100 ML|Humana Medicare Advantage|HUMANA MA|0.85||||0.85||| J3411|EAP|0250|THIAMINE 100 MG IN 100 ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.85||||||| J3411|EAP|0250|THIAMINE 100 MG IN 100 ML|Managed Medicaid|MEDICAID AMERIGROUP|||||0.85||| J3411|EAP|0250|THIAMINE 100 MG IN 100 ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|0.85||||||| J3411|EAP|0250|THIAMINE 100 MG IN 100 ML|Blue Cross PPO Specialty|BCBSTX OTHER|0.85||||||| J3411|EAP|0250|THIAMINE 100 MG IN 100 ML|Blue Cross PPO Specialty|BCBSTX PPO|||||0.85||| J3489|EAP|0636|ZOLEDRONIC ACID 5 MG/100M|Blue Cross PPO Specialty|BCBSTX PPO|||||3,777.20||| J3489|EAP|0636|ZOLEDRONIC ACID 5 MG/100M|Humana Medicare Advantage|HUMANA MA|||||3,777.20||| J3489|EAP|0636|ZOLEDRONIC ACID 5 MG/100M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||3,777.20||| J3489|EAP|0636|ZOLEDRONIC ACID 5 MG/100M|Aenta Medicare Advantage|AETNA MEDICARE MA|||||3,777.20||| J3489|EAP|0636|ZOLEDRONIC ACID 5 MG/100M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||3,777.20||| J3489|EAP|0636|ZOLEDRONIC ACID 5 MG/100M|Medicare|MEDICARE ACUTE|||||3,777.20||| J3489|EAP|0636|ZOLEDRONIC ACID 5 MG/100M|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||3,777.20||| J3490|EAP|0258|SOD CHL 0.9% KCL 20MEQ/10|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||74.75||| J3490|EAP|0258|SOD CHL 0.9% KCL 20MEQ/10|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||74.75||| J3490|EAP|0258|SOD CHL 0.9% KCL 20MEQ/10|United Medicare Advantage|UHC MEDICARE GOLD MA|74.75||||74.75||| J3490|EAP|0258|SOD CHL 0.9% KCL 20MEQ/10|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|74.75||||74.75||| J3490|EAP|0258|SOD CHL 0.9% KCL 20MEQ/10|NON CONTRACTED|COMMERCIAL OTHER 1|||||74.75||| J3490|EAP|0258|SOD CHL 0.9% KCL 20MEQ/10|Managed Medicare|HEALTHSPRING MA|||||74.75||| J3490|EAP|0258|SOD CHL 0.9% KCL 20MEQ/10|Medicare|MEDICARE ACUTE|74.75||||74.75||| J3490|EAP|0258|SOD CHL 0.9% KCL 20MEQ/10|Blue Cross PPO Specialty|BCBSTX PPO|||||74.75||| J3490|EAP|0258|SOD CHL 0.9% KCL 20MEQ/10|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||74.75||| J3490|EAP|0258|SOD CHL 0.9% KCL 20MEQ/10|Humana Medicare Advantage|HUMANA MA|74.75||||74.75||| J3490|EAP|0258|SOD CHL 0.9% KCL 20MEQ/10|Blue Cross HMO Specialty|BCBSTX HMO|74.75||||||| J3490|EAP|0258|SOD CHL 0.9% KCL 20MEQ/10|Managed Medicaid|MEDICAID UNITED HEALTHCARE|74.75||||74.75||| J3490|EAP|0258|SOD CHL 0.9% KCL 20MEQ/10|Managed Medicaid|MEDICAID AMERIGROUP|||||74.75||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|Aetna|AETNA PPO|||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|Aetna|AETNA OTHER|||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|Cigna|CIGNA|||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|Humana Medicare Advantage|HUMANA MA|140.25||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|Blue Cross HMO Specialty|BCBSTX HMO|140.25||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|Aenta Medicare Advantage|AETNA MEDICARE MA|140.25||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|Managed Medicare|HEALTHSPRING MA|||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|140.25||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|Managed Medicaid|MEDICAID AMERIGROUP|||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|Managed Medicaid|MEDICAID SUPERIOR|||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|Medicare|MEDICARE ACUTE|140.25||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|NON CONTRACTED|COMMERCIAL OTHER 1|140.25||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|Tricare|TRICARE EAST REGION|||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|Medicaid|MEDICAID|140.25||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|United Medicare Advantage|UHC MEDICARE GOLD MA|140.25||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|Blue Cross PPO Specialty|BCBSTX PPO|140.25||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|140.25||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|140.25||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|Veterans Affairs|VETERANS ADMINISTRATION|||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|Veterans Affairs|VETERANS ADMINISTRATION|140.25||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|United Healthcare|UNITED HEALTHCARE ERS|||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|United Healthcare|UNITED HEALTHCARE OTHER|||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|United Healthcare|UNITED HEALTHCARE|||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|United Healthcare|UNITED HEALTHCARE|140.25||||140.25||| J7040|EAP|0636|SODIUM CHLORIDE 0.9% 500M|Workers Compensation|WORKERS COMPENSATION OTHER|||||140.25||| J7050|EAP|0636|SODIUM CHLORIDE 0.9% 250M|United Medicare Advantage|UHC MEDICARE GOLD MA|153.25||||153.25||| J7050|EAP|0636|SODIUM CHLORIDE 0.9% 250M|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||153.25||| J7050|EAP|0636|SODIUM CHLORIDE 0.9% 250M|United Medicare Advantage|AARP UHC WEST COMPLETE MA|153.25||||153.25||| J7050|EAP|0636|SODIUM CHLORIDE 0.9% 250M|United Healthcare|UNITED HEALTHCARE|||||153.25||| J7050|EAP|0636|SODIUM CHLORIDE 0.9% 250M|United Healthcare|UNITED HEALTHCARE OTHER|||||153.25||| J7050|EAP|0636|SODIUM CHLORIDE 0.9% 250M|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|153.25||||||| J7050|EAP|0636|SODIUM CHLORIDE 0.9% 250M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|153.25||||||| J7050|EAP|0636|SODIUM CHLORIDE 0.9% 250M|Managed Medicaid|MEDICAID SUPERIOR|||||153.25||| J7050|EAP|0636|SODIUM CHLORIDE 0.9% 250M|Managed Medicaid|MEDICAID AMERIGROUP|||||153.25||| J7050|EAP|0636|SODIUM CHLORIDE 0.9% 250M|Medicare|MEDICARE ACUTE|153.25||||153.25||| J7050|EAP|0636|SODIUM CHLORIDE 0.9% 250M|NON CONTRACTED|COMMERCIAL OTHER 1|||||153.25||| J7050|EAP|0636|SODIUM CHLORIDE 0.9% 250M|Tricare|TRICARE EAST REGION|||||153.25||| J7050|EAP|0636|SODIUM CHLORIDE 0.9% 250M|Blue Cross PPO Specialty|BCBSTX PPO|||||153.25||| J7050|EAP|0636|SODIUM CHLORIDE 0.9% 250M|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|153.25||||153.25||| J7050|EAP|0636|SODIUM CHLORIDE 0.9% 250M|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||153.25||| J7050|EAP|0636|SODIUM CHLORIDE 0.9% 250M|Humana Medicare Advantage|HUMANA MA|||||153.25||| J7060|EAP|0250|DEXTROSE 5%-WATER 500ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||122.75||| J7060|EAP|0250|DEXTROSE 5%-WATER 250ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||140.25||| J7060|EAP|0250|DEXTROSE 5%-WATER 500ML|Humana Medicare Advantage|HUMANA MA|140.25||||122.75||| J7060|EAP|0250|DEXTROSE 5%-WATER 500ML|Humana Medicare Advantage|HUMANA MA|122.75||||122.75||| J7060|EAP|0250|DEXTROSE 5%-WATER 100ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||37.50||| J7060|EAP|0250|DEXTROSE 5%-WATER 100ML|Humana Medicare Advantage|HUMANA MA|37.50||||37.50||| J7060|EAP|0250|DEXTROSE 5%-WATER 500ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||122.75||| J7060|EAP|0250|DEXTROSE 5%-WATER 250ML|Medicaid|MEDICAID|||||140.25||| J7060|EAP|0250|DEXTROSE 5%-WATER 500ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||122.75||| J7060|EAP|0250|DEXTROSE 5%-WATER 250ML|United Healthcare|UNITED HEALTHCARE|||||140.25||| J7060|EAP|0250|DEXTROSE 5%-WATER 100ML|United Healthcare|UNITED HEALTHCARE|||||37.50||| J7060|EAP|0250|DEXTROSE 5%-WATER 500ML|Medicare|MEDICARE ACUTE|122.75||||122.75||| J7060|EAP|0250|DEXTROSE 5%-WATER 250ML|Medicare|MEDICARE ACUTE|122.75||||140.25||| J7060|EAP|0250|DEXTROSE 5%-WATER 100ML|Medicare|MEDICARE ACUTE|37.50||||37.50||| J7060|EAP|0250|DEXTROSE 5%-WATER 250ML|United Medicare Advantage|UHC MEDICARE GOLD MA|140.25||||||| J7060|EAP|0250|DEXTROSE 5%-WATER 250ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||140.25||| J7060|EAP|0250|DEXTROSE 5%-WATER 250ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||140.25||| J7060|EAP|0250|DEXTROSE 5%-WATER 500ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||122.75||| J7070|EAP|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Veterans Affairs|VETERANS ADMINISTRATION|||||74.75||| J7070|EAP|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Workers Compensation|WORKERS COMPENSATION OTHER|74.75||||||| J7070|EAP|0250|DEXTROSE 5%-1/2 NS 1000ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|74.75||||188.25||| J7070|EAP|0250|DEXTROSE 5%-LR 1000ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||188.25||| J7070|EAP|0250|DEXTROSE 5%-NS 1000ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|188.25||||188.25||| J7070|EAP|0250|DEXTROSE 5%-1/2 NS 1000ML|United Medicare Advantage|UHC MEDICARE GOLD MA|74.75||||188.25||| J7070|EAP|0250|DEXTROSE 5%-NS 1000ML|United Medicare Advantage|UHC MEDICARE GOLD MA|188.25||||188.25||| J7070|EAP|0250|DEXTROSE 5%-WATER 1000ML|United Medicare Advantage|UHC MEDICARE GOLD MA|188.25||||177.75||| J7070|EAP|0250|DEXTROSE 5%-1/2 NS 1000ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||188.25||| J7070|EAP|0250|DEXTROSE 5%-LR 1000ML|Medicaid|MEDICAID|74.75||||188.25||| J7070|EAP|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Medicaid|WOOD COUNTY INDIGENT|||||74.75||| J7070|EAP|0250|DEXTROSE 5%-LR 1000ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||188.25||| J7070|EAP|0250|DEX 5%-1/2NS KCL 20 MEQ 1|NON CONTRACTED|COMMERCIAL OTHER 1|74.75||||74.75||| J7070|EAP|0250|DEXTROSE 5%-WATER 1000ML|Medicare|MEDICARE ACUTE|177.75||||177.75||| J7070|EAP|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Medicare|MEDICARE ACUTE|74.75||||74.75||| J7070|EAP|0250|DEXTROSE 5%-LR 1000ML|Medicare|MEDICARE ACUTE|188.25||||188.25||| J7070|EAP|0250|DEXTROSE 5%-1/2 NS 1000ML|Medicare|MEDICARE ACUTE|188.25||||188.25||| J7070|EAP|0250|DEXTROSE 5%-NS 1000ML|Medicare|MEDICARE ACUTE|188.25||||188.25||| J7070|EAP|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Blue Cross PPO Specialty|BCBSTX PPO|74.75||||74.75||| J7070|EAP|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Aetna|AETNA PPO|74.75||||||| J7070|EAP|0250|DEXTROSE 5%-1/2 NS 1000ML|Access Direct Platinum|HEALTHFIRST TPA UMR|188.25||||||| J7070|EAP|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|74.75||||||| J7070|EAP|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|74.75||||||| J7070|EAP|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|74.75||||||| J7070|EAP|0250|DEX 5%-1/2NS KCL 20 MEQ 1|United Healthcare|UMR UNITED MEDICAL RESOURCES|74.75||||||| J7070|EAP|0250|DEXTROSE 5%-1/2 NS 1000ML|Medicaid|MEDICAID|188.25||||188.25||| J7070|EAP|0250|DEXTROSE 5%-WATER 1000ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|177.75||||||| J7070|EAP|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Cigna|CIGNA|74.75||||74.75||| J7070|EAP|0250|DEXTROSE 5%-LR 1000ML|Cigna|CIGNA|||||188.25||| J7070|EAP|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|74.75||||74.75||| J7070|EAP|0250|DEXTROSE 5%-LR 1000ML|United Medicare Advantage|UHC MEDICARE GOLD MA|188.25||||188.25||| J7070|EAP|0250|DEXTROSE 5%-LR 1000ML|Humana Medicare Advantage|HUMANA MA|188.25||||188.25||| J7070|EAP|0250|DEXTROSE 5%-1/2 NS 1000ML|Humana Medicare Advantage|HUMANA MA|74.75||||188.25||| J7070|EAP|0250|DEXTROSE 5%-WATER 1000ML|Humana Medicare Advantage|HUMANA MA|177.75||||177.75||| J7070|EAP|0250|DEXTROSE 5%-1/2 NS 1000ML|Aenta Medicare Advantage|AETNA MEDICARE MA|188.25||||188.25||| J7070|EAP|0250|DEXTROSE 5%-1/2 NS 1000ML|Managed Medicaid|MEDICAID SUPERIOR|74.75||||188.25||| J7070|EAP|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Managed Medicaid|MEDICAID UNITED HEALTHCARE|177.75||||74.75||| J7070|EAP|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Managed Medicaid|MEDICAID AMERIGROUP|74.75||||74.75||| J7070|EAP|0250|DEX 5%-1/2NS KCL 20 MEQ 1|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|74.75||||||| J7070|EAP|0250|DEXTROSE 5%-LR 1000ML|Managed Medicaid|MEDICAID SUPERIOR|74.75||||188.25||| J7070|EAP|0250|DEXTROSE 5%-NS 1000ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|188.25||||||| J7070|EAP|0250|DEXTROSE 5%-1/2 NS 1000ML|Blue Cross HMO Specialty|BCBSTX HMO|188.25||||188.25||| J7070|EAP|0250|DEXTROSE 5%-NS 1000ML|Blue Cross HMO Specialty|BCBSTX HMO|74.75||||188.25||| J7070|EAP|0250|DEXTROSE 5%-WATER 1000ML|Blue Cross PPO Specialty|BCBSTX PPO|177.75||||177.75||| J7070|EAP|0250|DEXTROSE 5%-1/2 NS 1000ML|Blue Cross PPO Specialty|BCBSTX PPO|188.25||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Blue Cross PPO Specialty|BCBSTX PPO|188.25||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Aetna|AETNA PPO|||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Aetna|AETNA OTHER|||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Cigna|CIGNA|188.25||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Access Direct Platinum|HEALTHFIRST TPA UMR|||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|188.25||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|188.25||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Humana Medicare Advantage|HUMANA MA|188.25||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Aenta Medicare Advantage|AETNA MEDICARE MA|||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|188.25||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|188.25||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Managed Medicaid|MEDICAID AMERIGROUP|188.25||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|188.25||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Managed Medicaid|MEDICAID SUPERIOR|188.25||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Blue Cross HMO Specialty|BCBSTX HMO|188.25||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Medicaid|WOOD COUNTY INDIGENT|||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||188.25||| J7120|ERX|0250|L|Humana Medicare Advantage|HUMANA MA|||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Medicaid|MEDICAID|188.25||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Medicaid|MEDICAID TEXAS CHILDRENS|||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|188.25||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Managed Medicare|HEALTHSPRING MA|||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|188.25||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|NON CONTRACTED|WOOD COUNTY HOSPITAL DISTRICT|||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|NON CONTRACTED|COMMERCIAL OTHER 1|188.25||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Aetna|AETNA QHP HMO|||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Tricare|TRICARE EAST REGION|188.25||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|United Healthcare|UNITED HEALTHCARE|||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|United Healthcare|TML GROUP BENEFITS|||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|United Healthcare|UNITED HEALTHCARE OTHER|||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|188.25||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Medicare|MEDICARE ACUTE|188.25||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Veterans Affairs|VETERANS ADMINISTRATION|188.25||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|Workers Compensation|WORKERS COMPENSATION OTHER|188.25||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|United Medicare Advantage|UHC MEDICARE GOLD MA|188.25||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|188.25||||188.25||| J7120|EAP|0250|LACTATED RINGERS 1000ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|188.25||||188.25||| J7323|EAP|0636|EUFLEXXA, 2ML SYRINGE|Medicare|MEDICARE ACUTE|||||1,461.70||| J7323|EAP|0636|EUFLEXXA, 2ML SYRINGE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1,461.70||| J7325|EAP|0636|HYLAN G-F 20, 48 MG/6ML S|Medicare|MEDICARE ACUTE|||||118.17||| P9016|EAP|0381|LEUKO-POOR RED BLOOD CELL|United Medicare Advantage|UHC MEDICARE GOLD MA|197.50||||197.50||| P9016|EAP|0381|LEUKO-POOR RED BLOOD CELL|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||481.74||| P9016|EAP|0381|LEUKO-POOR RED BLOOD CELL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|481.74||||481.74||| P9016|EAP|0381|LEUKO-POOR RED BLOOD CELL|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||481.74||| P9016|EAP|0381|LEUKO-POOR RED BLOOD CELL|Humana Medicare Advantage|HUMANA MA|388.50||||481.74||| P9016|EAP|0381|LEUKO-POOR RED BLOOD CELL|Aenta Medicare Advantage|AETNA MEDICARE MA|197.50||||388.50||| P9016|EAP|0381|LEUKO-POOR RED BLOOD CELL|Blue Cross HMO Specialty|BCBSTX HMO|481.74||||||| P9016|EAP|0381|LEUKO-POOR RED BLOOD CELL|Medicare|MEDICARE ACUTE|481.74||||481.74||| P9016|EAP|0381|LEUKO-POOR RED BLOOD CELL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||339.62||| P9016|EAP|0381|LEUKO-POOR RED BLOOD CELL|Managed Medicaid|MEDICAID SUPERIOR|||||481.74||| P9016|EAP|0381|LEUKO-POOR RED BLOOD CELL|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|481.74||||||| P9016|EAP|0381|LEUKO-POOR RED BLOOD CELL|NON CONTRACTED|COMMERCIAL OTHER 1|197.50||||481.74||| P9016|EAP|0381|LEUKO-POOR RED BLOOD CELL|United Healthcare|UNITED HEALTHCARE|||||481.74||| P9016|EAP|0381|LEUKO-POOR RED BLOOD CELL|United Healthcare|UNITED HEALTHCARE|||||197.50||| P9017|EAP|0383|FRESH FROZEN PLASMA, PER|Medicare|MEDICARE ACUTE|161.25||||||| P9017|EAP|0383|FRESH FROZEN PLASMA, PER|United Medicare Advantage|UHC MEDICARE GOLD MA|161.25||||||| P9019|EAP|0384|PLATELETS, PER UNIT|Medicare|MEDICARE ACUTE|||||1.57||| P9034|EAP|0384|PLATELET PHERESIS, PER UN|United Medicare Advantage|UHC MEDICARE GOLD MA|1,165.50||||||| P9034|EAP|0384|PLATELET PHERESIS, PER UN|Humana Medicare Advantage|HUMANA MA|1,165.50||||||| P9034|EAP|0384|PLATELET PHERESIS, PER UN|NON CONTRACTED|COMMERCIAL OTHER 1|1,165.50||||||| P9038|EAP|0381|IRRADIATION|Medicare|MEDICARE ACUTE|521.42||||||| P9038|EAP|0381|IRRADIATION|NON CONTRACTED|COMMERCIAL OTHER 1|420.50||||||| P9038|EAP|0381|IRRADIATION|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||521.42||| P9047|EAP|0250|ALBUMIN 25% 12.5G/50ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|1,155.75||||1,155.75||| P9047|EAP|0250|ALBUMIN 25% 12.5G/50ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,155.75||||1,155.75||| P9047|EAP|0250|ALBUMIN 25% 12.5G/50ML|United Medicare Advantage|UHC MEDICARE GOLD MA|1,155.75||||||| P9047|EAP|0250|ALBUMIN 25% 12.5G/50ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1,155.75||||1,155.75||| P9047|EAP|0250|ALBUMIN 25% 12.5G/50ML|Humana Medicare Advantage|HUMANA MA|1,155.75||||||| P9047|EAP|0250|ALBUMIN 25% 12.5G/50ML|Aenta Medicare Advantage|AETNA MEDICARE MA|1,155.75||||||| P9047|EAP|0250|ALBUMIN 25% 12.5G/50ML|NON CONTRACTED|COMMERCIAL OTHER 1|1,155.75||||||| P9047|EAP|0250|ALBUMIN 25% 12.5G/50ML|Medicare|MEDICARE ACUTE|1,155.75||||1,155.75||| Q2009|EAP|0636|FOSPHENYTOIN 500MG/10ML V|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.16||| Q2009|EAP|0636|FOSPHENYTOIN 500 MG/100 M|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.16||| Q2009|EAP|0636|FOSPHENYTOIN 500 MG/100 M|Managed Medicaid|MEDICAID SUPERIOR|1.16||||1.16||| Q2009|EAP|0636|FOSPHENYTOIN 500 MG/100 M|Medicare|MEDICARE ACUTE|1.16||||1.16||| Q2009|EAP|0636|FOSPHENYTOIN 500 MG/100 M|Blue Cross PPO Specialty|BCBSTX PPO|||||1.16||| Q2009|EAP|0636|FOSPHENYTOIN 500MG/10ML V|Aetna|AETNA OTHER|||||1.16||| Q4008|EAP|0510|CAST SUP LONG ARM PED FBR|Medicaid|MEDICAID|||||0.45||| Q4010|EAP|0270||United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.95||| Q4010|EAP|0510|CAST SUP SHT ARM ADULT FB|United Medicare Advantage|UHC MEDICARE GOLD MA|||||0.95||| Q4010|EAP|0510|CAST SUP SHT ARM ADULT FB|Blue Cross PPO Specialty|BCBSTX PPO|||||0.95||| Q4010|EAP|0510|CAST SUP SHT ARM ADULT FB|Medicare|MEDICARE ACUTE|||||0.95||| Q4012|EAP|0270||Blue Cross HMO Specialty|BCBSTX HMO|||||0.30||| Q4012|EAP|0510|CAST SUP SHT ARM PED FBRG|Blue Cross HMO Specialty|BCBSTX HMO|||||0.30||| Q4012|EAP|0510|CAST SUP SHT ARM PED FBRG|United Healthcare|UNITED HEALTHCARE|||||0.30||| Q4038|EAP|0510|CAST SUP SHRT LEG FIBERGL|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.90||| Q4038|EAP|0510|CAST SUP SHRT LEG FIBERGL|Managed Medicaid|MEDICAID AMERIGROUP|||||1.90||| Q4038|EAP|0270||Medicaid|MEDICAID HMO|||||1.90||| Q4038|EAP|0510|CAST SUP SHRT LEG FIBERGL|Medicare|MEDICARE ACUTE|||||1.90||| Q4038|EAP|0510|CAST SUP SHRT LEG FIBERGL|Medicaid|MEDICAID HMO|||||1.90||| Q4038|EAP|0270||Medicare|MEDICARE ACUTE|||||1.90||| Q4038|EAP|0270||Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.90||| Q4100|EAP|0278|AMNIOFILL 250MG|Medicare|MEDICARE ACUTE|||||1,837.50||| Q4100|EAP|0278|AMNIOFILL 500MG|Medicare|MEDICARE ACUTE|||||36.75||| Q4100|EAP|0278|AMNIOFILL 500MG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|36.75||||||| Q4100|EAP|0278|AMNIOFILL 500MG|United Medicare Advantage|UHC MEDICARE GOLD MA|36.75||||||| Q4100|EAP|0278|AMNIOFILL 250MG|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1,837.50||||||| Q5105|EAP|0636|RETACRIT 10000 UNIT/1ML (|Medicare|MEDICARE ACUTE|||||4.74||| Q5105|EAP|0636|RETACRIT 40000 UNIT/1ML (|Medicare|MEDICARE ACUTE|||||4.74||| Q5106|EAP|0636|RETACRIT 10000 UNIT/1ML (|Medicare|MEDICARE ACUTE|||||47.43||| Q5106|EAP|0636|RETACRIT 40000 UNIT/1ML (|Medicare|MEDICARE ACUTE|||||47.43||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|United Medicare Advantage|UHC MEDICARE GOLD MA|4.35||||||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|United Medicare Advantage|AARP UHC WEST COMPLETE MA|4.35||||||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Aetna|AETNA PPO|||||4.35||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Humana Medicare Advantage|HUMANA MA|||||4.35||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|Medicare|MEDICARE ACUTE|4.35||||4.35||| Q9957|EAP|0636|DEFINITY 1.3ML VIAL|NON CONTRACTED|COMMERCIAL OTHER 1|||||4.35||| Q9962|EAP|0255|XR ISOVUE 300 100ML BTL|Medicaid|MEDICAID|2.75||||||| Q9962|EAP|0255|XR ISOVUE 300 100ML BTL|United Healthcare|UNITED HEALTHCARE OTHER|||||302.75||| Q9962|EAP|0255|XR ISOVUE 300 100ML BTL|Medicare|MEDICARE ACUTE|302.75||||302.75||| Q9962|EAP|0255|XR ISOVUE 300 100ML BTL|Blue Cross PPO Specialty|BCBSTX PPO|152.75||||2.75||| Q9962|EAP|0255|XR ISOVUE 300 100ML BTL|Blue Cross PPO Specialty|BCBSTX OTHER|||||302.75||| Q9962|EAP|0255|XR ISOVUE 300 100ML BTL|Humana Medicare Advantage|HUMANA MA|||||302.75||| Q9962|EAP|0255|XR ISOVUE 300 100ML BTL|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||2.75||| Q9962|EAP|0255|XR ISOVUE 300 100ML BTL|Managed Medicaid|MEDICAID AMERIGROUP|||||302.75||| Q9962|EAP|0255|XR ISOVUE 300 100ML BTL|Veterans Affairs|VETERANS ADMINISTRATION|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|United Medicare Advantage|UHC MEDICARE GOLD MA|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Veterans Affairs|VETERANS ADMINISTRATION|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Workers Compensation|WORKERS COMPENSATION OTHER|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Blue Cross PPO Specialty|BCBSTX PPO|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Blue Cross PPO Specialty|BCBSTX OTHER|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Aetna|AETNA QHP HMO|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Cigna|CIGNA|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Aenta Medicare Advantage|AETNA MEDICARE MA|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Blue Cross HMO Specialty|BCBSTX HMO|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Managed Medicaid|MEDICAID AMERIGROUP|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Managed Medicaid|MEDICAID SUPERIOR|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Humana Medicare Advantage|HUMANA MA|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Managed Medicaid|MEDICAID UNITED HEALTHCARE|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 370 50/ML|Managed Medicaid|MEDICAID AMERIGROUP|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Medicaid|MEDICAID|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Aetna|AETNA PPO|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Medicaid|WOOD COUNTY INDIGENT|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Medicaid|MEDICAID HMO|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Managed Medicare|HEALTHSPRING MA|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Managed Medicare|BCBS MEDICARE PPO MA|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Managed Medicare|OTHER INSTITUTIONS|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|NON CONTRACTED|COMMERCIAL OTHER 1|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Tricare|TRICARE EAST REGION|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|United Healthcare|UMR UNITED MEDICAL RESOURCES|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|United Healthcare|UNITED HEALTHCARE ERS|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|United Healthcare|UNITED HEALTHCARE OTHER|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|United Healthcare|TML GROUP BENEFITS|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|United Healthcare|UNITED HEALTHCARE|||||2.75||| Q9967|EAP|0255|ISOVUE 370 100/ML|Medicare|MEDICARE ACUTE|2.75||||2.75||| Q9967|EAP|0255|ISOVUE 370 50/ML|Medicare|MEDICARE ACUTE|2.75||||2.75||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Medicare|MEDICARE ACUTE|0.25||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|NON CONTRACTED|COMMERCIAL OTHER 1|0.25||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Tricare|TRICARE EAST REGION|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Managed Medicaid|MEDICAID SUPERIOR|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Managed Medicaid|MEDICAID AMERIGROUP|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|0.25||||0.28||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|United Healthcare|UNITED HEALTHCARE|0.25||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|United Healthcare|UNITED HEALTHCARE OTHER|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Access Direct Platinum|HEALTHFIRST TPA UMR|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|United Healthcare|UNITED HEALTHCARE|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Blue Cross PPO Specialty|BCBSTX OTHER|0.25||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Blue Cross PPO Specialty|BCBSTX PPO|0.31||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Aetna|AETNA OTHER|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Aetna|AETNA PPO|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Aetna|AETNA QHP HMO|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Cigna|CIGNA|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Humana Medicare Advantage|HUMANA MA|0.25||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Aenta Medicare Advantage|AETNA MEDICARE MA|0.25||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Blue Cross HMO Specialty|BCBSTX HMO|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|United Medicare Advantage|UHC MEDICARE GOLD MA|0.25||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||0.25||| Q9969|EAP|0343|NON HEU TC99 ADD ON DOSE|United Medicare Advantage|AARP UHC WEST COMPLETE MA|0.28||||0.25||| U0001|EAP|0300|COVID - 19PCR|Veterans Affairs|VETERANS ADMINISTRATION|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.80||| U0001|EAP|0300|COVID - 19PCR|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.80||| U0001|EAP|0300|COVID - 19PCR|United Medicare Advantage|AARP UHC WEST COMPLETE MA|||||1.80||| U0001|EAP|0300|COVID - 19PCR|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Blue Cross PPO Specialty|BCBSTX PPO|1.80||||1.80||| U0001|EAP|0300|COVID - 19PCR|Aetna|AETNA QHP HMO|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Aetna|AETNA PPO|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Cigna|CIGNA|1.80||||1.80||| U0001|EAP|0300|COVID - 19PCR|United Medicare Advantage|UHC MEDICARE GOLD MA|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Humana Medicare Advantage|HUMANA MA|1.80||||1.80||| U0001|EAP|0300|COVID - 19PCR|Aenta Medicare Advantage|AETNA MEDICARE MA|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Blue Cross HMO Specialty|BCBSTX HMO|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Managed Medicaid|MEDICAID UNITED HEALTHCARE|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Managed Medicaid|MEDICAID AMERIGROUP|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Medicare|MEDICARE ACUTE|1.80||||1.80||| U0001|EAP|0300|COVID - 19PCR|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||1.80||| U0001|EAP|0300|COVID - 19PCR|Medicaid|MEDICAID|1.80||||1.80||| U0001|EAP|0300|COVID - 19PCR|Tricare|TRICARE EAST REGION|||||1.80||| U0001|EAP|0300|COVID - 19PCR|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.80||| U0001|EAP|0300|COVID - 19PCR|United Healthcare|UNITED HEALTHCARE|||||1.80||| U0001|EAP|0300|COVID - 19PCR|United Healthcare|UNITED HEALTHCARE OTHER|||||1.80||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Medicare|MEDICARE ACUTE|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Medicare|MEDICARE PART B ONLY IP|1.54||||||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Medicaid|SUPERIOR HEALTHPLAN CHIP|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Medicaid|MOLINA HEALTHCARE OF TEXAS|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Medicaid|MEDICAID TEXAS CHILDRENS|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|NON CONTRACTED|COMMERCIAL OTHER 3|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|NON CONTRACTED|COMMERCIAL OTHER 2|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Managed Medicare|OTHER INSTITUTIONS|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Managed Medicare|MEDICARE ADVANTAGE OTHER MA|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Managed Medicare|HEALTHSPRING MA|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|PHCS|HUMANA INSURANCE|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Tricare|TRICARE FOR LIFE|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Tricare|TRICARE EAST REGION|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|United Healthcare|GEHA|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|United Healthcare|TML GROUP BENEFITS|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|United Healthcare|UMR UNITED MEDICAL RESOURCES|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|United Healthcare|UNITED HEALTHCARE|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|United Healthcare|UNITED HEALTHCARE OTHER|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Blue Cross PPO Specialty|BCBSTX PPO|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Blue Cross PPO Specialty|BCBSTX OTHER|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Aetna|AETNA OTHER|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Aetna|AETNA QHP HMO|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Aetna|AETNA PPO|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Access Direct Platinum|HEALTHFIRST TPA OTHER 1|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Access Direct Platinum|HEALTHFIRST TPA UTH UMR|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Managed Medicare|BCBS MEDICARE PPO MA|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Access Direct Platinum|HEALTHFIRST TPA UMR|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Blue Cross Traditional Specialty|BCBSTX TRADITIONAL|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|ChampVA|CHAMPVA CENTER|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Cigna|CIGNA|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Cigna|CIGNA|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Humana Medicare Advantage|HUMANA MA|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|NON CONTRACTED|COMMERCIAL OTHER 1|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Medicaid|MEDICAID|1.54||||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 HMO Specialty|BCBSTX HMO|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Managed Medicaid|MEDICAID AMERIGROUP|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Managed Medicaid|MEDICAID UNITED HEALTHCARE|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Managed Medicaid|MEDICAID SUPERIOR|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Veterans Affairs|VETERANS ADMINISTRATION|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|Workers Compensation|WORKERS COMPENSATION OTHER|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|United Medicare Advantage|UHC MEDICARE GOLD MA|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|United Medicare Advantage|UHC MEDICARE SOLUTIONS MA|||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|United Medicare Advantage|AARP UHC WEST COMPLETE MA|1.54||||1.54||| U0002|EAP|0300|COVID-19 LAB TEST NON-CDC|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|||||1.54||| U0003|EAP|0300|COVID-19 TO UT NORTH|United Medicare Advantage|AARP UHC WEST COMPLETE MA|114.40||||114.40||| U0003|EAP|0300|COVID-19 TO UT NORTH|United Medicare Advantage|UHC DUAL COMPLETE HMO SNP MA|114.40||||114.40||| U0003|EAP|0300|COVID-19 TO UT NORTH|United Medicare Advantage|UHC MEDICARE GOLD MA|114.40||||||| U0003|EAP|0300|COVID-19 TO UT NORTH|Blue Cross PPO Specialty|BCBSTX PPO|114.40||||||| U0003|EAP|0300|COVID-19 TO UT NORTH|Aetna|AETNA PPO|114.40||||||| U0003|EAP|0300|COVID-19 TO UT NORTH|Access Direct Platinum|HEALTHFIRST UHSS UT HLTH|||||114.40||| U0003|EAP|0300|COVID-19 TO UT NORTH|Blue Cross Advantage HMO|BCBSTX HMO BLUE ADVANTAGE|114.40||||||| U0003|EAP|0300|COVID-19 TO UT NORTH|Humana Medicare Advantage|HUMANA MA|114.40||||114.40||| U0003|EAP|0300|COVID-19 TO UT NORTH|Aenta Medicare Advantage|AETNA MEDICARE MA|114.40||||114.40||| U0003|EAP|0300|COVID-19 TO UT NORTH|Managed Medicaid|MEDICAID CIGNA HEALTHSPRING|114.40||||114.40||| U0003|EAP|0300|COVID-19 TO UT NORTH|Managed Medicaid|MEDICAID UNITED HEALTHCARE|114.40||||114.40||| U0003|EAP|0300|COVID-19 TO UT NORTH|Managed Medicaid|MEDICAID AMERIGROUP|114.40||||||| U0003|EAP|0300|COVID-19 TO UT NORTH|Medicare|MEDICARE ACUTE|114.40||||114.40||| U0003|EAP|0300|COVID-19 TO UT NORTH|Medicare|MEDICARE PART B ONLY IP|114.40||||||| U0003|EAP|0300|COVID-19 TO UT NORTH|Medicaid|MEDICAID|114.40|||||||